claire beauchamp – Page 14 – Outlander Anatomy

January 20, 2015March 10, 2020

Anatomy Lesson #11: “Jamie’s Face” or “Ye do it Face-to-Face?”

We humans communicate via written word, oral articulation, body language and facial expression.

Welcome to Anatomy Lesson #11 where we learn about muscles that give expression ta the face; it telegraphs more emotional content than perhaps any other body part (Image A) and it’s probably the main way the world recognizes each of us.

WARNING: if ye are a wee bit squeamish, this post contains drawings of the skull and facial muscles sans skin. But, if you concentrate on the science queasiness is usually replaced by the intellectual challenge of learning. I promise. Be brave!

Image A

This lesson starts and ends with Jamie. Why? Can you name an actor with a more expressive face? Frankly (no, not that Frank), I think our ruadh Jamie ranks up there with expressives such as Sir Anthony Hopkins and Sir Laurence Olivier. His range of facial expression is so great that there are times he looks like a different actor! Check the next image: at first glance, his gorgeous countenance appears serene but look again: it fair beams wi’ intelligence, determination, calculation and wit (Starz episode 4, The Gathering)!

And, I’ll be saying that Jamie is no afraid to use his muscles of facial expression if they yield keener insight into his emotional state – here as the warrior furiously fighting the Grants (Starz episode 8, Both Sides Now).

OK – on to the lesson!

Skull: Several skull bones provide attachments for muscles of facial expression (Image B). Please palpate (feel) these on your own skull: the bone of your forehead is the unpaired frontal bone; at the back of the skull is the unpaired occipital bone; the cheeks are mostly the paired zygomatic bones (Anatomy Lesson 8); the upper teeth are seated in paired maxillary bones; the lower teeth anchored into the unpaired mandible; the bridge of the nose is formed by paired nasal bones.

Try this: Grip the bridge of your nose wiggle it – normally, it doesn’t move. Now, work your fingers toward the tip until you feel bone give way to soft tissue – at this point the nasal bones are joined to nasal cartilages which you can easily wiggle.

Image B

The human face has 20+ pair of muscles of facial expression (Image C – not all muscles are shown). Little wonder that the face can display an astonishing range of emotion with more than 40 individual muscles plus working individually or in groups for combined effects!

Facial muscles vary considerably from person to person. Most are thin, flat and subcutaneous (just under the skin). Some attach to skull bones, or to the dermis of the skin (Anatomy Lesson 5 & Anatomy Lesson 6) or with other facial muscles. Thus, some have no bony attachments at all. As these muscles contract, the skin wrinkles at right angles to the direction of the muscles fibers, which over time gives rise to wrinkles. They also have strange names that are pronounced like they are spelled.

Image C

The muscles of facial expression develop from the same embryonic region and all are innervated by the paired facial nerves which arise from the brain (Image D).

Each facial nerve leaves the skull via a hole (foramen) just below the ear canal and breaks into 5 branches that supply the muscles of facial expression. (psst…The large bumpy orange mass at the side of the face is the right parotid (salivary) gland).

Image D

We anatomists love using devices and mnemonics to help us remember the myriad of names and details of the human body. It’s a mess of info you ken? Here is a fun one to recall the branches of the facial nerve (Image E); it’s a teaching device – not intended to intimidate the wee lassie. I like this acronym to recall the branches: To Zanzibar By Motor Car!

Image E

The paired facial nerves signal the muscles of facial expression to contract! If a facial nerve is compromised by injury, etc., then the facial muscles are paralyzed on the same side. This condition, known as Bell’s palsy, is demonstrated in the archival photo of a gentleman from the late 1800s (Image F). The right side of his face (on your left) has lost expression: he cannot close the eyelid, his mouth droops and his smile (nasolabial) fold is flattened.

Bell’s palsy is a difficult, debilitating and depressing condition because, as noted earlier, our face is how we face the world. To honor contributions by Scots to medical science (there are many) the syndrome bears the name of the man who first described it: Dr. Charles Bell (1774-1842) surgeon, anatomist and graduate of The University of Edinburgh. Pertinent to this topic and based on his anatomical knowledge, in 1806 Bell published “Essays on the Anatomy of Expression in Painting” for the instruction of artists.

Image F

Back to the muscles of facial expression!

