Spider-Palm: Number 3

THE TRANSFORMATION

To recap: Parker is bit by the radioactive spider that is also a genetic hybrid of three different breeds of spider, one of which happens to be an excellent and prolific web-spinner. The venom, or some DNA from the spider's saliva, or something starts to do a number on Parker and his immune system. He goes to bed with flu like symptoms(1).

During the night, fibroblasts and myoblasts(2) migrate to Parker's palms because he has been chronically abrading them from some unkown activity, which he may have been performing that night, despite his illness. The fibroblasts form a bursa in each palm, full of synovial fluid that is altered by the spider's venom, or DNA, so that it dehydrates quickly, is adhesive instead of slimy, and has incredible tensile qualities.

Myoblast (Looks a little like a fibroblast, doesn't it?)

For more images of muscle cells and structures, click here.

Now, here is my more fanciful stretch of the imagination(3): myoblasts, found in the repairing injured tissue of Parker's inflamed palm, infuse and strengthen the structure of the bursa. Normally they would weaken or recede after repair is complete. These cells, thanks to the spider DNA, become incredibly strong smooth muscle cells, much like the cells that line one's intestine(4). Come to think of it, since Parker's skeletal muscle is transformed into incredibly strong tissue, it stands to reason that the smooth muscle in his gut (and everywhere else) is now super-strong as well.

Smooth muscle contracts with a wave-like actions known as peristalsis. This coordinated rippling in the gut gets your food through your digestive tract and excreted through your other end(5).

Mechanics of peristalsis

A photo of peristalsis in a horse's gut

(The principle is the same)

WHERE'S THE HOLE?

Parker aims his wrist at a distant object, flexes his third and fourth fingers, pressing into his newly formed bursa as he hyperextends his wrist to increase pressure on the fluid deep within the new sac of palmar fascia. The smooth muscle around the bursa contracts with peristaltic Spidey-strength and propels a mighty stream of whitish sticky stuff out his... wait a minute...

Wrist technique

My God!!! Parker has no hole! (In his wrist.) He has to have a hole there or nothing is going to come out. And how can Parker release a precise stream of fluid propelled for tens of yards on muscle power alone without a sphincter to control that mighty stream?

Only a scar

At his wrist we see a shot of a star-shaped scar-like structure, but there is no opening in his skin. there has to be a flap, or slit in the skin, or a miniature anus, or something. i understand that the producers might have felt that showing a puckered little sphincter or even a urethra-like opening on Parker's wrists might be a mood killer, but authenticity is important!

We're supposed to believe that these super-spider-DNA-enhanced-bursae with peristaltic sphincter propulsion just magically transport this sticky fluid through his palms and onto buildings without an opening in his skin? If there's no hole there, then how is any of this believable? My day has been ruined! Now I feel foolish analyzing this whole scenario, which obviously can't occur due to a simple lack of aperture!

Next, they'll be trying to get us to suspend disbelief as we watch some guy hook himself up to a robot with tentacles, that takes over his mind during a lab accident.

Doc Ock

Speaking of robots, well robots and cyborgs, next time we will look at a few moments from the new Terminator movie.

1. For more about flu like symptoms you can see Spidey Palm 1 (5/04/09). For you trivia buffs, Star Trek also relies on flu like symptoms for a small bit of plot (5/10/09).

2. Myoblasts are the cells from which all three types of muscle tissue develops, in utero. A type of myoblast helps repair injured tissues in adults. The textbook Human Anatomy and Physiology by Marieb and Hoehn, 7th Edition, 2007 from Pearson Benjamin Cummins, pp. 316-317, has an interesting explanation of myoblasts and what they do.

3. As if the rest of this was "sound science."

4. There are three kinds of muscle tissue: cardiac, found in (you guessed it!) the heart; smooth, found in glands and tubular organs; and skeletal, attaching mostly to bone. This is the type of muscle we use to move around with, and we eat as steak.

5. Anus. There. I said it. You have an anus, as do I, as does Peter Parker, and Mary Jane Watson. Plural of anus can be either anuses or anii.

