Polite Dissent

Clandestine #2 by Alan Davis and Mark Farmer.

As far as I can tell this is the first, and apparently last, appearance of Tral. So it goes.

All previous Psychic Nosebleed Zen posts

With summer nearly upon us, and camping season already here, I thought it would be a good time for this PSA ad from August 1964

“Prescription Against Accidents” tells us the story of Bob and his hapless scoutmaster Mr. Joby as Mr Joby does his best to keep Bob from killing himself. In the end though, it is Mr. Joby who is done in, yet another victim of irony.

As usual for DC, this PSA was written by Jack Schiff. Art was provided by Sheldon Moldoff. It appeared in various August 1964 issue of DC comics, including Brave and Bold #55 (the source of this scan), Detective Comics #330, Doom Patrol #89, and Metal Men #9.

I like the way the writer wanted to make sure the reader knew that Rx = “Prescription” by including the footnote. Since nothing in the actual story suggests any sort of prescription, I’m guessing Schiff just wanted a catchy title, or ran out of space for a longer one.

More PSAs

The Differential Diagnosis is one of the key aspects of good medicine. To make a differential diagnosis, the physician takes the patient’s chief complaint and comes up with a list of the possible causes of that problem. This list is then narrowed down by considering the patient’s other symptoms, physical exam findings and lab and radiology results. Eventually, the correct diagnosis is uncovered.

When House and his team try to determine what their patient has by looking at the whiteboard with all the symptoms listed, they are performing a differential diagnosis (a bastardized version actually, since they seem to focus on rare conditions — “zebras” — rather than more likely causes).

For a real world example, if a patient presents complaining of a sore throat, there are at least fifty to sixty possible diagnoses, the most common of which (in my practice, anyway) would be viral infection, allergies, Strep throat, or sinusitis. If the patient also complains of a fever, this makes it likely to be an infection. A cough would make Strep less likely and allergies and sinusitis more likely. Headaches are common with Strep and sinusitis. Chronic symptoms are more likely to be allergies. Symptoms presenting in the dead of winter are more likely infectious. Taking all the symptoms into account, along with a good patient history and a thorough physical exam, would allow the physician to come up with the likely cause of the sore throat (this time of year in the Midwest, probably allergies).

Differential diagnosis can be very challenging in the real world, but imagine how incredibly difficult it must be in a fantasy world where literally anything is possible. Take one of my favorite examples: a nosebleed. In the real world, this probably represents an irritated nose (from an infection or allergies), trauma (including “finger trauma”), or a bleeding problem. In the super-hero world, you also need to add psychic powers, magic powers, possession, and alien abduction, just to name a few. How do you test for those?

Another example comes from this week’s JSA Classified. Wildcat visits one of his old-time boxing opponents and finds him slumped in a wheelchair, virtually comatose. The family tells him that this happened suddenly, on a recent trip to New York. If this were my patient, I would be worried about a stroke, aneurysm, encephalitis, or dementia pugilistica. But not Wildcat, he immediately deduces that his friend was the victim of memory draining villains. That would never cross my mind, but it was the first thing he thought of.

As boring and conventional as it may sometimes be, I think I prefer the practice of medicine in the real world.

THE JEEP DEPENDS ON ENERGY!
These small armored cars pack a might wallop of energy created from the fuel they burn — energy that has given the “Jeep” a reputation for “getting there!”

The use of the Jeep in the ad makes sense; this ad is from Captain America Comics #23 and was written during the height of World War II.

YOUR ENERGY DEPENDS ON THE FOOD YOU EAT!
“Jeepers” your body needs energy too — to “get there” –energy from fuel that the human body utilizes — food!

You see where this is going, don’t you?

BABY RUTH IS RICH IN FOOD ENERGY!
A Baby Ruth Candy Bar is rich in Dextrose, and other nourishing ingredients. It helps give you a quick “pick up!”

But if food (and Dextrose!) is my fuel…what’s my motor oil? Or wiper fluid? Am I manual or automatic?

