If I absolutely had to get into a school-yard fight back in junior high, I don’t know why it had to be with Ira Blitz. I should have known I wouldn’t stand a chance.
First of all, unlike me, Ira had mastered a number of exotic skills that gave him a distinct advantage in almost any scrap. Punching, for instance. More important, Ira actually seemed to enjoy fighting. When I was faced with the possibility of an after-school brawl, my first response typically was to submit the matter to binding arbitration and hope for a resolution satisfactory to all parties. If that didn’t work, I’d ask my family if we could move.
Most important, however, was the matter of Ira Blitz’s name. If you’re looking for a partner for an adolescent brawl, it’s always a good idea to avoid someone whose surname sounds like it applies less to a person than a Panzer division. I’m not saying that Ira’s family handle was the only reason I lost this battle, but I would have been a lot more comfortable if he had been named, say, Ira Negotiated Settlement. As it was, however, Ira won our scuffle handily, deftly landing head-to-toe blows and finishing me off with a pop in the eye that caused me to see stars, several comets, and a large portion of the Crab nebula.
While my one childhood fight taught me a couple of valuable lessons (notably, to be incredibly nice to Ira Blitz until after graduation), it also raised a question: Exactly what kind of trauma had I put my body through? Just why had I seen stars, for example, between the time fist hit eye and I hit asphalt? What was responsible for the singular sensation I had experienced when I was hit in the stomach and had the wind knocked out of me? Why did my nose turn out to be such an utterly sensitive--and utterly breakable--organ? What on earth is a cauliflower ear, and had I run the risk of developing such unwelcome vegetation?
Happily for us curious non-pugilists, we don’t have to go to Ira Blitz for the answers. Easier and less painful explanations are available from all across the world of science. Even if you’re a lifetime pacifist, it can be interesting to learn just what your body has been missing all these years--and why it should keep on missing it.
Among the most interesting sources of information on the physiology of injury is Jeremy Wolfe, an associate professor of ophthalmology at Harvard Medical School and a lecturer at MIT. Wolfe recently began teaching a visual-perception seminar straightforwardly entitled Ten Things You Can Learn by Poking Yourself in the Eye. Though such a lecture struck me as less than a natural crowd pleaser, I discovered that the students at MIT apparently think otherwise. At Wolfe’s last talk, he played to a near-capacity crowd of 50 enthusiastic undergrads, all of whom gladly went along with his eye-poking exercises. I was not on hand to watch Wolfe’s pupils attack their pupils, but I was able to reach him on the phone, and he agreed to talk me through some of the experiments. To be perfectly candid, I was not looking forward to the experience. In a world of specialty phone services, spending half an hour learning how to poke yourself in the eye seemed less like a date with, say, 976-LUST than a call to 1-800-PROSTATE EXAM. Nevertheless, Wolfe assured me I would be perfectly safe, as long as I did the exercises very gently and attempted them only under his guidance.
Wolfe first asked me to partially close one eye and gently press a finger against the eyelid near the tear duct. What I should see, he said- -apart from a good personal-injury lawyer--was a flash of light in my field of vision on the opposite side from the spot where I pressed. This, Wolfe explained, illustrates the phenomenon of labeled lines.
All nerves send signals to the brain when they’re stimulated, he said, but the part of the body those nerves service determines how the brain will perceive that stimulation. If you activate a tactile nerve in the skin, the brain will register the stimulation as touch. If you activate certain nerves in the ear, the brain will perceive that as sound. When you press the eyeball, you’re mechanically stimulating retinal nerves, and the brain registers that as light.
To me it seemed that the brain whose owner has just poked a finger in his eye should register something else, like a grievance with its union. Nevertheless, under Wolfe’s careful prodding I tried a tentative poke and indeed got the promised flash of light. The reason the flash was on the opposite side of the eye has to do with the way the brain processes an image. The ordinary lens focuses incoming light in such a way that it flips an image upside down and backward. (The exception to this rule, of course, is the lens of the Hubble Space Telescope, which focuses incoming light into something resembling a bowl of chipped beef.) When the eye inverts an image, the brain knows that it must automatically compensate by flipping the picture back the right way.