Star Date: 2253.04

I saw Star Trek last night. Great movie! It has lots of action and aesthetically pleasing blood, which are two of my main priorities for this type of film.

Why am I interrupting the Spider-Man posts to talk about Star Trek? Well, dammit, Jim! This is important, man! It seemed like a good idea to go over a couple medical points that stood out. They were remarkable enough for me to try and take a couple notes in a dark theater, but shouldn't interfere with your enjoyment of the movie, in the least. Minor spoilers (for the extremely sensitive) follow.

Boy Spock: This is not the shot in discussion. I couldn't find that one on the IMDB

RED EARS, GREEN BLOOD

There is so much that is good about this movie, I don't want you to think I didn't enjoy it. The baby delivery scene is a hoot! But I did notice something that seemed like a bit of an oversight in a later shot that could have been corrected easily(1).

What was the problem? Boy Spock's ears. We see young Spock (Jacob Kogan), his lip split from a fight and oozing green blood, as he sits in front of a window, providing a flattering, glowing back light. He is impish and cute and has the look of an emotionless Vulcan school boy who knows he's been bad. The light from the window gently enfolds him and gives his little pointy ears a glowing pink tint.

This is where the record scratch sound that implies, "What the f---!" would come in. Don't get me wrong, the ear-glow is good. They make the prosthetic pointy ear (I assume it's a prosthetic) match its glow to Kogan's real ear, creating a seamless piece. But ears glow pink when light shines through them because of the red blood in the capillary beds of the ears.

I'm okay with green blood oozing from cute Vulcan red lips, this is art after all, but they missed an opportunity for a little finesse when they didn't make those ears glow green. The shot only lasts a few seconds. How hard can that be?

FLU LIKE SYMPTOMS

I just wanted to point out the scene where McCoy (Carl Urban) gives Kirk (Chris Pine) a vaccine so that Kirk will develop symptoms of illness and be taken on the Enterprise. He develops flu-like symptoms such as headache, nausea, fatigue, fever, etc. This is true of many vaccines for many diseases. They also added some colorful symptoms like blindness in the left eye. This sequence is not too far off base, but extremely sped up to keep the plot moving. An injection may be able to get into your bloodstream in seconds, but it is still going to take your body hours or days to react to the pathogens in the vaccine(2).

Kirk has an allergic reaction to the shot. This is a Type I hypersensitivity reaction. His hands and tongue swell. He's lucky he can still breathe. People who get swollen tongues often get swollen lips, and not like they've had a bit too much collagen injected there, either. Think of having a child's football attached to your face. This doesn't happen to Kirk, only his hands are disfigured by swelling, and he can't talk. It may be the severest reaction McCoy has seen to the vaccine, but Kirk is lucky nonetheless.

McCoy orders something that sounds like "cortisone" to be given to Kirk. Epinephrine-like drugs will probably still be the drug of choice in the future over a cortisone-like drug. Epi-pens are used for these types of emergencies, currently. But what do I know, I'm not a pharmacologist by any stretch of the imagination. That stuff is hard.

Vulcan nerve pinch: note the third and fourth finger placement over the area of the right brachial plexus as it emerges from the scalenes.

Brachial plexus

VULCAN PINCHES

This Vulcan nerve pinch thing cracks me up. As a massage therapist I can put people into exquisite pain by squeezing the upper trapezius or anterior and middle scalene muscles, but I have yet to be able to render a patient unconscious. Lord knows I've tried.

Anatomically speaking, the only bundle of nerves in the area is the brachial plexus, which is composed of nerves leaving the vertebrae of the neck. They pass between the two scalenes mentioned above, and then form a number of nerves that innervate the arm and hand.

Squeezing the brachial plexus with the Vulcan nerve pinch won't effect the brain, but could cause someone to develop a bad case of Carpal Tunnel Syndrome, or Thoracic Outlet Syndrome, or in extreme cases paralysis of the upper extremity.

This being said, I assume the nerve pinch is only doable by Vulcans because it involves some sort of telepathy, or mind-meldy thing to make it work.

ROSEY BLUSH

One last thing: Spock (Zachary Quinto) tries to strangle Kirk. When Spock releases him, Kirk has ruddy finger marks on his neck. Nice touch!

