Author: Outlander Anatomist

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Mini Anatomy Lesson – William’s Wound!

Hello, anatomy students!

Good to see you again so soon. 😉

Today’s lesson explores the horrific circumstances leading to an intended amputation of William’s forearm.

Just so you know what to expect, this lesson does contain a number of rather gruesome images!

William’s wound appears in Outlander episode 704,  “A Most Uncomfortable Woman.”

A short recap: William hastily rides through the Great Dismal Swamp. His steed, Jupiter, is startled by a snake, which looks very much like a copperhead to me!

Jupiter unseats William who tumbles down a steep hillside hitting a fallen tree snag during his rapid descent.

As William comes to rest, he assesses the damage to his arm. Oh, dear,! A branch broke off the snag and buried itself into his right forearm. Ouch! 😱

Being of Fraser blood, he grits his teeth and pulls it out! 😬 Then, using his stock as a bandage, he wraps the wound under pressure and moves forward with his mission. This time, on foot, as Jupiter has hightailed it leaving William alone and without supplies or the notes from Captain Richardson! 😳 

Later,  he hears a sound. Looking up, he spies an “Indian” who speaks a Scot’s version of the King’s English. 😜  Wolf’s Brother (Ian Murray Jr.) in the flesh!

A very nice chit-chat ensues as they exchange bona fides.  Then Ian spies Williams’s wound. Um….best get that taken care of. Because, by now that oozing wound looks pretty yucky! 🤢

Ian sets about building a wee fire and boils a pot of water. Then he crouches beside William, pulls his knife from its sheath, and begins to free the wound of several splinters. Ouch! 😮

The blood clots are well done. 👍🏻

Then he pours boiling/hot water over the wound to try to cleanse and perhaps sterilize it? Oh, boy, that hurts! 🤯

Ian hustles William to the cabin of one Dr. Denzel Hunter and  his sister, Rachael. They help William onto a table and Denzel takes a quick keek. Oh, dear, that looks bad. Rachael, fetch me the saw!

After some protestations from Ian and William (it is his forearm, after all!), Dr. Hunter begins to saw. Suddenly, pus oozes from the wound and Denzel declares that the bile has been freed and there will be no need for a hack job today! 🪚

Much later, Williams shares his travail with fellow soldiers. Here, from “A Breath of Snow and Ashes:”

“Wandered round the Great Dismal Swamp for three days in a fever,” he said. “Some … Indians found me and got me to a doctor. I nearly died, and”–he lowered his brows and gave Zeb a piercing look–“the doctor was just about to cut off my arm, when the abscess burst and he cauterized it. You might not be so lucky, hey?”

Sometime later, Rachel tells William his scar has healed well. It looks like the star that guided the wisemen to the Christ child and it suits him. In the book, his scar looks like a comet.

A quote from “A Breath of Snow and Ashes:”

‘The wound was still red and puckered, the skin around it unpleasantly white and moist. It was, however, undoubtedly healing; the arm was no longer swollen, and the ominous red streaks had disappeared. “Well,” she said consideringly, “it’s a fine scar, I think. Well knit, and rather pretty.” 


Anatomy and Pathology: Now that the recap is over, let’s discuss the pathology of William’s wound. You may recall, that pathology, which literally translates to “knowledge of sorrow,” is abnormal anatomy, so we are not far off the mark. 🤓

I propose we review one issue at a time, so here we go!

The Accident:  I have been asked if I think the accident was plausible. My short answer is, yes. My reasoning is that William is a large man, rolling downhill, rapidly. All that weight with an extended arm and yes, it is possible. 🤔

Believe it or not, this issue is covered by Newton’s (next image) second law of motion which states that F = ma, in which net force is equal to mass times acceleration due to gravity.

Stated more plainly, the force with which William’s extended arm struck the wooded spike equals William’s mass times acceleration rolling downhill.

