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Action Comics #366 “Substitute Superman!”
Leo Dorfman, writer
Ross Andru, penciler

This comic¹ is the conclusion of the Virus X Saga, though only the first few panels are actually spent curing the disease. The rest of the comic consists of Superman trying to determine who has been masquerading as the Man of Steel while he’s been away from Earth.

As I speculated², the cure for Virus X did rest with the red and white kryptonite thrown in his path by the Bizarros. Well, the white kryptonite actually. I’ll let Superman explain:

Obviously, the Virus X which gave me the Kryptonian Leprosy, was a form of plant life, like bacteria! And white kryptonite is deadly to all plants!

Great answer Superman, only it makes absolutely no sense. Viruses are not plants; they are bits of DNA (or RNA) in a protein shell. Bacteria are not plants either; they are an entirely different type of organism. I’ll admit that at one point, bacteria were thought to be plants, but by 1968 when this comic was published it was well accepted that bacteria were neither plants nor animals but belonged in a kingdom of their own. This has been a long winded way of saying that white kryptonite would have no effect on Virus X³.

Superman then returns to Earth and discovers that someone has been pretending to be him while he was gone. After some quick detective work, he determines that the members of the Justice League of America were taking turns pretending to be Superman⁴. What friends! But I wonder what if Superman had really died? Would the JLA have been able to keep it up for the next few decades?⁵

The Virus X Saga is like Huckleberry Finn: it starts off great but then it’s clear the author had no idea how to end it, so was just throwing stuff in for padding. Only Mark Twain never confused viruses, bacteria and plants.

---

¹ Many thanks to Mike and Ralph’s Comic Corner for tracking down this book for me at a very reasonable price.
²…and Dave remembered.
³ Maybe it was Bizarro-white kryptonite that affected everything BUT plants.
⁴ Except Wonder Woman. Her “tracts of land” would probably have given away the fact that it wasn’t really Superman.
⁵ I propose an Elseworlds based on this idea. I call it Superman: Dead Son.

The Treatment of Cough, as recommended by Every Man His Own Doctor, or The Poor Planter’s Physician, written and published in 1736. Punctuation, spelling, emphasis and capitalization are all reproduced faithfully from the original text.

I SHALL begin with a Cough, which is the Foundation of many bad Distempers, and Therefore should be taken care of assoon as possible. It may be cured in the Beginning with riding moderately on Horseback every Day, and only taking a little Ground Ivy Tea sweetn’d with Syrrup of Horehound, at Night when you go to Bed. But in case it be violent it will be proper to bleed Eight Ounces, and be constant in the Use of the other Remedies. In the mean while, you must use a spare and cooling Diet, without either Flesh or strong Drink. Nor should you stove your self up in a warm Room, but Breathe as much as possible in the open Air. And to prevent this Mischief, don’t make your self tender, but wash your Head every Day in cold Water, and very often your Feet.

---

NOTES:

1. Ground Ivy (also known as Alehoof) is a common ground cover considered by most to be a weed.
   • A brief entry on Ground Ivy from InfoPlease.
   • Botanical information (and pictures) from the fine folks at Virginia Tech.
   • The entry on Ground Ivy from A Modern Herbal (publsihed in the modern year of 1931).
   • More information on the reputed medicinal (and magical) uses of Ground Ivy.
2. Horehound can still be found in old-time candy and coughdrops. It has a taste somewhat reminiscent of root beer (but closer to Jägermeister).
   • Pictures of Horehound.
   • Information on Horehound from the Food Reference Website.
   • Horehound, according to the previously mentioned A Modern Herbal.
3. Bloodletting was a common practice in medicine through the 19th century.
   • A brief but excellent article on “Bloodletting and the Four Humors.” Good illustrations and explanations.
   • An even shorter article on Bloodletting.
   • George Washington died due to bloodletting.

---

Disclaimer: This book was written nearly three centuries ago, long before such modern ideas as hygiene and germ theory. As a physician, I in no way recommend the treatment suggested above. If you have a worrisome cough, see a doctor. This excerpt is presented merely for interest and entertainment.

A quick reminder that I am hosting this week’s MedBlogs Grand Rounds. All submissions need to be e-mailed to me by Monday night (April 4th), no later than 8 PM (central).

Submission e-mail:

My vacation delayed my weekly review of House, but now I’m back and tanned (well, sunburned) and ready to review:

The ultimate solution to the patient’s problem was elegant, yet the route the team took to get there was full of dangerous assumptions. An obese 10 year-old girl has a heart attack. The lab tests and EKG all support this fact. The physicians aren’t entirely sure why she had this heart attack. Dr. Chase believes it is because of the child’s obesity, but Dr. Cameron thinks the patient may have Syndrome X (otherwise known as Metabolic Syndrome). Testing does not support this theory and the patient exhibits a bizarre mood swing while undergoing the test. Maybe it was the diet pills she was taking? Now the team decides that the patient is clotting so they start her on the anticoagulants heparin and warfarin. They believe that this clotting led to her initial heart attack as well as a small stroke that led to her mood changes. At no point does the team actually perform any tests or studies to confirm clots or to discover why the patient is clotting (if she even is), they just start her on the anticoagulants. (As a side note, if the patient had a heart attack, she should already be on the heparin). Areas of skin necrosis appear on the patient and House decides it must be warfarin necrosis. At the last minute, just before the patient is to go through some major surgical repair, in one of those “but doctor, if you’re wrong the treatment will kill the patient” moment, House discovers that the patient has Cushing’s Syndrome caused by a pituitary tumor. After the tumor is removed, the patient is cured – and even manages to drop 30 pounds by the end of the week.

The doctors on this show routinely jump wildly from conclusion to conclusion, but they normally run tests (lots and lots and lots of tests) to learn more. This episode there was a great deal of jumping to conclusions, but very little testing. There were also way too many overlooked issues. Assuming the 10 year-old had a heart attack, why? Was it due to clotting, a spasm of a blood vessel, or some other reason? No testing was done to find out, but this is a very important issue. Nobody bothered to figure out what diet pills the patient took, they just assumed “diet pills = bad” without bothering to learn what medications/herbs/placebos were in the pills. Later, an assumption was made that the patient was clotting, but no one tried to figure out why. Does the patient have a clotting disorder? Better run those tests before she starts on the anticoagulants they put her on (without checking for sure if she had a clot), because they’ll screw up the test results once she’s on them. Oh, and warfarin is a pill, not an injectable drug.

