Polite Dissent

Batman #672, #673, and #674 “Space Medicine,” “Joe Chill in Hell,” and “Batman Dies at Dawn” Grant Morrison, writer Tony Daniels, penciler Batman is shot point blank in the chest by the mysterious “Third Batman” (a police officer once trained to take Batman’s place if he were to die), which causes his heart to stop. Batman collapses, but is later revived when the Third Batman shocks his heart back into a normal rhythm. At this point, Batman exclaims: “My God — I had a heart attack — on the roof of the GCPD — “ There are a handful of problems with this scenario: #1. There is a difference between a cardiac arrest and a heart attack. A cardiac arrest occurs, as the name suggests, when the heart (cardiac) stops beating (arrest). Cardiac arrest can be caused by several different conditions, including a heart attack, an abnormal heart rhythm, trauma, and electrolyte abnormalities. A heart attack (”myocardial infarction” in medical-ese) occurs when one or more of the small arteries supplying the heart with blood are suddenly blocked and the heart can no longer obtain the oxygenated blood it needs to survive. The affected part of the heart muscle (myocardium) then dies (infarcts). If a large enough part of the heart dies, it can lead to a cardiac arrest and death, but it is certainly possible to have a heart attack without suffering a cardiac arrest. In the story, despite what he says, Batman suffered a cardiac arrest, not a heart attack. He developed an abnormal heart rhythm that degenerated into asystole (a flatline). This abnormal rhythm was brought about by direct trauma to the chest, a kind of commotio cordis (a condition which occurs when a blunt trauma to the chest happens at just the right instant in the heart cycle to disrupt the normal heart rhythm and cause a fatal arrhythmia and cardiac arrest. It is most common in children, and is thought to kills several Little Leaguers struck in the chest by baseballs every year. There have also been recorded cases of commotio cordis occurring in adults struck by a bullet who were wearing body armor, much like Batman in this situation). #2. After Batman slipped into asystole, he was brought back by the Third Batman using a defibrillator. I know I’ve covered this many time before, so everyone repeat after me: you don’t shock a flatline. It’s a bad idea — especially after several minutes of asystole have elapsed, as in this case. (Though Morrison is right that brain damage after a cardiac arrest starts at the five minute mark.) #3. The Third Batman appears to have defibrillated Batman through his uniform, which I always understood to be insulated. Or else he defibrillated him through the hole blown in his uniform, which would put the paddles in the wrong position to work. The art in the book actually suggests he defibrillated the right side of the chest (the wrong side), so I’m giving Daniels the benefit of the doubt and assuming he’s showing the moments leading up the actual defibrillation, as the Third Batman moves the paddles into position. Tags: comics medicine batman cardiac arrest defibrillation commotio cordisgrant morrison tony daniels

Personally ,I always find it best when delivering emotional news to actually face the patient.

(Look at him nervously adjusting his glasses — you just know he was the kind of father who was too embarrassed to explain the birds and the bees to his kids, so either handed them an old book to explain it, or just told them to “ask their mother.” How did he ever end up as a doctor?)

Scene from I Loved, Real Confession Stories #29 (September 1949), author and artist unknown.

scene from Checkmate #24 (Rucka/Trautman/Bennett)

Quick quiz here. What’s caught my eye as wrong in this panel? It’s not one of my top five writer or top five artist errors, but it’s so common, I’m starting to think it should be…

Hints: #1, #2, #3, #4, #5, #6

Previous picture quizzes

panels from Amazing Spider-Man #544 (Bob Gale/Phil Jimenez)

Isn’t it amazing how — despite Spider-Man angering J. Jonah Jameson enough to skyrocket his blood pressure by fifty points — his pulse remains perfectly stable, even when he’s flatlining.

(And Spider-Man, FYI, when you yell to the staff that JJJ is having a heart attack, he actually seems to be having a cardiac arrest, a different condition entirely. To your credit, you tried rescue breathing, but chest compressions would have been better choice. On the other hand, full credit to Phil Jimenez for drawing a good nasal canula.)

