Category: Anatomy Lessons

Greetings anatomy students! Time for another installment of our “slip and slide” down the gastrointestinal tract. Last time, Anatomy Lesson #44, “Terrific Tunnel – GI System, Part 1,” covered oral cavity, including tongue and teeth. There, we learned the major functions of the GI tract are ingestion, digestion, absorption, and excretion of food stuffs or their residues. As these activities are essential for survival (excepting parenteral feeding via intravenous route), every part of the GI tract is adapted for one or more of these functions. Please bear this in mind as we continue our guided tour down the Tremendous Tube!

Oh, before I forget, this lesson contains a book spoiler, so watch for the fleeing weiner dogs (a.k.a. Canis lupus familiaris); they will alert you!

Fauces: Last lesson ended with the oral cavity. So picking up the thread, the fauces is the next part, a passageway connecting oral cavity with pharynx. The word derives from the Latin fauces meaning throat, but originally referenced the vestibule of an ancient Roman home.

Fauces are formed by two pairs of arching pillars (Image A), one pair in front (anterior) and one pair in back (posterior).  Palatoglossal arches are anterior folds, reaching from soft palate to each side of tongue; these appeared in Anatomy Lesson #44, “Terrific Tunnel – GI System, Part 1.”  Paired palatopharyngeal arches are posterior folds, reaching from soft palate to sides of pharynx. All four folds contain small muscles used in chewing, swallowing, speaking, and so forth. Like the oral cavity, fauces are lined with mucosa, a layer containing numerous small salivary glands which add fluids to keep mucosal surfaces moist.

Image A

Faucial Arches: Together with the tongue, the palatoglossal arch and palatopharyngeal arch of one side form a triangular-shaped depression. This is readily apparent in Image B, a parasagittal section, meaning a vertical plane dividing the body into right and left sides (the plane passes slightly to the right of mid-line). Here, we view the inside of the right half of head. An oval, bumpy structure sits in this triangular depression; keep reading to learn about it.

Try This: Go to a mirror with a flashlight. Shine the light into the mirror and open your mouth; the reflected light will illuminate your fauces. Find the anterior folds, the palatoglossal arches. If you open very wide and depress your tongue strongly against the floor of mouth, you may be able to see the posterior palatopharyngeal arches. Try it!

Image B

Pharynx: You may recall, Anatomy Lesson #42, “The Voice – No, Not That One!,” explained that pharynx is pronounced fare-inks, not far-nix. As noted in that lesson, one of my anatomy profs used to threaten: “if you say lar-nix one more time, I will rip out your far-nix!”

The pharynx is a muscular tube lined with mucosa and divided into three regions, named by their association with adjacent regions. Nasopharynx lies posterior to the nasal cavities (Image C – green). Oropharynx sits posterior to the oral cavity (Image C – yellow). Laryngopharynx (some physicians prefer the term hypopharynx) is posterior to the larynx (Image C – blue).

Like the oral cavity, pharynx is lined with mucosa (Anatomy Lesson 44: “Terrific Tunnel – GI System, Part 1”). A layer of muscle underlying the mucosa contracts to aid in swallowing, coughing, etc. Many tiny mucous (adj.) glands embedded in the pharynx release mucus (n; a.k.a. phlegm), a glycoprotein making the mucosal surface slimy. Talk about a slippery slope!

Image C

Try This: Return to the mirror with flashlight in hand. Open mouth wide and look passed the oral cavity and fauces. Do you see the red wall at the back of throat? This is the posterior wall of the oropharynx. Without proper lighting and equipment, you cannot see naso- or laryngopharynges (pl.). Good work, all!

Pharyngeal Muscle:  Image D illustrates a coronal section wherein a vertical plane divides the body into front and back segments. The deep plane passed through the skull revealing back of pharynx and it’s muscles.

Muscles of the pharynx are complexly arrangement as they are telescoped inside one another. The right pharyngeal side of Image D is opened to reveal the back of larynx and uvula of soft palate. The left side shows intact pharyngeal musculature. Paired superior pharyngeal constrictor muscles are suspended from the skull. These fit inside the paired middle pharyngeal constrictor muscles which fit inside the paired inferior pharyngeal constritor muscles. This muscular arrangement allows the pharynx to usher food boluses from oral cavity and fauces into the esophagus (Image D).

