blackjackrandall – Outlander Anatomy

May 17, 2018November 22, 2019

Anatomy Lesson #59: Complete Feet

Hello, anatomy students! Hello feet! Today’s anatomical offering derives from the Old English fot, meaning “foot.”

You might think Outlander has little to say about feet, but not so. Outlander has fleet feet, sweet feet, trick-or-treat feet, body heat feet, upbeat feet, mincemeat feet, eek feet, beat feet and indiscrete feet. As always, Outlander images and quotes are sprinkled throughout the lesson. Yay!

You might also think society has little to say about feet, but not so. Dozens of feet adages accent life’s little highs and lows:

Foot in both camps (fence sitter)
Ankle deep (in trouble)
Back on your feet (on the mend)
Bound hand and foot (hampered)
Cold feet (lost interest)
Get your feet wet (get involved)
Drag your feet (unenthusiastic)
Feet of clay (flawed)
Foot in mouth (oops!)
Keep feet on the ground (be sensible)
Footloose (6 degrees of Kevin Bacon)

As a grad student, my gross anatomy prof declared feet the ugliest body part! Beauty being in the eye of the beholder aside, our foot is far more specialized than our hand as no other animal has a foot quite like ours! I hold with the master, Leonardo DaVinci who opined:

The human foot is a masterpiece of engineering and a work of art.

Yes!

Understand, the human foot is a truly complex mechanical structure consisting of 26 bones, 33 joints, and more than a hundred muscles, tendons, and ligaments! Despite this complexity, our feet usually work pretty well, especially if we care for them. Also, know this lesson is geared for general readers, so the most complex features and smallish details are not covered.

Before we begin the lesson, let’s take a gander at Claire’s fleet feet (Outlander ep 101 Sassenach) as she retreats from redcoat muskets firing live rounds! Her poor heels are rubbed raw from running – leather shoon sans sox. Not a good plan, but did the lass have another choice? Och!

Foot: Always prudent to begin a lesson with definitions. In anatomy, the foot is the lower limb below (distal to) the ankle joint (Image A – blue line).

Orienting ourselves further, the top of foot is the dorsal surface; the bottom (sole) is the plantar surface. Inner side is the medial surface and the outer side is the lateral surface.

Image A

Skeleton: We begin with the foot skeleton, a foundation of 26 bones. Image B shows bones of a right foot, 26 in all. The left panel shows bones from the bottom or plantar perspective. The right panel shows foot bones from above, the dorsal view.

Toe bones are homologous to digits of the hand (Anatomy Lesson #22, Jamie’s Hand – Symbol of Sacrifice). They are numbered 1-5 beginning with the big toe and working to the little toe.

Phalanges: Toes contain 14 phalanges (Image B, pink) – three bones per each toe, except the big toe which, like the thumb, only contains two phalangeal bones. And, the big or great toe goes by the scientific name, hallux.

Metatarsals: Five metatarsal bones (aqua) are homologous with metacarpals of the hand.

Tarsals: Seven tarsal bones are homologous to eight carpals of the wrist, although more massive and oddly-shaped than the small carpals. The largest, the calcaneus, is the heel bone. Atop it is the talus which helps form the ankle joint.

There won’t be a quiz of tarsal bones <g>, but, just so you know, their names are (Image B):

three cuneiforms – 1, 2, & 3 (start counting on big toe side – orange)
cuboid (pink)
navicular (green)
calcaneus (yellow)
talus (blue)

Need another Outlander hit? My pleasure. No, really! The morning after (he, he), Claire sports a pair of verra sweet feet (Starz ep 107, The Wedding)! Aw, look at those wee tootsies, shyly nesting. It was a big, big night! ’Nuf said! 😉

Oops, not quite, ‘nuf said. A lovely foot passage from Dragonfly in Amber book. Herself even mentions metatarsals!

“I’m honest enough to say that I dinna care what the right and wrong of it may be, so long as you are here wi’ me, Claire,” he said softly. “If it was a sin for you to choose me … then I would go to the Devil himself and bless him for tempting ye to it.” He lifted my foot and gently kissed the tip of my big toe. I laid my hand on his head; the short hair felt bristly but soft, like a very young hedgehog. “I don’t think it was wrong,” I said softly. “But if it was … then I’ll go to the Devil with you, Jamie Fraser.” He closed his eyes and bowed his head over my foot. He held it so tightly that I could feel the long, slender metatarsals pressed together; still, I didn’t pull back. I dug my fingers into his scalp and tugged his hair gently.

Divisions: Foot bones are divided into three regions. Such divisions aren’t whimsy, they are important in issues such as evaluating trauma, surgical amputation of part of all of a foot or evaluation of foot mechanics.

Forefoot: Includes phalanges and metatarsals (Image C – white, left side).
Mid-foot: Includes three cuneiforms, cuboid and navicular (Image C, turquoise).
Hind-foot: calcaneus and talus (Image C – white, right side).

Image C

Ligaments: Now, the 26 foot bones don’t just hang out under the skin. They are firmly bound to each other and to our leg bones via dozens of ligaments (Image D)!