The soap opera aspects were much better than the medicine this week with House having to decide which of his three underlings he’ll have to fire. At the same time, the hospital administrator is busy playing games with people’s minds, both the young doctors and Dr. House. Who leaves? You’ll have to wait until the next (non-repeat) episode.

This episode deserves a B+ for the mystery and another B+ for the solution. Sadly, the medicine this week only receives a D+ (and that’s probably being generous). The non-medical soap opera aspects earn a solid A.

Reviews of previous episodes of House

Last Call for Grand Rounds XVIII! I have some very nice articles, but I’d love to have more. Please submit anything and everything at least tangentially related to medicine.

One of my favorite comic books when I was growing up was The Micronauts – they were some of my favorite toys too, so it made sense that I’d read the comic (but boy was I upset when I realized that they had made Acroyear a good guy. Everyone knows that he’s a bad guy! One of the most exciting things about the comic were the hidden messages. The denizens of the Microverse used an alphabet that looked a great deal like Sanskrit, but managed to translate perfectly into English. Using this alphabet, the comic creators could write secret messages and insert them directly into the panel where only a few loyal (and/or obsessive) fans would be able to read them. As a kid, that struck me as cool (actually, it still does today).

Micronauts wasn’t the only book with it’s own alphabet. Interlac showed up frequently in the Legion of Super-Heroes and Kryptonian showed up in the various Superman titles.

Sadly, this practice seems to have diminished over the years, though I have every hope that Waid and Kitson will bring it back in the new Legion (though I do appreciate the “secret codes” in the back of Girl Genius – another flash of Silver Age fun).

• The Homeworld Alphabet (from Micronauts).
• The Interlac alphabet.
• Kryptonian.

Welcome to the Twenty-Eighth Edition of Med Blogs Grand Rounds. Presented below are the cream of the crop from the past week’s medical blogging, covering everything from politics to television.

	Politics (in various arenas) Thoughts On a Speech by Former Surgeon General Jocelyn Elders (from Blogborygmi) Credentials (from Dr. Tony) IRB Politics (from the Bioethics Dude) USMLE Step 2 Clinical Skills Exam (from The Future of Medicine)
	Medicine How Long Will You Live? (from Political Calculations) Avian Influenza and the ‘War on Birds’ (from Living the Scientific Life) Peanuts and Garlic (from Parallel Universes) Contented Melancholy (from The Examining Room of Dr. Charles)
	Doctors’ Lives A Serious Conversation (from DB’s Medical Rants) The Dream (from Vertical Mattress) Extra Room (from I’m So Sleepy) The List (from Hospice Blog) Where Ignorance is Bliss… (from The Cheerful Oncologist)
	Technology The Night Nothing Happened (from GruntDoc) Do Smart Infusion Pumps Improve Medication Safety? (from Medical Connectivity Consulting)
	Psychiatry Screening for Depression (from The Anonymous Clerk) God and the Devil (from Intueri)
	Big Business An Early Warning to the Orthopedic Industry (from the Health Business Blog) Blame the Drug Companies (from Dr. Andy)
	Legal Aspects of Medicine A Misdiagnosed Gall Bladder Leads to a Malpractice Trial (from Kevin M.D.)
	Quack Ideas The Galileo Gambit (from Respectful Insolence) Boutique Fetal Imaging (from Red State Moron)
	Television A Review of Grey’s Anatomy (from A Chance to Cut is a Chance to Cure) A Review of House (from Polite Dissent)

If you’ve never visited before, Polite Dissent is a blog that takes a (mostly reverential) look at both medicine and comic books, especially the areas where they overlap (or collide, depending on your point of view). I also discuss television, books, and whatever else happens to pique my interest. Take a look around now that you’re here; I think you’ll like what you see.

Favorite posts include The Legion of Super-Heroes After School Special, How A Comic Book Helped Me in Physics and Is Dr. Doom Really A Doctor?

Thanks for stopping by!

Next week Grunt Doc hosts Grand Rounds, and the entire Grand Rounds Archives can be found here.

Quiz Time:
How many of the famous, infamous and obscure comic book characters depicted in this post can you name? Highlight the box below for answers:

ANSWERS Lex Luthor (villain of Superman) Dr. Mid-Nite (technically Dr. Mid-Nite II, from JSA) Cardiac (a forgettable villain from The Amazing Spider-Man) Reed Richards, a.k.a. Mr. Fantastic (from The Fantastic Four) Dr. Leonard Samson (green-haired psychiatrist from The Incredible Hulk) Wilson Fisk, a.k.a. The Kingpin (enemy of Spider-Man and Daredevil) Matt Murdock, a.k.a. Daredevil (blind attorney and super-hero) Howard the Duck (’Nuff Said) Clark Kent, a.k.a. Superman (from his stint as a newsman for WGBS)

• Squiddies
  It’s time for the annual Rec.Arts.Comics awards. Better known as “The Squiddies”, voting for these long-running awards is open until April 24th. Johanna has much more information over at Cognitive Dissonance.
• Science
  For the best of Science on the web, visit Orac for the latest Tangled Bank.
• A Fond Farewell
  Happy news, tinged with some regret, as Franklin Harris has been promoted. This is good news for him, but not as good news for his fans as his blog will go on hiatus. Adios, Franklin…

The Doom Patrol and Suicide Squad Special, published in 1988, is the final solo Hawk story. It’s been four years since Dove was killed and Hawk has bounced from title to title, each appearance more embarrassing than the last. This story is his final ignominy (well, at least until Armageddon 2001 #2).

Written back in the glory days of Reaganomics, Hawk travels to Nicaragua to “fight commies.” Unfortunately, his plane is shot down and he is quickly captured by the Sandinistas and held as a political prisoner.

Amanda Waller is ordered by the President to send Task Force X (i.e. Suicide Squad) down to Nicaragua to rescue Hawk, or if that can’t be accomplished, to kill him. Waller places Colonel Flag in charge of a team composed of such second-string (at best) characters as Thinker, Psi, Weasel and Mr. 104.