Continuing a look at psychic nosebleed in other media besides comic books. Today’s example comes from the science fiction television show Kyle XY.

Kyle XY is an original series on the ABC Family network featuring a pair of genetically altered teenagers: the eponymous Kyle, and his female counterpart Jessi. They both seem to be developing a wide variety of powers, both mental and physical in nature. However, whenever they push their powers, they end up suffering a nice little nosebleed.

Jessi

Kyle

The first scene takes place after Jessi uses her telekinetic powers to cheat at pool, and the second takes place after Kyle uses his powers to heal another character of cancer. Both scene come from Episode 19, Season 2: “The First Cut is the Deepest.”

All previous Psychic Nosebleed Zen posts

The All-New Atom #21 “Inside Out”
Rick Remender, writer
Pat Olliffe, penciler

Ryan (the “all-new Atom”) wants to see what’s going on inside his body, so he plans on shrinking to a microscopic size and entering one of his white corpuscles (white blood cell).

Ryan: Stage One: Diminution-mapping engine directs me into a corpuscle near the exterior of its nucleus.
Stage Two: By ratcheting the bangstick to super speed, I should be able to exponentially multiply size reduction, thus squeezing between the negatively charged electron cloud surrounding the exterior of the nucleus.

I think Ryan is confusing the nucleus of a cell (in this case a white blood cell), and the nucleus of an atom. Same word, two very different situations.

A corpuscle’s nucleus is surrounded a specialized membrane called the nuclear envelope. An electron cloud surrounds an atomic nucleus.

(OK, technically, what Ryan is saying could be construed as correct in that the cell membrane is made up of millions of atoms which each have their own electron cloud, but I don’t think that’s what he meant.)

A Cell Nucleus	An Atomic Nucleus and Electron Cloud

Not a reference to a Depeche Mode song — but maybe the song is based on this 1961 public service ad that deals with treating all races as equal. This isn’t the first PSA with the title “People are People,” that honor belongs to a far superior Superman PSA that conveys pretty much the same theme and was published nearly a decade earlier in 1953 (and in my review of that PSA, I made the same sad Depeche Mode joke).

Click on the image to the right for the full ad.

Unlike the Superman PSA, this one ties into the United Nations, a theme that would crop up commonly in DC PSAs of this era.

As usual for these PSAs, this PSA is written by Jack Schiff. Art chores are handled by Lou Cameron this time around.

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scene from Detective Comics #41 (Finger, Kane, et. al.)

Apparently Bruce Wayne has never heard of a “Phantom Limb” — a term in use since the late 19th century. Most people (50-80%) who have had amputated limbs will still feel the occasional sensation — pain usually, but itching is also common — in the missing limb. So it’s not really that surprising that the Colonel would unconsciously scratch his missing leg.

A more telling sign that it was not the real Colonel would be the limp, or lack thereof. Prosthetic limbs were notoriously bad in the 1930s and ’40s, so the Colonel should have a limp that would be very recognizable to his old friend Bruce Wayne.

Medications extracted from animal glands were once the mainstay of therapy for certain conditions. Hypothyroidism (low thyroid) was treated with Armour Thyroid, a medication derived from pig thyroids (and that’s Armour as in “Hot Dogs, Armour Hot Dogs…”). Diabetes was treated with insulin obtained from the glands of cows and pigs. There were problems with these medications: they were hard to dose correctly, nasty allergic reactions could occur, and you never knew how pure the source was — how do you know your insulin wasn’t made from a cow with BSE (Mad Cow Disease)?

These animal-gland derived medications have been almost entirely supplanted by synthetically produced thyroid hormone and insulin. There are still some patients who are resistant to changing over to the newer medications — generally because they feel that it is the only drug that works for them, or that the older medications are more “natural” — but they don’t always have a choice: Armour Thyroid is still available in the United States, but bovine and porcine insulin have been off the market for years.

Comic books take the concept of medication derived from animal glands and raise it to the next level. The rewards are greater — generally super powers of some kind — but the risks are also that much higher.