Ligaments are fibrous tissues binding bone to bone and they are critical for foot integrity because feet bear our weight against gravity! Loose or torn ligaments give folks many problems because these compromise the integrity of the skeletal system!

Image D shows only some of the numerous ligaments anchoring and stabilizing foot bones; here, we see lateral and dorsal ligaments. The plantar and medial ligaments are not visible.

The lesson won’t discuss these ligaments in detail because they are complex and tedious, but the image dramatically emphasizes some of the many ligaments needed to stabilize the foot skeleton!

Image D

Arches: We all know the foot has an arch, but did you know it actually has three arches (some count a 4th partial arch)? Two are longitudinal and one is transverse. The arches are maintained by interlocking tarsal and metatarsal bones, supported by ligaments and very strong tendons (image E).

medial longitudinal arch (Image E – blue dashed line) extends from heel bone to first three metatarsals. Typically, it curves above the ground. When barefoot at the beach, it does not leave an imprint in sand (unless one is seriously flatfooted!).
lateral longitudinal arch (Image E – green line) is a low arch arch between calcaneus and 5th metatarsal. When barefoot, it typically leaves an imprint in sand.
transverse arch (Image E – red line) runs across the foot at the tarsometatarsal joints (defined below).

Although these arches are supported by strong ligaments and tendons, they exhibit some mobility when weight is applied to or removed from the foot. This springiness makes walking and running more economical in terms of energy.

Image E

Speaking of arches, how ‘bout some booted ones! Yep, another dose to wake you students! BJR’s booted “trick or treat feet” (Starz, ep 108, Both Sides Now) will do the trick, nicely! The blackguard throws Claire over his desk preparing to further assault her. Darn! She canna reach the sgian dubh in her boot! No treat here – all vicious tricks!

Diana describes Claire’s toes just after Jamie squats in the prison window (Outlander book).

Randall bent and scooped up the gun in a quicksilver motion. As soon as the knife left my throat, I tried to sit up, but he placed a hand on my chest and shoved me flat again. He held me down with one hand, using the other to aim the pistol at Jamie. The discarded knife lay somewhere on the floor near my feet, I thought. Now, if only I had prehensile toes.… The dirk in my pocket was as unreachable as if it were on Mars.

Plantar Aponeurosis: Remove plantar skin (very difficult on a cadaver) and a triangular sheet of connective tissue is revealed, the plantar aponeurosis. It is anchored to the calcaneus, flares in the mid-foot and ends as five (or more) bands radiating toward bases of the toes (Image F).

The tough, fibrous aponeurosis is made mostly of collagen fibers. As such, it is a shock absorber when the foot strikes the ground. It also stabilizes arches of the foot and allows flexion at the first metatarsophalangeal joint, which carries the majority of body weight during ambulation.

If the plantar aponeurosis becomes injured or inflamed, it may cause plantar fasciatis. A painful condition common to athletes, it causes stinging foot pain that can lead to further leg injuries if untreated.

Another break for Outlander! This is a splendid example of body heat feet (Starz, ep 109, The Reckoning). Things are on broil up at Castle Leoch! Claire’s right heel hooks over Jamie’s Fraser plaid….hum…. Talk about a foothold! Snort!

Joints: We have covered joints (the anatomical type) in prior lessons (e.g. Anatomy Lesson #2, When Claire Meets Jamie or How to Fall in Love While Reducing a Dislocated Shoulder Joint!).

To reiterate, joints are sites where two or more bones meet; some are moveable and some are not. Moveable joints allow for motion and there are several types. Our 33 foot joints fall into the following categories:

TC Joint (1): between distal tibia, fibula and talus, a.k.a. talocrural or ankle joint
IT Joints (13): between tarsal bones
TM Joints (5): between metatarsals and tarsals
MP Joints (5) : between proximal phalanges and metatarsals
IP Joints (9): between phalangeal bones

Reducing the technicality of this topic, we will only cover the superbly designed TC or ankle joint! The ankle joint is a mortise joint, a term used in carpentry. Here, the talus projects upwards and fits inside a three-sided bone box formed by tibia and fibula of the leg (Anatomy Lesson #27, Colum’s Legs and Other Things, Too!). Thus, our “ankle bones” are not separate bones, they are parts of tibia and fibula. The inner ankle bone is actually the medial malleolus of the tibia; the outer ankle bone is the lateral malleolus of the fibula. This is a highly stable hinge joint that allows movement (see below).

Image G

Before the lesson turns to movements, let’s take a quick keek at Jamie’s upbeat feet! Cheerfully dressed in nothing but a sark, he strides to the freezing mill stream to sleuth out a prob with the water wheel (Starz ep 113, Lallybroch). Seems it is producing gritty bannocks! Upbeat feet, that is, until a mess ‘o Redcoats arrive! Notice: his right foot is lifted at the ankle, a movement known as dorsiflexion. Yep! Read on to learn more about this term.

