Polite Dissent

I’ve fallen a little behind in my medical reviews of manga, so here’s my annotations for the second volume of Apothecarius Argentum, a manga that takes place in a fantasy medieval kingdom. That may sound fairly cliché, but in this case, the main character is a skilled pharmacist and physician.

As Apothecarius Argentum, Volume 2 starts, Argent is getting set up in his new shop as the official “Royal Apothecary” and has reluctantly taken on a young apprentice. The Princess seems to stop by daily, and her father the King is still wary of his true intentions. The first chapter concerns an old woman with a strange ailment. The second and third chapters are flashbacks to shortly after Argent first came to the kingdom to serve as Princess Primula’s food taster. These chapters are rife with palace intrigue and political plotting. The final chapter of the volume manages to bring some of the intrigues forward to the modern day as the Princess heads out on her own to determine if she is fit to be a ruler.

While the story is captivating, I still find the art a little sketchy, particularly the backgrounds. It can be hard at times to distinguish characters, especially during the flashback scenes – which take up half the book. The characters are becoming more fully formed this volume and don’t seem as two dimensional, especially the King who has some dark secrets which are revealed in the final chapter. The Kingdom of Beazol is becoming a little better defined with this volume as well, though it still borders on the generic.

There is not quite as much medicine, per se, in this volume as the first because most of the stories revolve around the use of various poisons — though at least they’re “all natural” and “organic” poisons.

Arsenic was first recognized as poison during the Roman ages. It was the favorite poison of the infamous Borgias. It was a popular poison because when mixed with food or drink, it was impossible to detect.

Acute (high dose) arsenic poisoning causes abdominal pain, bloody vomiting, and diarrhea. Seizures, coma, and death will often follow. Chronic (low doses over a long period of time) arsenic poisoning can show a variety of symptoms including headaches, fatigue, peripheral neuropathy (pain and numbness of the hands and feet), a skin rash, lines on the nails, kidney and liver failure, and heart damage. A garlic-like smell can sometimes be detected on the breath of victims of arsenic poisoning.

Over the years, arsenic has been used as a treatment for a number of medical conditions including diabetes, syphilis, psoriasis, and cancer, but is rarely — if ever — used today for such purposes. In the Victorian era, it was also a common ingredient of cosmetics.

Datura stramonium is a widespread plant with a variety of common names including Jimson Weed, Thorn Apple, Stinkweed, Loco Weed, Devil’s Apple, and Devil’s Trumpet. As the latter names suggest, it is a plant with a bad reputation. Datura can be used as a medication or a hallucinogen, but the line between a safe dose and toxicity is paper thin and fatal overdoses are common — even the pro-hallucinogen sites recommend against it.

In the past, Datura was used to treat a variety of ills including asthma and hemorrhoids. The plant contains the compounds atropine, scopolamine, and hyoscyamine — medications which are still used today (just in small, purer, better controlled doses).

The symptoms of Datura poisoning are anticholinergic in nature: dilated pupils; dry mouth; warm, red skin; racing heart; and memory and coordination problems. There’s a little mnemonic medical students memorize for anticholinergic toxicity; here’s the version I learned: “Mad as a hatter, blind as a bat, dry as a bone, red as a beet, hot as a hare.”

Datura flowers have a sweet fragrance, but the rest of the plant has a foul odor (hence the name stinkweed). Thus when Argent is able to detect the fragrance, the villains must have been using the flowers (or else it’s a mistranslation and “strong odor” was meant instead of “strong fragrance”).

The name “Wolfsbane” can refer to several plants within the Aconitum genus (part of the buttercup family). Other common names include Monkshood, Blue Rocket, and Devil’s Helmet. All the plants share similar properties and all contain the alkaloid Aconite.

Symptoms of wolfsbane poisoning begin with numbness of the mouth and skin. Abdominal pain and severe vomiting follow. Next, paralysis of the lower than upper extremities occur. Finally, the pulse weakens, the breathing muscles tire, and convulsions begin. Death usually occurs within 2 hours of poisoning.

Wolfsbane and other Aconitum species have been used in both Western and Eastern medicine. It was used as a pain killer, a diuretic, and an anti-inflammatory. The root contains the most Aconite, though the young flowers also contain a substantial amount.

Wolfsbane was thought to be one of the ways to detect a werewolf in humanform. If you held the flower up to someone’s chin and it cast a yellow shadow, then they were a werewolf.