Certain members of government aren’t happy about the power Waller wields and decide to trick the Doom Patrol into rescuing Hawk and making the Suicide Squad look bad. This isn’t the Grant Morrison Doom Patrol (or even the John Byrne one); it’s the eminently forgettable early ‘80s revival consisting of Celsius, Tempest, Negative Woman and Cliff “Don’t Call Me Robotman” Steele.

Meanwhile, the Soviets would also like to get their hands on Hawk for propaganda purposes, so they send a squad of their Rocket Reds to Nicaragua.

The Doom Patrol and Suicide Squad run into each other almost immediately after arriving in Nicaragua and start fighting. Before either team can gain an advantage, they are surrounded by the Rocket Reds and the real fight begins. The Suicide Squad proves quite inept and within a few minutes they’ve all been killed except for Colonel Flag.

What about Hawk? A mysterious dark-haired stranger breaks into his cell, smashes a hole in the outside wall, throws Hawk through, and then disappears into the jungle. The Doom Patrol, Colonel Flag and Hawk meet up, climb aboard the waiting U.S. military helicopter and fly out of Nicaragua.

The end of the story? Not quite. It turns out that the stranger who rescued Hawk was actually a Soviet agent whose mission was to discredit the Rocket Reds, much like the Doom Patrol were in Nicaragua to discredit Suicide Squad. What’s left after 45 pages of scheming and fighting? Two disgraced (and mostly slaughtered) teams, one rescued Hawk and the Doom Patrol that Time Forgot.

The art, to put it bluntly, is amateurish. I’ve never cared for Erik Larsen’s penciling, and this issue showcases everything I don’t like: angular faces, with a particular love of jutting jaws and masculine-looking women; bizarre giant female lips (all his women look like they’re wearing those Halloween wax lips); the worst hair every drawn in comic books; an inability to master perspective; incomplete backgrounds (if there are any backgrounds at all); inconstant character art from panel to panel; and too many momentum-breaking character close ups The sketchy inking by Bob Lewis only adds to the problem. I’m sure there’s a good story under all the bad art, but I haven’t found it yet.

The last day of the work week at Polite Dissent means only one thing: Lois Lane Friday!

Superman’s Girlfriend Lois Lane #126 “The Brain Busters” (first story in the issue)
Cary Bates, writer
John Rosenberger, penciler

Lois Lane and Clark Kent are headed across town to the WMET television studio to interview the suddenly famous clown, Captain Dingle. On the way there, they run across a street full of people acting very strangely. Some are singing and dancing, others are acting like children. The people aren’t the only ones affected; even the pets are acting weird. Clark conveniently disappears and Superman appears. He freezes the rain into sleet and the cold snaps everyone out of their bizarre behavior.

Lois continues on to the studio where she meets the station manager and Captain Dingle himself. They invite her to watch the tape of a recent Dingle episode and she agrees. At first she loathes the show, but soon she begins to like it. After watching the episode, she finds herself obsessed with the show and can’t wait to see it on Saturday morning.

Riding the subway home she is surprised to hear everyone talking about Captain Dingle and how they’re not going to miss the show this weekend. She is surprised by how popular a children’s television show is. Acting on a hunch, she takes out her camera with a special high speed film. Snapping a picture of the show she discovers…subliminal messages! She deduces that the people she and Clark spotted the previous day were the test subjects for the subliminal messages and that the station manager must be up to something.

Lois takes a cold shower (in her clothes, for some reason) to break the subliminal mind control and alerts Superman. With his help, she stops the station manager and his goons from robbing a bank while everyone else is watching Captain Dingle.

Sadly, the scene from the cover image never actually appears in the story; Captain Dingle is an innocent dupe of the evil station manager.

This idea of using subliminal messages to control someone’s mind is nonsense. Subliminal messages simply do not work. The original study that purported to show a dramatic increase in the purchase of soda and popcorn at a movie theater using subliminal messages has been shown to be a hoax. No legitimate study has demonstrated any evidence that subliminal messages can influence behavior; in fact every study shows just the opposite – that subliminals have no effect upon behavior (and that includes those expensive subliminal self-help tapes).

However, let’s suppose for just a minute that subliminal messages did work. That would explain the bizarre actions of the people, but what about the pets? Since when can dogs read?

(Honestly, if there is anything vaguely subliminal in the story, it’s the clown’s name.)

Thanks to friends with a voracious appetite for Pepsi, I have quite a few free songs on my iTunes account.

I’ve downloaded all the songs I know that I wanted, but what about all the songs I didn’t know I wanted? I can download fifteen more songs, so I’m looking for suggestions. If you could choose just one song to sell me on a favorite band, what would it be?

My taste is quite eclectic (anyting but gospel), so any and all recommendations are appreciated.

This weekend, the Disney Channel premiered its second Kim Possible movie, Kim Possible: So the Drama (yes, I know they’re claiming it’s the first Disney Channel animated movie, but they’re forgetting last year’s Kim Possible: A Sitch in Time).

Kim Possible is a great animated cartoon series on the Disney Channel. Its star is Kim Possible, your average run-of-the-mill high school cheerleader who just happens to save the world on a weekly basis. Her father: a rocket scientist. Her mother: a brain surgeon. She has younger twin brothers (the “Tweebs”) who are the bane of her existence.

Her best friend and partner is Ron Stoppable, your basic lovable sidekick oaf. Her high school nemesis is Bonnie, the cheerleading team captain. Her arch foe is Dr. Drakken, a blue skinned megalomaniac (and his more formidable sidekick She-Go). She has other great villains including Lord Monkeyfist (and his Monkey Ninjas), Señor Senior Sr (and his son Señor Senior Jr), Duff Killagin (”The World’s Most Dangerous Golfer”) and, of course, DNAmy.

The first Kim Possible movie, A Sitch in Time, was great because of four words (well two words, if you count hyphenated words as one): Super-villian Team-Up. Kim’s arch-villains Dr. Drakken, She-Go, Lord Monkeyfist and Duff Killagin join forces to steal a sacred monkey idol. This is not just a religious gewgaw, but the key to time travel. The team of villains decide to use the idol to travel back in time to stop Kim Possible at her most vulnerable moments. Thus we are treated to Kim’s first day of pre-school (where she meets Ron for the first time) and the day she inadvertently starts her save-the-world business. The current Kim and Ron also travel back in time and are able to defeat the villains each time. She-go, sick of being second fiddle to Dr. Drakken, steals the idol, travels to the future and becomes absolute dictator of Earth. Kim and Ron travel to the future, join up with the Resistance (led by the now-grown up Tweebs) and defeat She-Go once and for all.