For simplicity, I divide the face into five regions, naming their facial muscles and providing examples from Outlander cast members. Please ken that I canna cover all the muscles of facial expression nor all the cast for such a post would be way toooo long.

Region #1 – Forehead/Eyebrows: Four paired muscles act in this region but we will discuss only three pairs (Image G):

- Frontalis (black arrow),
- Occipitalis (blue arrow) and
- Corrugator supercilii (purple arrow)

NOTE: Skin overlying the corrugator supercilii (purple arrow) receives it own name, glabella, meaning smooth. At rest, the skin between the eyebrows is smooth unless the corrugator contracts and then it wrinkles.

Frontalis: Fibers of the frontalis muscles are oriented vertically from a connective tissue sheet overlying the skull (galea aponeurotica – grey in Image G) to the dermis o’ the eyebrows. Frontalis muscles raise the eyebrows and wrinkle the skin of the forehead as in asking a question or expressing concern.

Image G

Now, several of you have begged for Dougal in a lesson. So, here he is with both frontalis muscles contracted as he interrogates Claire (Starz episode 5, Rent).

Occipitalis: The paired occipitalis muscles (Image G 🤞🏻) are oriented vertically from the occipital bone to the galea aponeurotica. When they contract, forehead skin is pulled backward.

As Claire causes kissus interruptus, Jamie contracts his occipitalis muscles and his forehead and scalp are pulled backward (Starz episode 7, The Wedding)! Watch the episode again (as if you need an excuse) to see his occipitalis muscles in action and you’ll ken what I mean.

Claire, what a tease! (psst…Jamie, if the lass willna do her duty, in the interest of science I’m sure there are plenty of others willing to step in…just sayin’!)

Corrugator supercili: Fibers of the paired corrugator supercilii are oriented diagonally from the frontal bone to the dermis between the eyebrows (Image G 🤞🏻). As they contract the brows “knit” together creating vertical wrinkles between the eyebrows as in worry, frown or puzzlement. Here, Claire watches as Geordie nears death at the tynchal (Starz episode 4, The Gathering).

Q: Now, here’s a more complicated facial expression: Jamie watches a foul redcoat deserter assault Claire (Starz episode 8, Both Sides Now). Which muscles of his forehead are contracted?

A: Well, turns out both frontalis and corrugator supercilli muscles contract to reflect terror, despair or helplessness. Jamie looks to be in agony here. Good job if you named either muscle!

Region #2, Eyelids: One pair of facial muscles operates the eyelids, the orbicularis oculi (Image H – black arrow).

Orbicularis oculi are paired elliptical muscles attaching to frontal and maxillary bones and to a fibrous band at the inner corner of each eyelid.

- Orbital loops of each orbicularis oculus rise to the brows, reach the temple and overlay the zygomatic bone.
- Palpebral loops extend into the upper and lower eyelids.

Contraction of orbicularis oculi close the eyelids to varying degrees. (NOTE: the eyelids are opened by muscles that do not belong to muscles of facial expression.)

Image H

Here is a funny scene from Starz episode 5, Rent: Dougal is telling the Highlanders about auld granny Mary asking her husband what he was thinking “when ye first saw me nipples!”

Note the crow’s feet at the corner of his right eye (L not visible)? These are caused by contraction of each orbicularis oculus muscle – here in an expression of mirth. Dougal is so into his story that he drools! It happens quickly, but you can see a wee sliver of saliva after it drops from his mouth (red arrow). Verra funny!

In the same episode Jamie tells Claire: “Dinna worry – trees are safe, Sassenach” (much safer than Uncle Dougal. Aye?).

Here only the orbicularis oculi of his lower eyelids are contracted giving him the Fraser cat’s eyes and broad cheekbones that Herself attributes to Jamie.

Here’s Claire’s with her eyelids closed because the palpebral parts of her orbicularis oculi muscles are fully contracted. She’s just told Jamie that his dirk is too long and heavy for her (Starz episode 8, Both Sides Now). Snort! Rupert replies that the lassies say that to him all the time so Claire gives him a look of mild disgust. Naughty Rupert!