The bark of the willow tree has been used medicinally since Sumerian times. It contains salicylic acid, a chemical very similar to acetasalicylic acid, better know as aspirin. As such, it is good for treating pain, fevers, and inflammation. It is more irritating to the stomach than aspirin and nausea and stomach pain are common side effects. The bark can also be used to make a topical astringent as it contains high levels of tannins.

Superman Beyond #1
Grant Morrison, writer
Doug Mahnke, penciler

This comic issues a clarification, of sorts, from Clark’s previous statement:

I’m not sure the clarification actually makes things any clearer. How does one massage the heart with heat vision? (I have this vision of Lois in a towel, the lights down low, Barry White on the stereo, and Clark whispering, “Let me massage that for you Lois, with my heat vision…”) Is Clark suggesting he’s been using his heat vision on Lois ever since surgery? And can infrared light even penetrate to the heart without damaging the tissues above it?

I suspect that Grant Morrison is referring in his own oblique way to photobiomodulation, the use of specific light wavelengths to help the body with healing, but at this point it’s an emerging science and has no known cardiac uses. Plus, as I mentioned above, the heart is well inside the chest cavity, how can the infrared affect it without cooking everything else around it?

Batman appears in the Gotham General Emergency Room carrying an unconscious Joker. During the battle, the Joker accidentally inhaled his own Smilex and has collapsed. Batman needs him revived as soon as possible to reveal the location of the third bomb.

Dr. Koslowski (narrating): Dr. Singh decided to inject 5ccs of Adrenalin directly into the Joker’s heart. It was our only chance to save thousands of lives.

Injecting medication directly into the heart, despite what you may have seen in Pulp Fiction, is not a good idea. It’s too easy to lacerate a coronary artery (causing a massive heart attack) or inject the medication into the heart muscle (causing a fatal arrhythmia). It’s not done anymore.
Medically, we don’t call it “Adrenalin” in the United States, but instead use the term “Epinephrine”. That’s the third British medical term showing up in Gotham Central ER — definitely a British writer.
Speaking of Adrenalin, 5cc is too large of a dose.

Dr. Koslowski: At which point the Joker flatlined.

So what does the medical team do? They defibrillate him.
Once again repeat after me: Do not shock a flatline. It is a bad idea. It may work in comic book (like it does here), but in real life it doesn’t work and may actually make the situation worse.

Batman figures that the Joker’s abnormal physiology is messing with the antidote and the adrenalin, which caused him to develop an extremely high blood pressure and suffer cardiac arrest. Batman decides to lower the Joker’s blood pressure with medication and then try the treatment a second time. (No criticism here: it’s as good of an idea as any.)

Once again, the Joker suffers a cardiac arrest . This time, Batman himself jabs the Joker in the heart with a syringe full of Adrenalin. The second time’s a charm and it works! The Joker returns to consciousness and promptly escapes…which was all part of Batman’s plan; he wanted to trick the Joker into leading him to the third bomb.

Let’s count the medical errors in a mere eight pages: the Joker flatlines and is subsequently defibrillated, not to mention injected twice directly in the heart with an overdose of Adrenalin.

Note to self: Do not seek emergency medical care in Gotham City. Hold it until you reach Metropolis.

Medical criticism aside, Batman: Legends of the Dark Knight #200 is a good story. I like the idea of a night in the Gotham General ER told through the eyes of an intern, and the story handles this aspect well. I’d like to see more of Dr. Koslowski and Gotham General.

Batman: Legends of the Dark Knight #200 “Gotham Emergency”
Eddie Campbell and Daren White, writers
Bart Sears, artist

This comic’s a few years old, but it was just re-released as part of the Batman: Going Sane collection, so it’s fair game to discuss again. When it first came out — other than the unexplained use of a British medication name — I thought the medicine was good. However, on second review, while the authors do an excellent job conveying the feel of a hectic night in the ER, the medicine leaves a lot to be desired.

It’s a busy night in the Gotham General Hospital emergency room, and things get even worse when the Joker becomes involved. This story is told mostly through the eyes of Dr. Natalie Koslowski, an intern on the first day of her Emergency Room rotation.

Paramedic #1: Gunshot wound to the mid sternum, exit wound to back of the right shoulder. Blood pressure 100/50, Pulse 158, Respirations 36.
Paramedic #2: Unconscious upon our arrival.
Dr. Koslowski: Resuscitation. Establishment of airway and restoration of hemodynamics.