Image D

Tonsils: Oral cavity, fauces, and nasopharynx house the tonsils. Returning to the parasagittal image shown earlier, the tonsils are now labelled (Image E). Anatomists typically teach that humans have three sets of tonsils. But, to be precise, humans actually have four sets of tonsils: palatine, lingual, pharyngeal, and tubal.

By tradition, tonsils are written and named using the pleural form. This can be a bit confusing as two sets of tonsils are truly paired, but two are not. Her’s how this works. Lingual tonsils are not paired – rather, this is a large, single mass of tonsilar tissue under the mucosa at back of tongue. Pharyngeal tonsils, better known as adenoids, is a second singular mass of tonsillar tissue embedded high in the nasopharynx. Paired palatine tonsils are seated between the faucial arches; these structures are what most people mean when they say tonsils! Lastly, the oft ignored tubal tonsils (Image E – black arrow – they aren’t even labelled in the original figure) are paired masses near pharyngeal openings of each auditory (Eustachian) tube. Remember, the Eustachian tube leads to its respective middle ear (Anatomy Lesson #25, “If a Tree Falls – The Ear”).

Image E

Waldeyer’s Ring: If one considers all four sets of tonsils from a frontal view (Image F –  right side), they form a “ring-around-the” nasopharynx and oropharynx. This so-called Waldeyer’s ring is named after a famous nineteenth century German anatomist, Heinrich Wilhelm Gottfried von Waldeyer-Hartz (Whew, glad I don’t have to sign that name on my credit card receipts!). This anatomical configuration is not accidental as tonsils are strategically placed to encounter pathogens and unwanted materials in food we ingest and in air we breathe.

Try This: Unless a surgeon has already messed with your fauces, return to the mirror to find your own palatine tonsils situated between the faucial arches. Remember the surgeon’s chant: a chance to cut is a chance to cure! <G> Just so you know, palatine tonsils typically shrink with age, so if you are a senior citizen, don’t be alarmed if yours are way smaller than in your teens!

Image F

Lymphoid Tissue: What the heck are tonsils? Tonsils are concentrated communities of lymphocytes, a particular class of leukocyte (white blood cell). Anatomy Lesson #37 “Outlander Owies Part 3 – Mars and Scars” stated that our blood contains five classes of leukocytes, one of which is the lymphocyte. There are also several types of lymphocytes, all of which work to provide us with immunity. Just so you know, lymphocytes are present both in circulating blood and in tissues outside of blood vessels.

Now, don’t run away screaming, but tonsils exhibit a classic morphology (appearance) by light microscopy (Anatomy Lesson # 34, “The Amazing Saga of Human Anatomy”). Image G shows a microscopic section through a bit of lingual tonsil.  The darker masses labelled lymphatic tissue (I prefer lymphoid tissue) are characteristic. Such clusters typically stain blue-purple (H&E staining for those with histology backgrounds). Notice that each cluster labelled “lymphatic tissue” contains smaller circles exhibiting a thin dark rim around pale centers – they kind of look like beads. Yay (I do beadwork)! This classical appearance of lymphatic/lymphoid tissue is present in various forms throughout the GI tract. Stay tuned. We will likely encounter them again during our TTT (tremendous-tube-tour)!

Image G

Tonsillitis: Because tonsils are continuously exposed to pathogens (bacteria, viruses, and other microorganisms), they may become enlarged and inflamed, a condition known as tonsillitis. In fact, the suffix, “itis” attached to any word, means inflammation. Tonsillitis is invoked by various pathogens including viruses causing influenza or the common cold, or bacteria causing group A streptococcus (GAS), gonorrhea, and diphtheria. Image H shows the exudate common to a positive strep throat. BTW, exudate is the scientific term for the whitish gunk that may be exuded by inflamed tissues.

Image H

If tonsils become chronically enlarged (hypertrophy) and/or repeatedly infected, they may be surgically removed by tonsillectomy (Image I).

WARNING: I try to avoid quotes from Diana’ books that have yet to be filmed, but sometimes naught else will do. Run free and flee with the hot dogs if you don’t want to skip the next three paragraphs!