Next time we continue our discussion of fibroblasts and Spider-Man's biological web spinning abilities... I swear it!

1. If you have an extra million dollars lying around for things like this.

2. For more on flu-like symptoms, go to the first Spider-Man post.

Spider-Palm: Number 2

Spider-Man

FIBROBLASTS

Fibroblasts? Really, fibroblasts as the key to engineering Spider-Man's web-squirting palms? Yes, fibroblasts. They even sound cool.

What are fibroblasts? They're cells that build connective tissue. They hang out in fascia, tendons, joint capsules, and other connective tissues and produce tough bundles of fibers made out of collagen. In a way, you could say that fibroblasts can spin a web, any size(1)!

Fibroblasts

Collagen

Fascia

When you tear a muscle or get tendinitis, or bruise or cut yourself, an inflammatory reaction results which helps to promote a series of events that will help repair dead or damaged tissues(2). Fibroblasts and some special types of muscle cells will move into the area to repair the damaged tissue. This repair process usually results in a scar.

Sometimes if a tendon, or the superficial connective tissue below the skin, becomes chronically stressed, abraded, and inflamed, fibroblasts will migrate to the area and begin to form a sack of connective tissue called a bursa, to try and cushion the area being stressed.

Bursa

What does a knee have to do with bursae? They're everywhere, that's what. If you want to experience a bursa first hand, pinch up the skin over your knee cap and roll it between your fingers. Feel how slippery it is inside? That's because there's a (pre-patellar) bursa there and you are rolling its slimy surfaces across one another.

SLIME BAG

Bursae(3) are normal parts of the musculoskeletal system. They are connective tissue sacks full of slimy synovial fluid(4). They are usually located between a tendon and a bone and provide cushioning to protect the tendon and its muscle from injury. The German word for bursa is schleimbeutel, which means "slime bag," which is exactly what they are. I love German!

As I said, you can grow extra bursae if you're chronically irritating an area. So... what kind of activity could a teenage male be engaged in on a regular basis that would create so much friction and abrasion of the palms, that his body would need to alter his palmar structure to protect it? Hmmmmm... it would have to be some kind of grasping, or rubbing, repetitive activity, performed regularly over weeks or months. I'm sure I can't think of anything.

Next time I'll tie these parts together to describe Parker's incredible transformation...

1. Is anyone keeping track of how many times I have recycled this joke?

2. For you trivia buffs, this inflammatory reaction is pretty much the same type of thing that I mentioned in the posts about Face/Off. The context is slightly different, but once again, we see that the body has only a limited number of ways to respond to trouble, and inflammation is a common response. Inflammation is also the reaction that would cause those hives Peter was experiencing in my last post.

3. Bursa is singular, bursae (pronounced bursay, or bursee, depending on who's arguing the loudest) is plural.

4. Synovial fluid is a slimy substance with the consistency of egg whites. It's just like that, really. I dissected a cadaver once and there was still synovial fluid in his knee. It's very clingy. Ick! Synovial fluid is secreted by a membrane called the (you guessed it!) synovial membrane, which lines the bursa, and also lines the inside of your joint capsules. The stuff helps lubricate surfaces to reduce wear and tear as they slide across one another.

Spider-Palm: Number 1

THE CHALLENGE

One of my anatomy students has asked me to explain Spider-Man's web squirting ability in one of my posts. How could I resist the opportunity to make jokes about the sticky palms of teenage males? I couldn't. I didn't even try. But I will try to keep myself in check and only crack wise at every fifth opportunity.

The bite

In both the comic and the movie (starring Toby Maguire as Peter Parker and directed by Sam Raimi), Peter is bitten by a genetically altered radioactive spider whose venom transforms Parker physically into the Spider-Man.

As we all know, Spider-Man's biological web making skills are not an issue in the comic book because although Parker was bitten by a spider, he devised a mechanical device that he straps to his wrist, by which to spin a web (any size!)

Steve Ditko drawing from Amazing Fantasy 15

(Being married to a cartoonist comes in handy!)