That’s a good start, Dr. K. But don’t forget the B of the ABCs of resuscitation (Airway, Breathing, and Circulation). Just getting an airway is not enough; you have to make sure the patient has good (or at least adequate) air exchange.

Dr. Koslowski: Symptoms suggest serious blood loss. Unless treated aggressively and in a timely manner it can lead to hypovolemic shock.

True, but take a look at those vitals. He’s already in hypovolemic shock.

Dr. Singh: OK. Let’s tube him, get blood gases, and 2 liters of O Neg.

Intubation is good — it establishes the airway mentioned by Dr. Koslowski (though frankly the paramedics probably should have intubated the patient before he got to the hospital).
Blood gases aren’t going to tell anything useful and are not going to improve the care of this patient one whit. Not to mention he’s being tubed, so his respiratory situation is changing (hopefully for better) and this will alter those blood gases.
Starting a blood transfusion is appropriate, but blood comes in units, not liters, in the United State. I suspect this is a second Britishism creeping into this American ER.

Finally, those paramedics didn’t do a good job at all. Looks like they wrapped the patient in a sheet, lashed him to a stretcher, and came to the ER. He should be intubated and have a couple of IV lines started already.

Cop #1: Help us. Look like Sam’s inhaled Smilex.
Dr. Singh: Rose, quickly get up to toxicology on the fourth floor. They have an antidote but it must be injected as soon as possible after inhalation.
Cop #2: Does this stuff work, man? Sam’s got kids.
Dr. Singh: It works if we can administer it quickly enough…If we get to the victim within the hour, we normally expect a coma for twenty four hours. Much beyond that it’s touch and go.

If time is of the essence, why is the antidote being stored in a closed department on another floor? Wouldn’t it make more sense to store it in the ER — at least at night, when the Toxicology department is closed?

This is only story I can recall where Joker venom is considered treatable, and one of the few where it’s called “Smilex.”

An important announcement from the Brother Voodoo campaign headquarters:

What’s wrong with this scene from Black Terror #11 (August 1945) in which Bob Benton (a.k.a. the Black Terror) is analyzing some ore from a remote island.

Overall, this should be fairly easy — given recent posts — but there are a couple levels of error here.

FYI (not a hint): Pitchblend.

Previous picture quizzes

One of the classically identifiable characteristics of a doctor, at least as far as comic books and cartoon characters are concerned, is their use of the head mirror. “Use” is really the wrong word here — the characters wear the head mirror, but rarely actually use it.

As the name suggests, a head mirror is worn on the head, attached to a headband. It is a shallow, concave mirror and reflects a broad beam of light. When not in use, it is worn on the forehead above one eye — not in the center of the forehead*. When worn in the up position, the backside should be showing, not the reflective surface. Then, when illumination is needed, the mirror is flipped down over the eye, the reflective surface facing the patient.

To use a head mirror, there needs to be a strong light source above and behind the patient which is aimed at the doctor. The doctor sits in front of the patient and flips down the mirror so that it covers his eye. There’s a convenient hole in the center of the mirror so he can look out and maintain his binocular vision. The light is reflected by the mirror and automatically aimed at wherever the eyes are looking, providing a constant, bright illumination.

Most doctors gave up using head mirrors years ago as more modern and more convenient lighting technology became available. Many ENTs (Ear, Nose, and Throat specialists) still use them, though I think it depends a great deal on where you train. For example, the ENTs at my medical school used them, but not the ones at my residency.

Like many cases of tradition versus technology, there are pros and cons of using head mirrors.

Classically, head mirrors are drawn on a character as an “artistic shorthand” to show that someone is a physician. As technology has passed the head mirror by, so has comic book shorthand, and it isn’t as common as it once was — though it still shows up from time to time (Dr. Hibbert, Dr. Zoidberg, Metamorpho). You’ll notice that it’s almost always drawn incorrectly , in the center of the forehead, and is rarely shown actually being used.

Still, the head mirror’s a comic book classic, and I doubt that it will ever completely go away. Decades from now, somehow, people are still going to realize that head mirrors are meant to indicate a doctor — even though they’ve never seen one in real life (a head mirror, that is, not a doctor).

*And the mirror should not be drawn in the middle of the headband either, but either just above or below it. See the official looking picture above and to the right.