The second Kim Possible movie, So the Drama, deals with a common high school fear: the Prom. Kim is stunned to learn that the other cheerleaders have snapped up all the good dates at the “top of the High School food chain.” Will she have to go to Prom alone, or worse, with Ron? Meanwhile, Dr. Drakken and She-go are up to something, and this time his secret plan actually seems to be working. Ther’s lots more to tell, but I don’t want to spoil it. I’m sure the Disney Channel will be playing it ad infinitum for the next few months, so there’s plenty of time to catch it.

Both movies are good, but I think I prefer the first one because of the glimpses back into Kim’s past. Plus it has that alternate history theme I like so much. My wife, the romantic, prefers the second one.

If these two movies aren’t enough, there are forty or so episodes shown daily (more or less) on the Disney Channel. For comic aficionados, make sure to catch “The Fearless Ferret” and “Team Go”

Following last week’s discussion of the treatment of cough, this week the focus is a particularly nasty type of cough — the Whooping Cough. The treatment below is recommended by Every Man His Own Doctor, or The Poor Planter’s Physician, written and published in 1736. Punctuation, spelling, emphasis and capitalization are all reproduced faithfully from the original text.

THE Whooping Cough (often fatal to Children,) is attended with a stronger Convulsion than ordinary, which causes the Whooping.

FOR this, boil Hysop and Elicampane, a Handful of each, in 2 Quarts of Water, strain it off, and adding 1 Pound of clean Muscovado Sugar, boil it again, and give the Patient 2 Spoonfuls every 3 hours.

THIS same Remedy is good for shortness of Breath, and Hoarseness, only in those Cases, Linseed Tea sweetn’d with Honey, should be the constant Drink, and a spare and cooling Diet punctually observ’d.

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NOTES:

1. Whooping Cough, also known as Pertussis, was a very common disease in Colonial America. Currently in the United States, a vaccine is used to prevent infection, but there has been an increase in the number of cases over the past several years, particularly among adults. There is concern that the protection granted by the vaccine wanes enough over time to allow infection in older individuals.
   • CDC information on Whooping Cough.
2. Hysop (more commonly spelled Hyssop) is an herb from the mint family.
   • Information from the Spice Pages.
   • Entry on Hyssop in The Modern Herbal (from 1931) .
3. Elicampane (more commonly spelled Elecampane) is a common medicinal herb.
   • Entry on Elecampane from the Culpeper Index of Herbs (17th century).
   • Information from The Modern Herbal.
   • Quick information (and picture) of Elecampane .
4. Muscovado Sugar is a type of very dark brown sugar with a strong molasses flavor
   • Information on Muscovado Sugar from Hormel’s “Our Kitchen”
5. Linseed Tea is another traditional herb “medicine”
   • Information on Lisneed Tea from The Materia Medica.

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Disclaimer: This book was written nearly three centuries ago, long before such modern ideas as hygiene and germ theory. As a physician, I in no way recommend the treatment suggested above. If you have a worrisome cough, particularly if you seem to be whooping, see a doctor. This excerpt is presented merely for interest and entertainment.

Dr. Schnee was a soda produced by the Vess Soda (“The Billion Bubble Beverage”) Company. As the name suggests, Dr. Schnee was a Dr. Pepper knock-off, though its taste was a little sweeter and cherry-er (probably closer to a Mr. Pibb).

Each day after Cross-Country practice, my friends and I would swing by Quayle’s Amoco station, pool our money, and buy several 12-ounce bottles of Vess soda (4 for a dollar). Dr. Schnee was always a favorite, though Vess also made excellent black cherry soda, cherry cola and cream soda. Knowing I would have a Dr. Schnee waiting for me made all those dyspnea-inducing foot-pounding cross-country miles (almost) worth it.

Finally returning to the Mid-West after many years away, I was saddened to discover that Dr. Schnee no longer exists. Sure, Vess now makes “Dr. Vess”, which is the identical soda, but half the fun was the name.

It’s still a tasty soda though.

Returning Favorites:
As usual, Hawk and Dove and Zatanna were popular search terms. Dave Trampier and Wormy also had fewer searches and Bwana Beast had no searches this month (nor, I should point out, did “Freedom Beast”). New favorites include “Dana Delaney” and “Crimetime After Primetime.” Who knew CBS’s failed late-night experiment would still be so popular ten-years later?

Other interesting searches:
How boring nascar is
I’ll admit it’s not always the most exciting sport to watch, but then it still beats watching golf or fishing (or football, as far as I’m concerned). It also helps to know enough about the sport to understand the drama behind it, and that takes a little bit of time. Personally, I’d recommend watching the short track races (Richmond, Bristol, Martinsville) and avoiding the restrictor plate races.

Zoo attacks
Now that’s a comic I’d read.

Who was alice chasing when she fell down the hole in wonderland?
The White Rabbit (cue Grace Slick). Though Alice didn’t fall down the hole in Wonderland, she fell down the hole and ended up in Wonderland. Maybe you should read your Cliff’s Notes again.

WKRP DVD
Sadly, no time soon, if ever. I refer you to the ultra-knowledgeable Tom the Dog.

Do doctors hate drug reps?
Personally, I dislike their profession, but I like most of them individually.

How to remove smoke stains from hummel figurines?
How did this search end up at my site, of all places?

Teen titan characters bumble bee lady
You mean Bumblebee?

Most common house color
I would think white, though beige siding seems to be very popular around here.

Could you give me some information on Blackbeard the pirate?
Sure, thanks for asking. His real name was Edward Teach and his ship was the Queen Anne’s Revenge. Here’s some more information. http://www.legends.dm.net/pirates/blackbeard.html

Ugliest baseball players of the 1990s
A good question. I can’t think of anyone particularly horrid off the top of my head, but give me a little time. Also, are we talking minor leagues too, or just MLB? And how did you end up on my site?

