Medical manga comes to America

Black Jack, the brooding surgeon who operates outside of medical convention — and usually beyond the realm of scientific possibility — has finally come of age in America 25 years after his debut in Japan. We're talking about a comic hero, but one that makes Batman look like Goldilocks. Black Jack, a super-powered surgeon and rebel with punky hair and gothic garb, swoops into the surgical suite to exploit the rich, save the disenfranchised and discombobulate the status quo. The 17 volumes of the renegade doctor's adventures, being released by Vertical, Inc. every other month (Volume 4 arrives this month) for the next 3 years, are part of the oeuvre of the godfather of Japanese manga, Osamu Tezuka — a medical doctor.

Tezuka (1928–1989) was a frail child with a limp who spent his spare time drawing insects. By high school he had seen several doctors, most notably one who treated drawing-related arm injuries. Ironically, he chose to study medicine because of the physically and financially straining prospect of being a cartoonist, but he continued to draw throughout his years at Osaka University Medical School. His first book of manga (Japanese for comics), which he published in 1947 at the age of 19, sold 400 000 copies. Commercial manga art is distinguished by the character's exaggerated features and emotions: large eyes that cry buckets and small mouths that can open to fill a face. When angry, characters may have flushed cheeks and steam rolling around their bodies.

After graduation, Tezuka became a full-time cartoonist and hit the big time with Astro Boy, about a robot boy who is rescued by a sympathetic doctor. In 1963, Astro Boy became the first home-grown animated cartoon to air in Japan, giving birth to the billion-dollar anime industry. Tezuka had created one of Japan's most enduring post–World War II cultural exports.

But in the late 1960s people started to complain that cartoons were rotting kids' brains and teachers began enforcing a “no comics” rule in the classroom. Tezuka's cutesy animated television shows, so novel in the 1950s, became laughable during the 1960s. Tezuka responded by creating some of the most outrageously racy, controversial, morbid adult-oriented comics, ever.

Enter, medical manga.

Tezuka imbued works such as Buddha (about a healer), Ode to Kirihito (about a disfigured doctor) and Black Jack (about an unlicensed doctor at odds with the medical establishment) with anatomically realistic renderings and sophisticated medical language. But while some of these works fell into obscurity, Black Jack thrived. Its success stemmed in part from the fact that it was an unapologetically adult comic, replete with complex plots and graphic details.

Black Jack is also an entertaining blend of the serious and comedic; the dark and brooding main character — an outcast from society — is offset by the antics of Pinoko, his assistant. Fun aside, however, the works express Tezuka's fascination with medical ethics and his abiding regard for the frailty of life. The resulting works are both provocative and sympathetic. Black Jack is a victim of modern society — orphaned and self-taught — and an expert at blackmailing the rich. He then works pro bono for the disenfranchised and impoverished.

The story arcs say it all. At the beginning of most episodes, Black Jack is motivated solely by money, performing seemingly crazy medical procedures for millions and millions of dollars, usually for very wealthy and callous businessmen, celebrities or politicians. However, by the end of every episode, a compelling motive to do the right thing arises, usually in a do-or-die situation that requires him to choose to save one life over another: He saves the life of a cranially malformed, but breathing and stable sextuplet at the expense of the 5 beautiful, but severely premature others. He lets a child kill his conjoined twin. This heroic ambiguity no doubt contributed to Black Jack's immense popularity in Japan.

The graphic nature of the series was another factor. In a country where autopsies are rarely performed (some estimates say only 10% of unnatural deaths are examined by autopsy) due to an aversion to mutilation, Black Jack eviscerates the status quo by featuring fantastically detailed depictions of an astounding array of surgeries, some of which make Frankenstein look like a Disney character. He performs interracial skin sutures on a xenophobic Japanese man and a sex-change operation before transsexual was part of the contemporary lexicon.

The average reader may be entertained by Tezuka's composite hero, equal parts Robin Hood and Dr. Frankenstein, but curiosity — How did he do that? — will invariably turn into incredulity — How could he! — for many medical professionals.

Originally conceived as part of an “All Star Showcase” of Tezuka characters, Black Jack was a short-term hero, what Tezuka called “an example of the kind of doctor I would want to be.” But who was supposed to be an ancillary case study in manga characterization turned into a nationwide bestseller. Black Jack was first serialized in Japan from 1973 to 1978, and was followed by 13 sporadic episodes that concluded in 1983. Sadly, the series faltered in America when first published in the late 1990s, likely because it was targeted to children in a serial comic book format. Furthermore, none of the controversial “sealed episodes” (which were never printed in Japan owing to their morbid and offensive content), were translated into English, until now. Based on a hardcover compendium first compiled by Akita Shoten, Vertical, Inc.'s new releases include several of these sealed issues. The episodic nature of Black Jack's medical experiments backed up by accurate medical detail, bear more resemblance to television shows such as ER or House MD than to any North American comic book; medical narratives such as these simply do not exist in the US or Canadian comic media.

Several anime adaptations of the series have also been made, notably Four Miracles of Life (2003), a Black Jack TV Series (2004) and Black Jack 21 TV Series (2006), all directed by Tezuka's son, Makoto Tezuka.

Other medical manga have surfaced in the wake of Black Jack's success in Japan. Even Astro Boy has been retrofitted (in Naoki Urasawa's Pluto) with forensic engineering. The medical manga moniker has also been stretched to apply to manga works such as Death Note by Tsugumi Oba and MPD Psycho by Eiji Otsuka, both of which feature police investigators — rather than doctors — who are fascinated and perplexed by the evidence hidden within the human body. But none of them feature a protagonist with Black Jack's complexity and depth. The characteristic most frequently associated with Tezuka (online at any rate) is humanism. It fits him well.