Polite Dissent

Apothecarius Argentum is a manga recently published by CMX. It concerns Primula, the princess of the medieval Kingdom of Beazol, and Argent, the local apothecary (a cross between a pharmacist, physician, and healer). Argent is a Basilisk — individuals who were purposefully fed potent poisons as children. They subsequently develop immunity to toxins and their touch is poisonous. Argent was originally a slave who was bought by the king to be his daughter’s food taster. Later, when he accidentally touched the princess while saving her life, he was sentenced to death but Primula let him escape. He has now returned to the kingdom years later as an apothecary.

The book is a good read. It contains four independent chapters which involve (as one might expect) poisonings, fights, and palace intrigue. Argent is an interesting character, and the princess and her father have potential, but still need more development. The art is competent, but not outstanding — it seems sketchy at times, particularly when the princess is the subject. The medical aspect is quite good as the writer worked as a pharmacist before becoming a mangaka. He provides some interesting endnotes. My main complaints are relatively minor. I wish the Kindgom of Beazol were better developed as it plays an important part of the narrative, yet seems no different than any other generic genre quasi-medieval kingdom. The book seems a little thin to me as well, at least compared to other manga. I’m not sure if it has fewer pages or thinner paper (or it might just be my imagination).

There are some minor spoilers below, so I suggest you read the manga before perusing my medical annotations…

Chapter 1
1. The symptoms of mercury poisoning vary depending on what form the mercury is in: elemental, organic, or inorganic. Symptoms can also vary based on the length of time of administration — was it a large dose at once, or many smaller doses over a long period of time? — as well as the route of administration (inhaled or ingested).

The villain tells the princess that he has been slowly and methodically poisoning her food, so she has chronic ingested mercury poisoning. Her symptoms match those of inorganic mercury (mercuric salt) poisoning. The princess’s complaints include nausea, vomiting, pale mucous membranes (the gums and inside of the cheeks), and edema in the arms and legs. Inorganic mercury poisoning causes ashen gray mucous membranes due to the deposition of mercuric salts. Gastrointestinal symptoms are common including nausea, vomiting, stomach pain, and even bleeding. Inorganic mercury poisoning can also cause a strange condition known as acrodynia. Patients with this have red palms and soles, as well as edema of the arms and legs. More severe cases can lead to hair loss, a peeling rash, and cardiac and neurological problems. Acrodynia is thought to be due to a mercury allergy. Based on the princess’s symptoms, Argent was correct, and she has a (conveniently) minor case of chronic inorganic mercury poisoning with symptoms that include early acrodynia.

Treatment of symptomatic mercury toxicity requires chelation. A special medication is given which binds to the mercury and allows the body to excrete it. The most common modern chelating agent is given by intramuscular injection, but there are oral chelating agents available as well.

2. Later in the chapter, Argent is poisoned with an arrow dipped in curare. The villain gloats over his downed body:

Curare is a highly potent poison derived from the vines of a tropical plant used by foreign savages. When struck by a poisoned arrow, it causes gradual muscular paralysis. You will soon die of respiratory failure!

The bad guy has it right. Curare was used as a dart poison by certain South American tribes. It is a potent muscle paralyzer — high doses cause asphyxiation because the victim’s respiratory muscles stop working. Modern medicine still uses curare and some of its derivatives as paralyzing agents before surgery or intubation.

3. Cowslip(Primula veris) is a common flowering plant in Asia and Europe. It has many reputed uses as medicinal herb, including use as a sedative, like Argent mentions.

Chapter 2
1. While preparing for a speech, the princess steps on a deliberately placed rusty nail. She soon develops a fever and becomes sick. Given the speed with which the infection hit, the nail was likely treated with some form of infectious agent. In the United States, whenever we hear “rusty nail,” we think of tetanus, but her symptoms and quick recovery do not match that disease. It makes me wonder if the “rusty nail equals tetanus” implication exists in Japan as well, or if its use was just coincidence (or a red herring).

2. Argent is right that sulfur gas can cause optical problems (blurry vision) and respiratory irritation. It doesn’t cause the respiratory arrest and death he threatens though. In the end, he admits that he is lying about the medication he gave, so he could easily be exaggerating about the effects of sulfur as well (or he might be confusing it with sulfur mustard, i.e. mustard gas, a chemical warfare agent first used in World War I.)