Movements: Various movements occur at the foot joints. Some are slight; others are more generous and important for ambulation. The talocrural joint (ankle joint) allows for six movements at the ankle; the first four are demonstrated in Image H:

dorsiflexion: lifting foot at the ankle
plantar flexion: pointing the foot at the ankle
inversion: turning sole medially (toward midline)
eversion: turning sole laterally (toward the side)
abduction: turning foot to side (slight)
adduction: turning foot toward midline (slight)

Psst…..Practitioners often prefer the terms, supination for inversion and pronation for eversion.

Image H

Next, there are toe movements which can occur independent of the ankle joint. These involve IP and MP joints:

flexion: curling the toes
extension: lifting the toes
abduction: spreading the toes
adduction: returning the toes to a resting position

Image I

Back for an Outlander scene and a collective gasp! Jenny takes a hot poker to the sole of a redcoat captive. Ouch! The poor man now has mincemeat feet. What ya doing Jenny?

Spill, messenger! Where is my bro??? In no uncertain terms, Big Sis declares to Claire:

Love Forces a Person to choose!

Extrinsic Muscles: First, a wee definition…long time students will remember that in anatomy the leg is the lower limb between knee and ankle joints; thigh is between hip and knee joints. Most people use the term lower leg for the anatomical leg.

Muscles acting on the foot are classified as extrinsic muscles, those originating in the leg, and intrinsic muscles, those originating in the foot.

Amazing Fact: all leg muscles, excepting one, actually act on the foot! These are so complex, they must be simplified. Yes, Image J is simplified!!!

Extrinsic muscles in Fig. J (anterior and side muscles – left panel):

tibialis anterior – dorsiflexes & supinates foot
extensor hallucis longus – extends big toe & dorsiflexes foot
extensor digitorum longus – extends toes 2-5 & dorsiflexes foot
fibularis longus & fibularis brevis – pronate & plantar flex foot

Extrinsic muscles in Fig. J (superficial posterior muscles – middle panel):

gastrocnemius – plantar flexes foot (cut away in image)
soleus – plantar flexes foot

(Note: gastroc and soleus jointly share the massive achilles tendon which inserts into calcaneus. Normally, these are extremely strong plantar flexors)

Extrinsic muscles in Fig. J (deep posterior muscles – right panel):

flexor hallucis longus – flexes big toe & plantar flexes foot
flexor digitorum longus – flexes toes 2-5 & plantar flexes foot
tibialis posterior – plantar flexes & supinates foot

Image J

Whew. That was scary! Time for another Outlander treat to lower the blood pressure. Oops, this is pretty scary, too (Starz ep 209, Je Suis Prest) – yuk! It’s eek feet for puir Angus – the lad has been careless with his feet. Nurse Claire warned him to keep them dry!

Back to anatomy. No, we are not finished with muscles. Gasp!

Intrinsic Muscles of Dorsum (top) of Foot: As stated above, intrinsic muscles arise from foot bones. There are two smallish muscles on the dorsum of the foot, not shown in Image K.

extensor hallucis brevis – extends the big toe
extensor digitorum brevis – extends toes 2-5

Intrinsic Muscles of Plantar Foot: Believe it or not, 18 muscles are located deep to the plantar aponeurosis. Who would have thought??? These are arranged in four layers (Image K – from left to right). If you think these look challenging, you are right. Outside the head, the foot is one of the most difficult body parts to dissect!

First structure in Image J (left panel)

Plantar aponeurosis – not a muscle

1st Layer of Intrinsic Muscles in Image J ( 2nd panel):

abductor hallucis – draws big toe towards midline of body
abductor digiti minimi (I love this name!) – draws 5th toe away from foot
flexor digitorum brevis – flexes toes 2-5

2nd Layer of Intrinsic Muscles in Image J (3rd panel)

Lumbricals – both flex & extend different phalanges of toes 2-4
Quadratus plantae – flexes toes 2-4

3rd Layer of Intrinsic Muscles in Image J (4th panel)

flexor hallucis brevis – flexes big toe
adductor hallucis – draws big toe towards foot
flexor digiti minimi brevis – flexes 5th toe

4th Layer of Intrinsic Muscles in Image J (5th panel – horizontal)

dorsal interossei – abduct toes 2-4 (spreads toes)
plantar interossei – adduct toes 3-5 (returns toes to resting position)

Image K

Now, given that mess of muscles, you probably appreciate how complex foot movements can be achieved. With some 20 intrinsic and 10 extrinsic muscles controlling our feet, they are quite capable, indeed!

Back to Outlander! We see Claire’s poor, weary beat feet, exposed to sand, surf, sun and formicidae (Anatomy Lesson #55, Formidable Formicidae) in Outlander ep 311, Uncharted! Trudging in wet shoes, dealing with festering ant bites, surviving snake slithers…. Diana explains Claire’s feet in Voyager book:

Squads of tiny purple crabs ran off in profound agitation at my approach. My feet sank into the mud to the ankles, and I thought better of putting on my shoes, wet as they were… My feet were bruised and sore, and punctured by fallen palmetto fronds, but the path before us looked relatively smooth.

