Polite Dissent

In 1962 Gold Key published Ben Casey Film Stories #1. It wasn’t really a comic book. Instead, it was a series of black and white still frames from the television show with captions beneath to explain what was happening. This is not the best way to tell a story. The pictures are often blurry and usually vague about the action. The captions — which have to explain what is going on in the picture — are written for a third-grader, and a very dumb third-grader at that. Overall, it’s a very unsatisfying read as the words and pictures are competing with each other instead of complementing each other.

The comic contains two stories, cribbed straight from the television show. Both scripts made for an exciting television drama, but are not terribly exciting when simplified into half of a comic book.

“Operation Tycoon” , the first story is about ruthless industrialist Walter Tyson. He informs his board of directors that he’s going on a hunting trip, and then secretly checks into the hospital for an operation. He brings his secretary with him and they set up an office in his hospital room. This infuriates Dr. Casey who prefers his patients actually acting sick. Meanwhile, Tyson’s estranged wife discovers he’s in the hospital for an operation and tells the board of directors. They replace him as CEO. Being replaced is what convinces Tyson to finally go through with the operation, which is successful. A few days later, he leaves the hospital a happier, if unemployed, man.

In the second story, “Thirty Days to Live,” Casey has been reprimanded by the hospital board for performing a risky operation on a young boy. Casey knows the child will eventually need three surgeries, but he has angered the board and may get kicked out of the hospital. Jut when he thinks his day can’t get any worse, he accidentally sticks himself with a needle contaminated with the blood of a patient who has rabies. As Casey spends the next month wondering whether or not he will come down with rabies (until this year, an incurable disease), he has to convince the hospital board to let him operate twice more and save his patient’s life. I suspect this made for a riveting hour of television, but it made a very disjointed sixteen page story.

The medicine, what they show of it, is fine; it’s the storytelling itself that is sub-par. Given this it’s no surprise that the comic only lasted for one issue (but what is surprising is how many people are willing to pay $50 for a black and white comic that aspires to fumetti).

Tags: comics medicine ben casey flashback rabies

After the infamous 1950s congressional hearings that attempted to link comic books to juvenile delinquency, EC made a dramatic change in its publishing style. Gone were the Tales of the Crypt and other horror and crime comics. Instead, they published their “New Direction” comics. These comics included several topics not usually covered by comic books, including medicine (M.D.) and psychiatry (Psychoanalysis). Unsurprisingly, these New Direction comics weren’t particularly good sellers and lasted less than a year.

M.D. #3 consists of four medical stories and a one-page text piece. The art is in the usual intricate EC style, though the art in the second story does degrade into parody. The lettering is the classic typeface style long used by EC.

The opening story, “What You Need to Know,” warns us of the dangers of sledding and overprotective mothers. After the other boys tease Tad about being a mama’s boy, he grabs his sled and heads to the top of Snake’s Hill. Sledding down the treacherous slope on a dark blizzard night, he crashes into a tree stump. The other boys find him bleeding and unconscious and flag down a passing trooper. Tad is rushed home and Dr. Yates, the local general practitioner, is called.

Dr. Yates examines Tad and diagnoses him with several fractured ribs and a punctured lung. An operation is needed, but the ambulance can’t get through in the blizzard. Dr. Yates decides to operate on the kitchen table. With help from the trooper and Tad’s father, Dr. Yates begins the delicate operation (Tad’s mother, of course, receives a sedative). Due to skill of the doctor, Tad survives. After the operation, does Dr. Yates lecture Tad about taking foolish risks? No, he tells Tad’s mother that it was her fault for being overprotective.

The second story, “The Right Cure,” concerns Appalachian hill folk and their reliance on questionable folk remedies. An older woman has excruciating abdominal pain and her husband has taken her from herbalist to herbalist with no success. Her daughter wants to take her to a doctor, but the father refuses to take her to “a furriner.” When the pain becomes so bad that the old woman begs her husband to shoot her, the daughter sneaks off and finds a doctor. She brings the doctor to their house and then holds a rifle to her father so he can’t interfere while the doctor examines her mother and takes her to the hospital. The patient is diagnosed with an abdominal cyst and successfully treated surgically. Her husband arrives at the hospital with a shotgun and a mad-on for the doctor, but puts down the weapon when he sees how dramatically his wife has recovered. At the end he tearfully promises the doctor that he’ll never go near a folk healer again.

“Shock Treatment” more than any other story highlights the difference between 21st century medicine and the medicine of the 1950s. In this story, a young man attempts suicide and is diagnosed with manic depression. He is admitted to a psychiatric hospital where he is kept heavily sedated for the next ten days in the hopes that he will forget that he’s depressed and suicidal. When that doesn’t work, he is subjected to electoshock therapy, again so that he’ll forget he’s depressed. Meanwhile, the doctor lays the blame for the patient’s depression squarely on the parents and their constant bickering and fighting.

Treatment of depression has improved by leaps and bounds since this story was written. For one thing, there are very effective antidepressant medications available. It’s true that in some situations electroshock therapy (better known as ECT: electroconvulsant therapy) is still used, but not to the extent it once was. We also know a lot more about the causes of depression, and while family life may complicate the situation, it’s not the root cause. Finally, I should point out that the patient was diagnosed with manic depression (i.e. bipolar disorder) despite the fact that he has never been shown to have experienced a manic episode; major depression is probably a better diagnosis.

The last story, “The Lesson,” concerns a young man who was speeding on a wet road and lost control of his car. He has a few bruises, but his girlfriend suffers multiple broken limbs and a closed head injury. The local doctor arrives at the scene and takes everyone to the hospital. The young man is very apologetic but the doctor drags the him into the operating room so that he can watch as his girlfriend’s broken legs are set and a hole is drilled into her skull to relieve the pressure and remove the clot. At the end we learn the reason the doctor insisted the young man witness the operation: his girlfriend was the doctor’s daughter.

There is a single page text piece about Dr. Ignaz Philipp Semmelweiss. Back in the 18th century, Semmelweiss was the first physician to realize that washing hands between patients saves lives, particularly in the maternity ward. Semmelweiss is an interesting character and deserves a post of his own at a later date.

