Polite Dissent

Avengers #240 is a veritable treasure trove of comic book medical cliches:

From the errant tubing on the cover:
Why is the air conditioner hooked to her cheek?

To the precordial thump:
A poor choice because her collapse wasn’t witnessed; she was just found down

To the doctor-with-a-head-mirror (and in the hospital lobby, no less):

I’m off to San Diego for the rest of the week for a medical conference and a little family R&R.

As I’ve done several times previously when I’m out of town, I’ve written a close medical look at a “‘90s comic event” to post while I’m gone. In the past, I’ve written about Batman: Knightfall and The Death of Superman. This year’s topic is Batman: Contagion. Unlike previous years, this is going to be a multi-post review.

I’ll start out with a brief Spoiler Warning, but really — this is a fifteen year old storyline — if you haven’t read it by now, you have only yourself to blame:

The Plot: Through the machinations of the Order of St Dumas (the quasi-religious cult that churns out Azraels), a highly contagious Ebola virus is loosed in Gotham. There is no known cure, but there are rumors that three people survived a previous outbreak in Greenland, so Robin, Catwoman, and Azrael head out of Gotham to track them down, hoping that they may yield a clue to a cure. Back in Gotham, Batman scowls and glares. Huntress appears and gets scowled at. Nightwing appears, but only for a few panels, because apparently he’s got better things to do. In the end, Azrael deduces that if the Order of St. Dumas created the virus, then they probably have a cure. He busts a few heads, finds the cure, and Gotham is saved.

It’s not quite a deus ex machina ending, but close. The cure is found with only Azrael breaking a sweat, and just a little one at that. There are twelve chapters in the storyline, but the center ten could easily be cut out without affecting the outcome one bit. Neither Batman’s, nor Robin’s, nor Catwoman’s, nor Huntress’s actions in anyway hasten the finding of the cure. Their actions have no effect on the plague whatsoever. Only Azrael is important in finding the cure, and frankly, he should have figured it out in the first chapter.

It’s a Batman event, but, like I said, he contributes little, if any, to the solution. Sure, it can be argued that he kept the rioters in check — but this is Gotham City, the populace riots at the drop of a hat. The anarchy on the streets of Gotham has been done many times before and since, and while this is a decent interpretation, it’s not the best (which would be No Man’s Land).

It’s not that I don’t like Batman: Contagion — I do — it just has its share of flaws, including an ending that effectively renders most of the previous issues pointless.

For those of you who’ve been around long enough to remember the S.C.R.U.B.S. system, Batman: Contagion has a SCRUBS score of 22.

For the first part of my look at Batman: Contagion, I want to take a close look at the cause of all the trouble: the Apocalypse Virus.

A viral plague has come to Gotham City: the Apocalypse Virus — unleashed upon the city by the Order of St Dumas. Azrael, once a member of the Order, warns Batman of the impending pandemic.

Azrael describes the Apocalypse virus as a Filovirus.

Batman goes on to state:

Filoviruses are a family of pathogenic viruses which cause a particularly nasty type of infection known as a viral hemorrhagic fever. Not all Filoviruses are infectious to humans, but those that are have extremely high fatality rates. At the time the story was written, there is no known cure for any Filovirus.

Ebolavirus is one of two genera in the Filovirus family, and there are five known species of Ebola (and none of them are Ebola Gulf-A, it’s a fictitious virus). Despite what Batman says, the Filoviruses are all from Africa, and none have been found in Central America. There is no Ebola Honduras, so your flesh is safe.

A short time later, Batman breaks into an Army germ warfare center and learns:

Initial flu-like symptoms are commonly seen in Ebola infections. Airborne spread is likely, but not conclusively proven. Blood has been shown to transmit the infection.

A key part of viral hemorrhagic fevers like Ebola is the bleeding (hence the “hemorrhage” in the name). Under normal conditions, the liver makes the proteins that prevent our blood from hemorrhaging. The Ebola infection attacks the liver, stopping the production of these proteins, which ultimately leads to heavy bleeding from pretty much every orifice in the body, including the eyes.

While I appreciate the visual of the misshapen victims of the Clench, the reasoning makes little sense. If the muscles are shrunken and desiccated (dried out), then how would they have the strength to break bones?