Other Dextrose-fueled ads from the WWII era:
Baby Ruth
Baby Ruth (again)
Tootsie Rolls

One by one, all the female members of the Legion of Super-Heroes fall ill and collapse. Even Night Girl, who goes to help them, succumbs to the same malady. Mon-El announces that they all have a mysterious “Crimson Virus” and that there is no known cure¹. Worried that the infection may spread, the male legionnaires ship all their female members off to “Quarantine World” — but not before doing their best to cheer them up:

A short time later, a masked woman calling herself Satan Girl shows up and offers to join the Legion. When she is turned down, she announces that she is the one who made all the women sick, and now — out of spite — she’s going to kill them. She heads off to Quarantine World to finish the job. Luckily, Supergirl arrives at that moment, discovers what has been happening, and heads off to stop Satan Girl. She arrives just in time and a vicious battle erupts. Surprisingly, Satan Girl is am equal match for Super Girl and manages to escape, but not before swearing to return:

The sick Legionnaires are moved to another planet³ and then another to hide them from Satan Girl, but she always manages to find them. Supergirl sets traps for her nemesis, but they are always avoided or ineffectual. In the end, Satan Girl manages to defeat Supergirl by burying her under green kryptonite.

Overconfident, she turns on the male Legionnaires but is defeated by the Legion of Super-Pets⁴ — and then the truth is revealed. Satan Girl is really an evil double of Supergirl that split off when Supergirl unknowing collided with a red kryptonite meteor. The evil double knew she only had 48 hours to live unless she could somehow rid herself of the red kryptonite radiation. She was able to project the radiation into the female super-heroes, causing their illness. But now her 48 hours are up and she fades away to be absorbed by the original Supergirl. With Satan Girl gone, the “Crimson Virus” vanishes and all the Legionnaires are instantaneously cured⁵.

Notes:
1. There is never any actual virus in this storyline, so why is Mon-el so adamant that the disease was caused by the Crimson Virus? In fact, it turns out not to be an infectious disease at all.

2. It would have been a better story if she had brought Doom, and then they played video games all night long. But then Jack Thompson would have blamed them for the rising violence among Khund children and it would have all gone downhill from there.

3. One of the planets seems to be inhabited entirely by Madballs.

4. That would be Krypto (the Super-Dog), Streaky (the Super-Cat), Comet (the Super-Horse), and Beppo (the Super-Chimp).

5. Despite being 1000 years in the future, the Legionnaires sure have some dismal medical care. Sure they have fourth dimensional surgery, but when you get down to it, that’s actually pretty backwards. An earlier issue showed that they keep a powerful healing urn stored in a museum — why not actually use it? This is what happens when you have a Coluan who thinks that he’s a doctor.

Another subtext laden post, just from a different point of view this time.

Cub Reporter Jimmy Olsen is denied entrance to the Bearded Band — a mysterious club only open to men with beards — because he lacks a beard (well, he tried to sneak in with a fake beard, but it was quickly exposed). As he slinks away, a strange bearded man accosts him and offers him a bottle of special beard tonic. Jimmy chugs the strange brew¹ and starts growing a thick beard almost immediately².

Jimmy attends the next Beard Band meeting and discovers that he’s been tricked. The beard tonic is real — but it is far too strong. His beard will keep growing, five or six feet per day, unless he receives the antidote. And the club members will only provide the antidote if Jimmy makes several public appearances across town, proudly displaying his new beard³.

Jimmy tries his best to uphold his end of the bargain, but he keeps getting his beard cut off through no fault of his own⁴ — simply bad luck. Angry, the club members destroy the antidote so that Jimmy will always be bearded. Then they proceed with “Operation Whiskers” — their plan to brew a huge amount of the beard tonic and pour it in Metropolis’s water supply. Thanks to more bad luck from Jimmy, their plan backfires and the beard tonic ends up turning into the very antidote they had earlier destroyed. Unaware of this, they all take a swig of the concoction and everyone — including Jimmy — suddenly loses their beards⁵. Superman appears and destroys the equipment so the members of the club can never brew their tonic again⁶. No more beards for the Beard Band (or Jimmy Olsen).

Notes:
1. Did Jimmy ever meet a potion, tonic, or medicine he didn’t sample?
2. It’s impressive the way the tonic only affects facial hair, and not scalp hair or other body hair. Of course, that’s probably a good thing or Jimmy would have ended up looking like Cousin Itt.
3. The Beard Band are under the impression that these public appearances will increase the popularity of beards. Why? He’s just a bowtie-wearing cub reporter at one of several newspapers in town. Why would men of distinction follow his example? If anything, I think it would make men who already had beards want to shave them off.
4. For the record, his beard is sliced off with a sickle, burned off while cooking lunch, shot off during a robbery, and cut off and used as a means of escape from quicksand — which is apparently common around Metropolis.
5. It’s not really an “antidote” if it caused everyone to lose their beards; more of a facial depilatory.
6. Or at least until they buy more equipment.