For this particular film, my challenge is to support the story by explaning the physiology behind the physical metamorphosis that Parker undergoes in teh movie. Let's start with his reaction to the spider's bit.

FLU LIKE SYMPTOMS

Here's a riddle: What do you get when you cross malaria with measles, Lyme disease, AIDS, and the flu? The answer is: Flu like symptoms! Ha! Ha!

Whenever your body is invaded by a pathogen, you fight it off in the best way you know how, which often means an elevated body temperature (fever) and some other events that help to boost up your immune system. The result is headache, malaise, muscle aches, fatigue, chills, etc. It doesn't matter whether the pathogen is something that will kill you or just make you miserable for a week, you body will usually respond the same way to practically anything.

So Parker gets bit by the spider and what happens? He ends up in bed with flu like symptoms or something. He sweats, he's shaky, a little delirious, probably has a headache, etc.

Flu like symptoms

URTICARIA

He also develops some lesions on his skin. Some diseases, like chicken pox or measles cause skin lesions, but can skin eruptions be the result of insect bites? Sure, a common disease caused by an insect bite is Lyme disease(1), which produces a bulls-eye rash at the site of the bite. Come to think of it, Parker gets a tiny bulls-eye rash at the bite, and skin lesions as well. Maybe the spider is also a vector for a radioactive bacteria? No... that's crazy.

Parker's bulls-eye like rash

Sign of Lyme disease: a bulls-eye rash

Parker gets a bunch of other welts over his forearms and not just at the site of the sting. commonly, one would only find a skin lesion at the area of the bite. Perhaps Parker is having an allergic reaction(2) to the radioactive spider venom. As far as make up goes, those hives (urticaria) are good and pronounced, but personally I'd like to see them pinker.

The welts work for allergic urticaria as is, but pink or ruddy skin indicates a perfusion of blood in the tissues' capillary beds. If Parker is undergoing a physical metamorphosis, that process is going to require a lot of oxygen, nutrients, and waste removal, all of which would happen via the blood. A little more rouge would boost authenticity.

Parker's flu like symptoms are not only a sign of his body's attempts to combat the spider's venom, but also a sign of his heightened metabolism, as his cells transform themselves and reorganize his body into that of a super-strong creature able to squirt adhesive fluid from more than the usual places.

How did he do it? How did his body grow a bunch of liquid web that would propel itself out of his wrists? Here's the magic cell that I say did most of the work...

The amazing fibroblast!

For more amazing adventures, stay tuned for the next post!

1. Lyme disease is caused by a tick that carries bacteria in its saliva. The tick is a vector for disease, meaning it does not cause the disease itself, it carries the organism that causes it in its mouth. The bacteria are then transmitted to a new host and the host, if it's a person, develops Lyme Dissease.

2. Allergies to many stings are a Type I hypersensitivity reaction. An allergic victim of a sting can experience a severe reaction at the site of the bite, but also in other areas, such as the airway. Hives and swelling of the respiratory passages are common, and if severe enough can lead to death. It's possible that Parker is having a milder allergic reaction, although the welts would probably happen before he could get home. What an embarrassment! To be all welted up on a school bus, eyes watering, itching like crazy, wheezing, etc. and under the gaze of the girl you have a crush on, Mary Jane Watson (Kirsten Dunst)

Surgery in the time of THE ELEPHANT MAN

What kind of a cinematologist would I be if I didn't reference the surgery scene at the top of The Elephant Man? A mediocre one, I'd say.

As it happens, just for fun, I've been reading The Greatest Benefit to Mankind, a history of medicine by the late (great!) Roy Porter. The Greatest... can get a little encyclopedic, but Porter's other book, Blood & Guts: A short history of medicine has a lot of entertainment value, especially the chapter in which Porter describes catheterizing a penis with mercury as a cure for syphilis. Off topic I know, but the book is fascinating.