Things doctors do not want you to know
If I told you, then you’d tell someone else, and then soon everybody would know! Seriously though, I get discouraged when I see e-mails, ads and infomercial touting secrets we physicians are supposedly hiding from our patients. What a crock! My job is to get patients better, period. I would gain nothing by withholding information. I would love to be able to cure cancer, heart disease or even the common cold*. I got into medicine to help people, not to make money (or I certainly wouldn’t be a Family Physician).

Bart Simpson erotic cartoons
The single most disturbing search of the month.

College freshmen mistakes
I made my share, and most involved blondes.

Four legged insects.
None. Insects have six legs (well, except caterpillars, now that I think about it)

I like gummi bears
So do I.

It’s Tuesday, and that means that it’s time for Grand Rounds, a collection of the best in medical blogging from the past week. Grunt Doc does the honors this week and has an impressive list of articles. Check it out!

A rising black politician has just finished giving a speech when he suddenly collapses. He blames it on being overworked and under the weather for the past few weeks. A physical exam turns up some neurological abnormalities and a lumbar puncture and brain MRI are performed. The MRI shows a suspicious lesion that is ultimately determined (after brain biopsy) to be toxoplasmosis. Dr. House and team suspect that this means the politician has AIDS, because that is by far the most common cause of disseminated toxoplasmosis. The politician swears he does not have AIDS, and while a first HIV test is positive, a second test is negative. Discarding the AIDS diagnosis, the doctors concentrate on cancers that could be causing his symptoms such as hairy cell leukemia. Ultimately, House diagnoses the patient with Combined Variable Immune Deficiency (CVID) based on the combination of a seizure medication and common infection the patient had as a child. Some immunoglobulin shots and the patient is good to go.

AIDS is a logical thought when severe toxoplasmosis is found. The idea of repeating the HIV test doesn;t make much sense as most HIV tests are already a double test – an ELISA followed by a Western Blot if the ELISA is positive (to check for false positives, such as was the case in this episode). The seizure medication phenytoin (brand name Dilantin) has been associated with CVID, as has Epstein-Barr Virus. However, it’s not the double whammy of the two together that can cause CVID as House suggests; instead it appears that that either one alone can cause it (though genetics seems to be a more common cause of CVID). I also find it suspicious that the patient’s CVID had remained quiet for thirty years before suddenly showing up as two serious (and dramatic) fungal infections in a matter of days. A more realsitic scenario would have the politician suffering recurrent common infections for years before developing a more serious infection such as toxoplasmosis or PCP.

The soap opera was good again this week, but not quite as tense as the previous episode. I get the feeling that the writers are setting us up for something big. The writers also seem confused about Vogler’s motivation. He wants to get rid of House becuase he’s costing the hospital money, but also chooses him to speak on his newest drug because he’s a well-known and well-respected physician. Anyone who’s well-respected enough to introduce a new cardiac drug — if they’re not a cardiologist — would be well-known enough to bring a great deal of money into the hospital. The writers are trying to have it both ways: House is famous enough to for Vogler to pull his little stunt, but not famous enough for Vogler to want to keep him around. Puzzling. And don’t get me started on Vogler’s conflicts of interest…

The mystery gets a B+ with the ultimate solution getting a B- (the timing is just a little too coincidental). The medicine earns an A-. The soap opera earns a B.

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When Dr. House announces that the patient has AIDS, my wife looks at the clock then looks back at me.
“He can’t have AIDS,” she says. “We’re only fifteen minutes into the episode.”
And she was absolutely correct. The show’s writers really need to make this a little less predictable.

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The Good News: House has been renewed for a second season.
The Bad News: Because of this, Hugh Laurie will not be able to play Perry White in the upcoming Superman movie. Instead Frank Langella will. I’m not sure I see that.

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Reviews of past House episodes.

The adventures of the futuristic swashbuckling rogue Nikolai Dante continue in Nikolai Dante: The Great Game. Just like the first volume, this is wonderful collection of fun comics. Nikolai is a scoundrel, but a good hearted one, and his adventures and misfortunes are fun to read.

This volume takes up where the first one ended. Nikolai Dante, thief extraordinaire and “too cool to kill” has learned that he’s a bastard son of the Romanov family. In the future Russia, the Romanovs are one of two remaining great aristocratic houses, the other being the Makarovs – the Tsar’s family – and the sworn enemy of the Romanovs. Nikolai’s Romanov blood has allowed him to bond with an alien technology known as a Weapon Crest, which gives him heightened abilities. His half-siblings also have these Weapon Crests and enhanced abilities. Unlike Nikolai, they have no conscience and are quite bloodthirsty about getting what they want.

The book starts out with two brief stories to set the tone. The first features Nikolai’s attempt to rescue Captain Arbatov from the firing squad. He’s feeling a little guilty, because he’s the reason Arbatov is facing execution (he charged his stay at the extravagant Hotel Yalta to Arbatov in one of the best stories from volume one). In the second story Nikolai travels to Britain on a diplomatic mission and has to cope with a king who is truly insane.

Next comes the eponymous story “The Great Game,” the heart of the book. A rogue member of the Romanov family has stolen a super-weapon and it is up to Nikolai, with the help of his love/hate interest Jenna Makarov, to recover the weapon. And did I mention that Nikolai’s wife shows up as well?

The last halfof the book has a collection of stories featuring Nikolai and his half-siblings. First, he and Viktor travel to Paris to recover a list of Romanov spies before the Tsar’s men can find it. Next, Nikolai must stop his narcissistic (and homicidal) sister Anastasia from killing a lover who jilted her (and runs into Countessa de Winter, also from the Hotel Yalta, again). After that, he helps his brother Andreas defend the world’s largest brothel from an attack by religious cultists. Konstantin makes sure Nikolai sees the dark side of politics, and his sister Lulu shows him a night he will never forget at the Hellfire Club in Venice. Finally, Nikolai goes on the annual Romanov hunting trip, but all is not as it seems.

If you enjoy light-hearted science-fiction with a little bit of mild R-rated naughtiness, then this is the book is highly recommended. Get it while you can.

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I was disappointed to learn that DC will no longer be publishing work from 2000AD (where Nikolai Dante comes from). Reading Johanna’s post (and the comments) over at Cognitive Dissonance I realized that I never saw any promotional push for this book (or any 2000AD or Humanoids book) from DC. I probably did more promotion for the first volume with my Nikolai Dante Contest than DC did with the entire 2000AD Line.