Take Kirk Langstrom: he developed a serum made from bat glands so that he could develop super-hearing and echolocation just like a bat. The serum worked, but too well: he gained painfully acute hearing. But that’s not all that happened: his bat gland serum also transformed into the bestial Man-Bat — half bat and half man.

For another example, we head back to 1953. In this pre-code horror story (titled appropriately enough “The Monkey Glands”), a ne’er do well brother is determined to outlive his elder brother so that he can inherit the family fortune. Having heard that an extract of monkey glands can restore youth, he acquires a pair of monkeys and obtains the serum. He injects the solution, and sure enough, his wrinkles fade and he gains that youthful glow. Unfortunately, a short time later…well, just look for yourself (and I highly suggest you check out the full story over at The Horrors of it All).

Overall, it seems that there are 5 Steps to Developing and Using a Comic Book Animal Gland Serum:
1. Obtain the desired animal
2. Derive a serum from its glands (but note: which glands in particular are never specified).
3. Inject said serum into yourself.
4. Gain the promised benefits.
5. Turn into a freakish half-man/half-animal

With all the recent discussion of animal-based serums, I would be remiss if I didn’t mention one of the greatest stories ever about such a concoction: Stanley Weinbaum’s The Adaptive Ultimate.

It’s not a comic book story, but instead a classic pulp science fiction short story from 1935. The setup is simple: a scientist creates a serum from drosophila (the fruit fly), knowing it is one of the most adaptive animals in the world. He and his partner inject the serum into a dying woman, figuring it is her last chance of survival. The patient not only survives, but she thrives in ways the scientists could have never predicted. The rest of the story deals with what happens with a woman who has the ability to literally adapt to anything.

Stanley Weinbaum, sadly, is a mostly forgotten science fiction writer from the 1930s. He died young, only 18 months after publishing his first story, so didn’t have the chance to produce many stories. He may have only written a handful of stories, but they’re all well worth reading. From the medical science point of view, Parasite Planet and Redemption Cairn are the most interesting. The planet Venus is the setting of Parasite Planet — Weinbaum’s Venus is a jungle world so virulent that any living flesh exposed to the air for more than a second or two develops a score of deadly infections. At the other end of the spectrum, Redemption Cairn takes place on Europa, a world where there is no microscopic lifeforms, so there is no risk of infection at all.

Other favorite stories of mine include Mad Moon, Shifting Seas, and A Martian Odyssey, probably his best known story.

The Adaptive Ultimate is available from Project Guttenberg (the Australian site anyway — I suspect it may not quite be public domain in the U.S. yet). Take a few minutes and read it, if you never have.

I also strongly recommend you pick The Best of Stanley Weinbaum, a 1974 collection of his works, including all the stories I mentioned above, available fairly inexpensively on Amazon and eBay.

In this scene from the final non-apocryphal Durham Red storyline (“The Empty Suns”), the mutant priest Father Syte gets psychically attacked by the grandaddy-of-all-evil-mutants, the Offspring. It’s not a pretty picture — no lack of Self Esteem here.

Durham Red is written by Dan Abnett with art by Mark Harrison. If you’re a United States reader, good luck finding any Durham Red books in the U.S. at anything resembling a reasonable price, though a few enterprising comic shops may have a copy or two stashed somewhere. Amazon UK is another option — though that’s not exactly in the U.S. now, is it? (Truth be told, it’s where I ended up buying the previous volume, Durham Red: The Vermin Stars, because they ahd the best deal, even factoring in shipping)

All previous Psychic Nosebleed Zen posts

This week’s Booster Gold #8 features the return of the one of the classic psychic nosebleeders: Max Lord. By rescuing Ted Kord, Booster has shifted the time stream so that Max Lord no longer died and the OMACs were never defeated. It’s not a pretty picture.