Region #3, Upper Lip: A whopping five pair of muscles operate the upper lip (Image I)! We’ll cover four of the pairs:

- zygomaticus major (purple arrow),
- levator labii superioris alaeque nasii (green arrow) and
- rizorius (blue arrow).
- orbicularis oris (black arrows) operates both upper and lower lips

Image I

Zygomaticus major: Zygomaticus major reaches from the zygomatic bone to the corner of the lips. Its contraction pulls the corners upward as in a smile. Jamie shows a good one here (Starz episode 5, Rent).

Claire has just declared that Angus can “kiss her bloody English ass.” Jamie canna help but grin – she’s a spirited lass and he likes her potty mouth. Hey, hey, did you also ken that he has cheek dimples? Too cute!

Levator labii superioris alaeque nasi (LLSAN): The LLSAN muscles have the longest name of the 600+ skeletal muscles of the human body but they are small. The name is Latin for “lifter o the upper lip and wing of the nose”.

Each muscle arises from the maxillary bone and divides into two slips – one to the upper lip and the other to a nostril. In plain English, the lip-slip lifts the lip into a snarl and has been tagged “The Elvis Muscle”. Well, Rupert beat Elvis out by two centuries when he snarls at Claire “Horse, my cock” (Starz episode 4, The Gathering)! Yep, that’s his right LLSAN muscle contracting.

The other slip of LLSAN flares the nostril (red arrow). It’s quick but here Jamie flares his nostrils as he tells Claire he reckons they will be riding all that night and the next one too (Starz episode 1, Sassenach)! There is a better one of his flaring nostrils but I’ll be saving that for a later lesson!

Risorius: Rizorius muscles reaches from the parotid glands (Image I 🤞🏻) to the corner of the lips. As they contract, the mouth pulls into a grim, flat smile – here, Jamie kens just how pissed Claire is about the marriage contract (Starz episode 6, The Garrison Commander)!

Orbicularis oris: Orbicularis oris circles the mouth but isn’t a sphincter; it is a complex of four interlacing quadrants of muscle that contract to:

Close the mouth
Pucker the lips
kiss
Play brass instruments
Spit

See it in action here as Jamie warns Claire that he will brook no dissent from her – aye, she is coming with him (Starz episode 1, Sassenach)! If she willna walk then he will pick her up and throw her over his shoulder! Does she want him to do that? Her mouth says no, but her heart says, oh aye!

And here is Claire’s orbicularis oris muscle getting into the act as she puckers up and spits in the face of BJR (Starz episode 1,Sassenach)! Doesna matter if he does look like Frank, the smart lass wants nothing to do with this bloody bastard!

Region #4, Lower Lip: The lower lip has 5 paired muscles that activate it. The lower lip is also moved by the unpaired orbicularis oris but it has already been discussed above 🤞🏻. We will cover four (Images J & K):

- mentalis (green)
- depressor anguli oris (purple arrow)
- platysma (blue arrows)
- depressor labii inferioris (see Image K)

Image J

Mentalis: Mentalis muscles contract to pucker the chin skin. See Mrs. Fitz (red arrow) asking God to bless Claire for saving her nephew, Tammas Baxter (Starz episode 3, The Way Out).

Just so you understand, the lips are everted by other muscles. Mrs. Fitz adores Claire. She would have the Miracle Worker sit for a portrait if it were up to her!

Depressor anguli oris: Depressor anguli oris muscles pass from the mandible to the orbicularis oris muscle (Image J). As they contract, the lower lip is drawn down; Claire contracts both of hers to demonstrate disgust at the British treatment of the Scots (Starz episode 6, The Garrison Commander). Her outspoken words place her in the hands of BJR!

Platysma: Each platysma is a long, thin flat muscle that begins in the dermis near the 2^nd rib, passes over the jaw and ends in the dermis near the lower lip; it has no bony connections and is sometimes listed as a muscle o’ the neck (Photo J).

Have ye noticed how a horse can quiver its skin to rid itself of flies? It has a pair of muscle equivalent to the human platysma. As our platysmas contract, they pull down the lower lips and wrinkle the skin of the neck conveying the expression of a grimace.

Here we see Jamie with his platysmas contracted (red arrows) after he hoists Dougal over his shoulder because his uncle was playing dirty shinty (Starz episode 4, The Gathering)!

Depressor labii inferioris: The fifth and last pair of lower lip muscles is depressor labii superioris, green in Image K. This muscle extends from mandible to dermis of lower lip. As its name implies, it pulls down on the lower lip. Couldn’t find a good Outlander example so the drawing must do.