Where was I? Oh yes... When Fredrick Treves met J. Merrick in 1884, Treves was a surgeon at London Hospital. At the beginning of the film we see him (Anthony Hopkins) performing surgery on a man who has apparently been in an "industrial accident." In graphic black and white we see the man's open bloody abdomen rising and falling with his breath as the hospital staff work to save his life. The surgeons wear smocks, with cuffs protecting their shirtsleeves. They are bare-handed, they aren't wearing masks, and their breath and their hair can go anywhere, including into the patient's abdomen. Come to think of it, the patient's own hair from his chest or abdomen can get in there too. Brrr! If the man doesn't bleed to death, he still has a good chance of dying from infection.

A LITTLE ASEPSIS GOES A LONG WAY

By the 1880s, in Glasgow, Joseph Lister (think Listerine) had been working out his theories involving bacteria and aseptic(1) practices, but the idea of doctors being a source of infection themselves (via transmission of microorganisms) was still controversial.

At this point in history, nurses had been trained (by Florence Nightingale and others) to scrub every surface within an inch of its life. But, there was still a popular idea held by doctors and nurses alike, that miasma caused infection and death, not bacteria. Many medical people were willing to believe in bad air, but not in invisible little creatures like bacteria which could be on a seemingly clean surface or even blown around on the breath.

We can hope that in this surgery scene from the movie, some form of antiseptic(2) practice is in place. But at this time, it was common practice to roll up your shirt sleeves and don a surgical smock that was stiff with blood, having been worn by other surgeons previously and not laundered. Facemasks didn't come into vogue until the late 1890s. Rubber gloves were popular in dissection, but didn't get a grip in surgery until the late 80s or early 90s. Antiseptic and aseptic practices were also inconsistent. Lister sprayed carbolic acid all over himself, the patient, and his surgical team to cut down on germs, but he didn't make it a practice to scrub his hands, just dip them in carbolic.

ANESTHESIA

Here we see a shot in the scene with a breathing mask and what we must assume is chloroform, since ether was used in the 1840s for surgery, but replaced by chloroform pretty quickly. Apparently the stuff is safer to use, but I don't know why.

Can you believe that before the 1840s, surgeries (when they were done) were done without anesthesia??? Tumor removal, amputations, gallbladder and bladder stone removal, mastectomies... my various body parts are shrinking at the thought of getting cut into without the benefit of pain killers stronger than gin.

DO YOU SMELL SOMETHING BURNING?

Treves calmly takes a hot poker and cauterizes the patient's arteries, as needed. I thought the smoke in the scene particularly well done. I imagine there would have been a substantial smell to the procedure. I imagine there still is a smell, however these days I believe cautery is performed with an electrical charge or some kind of chemical on a stick, depending on the type of surgery, its location, and the amount of bleeding.

All in all, David Lynch managed to stay true to his own dream state trippy-ness and layer some very interesting medical history into a very poignant story. I highly recommend it.

NEXT TIME

I've had a request from one of my students: he asked me to describe the mechanism by which Spider-Man can squirt web out of his wrists. Young men and their curiosity about sticky palms! As we all know(3) Peter Parker in the comic strip had a mechanical web-squirting device. In the movie Peter is an organic squirter, so... Look out! ... Here comes the Spider-Man!

1. Asepsis means to exclude all microbes. Something that is sterilized has nothing at all living on it. As a colleague of mine often points out to his students, there is no such thing as partial sterilization.

2. Antisepsis means to prevent microbes from multiplying and getting out of hand, but they are still present, sometimes in a weakened condition.

3. Thanks to my cartoonist husband, R. Sikoryak.

THE ELEPHANT MAN part 3- Pain

J. HURT AS J. MERRICK

This will be the last entry about Proteus syndrome and The Elephant Man. Brace yourself: the entry is a little long and complicated because I'm still working through the diagnostic criteria chart from the Leslie Biesecker article from The European Journal of Human Genetics, mentioned in my April 2 post. Yes, I know that some people may be ready to go on to other things, like antiseptic practices in the late 1800s, or a description of how Spiderman could grow web-squirting organs in his palms. To them I say, "All In Good Time." I assume that most of you are willing to go the distance with David Lynch and J. Merrick. So here we go...

WHAT WOULD IT FEEL LIKE TO LIVE WITH PROTEUS SYNDROME?