I asked my physicist son, Diedrich, to help with variables such as hypothetical mass, rate of descent, incline, size of branch, etc. He did the calculations and William  struck the branch with roughly 163 ft-lbs of force!  Consider that this force was expended onto a stick no more than 1” in diameter. Well, suffice it to say, that force is more than sufficient to snap the branch, break the skin, pierce the muscle, and even fracture one or both forearm bones (radius and ulna)! 😱

Make sense? Gooood! 🤗

Penetrating Wound: Poor William suffers what pathologists categorized as a penetrating wound. This occurs when a sharp object pierces the skin and creates a single opening into either tissues or a body cavity.  Clearly, there is one wound and the tissues in this instance are the meaty flexor muscles of his forearm. 💪🏻

Our flexor forearm (the palm side) houses eight muscles (15% of us have only seven). The spike would have driven deep into probably 2-3 of these muscles. This means any bacteria or other pathogens on the swampy branch would have sunk deeply into the tissues. This is why the wound became infected.

Inflammation: Ian unwraps William’s arm and spies a swollen,red, painful wound that will feel hot to the touch. These are four of the cardinal signs of acute inflammation, the body’s common response to injury and  infection.

Inflammation is heralded by five cardinal signs, four were described 2,000 years ago by Celsius. These are:

  • rubor (redness)
  • calor (heat)
  • tumor (swelling)
  • dolor (pain)

and….

  • functio laesa (loss of function) the fifth cardinal sign was added 200 years later by Galen, surgeon to Roman emperor, Marcus Aurelius.

    Does William’s Wound show all five cardinal signs of acute inflammation? Well, yes, yes it does! It is painful, swollen, red, hot, and he has lost normal use of the forearm. 

A current day example: The image below shows acute inflammation of the great toe (hallux) due to an ingrown toenail. The toe is red, swollen, warm, sore, and difficult to use.

Cleaning the Wound: I have to say, Ian was caring and compassionate to clean the splinters from William’s Arm.

But, I must protest! Ian has seen Auntie Claire take care of enough trauma to know that he should either cauterize that knife tip in the fire, or plunge it into the boiling water for a bit. Inserting the tip of a  dirty blade will introduce more pathogens into the already infected wound! 

And, pouring boiling/hot water into the wound? That  isn’t much help, either and was traumatic for William. Much better to let the water cool a bit and then cleanse the wound with the “sterilized “ liquid.

The amputation: When I saw this, I thought. Um……No! Denzel grabs his amputation saw and starts sawing away on William’s arm!  Now, this enactment exactly follows what is recorded  in “A Breath of Snow and Ashes:”

He had—he was told sometime after the fact—narrowly escaped loss of the arm: Dr. Hunter had grasped it and placed his amputation saw just above the wound, only to have the abscess that had formed below it burst in his hand. Seeing this, the doctor had hastily drained the wound, packed it with garlic and comfrey, and prayed—to good effect.

It was very dramatic, but you should know that a doctor with training like Denzel’s would not start sawing on skin. The saw teeth will rip and tear skin and muscle causing even more pain and morbidity for the patient. Instead, a practitioner used an amputation knife to slice the flesh around the bone and then saw through the bone. Below is an example of a typical amputation knife and an amputation saw of the time. 🔪🪚

As horrifying as this sounds, a capable practitioner could remove a limb very swiftly this way, reducing the trauma to the sufferer.

Finally, as Denzel puts pressure on the limb, pus bursts from the deep lying abscess. After removing the pus, the wound was carefully cleaned and wrapped..

Pus is a  thick yellowish or greenish opaque liquid produced in tissues infected with pyogenic bacteria such as Streptococcus or Staphylococcus (Not all infections elicit pus formation). Pus is formed of dead white blood cells, bacteria, tissue debris, and serum.

The term pus derives from the Latin and it has been used since the 14th C. Again, since Denzel is a well-trained physician, he would have likely used the term pus rather than bile.