We really must take good care of our feet if we want them to last. Exercise, weight control, healthy diet, wearing supportive shoes all help ensure the feet bear our weight for a lifetime. Even to the most careful, our feet suffer many assaults: bone spurs, athlete’s foot, plantar fasciitis, corns, bunions, Morton’s neuroma, flat feet, hammer toe, warts, stress fractures, etc. Or, we lose toes because of poor circulation, trauma, or developmental issues – such problems have plagued us since ancient times. To the point, the oldest known functional prosthesis is an Egyptian wooden mummy toe (Image L). It actually articulates at the laced surfaces. So clever!

Hey, wait! How do we know it is not a daddy toe? He, he!

Image L

Speaking of toes, Voyager book describes a splendid battle with pirates aboard ship. Sadly, the scene did not make it into the TV version. But, here is a shocking tidbit from the bloody fight:

Cursing incoherently under my breath, I ran to the bottom of the ladder, and reaching up, swung the long-handled amputation knife at his foot, as hard as I could. There was a high-pitched screech from the pirate. Something flew past my head, and a spray of blood spattered across my cheek, wet-hot on my skin. Startled, I dropped back, looking down by reflex to see what had fallen. It was a small brown toe, calloused and black-nailed, smudged with dirt.

Alrightie then! <G>

Let’s consider how you can hurt your neat, sweet, elite, complete feet… In your wildest dreams, do you think shoes such as these are good for feet (Image M)? Wear high heels for long, and one guarantees that later in life, the wearer will have foot problems. The foot is not designed to walk around on the metatarsophalangeal joints (ball) of the foot, which is why wearing spikes hurt!!!

Gentle admonition: if you wear this type of footwear, you should stop.

Image M

Closing this lesson with indiscrete feet: no Outlander lass is quite as indiscrete and raunchy as Geillis (Gillian) Edgars Duncan Abernathy. Puir young Ian; that dear lad’s cheek is no place for a witch’s foot (Outlander ep 313, The Bakra)!

BTW, the prominent ridges passing to 2nd to 5th toes are tendons of extensor digitorum longus! Yay!

Bottom line: The complete and complex human foot is truly an anatomical work of art. Let’s vow to take good care of ours!

The deeply grateful,

Outlander Anatomist

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Photo Creds: Sony/Starz; www.cba.ca (Image – L); www.DHgate.com (Image M ); www.digikalla.info (Image J); www.earthslab.com (Image G); www.footankle.strker.com (Image C); www.goodfeet.com (Image A); www.heatheappointments.com (Image I); www.nurseslab.com (Image K – ); www.slideplayer.com (Image E, Image F, Image H); www.teachmeanatomy.com (Image B); www.wickimedia.commons.org (Image D)

November 7, 2014July 31, 2015

Anatomy Lesson 5: “Claire’s Skin” – “Ivory, Opal and White Velvet”

Greetings, followers of Outlander Anatomy! Today’s Anatomy Lesson #5: The Skin – Part 1 is extraordinarily important (as are all anatomy lessons) and ye wouldn’t want to get skinned for skipping what is vital to yer own well-being as we learn about our skin!

WARNING! This post includes spoiler alerts and the image of a dissected human body. If you are a bit squeamish about such images, you may want to skip it. Dougal will give ye a second warning just prior!

OK, now, about skin….Herself writes about skin throughout all of the Outlander books where it is used to define characters, enhance scenes, and provide a substrate for Claire’s practice of medicine. As ye ken, the Starz Outlander series and the books are told in the voice of Claire, our braw and lovely heroine! Thus, we must rely on images or observations made by others to inform us as about Claire’s skin which I will use to segue into today’s anatomy lesson!

Let us begin…

In Starz episode 1, Sassenach, we see Claire and Frank driving through the Scottish countryside. On a second honeymoon, they are trying to reconnect after serving apart in WW II. We see that Claire has very pale, clear skin framed by a mass of curly, brown hair.

Herself informs us through polished, sophisticated and urbane Frank that Claire’s ”…skin glows like ivory.” Then Frank makes love to Claire in the grass at the base of Craigh na Dun where he tells her that her skin is like white velvet. Because I don’t have images to match these descriptions, I substitute one from a later episode (Starz episode 6, The Garrison Commander), so along with Frank, we may witness Claire and her beautiful skin!

Next, in a very telling scene from Starz episode 3, The Way Out, Mrs. Fitz helps bathe and dry Claire despite to her protestations; Claire avers that she is able to tend to her own ablutions! But a persistent Mrs. Fitz kindly observes:

Such beautiful skin ya’ have! I’ve never seen a woman past 8 or 9 with skin so unmarked by injury or illness. Yer next husband will be a lucky man!

Aye, that he will…chuckle!

To me, Claire’s beautiful skin is most telling (Starz episode 8, Both sides Now) during the assault by the redcoat deserter. She wears virtually no makeup, nor is any required in my opinion! Her skin is very pale, very clear and her nose and cheeks are endowed with a faint sprinkle of freckles. Claire also looks very vulnerable, very young and absolutely LOVELY despite the unspeakable situation she finds herself in! I can say this without prejudice because I am an anatomist! Ye ken?

