Polite Dissent

Continuing a medical look at the manga Apothecarius Argentum, this time looking at the last two chapters. The review of the first two chapters can be found here.

Chapter 3
1. Argent and the king of Beazol travel to a nearby dukedom to treat the Duke’s sick son. Argent diagnoses him with asthma. Given the fact that the son has daily symptoms and has been that way for years, he most likely has severe persistent asthma, the most severe form of asthma. His predominant symptom seems to be cough, so he could have cough variant asthma, a rare form of asthma that presents predominantly with a chronic cough.

Severe persistent asthma is a challenging condition to treat, even with today’s modern medicine. In the middle ages, it would be even harder to treat, and most patients with severe asthma died early. Argent has elected to treat the child with Ephedra sinica, also known as Ma Huang. This plant produces ephedrine (a close chemical cousin of pseudoephedrine, i.e. Sudafed), a potent stimulant that has been a traditional asthma treatment for centuries. I expect it would help his condition, but not to the miraculous extent seen in the book. Argent also points out that too much ephedrine can be fatal, which is true and one reason that nutritional and dietary supplements containing ephedrine are now banned in the United States.

2. Argent is explaining why his medication tastes bad:

Bitterness stimulates the body’s organs to excrete many different enzymes that helps with digestion.

I suspect Argent means secrete rather than excrete since excrete only applies to waste products, but I’m willing to chalk this up to a translation issue.

Chapter 4
1. In the final chapter of the fourth volume, Argent, now the Court Apothecary of Beazol, comes into conflict with the kingdom’s Apothecary Guild. The guild master’s name is Zantak. This is too similar to Zantac (a prescription heartburn medication, generic name ranitidine) to be a coincidence.

2. Argent uses a solution of Foxglove to treat a patient with heart problems. Foxglove is the source of the drug digitalis, a potent cardiac medication. Digitalis is still used today, but not to the extent that it once was because safer drugs have been developed. The use of Foxglove for heart patients has a history going back centuries, but it has always needed to be used with caution because there’s not much difference between a healthy dose and a fatal one. High doses can lead to cardiac arrest (remember the scene in Casino Royale where James Bond is poisoned and almost dies? That was digitalis).

3. Another plant Argent is growing in his garden is Jimson Weed (Datura stramonium), also known as Thornapple, Jamestown weed, Devil’s Trumpet, Mad Hatter, Crazy Tea, and Loco Weed. It has potent anticholinergic properties. Traditionally, Datura was used to treat asthma; in addition, it was used as an antispasmotic, narcotic, and mydriatic (to dilate the pupils). According to my copy of Every Man his Own Doctor (a colonial medical guide first published in 1734), “James-town weed” was used for piles (hemorrhoids) and other swellings. Even worse than Foxglove, there is a very thin line between a proper dose and a toxic one, and fatal overdoses are common.