Image K

Region #5, Cheek: Each facial cheek contains one muscle, the buccinator (Photo L – black arrows); it hides deep to risorius muscles. Each muscle starts near the back of the jaw and blends wi’ the orbicularis oris. It’s known as the bugler’s muscle fer guid reason; try this, fill yer mouth wi’ air and push out yer cheeks. The bulging cheeks contain the buccinators. Now, draw yer cheeks inward ta blow out the air; ye just contracted yer buccinators. Congrats!

Image L

Here, Jamie’s right buccinator (green arrow – canna see the left one) is expanded as he contemplates one of a bazillion questions thrown at him.

That brings our lesson on the muscles of facial expression to a close.

but, here is something to contemplate…. in case you think that animals cannot have facial expression take a wee keek at these next four images (Starz episode 5, Rent).

In this scene, Rupert has just told the Highlanders how he was stuck between hairlip Chrissie and sweaty Nettie trying to decide which one to swive first. Sassy-lassie Claire declares that she believes his left hand is jealous of his right! This brazen comment is followed by a moment of tension where everyone, especially Jamie, awaits Rupert’s Response (sounds like the title of a book – Aye?). Jamie gets the joke right away.

Takes a few seconds but then the other Highlanders get her joke! Jamie’s zygomatic majors are contracted here in a big old grin! Then, Brimstone gets the joke!

Brimstone is really getting into it along with Jamie!

BTW did you notice the beautiful cutwork on Brimstone’s bridle? Dinna know who did the leather work but it’s almost as lovely as Claire’s wardrobe which Mrs. Fitz puts together sometime between supper after the boar hunt and first light the next day as they head off to collect the rents! (That Mrs. Fitz sure is a miracle worker herself). I figure the covered wagon they take is to carry Claire’s wardrobe – it would put a queen to shame!

And finally, the full horse laugh from Brimstone. Och, ye are a witty one, Claire!

Now I promised you that I would begin and end with Jamie. I have pondered how it is that he has such an expressive face. Here are my ideas:

He has more muscles of facial expression than most folk! Aye, it happens and I have seen examples in the dissection lab.
His facial muscles are more highly innervated giving greater control over them.
He is a keen observer of human emotional nuance and highly intuitive which allows him to feel his way through a character more than most actors.
His emotional intelligence derives from some combination of the above.

Whatever the explanation, we viewers are the lucky beneficiaries of his acting skills. So, thank ye Jamie!

Here’s a terrific example from Starz episode 3, The Way Out as Claire unties Jamie’s stock to check his gunshot wound: with little more than sideward glance, a slight narrowing of the eyelids and a wee tug of the lips, Jamie conveys extreme discomfort and smoldering UST! Och, if ye dinna know what it means, check www.urbandictionary.com!

I hope ye enjoyed learning about the verra important muscles of facial expression, especially Jamie’s!

And for those who are new to my blog, a note of explanation: I follow the convention of using character’s names rather than actor’s names. This gives the cast at least one degree of separation and a wee modicum of respect as I dissect their bodies with words! I hope you all understand!

The deeply grateful,

Outlander Anatomist

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Image credits: Sony/Starz, Netter’s Atlas of Human Anatomy, 4^th ed., Clinically Oriented Anatomy, 5^th ed., Hollingshead’s Textbook of Anatomy, 5^th ed., www.kenhub.com, www.Wikipedia.org

January 7, 2015December 1, 2019

Anatomy Lesson 10: “Jamie’s Back!”

Anatomy Lesson #10: The Back.

Happy New Year to all of you! I’m a wee bit late posting this because I just returned from my trip to Fraser’s Ridge country. It was a verra beautiful region. I can see why Jamie and Claire made their home there.

Welcome to all newcomers and thanks to all those returning to learn about Anatomy Lesson #10: The Back. Because our red-haired hero is so utterly braw, I will use many images of Jamie to teach this verra important topic.

Claire first sees Jamie’s back in Starz episode 102, Castle Leoch, as she removes the blanket to clean his gunshot wound. Herself writes in Outlander book:

“I had finished the bandaging and stood quiet behind him, a hand resting on his good shoulder… His upper back was covered with a crisscross of faded white lines. He had been savagely flogged, and more than once. There were small lines of silvery scar tissue in some spots, where the welts had crossed, and irregular patches where several blows had struck the same spot, flaying off skin and gouging the muscle beneath.”