But, the ultimate proof comes from Jamie himself: in Outlander, he tells Claire that she has skin like an “opal” as he slowly traces a finger along her collar bone making her skin glow beneath his touch! And, again from our hero:

“Mo duinne,” he said softly. “But now I should say mo airgeadach. My silver one. Your hair is silver-gilt and your skin is white velvet. Calman geal. White dove”.

Again, no images to match the words, so let’s use this lovely substitute!

Hey! Mukker! Are ye still wit’ me?! One last image before we git on to our science lesson! In Starz episode 3, The Way Out, Claire is summoned by the MacKenzie. Colum removes his kilt asking her to massage his aching legs. He also asks Mistress Beauchamp if she sews as well as physicks to which Claire responds: “only flesh, a rather poor garment, I’m afraid.” My cue! Weel, I am athinkin’ that Claire’s answer to Colum was deliberately a wee bit coy and evasive because she would know that skin is NO a puir garment at all!

So, now we segue into Anatomy Lesson #5, The Skin…folks, I am here to tell ye that the skin is absolutely a remarkable garment! Ye will no be amiss to think of it as your own personal space suit that enables you to live a terrestrial rather than an aquatic life! It is also the major barrier between a rather inhospitable world and yer insides! Yes, it gets diseased and injured because we are mortal, after all. But, it serves us verra well so please read on!

If ye are squeamish, ye may wish to skip the next image or heed Dougal’s advice…

A few years back, German anatomist, Professor Gunther von Hagens brought his world-renown Body Worlds exhibit to my neck of the woods. I was privileged to deliver the key note lecture before the event and was Professor of Anatomy on opening night where I gave mini-lectures and answered questions posed by attendees. Of the many extraordinary figures at that exhibit was one of a man holding his own skin and gazing at it in awe (Photo A). I hope after reading this post, you too will view your own skin with the awe it so richly deserves!

Photo A

First off, skin is an organ. Yes, it is! It is also the heaviest organ of the human body! Really, ye say? Yup, it accounts for at least 8% of our body weight (some studies claim as much as 16%) and covers a surface area of about 20 ft² or 1.9 m²! Want to determine the weight of your own skin? It’s simple! Just multiply your weight in pounds or kilos by .08 – the answer is the approximately the weight of your own skin!

Skin also produces all of our body hair, fingernails, toenails, sweat glands, sebaceous glands, the female breasts and the male nipples and areolas. All of these appendages are skin derivatives and therefore part of the organ itself. Earlier, I mentioned Claire’s hair and now ye ken why because hair is part of the skin. But, as Claire’s hair makes for an interesting subject in its own right, I will address hair in my next post: The Skin – Part 2! And won’t it be fun to see the Outlander Starz results in it’s “hair as a character” poll this Saturday!

Ok, this next one is a gratuitous shot…sorry I just canna help it! Weel, not entirely gratuitous – it does show hair and skin and one other thing I havna yet told ye: the enamel of the teeth is derived from modified skin of the mouth. Geez, even his teeth are gorgeous! Get a grip prof! Focus!

Ahem…now, back to the lecture! Skin thickness varies throughout the body; some skin is thick for protection such as on the soles of our feet or thin as on our eyelids where thickness is not required. Skin is also more heavily pigmented in some areas (nipple and areola) than in others (belly). Most of the skin bears either fine or coarse hairs but some areas are completely devoid of hair: the so-called glaborous surfaces of the body such as the palms and soles where hair, if present, would interfere with grip.

Skin is composed of two important layers: a thin outer epidermis that sits atop a thicker inner dermis (See photo C). Deep to the dermis is the hypodermis; although not part of the skin, it is important because it helps anchor the skin to underlying structures such as muscle or bone (Photo B). In addition, some skin structures are actually anchored in the hypodermis.

Photo B

The epidermis is composed of skin cells and some other cell types. It also completely replaces itself about every four weeks, with new cells forming at the base and advancing toward the surface where they die and slough. So, cells at the skin surface are flat and dead – these cells exfoliate naturally (did ye know that a large portion of house dust is shed skin cells?) or ye pay for exfoliation by costly products or at expensive salons (Photo C – this 3-D image was taken with a powerful scanning electron microscope or SEM)! The supporting dermis houses two types of sweat glands, sebaceous glands, blood vessels, hair follicles, and special microscopic endings for sensation.

Photo C

So what about sweat glands? The skin actually includes two different types: apocrine sweat glands are present only in the arm pits (axilla in anatomy, remember?) and our private regions (perineum in anatomy). The thicker sweat from these glands is initially odorless but when acted on by skin bacteria, it develops a pungent, acrid smell. This is the unwashed male that Claire muses on while sharing Jamie’s mount (Outlander book) – although females most certainly battle the same issue! A second type, the eccrine sweat gland, is ubiquitous throughout the remaining skin; sweat from this gland is watery and usually exudes an ammonia smell. Photo D shows the multiple openings (pores) of eccrine sweat glands on the finger pad.