M.D.s are entertaining to read but are clearly a product of their time. As best illustrated by the first story, a not-so-subtle sexism exists in many of the stories. The practice of medicine has changed a great deal in the past fifty years. While some rural general practitioners still perform emergency surgeries, most have long abandoned this practice. House calls are also a thing of the past, mostly for monetary and time-related reasons. Medication and surgeries are much more reliable and effective now. There are reasons to look back fondly on this era, but I much prefer the current state of medical care.

The idealistic young intern Dr. James Kildare was the star of a series of successful movies in the late 1930s and early ’40s. In the 1960s, Dr. Kildare returned as a television drama starring a young Richard Chamberlain. In 1962, Dr. Kildare starred in his first comic book: Four Color Comics #1337 published by Dell.

Eddie Eastman, a well-known gambler, is in trouble. A bookie owes him $10,000 and instead of paying, has decided to kill him. Eastman decides the best way to hide is to check himself into the hospital.

Eastman comes to the hospital and is admitted for sharp chest pains. His physical exam is normal so Dr. Kildare runs some standard heart tests, which unsurprisingly come back normal as well. The next morning, Kildare wants to discharge Eastman, but the gambler has other ideas — he wants to stay in the hospital until the coast is clear. First he tries to bribe Kildare, but Kildare refuses to be bought. Instead, Eastman resorts to threats and suggests that he’ll have Dr. Gillespie, the hospital Chief of Staff, killed if Kildare doesn’t keep him in the hospital.

Reluctantly, Kildare agrees, but orders an entire battery of tests — many of them painful — to “justify” the stay in the hospital. Except for a slightly elevated blood sugar, the tests are normal. Kildare then tries to appeal to the gambler’s conscience by telling him that his bed is needed for a sicker patient. To prove his point, he takes the gambler on rounds with him to show him how crowded the rest of the hospital is.

Kildare is called away to an emergency surgery on a young girl caught in a car accident. Hearing this, the gambler’s conscience gets the best of him and he checks out of the hospital. In a shocking turn of events (well, not really that shocking), Eastman is gunned down as he walks out of the hospital. Luckily Dr. Kildare is nearby and rushes him into surgery and saves his life. The police catch the gunman and arrest the bookie. A grateful Eastman gives the hospital a check for ten thousand dollars. Dr. Kildare, instead of being rewarded, is reprimanded by Dr. Gillespie because Gillespie thought he was looking down on Eastman because of his occupation. How’s that for gratitude? Save your boss’s life and earn a reprimand. Such is the life of an intern.

The art is pretty bad. The supporting characters are caricatures and have been taken straight out of central casting. The main characters don’t look at all like themselves and the coloring is off as well. Kildare looks likes he’s at least 65 years old and has hair of that unique-to-comics blue/black color; Dr. Gillespie looks like W. C. Fields. Despite these flaws, the comic proved successful enough to earn Dr. Kildare his own series that ran for nine issues from 1962 to 1965.

As part of their post-Congressional hearings “New Direction,” EC put out several new comic series including the one titled Psychoanalysis. The comic is exactly what it sounds like: a comic book in the EC style detailing three patients visiting their psychiatrist.

The psychoanalysis in the comic is a fairly basic take on Sigmund Freud’s philosophies. It all boils down to two concepts: First, everything is the parents’ fault. Second, any mental problem can be cured by psychoanalysis. Granted, this is before there were any effective medications for such problems, but several of these patients would benefit from medication..

The first patient is Freddy Carter. His parents bring him to the psychiatrist and are clear that he is a big disappointment to them because he has been caught stealing from his best friend. His father is a successful engineer and is upset that Freddy won’t apply himself in school or at sports. Instead, Freddy prefers the more artistic endeavors such as music and painting. His mother encourages these activities — wanting Freddy to be “refined,” but his father considers them “sissy.”

After some harsh words for Freddy’s parents, the psychiatrist sits down and talks to Freddy. He explains that Freddy is mad at his father for not letting him do what he enjoys. Also, he is mad at his mother for encouraging him in these activities, thus inviting and worsening the anger of his father. Freddy steals things from his friend because he thinks his friend has the perfect parents and perfect family and subconsciously wants to be a part of it.

The second patient is Ellen Lyman. Ellen is clearly a very anxious person. She is also troubled by a recurring dream. This dream, which is incredibly detailed, recounts young Ellen trying to get into a walled garden. A kilted Scotsman bars the way and won’t let her enter until she passes a written exam. She fails the exam, but sneaks into the garden anyway, only to find it is dead and barren.

The psychiatrist explains that the dream is about her sister. The garden represents her parents’ love and it is sealed off and guarded because she believes that they always loved her sister best. The kilted guard represents her sister (kilt = dress). The test represents the fact that her sister always did better in school than Ellen. Finally, the dead garden represents how bereft Ellen’s life would be if her sister wasn’t in it.

The final patient, Mark Stone, is a successful television writer who is having panic attacks. It turns out that the Mark really wants to be a novelist, not a Hollywood writer. The psychiatrist is able to have Mark realize that his stress is from his fear of success and his acceptance of mediocrity. Mark sticks with the television writing because he fears that he may fail as a novelist, and this conflict is causing his stress and panic attacks.

Makes sense? Sure, but it’s not enough for our Freudian psychiatrist. He digs deeper into the patient’s past and is able to discover that true conflict is the patient’s extravagance versus his father’s frugal ways. Thus it is all the father’s fault.

Although every patient is much better by the end of their session, the psychiatrist reminds the reader that they’ll be able to check back in on the patients in the next issue of Psychoanalysis. The series only lasted four issues, so I hope the patients didn’t need long term counseling.

Dr. Ben Casey has just left the urban clinic where he volunteers¹ when he stumbles across a man who has been beaten unconscious. He loads the unfortunate man in his car and rushes to the hospital.

Only after he has operated on the patient and saved his life does Casey discover that he has entered a political minefield. His patient is Marcus Tiberius, the deposed dictator of a small unnamed Caribbean nation.

Casey protests that he doesn’t care about his patient’s politics (or apparently his history of genocide), he just cares about his neurological health.

A police officer shows up, flashes his badge, and sets up a twenty-four hour watch over Tiberius. A short time later, the power mysteriously goes out. By the time the emergency generators have kicked in, the patient has been murdered.

Casey, with help from his associates, decides to play detective. First, he is able to determine that one of the hospital maintenance men is from the same small unnamed island as Tiberius. Upon seeing the former dictator admitted, he realized that he had a chance to avenge his family. He shut off the power, stole from chloroform from the OR, and in the dark snuck in and used the chloroform to suffocate the patient.