The title of this PSA from September 1966 pretty much sums up the entire ad, and anything I say about would really be superfluous, so just go ahead and click on the image to the right to read “Get Hip to Old Folks!”

Once again, this PSA was written by Jack Schiff with art by Sheldon Moldoff. It appeared in various September 1966 issues of DC comics, including Adventure Comics #348 (the source of this scan), Detective Comics #355, Superman’s Girl Friend, Lois Lane, and World’s Finest #160.

This ad was provided by H from The Comic Treadmill, who has been generous enough to supply me with a multitude of PSA scans over the past few years. (And for H’s take on Adventure Comics #348, check out his recent post on the comic.)

More PSAs

The good old days: when mad scientists could concoct evil drugs and schemes in their own basement labs. Nowadays, it seems to take at least a university lab — more commonly an entire industrial chemical research lab — just to create one marketable evil drug. Just ask Norman Osborne (especially the “Ultimate” version) — how many scientists did he have working for him?

In this scene from Detective Comics #61 (March 1942), an unnamed mad scientist has discovered a drug that makes people lazy. How lazy? So lazy that victims will be too tired to eat and will starve themselves to death. Like any good mad scientist, he has a scheme to make money off his drug (money which will be used for more mad science — that’s how the cycle works). He slips some of his drug to an important corporate leader, and then extorts money from his corporation or he won’t provide the antidote (and isn’t it nice how mad scientists always take the time to concoct an antidote?)

Unfortunately, the scientist chose the wrong company this time: a company where Bruce Wayne was sitting on the board of directors. As the scientist left, Wayne switched into his Batman persona and followed him back to his lab. In the scuffle that followed, the scientist managed to get the upper hand and forced Batman to drink his lazy drug. It worked just as promised:

Batman: Suddenly feel tired — lazy — need a vacation from fighting crooks — out to take a month fishing. Sooo tired — think I’ll take a nap…

Batman didn’t succumb as quickly as the mad scientist expected though, and he was able to secretly signal Robin, who managed to knock out the scientist and find the antidote for Batman (and presumably the CEO, though that was never mentioned). The fate of remaining supplies of the lazy drug was never mentioned either. I suspect that it’s still around. The next time you feel like staying in bed all morning and lazing the day away it just might be because somebody slipped you the lazy drug…

You can watch the episode in its entirety here.

This week’s moment of psychic nosebleed zen was suggested by the inimitable PTOR.

All previous Psychic Nosebleed Zen posts

Nightwing #145 “Freefall”
Peter J. Tomasi, writer
Rags Morales, penciler

At the end of the Resurrection of Ra’s Al Ghul storyline, Al Ghul had been defeated by Batman and locked in Arkham Asylum. Batman had the asylum staff convinced that Al Ghul was a dangerously psychotic schizophrenic who required constant heavy sedation with multiple drugs. This way Batman figured it would be a long time before Al Ghul was a threat to anyone again. This may come as a surprise — but he was wrong.

In the recent Nightwing #145, Al Ghul surreptitiously grabs a pen dropped by a guard and uses it to lacerate his “brachial, ulnar, and radial arteries.” By the time the wounds are noticed, he’s already lost a tremendous amount of blood. The doctors at Arkham work feverishly to fix the lacerations and stop the bleeding, and they pump Al Ghul full of multiple units of blood to replace what he has bled out. This basically acts as an exchange transfusion. His drug-tainted blood has been lost and been replaced with fresh blood, eliminating the psychiatric drugs from his system. This allows Al Ghul to overcome the residual effects of the medication, slay the helpful doctors and nurses, and escape Arkham.

I give full credit to Al Ghul (and to writer Tomasi) for developing such a fiendishly clever plan. Assuming one ignores that fact that Al Ghul would have been too drugged up to conceive it — let alone carry it out — the plan should work well. The blood he lost would have been the blood carrying whatever drugs he’d been given, and the new blood transfused into him would have been drug free. For all intents and purposes, this would have purged the sedatives from his system — though probably not as fast as shown in the comic.