Then says Jamie:

“Lobsterbacks. Flogged me twice in the space of a week. They’d ha’ done it twice the same day, I expect, were they not afraid of killing me. No joy in flogging a dead man.”

I wish I could work off a blank canvas of Jamie’s back before it was scarred by that mad bastard Randall! Fact is we have only a brief and limited glimpse at Lallybroch (Starz episode 102, Castle Leoch) as Black Jack administers his first whipping of our brave hero. Ugh!

Now, take a wee gander at Jamie’s back after the first blow. The blue arrows mark welts or wheals! Our Starz Jamie has verra fair skin and these swellings appear to be real. Wheals are typically initiated by an allergic response or tough handling such as pressure, blows or friction. Mayhap Jamie was handled a wee bit roughly during this scene?

Back: Now, in anatomy, the human back is defined as the large area from the base of the head to the tail bone (Photo A). It is widest at the shoulders, narrows at the rib cage and ends as a “V” between the buttocks. The topographical (surface) anatomy of a well-muscled back displays a mess of lumps, bumps and valleys created by underlying muscles, etc.

The two black arrows in Photo A mark a prominent vertical midline groove, the posterior median furrow. You should also understand that for protection, back skin is thicker and has fewer nerve endings than, for example, belly or chest skin. It is also an area that we cannot typically see or touch without aid of mirrors, photos, or yoga practices. Namaste!

Photo A

Now, sans the skin, let’s take a peek at the superficial structures creating back contour (Photo B). The paired trapezius muscles (Anatomy Lesson #3) cover the upper back. You recall they take origin (begin) from bones of the skull and spine but they insert (end) on clavicle and scapula; acting together or separately, they these bones. Latissimus dorsi muscles cover the lower back. They also take origin from bones of the back but insert on and move the humeral bones (Anatomy lesson #2). Gluteus maximus and Gluteus medius (Anatomy lesson #1) muscles appear to be part of the back but they form most of the buttocks and belong to the lower limbs. The V-shaped depression at the base of the spine (white area) is the thoracolumbar fascia flanked by the gluteal muscles and iliac crests. The thoracolumbar fascia is a strong sheet of collagen that gives origin to back and abdominal muscles (cover in a later post). The iliac crest forms the top of each hip bone. The vertical midline groove (see Photo A) is created by the spine as it adheres to the dermis of the skin (Anatomy Lesson #5 & Anatomy Lesson #6).

Photo B

Removal of the superficial back muscles exposes the deeper erector spinae muscles (Photo C). They attach to the spine and ribs. In the physically fit, they are visible as thick longitudinal columns of muscle flanking each side of the spine. Their function is to arch or extend and rotate the spine (see below). Again, although seemingly part of the back, the buttocks and their gluteal muscles are actually parts of the lower limbs.

Photo C

The length of the back is determined by the spine or vertebral column which extends from the base of the skull to the tail bone (green in Photo D).

Photo D

The vertebral column forms the bony central axis of the back (Photo E). Five regions are identified from the cephalic end (Greek meaning head) to the caudal end (Latin meaning tail): cervical, thoracic, lumbar, sacral and coccygeal. There are 7 cervical (C 1-C7), 12 thoracic (T1-T12), 5 lumbar (L1-L5), 5 sacral (S1-S5) and 4 coccygeal (Co 1-Co4) for a total of 33 vertebrae (Photo E).

Photo E

A typical vertebra (some are atypical) shows the following main features (photo F): a spinous process that projects posteriorly and provides ligament and muscle attachments; a cylindrical body that is flanked top and bottom by intervertebral (IV) discs; paired transverse processes (black arrows) that provide for muscle and ligament attachments; and a hole known as a vertebral foramen.

Photo F

The vertebrae of an intact spine are aligned and held in check by numerous powerful ligaments, connective tissue bands that link bone to bone (Photo G – don’t fash about their names).