BOOK SPOILER: Later book readers know that Diana wrote about tonsillectomy.  An Echo in the Bone has surgeon Claire performing a tonsillectomy of both palatine and pharyngeal (adenoids) tonsils on a youngster:

“Owg-owg-owg,” he said, grinning widely, but obligingly opened up. A faint putrid smell wafted out of his wide-open mouth, and even lacking a lighted scope, I could see that the swollen tonsils nearly obstructed his throat altogether. “Goodness gracious,” I said, turning his head to and fro to get a better view.

… Marsali had a small mirror with which to direct light, and that would perhaps help with the tonsils—the adenoids would have to be done by touch. I could feel the soft, spongy edge of one adenoid, just behind the soft palate; it took shape in my mind as I carefully fitted the wire loop around it, handling it with great delicacy so as not to let the edge cut either my fingertips or the body of the swollen adenoid…

Claire’s extraction likely produced specimens similar to these shown in Image I.

Image I

Tonsilloliths: Tonsils typically have surface creases known as tonsillar crypts. It is not uncommon for people to develop whitish globs in these crevasses. Such bodies are tonsilloliths, also known as tonsil stones, or sulfur granules. Tonsilloliths (-lith from the Greek lithos meaning stone) are stinky globs of mucus, dead cells, debris, and bacteria (Image J). They may be cheese-like or they may calcify into hard “stones” and are often the culprits in chronic bad breath due to the type of bacteria they harbor!

Most tonsilloliths are small but they can become huge, large enough to inhibit swallowing! Image J shows a tonsillolith embedded in a right palatine tonsil.  “Health-care-fingers” wield a tool to ease and tease the tonsillar stone out of its nest.

Social media carries a lot of advice about self-removal, including use of water picks, wet Q-tips, fingers, yadda, yadda, yadda. Warning! Palatine tonsils, the only pair you can readily see and access, has a very rich blood supply. Messing with deeply embedded or large tonsilloliths can cause bleeding and may result in subsequent infection. I cannot verify the efficacy of home-grown techniques but if you have doubts, please consult a professional!

Image J

Not-So-Fun-Fact: Did you know, from 1926 through the 1960’s, children and adults suffering chronic middle ear infections were treated with radium to destroy the tonsils? Radioactive radium was inserted through the nasal cavities. Gah! And, during World War II, US, Canadian, and European military personnel also received NRI therapy (Nasopharyngeal Radium Irradiation – think Dana Scully and The X-Files!). Selected for treatment were soldiers with chronic middle ear dysfunction and who experienced job-related pressure differences.  Pilots, divers, and submarine trainees (Image K – submariners) were among the unlucky folks receiving such ghastly (my opinion) “health care.”  Consider the adage: “Yesterday’s heresy is today’s orthodoxy, is tomorrow’s fallacy.” Such is the checkered path of science and medicine! In its defense, science does maintain a check-and-balance system which helps it move onward and upward, even though the path may be uneven.

Image K

OK, moving on. Buh-bye tonsils!

Swallowing: So, food has entered the oral cavity, has been chewed (hopefully), and now it is time to swallow. What happens with swallowing? Well, swallowing involves oropharyngeal and esophageal stages.

Oropharyngeal Stage of Swallowing: Quite a few events occur almost simultaneously during swallowing and the list for the oropharyngeal stage is pretty astonishing:

• Food is chewed
• Saliva and food mix to form a wet blob known as a food bolus
• Tongue lifts to press food bolus against the roof of mouth
• Swallowing center (medulla of brain) initiates a reflex muscular closure of the laryngeal inlet to exclude food.
• Epiglottis closes over the laryngeal inlet to block food bolus from entering larynx
• Uvula constricts blocking food bolus from entering nasopharynx
• Laryngeal muscles contract and respiration stops

You fully ken that things sometimes go wrong during swallowing; drink accidentally enters the nose or food gets sucked into the larynx. This is what happens if we try to breathe and swallow at the same time (please don’t try it as an experiment!). Such events stop us dead in the water until we cough out or blow out the offending materials. Hack! Honk!

Next is a video showing fluoroscopy of the oral cavity and pharynx during swallowing. Can you identify the oropharyngeal events in this video? Watch movements of the tongue, uvula, and epiglottis. Amazing! The esophageal phase appears in this video but it is discussed below.