Al Ghul’s exchange transfusion plan wouldn’t work for every drug. For instance, drugs that are strongly bound to their receptors are likely to stay bound even with a transfusion. Additionally, drugs that are injected into the muscle and then slowly absorbed by the body (Depo Provera or Depo Medrol, for example), would see their levels drop right after the transfusion and then build back up as more drug is released into the circulation. Neither of these seem to apply in this case. While it’s never clear exactly what drugs Al Ghul has been given, the guards mention that he’s receiving them five times a day, suggesting that they are very short acting and should flush from his system quickly in an exchange transfusion.

A few nit-picks:
The brachial artery splits into the radial and ulnar artery, so it seems a bit redundant for Al Ghul to cut all three.

You don’t suture with your hands, you use instruments. But that could explain why the doctor seems to be so slow. He should have been long finished with his suturing by the time the seventh unit is transfused. Then again, he’s probably a psychiatrist who hasn’t sutured since medical school.

If the patient has lost that much blood, there should be multiple IVs running, not just a single bag of blood.

A unit of blood is 450cc. It looks like the nurse is just hanging the seventh unit, so he should have received only 2.7 liters by then, not 5.6

There are 5 liters of blood in the human body. That means it takes just over 11 units to completely replace someone’s blood. The doctor should have repaired the wounds in time for some of Al Ghul’s blood to remain, so he shouldn’t have needed the full 11 units (meaning some of the sedative would still be in his system, just very less concentrated). On the other hand, the doctor is clearly very slow, so Al Ghul might have needed more than the 11 units if he was still bleeding while they were transfusing more in.

What kind of asylum has their own blood bank? Wait, no need to answer that, it’s Arkham.

Although this public service ad was originally written in 1959, we can already see the formation of several of the various modern geek cliques: the modders, the cosplayers, and the copyright infringers. Little did Jack Schiff know how prescient he was being when he scripted this simple PSA about all the good stuff at your local library…

More PSAs

In Nightwing, the Mother of Champions (a Chinese super-hero who gives birth to “litters” of super-powered children every few days) has been kidnapped by Talia Al Ghul so that she can raise her own super-powered army. To make the process even more efficient, one of Talia’s (mad) scientists explains the the plan.

Chemicals that induce labor? We have them now: Pitocin (oxytocin) — it’s commonly used by obstetricians for induction of labor. It induces labor by stimulating contractions, which brings me around to the point that you can’t have labor without having contractions.

How can a chemical “mimic” contractions? And even if it could, what good would it do? The muscular contractions of the uterus are what propels the baby along and through the birth canal. If you mimicked contractions there would be no real pushing (just “mimicking”), and thus no delivery. I’m pretty sure that this would actually slow the process down.

Of course, we’re talking about a woman who gives birth to dozens of children every few days, which means that any legitimate obstetrics and medicine is out the window. I really think that this is one of those concepts that was better left unexplained.

Scene from Ultimate Origins #1. Script by Brian Michael Bendis, art by Butch Guice

The scientist in this scene — and Bendis, by extension — have just enough knowledge of biology to get almost everything painfully wrong. Let me just hit the highlights — feel free to chime in with your own thoughts (the full scene can be found here).

1. Genomes and genes are two different things; they are not interchangeable terms. A genome is a set of an organism’s genetic material. A gene is a sequence of DNA that codes for a particular protein or product.

2. Genealogy is a different field of study.
3. There is no official “pure strain” human genome used as a standard — each person is a little different genetically from every other person** — who’s to say who is “normal” and who is a “mutant”?
4. He seems to be suggesting the there is a single mutant gene that has variable expression (this last point isn’t about an error in the scene, just an interesting observation).

Yet another threat we family doctors routinely face: rabid dogs.

scene from Rex Mundi #14 (by Arvid Nelson and Juan Ferreyra)

But history is not the only thing that is different. In Rex Mundi, sorcery exists, although it is very rare. It also seems to exact a price, as shown here by Isabelle, estranged daughter of the Duke of Lorraine.

All previous Nosebleed Zen posts

In the early 1990s, Captain America writer Mark Gruenwald announced that wanted to examine the world of drug addiction through the eyes of Captain America, a super-hero who required a drug to gain his powers. This became the Streets of Poison storyline and ran in issues 372-378 of the title.

In the first issue of the storyline, Captain America was caught in a drug lab explosion. Somehow, the methamphetamine from the explosion bonded to the Super Soldier Serum already in his blood to create a dangerous new drug. This drug made Cap extremely savage and violent. He became paranoid and ultimately started to hallucinate; he became unable to differentiate friend and foe. In the end, it took direct blast from Black Widow to his skull to bring him down.