Mind control and nosebleeds seem to be Max’s defining characteristics now — not that he was ever that complex a character to begin with. Regardless, in celebration of his return to his psychic power abusing ways, here are some Max Lord haiku:

manipulator
likes to play with other minds
needs a red hanky

ran the Justice League
more or less a hero…once
always wears black now

drove Superman mad
psychic skills have a down side
nose goes drip drip drip

All previous Psychic Nosebleed Zen posts

This is a nicely dated PSA from 1960. While the message remains good, the examples — or at least the illustration of the examples — clearly show the era this PSA is from.

Click on the image to the right for the full ad.

While this ad was clearly written for kids, I think it reads as much as a warning about lax parenting; an alternate title would be “How Are Your Parenting Skills?” Mom shares a large part of the blame for every example of Jimmy’s misbehavior. He’s an eight year-old boy, he has the attention span of a gnat. He needs much more hands on parenting. She saw Jimmy “hot-rodding” with the shopping cart — why didn’t she stop him? Where was she when he was messing up the magazines or racing down the escalator. Her opening sentence shows the entire problem — she agrees to give Jimmy a reward despite his poor behavior. What’s he really learned in this day of shopping? He’s learned that Mom will still buy him a soda even when he’s a terror.

This PSA was written by Jack Schiff with art by Bernard Baily. It appeared in various October 1960 issue of DC comics, including Brave and Bold #32 (the source of this scan), Batman #135, Superman’s Pal Jimmy Olsen #48, Wonder Woman #117, and — of course — Sugar & Spike #31.

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I’m impressed that Vixen is able to tell that the dozens of dead people she stumbled across died of “cerebral hemorrhage” (bleeding in or around the brain) or a “burst heart”, since neither of these leave noticeable external marks or signs. Generally it takes an autopsy or some sort of radiology (e.g. x-ray or CT scan) to diagnose these.

Click on the image for the full ad.

NOW — at last — a new scientific idea which guarantees you can lose as much weight as you wish!

No hardship! No exhausting exercise! drugs, or laxatives. Here’s the new modern way to reduce…to acquire an improved figure and the slimmer, exciting, more graceful silhouette you’ve dreamed about.

Simply chew Special Formula Chewing Gum and follow the Doctor’s Plan. This tasty wholesome chewing gum possess Sorbitol, is sugar-free, and reduces appetite. Sorbitol is a new discovery and contains no fat and no available carbohydrates. Just chew this delicious gum and reduce with the Doctor’s Plan!

This ad for weight loss gum comes from the romance comic Lovelorn #39, published in July 1953. According to the ad, the gum contains the miracle ingredient Sorbitol.

Sorbitol is still used today, 55 years later. It certainly is no miracle weight loss agent — it has it’s uses, but it also has some significant side-effects.

Sorbitol is a type of chemical known as a sugar alcohol. It is roughly 60% as sweet as sugar and is used as an artificial sweetener in many sugar-free products including chewing gum, diet soda, ice cream, mouthwash, and toothpaste. Sorbitol cannot be broken down by oral bacteria, so does not contribute to tooth decay. It gives off a cooling sensation, and is used in mints, gums, and the like for that purpose as well as its sweet flavor.

Despite what the ad states, Sorbitol is a fairly potent laxative. Though not intentionally ingested, enough Sorbitol can be swallowed from chewing gum to lead to some unpleasant side effects.

In terms of weight loss, Sorbitol is definitely no miracle cure. It has fewer calories than sugar, and some people find that chewing gum can help them lose weight, so I guess it has that going for it. The laxative side effect can also lead to weight loss, but that’s not a healthy way to go about losing weight. I suspect the actual weight loss touted in this ad comes from the “Doctor’s Plan” they keep mentioning — and that it’s nothing more than a low-calorie diet (you’ll notice that nowhere in the ad does is state “no diet” or “no dieting”.)

Just so everyone doesn’t think I just pick on comic books and television (and the occasional movie), today’s Picture Quiz comes straight from the pages of this week’s Newsweek.

What are the error(s) in the image reproduced above? It comes from the article “A New Reason to Frown” and is about potential problems recently discovered with Botox injections. For those of you who want to play along at home, it’s on page 45 of the April 21st edition of the magazine.