However, it turns out that one of the pharmacy technicians is also from this same country and also harbored thoughts of revenge. She stole some strychnine from the pharmacy² and slipped it in the patient’s water, then poured it down his throat.

Which of these avengers killed Tiberius? Neither of them. Casey reveals that it was the cop — actually a fake cop — who killed the dictator by stabbing him with an ice pick. Casey reveals he became suspicious of the faux-cop when he called it a “badge” instead of a “shield,” like a real policeman would³. Oh, and he was cleaning his nails with an ice pick too.

When the fake cop tries to escape, the real cops shoot him. Dr. Casey rushes him into surgery and saves his life, proving that the work of a surgeon never done.

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Notes:
¹Because chief neurosurgical residents always spend their extra time working as family physicians in clinics for the poor.

²Why would the pharmacy even carry strychnine?

³This seems a pretty flimsy reason. Every policeman I’ve known has called it a badge, not a shield (gee, maybe they’re all fake cops), but maybe things were different forty years ago. The cleaning-the-nails-with-an-ice-pick is still a dead giveaway though.

Vacation’s over. Back to work tomorrow.

sigh…

We spent the first night in Las Vegas (Henderson, Nevada, really) at the in-laws. Early the next morning, we headed for the airport, met up with the two other couple vacationing with us, and flew to Honolulu. We checked into the hotel, then hopped a bus down to Waikiki and enjoyed an afternoon of beach and sushi (and shopping, for the Polite-Wife). The next morning we traveled to Pearl Harbor to see the USS Arizona Memorial. Due to time constraints, we were unable to tour the USS Missouri, but did get to climb through the USS Bowfin (a WWII submarine).

Back to the airport and on a hop to Kauai. We stayed in a very nice rental house in Poipu for the next week. The house was about two blocks from the beach and had a big yard with a pool and hot tub (and geckos). To be honest, most of our time in Kauai we were pretty lazy — lots of sun, sand and reading. The other couples spent an afternoon zip-lining down one of the island’s canyons. Since neither of us is particularly fond of heights, the Polite-Wife and I sat that afternoon out. The kayaking was fun — I’ve always liked canoeing and kayaking — and I wish we could have gone on a longer excursion. My favorite was our last afternoon where we inner-tubed down the irrigation canals of an old sugarcane plantation – including about a mile of tunnels hand-carved into the volcanic rock over a century ago. We had to wear hard-hats with lights, and the water was ice cold, but it was like a good amusement park water ride — only real and a lot more fun.

We returned to Las Vegas, spent another day and a half with the in-laws, and then returned to central Illinois last night.

I managed to catch up on a great deal of reading while on vacations. No medical journals, no comic books — just traditional books — of both the honest pleasure and guilty-pleasure variety.

• My Name is Legion by Roger Zelazny.
  An old science-fiction gem by Zelazny, this book is a collection of three novelette-length stories featuring a hero who has dropped out of the over-computerized future society and become an investigator for hire.
• To Say Nothing of the Dog by Connie Willis.
  A fun book that takes on time travel, cats, dogs and Victorian England. Some of the plot point are a little to obvious (did anyone not know where the cat was — or who Mr. C would end up being?), but half the fun is seeing how Willis works these points into the seamless narrative.
• The Big U by Neal Stephenson.
  Stephenson’s first novel, hard to find, but worth reading. Not as dense as some of his recent novels, but the multilayered plot is undeniably his. Snow Crash is still my favorite.
• The DaVinci Code
  Digital Fortress
  Deception Point by Dan Brown
  After reading these books, and previously having read Angels & Demons, Iam convinced that Dan Brown has only written one book — he’s just written it four times: An intellectual is asked for assistance on a dramatic problem and then finds himself (or herself) in the middle of an intricate scheme. The love interest, another brilliant intellectual, also becomes embroiled in the plot. The antagonist controlling the entire conspiracy, originally hidden from view, is revealed to be a close friend or mentor who is not really evil, just misguided.
• The Lust Lizard of Melancholy Cove
  The Stupidest Angel by Christopher Moore
  Two short novels involving the California town of Pine Cove. Despite some memorable characters (particularly Sheriff Theo Crowe and ex-scream queen Molly Michon) and a few laugh out loud moments, these books pale beside Moore’s better novels (in particular I like Coyote Blue and Bloodsucking Fiends: A Love Story).
• The Dain Curse
  The Glass Key by Dashiell Hammett
  Two crime noir classics. The Dain Curse reminded me a great deal of Wilkie Collins’s The Moonstone because of the faint supernatural overtones. The politics and political machine featured in The Glass Key dates the book a little, but the intrigue is still quite clever.
• Back Story by Robert Parker
  You can never go wrong with Spencer and Hawk.

This week’s Grand Rounds — the weekly collection of the best of Medical Blogging — can be found over at .Parallel Universes. As always, there is lots of good reading — check it out!

One of the most fascinating part of the old medical comics from the 1960s is the filler material they added to the books. The inside covers and the back cover often contained little one page articles or vignettes. These one-pagers do a good job of showing the practice of medicine back then, and how it compares to current medical practice. Presented below are two inside back covers from Dr. Kildare comics. Click on the images for a larger version.

First a look at First Aid, 1962 style, from the inside back cover of Four Color Comics #1337. Some interesting advice here — most of it is fine, but look at the “prone method of artifical respiration” — kids, don’t try this at home! (I like how the article is ostensibly about first aid, something anyone should be able to do, but readers are warned to only attempt the artifical respiration if properly trained).

Next, from the inside back cover of Dr. Kildare #4 is a look at “Doctors for the Young.” Look around the doctors’ offices, then compare them with the office when you visit your doctor. Quite a bit different, eh? Well, this comic is over forty years old. I like the chemistry set on the counter in the first panel, the fact that the doctor can diagnose diaper rash without actually removing the diaper (in the second panel), and in the third panel we see the correct use of the flip down mirror — doctors are always drawn with these and this artist actually gets it right!

Still recovering from jet lag and lack of sleep (and being on call), so here are a couple more cover vignettes from medical comics of the 1960s. First, from the inside back cover Ben Casey #1 comes “Medicine’s New Wonder Machines.” A fairly optimistic look at medical technology. The Electron Microscope and Stereo Microscope have come to fruition, but the Electrical Anesthesia was a no go. There are variations of a Heart-Lung Machine used today, but nothing nearly as simple as pictured.