Merrick's defomities probably threatened his life by crowding and compressing other tissues and structures in his body. It may be possible that his growths invaded other tissues, but that seems unlikely. Cancer is invasive. Benign tumors like fatty lipomas (more on these later) are not invasive, but when these growths and tumors reach a certain size, they can wreak a lot of havoc on the body.

Section of specific criteria for diagnosis of Proteus Syndrome

As we continue to compare David Lynch's J. Merrick to the Specific Criteria(1) for diagnosis of Proteus syndrome, I will also talk about the types of pain that it is likely Merrick was experiencing from his deformities. Because I'm a teacher specializing in pathology for massage therapists and I'm not a doctor (although I watch one on TV)(2), I'll be focussing mainly on pain Merrick may have felt from over-crowding tissues and musculoskeletal complications, although he certainly may have had many other sources of pain and discomfort.

Look at this picture of Merrick’s skeleton.

As we hear in the film, only his left arm and genitals escape deformity. We can see the bony hypertrophy(3) in Merrick’s right femur (thigh bone), upper extremity, and skull. Muscles attach to those bones and rub across them as they shorten and lengthen. Every time a muscle contracts, it presses into the bone beneath it. The pressure and movement generated by the muscle on the bone would be rubbing it "raw" continuously. Man, that's gotta hurt! The degeneration of his joints would make it severely painful to move those limbs and he would have extremely limited range of motion.

J. MERRICK

The deformity in his joints would cause uneven weight distribution, leading to inflammation and a painful arthritis. As if that weren't enough, those skin growths aren't as flexible as regular skin. They would be heavy, and restrict joint movement by not being able to stretch as Merrick lifted his arm or flexed his elbow. Come to think of it, the bulk of those growths could also get compressed as a joint moved, restricting motion. In the film Merrick limps and rarely uses his right arm and hand. When in public, he also covers his right arm and hand entirely, which means the task of make up would be easier.

RUB SOME SALT IN THOSE WOUNDS

In The Elephant Man, Merrick is beaten by the side show manager. Whether this really happened or not, the violence is off screen, but still very disturbing. I study stage combat as a hobby(4) and I appreciate effective violence. I found myself swept up in the scene and although I couldn't see it, I imagined poor Merrick with everything he'd gone through being caned by his manager. Merrick probably had chronic painful muscle spasm and joint pain from arthritis and postural deformity, he's horribly disfiguring by skin and connective tissue growths, and he's beaten! I envisioned that cane pummeling those cerebriform growths, which would have a pretty good blood supply, and the amount of bruising and pain those blows would cause. It makes my neck tense just to think about it.

Since Merrick was beaten in the film, the next logical question is: who would have spent time keeping Merrick's wounds clean if he weren't at the hospital? He couldn't do it himself. Even if those crevices on his back weren't injured, hygiene is extremely important for preventing skin infection and this was a time when hygienic practices weren't that popular.

Crevices in healthy skin are still susceptible to infection. Fungi love dark, warm, creases in the skin and Merrick certainly had a lot of them. Here's a normal armpit with a simple tinea (fungal) infection. ARMPIT

Even if Merrick's skin was intact, regular bathing and clean clothing would be imperative for maintaining skin health. It's not like he could just powder himself with Tinactin whenever there was a problem. Not only do we have pain, but itching with this scenario.

HEADACHE

J. MERRICK

J. HURT AS J. MERRICK

Merrick’s skull and facial deformities could be credited to “hyperostosis of the skull(6),” from Category B, above. The swellings on his forehead could be partially from bony growth but also from Category C's, “Dysregulated adipose tissue.” Adipose is fat and the swellings on the head could very likely be fatty tumors (lipomas).

Other diseases such as osteitis deformans (3), that cause enlargement of the skull often lead to severe headache because of the stress on the connective tissues surrounding the brain and possible pressure on the brain and cerebrospinal fluid. Merrick probably also had strain on his muscles from the weight of the head. This isn’t in the movie, but I would imagine that Merrick would be subject to some raging headaches caused by both his deformity and severe muscle tension.