Previous picture quizzes

In Suicide Squad #17, the villainous team Jihad attacks New York City in revenge for the United States sending the Suicide Squad to pre-emptively attack Jihad earlier in the series. In this scene, the villain Badb (named after an Irish goddess) attacks a crowd waiting for the subway.

This scene sets up the CSI: Suicide Squad post from earlier this week.

In this storyline, a reason for Badb’s victims exhibiting a nosebleed is given. It makes no sense anatomically, but at least the attempt is made. Her powers cause a cerebral hemorrhage (bleeding in or around the brain), and this is what causes the nosebleed. Of course in real life, the brain is encased in the dura mater (a thick membrane surrounding the brain) and the skull. There’s no way bleeding in the brain will leak out without a major physical trauma as well — but maybe the anatomy of the head is different in the DC Universe.

All previous Psychic Nosebleed Zen posts

I’ve decided it was finally time to get around to blogging about Armageddon 2001, and what ended up being the coda on Karl and Barbara Kesel’s run on Hawk and Dove. For those of you who may not remember, Armageddon 2001 was the “big event” comic series of 1991. It started off promising, but whimpered to an end — and took Hawk and Dove down with it.

Armageddon 2001 #1
In the future — the year 2030 to be precise — Matthew Rider is one of the world’s top physicists. He is an unhappy man, though. The future of 2030 is a dystopian fascist state, ruled over by the all powerful despot Monarch. Not much is known of Monarch’s past because he’s done his best to wipe out all historical records. All that Ryder knows is that Monarch was once a super-hero, but something happened in the year 1991 that caused him to become Monarch. By the year 2001, Monarch had destroyed all his fellow heroes and taken over as the unquestioned ruler of the world. It is clear that Ryder longs for the world before Monarch, when all the other heroes were still alive, and free thought and expression were allowed. As a young child, he was rescued by one of those heroes on that fateful day in 1991, but he cannot recall who, and the thought has haunted him for the past forty years.

Other scientists working for Monarch have discovered the secret of time travel, but their human test subjects have not survived the experience. Ryder volunteers for the program, but he is turned down because of his anti-state tendencies. Undaunted, Ryder is able to meet and convince Monarch that he has the will to survive that the other test subjects lacked, which Ryder argues will allow him to survive the time travel. Monarch is intrigued, but concerned about sending such an obvious malcontent back in time. However, he believes that Ryder’s love for his family will keep on the straight and narrow, so he agrees for Ryder to become a test subject. What Ryder has kept hidden is that the love of his family is overshadowed by the possibility of destroying Monarch once and for all, and that is the real reason he wants to travel into the past.

Ryder enters the machine and is sent back through the time stream to the year 1991 (coincidentally the same year these comics were published). Along the way, Matthew Ryder becomes the super-hero Waverider, who has the ability to see the events of someone’s future just by touching them. He resolves to use his power to find out which hero will become Monarch so that he can put an end to him before it happens.

The Armageddon 2001 Annuals
The DC Comics annuals published in the summer of 1991 all started the same way: Waverider shows up and touches the hero, revealing their future ten or more years down the line, searching to see if they will become Monarch (and none of them do). Most of these comics were surprisingly good, far better than most other themed annuals (Atlantis Attacks **cough cough** Days of Future Present). I covered the Hawk and Dove Armageddon 2001 Annual in more depth previously.

Armageddon 2001 #2
The second and final issue of Armageddon 2001 starts with Waverider touching Captain Atom and revealing his future. It is a dim and dark future that ends unhappily for pretty much the entire world. Captain Atom does not become Monarch, but he is just as much a threat to his own future. The shock of seeing what might happen causes Atom to briefly lose control of his quantum field. It’s just a momentary lapse, but it’s enough for Monarch to slip through into the present (well, the present of 1991). It seems he had followed Ryder into the past, but was prevented from entering by Atom’s quantum field.