Though the delicate touch I gave my eye yielded just a single small flash, Wolfe explained that when the eye is struck by something less forgiving--like a swinging door or an errant Ira--many parts of the retina may be stimulated simultaneously, giving rise to a whole constellation of light. Sometimes the retina can become so mechanically stimulated that a large portion of the visual cortex of the brain begins firing at once. This is what happens when you rub your eyes and your field of vision is filled with that undulating checkerboard everyone sees but no one can explain.
Neurophysiologists have discovered that particular cells in the brain are responsible for registering particular shapes--say horizontal lines or vertical lines, said Wolfe. If you rub your eyes too much, you send random, garbagey noise to your brain, and all the cells for all the shapes begin screaming at once.
At Wolfe’s instruction, I commenced a very vigorous rub and, as always, got the promised checkerboard. To me this was enough retinal recreation for one day, and before I could get too involved in Wolfe’s other experiments--including the wiggle-the-eyeball and misalign-the-eyes tests--I thought it best to try my own exercise, known as hang-up-the- phone.
With my eyes thus under my belt, I went off to see what I could learn about the body’s other great injuries. Perhaps the most dramatic of these is the all-too-common punch in the stomach--or, specifically, the punch in the solar plexus. As most people have discovered, the solar plexus is that area just below the rib cage which, if hit just right, can cause you to feel as if you’ve had the wind--as well as the rain, the snow, and at least one kidney--knocked out of you. The term solar plexus comes from the Latin solaris, for Try not to get punched here, and plexus, for We’re not kidding.
My introduction to the perils of the solar plexus came when I was nine or ten years old and got into a fight with my older brother after he gave me a model of the Mayflower and then tried to take it back. Sibling common law usually grants an older brother unilateral rights to seize possession of any toy at any time for any reason; on this occasion, however, I had made it a point to touch a black object and recite, Touch black, no back, an incantation that the Supreme Court had ruled binding in 33 states, the District of Columbia, and Guam. My brother, however, was evidently not up on recent court rulings, and a scuffle ensued, resulting in my sustaining a severe blow to the solar plexus. The loss of breath was sudden and total. I’ve never been entirely certain how long it took me to get my wind back, but family members tell me I was more or less myself again by my sophomore year in high school. Excruciating as the experience was, however, it turns out that it was a largely harmless one.
Getting the wind knocked out of you is analogous to jamming your funny bone, says physician Chris Freyberg, acting director of the Emergency Department at New York Downtown Hospital. It’s a temporary paralysis of the diaphragm caused by traumatizing the phrenic nerve.
The phrenic nerve descends from the upper part of the torso and forks off to make contact with the diaphragm on both sides. When the solar plexus is struck, researchers believe, the diaphragm sustains a concussion, which it transmits to the phrenic nerve. The nerve shuts down temporarily and can’t make the diaphragm contract. To the surprise and considerable disappointment of the victim, he finds he can’t draw his next breath. The worse the blow, the longer the shutdown.
Almost as sensitive to injury as the solar plexus are the exquisitely delicate nose and ears. As you know if you’ve ever flipped through a professional boxing magazine or taken a good look at Leon Spinks, strange, almost Picasso-esque things can happen to the face that gets in the way of too many punches. The common cauliflower ear, which gives so many professional fighters that always fashionable fresh crudités look, is caused by a blow or other trauma to the outer ear, leading to the accumulation of blood between the cartilage and its fibrous covering. This coagulated blood then blocks the flow of new blood to the cartilage, resulting in tissue death and the buildup of scar tissue. Treatment involves draining the ear, removing the scar tissue, repositioning the fibrous covering, and giving serious thought to seeing a good career counselor.
Even if you’ve never stepped into a boxing ring, you know that almost any bump or blow can do serious damage to the average proboscis, causing immediate bleeding and agonizing pain and eventually turning even a modest button nose into something closer to a buttonhook. Though such fragility would make the nose seem a shabbily designed organ at best, it is in fact its very elegance that causes it to be so delicate.