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Heidi reports that the 2000AD books will continue, just not under the DC banner. More Nikolai Dante!

I apologize for the delay, but I’m a little behind on reading and reviewing comics. As the summer comes and things slow down in the office, I should be able to catch up.

Hard Time #12 “Sixteen”
Steve Gerber, writer
Brian Hurtt, penciler

Arturo and Mercedes are getting married in the prison chapel. Mercedes is somewhere around her 38th or 39th week of pregnancy. Just as the ceremony is concluding, Mercedes develops severe abdominal pain and starts bleeding profusely. Her maid of honor (more or less) yells out: “Guard! I’m a nurse, this woman is losing her baby!”

The doctor and medics come but it appears Mercedes is in bad shape as the doctor can’t find a pulse.

Then the series ends abruptly, and we never find out what happens to Mercedes or the baby.

Mercedes is most like suffering a placental abruption. This occurs when the placenta shears away from the wall of the uterus. The more of the placenta that separates from the wall, the more serious the abruption.

An abruption can be dangerous to both the mother and the child. The placenta is the lifeline to the baby, so if it is damaged or stops functioning, the health – and very survival – of the baby may be at risk. A large hemorrhage from the abruption can also put the mother’s life at risk because of the amount of blood lost. Treatment for an abruption depends of its severity. Mild cases may require just bed rest and observation while severe cases sometimes require the Intensive Care Unit, blood transfusions and an immediate caesarean section.

Based on the description and the depiction of Mercedes, it is most likely that she had a severe abruption and I suspect that neither she nor the child will survive.

This is the second recent comic to depict a placental abruption. Fallen Angel #18 mentioned it as well, but in that case the abruption was due to trauma.

Now I guess I have no choice but to explain the hero that is “Freedom Beast.” I’d take notes if I were you; H is probably going to give us a test when he finishes with the DC Comics Encyclopedia.

B’wana Beast debuted in Showcase #66. Mike Maxwell, a big game hunter, encounters a wizened native shaman who gives him a magic helmet and potion with which he can become B’wana Beast. The helmet grants him the power to fuse two animals into one and the elixir gives him heightened senses and strength. As B’wana Beast he lives in a secret hideout on the top of Mount Kilimanjaro with his ape companion Djuba and fights injustice throughout Africa.

Recently, Maxwell passed on the B’wana Beast mantle to Dominic Mndawe who chose to rename himself (sadly) Freedom Beast. With this, a ridiculous — yet somehow fun — character became just stupid.

B’wana Beast’s best appearance was in Grant Morrison and Chas Truog’s Animal Man#1-4. A close second would be his appearance in the Justice League Unlimited episode “This Little Piggy.”

Richard Dragon #10 “Out of the Past, part four”
Chuck Dixon, writer
Brad Walker, penciler

The splash page in Richard Dragon #10 features a very bad OR (Operating Room) scene. At least, I think it’s the OR, it might be taking place in the Emergency Room — the previous issue wasn’t clear about that and this one is no better. It’s not like there are just a few minor errors and I’m being nit-picky — the scene is full of them. Think of it as one of those puzzle pictures they used to give you in grade school: how may errors can you find?

Here’s the mistakes that caught my eye, from the top to the bottom of the page:

1. The nurse checking Teddy’s pulse is
   A) doing so using a watch, and
   B) nowhere near Teddy; she appears to be taking the bed’s pulse
2. The doctor is not wearing gloves, a gown or eye protection.
3. Actually, nobody in the room is following sterile technique, and most aren’t even wearing masks.
4. Teddy is not under anesthesia.
5. The nasal canula is drawn incorrectly.
6. Teddy is still wearing his clothes. One of the first steps in any trauma assessment is to examine the entire patient, at that requires removing their clothes. With chest wounds they particularly need to examine his back to look for exit wounds.
7. There is only a single IV. Anyone with trauma experience will you that one of the first tasks is to place two large-bore IVs.
8. Duct tape is not generally used to restrain patients.
9. There aren’t any heart monitor leads in place. With chest surgery this is understandable, but later in the issue the heart monitor plays a big part, so they can’t have it both ways…(and yes, this was a trick question as you had to have read — and remembered — the comic!)
10. The bed is a standard hospital bed, not a surgical bed.
11. There are non-essential people in the room (the policemen for instance).
12. What’s with all the blood in the hand sink?
13. Those aren’t surgical instruments; they’re torture implements…and isn’t that a bottle opener?
14. The perspective and lighting are off.

I know it may seem like I’m being a little picky, but is a surgeon wearing gloves really too much to ask?

No medical review in this week’s Lois Lane Friday. Instead, I’m going to take a look at Superman’s Girlfriend Lois Lane #121 and the debut of the “new look” Lois.

Superman’s Girlfriend Lois Lane #121 “Everything You Wanted to Know About Lois Lane * But Were Afraid to Ask!”
Cary Bates, writer
Werner Roth, penciler

The cover is wonderful, but unfortunately there is no scene even remotely resembling that cover in the comic. Sigh.

Distraught over the death of her sister Lucy¹, Lois Lane wanders the streets of Metropolis for days on end. At one point, a young woman named Julie saves her from muggers. Only when Julie’s life is threatened by these muggers does Lois finally wake up out of her funk.

Later, as Julie and Lois are talking in her parent’s apartment, the landlord comes by and tells them that unless Julie can pay the rent, her parents will lose their apartment. It seems that her parents and all the other elderly couples in the apartment building received brochures from a retirement village called “Paradise Haven.” A bus from Paradise Haven was sent to pick up the retirees, but they never returned. The police have no leads².

At this point Lois decides that she needs to rededicate her career as a journalist to helping others. She quits the Daily Planet and starts work as a freelance reporter. She shows up at the Planet office in her new hairstyle and hip-70s outfit to tell Perry, Clark and Jimmy she quits. On the way out, she tearfully breaks up with Superman, telling him she’s no longer “the girl he comes back to between missions.”

