Polite Dissent

Apothecarius Argentum is a manga series written by a trained pharmacist, so while the setting is a fairly generic medieval kingdom, the medical aspect is well done and based on both Eastern and Western medical traditions. Volume Three covers chapters 9 through 12 of the overall story. Volume One (part 1 and part 2) and Volume 2 annotations are also available.

Beazol is a small prosperous kingdom ruled over by a wise but very stern king. His only child, the princess Primula, is slowly coming into her own as a leader. Her closest companion is Argent, the royal apothecary (healer). He is a basilisk, a member of a secret society who has been purposefully exposed to various poisons since an infant. This renders him immune to toxins, but his skin also excretes a deadly poison, so he cannot touch anyone else.

In this volume, Lorca, the youngest son of Navara, the next kingdom over, comes to Beazol to woo Primula. He is sickly, but very devious -– quite the contrast to the straightforward Primula and Argent. Just as Argent is an expert on medicinal plants and herbs, Lorca is an expert on insects, especially beetles. The volume starts in Beazol, but then the action moves to the famine-ridden country of Navara.

Chapter 9
1. Argent: “He [the king] had a stress related heart spasm.”
When I first read this, I though Argent was suggesting that the king had experienced palpitations: a slightly irregular heartbeat commonly caused by stress and anxiety. I tell my patients that they are “frustrating and scary, but not generally dangerous.” However, since Argent went ahead and treated the king with digitalis, a potent heart drug, I suspect the king has the beginnings of heart failure — a weakened heart — which can be brought on by a variety of stresses including high blood pressure and heart attacks.

2. Foxglove was used to make the medication digitalis (also called digoxin), a drug that is used to treat heart failure by making the heart beat stronger. It was hard to get a consistent dose from foxglove leaves — important with digitalis because the line between “not enough” and “too much” is quite narrow — so a synthetically produced version is used now, though frankly digitalis is not used much at all anymore as better, less dangerous drugs for heart failure have been developed.

3. Argent pretends the princess and king have Chicken Pox, explaining why her ball has to be cut short. His assistant fans the flame by stating, “If a mature man gets infected with chicken pox, he’ll become impotent.” Chicken pox can very, very rarely cause an orchitis (testicular inflammation) which can sometimes lead to impotence, so I guess this is technically true, though nothing I’d lose any sleep over (for the record, mumps is much more common cause of impotence — so get your immunizations!). Chicken pox does tend to be more severe and have more complications in adults than in children.

Chapter 10
1. Dicronorrhina micans is a beetle from the scarab beetle family, and is also known as the “flower beetle” (a common name for many beetles) or “golden chaffer beetle.” D. micans is a bright green beetle found in Africa.

2. Jewel Beetles are a family of colorful and iridescent beetles.

3. Argent: “The toxin of Epicauta gorhami can cause inflammations. The powder can be used as an aphrodisiac or hair tonic, but in large amounts it can be lethal.”
E.gorhami is a blister beetle, a family of insects that produces an extremely irritating chemical that causes, among other effects, painful blisters of the skin (hence the name). The chemical was once used as a medication for a variety of ills, but it is another drug where the line between effective dose and fatal dose is very thin — and frankly it didn’t offer enough benefits to be worth the risk.

Chapters 11 and 12
1. Lorca’s disease affects most of his body. Victims of the disease are noted to have joint pain and swelling, neurological abnormalities (leading to weakened limbs, seizures, coma, and death). Metabolic and organ damage is also mentioned, particularly liver and kidney damage.
These symptoms suggest a slowly progressing chronic disease. They fit most with a long-term chemical exposure or an autoimmune disease — or a combination of the two.
Later, the story suggests that long-term exposure to the pesticides used in Navara is the cause of the disease. Given that many pesticides are neurotoxins (chemicals that damage the nerves), this fits the symptoms. As mentioned in the last chapter, many pesticides can also be absorbed through the skin.

2. Activated charcoal is excellent for adsorbing toxic chemicals, poisons, and medications before they can have an effect. It has a variety of other uses as well: filters for tap water, for instance.
However, it’s not a good choice for Lorca’s treatment:
1) Activated charcoal is given orally and works against toxins in the gastrointestinal tract. As is mentioned in the next chapter, the toxin in question is absorbed through the skin and lungs, bypassing the gastrointestinal tract entirely, rendering the activated charcoal useless.
2) Activated charcoal works on recent toxic exposures that haven’t yet been absorbed by the body. In Lorca’s case, he has been exposed to the toxins since he was an infant and is already showing organ damage (seizures, coma, etc). It’s way too late for the charcoal to have any noticeable effect.
3) Furthermore, if the charcoal was working it would mean that Lorca had been exposed recently — since traveling to Beazol, which would change the entire tenor of the story.