Does Herself write about swallowing? But, of course, Diana’s words are the “I Ching” for these Anatomy Lessons! Here, from Outlander book:

There was a lessening of the tension over the hall, and almost an audible sigh of relief in the gallery as Colum drank from the quaich and offered it to Jamie. The young man accepted it with a smile. Instead of the customary ceremonial sip, however, he carefully raised the nearly full vessel, tilted it and drank. And kept on drinking. There was a gasp of mingled respect and amusement from the spectators, as the powerful throat muscles kept moving. Surely he’d have to breathe soon, I thought, but no. He drained the heavy cup to the last drop, lowered it with an explosive gasp for air, and handed it back to Colum.

The dramatic scene comes to life in Starz episode 104, The Gathering. Better than Colum, Claire thinks (Outlander book), the lad is a natural born showman!

Muscle Detour: Before we study the esophagus, we must take a brief detour to glean basic info about muscle. This topic may seem misplaced, but bear with me, as the reason soon becomes apparent.  Thus far, muscles of oral cavity and pharynx have been skeletal muscles, the most familiar type. Calling all anatomy students: you should know our bodies contain three different types of muscle tissue: cardiac, skeletal, and smooth (Image L).

Image L

Cardiac Muscle: Cardiac muscle is so named because it is found only in the heart (Image M). Psst … this isn’t really true, as it is also present in first part of the pulmonary veins (vessels carrying blood from lungs back to heart), a by-product of embryology.  But dinna write this on your biology quiz or try to correct your teacher. He or she willna appreciate it! <G>

Image M

Cardiac muscle is described as striated, involuntary in type. Striated because cardiac muscle cells bear microscopically-visible cross stripes (see them?): alternating dark and light bands across the cells (Image N – dark oval is a nucleus). Involuntary because we cannot voluntarily contract them; their contractions are regulated by involuntary mechanisms.

Image N

Skeletal Muscle: Skeletal muscle is so-named because it attaches to and moves bones of the skeleton (Anatomy Lesson #39 “Dem Bones – Human Skeleton”).  This type appeared in most of our anatomy lessons to date: pectoralis major, gastrocnemius, deltoids, quadriceps femoris, biceps femoris, blah, blah, blah, are examples.  Skeletal muscle contributes substantially to our over-all body weight: 38-54% in males and 28-39% in females! Many of the named skeletal muscles can be seen in this striking Body World’s display (Image O). BTW, the lifting partner wears ice skates but, the lifted partner wears none! Mayhap, a new Olympic sport?

Image O

Skeletal muscle is further described as striated, voluntary muscle.  Striated, because like cardiac muscle cells, skeletal muscle cells bear cross stripes. Voluntary, because, with the exception of reflex contraction (think a knee hammer), we can contract skeletal muscle at will. As these muscles contract, they move the bones they insert into. Note the bold cross striations (stripes) along the length of skeletal muscle cells (Image P). These are typically more obvious in skeletal than in cardiac cells (dark ovals are nuclei).

Image P

Smooth Muscle: The final type is smooth muscle. Smooth muscle is not new to long-time anatomy students, as it appeared in two prior lessons. Anatomy Lesson #6, “Claire’s Hair – Jamie’s Mane” or “Jesus H. Roosevelt Christ!” introduced arrector pili muscles, made of smooth muscle cells whose contraction give us goose flesh. And, in Anatomy Lesson #31, “An Aye for an Eye – The Eye, Part 3,” we learned that the pupillary sphincter muscle is also made of smooth muscle. Smooth muscle appears in this lesson because hollow organs of the GI tract, such as esophagus, stomach, colon, and small intestine, contain layers of smooth muscle (Image Q) .

Image Q

Smooth muscle is classified as non-striated, involuntary. Non-striated, because its cells lack cross striations, hence the term, smooth (Image R – elongate purple bodies are cell nuclei). Involuntary because we cannot contract smooth muscle at will. Like cardiac muscle, it operates without our commands.

It is abundant in the walls of hollow organs of the GI tract, errector pili muscles, blood vessels, gallbladder, urinary bladder, reproductive tract, and in various other ducts and tubes. If you consider smooth muscle the wimp of muscles, think again: the uterus, endowed with thick layers of smooth muscle, can generate enough contractile force to push a 10 lb. babe out the bony pelvis!

