Polite Dissent

JSA Classified #23 “Nightfall, part 1”
J.T. Krul, writer
Alex Sanchez, artist

It’s a good time to be a Dr. Mid-Nite fan. In addition to his regular appearances in the Justice Society of America and cameos in 52, he has had a starring role in 3 of the past 5 issues of JSA Classified. J.T. Krul, who I’m most familiar with from his work at Aspen, has turned in a strong story in this issue. It returns Dr. Mid-Nite to his roots in Portsmouth, and is more in the vein of a horror and detective story than his last appearance, which (also excellent) was more of a standard super-hero tale. Sanchez’s art is good and fits the noir mood well, except that I’m not a fan of how he draws Dr. Mid-Nite’s costume.

In terms of the medicine, Krul has done his research and it shows. Still, there are a couple of areas I’d like to discuss:

Detective: Big fella. Did he give you much trouble?
Dr. Mid-Nite: Nothing 150mgs of Ketamine couldn’t handle. He should be out for at least the next thirty minutes.

Ketamine is a rapidly acting anesthetic. It is used medicinally in people, but is probably more common nowadays in veterinary use. In lower doses, ketamine has dissociative and hallucinogenic properties and has an extensive history as a street and club drug.

For a generally safe, quick acting anesthetic, Ketamine is a good choice for Dr. Mid-Nite. However, a dose of 150mg is too low for a man of that size. That amount is reasonable (if not a little high) for recreational use (definitely not recommended!) but it wouldn’t be enough to produce the anesthesia shown in the comic. Assuming a 250 pound (114 kg) man, an anesthetic dose would start around 800mg. It should take effect in about 3-5 minutes, and as Dr. Mid-Nite states, lasts for 20-30 minutes. Ketamine is also Schedule III Controlled Substance in the US, so this is yet another example of Dr. Mid-Nite breaking Federal and state drug laws.

Dr. Mid-Nite: You really should consider limiting your blood intake. You could suffer an iron overdose or even develop toxic porphyria.

Porphyria is a condition where there is a breakdown in the synthesis of heme (one of the components of hemoglobin). Toxic levels of precursor chemicals build up and lead to a variety of symptoms including abdominal pain, vomiting, irregular heart rhythms, seizures, hallucinations, and paranoia. Skin rashes are common as well.

Porphyria is usually an inherited disease, but there have been cases where exposures to certain chemicals have caused the condition. This is the “toxic porphyria” Dr. Mid-Nite mentions. The most extensive case occurred in Turkey in the 1950s when grain made into flour was contaminated with hexachlorobenzene. Over a five year period, nearly 5000 people were affected.

I can find no connection between drinking blood and toxic porphyria in the medical literature. Biochemically, it really doesn’t make much sense either unless the blood is somehow contaminated. If ingestion of blood could cause toxic porphyria, then patients with gastrointestinal bleeding would develop the disease, but they don’t. Frankly, the only mentions I can find relating blood and toxic porphyria are on several fringe websites that discuss — and seem to recommend — drinking blood and mention as a side effect “(possibly) toxic porphyria”. It’s not hard to notice that every website has the identical paragraph about the risks of drinking blood so it’s likely they all cribbed it from the same place, and that place was wrong. I think it’s safe to label this one an urban legend.

On the other hand, a good case can be made that drinking blood could lead to iron overload. Most iron overload situations are due to hemochromatosis, a hereditary disease where the body cannot process iron properly. Even without hemochromatosis, it is still possible — though rare — to develop iron overload by taking in too much dietary iron. There is a condition known as “African Iron Overload” that occurs among certain African tribes who brew a drink high in iron. Individuals who imbibe large amounts of this beverage develop iron overload*. I would think that regular ingestion of blood would be a similar situation.

*There is some evidence that there may be a genetic disposition involved as well as drinking high-iron beer.