Once Monarch has appeared, he wastes little time in attacking the Justice League. In the middle of the battle, he teleports away, but later informs the heroes that they must all meet him in Metropolis at 3PM the following day, or he will destroy the world.

In the meantime, Monarch puts his plan into motion. He shows up at the remote campsite where Dawn Granger (Dove) and her boyfriend Brian Arsala are having a romantic weekend. Without batting an eye, Monarch slaughters Brian and them immobilizes and kidnaps Dawn once she turns into Dove. Next, Monarch confronts Hank Hall (Hawk). He goads Hank into becoming Hawk, then immobilizes and kidnaps him as well. Monarch then snatches a variety of scientific equipment from around the world to build a specialized Neutron Bomb designed to kill every super-hero.

Before putting his plan into action, Monarch announces to Hawk and Dove that he still has two things to take care of. He grabs Dove and kills her, right before Hawk’s eyes. The sight of his partner’s murder and the loss of her “balance” is enough to drive Hawk mad. He attacks and kills Monarch only to discover that Monarch is actually the future Hank Hall. This knowledge sends him even farther over the edge, and he decides to become Monarch so that he can create his own balance in the world. He dons Monarch’s armor, takes his plans and weapons, and teleports off to fight all the heroes in Metropolis.

It’s an epic battle, but Monarch seems to have the edge. Then Captain Atom unleashes his full powers and they interact with Monarch’s, sending them both tumbling into the distant reaches of time stream. Meanwhile, Matthew Ryder discovers that the hero who saved his life on this day was none other than himself, as Waverider (and who didn’t see this coming?).

The Controversy
Did the ending of the series seem nonsensical, out of character, and cobbled together at the last minute? Well, it was.

In the original story, Captain Atom was to become Monarch. Clues were planted throughout the series and annuals pointing to him. But then somebody prematurely gave it away, and DC decided to rewrite the ending. That’s why it makes little sense — it was never supposed to be Hawk in the first place (for instance, you’ll notice Monarch has bright blue eyes in issue #1 — just like Captain Atom — but in issue #2, they’re suddenly brown like Hank Hall’s).
Wikipedia has a concise explanation of the controversy, and here’s a page I scanned in from Wizard #179 that interviews some of the key players.

The End?
So is this the end of Hawk and Dove? Yes and no. The Hawk and Dove redesigned by Karl and Barbara Kesel — based on the works of Ditko and Skeates — are gone. Hank Hall and Dawn Granger still make a few more appearances in one way or another, and I’ll cover that soon in an epilogue post. In the past few years, Dawn has taken up the mantle of Dove again, but with a heretofore unmentioned sister as Hawk (and there was the Mike Baron penned Hawk and Dove series in 1997 that bore no relation to the original at all, but the less said about that, the better). Then there is Infinite Crisis and its aftermath. Continuity seems to have been re-written (or corrected) so that Captain Atom is once again Monarch. But then, what happened to Hank Hall? Was he ever Monarch in this new continuity, or was it Captain Atom all along?

All Previous Hawk and Dove Reviews

Tags: comics hawk dove armageddon 2001 monarch waverider captain atom

A different look for today’s PSA: it’s not your standard story-with-a-moral, but instead a quick, almost cartoony, look at scientific discoveries and the technologies that result from it. It also ends on a medical note, and I’m all for that, so remember: “Take advantage of the latest in science — get a regular physical exam and immunization against polio, tetanus, and other diseases.”

Of course, the “regular physical exam” hasn’t really changed in the past twenty or thirty years, so it’s hardly cutting edge science, but I guess it’s the thought that counts.

Click on the image above for the full ad.

Despite the change in style, the Grand Comic Database still cerdits Jack Schiff, DC’s prolific PSA writer, with the script. The art is thought to be by either Morris Waldinger or Tommy Nicolosi. This PSA appeared in the February 1962 issues of DC comics.

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The good old days — when candy was considered a health food!

RICH IN DEXTROSE
The sugar your body uses directly for ENERGY!