Apparently, not only are comic book readers uncool, but we’re short too:

both ads from Action Comics #624

Here’s a nicely dated educational page from 1963 (more specifically, it is from the inside back cover of Dr. Kildare #4).

Things I learned from this PSA:

• Apparently, an obstetrician’s main job is to tell a woman that she’s pregnant. Caring for her during pregnancy and delivering the baby are only secondary.
• Obstetricians are required to have chemistry sets in their office.
• Pediatricians are so good that they can diagnose a diaper rash without even removing the diaper and looking. OK, that may not be all that hard with a good history, but at least look at the area in question to see what type of diaper rash it is.
• I’m pretty sure most pediatricians I know would point out that they treat more than just “babies and small children.”
• Today, we stress prevention as much as treatment in primary care, which includes pediatrics. The wording of the second panel hearkens back to the day when the doctor was there to treat sick patients, nothing else. At least the third panel suggests preventative care — though seems to ignore the concept of patient confidentiality.
• It’s nice to see a comic book doctor actually using a head mirror correctly.
• Finally, as a Family Physician, I’d like to point out that we are trained for all three panels here — it doesn’t take an obstetrician or pediatrician. (Admittedly, this was published six years before Family Medicine became a recognized specialty.)

More PSAs

Here’s an ad from the back of The Young Doctors #5.

I can’t imagine that a home study nurse, even one who studies for ten full weeks, would be a very good nurse. On the other hand, this may have been a good way to start for young women who wanted to enter nursing but didn’t have the knowledge or money to attend a regular nursing school. Still, even in the mid-sixties I wouldn’t think that $65 a week ($3380 a year, assuming paid vacations) would put a lot of food on the table (but it would buy over 540 12¢ comic books a week).

Click on the ad for the full-sized version

Other nursing school ads from comic books:
Look Into Your Future!
Earn $70 a Week!

This comic can best be described as “medicine done wrong — very wrong.” It features some of the worst medicine (the worst medical decision making, anyway) that I have ever seen, and that includes four seasons of Grey’s Anatomy.

The Young Doctors was a series published by Charlton comics at the same time Dell was publishing Ben Casey and Dr. Kildare and clearly designed to taget the same audience. It featured two senior residents, Doctor Martin Burke and Doctor Cliff Landon, and their exploits at Metro Hospital. Dr. Landon was a stuck-up surgeon and Dr. Burke was a stuck-up psychiatrist. They couldn’t stand each other, and apparently no other doctors could stand them either since they always seemed to be the only two doctors in the entire hospital.

In the first story, Doctor Burke and Doctor Landon have reluctantly agreed to attend a fund raising dinner hosted by one the local big wig politicians in preparation for the upcoming election. In the middle of his speech, the politician suddenly loses his voice and develops difficulty swallowing and breathing. He is admitted to the hospital and placed under the care of Dr. Landon. Landon performs a thorough examination including lab work and x-rays and can find nothing wrong with the patient. He suspects it is a psychosomatic illness and he brings in Dr Burke, the psychiatry resident. Dr. Burke evaluates the patient then talks to his family and finds that the politician has these symptoms before every election. Dr. Burke agrees with Dr. Landon: the problem is not physical, but psychological. The two of them attempt to discuss their diagnosis with the patient, but he will hear none of it. The two residents run for cover and repeat the tests, but everything comes out the same. It is a psychological problem.

So what do Dr. Landon and Dr. Burke do? In the end, the two residents take the easy way out and lie to the patient. They inform him that his tonsils are giving him problems. Dr. Landon removes the tonsils and the politician returns home, satisfied.

But should he be satisfied? No, he received poor and deceptive medical care. Rather that address the actual problem — and admittedly that would have been difficult — the doctors chose to perform an unnecessary and potentially dangerous surgery on healthy tissue. A tonsillectomy is not always an easy surgery; it can be risky, particularly in adults. And in the end, the politician’s problem still exists. He needs therapy, no surgery. When he develops the same symptoms at the next election, what are they going to blame and remove then?