Next, from the back cover of Dr. Kildare #4 is “A Doctor’s Work” — and in color (or four-color at least). And there’s another image of the old style artificial respiration technique.

Adventures of Superman #642 “Sacrifice, part 3: Remembrance”
Greg Rucka, writer
Karl Kerschl, Derec Donovan, Cam Smith and Sean Parsons, artists

Superman: I’m listening to him…to the sound of his ribs crushing in when they should be moving out. Moving out when they should be moving in…

…to the hiss of supplemental oxygen at twelve liters per minute, forcing it’s way into his blood…

…to the drip of the plasma into his veins…

Batman was badly injured in a recent fight aboard the JLA watchtower. He’s experiencing paradoxical chest movement which means that part of the chest is moving backwards: out with exhalation and in with inhalation. This tells us that Batman has a flail chest. Flail chest is common in blunt trauma and occurs when a group of ribs are each broken in two places so that they are no longer tethered to the rest of the chest wall. The best treatment for flail chest is good pain management and ensuring that the lungs work well. Sometimes surgical correction is required, though it seems that the “Healing Ray” used by Wonder Woman (that looks like it comes from a frying pan) is quite effective too.

12 liters-per-minute is a lot of supplemental oxygen. The JLA must be using a high flow system, such as a Venturi mask. These are not normally used in trauma situations (usually only in people with severe underlying lung conditions like bad emphysema), but in this case it’s probably being used because of his flail chest and underlying lung damage. Or it could be some high tech Thanagarian system — it does look more like a fighter pilot’s mask than a medical mask…

Plasma is not used for fluid resuscitation; it is only given when people have clotting disorders. Batman needs blood, not plasma (and the artist gets it right, drawing red blood in the IV, not pale yellow plasma).

Finally, a nit pick about trauma medicine. I’ve talked before about the ABCs of emergency medicine (Airway, Breathing and Circulation). In trauma situations, there is also a D and E. D stands for Disability: perform a quick neurological exam to look for any nerve damage. E stands for Exposure: undress the patient and make sure there are no hidden injuries. Even a small missed injury can spell big problems later. You’ll notice that Batman is still wearing his costume — in fact he has a bandage over parts of it. The rescue team seems to have missed the E step. Where’s Dr. Mid-Nite when you need him?

Teen Titans #26 “Soul Searching”
Geoff Johns, writer
Tony Daniel, artist

A quick and simple lesson on fractures.

Batman to Superman: You know what he did to Robin. His right arm suffered a comminuted fracture. Superboy crushed his bones.

Kudos to Johns for getting his broken bone terminology correct. A comminuted fracture is one where the bone is broken into multiple pieces (too many writers confuse this with a compound fracture, which is completely different).

Here’s a brief primer on some common types of fractures:

• Closed fracture
  A broken bone when the skin over the fracture site is intact. The opposite of an open fracture.
• Comminuted fracture
  A fracture that is broken into more than two pieces.
• Compound Fracture
  An older name for an open fracture.
• Greenstick Fracture
  A fracture that does not go all the way through the bone. Think of what happens when you bend a freshly-cut tree branch: part of the stick breaks, but the rest just bends under the pressure. This is where the name “greenstick fracture” came from. They are more common in children because their bones are much more flexible than adult bones.
• Open fracture
  A fracture where the bone has broken through the skin or where there is a communication between the fracture and the skin. These have a high rate of infection. Generally, any person who suffers a broken bone with a concomitant skin injury is assumed to have an open fracture until proven otherwise.
• Simple fracture
  An older term for a closed fracture.
• Spiral Fracture
  A fracture where the bone has been twisted apart with rotational force. Often a sign of abuse in children.

For the third time in as many days, I was doing some internet research on various comic, blog and medical related topics, and I kept getting referred to my own site as the best (if not only) information available.

OK, I’ll admit in some ways that’s flattering, but it doesn’t help with the research at all.

As much as I enjoy some of the more recent computer games, I get the feeling that way too often they feature nice-looking (yet CPU-churning) graphics instead of a decent plot. I find myself reminiscing for the days when computer games had at most 4 or 16 colors, or none in the case of Infocom’s text only games.

No sound cards, no graphics cards, no modems, 5 1/4″ floppy drives (and even tape drives) and hard drives of about 30 megabytes.

These were by far my favorite games of that era:

• Legacy of the Ancients
• Zork I, Zork II and Leather Goddesses of Phobos
• Manhunter: New York and Manhunter: San Francisco
• Covert Action
• SSI’s “Gold Box” AD&D games

During my senior year of high school, our family purchased a computer. It was a Zenith computer (yes they made computers back then) that had a monochrome monitor (amber/black), a 5 1/4″ floppy disk drive and a 30 MB hard drive. No mouse, as the Macintosh was fated to be introduced later that year. If you wanted to select text, you higlighted it by using the F8 key. Sure, it was cumbersome compared to today’s computers, but it was still better than a typewriter. We also had an Epson dot matrix printer that could churn out an amazing 2 oe 3 pages per minute.

Still, this was not my first computer. Let’s go back a few years to my freshman year in high school. Upon returning from a marching band trip over Christmas break, I took the money I had left over and puchased an Atari 800XL. This computer was a thing of beauty. It had 64KB of memory and built in BASIC. True to its Atari lineage, it had a video-game cartidge slot on the top and two joystick ports*. It didn’t have a monitor but instead had an RF switch to attach to the back of the TV. No floppy drive or hard drive, though you could purchase a floppy drive separately. I couldn’t afford those, so I picked up a tape drive that utilized regular casette tapes. You’d put the tape in the drive, fast forward it to the point where you thought the program you wanted was and then type “CLOAD” and it would (hopefully) load. This was a simple computer, but that’s why I loved it. I knew exactly how everything worked and what every variable and command did. Now I’m lucky if I know 1%.

*It had very few good games — it wouldn’t play Atari 2600 games, only the 5200. I think I had Donkey Kong, Pitfall II and Space Ranger.

Tags: computer atari

A common cliché of super-heroics, science fiction and fantasy is that using psychic powers causes nose bleeds. Individuals who are the recipients of psychic attacks are also susceptible to these nose bleeds as well — and even bleeding ears and eyes in extreme cases (the end of God Loves, Man Kills for example).