Finally let’s consider William’s scar. Here, he recounts his travail to fellow soldiers…..from “A Breath of Snow and Ashes:”

Look,” he said, displaying the long, comet-shaped scar on his forearm. “That’s what happens when you get an abscess.”

Both Zeb and the doctor peered at the scar, impressed. It had been a splinter wound, he told them, caused by a lightning-struck tree.

Big, kudos to the FX folks. I thought the slightly reddened, puckered, and contracted scar was believable. Well done!

I hope you enjoyed this review of William’s Wound.

Until we meet again, fare thee well! 

The deeply grateful,

Outlander Anatomist

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Photo creds: Sony/Starz, www.myclevelandclinic.org, www.en.Wikipedia.org, www.teachmeanatomy.info, www.teachmesurgery.com

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Anatomy Mini-Lesson – Popliteal Aneurysm!

Greetings Outlander anatomy students!

Much time has passed since my last post partly because I am nursing broken bones of my left ankle. I am working off an iPad, instead of my desktop computer, so it is slow going. 😱

Today’s lesson details Mr. Walter Woodcock’s dilemma as presented in Outlander episode 705, Singapore.

You will recall, Walter lies in the infirmary at Fort Ticonderoga with a significant injury to his right foot. The wound has turned gangrenous so an amputation is required.

Claire arrives to witness a medical dispute between Dr. Denzel Hunter and the pompous, Lieutenant Stactoe.

Curious Claire asks, what is going on? 🤔

Denzel recommends an above-knee amputation for Walter. Stactoe is adamant that a below-knee amputation makes for a more functional limb.

Stactoe is correct that in most circumstances, every attempt is made to salvage as much of a limb as is possible.

However, Denzel explains that Walter has a popliteal aneurysm, thus, an above-the-knee amputation is necessary! Claire palpates Walter’s calf and agrees with Denny.

Oh, oh! This changes everything! 🤔

There ensues a wee strammash when Stactoe says Claire will not use boiling water on HIS instruments. This is a direct quote from Diana’s An Echo in the Bone:

You will ruin the temper of the metal, subjecting it to boiling water!”

“No,” I said, keeping my own temper—for the moment. “Hot water will do nothing but clean it. And I will not use a dirty blade on this man.”

“Oh, won’t you?” Something like satisfaction glimmered in his eyes, and he clutched the blade protectively to his bosom.”

In the episode, Stactoe stomps off. But, no worries, Denzel to the rescue with his own set of fine surgical instruments!

To understand the implications of a popliteal artery aneurysm, let’s look at the anatomy of the arterial supply to the knee.

Essentially all of the lower limb is supplied by the huge femoral artery which begins at the groin and descends through the front of thigh. Near the top of the knee, the artery passes to the back of the knee and is renamed the popliteal artery (next figure). It then descends behind the knee joint. At the bottom of the joint, it splits into two and then into a third artery, all of which receive new names and supply lower leg and foot.

The hollow behind the knee joint is the popliteal fossa.

Try This:  Make a fist, bend opposite knee slightly, and tuck your fist into the hollow behind your knee. This is the popliteal fossa. Remove your fist and insert middle and ring fingers into the hollow. Press. You may be able to feel the pulsing of the popliteal artery in the popliteal fossa.

Feel it? Good job, students! 🤗

   
Next. The aneurysm! 🤓

A popliteal artery aneurysm, known by the acronym PAA, is a weak spot in the wall of the popliteal artery. Pressure exerted by arterial blood causes the weak spot to balloon into a palpable bulge behind the knee joint. This is of concern because if the aneurysm should burst, the blood loss would be difficult to control especially in an amputee.

Some causes of PAA are:

  • Atherosclerosis
  • High blood pressure
  • Wear and tear of the popliteal artery due to over use of knee joint
  • Weakening of the artery wall

The image show a couple different types of PAA.


Now, back to the episode!