Her first job as a freelancer is to discover what happened to Julie’s parents. She digs through old papers and finds out that their landlord is a former con artist. She dresses as an old lady and threatens to blackmail him unless he cuts her in on the deal. He flies her out in his helicopter to Paradise Haven, which is really just a row of shacks in the desert. He then revels that he knows that she’s an imposter and not an old lady because she’s wearing sexy fake eyelashes. “Oops! This is the kind of mistake that can get a girl killed!” thinks Lois as she is pushed out of the helicopter.

Superman arrives just in the nick of time to save Lois. He rips the blades of the helicopter and knocks out the landlord. Just then an earthquake hits Paradise Acres and he flies down to help. In my favorite scene, he tells Lois to take control of the helicopter – that’s right, the helicopter he just ripped the blades off of.

Superman is able to rescue the elderly couples and makes an astonishing discovery, the land Shady Acres is built on is loaded with uranium – they’re rich³!

Lois returns to Metropolis and decides that since she’s no longer a star reporter, she needs to take in some roommates. Julie moves in with her, along with the mysterious Kristin Cutler and the Rubenesque Marsha Mallow⁴. These roommates remain characters in the comic until it is finally cancelled with issue #137.

¹ Lucy disappeared over a waterfall while in a canoe in South America. Superman could find the ruined canoe, but no sign of Lucy. He believes her dead, but I believe to be in The Land of the Lost.
²Exactly how hard is it to find a large bus full of retirees?
³I wonder how this uranium find made the older couples rich. They had never actually bought into Paradise Haven, they were just touring it. The crooked con man still own the land — so he’s the rich one.
⁴I think some people are just doomed to be chunky from the day they were born. With a name like “Marsha Mallow” what chance did she have? She sould changer her name or at least sue her parents.

Captain America and the Falcon #13 “American Psycho, Part 1″
Priest, writer
Dan Jurgen, penciler

This seems to be the month for OR scenes. We’ve seen it all from the good (Birds of Prey #80) to the bad (Richard Dragon #10) and the in-between (this issue).

Steve Rogers (better known as Captain America) is shot by a street punk gunning for Sam Wilson (the Falcon). It’s not clear how many times Steve was shot or even where, but he presumably took a bullet to the head (because it has a bloody bandage wrapped around it) and one to the chest (because that’s where the doctors spend all their time operating).

Steve is rushed to Harlem Hospital and into the operating room. Chest leads are in place and a face mask is delivering oxygen. His uniform is cut away to expose his chest and the operation is started. The situation is critical: the doctors keep losing him but manage to get him back. Then he flatlines and it is too late — at 3:08 AM Steve Rogers is declared dead.

The operating room scenes in the issue have a few faults, but they are much better than the ones in Richard Dragon. This appears to be a real OR with proper instruments and equipment. The doctors are wearing gloves, caps and eye protection; in some panels they are even wearing gowns. The lack of continuity in the medical scenes is a major distraction. Cap’s uniform is cut down the middle and the next scene he’s not wearing it at all and then for a couple of panels he’s in a t-shirt and then in the final panel when Sam is hugging his dead body, he’s wearing the cut open uniform again (and there’s no blood or incision on his chest at all, despite the operation). His head bandages also seem to randomly appear and disappear with blood stains appearing randomly on them.

The lack of proper critical care is the biggest medical error in the issue. Cap is hooked up to an oxygen mask, but if he is an as bad shape as the story suggests he needs to be intubated and hooked up to a mechanical ventilator. While he is hooked up to a heart monitor, the leads are in bizarre places (but I’ll admit that’s nothing but nit-picking). Finally, I’m amazed that the doctors declared him dead so soon after his heart stopped. They made no attempt to call a code or try any critical care medicine (no shocks, no injections – nothing!).

It’s never precisely clear what operation the doctors are performing, but that can’t be considered a mistake. The OR is there to serve as a springboard for flashbacks and to impress upon the reader the dire situation Steve is in; the exact procedure performed (or even where Steve was shot) is not particularly important. The continuity errors are undoubtedly due to this non-contiguous storytelling.

Maybe I’m just a cynical long-time fan, but I’m betting that Cap’s not really dead…

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Look at the picture below. Tell me the doctor is not doing his nails while Captain America flatlines, because it sure looks like that to me. (Click on the image for a larger version)

Continuing a look at the practice of medicine in the 18th century, the topic this week is Pleurisy. The treatment below is recommended by Every Man His Own Doctor, or The Poor Planter’s Physician, written and published in 1736. Punctuation, spelling, emphasis and capitalization are all reproduced faithfully from the original text.

A COMMON Consequence of a violent Cough is Pleurisy; which discovers itself by a brisk Fever, and sharp Pain, pretty low in one of the Sides, shooting now and then into the Breast, and sometimes quite back into the Shoulder-Blades: It is uneasy every Time the patient draws his Breath, and more so when he coughs; which is generally the Case in this Disease.

THE Moment any Person finds these Tokens upon him, he must, without Loss of Time, take away 10 Ounces of Blood, and repeat 3 or 4 Days successively, if the Pain go not away before. On the Third Day, he may vomit with 80 Grains of Indian Physick (Virginian Ipecocacanna,) and every Night, drink 7 Spoonfuls of Pennyroyal Water, or the Decoction of it, moderately sweetn’d. In the mean Time, let him, every Three Hours, take Half a Spoonful of Honey and Linseed Oyl mixt together. He should also strew Indian Pepper, upon Pennyroyal Plaister, and apply it very hot to the Place where the Pain lies, and be sure to keep himself warm, and abstain from cold Water: Tho’ if the Distemper should prove obstinate, you must apply a Blister to his Neck, and one to each Arm, on the fleshy Part above the Elbow.

THE Patient’s Diet should be light, and cooling; and his constant Drink, either Linseed, or Balm Tea, a little sweetn’d.

THE best Way to prevent this Distemper, will be, the bleed in the Beginning of any great Hoarseness, or Cough, and also to forbear swilling great Quantities of Water, or Small Beer, in ordinary Life.