Image R

Esophagus: Next organ is the esophagus, a muscular tube connecting oropharynx with stomach. This tube goes by a mess of names, including food tube (ha ha!), gullet, gorge, oesophagus (British), throat, abyss, thrapple, gizzard, passage, maw and pa. Oops, should read, maw and craw! Hee, hee.

Esophagus begins at the laryngeal cricoid cartilage (Anatomy Lesson #42, “The Voice – No, not that One!”) and ends at gastroesophageal junction where it meets the stomach (Image S – black arrows). In adults, it measures roughly 20 – 24 cm (8″ – 9.5”) in length.

Image S

Esophageal Relationships: This tube pursues a long pathway as it “travels” through neck and thorax, ending in the abdominal cavity (Image T).  As the esophagus descends, it passes behind trachea (Anatomy Lesson #42, “The Voice – No, not that One!”), heart, and lungs, but in front of the spine.

Image T

Esophageal Hiatus: Long time anatomy students may recall that thorax and abdomen are separated by a muscular dome, the respiratory diaphragm (Anatomy Lesson #8, “Jamie Takes a Beating” and “Claire’s Healing Touch”). How does the esophagus bypass this structure?  Well, it doesn’t have to because there’s a hole through this skeletal muscle layer. Actually, three holes pierce the diaphragm: one for passage by esophagus (Image U – black arrow), one for the body’s largest vein (vena cava, Image U – turquoise arrow) and one for its largest artery (aorta, Image U – red arrow). If the hole (hiatus) for the esophagus is too large, a hiatal hernia may result wherein part of the stomach pushes up through the hiatus and into the thoracic cavity. Such hernias may cause heartburn, difficult swallowing, belching, or even chest or abdominal pain. But, for many folks, these are asymptomatic.

Image U

Esophageal Wall: An esophageal (adj.) “slice-of-life” reveals the organization of its wall (Image V).  The organ has a central lumen (cavity) which runs vertically.  Mucosa lines the lumen. Further out, two thick layers of muscle are present. Smooth muscle cells of the inner layer encircle the lumen forming an inner circular layer of smooth muscle. External to this, smooth muscle fibers run vertically forming the outer longitudinal layer of smooth muscle. Let’s take a closer look at these parts.

Image V

Esophageal Mucosa: Like oral cavity and pharynx, the esophagus is lined with mucosa, including a thick layer of non-keratinized (living) surface cells (Anatomy Lesson #5, “Claire’s Skin – Opals, Ivory and White Velvet”). In animals such as the rat, mucosal cells of the esophagus and upper stomach are keratinized (dead) for protection because they eat a coarse diet highly fibrous foods, such as seeds. Mucous glands release their mucus onto the surface keeping it slipper, as apparent by endoscopy (Image W). Talk about disappearing into the depths; quite a tube!

Image W

Esophageal Muscle: Esophageal muscle changes type along its length, hence, the above muscle detour. Its upper 1/3 is skeletal muscle, the lower 1/3 is smooth, and the middle 1/3 is mixed skeletal and smooth. Ergo, we have voluntary control over the upper esophagus which activates during breathing, belching, swallowing, etc. But, as smooth muscle arrives, contraction becomes involuntary; bye-bye voluntary control. At this level, we also lose somatic sensation typical of skin (light touch, pressure, heat, cold, pain, vibration), replaced by visceral pain/discomfort. If a lighted match were to be placed against a visceral surface, the heat would not be detected. Although not as discriminating, visceral pain is fully capable of making us writhe (think passing a gallstone)!  Visceral pain is activated by ischemia (lack of oxygen), distension ( stretch), or inflammation (Anatomy Lesson #37, “Outlander Owies Part 3 – Mars and Scars”).

Try This:  Next time you swallow a hot cup o’ Joe, cocoa, or soup, notice when and where you no longer feel the heat as the food moves downward. If you are typical, heat is longer detected at about the top of the chest. This is where visceral sensation and involuntary muscle arrive on the scene!