Photo D

The process of sweating from eccrine sweat glands is captured in Photo E. Here, following exercise, blue sweat droplets bead on skin from the back of the hand. This 3-D photo was again taken the powerful SEM. The colors, however, are not real – they were computer generated.

Photo E

As fer the sebaceous glands, I’ll be leaving those until my next post: The Skin – Part 2! Next, a question commonly asked by students: what causes the wide variation in human skin tones (see Photo F)?

Photo F

Weel, it turns out that there are a number of reasons for our individual skin color. One cause is the number of blood vessels in the dermis and the color of blood surging through them (bright red arterial blood versus duskier venous blood). Just fer fun, let’s compare and contrast the color of Claire skin wit’ that of Jamie’s in this image from Starz episode 1, Sassenach. We clearly see Claire’s naturally cool and pale complexion but partly because she is royally pissed, holding herself aloof from all the male funnin’ goin’ on around her. But, Jamie’s skin is strikingly different! Although Jamie is splattered in blood and he has naturally ruddy skin, it is enhanced in this scene having exerted himself in battle and during Claire’s recapture so ye can bet at this point there’s a whole lot of bright red arterial blood circulating through the vessels of his dermis!

Another contribution to overall skin color depends on how much carotene we consumed in our diets: carotene is an orange pigment prevalent in fruits and veggies such as cantaloupe, sweet potato and carrot (Photo G). Carotene absorbed from our food gets deposited in the epidermis where it adds to skin color and also helps protect epidermal cells from damage by UV light.

Photo G

But, the most significant contribution to skin color comes from special cells of the epidermis, the melanocytes (Photo H). These scattered squid-like cells produce and package the pigment, melanin, into granules that are released into surrounding skin cells. Interestingly, the number of melanocytes in a given region of the skin is the same regardless of skin tone or gender. So, differences in skin color are due mainly to differences in the number and size of the melanin packets produced and this in turn is determined by genetics! In darker skins, the melanin granules are larger, more numerous, persist longer and are distributed throughout the epidermis. Pale skin has fewer, smaller melanin granules that are confined to cells at the base of the epidermis and degrade more quickly.

Photo H

Ye can deliberately increase the production of melanin granules and darken existing melanin in yer own skin by exposure to UV light either from the sun or from tanning beds. I ken the beds are a very popular trend, but I want to WARN ye: For some very sound medical reasons, ye should NOT expose yer skin to UV light from tanning beds and ye should also be judicious about tanning from the sun’s rays too, especially if ye are fair of skin like Claire! I urge ye to get informed about it!

Now, ye are all are probably aware of albinism (Photo I), a condition affecting animals (humans, spiders, snakes, apes, etc.) where the sufferer lacks an enzyme needed to make melanin (albinism occurs in plants too but is due to an absence of chlorophyll). Albinos (Latin: albus for white) do NOT make any melanin in the skin, hair or the irises of the eyes! This is a difficult condition because their eyes are highly sensitive to light (photophobia) and they have difficulty tracking the eyes normally. The skin is also highly susceptible to skin cancers! It is a condition which, at present, has no cure but there are steps that can be taken to protect the skin and aide the eyes.

Photo I

Finally our skin has a battery of sensory endings specialized to detect changes in our environment and transmit these to our nervous system. The fingertips alone have about 2500 of these receptors per cm² (about 0.2 in²) of skin! I’ll not show pictures of these endings because they are a wee bit too technical. In summary, then, here is a short list of what skin does for Claire and for us all!

It is an anatomical barrier against pathogens and damage.
It provides sensation in the form of pain, touch, pressure, heat, cold and vibration.
It regulates our body temperature by dilating or constricting blood vessels in the dermis and cooling the skin by the evaporation of sweat.
It helps control fluid loss.
Helps synthesize vitamin D via UV radiation.
It aids in excretion of waste products.
It aids in communication: others assess our mood, physical state or attractiveness by the state of our skin.

Impressed yet? I know I am and I’ve been teaching this subject for a verra long time!

Speaking of mood, let’s close wit’ this touching image from Starz episode 7 The Wedding, where Jamie pays homage to the skin of his bride of astonishing beauty with a soft murmur and a tentative touch!

Aye, Jamie, ye are ready! And, so is Claire – she sure took long enough! Snort!

I do hope ye have a better understanding and appreciation of the skin ye are in and have an increased desire to take verra good care of it!

A wee note of explanation: I will also continue my convention of typically using the character’s names rather than the names of the actors. This gives the cast at least one degree of separation and a wee bit o’ respect as I dissect their bodies on a blog! I hope ye all understand.

The deeply grateful,

Outlander Anatomist

Images are from Starz Outlander series. Microscopic images and drawings from Netter’s Atlas of Human Anatomy, 4^th ed., Bailey’s Textbook of histology, 10^th ed. or Bloom & Fawcett’s Concise Histology, 2^nd ed, and the National Geographic, Skinned man from Body Worlds exhibit (sans the fig leaf), CGI image of epidermis and dermis from Loyola University Dermatology website, Baby photo from an older United Colors of Benneton ad, Photo of carrots from Gov. of West Australia and fig leaf from ClipArt, Archival photo of albino man taken by an unknown photographer – beginning of the 20^th century.