Claire palpates Walter’s leg and agrees with Denzel. An above-knee amputation is best to avoid the aneurysm bursting with uncontrolled hemorrhaging.

A clear view of his damaged, gangrenous foot can be seen in the next image.

Unfortunately, Claire places her hands on either side of his calf. She cannot feel a PAA in this location because there is no popliteal artery behind the calf. Her hands should be up in the hollow of the knee.

Nevertheless, she gets an A+ for trying! 🤩

Also, in real life, the stench of gangrene would likely require them to mask and use some type of ointment under the nose to distract from the odor. 😮

And, today, imaging modalities would be used to determine the type and extent of a PAA.

In the final scene with Walter, Claire breaks the sad news that his condition does not permit him to be evacuated with the other patients.  He is to be left behind. 😢

Claire has a wonderful bedside manner which comes from her compassionate and caring heart. Hopefully,  the British will treat Walter well. 🤞🏻

Mercy! 😉

I hope you enjoyed today’s lesson. Just remember, if you ever feel a pulsing bulge behind  the knee, make an appointment swiftly or get into urgent care. A PAA is no joke!

The deeply grateful,

Outlander Anatomist

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Photo creds: Sony/Starz, www.myclevelandclinic.org, www.uptodate.com

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Anatomy Lesson Outlander Trauma-Drama, Part 2

Hey, all.

Hope you had a grand couple of weeks awaiting part two of Outlander Trauma-Drama… Here it is. Yay! 🤗

Our last Anatomy Lesson, Outlander Trauma-Drama, Part 1, showed the system pathologists use to classify trauma. In that lesson, we covered different types of mechanical trauma including contusion, abrasion, laceration, incision, avulsion, projectile injury, and puncture wounds.

Remember? Yasss! 😊

    • Mechanical trauma
      • Contusion
      • Abrasion
      • Laceration
      • Incision
      • Avulsion
      • Projectile injuries
      • Puncture wounds
    • Thermal Injury
    • Radiation Injury
    • Personal Exposure (tobacco and alcohol)
    • Therapeutic Drugs
    • Air Pollution
    • Industrial Exposures
    • Agricultural Hazards
    • Natural Toxins
    • Oxygen Deprivation
    • Infectious Agents
    • Immunological Diseases
    • Genetic Derangements
    • Nutritional Diseases

Today’s lesson continues with the trauma-drama theme ‘cos there are still loads of Outlander owies to uncover and discover!

Again, examples from Diana’s big books and the Starz Outlander series will serve as anatomical models for the injuries. 👍🏻

Today’s lesson will cover thermal injury and alcohol abuse. So, let’s get started!

There are six types of Thermal Injury:

    • Thermal burns
    • Hyperthermia
    • Chilblains
    • Hypothermia
    • Frostbite
    • Electrical injury

Here we go!

Thermal Burns: Thermal burns are caused by harmful exposure to heat, electricity, chemicals, or radiation.

Thermal burns are usually classified as first, second, or third degree burns. Occasionally, we hear of fourth degree burns, but do you ken there are also fifth and sixth degrees? Indeed there are! 🤓

Some students may have read Anatomy Lesson #5 and Anatomy Lesson #6 wherein we learned that skin is composed of epidermis (surface layer of skin cells) and dermis (underlying connective tissue). Thus, another useful way of grading thermal burns is to describe their relative depths.

Partial-thickness Burn: This type damages the epidermis or both the epidermis and outer dermis; it includes first and second degree burns. Such burns are red and may blister and are very painful. Most partial-thickness burns heal without scarring because hair follicle cells regenerate to cover the damaged surface. Even here, if a partial-thickness burn is too large, a skin graft may be required.

Full-thickness Burns: Full-thickness burns extend through both epidermis and  dermis and into underlying tissues. Such wounds are typically aesthetic (painless) because nerve endings are destroyed, although the rim of such a burn is usually painful. Full-thickness burns include third, fourth, fifth and sixth degree burns which may pass into muscle and bone. Fifth and Sixth degree burns are typically fatal.