Hank Pym was called in to assess the situation and he realized that if Captain America weren’t treated quickly, he would die. The only solution he could devise was an exchange transfusion — drain all of Cap’s contaminated blood and replace it with fresh donated blood. It would remove the toxins, but it would also remove the Super Soldier Serum. In other words, it would save Captain America’s life, but remove all his super powers. After suffering repeated nightmares and hallucinations about his drug use, Captain American agrees to the plan.

Streets of Poison was a good storyline for the first two-thirds of its run. The last third came on a little too strong with the anti-drug message, to the point of suggesting that any drug was bad. For instance, in the final issue when Hank Pym tells Cap that he has successfully cleaned all the toxin out of his blood and can transfuse it back into him again — the Super Soldier Serum intact — Cap refuses, telling Pym that he doesn’t need a drug to be a hero. The storyline then ends on a “Just Say No” joke.

It actually all ends up being a moot point. A few issues later, it is quietly explained the Super Soldier Serum and other treatments Captain America endured have permanently changed his DNA and his body now produces its own supply of the serum. And thus Captain America’s powers, and drug use, softly slipped back into the comic.

A previous post on Streets of Poison and other comic book exchange transfusions

From USA Comics #7, February 1943.

(And for those of you who aren’t sure what War Stamps were, they were basically mini-War Bonds with a price of 25¢ marketed at children. Fill a special album with 75 of them, and you could turn it in for a $25 War Bond that would mature in 10 years).

More PSAs

How good a diagnostician are you? Using the provided history and physical exam details, will you be able to provide the correct diagnosis for these three patients?

(Case studies #1 and 2, along with a brief explanation, can be found in the previous post “The Art of Differential Diagnosis in a Super-Hero World“)

Otorrhagia — bleeding from the ear canal — seems to be a recurrent theme in recent comics. It’s been showing up for at least twenty years, but it seems to have become more common lately.

Otorrhagia is not a very common symptom; I see maybe one or two cases a year (and most of those are self-inflicted Q-tip-related trauma). There are a variety of causes, including (in no particular order): basal skull fracture, trauma to the ear canal, tumors of the auditory canal, certain aneurysms, infections of the ear canal, and ruptured ear drums (especially from barotrauma – i.e. pressure).

Comic books add several more causes of otorrhagia:
1. Psychic attack
Not as common as the psychic nosebleed, which it usually accompanies. Here is a classic example of the psychic ear bleed, from the X-Men graphic novel God Loves Man Kills.

2. Sonic bombardment
Another common cause of comic book otorrhagia.
This example is from Cyborg #2

3. Extreme Vertigo.
Poor Invincible, not only does he have so dizzy he can’t think straight, but his ears are bleeding. It turns out the vertigo is caused by an implant in his ear, so that could be the cause of the bleeding (but if that’s the case then the surgeon who put it in should lose his license for sloppiness). Neither can explain the nosebleed he gets a few panels later though.

4. Possession/Reincarnation by a New God.
I’m not sure what the proper term is in this case, but whatever it is, Turpin’s ear is bleeding pretty heavily (from Final Crisis #2).

Here’s Vance Astrovik, then known as Marvel Boy, now known as Justice, showing that he’s got a problem with the psychic nosebleeds as well — not to mention a little psychic otorrhagia as well. (These panels are all from New Warriors #3 (first series), by Nicieza and Bagley.)

Justice has got to be one of the most milquetoast and boring of all superheroes. He’s the Chevy Cavalier of the super-hero set. Even Kurt Busiek couldn’t make him interesting.

All previous Psychic Nosebleed Zen posts

A better title for this public service ad may be “It’s Fun to Lecture Younger Kids While Watching Them Work.” Way to go Ted, you could at least lend a hand.

I also have serious doubts about whether that field will ever be good for playing ball. There’s trees still growing there, not to mention hillocks. It’s not a ball field — it’s an obstacle course (but then again, that could be exactly what the kids are looking for).

As usual for DC comics PSAs, the script is by Jack Schiff assisted by frequent artistic collaborator Bernard Baily. This ad appeared in various October 1959 comics, including The Brave and the Bold #26 — featuring the original Suicide Squad — where this I scanned this.

More PSAs