October 30, 2014October 26, 2017

Anatomy Lesson 4: “Jamie’s Chest – 8th Wonder of the World!”

Greetings friends of Outlander Anatomy and welcome to today’s lesson! Do you recognize the classic seven wonders of the world?

Colossus of Rhodes.
Great Pyramid of Giza.
Hanging Gardens of Babylon.
Lighthouse of Alexandria.
Mausoleum at Halicarnassus.
Statue of Zeus at Olympia.
Temple of Artemis at Ephesus.

The 8th wonder is, of course, James Fraser’s chest!

Getting in a mood, let’s take a wee keek at the breadth (Uncle Dougal, ye are a crud for exposing your nephew like this!)…

And the depth (BJR, man, ye are darkness itself!):

Of this very timely topic!

Now, we all ken that Claire gets her first TV looksee at Jamie’s blest-chest in Starz episode 102, Castle Leoch. But, Herself wrote in Outlander that Claire made touchdown with his chest when he fainted from blood loss after Cocknammon Rock:

“Stop! Help!” I yelled. “He’s going over!” … Jamie slid off headfirst like a sack of stones, luckily landing in someone’s arms. The rest of the men were off their horses and had him laid in a field by the time I had scrambled down. “He’s breathin’,” said one.

“Well, how very helpful,” I snapped, groping frantically for a pulse in the blackness… Putting a hand on his chest and an ear to his mouth, I could feel a regular rise and fall, with less of that gasping note. I straightened up. “I think he’s just fainted,” I said.

He groaned and opened his eyes… “I’m all right,” he said, trying to sit up. “Just a bit dizzy is all.” I put a hand on his chest and pushed him flat.

The instant the bandages were tied, the patient tried to sit up. I pushed him flat and put a knee on his chest to keep him there. “You are not to move,” I said fiercely.

So, leading up to Nurse Claire actually seeing his chest, let’s start with the castle courtyard. I have to begin the lesson here because I LOVE the courtyard scene with all its swirling undercurrents!

After dismounting, our bedraggled Claire stands there saying nothing but watching everything.

Puir lass, the front of her slip and dress have gone bye-bye, having given those up for Jamie’s field dressing. Left in her ruined, oxford walking shoes and hair in straggles, she stands out like a wee sore thumb! She is scairt and confused but tough as nails.

Our stalwart heroine stands completely IMMERSED in a maelstrom of male testosterone and ribald jokes. And, Jamie hovering…

…hovering I say!

Next, we witness a fabulous tete-a-tete between Claire, Mrs. Fitz, and Jamie where a lot is said, but a whole lot more remains unsaid!

Jamie says Murtagh found her and Dougal said to bring her along. But, it’s NO HIS FAULT that Ms. Fitz has another mouth to feed, bed to make, and body to clothe. Tcha! Just like a man!

Mrs. F is shocked at Claire’s scandalous appearance and doesn’t mind saying so!

And, Jamie still hovering in the background finding any inane thing to do with his horsey, even though there are several hostlers to do the work, all the while listening and watching the two lasses size each other up.

As Grand Dame, readies to drag Claire away for cleaning up, Claire is adamant that she must properly care for Jamie’s wound as Jamie brawly boasts “I can fend fer meself!”

Mrs. Fitz upon hearing Claire’s credentials, declares “Jamie, ye need fixin’, git yerself indoors!” Ye heard the leddy, Jamie!

And just like that, Jamie finds himself seated on a stool covered with a blanket and ALONE with Mistress Beauchamp. (Being a wee bit nosey here, who washed Jamie’s face? Whoever it was, thanks – he cleans up nicely!). Claire gently removes the blanket to cleanse the wound and hears the awful truth that her hubby’s sixth, great grandfather gleefully produced the horrific scars on Jamie’s back.

Claire takes time to properly clean Jamie’s gunshot and apply an ingenious dressing involving a pressure bandage and strips of linen crossed under both oxters, an excellent technique for anchoring a shoulder dressing. Jamie tries moving the injured shoulder and winces, so Claire promptly straps his arm to his chest by the golden glow of firelight. Why? Claire knows the arm must immobilized for at least a week to promote wound healing, a truly complicated process! By next day, someone has replaced the strap with a sling, which is not the same at all!

Sadly, we must leave this tender scene to start Anatomy Lesson #4. Sniff!

Terms: Let’s come to terms with it, anatomists do not use the terms upper and lower arms. Instead, the entire upper appendage is called the upper limb. The region between shoulder and elbow joints is the arm and the region between elbow and wrist joints is the forearm (Image A). This is important to know for this lesson.

Image A

Rib Cage: The bony foundation of the chest is the thoracic (rib) cage, including 12 pairs of ribs, their costal cartilages (blue structures), sternum (breast bone) and 12 thoracic vertebrae (Image B). This spring, bony enclosure not only protects heart, lungs, airways, esophagus, and great blood vessels, it also provides attachments for important chest muscles! Above the thoracic cage lies the clavicle (collar bone) which articulates (forms a joint) with it.