Does this concept make any medical sense or has it simply become a quick way of showing that someone is using psychic powers?

What causes nose bleeds¹?

The nose is very vascular. In other words, there are a lot of blood vessels near the surface. This is because one of the functions of the nose is to warm air as it is inhaled. The blood vessels in the nose give off enough heat to warm the air. Unfortunately because of all of these blood vessels near the surface, it doesn’t take much for the nose to start bleeding.

The most common causes for nose bleeds include trauma (such as fists…and fingers), extremely dry air, high blood pressure, irritation (blowing your nose repeatedly), foreign bodies, infections, and blood disorders. You’ll notice that the use of psychic powers is not in the differential diagnosis of epistaxis¹.

Why would using psychic powers cause a nose bleed?

• Is the individual thinking so hard and concentrating so fiercely that blood vessels in the nose just start popping? Nonsense! If this were possible then everyone taking the SAT would get a bloody nose (“Do not open the test booklet until instructed to do so. Use only a #2 pencil. If you make a mistake, make sure you erase your mark completely. If you get a nosebleed, use the tissue provided. Students getting blood on the answer sheet will be marked down.”)
• Are the psychics straining so hard that they raise their blood pressure high enough to burst arteries in their nose? High blood pressure can certainly cause nose bleeds, but I’d be a lot more concerned about other problems high blood pressure causes such as heart attacks and strokes. If high blood pressure were the reason for the bloody noses, we’d see psychics and telepaths dropping like flies from strokes and heart attacks. And are they straining any harder than the more physical heroes who are lifting houses and bench pressing Buicks? You never see those heroes with bloody noses.
• Could the use of psychic powers raise the pressure of the the cerebrospinal fluid (CSF) – the liquid surrounding the brain and spinal cord? This would be suicide. Elevated CSF pressure doesn’t cause nose bleeds but it sure does cause comas.
• Are psychics closet nose pickers²? Frankly it’s as good — if not better — than the other theories.

What about bleeding from the ears and eyes?

This makes even less sense. These structures aren’t as vascular as the nose and aren’t as prone to bleeding. They are also less affected by high blood pressure and other physiological changes.

In conclusion

I’m willing to accept that bloody noses³ are “comic book shorthand” for someone using psychic powers or being on the receiving end of psychic powers. I can even almost accept bleeding ears and eyes. Just don’t expect me to pretend it makes any sort of medical sense.

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Notes:
¹ The medical term for a nose bleed is epistaxis. That’s just a cool word.
² A bloody nose caused by picking the nose is referred to as epistaxis digitorum.
³ I hereby name a nose bleed caused by psychic powers epistaxis telepathica.

Tags: comics medicine nose bleeds maxwell lordpsychic

The move is going well…so far. The movers delivered all our stuff to the new house today, and the Polite-Wife is already down there. I’m remaining here in Central Illinois (with an air mattress and a box of pop tarts) until I finish my last day in the clinic next week. After that, I pack the last few items from this all-but-empty house, hop in the car and drive down the two and a half hours to our new house. And then start in the new office that Monday.

The Polite-Wife is very excited because she got offered a third-grade teaching postition yesterday. Of course it starts tomorrow, so she’s frantically trying to unpack boxes while mumbling about posters, name tags and lesson plans. I’m ecstatic that she got the job. The complete lack of a job opportunities was probably her biggest problem with Central Illinois — with full teaching certificates and a Master’s she was still only able to land the occasional substitute teaching job. Having her own classroom (and third grade, her favorite) will lift her spirits immensely.

Between all her teaching book sets and my comic books, I suspect at least half the moving van was reading material of one sort or another…

It’s OK Alfred, let me talk to the big guy:

The Medial Collateral Ligament (MCL) is one of the four main ligaments that stabilize the knee (the others are the lateral collateral ligament (LCL), the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL)). The MCL provides stability for the inside aspect of the knee.

MCL tears are a common sports injury. They occur when a person’s foot is firmly planted and a strong blow is delivered to the outer aspect of the knee. A good example of this is a clipping injury in football. Sometimes an injury to the MCL also involves the ACL or meniscus; these are more serious and require more time to heal.

Symptoms of an MCL injury are pain and swelling over the ligament. There may be bruising and swelling of the entire knee as well.

Isolated MCL tears rarely require surgery. For simple sprains, RICE (Rest, Ice, Compression and Elevation) and anti-inflammatory medications are suggested. More severe sprains and tears require the use of a hinged knee brace and probably some physical therapy. Except for the most minor of sprains, MCL injuries require several weeks — if not several months — of recovery time. If the ACL or meniscus are injured along with the MCL then surgery is probably required.

Top image from Batman: Jekyll & Hyde #4, written by Paul Jenkins, penciled by Sean Phillips. The graphic of the knee anatomy looks like it was taken from Netter’s.

My turn it seems:

1. Ten years ago:
I was a few months into my fourth (and final) year of medical school. I had just returned from several weeks over in the Philippines visiting my sister, who was a Peace Corps volunteer there. I arrived back in St. Louis just in time to take Part 2 of the Medical Boards and start a rotation in Pediatric Endocrinology.

2. Five years ago:
I was a physician in the USAF stationed at Nellis Air Force Base in Las Vegas. At this point, the Polite-Girlfriend (not yet the Polite-Wife) and I had been dating about a year.

3. One year ago:
I was refinishing our back porch. I had power-sprayed it, just trying to wash away some of the grime, but it turned out that I inadvertently washed away the cheap weather-proofing the previous owners had used. A one-day project became a two-week nightmare as I had to sand, re-sand and finish the porch. Looks great though.

4. Yesterday:
A long day at work, then a too-quiet evening at home (the wife and cats are down in the new house).

5. Today:
Another long day at work (mostly school and sports physicals) and another too-quiet evening at home.

6. Tomorrow:
Hospital rounds first thing in the morning, and then I’ll swing by the post office and mail some credentials forms for the new job. If the hospital is not too busy, I’ll head down to the St. Louis area and see how the unpacking is going in our new house.

7. Five snacks I enjoy:
Bottlecaps, Nerds, Iced sugar cookies, tangerines, honey-wheat pretzels

8. Five bands I know the lyrics of most of their songs:
The Who, Pink Floyd, Simon & Garfunkel, Chris Robison, Heather Alexander

9. Five things I would do with $100,000,000:
Pay off the house, send my nieces/nephews to college, go back to school myself, buy a vacation home and hide the rest under the mattress.