I give the writers credit for creating a truly alarming disease. Ebola is frightening enough in the real world, let alone the enhanced version seen here. Both the “Clench” and the “Apocalypse Virus” are nicely evocative names, even if the latter sounds like something that should be found in an X-book. Their underlying science is a little shaky and their geography suspect, but that does little to undermine what they’ve accomplished in creating the “Clench.”

As a final note, there have been some very promising work on both Ebola vaccines and anti-Ebola drugs recently, but none of these were around when the story was written, so it would be unfair to hold that against the writers.

Basically, this is a technobabble explanation why Batman and his cohorts cannot use antibodies obtained from survivors of the Apocalypse virus to protect others. You see, inside the body the antibodies are extra strong, but outside the body (and don’t ask me how the antibodies know they’re in a tube of blood outside the body) the antibodies become very weak.

It’s not clear if the pathologist is talking about all the survivor’s antibodies, or just those to the Clench.
Mutations occur at the genetic level, not the cellular one — though the effects may be seen at the cellular level phenotypically, and this may be what she is referring to…
Except that antibodies are not cells, but instead complex proteins produced by cells and released into the bloodstream.

Like much of the storyline, this whole aspect of the plot gets abruptly abandoned later when Batman announces that the survivors of the Clench weren’t actually survivors per se, but instead people who never were infected in the first place. To me, this would seem to be setting up a further line of inquiry: what prevented these people from getting infected, and can it be used to protect others? But then again, I’m not Batman.

Throughout the Contagion storyline, a number of different terms are used to refer to the proposed cure Batman hopes to make for the Apocalypse Virus.

First, it is called an antibiotic. I’m certain everyone reading this knows that antibiotics are only effective against bacterial infections, so is the wrong term to use on a treatment for a viral infection.

Next, it is repeatedly called an antidote. Antidotes are good for poisonings or toxic exposures, but not so much in infections.

Third, throughout most of the story, Batman calls it a vaccine –- but what he’s proposing isn’t a vaccine.

Finally, an antiviral cure is developed (and the correct term “antiviral” is used) — after Azrael suddenly remembers after a dozen chapters that the people who released the virus might also have a cure. Why couldn’t he figure this out on the fourth or fifth page of the story, right after he told Batman about the virus? It’s a miraculous cure too, as everybody who receives it becomes instantly better, even those on the brink of death. I wished the anti-infectives I gave worked that fast and that well.

…always coming to Earth with their ultra-medicine and stealing our patients! And making a profit to boot!

(From an imaginary tale in Superman #230-231, where Jor-El is Lex Luthor’s father, and they both come to Earth from the dying Krypton. Meanwhile Clark is the biological child of Jonathan and Martha Kent, criminals in the style of Bonnie and Clyde. )

The really bizarre medicine in this story comes not from Kryptonian ultra-medicine, but from Dr. Markem, a good old Earth mad scientist (go Earth!):

From this we learn that:

1. Criminality is inherited.
2. There are evil genes — and chromosomes.
   • Are the chromosomes evil because they contain evil genes, or are they evil on their own?
3. These genes and chromosomes can be implanted in the brain where they will eventually take root.
   • Do these evil genes make an evil protein or evil enzyme?
   • Are these genes only important in the brain?
4. The scientist apparently didn’t trust that Clark would inherit his parents “evil genes” on his own.
   • Which, by my quick math, would be a 75-100% chance per gene, depending on his parents genotype.

An prison escapee uses her psychic powers to rob a bank, much to the detriment of the bank manager, resulting not only in the classic psychic nosebleed, but also psychic eyebleeds (oculorrhagia?)

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed hercules oculorrhagia

It’s the first week of school, here in Southern Illinois anyway, so this is the perfect time for a public service ad about bus safety.

Sadly, it’s not that exciting a PSA (but honestly, could a school bus PSA be exciting?), but as I’ve mentioned before, those from later in DC’s monthly PSA program tend toward the uninspired. There’s nothing wrong with it other than the fact that even Bernard Baily’s art can’t stop it from being dull.

It’s interesting that of the six panels, only one features an actual school bus. I don’t know about 1961, but fifty years later, I’d be surprised if one percent of children rode non-school-bus public transportation to school, let alone 5 out of 6, as suggested (loosely) by this PSA.