Image B

Pectoralis Major: The chest muscles or “pecs” as trainers call them, actually include two pairs of muscles on each side of the chest. The word pectoralis derives from the Latin pectus meaning “breast.”

Pectoralis major muscles are the largest, most superficial, and most powerful of the two pairs. Each fan-shaped pec major covers half of the chest and is divided into three heads. The clavicular head (Image C) arises from the clavicle.

Image C

The larger sternocostal head arises from 1 through 6 costal cartilages and sternum (Image D).

Image D

A smallish, third part (Image E) arises from an abdominal muscle. This is a fairly insignificant part unless torn in which case, the pain surpasses all conscious thought. Just kidding, except it does hurt!

Image E

Pectoralis major muscle fibers converge toward the arm inserting into the humerus or arm bone (Image F).

Image F

Heh! Wake up, fledgling anatomists!

Yep, we can do pretty much anything for the Great Scot!

On their way to the humerus, pec muscle fibers create the anterior axillary fold (Image G). This fold forms the front border of the arm pit, oxter, or axilla! (I still want to see Claire stick her foot in Jamie’s oxter!) Grab this fold on a pal or sibling and give it a wee pinch. Gives them a jolt, so not a fab idea to try someone without a sense of humor!

Image G

In this horrifying image from Starz episode 6, The Garrison Commander, Jamie’s massive right anterior axillary fold is very easy to spot. Our darling hero near freezes to death as BJR parades, preens, and prepares for his fav outdoor sport!

Function: Each pec major is a very hard working muscle. And, because it has three heads, they do quite a bit of work!

raises arm forward (as in lifting a child)
returns arm against the torso (as in setting down the child)
pulls arm from spread eagle to the sides of torso (as in standing in mountain pose)
rotates arm (internally) toward the chest

And, for those who wonder, pec major is best developed by standard pushups (not triceps type!), bench presses and weighted flyes.

Try This: You can see the tendons of your own pec majors this way: place palms together about 6” in front of your chest as in prayer mode. Now, press the palms firmly together. Your own pec majors should stand out strongly as the anterior axillary folds. Just don’t get them pinched!

Pectoralis Minor: In anatomy (like baseball), if there is a major – there is a minor. So, deep to each pectoralis major is a pectoralis minor muscle (Image H). This smaller fan-shaped muscle is also very important. It arises from the ribs (2, 3 & 4) and inserts on a small bony knob of the should blade known as the coracoid process (Greek for “like a raven’s beak”). Its contraction pulls forward on the corcoid process aiding in shoulder mobility and stability.

Image H

Applied Anatomy: OK, with the thoracic cage and two pairs of pecs done, let’s find them on our wonderful warrior! After Claire trusses Jamie up, the only parts of his chest still showing are the verra fine sternocostal heads of his pec major muscles, covered with skin, of course (blue arrows). Ye can see them fair keeking out from under the dressing. Awesome sauce! And, good reason to consider them the 8th wonder of the world.

But, wait, here’s more! The clavicular heads of Jamie’s pec major muscles are unusually well developed! Check out this image (Starz episode 5, Rent) for prominent bulges just under those bonny clavicles (blue arrows). These are the clavicular heads of each pec major, an oft neglected part in body building – but not here! Props to the trainer! Gasp! They’re bloody awesome!

Finally, Claire has done all she can legally do for Jamie – he stands there with his glorious chest peeking through the bandages and his nipped waist and.. GAH! Lord, gimme a dram!

Now, returning to anatomy (I am a professional after all)… about 1 in about 50,000 people are born without some or all of pec major and minor muscles. Known as Poland Syndrome, it may include hand and finger anomalies and shortened forearm bones. Interestingly, people with the syndrome compensate quite well using other arm and shoulder muscles. In fact, there’s a well-known PGA player, an Olympic boxer, and a Formula 1 World Champion (car racing) that have Poland syndrome and, clearly, it didn’t hinder them! The lady shown below (Image I), from a theatrical production, has it; she is missing the sternocostal head of pec major (blue arrow).

Image I

That’s it! Let’s close this lesson with a lovely poem nicely expressing the growing attraction between Nurse and Highlander!

Aug 2014

Cradle

Place your hand upon my chest.
It reminds me how it feels when it’s mended.
Then use it to cradle your head while you rest.
The worst of it, like the day, has ended.

I hope this lesson helps you more fully appreciate the chest muscles and their bony attachments. Fare thee well for now. Am thinking that Claire might be the subject of my next posting! We have ignored our amazing heroine for far too long!

How many days left before Starz episode 9? 156 days or so but who’s counting?! Sigh.

The deeply grateful,

Outlander Anatomist

Photo credits:

All photos are credited to Starz or Frank Netter’s Atlas of Human Anatomy, 4th edition. The lady with Poland’s syndrome is an archival photo from my lectures and I do not know the photographer.