The entire human face is highly vascularized and highly innervated, says Freyberg. For all the different ways it has to move and all the jobs it has to do, it needs lots of blood and nerve endings. The nose, for example, has to detect subtle smells, and for that it needs to be rich in nerves. However, that also makes it very sensitive to pain. Similarly, mucous membranes are very active tissues and thus have to be rich in blood. But that means that an injury is going to cause them to bleed copiously.
Making matters worse for the beleaguered beak, the bone that makes up the top portion of the bridge is lighter and thinner than the surrounding skull, and protruding from the face the way that it does, it is thus very vulnerable to injury. When you look at an X-ray, you see this extremely fragile projection of bone sticking out, says Freyberg. It’s very delicate and very pretty, but it can also be damaged very easily. If there’s one bad rap that’s been hung on the nose, it’s the general belief that a single fracture can instantly turn the average GQ man into the average Elephant Man, complete with the ability to drink through his nostrils. In fact, explains Freyberg, the nose bone heals as undetectably as any other bone, provided that it’s set properly. It’s just that when your emergency room is the corner of the canvas at Madison Square Garden and your cosmetic surgeon is Don King, you can’t expect the best results.
Worse, of course, than a blow to the nose, a punch in the ear, a pop in the eye, and a swat in the stomach combined is that most feared of all body traumas, the one that only luckless males can experience: a knee in the, uh, external endocrine system. Give the average man a choice between getting hit in the groin or having a girder fall on his head and watch him go looking for construction sites.
The most graphic case of this kind of injury I ever saw came during a game of summer camp softball when Sidney Katz (not his real name) was playing second base (not his real position) and was hit by a line drive in the antler (not his real appendage). Apart from having to spend that night sleeping with a strategically placed ice pack--something that caused the rest of us to make fun of him from the summer of 1968 until just the middle of last week--Sidney displayed a level of unbridled agony I had only seen in the closing reel of Fiend Without a Face when the monster is trying to suck Kim Parker’s brain and spinal column out through the back of her neck. Sidney’s anguish finally subsided after several days, and he spent the rest of the summer engaging in no athletic activity more strenuous than turning on the kiln in arts and crafts.
How such a minor injury could cause such exquisite pain has long been a mystery to me--and no doubt to Sidney. Some answers, however, are available from Irwin Leventhal, a urologist at Mount Sinai Hospital in New York. The biggest thing that makes a hit in the groin region so painful, Leventhal says, is the same thing that makes other sensations in that area so pleasurable: an enormously high number of sensory nerve endings. When an area of the body is innervated so generously, any sensation--whether good or bad--is going to be felt very acutely. What’s more, glands don’t have a whole lot of give, so if one is hit, it’s going to absorb the whole force of the blow. Finally, while all other glands are located deep within the body, male reproductive glands are outside, since sperm cannot be produced normally at temperatures above 96 degrees. Whatever additional protection they’d get is thus lost.
Making matters still worse is that pain in this particular area tends not to stay in this area but to radiate throughout the groin and up into the abdomen (and occasionally out to any other man standing within a 100-yard radius). This, Leventhal explains, is due to the phenomenon known as referred pain, which causes a sensation felt at one spot to travel along the nerve root to other parts of the body.
In this case, the nerves that cause the most discomfort are the perineal, which innervates the groin, and the pudendal, which runs from the spinal column to the groin and scrotal area. For anyone unlucky enough to have his own pudendal and perineal traumatically stimulated, Leventhal recommends ice for the first 24 hours to keep down swelling, heat for the next 24 to stimulate blood flow and hasten healing, and perhaps giving up softball for a pastime like quoits.
For pain-phobes like myself, this kind of injury avoidance has always seemed like the better part of physical valor--and my guided tour of the body and its weak spots did nothing to change that belief. After Sidney Katz, I made it a point never to play baseball again without the protection of a good athletic cup--as well as a saucer, salad plate, and place setting for six. After Ira Blitz, I made it a point never to engage in another school-yard quarrel without first getting in touch with Cyrus Vance. And after the Mayflower, I made it a point to turn all models directly over to my brother--including any I might one day be lucky enough to date. I admit this strategy won’t ever earn me a heavyweight belt, but it won’t earn me any other kind of belt either, and that has always seemed like a pretty good trade-off.