Esophageal Phase of Swallowing: As state above, esophageal muscle fibers are arranged in two layers: inner circular and outer longitudinal (Image X – back of esophagus). Contraction of the longitudinal muscle layer shortens the esophagus; contraction of the circular layer closes the lumen. This allows the organ to stretch and contract around a bolus of food, pushing it toward the stomach in coordinated waves known as peristalsis (review swallowing video above). Lastly, the esophagus has a functional lower esophageal sphincter (LES) which normally prevents reflux of gastric acids from the stomach back into the esophagus.

As noted in Anatomy Lesson #42 about the larynx, the back wall of trachea lacks cartilage (Image X). Filled with a fibrous connective tissue, this “defect” permits food to slide down the esophagus without rubbing against the tracheal rings. Remember, the secreted mucus keeps the food bolus and mucosal surfaces slippery (when wet <g>).

Image X

Because the esophagus delivers food and drink, and because our food choices are not always wise (think excessive distilled spirits), and because the entire gut is highly responsive to stress, the esophagus is subject to quite a few diseases and disorders. Here’s one familiar example, simply described.

GERD: Known by the longer term, Gastroesophageal Reflux Disease, folks with GERD experience chronic gastric reflux wherein highly acidic gastric juices regurgitate from stomach into the lower esophagus. Not just simple heartburn, in this instance, the LES fails to perform adequately. Over time, esophageal mucosal cells may be replaced with gastric lining cells, a change observable by endoscopy.  The pale pink area (Image Y – black arrow) is esophageal mucosa. The peachy area (Image Y – blue arrow) is gastric mucosa that has grown up and out of the stomach (dark area at the bottom of the pit) and into the esophagus. Why does does this happen? For defense: stomach surface cells are more resistant to acid than esophageal surface cells. However, as stomach cells do not belong in the esophagus, GERD is also accompanied by an increased risk of gastroesophageal cancer.

Image Y

Fun Fact: Time for another obscure fact (I love these!): the first part of the esophagus is equipped with tastebuds! Yep. I know, hard to believe, but ‘tis true. Watch this fun video about taste buds and Bud beer (these are on the tongue; see the uvula hanging down?). The original ad starred John Belushi (RIP, John, ye were a funny man!). So clever, back in 1979, I called Anheuser-Busch begging for a copy of the film clip to use in my GI lectures. Sure enough, they kindly complied. But, that was before YouTube. So, enjoy!

OK, lesson done – time to play! Let’s visit Outlander’s outlandish examples of mouths, throats, gullets, thrapples, and gizzards!

This wonderful quote from Dragonfly in Amber book wasn’t filmed for S.2, so let’s use a substitute image. Just image King Louis of France popping wee birdies into his mouth and down his gullet instead of lusting after Claire in her (barely) scarlet gown (Starz episode 202, Not in Scotland Anymore).

After a triumphal tour of the table to show it off—to the accompaniment of murmurs of admiration all round—the dainty dish was set before the King, who turned from his conversation with Madame de La Tourelle long enough to pluck one of the nestlings from its place and pop it into his mouth. Crunch, crunch, crunch went Louis’s teeth. Mesmerized, I watched the muscles of his throat ripple, and felt the rubble of small bones slide down my own gullet. Brown fingers reached casually for another baby. At this point, I concluded that there were probably worse things than insulting His Majesty by leaving the table, and bolted. Rising from my knees amid the shrubbery a few minutes later….

Pregnant Claire feels the gorge rise in her gullet before bolting to upchuck in the Gardens of Versailles! Oops!

Dragonfly in Amber book again comes to our rescue as Comte St. Germaine forks fish (or something more sinister) into his mouth. His distain for hostess, Lady Broch Tuarach (Starz, episode 204, La Dame Blanche), eclipses the tasty trout! Canna appreciate good French cuisine if ye are intent on poisoning a bonny lass. Come on man, get a grip!  It was a ship, not your life. Oops, maybe it is your life! Who is your comely BFF? Why, Mary Hawkin’s intended, of course!

I caught Magnus’s eye as he served the Comte St. Germain, seated across from me, and beamed congratulations at him as well as I could with a mouthful of fish. Too well trained to smile in public, he inclined his head a respectful quarter-inch and went on with the service. My hand went to the crystal at my neck, and I stroked it ostentatiously as the Comte, with no sign of perturbation on his saturnine features, dug into the trout with almonds.