BACKACHE

MERRICK'S SCOLIOSIS

Look at the curvature of Merrick's vertebral column in the skeleton photo. In the film we can also see this scoliosis(8) in the naked sillouette of Merrick, as Treves presents his case to his peers at the hospital. When we look at the photo of Merrick’s actual skeleton, it’s hard to tell if there is severe bony deformity causing his curvature, or if it’s a functional deformity as his vertebral column tries to compensate for the incredible stresses put on it from other deformed bones, plus the pounds of tumors distributed throughout his body. I would think this kind of condition would cause debilitating back pain.

In the movie, and reported elsewhere, Merrick had to sleep sitting up because the weight of his head was too great. In the film Merrick chooses suicide by sleeping supine as a normal person would(9). Think about the way you felt the last time you slept sitting up, then imagine having to do that every night.

AND HE’S A NICE GUY

Throughout the film, Merrick is a pure soul. He is grateful for Treve’s support, treats everyone with courtesy and kindness, and never complains about physical discomfort. Is that possible in a person? As a massage therapist, I’ve worked with clients in chronic, incurable, debilitating pain who had to live most of their lives tanked on pain killers and hooked up to TENS (transcutaneous electric nerve stimuation) machines(10). Some of them were complainers, and frankly, who could possibly blame them? Some of them were the most pleasant, giving, non-complaining people you’d ever hope to meet.

Could Joseph Merrick, a grossly deformed person, probably in constant chronic pain, living in a world without Tylenol or other effective non-addictive pain-killers really be that type of person? If I had to cope with his incurable condition, I’d probably get super drunk all the time, then eventually go on a killing spree and throw myself out a window.

WHAT COULD I, CLAUDIUS POSSIBLY HAVE TO DO WITH THE ELEPHANT MAN?

Merrick has a speech impediment from his facial deformities. Did he have the “parotid monomorphic adenoma(11)” from Category B, number 3b? John Hurt

does a rather wet and drippy sounding voice for Merrick, which I would normally find admirable. But as I was watching the movie, I kept thinking of Derek Jacobi in I, Claudius. I couldn’t figure out why Hurt would sound so much like Jacobi until my husband pointed out that Hurt played Caligula in the same BBC production from 1978. Hurt's version of Jacobi's version of the Emperor Claudius' speech impediment was a little distracting. If encourage you to watch The Elephant Man then watch a later episode of I, Claudius and you will know what I'm talking about.

HURT AS CALIGULA (left)

JACOBI AS CLAUDIUS (right)

If you made it through this entire post in one sitting, you have some highly developed attention endurance skills! This one got away from me. But that’s it for Merrick and Proteus syndrome. Next time I’ll do a little Elephant Man mop up (ha!) about the surgery scene at the top of the film and antiseptic practices in the days of surgeon Fredrick Treves.

1. See post for April 2.

2. Yes, this is the second time I've used that joke, but it's good to keep reminding people that I'm not a doctor and can't do what they do.

3. Over-growth of bone

4. For great information about stage combat classes go to www.safd.org, or if you're in New York, try Joe Travers and Swordplay workshops.

5. Tinea is a common type fungus that is responsible for athletes foot, ringworm, nail fungal infections, etc.

6. Increased bone growth.

7. Osteitis deformans is a chronic condition usually affecting men in middle/late age in which the bones of the head, trunk, and legs become enlarged. The bone will also weaken as it grows, leading to deformities, pain, arthritis, and fractures. The condition is occasionally called "Tight Hat Disease," because your hat would get tighter as your skull got larger. Another popular name for this condition is Paget's disease, named after Sir James Paget.

8. Scoliosis is a lateral curvature of the spine, often accompanied by a rotation. The condition can vary greatly, and can be caused by lots and lots of things including having a head that weighs three times what it should.

9. I have read two different descriptions of how Merrick's supine position killed him. Wikipedia currently says that he dislocated his neck this way. Other sources say that he crushed his trachea, or if he didn't crush it, compressed it to the point which he couldn't breathe. The film doesn't get into the details here.

10. The TENS machine is an apparatus that applies an electrical current through the skin of a patient. This current helps to control pain. Here's a link to Wikipedia, if you're curious. Be warned that the article still needs some work.

11. A parotid monomorphic adenoma is a type of tumor of a salivary gland.