In the second story, Dr. Emile Braddock, a famous surgeon who was Dr. Landon’s mentor, comes to Metro Hospital. Dr. Landon is shocked to learn that Dr. Braddock has given up surgery and is now a researcher. He confronts his former teacher, who tells him that he was involved in a traffic accident that injured his hands. After recovering, Dr. Braddock returned to surgery, but his first patient after the accident died on the table, so he now believes he no longer has what it takes to be a good surgeon. Dr. Landon cannot believe what he is hearing. How can his mentor give up surgery? He decides that Dr. Braddock has simply lost his confidence, and that there is nothing physically wrong with him. Enlisting the help of Dr. Burke, he decides that tricking Dr. Braddock is the best way for him to regain his confidence. Late one night, Dr. Landon put his plan into action. A patient with a head injury and subdural hematoma needs emergency surgery and Landon asks Braddock to assist him since all the other doctors have gone home for the day. Braddock reluctantly agrees and scrubs in. Shortly after the surgery starts, Dr. Landon feigns feeling ill and Dr. Braddock has to finish the case by himself. He finishes the surgery and the patient survives (this is a code approved comic after all), and in the end he thanks Dr Landon for showing him that he still has the “eye of the tiger.”

This all ended well, but I really cannot stress this point enough: purposefully and deceitfully placing the life of a patient at the hands of a potentially impaired doctor is never a good idea. There are many better ways to help Dr. Braddock get his mojo back that don’t involve a scalpel blade poised millimeters above an innocent man’s brain.

One last word of advice: if you discover that the Young Doctors #5 inspired someone to become a physician, find yourself a new doctor quickly.

Previous Flashback Weeks

After gaining infamy for its lurid horror comics, EC Comics tried to rehabilitate its image by releasing its “New Direction” of wholesome comics. These included titles such as Valor, Aces High, and Impact as well as the medical comics M.D. and Psychoanalysis. As the name suggests, in Psychoanalysis the reader follows an unnamed pipe-smoking psychiatrist as he attempts to analyze and cure his patients.

Previous “analysis” of Psychoanalysis issues one, two, and three

For his first appointment, the psychiatrist sees Freddy Carter. Freddy is a fifteen year old who was initially brought for counseling after being caught stealing. The doctor deduced that the theft, along with Freddy’s asthma and poor grades, are really just desperate cries for attention. His parents are constantly sparring with each other — figuratively at least — with Freddy as the battleground.

The subject of this particular session is Freddy’s recent report card. Freddy is failing math and science — the classes important to his father — but doing well in English and history — classes important to his mother. In retaliation, Freddy’s father has grounded him and cut off his allowance. In addition, he has stopped giving any money to his wife other than for groceries, and he fired the maid. After talking with Freddy for several minutes, the doctor goes out to talk to Freddy’s parents who are upset that Freddy isn’t cured yet. The doctor points out that as long as the two of them are fighting, Freddy will never be cured because they each desire a different outcome. The doctor convinces the two of them that they each need psychiatric counseling for the good of their marriage and for Freddy’s sake. They both agree, and the doctor trades a single paying patient for two.

The last portion of the comic shows two sessions with Mark Stone, an unhappy screen writer. Mark has many difficulties, including problems with women, resentment towards his own success, and longstanding issues with his parents. This time, he is angry the psychiatrist because feels that he has become overly dependent on him. The doctor is able to get Mark to calm down, and then has him describe a recent dream. After hearing the dream, the doctor tells Mark that he is not mad at him, the psychiatrist, per se, but instead angry at authority figures in general — which goes back to his anger towards his father. The doctor is also able to deduce that Mark has a deep-seated fear of being abandoned, which brings out his feelings towards his mother. This has come to the surface because of the doctor’s upcoming vacation.

At a later session, Mark has once again started to experience the severe panic attacks and anxiety symptoms that brought him to the doctor in the first place. They started just a few days after Mark and the psychiatrist agreed that Mark had made remarkable progress and could cut back on his sessions. It doesn’t take a genius — or a board certified psychiatrist — to realize that this is nothing more than a subconscious reaction on Mark’s part. He is uncomfortable with the idea of cutting back on the counseling, so he recreates the symptoms that necessitated the visits in the first place. The psychiatrist is able to get Mark to realize the root of the problem, and once again Mark agrees that he doesn’t need many more sessions. This is probably a good thing as this was the final issue of Psychoanalysis.

Previous Flashback Weeks

For all the io9 readers looking for psychic nosebleeds, start here — that should be enough to keep you busy for a while.

For those of you too young to remember (including me), Ben Casey was a medical television show that ran on ABC from 1961 to 1966. It starred Vince Edwards as Dr. Ben Casey, chief neurosurgery resident at the hospital “59 West”. Striking while the iron was hot, Dell published ten issues of a Ben Casey comic book from 1962 through 1965. Today’s story comes from the first issue of that title, published in June/July 1962.