Or if that hasn’t convinced you:

Have more fun and more energy, too! Eat a Baby Ruth Candy Bar whenever you need an energy-boost to speed up your efforts. Its wholesome ingredients are rich in Dextrose to give you a delicious, nutritious treat. Baby Ruth tastes so good — it’s so good for you!

Just for fun, let’s compare some basic nutrition information for a Baby Ruth candy bar and today’s energy source of choice, a Monster Energy Drink (both standard sized). I’ll also throw in an apple for comparison:

Click on the ad to the right for the full image

	Baby Ruth	Monster	apple
Calories:	275	200	65
Carbs:	39g	52g	17g
Sugars:	32g	52g	13g

Ad from Captain America Comics #24, March 1943

“Somewhere in midtown Manhattan ‘Moe Barton,’ petty crook and stool pigeon, is found murdered in his room during a blackout test. Detective Mike Trapp from the Homicide Bureau is called into the case…”

from Captain America Comics #37, April 1944

For those of you having trouble reading the upside down answer, click here.

Hulk #3 “Creatures on the Loose”
Jeph Loeb, writer
Ed McGuinness, penciler

The retina is an extremely important part of the human body — it makes up the inside back of the eyeball and it’s what gives us the sense of sight. The retina has a variety of specialized photoreceptor cells that are capable of transforming light into nerve impulses. These impulses are transmitted to the optic areas of the brain and allow us to see. Each retina has a unique pattern of blood vessels. This uniqueness is what allows retinal scans to be used as a method of biometric identification.

Getting a good look at the retina is tricky — just ask any medical student.
1. Turn off all light sources but the ophthalmoscope, and keep that at its narrowest setting. You want the pupil to be as dilated as possible.
A wide light beam and a sunny desert day are not effective ways to get a good retinal scan.

2. Get right up to the patient and look through the ophthalmoscope and through their pupil at the retina. To get a good view of the retina you need to be right in front of the patient and as close as possible.
A scan from the side would only allow the viewing of a small slice of the outer edge of the retina, if that. With the lens of the eye involved, the optics can be tricky, so a short viewing distance is necessary: millimeters away, not inches.

Assuming a good retinal scan is acquired, that bring up an entirely different issue: the reliability of the scan itself. Retinal scanning the Hulk certainly seems to work in this comic, but I’m suspicious that it shouldn’t. When unnamed person changes into the Red Hulk, does their retina stay the same? The Hulk’s eyes, and thus his retinas, are much larger. They are going to need additional blood supply, so he’s either going to have to grow new retinal blood vessels, or increase the size of the ones already there (look at the profusion of bulging blood vessels that appear elsewhere on the Hulk’s body) Either of these is going to throw off the retinal scan algorithm.

I’ll grant that the retinal scan is a moderately clever way for Loeb to tease readers about the identity of the new Hulk, but the concept — and the way it’s illustrated — just wouldn’t work in this situation.

Tonight features the first of four new House episodes. It was a decently mediocre episode — not bad, but not particularly outstanding, either. Kind of “House Lite.” An episode recap, medical discussion, and spoilers follow!

Jeff, a carpet cleaner by trade, is spending his lunch hour with his wife, a nurse on the picket line in front of the hospital. While there, he starts to have nystagmus (twitching eyes) and then collapses. He is admitted to the hospital Emergency Room for evaluation, but — thanks to the chaos from the nursing strike — is given a low priority and basically sits there waiting for several hours. House, who is in the Emergency Room avoiding Cuddy, is perplexed by Jeff’s constant cheerfulness and niceness. He decides that something must wrong with him and admits him to his service for evaluation.