Nobody draws a disapproving adult better than Bernard Baily, though his buses could use a little more work.

In lieu of any actual deep insight into PSAs or school buses, here a couple of interesting school bus-related links:
Why are there no seatbelts on school buses?
The Chowchilla school bus kidnapping.
Why are school buses yellow? (And more than you ever wanted to know about “school bus yellow.”)

This PSA can be found in DC comics from November 1961. The script is by Jack Schiff with art by Bernard Baily.

More PSAs

Tags: comics psa busjack schiff bernard baily

Mr. Malverne, the father of Supergirl’s boyfriend Dick Malverne, has come down with a deadly tropical disease¹. As his condition worsens, the doctors decide they have no choice but to try the experimental “miracle” serum Spracolicin².

Meanwhile, Supergirl is having problems of her own because she has been exposed to six red kryptonite meteors. As every fan of Silver Age wackiness remembers, exposure to red kryptonite causes bizarre, but temporary, changes in Kryptonians. Each meteor has affected Supergirl in a different way, but luckily, like bad ninjas, she only has to deal with one at a time. The first meteor caused her to become morbidly obese³. The next turned into a wolfman (or wolfwoman, rather). When she turned back to normal, she used her x-ray vision to check on Dick and learned about how sick his father was.

The third red kryptonite meteor causes her to shrink down to microscopic size. Seeing the opportunity to help Mr. Malverne, trial-sized Supergirl flies across town to the hospital and enters his bloodstream by flying down a conveniently open transfusion bottle^4,5.

Once in his body, she locates the bacteria⁶ causing the tropical disease and pummels them into submission, then allows the body’s natural defenses to take over.

The doctors, of course, credit Mr. Malverne’s miraculous recovery to the Sparacolicin serum. But unfortunately: “What a shame our supply was the only amount of it in existence and the formula has just been destroyed in a fire!⁷”

Notes: 
1. What is it with the Superman writers and tropical diseases? Remember that in Silver Age continuity, Ma and Pa Kent died of a tropical disease. (Personally, I’m guessing this allowed the writers leeway with the symptoms by claiming it’s a “tropical disease” and nobody can argue otherwise.)
2. Or Sapracolicin. It’s mentioned twice in the story, and spelled differently each time.
3. At which point she disguised herself as a giant parade balloon. Seriously.
4. An infection requiring a transfusion? How unusual. Oh, it’s a tropical disease.
5. An open transfusion bottle? This couldn’t have been a good idea, even before our current era of acronym-laden health and safety regulations.
6. Forget those microscope photographs you saw in biology class — they’re wrong. What you see here is exactly what bacteria really look like.
7. Great planning there, guys. (No great loss though as the serum didn’t actually do anything.)

Story from Action Comics #283, “The Six Red K Perils of Supergirl,” by Jerry Siegel and Jim Mooney. I wasn’t sure where to file this one, was it a Forgotten Medicine of the Silver Age, Transfusion Confusion, or just general Supergirl Silver Age Wackiness?

A hospital x-ray machine has more than enough penetrating power to send x-rays all the way through the skull and brain. (In fact, you could argue that the x-ray machines used in 1961, when this comic was published, were more powerful than modern equipment. Today, we worry about radiation dose so we focus on finesse and minimizing exposure, while in years past the issue was one of raw power, radiation exposure be damned.)

The problem with locating the glass fragment has nothing to do with the range of the x-rays, it’s the fact that glass is radiolucent — invisible to x-rays. It doesn’t matter how strong the x-rays are, glass simply won’t show up on them.

Final Note: Not all glass is radiolucent, but the great majority of it is. For example, it is my understanding that the glass used in automobile windows is purposefully designed to be visible in x-rays (radiopaque). Personally, I’ve had numerous patients come in to the office complaining of a stepping on a splinter of glass, and only once has it ever showed up on x-ray — and that was a piece of lead crystal.

Apparently, lighter-than-air cargo (of radioactive gases, at that) = speedy trip to the moon

I always like to post non-Big Two comic book public service ads when I run across them, and here is one I stumbled across recently from Comico in 1987.