Doctor Ben Casey is about to head out for a night on the town (his version of a night on the town, that is: a neurosurgery convention) when he is summoned to an emergency case. The police have discovered a man who was struck by the subway. The impact only caused superficial injuries, but witnesses report that the patient was acting strange before the accident, so he was brought to the hospital for evaluation.

Dr. Casey examines the patient and suspects that he has a hematoma which is causing an increase in intracranial pressure, leading to the bizarre behavior. Casey wants to proceed with surgery, but the patient refuses. In fact, he refuses treatment of any sort, and even refuses to give his name to the hospital staff. He becomes paranoid and then starts acting out violently. Casey decides his best option is to sedate the patient.

About this time, a blond shows up in the hospital and identifies the patient as Roy Thorne, her husband. She tells Dr. Casey that Roy is a construction worker and was injured on the job several days ago. He refused to seek medical treatment and he has been acting more paranoid and more violent with each passing day. She reports that he nearly strangled her this morning. Dr. Casey explains the diagnosis to Mrs. Thorne and has her sign a consent for the surgery. However, when he goes to prep the patient for surgery, Casey discovers that Roy has escaped the hospital.

Dr. Casey reasons that Roy will head for his apartment, so he gets the police to join him and Mrs. Thorne there. Sure enough, Roy shows up a few minutes later. His wife tries to slip him a sedative in a cup of coffee, but he doesn’t drink it. He accuses her of trying to kill him and threatens her with a broken bottle. The police and Casey rush in and secure and sedate Roy. He is rushed to the surgery and Dr. Casey is able to successfully drain the hematoma and relieve the pressure on the brain. When Roy wakes up he reports feeling the best he has in days and apologizes profusely to both the doctors and his wife. His patient cured, Dr. Casey once again heads out for a night out — at the neurosurgery convention.

I’m amazed at how every patient who goes to 59 West seems to end up on the Neurosurgery Service. I suspect that if you showed up there with an ingrown toenail, you’d be admitted under Neurosurgery and Dr. Casey would want to perform brain surgery. This patient is a good case in point — someone with “mental status changes” may end up a neurosurgery patient, but shouldn’t start out there.

Sadly, there is no Dr. Dan Dazzler back-up strip in this issue: he doesn’t show up until the second issue.

Previous Flashback Weeks

According to an article published today by the Associated Press, scientists at Berkeley are one step closer to being able to render objects invisible.

I’d just like to point out that if they’d been reading Action Comics back in 1988, they could have learned the secret a lot faster, and for only 5 dollars at that.

For those of you asking about the hospital bracelet in Final Crisis #3: yes, it is indeed labeled “Louis” instead of “Lois.”

Art error? Maybe it’s the wrong patient, just like that episode of House from last season. Or maybe Metropolis Memorial Hospital is really in St. Louis.

Many of the Daily Planet staff, including Lois Lane, have been seriously injured. Clark Kent is sitting by Lois’s side at the hospital while Jimmy Olsen visits.

A quick nitpick to start things off: due to privacy laws and regulations, you can’t put patient’s names on the doors anymore.

In this panel, Clark/Superman is talking to the injured Lois and mentions that his “heat vision is the only thing keeping her heart beating.” I’m not quite sure how that would work. Is his heat vision physically causing her heart to contract? How would it do that? Is his heat vision electrically stimulating the heart so that it beats, like a pacemaker? Again, can heat vision do that? We know she had a lot of shrapnel in her heart that Superman removed (Jimmy remarks as such), so maybe he used his heat vision to cauterize those wounds. But that shouldn’t be something he has to stand by her bedside and perform continually. Speaking of that, is Clark going to stand by Lois’s side making her heart beat for the rest of her life?   Tags: comics medicine superman clark kent lois lane heart hospital

Ad from the pages of Action Comics #617 (September 1988)

There’s a sad irony involved when you have to learn to be cool from an ad found in the back of a comic book.

(Plus it seems the first step of being cool is becoming Canadian.)

Batman #677 “Batman R.I.P.: Batman in the Underworld”
Grant Morrison, writer
Tony Daniel, penciler

Arch-villain Doctor Hurt is explaining his plan to his villainous colleagues:

Librium (generic name: chlordiazepoxide) is a drug in the benzodiazepine class — in other words, it’s from the same class of medication as Valium, Xanax, and Halcion. Like all drugs in this class, it acts as a relaxant, a sedative, and an anti-anxiety medication. Librium is a fairly old drug and is not in common use today.