10. Five locations I’d like to run away to:
Anywhere in the Appalachians, Belgium, Reykjavik, Las Vegas or Kauai

11. Five Bad Habits:
A horrendous sweet tooth, ignoring people who are talking to me if I’m involved in something, being fanatical about the proper use of the word “unique” and yelling at the TV or radio when it is used incorrectly, the inability to count to 5

12. Five things I like doing:
Watching mindless TV, Reading books and comics, researching bizarre medical questions for this site, sleeping and playing computer and video games poorly.

13. Five TV shows I like:
Kim Possible. Black Adder, the Simpsons, MythBusters and Deep Space Nine.

14. Famous People I’d like to meet, living or dead.
Thomas Jefferson, Andrew Jackson, Teddy Roosevelt, C.S. Forester, Wellington, Steve Ditko, Robert Parker and Bobby Labonte, Alton Brown.

15. Biggest joys at the moment:
Just hoping the move will be over soon and praying that someone will buy our house.

16. Favorite toys:
The computer, my Trek and my iPaq.

For a weekend challenge, here are two “psychic games” pointed out by the always enlightening Skeptico. Play around with them and see if you can deduce why they work.

First, let the Amazing Garfield tell you which card you picked and then let the Mystic Ball will tell you which number you chose.

Hint #1: Neither site actually involves mind-reading.

Hint #2: Look for “Pretty sneaky, Sis” moves on both sites.

I finally had a chance to sit down and read the House of M (and most of its offshoots) this weekend, and I enjoyed it more than I expected. It got off to a incredibly slow start with House of M #1, but the subsequent issues really picked up the pace. The various offshoot title were mostly enjoyable as well, though I was underwhelmed by the art on Iron Man: House of M.

The main problem with the title is a problem shared by almost all “alternate reality” titles: it lacks permanency. As readers, we know that the storyline is only a temporary one and we are reluctant to invest in the characters and storylines. Sure, there may be some ramification when it goes back to “normal” , but we all know that soon the status quo will return.

The Elseworlds stories avoid this problem by telling stories that are set in their own world, not one that is a perversion of the normal one. Unfortunately most Elseworlds stories are too short for the reader to really care much for the characters. The Ultimate Universe is another example of an alternate world in and of itself, not simply a change in the regular world. Unlike the Elseworlds, the Ultimate Universe has been around long enough to develop some good character depth. Some of DC’s “Fifth Week” events were also able to create alternate universes with a sense of permanancy. You knew the Tangent Universe existed before we read about it and would continue afterwards. The Amalgam Universe pulled this off particularly well with editor’s notes referring to supposedly previously published Amalgam comics.

The Best Alternate Universe Stories* (in my humble opinion):

1. The Tangent Universe
2. Golden Age
3. The Amalgam Universe
4. Thrillkiller and Thrillkiller ‘62
5. The Ultimate Universe
6. House of M
7. Superman/Wonder Woman: Whom Gods Destroy
8. Age of Apocalypse
9. Superboy’s Legion
10. The Nail (but not so much its sequel, that was just too busy)
11. Superman: Red Son

The Worst?
Anything involving Kulan Gath is bad, but the absolute worst? Without a doubt that would be the year that was Heroes Reborn.

---

*I’m not counting any “alternate futures” because they haven’t happened yet, with the exception of Superboy’s Legion which is an alternate version of an already established future.

I hope that everyone’s had a chance to read Birds of Prey #85 by now. As usual, it’s a good issue and well worth your time and money. Notice anything special about the splash page? Take a close look at it, particularly the credits.

Here, let me help:

Yep, that’s me.

Thanks, Gail. I think I’m going to have to put this on my CV.

Speaking of Birds of Prey #85, later on this evening I’ll post a full medical review of the issue (though Rose is off to a good start in her review at Buzzscope).

I’ll try to keep the review as Spoiler free as possible, but that last page will definitely be discussed. In other words, make sure you read the comic before reading the review.

Birds of Prey #85 “A New Morning’s Resolution”
Gail Simone, writer
Joe Bennet and Eddy Barrows, pencillers

The story and the medicine in Birds of Prey #85 were very good, but the art should have been better. There were too many instances of poor panel-to-panel continutity and a couple of occasions where it seemed the artist hadn’t fully read the script.

The plot: Oracle has been infected with the Braniac Virus and is brought to the JSA’s brownstone for treatment. Dr. Mid-Nite has assembled an all star team of experts to operate on her. She is sedated with Diprivan, an intravenous anesthetic, while a team of surgeons remove the physical aspects of the virus. Barbara herself tackles the psychological aspects of the virus.

The team is using equipment that is fancier than standard surgical equipment, but it’s not that far-fetched. For example, wireless heart monitors are already used in most hospitals so it should be no surprise that the Surgical All-Star Team is shown using one — though admittedly a very advanced model. This is consistent with past appearances of Dr. Mid-Nite, who always has the most cutting-edge medical technology.

In terms of the art, it was certainly technically proficient. However, there were several continuity errors such as intermittent surgical masks on the All-Stars and occasionally invisible tubing on Mr. Tan. There were also several instances where I wondered if the artists had missed some of the finer points of the script. Mr. Tan mentions his respirator and we actually see it behind him in one panel, but where is it hooked up to him? If he’s on a ventilator long term, then he probably has a permanent tracheotomy. His body position is such that it would hide ventilator tubing running his neck, so I can’t fault the artist there. But if Mr. Tan has a tracheotomy — or is on a ventilator of any sort — then why is he drawn with nasal oxygen tubing?

The worst example of art not matching story was not in the medical aspect of the comic, but it was jarring enough to earn a mention. As the fight starts, Black Canary mentions that she drew first blood and then (a few frames later) Helena drew second blood. The artist disagrees, clearly shows Connor drawing blood long before the Huntress.

What about the big reveal of the last page? It makes sense medically (well, comic-book medically). Think of it this way: the Braniac Virus wanted a perfect host. The virus would do what it could to fix any imperfections, and since it is a highly advanced virus specially attuned to the nervous system, it should have no problem repairing nerve function. Of course, that doesn’t entirely explain why it wasn’t until after the virus was defeated that Barbara regained her mobility. We’ll just have to wait and see what Simone has in store for her.

