#and hour per patient is reasonable but the ratios fuck it up!! like what the hell!!!

[hardware-sparks]

why the FUCK are we letting business people running the fucking hospitals

[cat-brodsky]

richard pipen is the worst pre-med student ever: death caps in the secret history

"Judy, what would you do if you had a hundred and three degrees of fever?” “I would go to the fucking doctor,” she said without looking away from the TV.

must i say anything else

This post may contain errors, and anyone is welcome to point them out.

@sadbabywltch gets a thanks for the inspiration

some context

"You studied medicine for a while, didn't you?” [Henry] said.

I knew this to be a prelude to some health-related inquiry. My one year of pre-med had provided scanty knowledge at best...

I’m going to cite some parts of The Secret History, but I cannot copy the entire text of the scene in question. If you haven’t read it, this scene won’t make as much sense.

This post contains extensive discussion of mushroom poisoning as a murder method, so consider yourself warned. This post also contains math and biology, so people allergic to either should turn back.

Richard Pipen knows absolutely nothing about medicine. And I intend to prove that.

on amanita phalloides

Aka, death cap. The most poisonous out of all known mushrooms - half a mushroom (30 grams) is enough to kill a grown human. If Henry had really done extensive research, he should know that - and he said that he has.

“You have no idea how much thought I've put into this. Even to the strain of poison. It's said to make the throat swell, do you know that? Victims are said to be struck dumb, unable to name their poisoner.”

He should also know that the throat swelling is a myth. A.phalloides cause gradual organ failure. Symptoms of poisoning occur twelve hours later, too late to seek treatment, and death generally occurs six to sixteen days after the poisoning.

He should also know that there are less toxic species of Amanita. For instance, Amanita muscaria (fly agaric) is a hallucinogen, and symptoms take only thirty to ninety minutes to appear. Considering that the entire friend group has already been taking drugs regularly, Henry could offer Bunny a lethal dose, ingest a small one, and seek treatment.

There is also Coprinopsis atramentaria - the common ink cap, or tippler’s bane. This mushroom is poisonous, even lethally so, if combined with alcohol. I don’t need to spell the murder method out.

But, of course, Henry is high Intelligence low Wisdom and obsessed with ancient history; if Claudius allegedly died via death caps getting mixed with Caesar’s mushrooms, then it must clearly be the best way to poison someone.

on advanced calculus

“Let's say we know, for instance, that x amount of the drug in question is enough to affect a seventy pound animal and another, slightly larger amount is sufficient to kill it. I've figured out a rough formula, but still we are talking about a very fine distinction. So, knowing this much, how do I go about calculating the rest?”

Quick reminder that Henry killed one dog and poisoned another.

I’m not going to do calculations on A.muscaria or any other method of murder - A.phalloides is what the characters were poring over. I’m going to explain the calculations as simply as I can, and then provide some references for those of you who are interested in biology.

The characters don’t have the internet available, but they have the whole college library, a virtually unlimited amount of money, and a town where everyone takes illegal substances at their disposal. What they need is a pharmacology textbook (to look up the necessary equations), a reference on poisonous mushrooms (to look up death caps), and perhaps a handbook on toxins. 

LD50 is what Henry is after - that is, “the dose required to kill half the members of a tested population after a specified test duration.” (I hope that the readers can already see that two dogs are not a large enough sample size.) LD50 is conveniently measured in mg/kg. We have the characters’ exact weights: Bunny is 86 kg, Henry is 97.5 kg.

Amatoxins are a group of toxins contained in A.phalloides, and the one that causes symptoms of death cap poisoning. LD50 of amatoxins in humans is estimated to be 0.1 mg/kg. Thus, Bunny would need to ingest 0.1*86 = 8.6 mg amatoxins, perhaps less, preferrably more, to be stone dead. Here I make an assumption that 0.05 mg/kg is not lethal; with Henry’s poor health, it might be. Henry would need to ingest under 0.05*97.5 = 4.87 mg to not be dead.

Oral LD50 for amatoxins in dogs is 0.5 mg/kg. Finding out the amatoxin content should be an easy calculation: X grams divided by 31 kg contains 0.5 mg. We know that X grams minus one gram failed to kill the other dog, so we can assume this is not low-balling the dose.

For the sake of ease, let’s say X = 31 -> 0.5 mg amatoxins in one gram of locally harvested, organic death cap. This looks close to reality. Per Yilmaz et al (2015) a death cap ingested by a patient contained 0.426 mg amatoxins per gram, and you can calculate that yourself.

And now a simple proportion:

0.5 mg (per gram) / N mg (lethal dose) = 1 gram / X grams (of mushroom)

Bunny: 8.6/0.5 = 17.2 grams (ingest more than that)

Henry: 4.87/0.5 = 9.74 grams (ingest less than that)

partway disclaimer

Of course, I wouldn’t stake my life, or anyone’s, on those calculations.

The toxin content of the A.phalloides can vary drastically depending on geographical location, season, maturity, etc. This could be remedied, I guess, by gathering a large amount of them, mixing them and chopping them into paste, then testing some of the mixture to determine LD50 and the amatoxin content.