I find Librium to be an interesting choice of drug for Doctor Hurt to use. As previously mentioned, it is a fairly old drug (in this case, “old” means about fifty years) and it was the first benzodiazepine discovered. Librium is not nearly as potent as later benzodiazepines, and it requires a dose that is roughly 20-50 times higher. This is going to make a big difference when dosing someone by sword cut — an unreliable method at best. It’s got to be a lot easier to get 0.5 MG of Xanax into a wound compared to 25 MG of Librium.

Librium has a very long half life, with some of its metabolites taking over a week to be broken down by the body. This can make it dangerous to use as a daily medication because these metabolites build up quickly. However, Librium’s long effect after a single dose may be just what the doctor is looking for in this situation.

Benzodiazepines are primarily used as relaxants and anti-anxiety agents in anxious patients, and sleep aids in insomniacs. They can also be used as muscle relaxants, to stop seizures, and to ease alcohol withdrawal. I know of no benefit to hypnosis or trigger phase induction offered by these medications, by I’m willing to explain this aspect away as “comic book science.” Of note, all benzodiazepines are habit forming and can become addictive so I tend to prescribe them with caution. Librium isn’t used that much anymore, having been supplanted by newer and safer medications.

So why did Doctor Hurt choose Librium? Why not use a more modern medication that doesn’t require such a hefty dose?

Is it the benzodiazepine he is most familiar with? Or maybe the only one he is familiar with?
Librium was developed in the late 1950s, coincidentally (I’m sure) the same time Batman #113 (featuring “Batman: The Superman of Planet-X“) was published – a story which seems to be playing a large role in the Batman R.I.P. storyline (for instance, it introduced the planet Zurr-En-Arrh and the Bat-Radia). Diazepam (Valium), the second benzodiazepine, didn’t emerge until 1963.

Does the long half-life of Librium offer some advantage to his plan?

Or I may be reading too much into a throwaway line — it certainly wouldn’t be the first time — but Librium seems such a odd choice, and to refer to it by brand name, that it caught my eye.

In memory of vacations past, this week’s public service ad celebrates the great state of Hawaii. This ad appeared in various DC comics published in April 1960, less than a year after Hawaii became a state (and you’ll notice that its population has more than doubled since then).

I just wish my high school had a beach that came all the way up to the football field. Though on second thought, given that I attended high school in the St Louis area, any beach would have had to be on the Mississippi River…and “beach” and “Mississippi River” are two concepts that do not go well together.

This PSA was once again scripted by Jack Schiff, with art by by Bernard Baily. This copy comes from The Brave and the Bold #29.

More PSAs

Green Lantern #33, script by Geoff Johns, pencils by Ivan Reis

In this scene, Hal Jordan and Carol Ferris find themselves under psychic attack from the recently empowered Hector Hammond. As you can see, both Hal and Carol develop otorrhagia (bleeding from the ear) from the attack, though Hal also suffers from the classic epistaxis telepathica, better known as the psychic nosebleed.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed green lantern hal jordan hector hammond

The problem is that you’re trying to find Power Girl’s heart rate by listening to the back of her forearm.

It is nice to see Dr. Beth Chapman, a.k.a. Doctor Midnight, back alive, though that outfit remains one of the ugliest costumes ever — but please tell me she’s not listening to the stethoscope through her costume.

This image was scanned from New Warriors #33 (March, 1993)

More PSAs

Script by Michael Golden, pencils by Ramon Bernado

For today’s example of a psychic nosebleed, we return to chronic bleeder Nate Grey, i.e. “X-Man.” In this scene from X-Man Annual ‘97, Nate is using his powers to fight explosive decompression and close an enormous hole that has been ripped in the side of a Shi’ar destroyer (or maybe it’s a cruiser, I could never tell those apart).

Not to give too much away, but he succeeds.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed x-man nate grey shiar

By day, Bob Benton is a seemingly normal — and incredibly brilliant — pharmacist who runs his own small drug store. However, whenever evil or danger appears, he becomes the costumed crime-fighter known as the Black Terror. Thanks to “formic ethers” he invented, he has gained heightened strength, speed, agility, and endurance. But even more than that, he has the power of pharmacy.