We can imagine fifth and sixth degree burns suffered by poor Father Alexandre and Johiehon, his love interest in Outlander episode 412, Man of Worth.

Diana’s fourth big book, Drums of Autumn details the sad and horrific conflagration as the lovers burned to ash.

When the Indians had nearly finished with the priest, they untied him from the stake and fastened his hands instead to a long pole, held above his head, from which to suspend him in the flames….

… It was then that he had seen the Indian girl standing on Claire’s other side, with a cradleboard in her arms. … “She didna look to left or right, but walked straight into the fire.” … The flames had embraced the girl in moments. 

… “Her clothes caught, and then her hair. By the time she reached him, she was burning like a torch.” Still, he had seen the dark silhouette of her arms, raised to embrace the empty body of the priest. Within moments, it was no longer possible to distinguish man or woman; there was only the one figure, black amid the towering flames.

…The smell of burnt things hung in the air. We passed close by the pit and I couldn’t help seeing from the corner of my eye the heap of charred fragments, shattered ends frosted white with ash.

Hyperthermia: Hyperthermia  occurs if body temperature rises significantly above normal (>104 °F / 40 °C ). Many challenges, including infections, cause excessive body temperature.

Typhoid fever,  a.k.a. enteric fever, is caused by food and water contaminated with salmonella bacteria. Symptoms include:

    • High fever
    • Headache
    • Stomach pain
    • Constipation or diarrhea

A great example of hyperthermia appears in Outlander episode 310, Heaven and Earth. You remember Claire’s splendid  wee aide, Elias, who falls ill with typhoid? Claire is comforts him as he bravely succumbs to fever and dehydration. 😭

Cold temperatures 🥶 also cause thermal injury because the human body is poorly equipped to regulate and prevent heat loss; this is especially true of children and the elderly. Normally, fat deposits, heart, blood vessels, brain, skin, and muscles help combat cold. These organs provide insulation, induce shivering, re-direct blood flow from skin to vital organs, and reduce energy consumption.

However, exposure to cold temperatures over long periods of time overcomes our coping mechanisms and produces a range of thermal cold injuries such as chilblains, hypothermia, and frostbite.

Chilblains: Chilblains is a 16th century term for skin trauma due to repeated expose to cold, but not freezing, air. Digits are most commonly affected. The skin becomes red, swollen ,and itchy (next image), but usually heals without permanent damage.

Outlander TV episodes do not feature chilblains. But have no fear, our amazingly witty and resourceful Diana writes about it in her second book, Dragonfly in Amber, wherein Claire treats imprisoned men with chilblains.

She’s a wonder! Which “she” do I mean? Take your pick – either woman works!

I talked my way into the cells of the prison, and spent some time in treating the prisoners’ ailments, ranging from scurvy and the more generalized malnutrition common in winter, to chafing sores, chilblains, arthritis, and a variety of respiratory ailments.

Ouch, that looks a wee bit uncomfortable!

Hypothermia: Hypothermia occurs when the body’s core temperature drops below 95°F / 35°C as a result of extended cold exposure. Symptoms include low core temperature, vigorous shivering, confusion, sleepiness, slurred speech, shallow breathing, weak pulse, low blood pressure, changes in behavior, and slowed reactions.

Put simply, the victim of hypothermia experiences  the “umbles” meaning grumbles, mumbles, stumbles and fumbles because cold affects muscle and nerve response.

If the core temperature drops to 90º F / 32.2º C, then bradycardia (slow heart rate) and atrial fibrillation (fast and irregular contraction of the heart’s two upper chambers) may ensue.

The teenager, bad-lass Laoghaire, wasn’t suffering from hypothermia when she exposed her “ladies” to Jamie  in Outlander episode 109, The Reckoning, but she was well on her way!