From the data at hand, the exact content of amatoxins cannot be precisely determined. But, hey, Henry only needs to poison more dogs to find out!

and now for some more science

A.phalloides contains two main groups of toxins: amatoxins and phallotoxins, and also phallolysin. Phallolysin is not toxic if taken orally, so that’s out. Phallotoxins were found to have little contribution to death cap toxicity, perhaps because they are not absorbed through the gut. (Though it’s not certain whether the characters would have this information in 1982.) This leaves us with amatoxins.

Yilmaz et al (2015) describe a patient who recovered after ingesting approximately 0.32 mg/kg amatoxins (but after developing liver failure). This is why I’m assuming 0.05 mg/kg is non-lethal.

LD50 for amatoxins in dogs has been calculated for α-amanitin and methyl-γ-amanitin.

Garcia et al (2015) gives the amount of a-amanitin in different tissues of A.phalloides as follows (mg/gram dry weight): 0.67 to 0.78 in caps, 0.30 to 0.32 in stipes and 0.07 to 0.10 in volvas.

why richard is an idiot sandwich

Look, perhaps I’m misunderstanding what Donna Tartt has written, but Richard comes across as right for the wrong reasons. He’s right in that trying to non-lethally poison yourself with something so deadly as A.phalloides is a monumentally stupid affair. He’s wrong about everything else.

Faced with a simple calculation like the above, how does Richard go about it?

Equations about chemical concentration were never my strong point in chemistry, and they are difficult enough when you are trying to figure a fixed concentration in a suspension of distilled water; but this, dealing as it did with varying concentrations in irregularly shaped objects, was virtually impossible. He had probably used all the elementary algebra he knew in figuring this, and as far as I could follow him he hadn't done a bad job; but this wasn't a problem that could be worked with algebra, if it could be worked at all. Someone with three or four years of college calculus might have been able to come up with something that at least looked more convincing; by tinkering, I was able to narrow his ratio slightly but I had forgotten most of the little calculus I knew and the answer I wound up with, though probably closer than his own, was far from correct.

I didn’t know proportions required three or four years of college calculus. If the mushrooms are irregularly shaped, why not weigh them?

“It's a good try, but just by looking at it I can tell that it's insolvable without chemical tables and a good working knowledge of calculus and chemistry proper. There's no way to figure it otherwise. I mean, chemical concentrations aren't even measured in terms of grams and milligrams but in something called moles.”

There are different kinds of chemical concentration, and molar concentration is just one of them. “Something called moles”? A mole is, simply, an amount of substance that contains 6.02214076×1023 molecules (Avogadro number). This is sixth-grade chemistry. It’s also completely irrelevant here.

It’s a miracle Richard ever got into pre-med.

Henry, paraphrased: Oh, well, if I overdose - which I can totally figure out despite the fact that the symptoms take twelve hours to show when the damage is already done - I can just have some atropine. Atropine will totally counteract amatoxins.

...Never mind, Henry is also an idiot - though, at least, that is highlighted in-story. What does he plan on doing, drinking a whole bunch of atropine without knowing the precise dose he ingested?

“They are exactly opposite in effect. Atropine speeds the nervous system, rapid heartbeat and so forth. Amatoxins slow it down.”

No, they are not. To put it in plain English, amatoxins cause cell death - nothing about nervous system. Atropine basically counters the parasympathetic system, kicks your organism into fight or flight mode.

Do you know what atropine is an antidote to? Muscarine. It’s a compound found in certain mushrooms - such as A.muscaria, though only in trace amounts. Atropine and muscarine both bind to muscarinic acetylcholine receptors. Muscarine is not found in A.phalloides. Confusing amatoxins with muscarine is... I imagine it’s excusable if ancient Persian texts are your most recent source.

Oh, and one more thing while I’m at it.

“The Persians? I didn't know you read Arabic.”

In Persia (modern Iran), they speak Farsi, not Arabic. Oh, Richard. I imagine Henry took pity on him and didn’t correct the poor fool.

conclusion

There are two ways to engage with canon - from an in-story perspective (Watsonian) or an outside perspective (Doylist). I’ll leave you to discover what the third (Forsythian) perspective is.

From an in-story perspective, I am drawing the conclusion that both Richard and Henry are utterly inept at math, biology, medicine, and common sense; heaven only knows what “algebraic equations” they spent a good half hour going over.

From an outside perspective... well, if Tartt wrote all those errors purposefully, then it’s a nice bonus for any reader who knows basic medicine. If she didn’t, then I can fault her for not doing enough research. A middle ground is more likely: I’m certain that the 103F episode was intentional, but the Arabic in Persia wasn’t, since Henry of all people would lambast Richard for this error mercilessly.

half-assed references

Garcia, J et al. Determination of amatoxins and phallotoxins in Amanita phalloides mushrooms from northeastern Portugal by HPLC-DAD-MS. Mycologia, 107(4): 679-687. 2015.

Hooser, S.; Khan, S. Common Toxicologic Issues in Small Animals: An Update, An Issue of Veterinary Clinics of North America: Small Animal Practice: Ebook. Elsevier Health Sciences. 2018.

Tu, A.; ed. Handbook of Natural Toxins: Food Poisoning (1st edition). CRC Press.1992.

Wieland, T. Peptides of poisonous Amanita mushrooms. Springer-Verlag.1986.

Yilmaz, I et al. A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans? Wilderness Environ Med. 26(4): 491–496. 2015.