A simple one-panel anti-smoking PSA from Justice Machine #2, the Comico years. For those of you unfamiliar with the Justice Machine, the character shown is Talisman, who has luck/karma based powers, hence the “Don’t Press Your Luck” tagline.

Mike refers to Mike Gustovich, the artist and creator of the Justice Machine — who apparently is really opposed to smoking — and Tony refers to non other than recent blogging convert Tony Isabella, who was writing the comic.

More PSAs

Tags: comics psa justice machinemike gustovich tony isabella

Remember last week when I remarked how strange it was that so many people in Superman storylines seemed to come down with incurable tropical diseases? Here’s another good example: actress Lyrica Lloyd. Clark Kent falls in love with Llyrica and reveals his secret identity only to learn she’s dying from a fatal disease she picked up at a film shoot in Africa.

Superman vows to help, promising to scour the universe to find a cure, but instead we see that he’s constructed a “super oxygen tent” that does little to help Lyrica, and she dies…another victim of the Superman writers and their fondness for tropical diseases.

This panel presents a nice view of outdated medicine:

scene from Worlds of Fear #8 (1953)

For the better part of the twentieth century, bromide (potassium bromide) was a common treatment for anxiety and other “nervous afflictions.” Potassium bromide was first used medically in the 1850s as a successful treatment for epilepsy¹. By the turn of the century, its beneficial effects in treating anxiety were also noted — most of which were probably due to its sedative effects. Extremely common, bromide was found not just in prescription medications of the time, but in over the counter remedies as well.

In the Merck Manual, 7th Ed., published in 1940, potassium bromide was listed as the preferred medication for treating anxiety and hysterics. Here’s more of what the Merck Manual listed under Potassium Bromide²:

Over time, the use of bromide became less and less common. Newer, more potent medications with fewer side effects were developed. Chronic bromide toxicity (bromism) was also recognized as a very real problem. By the Merck Manual, 11th Ed. (1966), the drug isn’t even mentioned. In 1975, potassium bromide was withdrawn from the medicinal market in the United States³.

Oh no! Will Flash run again? Will his leg somehow be saved? Don’t ask me — ask the doctor with the strange head mirror since he seems to know what’s going on.

Published in 1986, this is the second Supergirl public service comic teaching about seatbelts. Like the first one, it was sponsored by American Honda and the U.S. Department of Transportation’s National Safety Belt Campaign.

In this story, Linda Danvers is driving two kids and their pet dog home. (No, I don’t know who the kids are, or why she’s driving them home – that’s never explained.) During the ride, the kids and dog fall asleep and dream they are in Motorville, a town home to all the famous characters of nursery rhymes and fairy tales, all driving cars or trucks – and most driving badly. Supergirl arrives and the three of them decide to catch a show while they’re in town, and they want to see the most popular show in town, The Crash Test Dummies (not those Crash Test Dummies, but these Crash Test Dummies).

Supergirl and the kids first catch a ride with the taxi-driving Humpty Dumpty, but he gets cracked in a minor fender bender because he wasn’t wearing his seatbelt. (Never is it explained why Supergirl doesn’t just fly them across town to the show).

Next, they hitch a ride with the Little Old Lady and her kids that live in a shoe, but the Little Old Lady’s car gets a flat when it’s rear-ended by a truck-driving Big Bad Wolf (luckily there were no injuries because everyone was wearing their seatbelts).

The Three Little Pigs offer Supergirl and the kids a ride, but they get hit from behind by the Big Bad Wolf’s little brother C.C. and Supergirl has to catch the two pigs which weren’t wearing seatbelts.

Finally, the Crash Test Dummies themselves pick up the trio and take them to the show. In the end, the kids wake up back in the car with Linda driving, wondering if it was really a dream.

In addition to the story, the comic also contains a letter from Elizabeth Dole (Secretary of Transportation at the time), an page on how to design a poster encouraging others to wear seatbelts, and “The Great Motorville Auto Race” game.

The comic was primarily written and drawn by Andy Helfer, Joe Orlando, and Barry Marx, with help from Jose Delbo, Dave Hunt, Bob Oksner, and Bob Rozakis.

Here’s one more to add to the list of common medically-based cover themes (previously I’ve covered x-rays, nurses, and syringes, just to name a few).

Uncle Scrooge #28

Looney Tunes #194

Panic #8