Jeff’s initial complaints are syncope (fainting), dysgeusia (altered sense of taste), and “niceness.” The altered taste (everything tastes like lemon meringue pie) and happiness have been present for eleven years. House suggests that Jeff may have a metabolic disorder, toxic exposure, carcinoma of the tongue which has spread to the brain, epilepsy, or multiple sclerosis. Taub suggests he just has the flu. House disagrees and orders Foreman and Kutner to search Jeff’s house for toxins, and tells Thirteen and Taub to check an MRI and EEG. The tests are normal, but the team searching the house finds carpet cleaning chemicals including hydrofluoric acid, which is known to affect calcium. From this, House deduces that Jeff has Williams Syndrome. Taub disagrees, pointing out that Jeff is missing some of the necessary symptoms to make the diagnosis including the characteristic facial appearance, lower than normal intelligence, and musical ability. While the team is arguing, Jeff suffers a stroke.

Thirteen suspects that Jeff has a heart defect (a patent foramen ovale) and this is what is causing his symptoms, but never gets the chance to run the test because the patient’s VDRL — a test for syphilis — has come back positive. The team now suspects that Jeff has neurosyphilis. He is started on penicillin to treat the syphilis, and a short time later he begins to vomit blood (”hematemesis”). According to the team, this could be from the syphilis, or it could be due to a reaction to the penicillin, carpet cleaners, or even alcohol. More tests are run and the patient is determined to have “hepatitis” — not viral hepatitis, but some other non-specified kind. House orders a test for sarcoid, and starts Jeff on steroids to treat the hepatitis.

Jeff’s wife returns to visit him, and he is uncharacteristically mean and angry. He then suffers a heart attack (which actually seems more like a cardiac arrest). The team considers the situation: is the rage due to the steroids (too soon; not as common on glucocorticoids as anabolic steroids), a penicillin allergy, a heart defect, or maybe his real personality finally re-emerging? In the middle of an echocardiogram to look for a heart defect, Kutner has an epiphany. The patient doesn’t have syphilis — he has another condition which gives a false positive VDRL result. Jeff has Chagas Disease, a rare parasitic condition (rare in the U.S., at least) which he picked up while in the Peace Corps. He has had a low-level encephalitis since then, and the immune suppression from the steroids caused it to flare up and his symptoms — the anger — worsen. He is started on the appropriate treatment and House assures him that he will be cured in a month — but what personality is the real personality?

I don’t have too much to comment about this one, medically. In this episode, the medicine was clearly secondary to the personality issues (What is Jeff’s real personality? and House vs. Amber). House and the team skipped over a bunch of more common causes of Jeff’s symptoms, going straight for the obscure. They then focused on these obscure causes, when some simple — and frankly standard of care — follow-up tests would have shown them their error from the beginning.

Syphilis antibody tests such as the VDRL are notorious for their false positives. That’s why you always run a confirmatory test such as the FTA-ABS, which was never done. For neurosyphilis, you should test the spinal fluid and not just the blood. Many different things can cause a false positive VDRL, not just Chagas Disease. The list includes HIV, Lupus and other autoimmune diseases, Lyme disease, mycoplasma, hepatitis, mononucleosis, and certain drugs.

Despite what House implies, cure rates for chronic Chagas Disease are dismally low. Treatment is not recommended for those who have been infected for over 10 years due to the low success rates (less than 25%). By this late in the disease, the damage to the heart and other organs has been done — this damage cannot be reversed, but can be fixed with appropriate medications, and in some cases, surgery.

I give the medical mystery a B+ because it brought up some interesting points — is being too happy a bad sign? And if so, is being too curmudgeonly equally bad? The final solution was moderately clever, but even more an out-of-the-blue answer than usual, earning a C. The medicine was weak and sloppy throughout and could have been handled better by a second year medical student; it deserves only a measly D. The House/Amber/Wilson/Cuddy soap opera was good, the House-has-syphilis not as good. Still, I give the soap opera aspect a generous A-.

(And as an aside, why would House and Amber submit to Cuddy’s punishment? When has House ever done anything Cuddy has said, and what power does she have over Amber?)

The previous House review
A list of all prior House reviews

Challenge scores will be posted later, probably tomorrow

“Brenda Kane, famed actress of the stage is found murdered in her dressing room — we find Mike Trapp at the scene of the crime”

from Captain America Comics #40, July1944

For those of you having trouble reading the upside down answer, click here.