To sum up: Story, good; Medicine, good; Ending, good; Dr. Mid-Nite’s All-Star Surgical Team, good (and they need their own comic); Art, needs work.

Outsiders #26 “Tick Tock, part one”
Peter J. Tomasi, writer
Will Conrad, penciller

Fuse, a villainous telepath has implanted several kidnapped individuals with miniature atom bombs (though 10 kilograms of uranium [i.e. 22 pounds] is a lot of uranium to hide in someone’s body…that’s a full term pregnancy!) The original Outsiders confronted Fuse and he fell into a coma during the fight. Most of the human bombs were rounded up, but a few escaped. Now several years later, Fuse is waking up from his coma and Black Lightning is reuniting the original team (plus Arsenal) to track down these human bombs. Somebody else is a few steps ahead of the Outsiders and is killing these people one by one.

In the opening scene of the comic, one of these human bombs has decided to cool himself down by submerging in a bath of ice water. He has installed a length of small hose to breathe through. Meanwhile, this mysterious person has snuck in and shot him — but they really shouldn’t have bothered. He would have been dead of asphyxiation within ten minutes. He’s using a long narrow tube to breathe through and there’s no way he’d be able to get enough fresh air to survive. He’d re-breathe his own carbon dioxide, pass out and drown. Even if he exhaled the carbon dioxide into the water, he still wouldn’t be able to draw enough oxygen in through the hose to stay conscious for long.

In a later scene, Black Lightning, Metamorpho and Arsenal are visiting the medical unit where the still comatose Fuse is being held.

Black Lightning: Fuse hasn’t had any brain activity for fove years. A few weeks ago they noticed a change in alpha waves.

There are four main types of brain waves: alpha waves, beta waves, delta waves and theta waves. They are thought to represent different types of brain activity (for example, alpha waves are thought to represent a state of relaxation). Sadly, a lot of New Age gobbledygook has been attached to these brain waves, so you have to sort through a lot of nonsense to get to the real science. People in comas can show different types of brain waves depending on how the brain was injured and what part of the brain was injured. Delta waves seem to be the most common in comas but, like Black Lightning says, alpha waves have also been noted in comatose patients.

My problem with the quote from Black Lightning is his first statement about the patient showing no brain activity. If Fuse had no brain activity then he was dead, not in a coma. That’s a big difference. People in comas have demonstrable brain activity on EEGs.

Metamorpho: Weird to see his eyes open even though he’s in a coma.

While most comatose people have their eyes closed, some have their eyes open. This is often a sign of the patient starting to come out of the coma, which fits the storyline here.

Tags: comics medicine outsiders asphyxiation coma

You would think that syringes would be pretty easy to draw: when the syringe is full, the plunger should be all the way back. When the plunger is plunged, then the syringe should be empty. When the plunger is half-way, then the syringe should be about half full (with the fluid in the end near the needle).

Somehow it never works out that way. Incorrectly drawn syringes are probably the second most common comic book/medical art error (with oxygen tubing being the first). I think most of these mistakes are probably due to the colorist who marks the wrong part of the syringe for filling. Most of the other syringe-related errors can be blamed on the penciler, who draws the plunger in the wrong location (or maybe he drew it right and the inker screwed it up). Regardless, keep your eyes open and you should be able to find one of these errors easily. (I don’t have my notes or my comics with me — they’re down at the new house — so I can’t show you any examples right now. I do remember seeing several syringe mistakes in last month’s comics and I know that Anima #3 has a fairly blatant example).

One of the most thought-provoking recent comic storylines was in the overlooked Marvel Knights 4 #19 and #20.

In this story, Gorgon’s daughter Alecto and her Alpha Primitive boyfriend Reyno flee from the sanctuary city of Attilan and arrive at the doorstep of the Baxter Building seeking asylum. The teens claim that they are being persecuted by her father and the rest of the Inhumans who will not allow the couple to stay together. Reed and rest of the guys are studying ocean life at the bottom of the sea, so Sue, Franklin and H.E.R.B.I.E. are the only ones home. Sue immediately takes the refugees in and swears she’ll protect them. Meanwhile, Gorgon has tracked his errant daughter to New York and the obligatory fight scene results.

The rest of the FF return just in time to rescue Franklin and Sue. After briefly looking over the situation — and without discussing his decision with Sue — Reed calls the rest of the royal Inhumans and hands the children back over to them. In the end, Sue reassures Franklin that the teens will find a happy ending, though she knows that won’t be the case.

At first, I was stunned by Reed’s actions. Handing back abused children to the abusers? What was he thinking?

But were Alecto and Reyno actually abused? Not liking your daughter’s boyfriend and trying to keep her away from him is a story as old as time and it’s not generally considered “abuse”. Sure, there’s a hint of racism — does Gorgon not like Reyno because he’s not royal, or because he’s an Alpha Primitive — but the reader can empathize that Gorgon is just doing what he thinks is best for his daughter.

I think Reed probably made the right decision, but he could have gone about it better. He should have made absolutely certain that there was no abuse before returning them to Attilan. Even more important (and I’m speaking as a married man here) he should have paid more attention to Sue’s opinions and decisions (I think he’s going to be sleeping alone for the next few months).

Marvel Knights 4 is by Robert Aguirre-Sacasa and Valentine DeLandro.

Final Thoughts:
Has Gorgon’s daughter ever been mentioned before? How about being sent through the Terrigan Mists more than once — has that ever been mentioned before?

During my second year of medical school I decided to make more an effort to be social. To that end, I had decided to attend the annual medical school Halloween party. It was held at the VFW in one of the smaller St. Louis suburbs (Each of our parties seemed to be held at a different VFW. Allegedly we made such a mess that we were never allowed back at the previous ones).

I had thrown together a costume at the last minute and dressed as Willie Nelson. I bought a cheap red wig and braided it into long ponytails. I dusted it with some gray and white paint to add some age. I trimmed the ends of the braids to get enough hair to make a matching beard which I attached with spirit gum. With some cardboard and aluminum foil I made a huge belt buckle. With my cowboy boots, a horrid plaid shirt and a baseball cap that I had scrawled “Farm Aid” on, my costume was complete.

The VFW was hopping. A DJ was playing some decent dance music and there was an open bar. Everywhere you looked there were medical students in cheap costumes and a slightly maniacal look in there eyes.