Take a keek at that goose flesh! 😉

Frostbite: Frostbite is cold injury in which the body’s surface is exposed to freezing temperatures; it affects mostly feet, hands, noses, cheeks, and ears. And, as Prince Harry points out in his tell-all book, “Spare,” the todger must be protected from frostbite. This makes sense since it is also an appendage. 😉

Frostbite occurs in three stages:

    • Frostnip: Frostnip is a mild form of frostbite. Continued cold exposure leads to numbness in the affected area. As the skin warms, the sufferer feels pain and tingling but no permanent skin damage.
    • Superficial Frostbite: Superficial frostbite causes slight changes in skin color. The skin may begin to feel warm — a sign of serious skin damage. Rewarming at this stage causes the skin to appear mottled. The victim may notice stinging, burning and swelling. Fluid-filled blisters may appear over the next 12 to 36 hours (next image).
    • Deep Frostbite. As frostbite progresses, it affects all layers of the skin and underlying tissues. The skin turns white or blue-gray; all sensation of cold, pain, or discomfort is lost in the affected area. Joints or muscles may stop working. Large blisters form 24 to 48 hours after rewarming. The tissue turns black and hardens as it dies. Amputation is usually warranted.

Claire teasingly relates how she and Jamie avoid getting frostbite in this steamy tidbit from Drums of Autumn.

His mouth was warm and soft, and whether he approved of what he was doing or not, he did it awfully well.

…“Ooooh,” I said, and shuddered ecstatically as his teeth sank delicately into my earlobe.

….“Oh, well, if it’s like that,” he said in resignation, and taking my hand, pressed it firmly between his thighs.

..“Gracious,” I said. “And here I thought the cold …”

…“It’ll be warm enough soon,” he assured me. “Get them off, aye?”

…It was rather awkward, given the cramped quarters, the difficulty of staying covered in order not to suffer frostbite in any exposed portions, and the fact that Jamie was able to lend only the most basic assistance, but we managed quite satisfactorily nonetheless. 😅

Electrical Injury: What is this? Electrical injury is damage to the skin or internal organs after a person comes into direct contact with a high-voltage source. An electric shock can be life-threatening.

Good advice: Get emergency help if the source of the injury is a high-voltage wire or lightning. Even those with minor injuries or no symptoms should be checked by a physician for internal injuries because these may not be evident to the non-professional.

Rare but life-threatening symptoms include severe burns, muscle pain and contractions, seizures, and unconsciousness. In some cases, heartbeat and breathing may be difficult to detect.

In the US, there are approximately 1000 deaths per year, as a result of electrical injuries. Of these, approximately 400 are high-voltage electrical injuries and lightning causes 50 to 300. There are also at least 30,000 shock incidents per year that are non-fatal.

If you think these stats are grim, consider the UK: Faulty electrical equipment and sockets cause approximately 70 deaths and 350,000 injuries in UK homes every year (RHA, 2022). Such figures show how important it is to follow electrical safety guidelines.

Outlander book and TV don’t really contain much about electrical injury. the closest I can come is Claire’s eerie encounter with Otter-Tooth’s ghost in Outlander episode 403, The False Bride. Here, she experiences the aftermath of a lightning strike.

Diana describes the scene in vivid detail. Again, from Drums of Autumn:

Sheet lightning shimmered far away, across the mountains. Then more bolts, sizzling across the sky, each succeeded by a louder roll of thunder. The hailstorm passed, and the rain resumed, pelting down as hard as ever. The valley below disappeared in cloud and mist, but the lightning lit the stark mountain ridges like bones on an X ray.

I woke all the way to the smell of burning, and sat bolt upright. The rain had stopped; it was the silence that wakened me, I thought. The smell of smoke was still strong in my nostrils…

…The ground rose in front of me to a small ridge. At the top of this stood a large balsam poplar tree, the source of the smoke. The tree had been struck by lightning; half of it still bore green leaves, the canopy bushy against the pale sky. The other half was blackened and charred all down one side of the massive trunk. Wisps of white smoke rose from it like ghosts escaping an enchanter’s bondage, and red lines of fire showed fleetingly, glowing beneath the blackened shell.