In this story from America’s Best Comics #24, Ben Benton and his assistant Tim were attending an estate auction when a group of thugs “forcibly” persuaded an elderly antique buff from bidding on a certain old chair. The chair had been used to hide some priceless jewelry, which the gang stole, fought off the Black Terror, and then escaped.

This is impressive detective work on the Terror’s part. He is able to recognize the exact drug in the pill, despite the fact that it was a specially compounded pill. In other words, this was no mass-produced pill, but instead one that was created from the constituent chemicals by a local pharmacist — no easy to read manufacturer’s markings! That’s why it’s so impressive that the Terror was able to identify the medication just by looking at it and without having to run any tests at all.

Dilantin sodium (more commonly known as just “Dilantin“, or by its generic name “phenytoin“) is a potent anti-seizure drug. It was first discovered in the early 1900s, but it wasn’t until 1938 that its ability to treat seizures was recognized. It was approved by the FDA for epilepsy in 1953, and quickly became one of the main seizure medications because it lacked the severe sedative side effects of previous medications. It is still a common medication for epilepsy today. (This story appeared in 1947, several years before Dilantin was FDA approved, so the Terror is probably correct in referring to it as a “rare drug” — at that point it was, for a few more years anyway).

There has been some evidence over the years to suggest that Dilantin has a role as a psychiatric medication as well; it seems to show both anti-anxiety and mood stabilization properties. It is these anti-anxiety properties that the Terror is referring to, implying that one of the crooks was using it to treat his anxious tic. (For the record, Dilantin has never been FDA approved for these psychiatric conditions.)

Bob Benton tracks down the local pharmacy that made the pills, and the pharmacist helpfully tells him exactly who the pills were for. So much for patient confidentiality. (This may have been before HIPAA, but I suspect sharing such information so freely was at the very least a breach of pharmacist ethics, if not state law). Thanks to the helpful pharmacist, the Black Terror shows up the crooks’ front door step, apprehends them, return the stolen jewelry, and gives the antique chair to the old man. Just another day in the life of a super-pharmacist.

The Black Terror was published by Nedor/Better comics in a variety of comic titles starting in 1941, and running until 1949. He was later revived by Eclipse Comics and then AC Comics to little success. More recently, he appeared (in a much modified form) first in Tom Strong and then Terra Obscura, both published by America’s Best Comics. Currently, he is one of the public domain super-heroes appearing in Dynamite’s Project Superpowers.

Bob Benton’s pharmacist background wasn’t just superficial color, as many of the Black Terror’s Golden Age stories involved mysterious medications, chemical concoctions, or dangerous drugs in one way or another. His pharmacy was fascinating too. It may have only been a small town pharmacy, but for some reason he stored the most unusual medications: huge drums of ether, giant jugs or chloroform, and jars of radioactive elements were all commonly shown on his shelves.

In this scene from Adventure Comics #325, Brainiac 5 spouts some pure Grade-A technobabble. Seriously, this is some of the best (or worst) technobabble that I’ve come across. It rivals anything from acknowledged technobabble master Bob Haney.

While reading this scene, it occurred to me that despite Brainiac 5 being one of the preeminent scientists of the DC universe, this is the first time I can remember him spouting technobabble. I suspect that’s because Brainy never explains why he’s doing things, he just does them — thus no need for explanations or technobabble.

As noted, the panels are from Adventure Comics #325. The artist is John Forte. According to the Grand Comic Database, the writer is Edmond Hamilton; however, the Showcase Presents the Legion of Super-Heroes, Vol 2 (where I scanned it from), lists Jerry Siegel as the author. Regardless, in this scene, Brainiac 5 is trying to help the young Luthor avoid a life of evil — though Brainy doesn’t realize that he is really dealing with an already evil Luthor who has cleverly disguised himself with…a wig.

Extolling the virtues of the United Nations was a common theme of DC Comics’ Silver Age public service ads; the subject came up quite a bit (and I’ve only reproduced a handful of them, there’s plenty more). Here’s one from September 1958 titled “Sharing — The United Nations Way!”

The subtitle almost makes the ad sound exciting (&ldquoA true story from the files of the International Labor Organization”), but don’t let that fool you — a best seller it’s not.

Like many of the United Nations public service ads, this one strikes me as a little condescending — but admittedly it’s not as bad as some others. On the other hand, unlike several other United Nations public service ads, this one was never re-used — so maybe I’m not the only one who dislikes it.

This PSA was scripted by prolific PSA writer Jack Schiff, w