I was standing in the fairly long line for the bar and had just made it to the front of the line. A girl dressed as a hippy came up and asked if I could grab her a beer. Being the gentleman that I am, I grabbed one for both of us. I handed her the beer and we spent the next hour or so talking. Her name was Lisa and she was a nurse at the university hospital. She and her nursing friends made it a point of attending most of the medical school parties.

As her friends dragged her off to another party, I realized that I should have gotten her number. I asked the bartender for a pen and some paper and he found an ancient pencil I could use. I ran out the door of the VFW after her to get her number and bumped into her coming back in to give me her number. Phone numbers were exchanged and things were looking good.

A few days later, some friends of mine decided to attend The Nightmare Before Christmas. They asked if I wanted to go. I agreed and thought that this seemed to be the perfect excuse to ask Lisa out. I called her up and she agreed, saying that she had heard it was a good movie. She gave me her address and I told her I’d pick her up in couple of hours.

I showered, shaved and got dressed. I didn’t want to be too dressy or too informal so I decided on the medical students informal uniform: dockers and a button down shirt. I put on my one nice pair of shoes and went outside to clean the car. I pulled up to the dumpster next to the apartment building so I could quickly clean it out. When I’m busy at work or school, junk tends to accumulate in my car (lecture notes, mail, magazines, medical journals, etc.), and I needed to empty it out so I could make a good impression. I opened the passenger side door of my old Tercel and started throwing out the accumulation a handful at a time.

Then I heard a very distinctive “ching” sound and realized that I had just thrown my car keys in the dumpster. Damn! Luckily the container was mostly empty, but I still had to jump in after them, wade across the dumpster and sift through about a foot of trash until I found them.

I ran up to my apartment to quickly change clothes and wash up. I was already running late, so I just grabbed the nearest pair of shoes and ran back to my car. I only had the one pair of good shoes, so I ended up in a slightly beat up pair of athletic shoes. I headed across town to the (much nicer than mine) apartment complex where she lived. Driving up and down the streets, I simply could not find her apartment. After about ten minutes of looking, I talked to a passerby and discovered that she lived not in apartment 1430, but in apartment 1430 ½, around the back of the main building.

I knocked on the door of the building.

“Come on in!” she yelled. “I’m almost ready.”

I opened the door and her dog, a giant Samoyed, made a lunge at me. I dodged and spun, but he kept coming after me.

“Prince! Stop that!” She shouted at the dog, but the giggle she added at the end didn’t suggest any real discipline. By now, he had stopped chasing me and seemed to have decided that I looked like a fire hydrant. He closed in, sniffed, and then raised his hind leg.

“I’ll wait for you outside.” I hurriedly said as I slipped out the door and away from Prince. Lisa came outside a minute later, nicely dressed in skirt and blouse. She smiled at me, but I swear I saw the smile falter a little bit when she got a look at my shoes.

We hopped in my little Toyota and headed to the theater. We made it just as the movie was starting but luckily my friends had saved us some good seats.

Five minutes after the movie started, her cell phone rang. She grabbed it and started a whispered conversation with one of her nurse pals. After receiving some dirty glares from the people around us in the theater, she headed to the back of the theater to finish her conversation. In a few minutes, she plopped back down in her seat. Just then, her phone rang again and once more she retreats to the back of the theater. This process of phone call migration continued for the rest of the movie.

After the movie, my friends were heading over to Cyrano’s where they served this absolutely sinful creampuff with ice cream and fudge sauce dessert that was famous across town. I asked Lisa if she wanted to go, knowing that nobody said no to a dessert at Cyrano’s, but she declined. She added in an aggrieved tone that she needed to go back home and feed her dog.

I drove her home and parked in front of her building. I got out of the car and walked over to the passenger side of the car to let her out. She hadn’t waited for me, however, and was already striding to her door. “‘Night,” she called out as she walked in her apartment and (I assume) securely locked her door.

I think it’s safe to say that that remains my worst date ever. I’ve never been entirely certain what went wrong. I have a few guesses. First, I suspect that she found me more attractive dressed as Willie Nelson. Second, I have a strong suspicion that she preferred more affluence in her dates, apparently forgetting that the vast majority of medical students (including me) live below the poverty line. Plus, I think the shoes may have done me in.

Epilogue: Two years later as I was starting my final year of medical school, I stopped by the “Welcome New Students” reception thrown by the school at a local bar. I grabbed a Bud Light and met up with one of my friends. We saw another friend of ours and headed over to talk to him. He was chatting with this bevy of cute girls and he introduced us to them. The last one, of course, was Lisa. She fixed me with a chilly stare and, with the icicles dripping from her words, said, “We’ve met.” I could only laugh.

Tags: comics justice+league moving

With a nod to Thrillmer, I’ve prepared a couple days of light reading while I wait for the high speed internet to be connected at the new house (damn monopolistic cable companies).

Jungle Doctor was a back-up feature published in several issues of Dell’s Dr. Kildare comic book. It starred Dr. Frank Dale and his assistant Bob Rose as they journeyed in the jungles of Africa. This first story is from Dr. Kildare #4 (December-February 1963). It is never stated who the writer and artists were.

Without further ado, here is Jungle Doctor: Who Will Be Chief? (Day One)

Click on the panel for the full page of Jungle Doctor

The excitement of Jungle Doctor: Who Will Be Chief? continues today with the second page of the story. Watch as Dr. Dale intervenes to save the life of a young native man…a young man who just may be the real chief!

Click on the panel for the full page of Jungle Doctor

Tags: comics medicine jungle doctor

I’ve managed to scrounge some dial-up access. It’s painfully slow, but it will at least allow me to stay connected.

So, “War Crimes” and Batman #644, What was that all about? Those of you who read my site regularly should already have guessed my reaction. Abhorrent. Puerile. Nonsensical. Bleah. And apparently this was the reaction the writer was trying to obtain — just the way you vomit on someone to get their attention.

I’ll have a couple more post later on looking at some of the medical aspects of the storyline, but in the meantime, here’s all you need to know about it:

The “War Crimes” storyline S.C.R.U.B.S. score: 26

In today’s episode of Jungle Doctor: Who Will Be Chief? the brothers Muwa and Suta fight…but is it a fight to the death?

Click on the panel for the full page of Jungle Doctor