Echoes of the shock of impact wavered through my flesh, and I tried frantically to fit myself back into my body. Then I drew breath, a painful gasp, and found myself shaking, the shock turning to the first intimations of damage. I lay still, eyes closed, concentrating on breathing, conducting an inventory. 

…The rain was still pounding down onto my face, puddling in my eye sockets and running down into my ears. My face and hands were numb. My arms moved. I could breathe a little easier now.

Drenched in cold, relentless rain, Claire spies the spooky ghost of Otter-tooth. Careful, lest you get hyperthermic, Claire!

And, there he is. Sharp as an Otter’s Tooth!

That is it for thermal injury. But….

Here’s some exciting thermal news: The US Department of Energy is developing clothes with thermal properties that adapt to the environment and to the wearer’s body. By changing the make-up or shuttling heat to and from the body, the garments can keep people comfortable whatever the external temperature (30 January 2016, New Scientist). I’m ready for one of these jackets, how about you?

Onward! 

Alcohol: Alcohol is a colorless, volatile, and flammable liquid that is the intoxicating element of wine, beer, and other spirits (duh!); it is also used as a fuel and is an industrial solvent! 😮

How the body handles alcohol: The stomach lining contains alcohol dehydrogenase (ADH), an enzyme which metabolizes alcohol. The liver also has ADH plus other enzymes that help break down alcohol. But, bad news for the lassies: Women naturally have lower levels of GAD than men and often develop higher blood alcohol levels after drinking the same or even less alcohol. So, be wary if ye are an XX!

Claire offers a pithy analysis of alcohol in this quote from the big book, “Drums of Autumn,“wherein Jamie gets John Quincy Myers drunk in preparation for his hernia surgery.  (Psst…Non-book readers ken Claire performed this surgery on Edmond Fanning in episode 408, Wilmington.)

“Alcohol isn’t a good anesthetic at all,” I said, shaking my head. “It’s a poison. It depresses the central nervous system. Put the shock of operating on top of alcohol intoxication, and it could kill him, easily.”

And, there we have it in a nutshell!

Not surprisingly, alcohol is the most widely used and abused toxic agent in the world. (Not meaning to preach as I enjoy a wee bit now and then)

Alcohol injury ranges from binge drinking to full on alcoholism with a myriad of accompanying ailments. Most of us are well-versed on the effects of excessive alcohol intake and realize some effects are acute and others are chronic.

Acute Alcohol Intoxication: In the US, there are over 3,000,000 reported cases of acute alcohol intoxication (AAI) from drinking too much, too quickly. Symptoms include slurred speech, incoordination, mood and behavioral changes, and poor judgement. Acute alcohol intake effects breathing, heart rate, body temperature, gag reflex, and can lead to coma and death. (psst… I wager many more cases go unreported) 🫢

Risk factors include:

      • Injuries, such as motor vehicle crashes, falls, drownings, and burns.
      • Violence, including homicide, suicide, sexual assault, and intimate partner violence.
      • Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
      • Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
      • Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.
Alcohol intoxication is managed with rest, hydration, and abstaining from alcohol. It is worth noting that severe cases may require hospitalization, intravenous fluids, observation, and supportive care.

Oh, Jamie is in the throes of AAI at Lallybroch (episode 112, Lallybroch). He is stinking drunk as he stumbles into the bedchamber reeking of booze; Claire is not “amoozed.” 