I love this scene between Dougal and Claire (Starz episode 106, The Garrison Commander) as they halt their flight from Captain Sicko’s grim grip. Ever the Heiland gentleman, Dougal invites Claire have a sip of a stinky water. “Oh, Aye, theres a stink to it. But, it’ll wet your thrapple, sure enough.” Thrapple? Yup, that is Scottish for throat, windpipe, or gullet. New word for our vocabularies. Yay!

St. Ninian’s Spring, the liar’s spring (Outlander book), purportedly burns throat and esophagus of any liar who drinks of it. Dougal does a dirk-draw to finish her off in case the burning starts:

The water had an odd dark color, and a worse smell—likely a sulfur spring, I thought. The day was hot and I was thirsty, though, so I followed Dougal’s example. The water was faintly bitter, but cold, and not unpalatable. I drank some, then splashed my face. The road had been dusty.

…“So at least you believe me when I say I’m not an English spy?” “I do now.” He spoke with some emphasis. “Why now and not before?” He nodded at the spring, and at the worn figure etched in the rock. It must be hundreds of years old, much older even than the giant rowan tree that shaded the spring and cast its white flowers into the black water. “St. Ninian’s spring. Ye drank the water before I asked ye.” I was thoroughly bewildered by this time. “What does that have to do with it?” He looked surprised, then his mouth twisted in a smile. “Ye didna know? They call it the liar’s spring, as well. The water smells o’ the fumes of hell. Anyone who drinks the water and then tells untruth will ha’ the gizzard burnt out of him.”

No visible “fires of hell” in her thrapple, Dougal sheaths his deadly dirk! Claire, horrified that he would gut her gullet, asks why he spared her? His logic: weil, he wouldna have liked cutting her throat because she is a handsome woman and, because privately, he dreams of grinding her corn. Really, Dougal? This is your criterion for deciding whether to slice and dice a classy, sassy lassie? Geez, man, were you born in the 18th century?

“I see.” I spoke between my teeth. “Well, my gizzard is quite intact. So you can believe me when I say I’m not a spy, English or French. And you can believe something else, Dougal MacKenzie. I’m not marrying anyone!”

Ahhhh, weil, ye are wrong about that, Mistress Beauchamp. Jamie is waitin’ and rarin’ to go. Yay! Claire’s gonna get her corn ground, her corn ground, her corn ground….meal and multure free. Hee, hee!

Let’s finish this Anatomy Lesson down the Tremendous Tube with a clever poem about Nessie’s own gullet. Composed by Keith Logan, it is entitled, Nessie’s Freedom. Yes, that Nessie!

Nessie’s Freedom

If you’re ever at Loch Ness
even in full highland dress,
put away your skean dhu,
order up a round or two.
Nessie really likes her bevvy
but drinks only Scottish heavy,
so don’t proffer Irish stout
or you may be carried out.
With a toast to the Black Watch
she might sip a little scotch,
though proportions of her gullet
spell a need for a deep wallet.
But if none of this concerns you
she may smile as she discerns you,
and there’ll ever be a welcome
as you drink to Nessie’s freedom.

Long live Nessie! BTW, Claire sees “her” in Outlander book. If you aren’t reading Diana’s books, you should start. Missing out on a mess of fantastic story!

Next Anatomy Lesson, the stomach and beyond!

A deeply grateful,

Outlander Anatomist

Photo Creds: Starz, Netter’s Atlas of Human Anatomy, 4th ed. (Images A, B, D, E, S, X), www.ddc.musc.edu (Images W, Y), www.doctors.net (Image G), www.en.wikipedia.org (Image I), www.flashblog2011.blogspot.com (Image O), www.health.harvard.edu (Image C), www.innerbody.com (Image U), www.jbbardot.com (Image T), www.kids.britannica.com (Image M), www.medcell.med.yale.edu (Image N), www.medline.plus.gov (Image L), www.mhhe.com (Image R), www.militaryhistoryonline.com (Image K), www.sites.google.com (Image F), www.mayoclinic.org (Image Q), www.studyblue.com (Images P, V), www.treatcurefast.com (Image J), www.wikipedia.org (Image H)