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NOTES:

1. Pleurisy is an inflammation of the pleura (the membrane surrounding the lungs). It causes a sharp chest pain, particularly with coughs and deep breaths. Pleurisy is usually a symptom of another condition rather than a condition in and of itself.
2. Bleeding
   See my previous discussion of bleeding in the Notes of the post on the Treatment of Coughs.
3. Indian Physick (i.e. Indian Physic)
   A plant (Porteranthus stipulatus) indigenous to the Eastern United States that can be used to make an emetic (a drug that causes vomiting).
   • Entry from The Modern Herbal (circa 1931).
   • A nice picture of Indian Physic
4. Pennyroyal
   A plant in the mint family, famed for its reputation to keep pests away (insect pests, not your annoying next-door neighbor).
   • A picture of Pennyroyal (courtesy of Purdue).
   • An FAQ on the traditional uses of Pennyroyal.
   • An interesting legal situation based on the traditional use of Pennyroyal.
   • A Modern Herbal entry on Pennyroyal.
   • An article about the use of Pennyroyal in a short story.
5. Decoction
   A tea that is boiled slowly for 15 to 20 minutes. It is usually made from bark, roots or large seeds.
6. Linseed Oil
   A common 18th century medicine (and paint supply). Another name for Linseed Oil is Flaxseed Oil.
   • Alleged benefits of Linseed Oil.
   • For a slightly contrasting view, here is the MSDS for Linseed Oil.
7. Indian Pepper
   The author is referring to black pepper.
8. Plaister (i.e. Plaster)
   Also known as a poultice. A paste made of various herbs and applied to a soft cloth which is then placed on the patient’s body.
9. Balm Tea
   A team made from Lemon Balm, yet another herb in the mint family.
   • Information on Balm Tea from an organic farm
   • Balm Tea and Magick
10. Small Beer
    A weak and second-rate beer. Traditionally, two beers were brewed from the same mash. The lighter (and weaker) second beer was known as small beer.

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Disclaimer: This book was written nearly three centuries ago, long before such modern ideas as hygiene and germ theory. As a physician, I in no way recommend the treatment suggested above. If you have a chest pain, see a doctor (and quickly!). This excerpt is presented merely for interest and entertainment.

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Previous looks at colonial medicine: Cough and Whooping Cough.

Of all the recent solo X-Men series, the one I least expected to enjoy was Gambit. Let’s face it: he’s been a horribly two-dimensional character ever since his first appearance. His other series have at best mildly diverting; at worst, a complete mess.

That’s why it came as a pleasant surprise that this latest series is so enjoyable. Writer John Layman made a wise choice in discarding all of the X-Men baggage. Only one other X-character has appeared in Gambit (the ubiquitous Wolverine), but that was in a situation designed entirely for humor.

This Gambit is a rogue (no pun intended), a charmer and an unrepentant thief. There are beautiful women, magicians, fortune tellers, backstabbing “friends” and betrayals galore… everything a good story needs. While the occult element seemed an awkward fit in Nightcrawler, it works perfectly in Gambit – but then the series does take place in New Orleans.

And did I mention Brother Voodoo? He’s already appeared in both storylines. In the first, he was merely a background character, but in the latest storyline he’s a full player (and with more power than I remember him having).

In the recent nostalgia boom (both in comics and elsewhere), there was one group that I noticed had been left out. That was remedied last night when one of the Shogun Warriors showed up on Robot Chicken. Fighting in the ring in the Yakuza Fighter World Championship, he was just like I remembered with flying fists and a weird little spaceship.

I never had the Shogun Warrior toys growing up, but I did have several of the Shogun Warrior models. I had Mazinga, Dragun and Gaiking. They were all put together badly, but at least they had paint — unlike most of my models. I liked modeling, but I was never any good at it. I simply didn’t have the patience or the eye-hand coordination to do a good job. That never stopped me from trying though. I had a whole shelf in my bedroom for the models I built. There were the Shogun Warriors, a dirty-white Star Wars X-Wing fighter, a smudgedthe see-through frog (with all the internal organs), the USS Missouri, an SR-71 and a P-51 Mustang (with a single bladed propeller). They were ugly and poorly done, and I knew it, but I was proud of them anyway.

Grand Rounds XXX, the best of the week’s medical blogging, is posted by GrrlScientist over at Living the Scientific Life

Yarr, mateys! Thar be spoilers below!

A pregnant woman has is admitted to the hospital for changes in her mental status. Dr. Chase suspects that this is pre-eclampsia (sometimes called “toxemia of pregnancy”) – but seems not to notice that she is missing the three cardinal signs: edema in the feet, high blood pressure and protein in the urine. Sure, she has some abnormal liver labs and that does happen with pre-eclampsia, so I’ll give him a pass on this one. Dr. Foreman thinks that she has some form of vasculitis. Dr. Cameron…isn’t around because she quit last week. Labs and radiology studies quickly show that both of these diagnoses are wrong.

When the patient develops trouble swallowing, House orders a CT scan of her chest which shows a prominent lung cancer. Her neurological symptoms were due to a paraneoplastic syndrome caused by this cancer. This is a very aggressive cancer and Dr. Wilson wants to start treatment as soon as possible. This would require an immediate caesarean section, but the patient refuses because she wants to carry the baby longer and give it a better chance at life. She confides to House that her first child died of Alexander’s Disease and she wants to give this second baby every chance. He reassures her that babies born at 28 weeks gestation (as opposed to the normal 40) have a high survival rate and ultimately she agrees to the c-section.

House enrolls her in an experimental study, but she is turned down abruptly once the researcher in charge is informed she is pregnant. Before any other action can be taken, the patient develops a pulmonary embolus. House presents her husband with a choice: his wife or the baby, because he states that a c-section will kill her “in her weakened condition”, but treating the pulmonary embolus will most likely kill the baby. The husband chooses his wife, but she hemorrhages during the procedure and as she dies a c-section is performed to save the baby.

A strong episode that was never going to have a happy ending. The medicine was pretty good. I’m disappointed in Dr. Chase’s call of pre-eclampsia (as I explained earlier), but Foreman’s theory made sense. The lung cancer and paraneoplastic syndrome diagnosis made for some good drama. House is right that the survival rate for a 28-week premature infant is decent, but he neglects to point out the key fact that most of these premature babies have severe problems both in the nurseyr and later on in life. The wife-or-baby choice seems a little forces and I can’t really see why they can’t try both (but then I’m not an obstetrician or a critical care physician).

Some nit-picks:
1) The doctors are once again doing their own ultrasounds (and how good is