But, he looks marvelous in his da’s splendid leather coat! 😜 

Chronic Alcohol Use: Alcohol Dependence Syndrome (ADS or alcoholism) is a condition characterized by long-term alcohol dependence and alcohol abuse that result in specific physiological and behavioral problems. ADS  includes ten or more different signs and symptoms, but from a medical standpoint, only two are required for diagnosis. Chronic use causes a host of problems, including:
    • High blood pressure, heart disease, stroke, liver disease, and digestive problems.
    • Cancer of the breast, mouth, throat, esophagus, larynx, liver, colon, and rectum.
    • Weakening of the immune system, increasing the chances of illness.
    • Learning and memory problems, including dementia and poor school performance.
    • Mental health problems, including anxiety and depression.
    • Social problems, including family problems, job-related problems, and unemployment.
    • Alcohol use disorders, or alcohol dependence

In season six of Outlander, we witness Fergus falling into ADS as he struggles with the cruelty and intolerance toward his dwarf son (episode 603, Temperance).  Alcohol  is commonly used to cope with personal tragedy and trauma.

You remember Colum MacKenzie back in Outlander, seasons 1 and 2?  Yes, of course ye do! 😊 Claire diagnosed Colum as a sufferer of  Toulouse-Lautrec Syndrome, also known as pycnodysostosis. 

Colum required large quantities of rhenish wine (9% alcohol content) to quell and dispel the agony of his existence (Outlander episode 102, Castle Leoch). 

…  “I beg your pardon?” I turned, having missed Colum’s words in the growing noise, to find him offering me the decanter, a lovely bell-shaped thing of pale green crystal.

The liquid within, seen through the glass, seemed green as the sea-depths, but once poured out it proved to be a beautiful pale-rose color, with the most delicious bouquet. The taste was fully up to the promise, and I closed my eyes in bliss, letting the wine fumes tickle the back of my palate before reluctantly allowing each sip of nectar to trickle down my throat.

“Good, isn’t it?” The deep voice held a note of amusement, and I opened my eyes to find Colum smiling at me in approval. I opened my mouth to reply, and found that the smooth delicacy of the taste was deceptive; the wine was strong enough to cause a mild paralysis of the vocal cords.

“Won—wonderful,” I managed to get out. Colum nodded.

“Aye, that it is. Rhenish, ye know. …”

Clearly, Colum suffered from his genetic disability but also from ADS . Near the end, when rhenish no long offered the needed relief, he turned to Claire to assist him in end of life options (Outlander episode 210 Prestonpans).

ADS is considered a medical emergency because it can lead to coma and death. Guidelines exist about the amount of alcohol the liver can metabolize per hour and these rates should not be exceeded. Again, please get informed if this is an issue in your life.

As a final example, we see wee Flora MacDonald taking a wee nip from her personal hip flask in Outlander, episode 605, Give Me Liberty!  Now, just because she carries a personal flask, it doesn’t mean she is suffering from either acute or chronic alcohol poisoning! 😉

Finally, this is an interesting tidbit. Some people carry a gene variant encoded for alcohol dehydrogenase (ALDH2*2) that stops the enzyme working, so these folks experience flushing soon after drinking. This happens because they have a lowered ability to metabolize alcohol and includes some 8% of the world’s population. Now, a link has been found showing that this gene raises heart disease risk in those who experience alcohol flush (New Scientist, 4 Feb. 2023). The risk of heart disease is four times greater in regular drinkers with the defective gene! if you flush immediately after alcohol ingestion, you may wish to consult your physician?

OK, that is our lesson for today. But before we call it quits let’s have a –

Pop Quiz! 

Name the injury (red arrow) Jamie sports after the Battle of Alamance, in Outlander episode 507, The Ballad of Roger Mac.

What was that you said?

An abrasion?  🚫

A laceration? 🚫🚫

An avulsion? 🚫🚫🚫

What was that you said?

 

 

A contusion? Yep!

Well done, anatomy students! 👏🏻👏🏻👏🏻

Next time, Part 3!

The deeply grateful,

Outlander Anatomist

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Photo creds: Sony/Starz, www.en.wikipedia, www.britannica.com