Photo G

This arrangement makes the vertebral column strong, flexible and springy! It also allows for a considerable amount of movement including lateral (side bending) flexion, twisting (rotation), and anterior (forward) flexion (Photo H):

Photo H

And, for spinal extension (Photo I):

Photo I

Vertebral alignment also converts individual vertebral foramina into a vertebral canal that houses and protects the spinal cord. Photo J is a schematic of the spinal cord inside the vertebral canal (only a few vertebrae are numbered). The colored coded regions give rise to spinal nerves issuing in pairs from cervical, thoracic, lumbar, sacral and coccygeal levels of the spinal cord; the nerves supply structures of the neck, trunk, upper limbs and lower limbs.

Photo J

The thoracic vertebrae are unusual in that they are directly anchored to the ribs and indirectly to the sternum (breast bone). This arrangement provides great stability and allows anterior flexion but little other movement (Photo K). Ribs in the image below are numbered but the thoracic vertebrae are not. Know that T1 vertebra articulates with the 1^st pair of ribs and so on.

Photo K

Here’s an interestin’ tidbit: as bipedal humans, our spines transform during life. With infants, the entire spine is flexed anteriorly (Photo L – purple line).

Photo L

As we lift our heads, sit up and walk, four alternating curvatures develop that are readily apparent in the adult spine. The cervical and lumbar vertebrae curve posteriorly – the thoracic and sacral vertebrae curve anteriorly (Photo M – spine viewed from the left side).

Photo M

Take a deep breath and enjoy this image o’ Jamie’s back: ye can clearly see his thoracic and lumbar curvatures as well as the deep midline groove flanked by impressive columns of his erector spinae muscles (Starz episode 105, Rent). And, thank ye verra much but from now on, he’ll be mending his own shirt – since his tender Uncle Dougal keeps tearing it off in front of strangers! He doesn’t care if the lad wears rags from now on!

Now, Claire who makes love to Jamie with her eyes (and other stuff too) throughout all the Outlander books, observes that Jamie’s back is “as straight as an alder sapling.” She doesna mean that he lacks the four curvatures; she means that he holds his back upright and erect…good muscle tone, aye? Here’s a great example of Jamie’s back while playing with the fillies (Starz episode 2, Castle Leoch). Snort!

And, och, while giving the Watch the slip (Starz episode 5, Rent)!

And one of my personal favorites where Jamie strides away from Claire after telling her that it is he who is virgin (Starz episode 106 The Garrison Commander)! One of them better ken what they’re doing! That put a wee gleam in Claire’s eye!

Now back ta anatomy. Another interesting tidbit about the vertebral column: at birth, the wedge-shaped sacrum consists of five separate vertebrae. Fusion begins in adolescence and ends about 30+ years explaining why the adult sacrum is counted as five vertebrae. Also, the sides of the sacrum articulate (form a joint) with each hip bone at the sacroiliac (SI) joints (Photo N – red arrows) to create a rigid pelvis. The purple arrows mark bilateral bony elevations o’ the hip bones known as the posterior superior iliac spines (PSIS).

Photo N

The PSIS are also sites where the dermis adheres to underlying bone forming the so-called dimples of Venus (Photo O):

Photo O

Although the dimples appear in countless nude images, it turns out they aren’t just beauty marks; they are superficial and easily used for bone marrow aspirations (Photo P).

Photo P

Hold on to your chair! Claire shows her dimples of Venus in this scene from Starz episode 107, The Wedding (red arrows)! Here, Claire guides Jamie’s hands to her hips and he starts to put his right fingers over her left dimple! Gasp, I think I just stopped breathing – need CPR STAT!

I cannot find any images of Jamie’s dimples of Venus but, aye, he’s got ‘em. It is just that they are absorbed into paired grooves where his lumbosacral fascia meets his very well-developed gluteus maximus and medius muscles (see Anatomy Lesson #1)! His butt muscles are so powerful that they create a groove on each side of the sacrum (Starz episode 105, Rent). Mmhm!

Now, this lesson must visit Jamie’s scourging by the Mad Man of Fort William! It breaks my heart to watch this episode (Starz episode 106, The Garrison Commander), but it is needful to understand. The harsh treatment of Jamie is not only a personal tragedy but is a harbinger of the approaching battle of Culloden and the subsequent crushing by the Redcoats of the Highlander way of life. You ken that Jamie had already received 100 lashes for trying to escape afore BJR decides he‘s due 100 more! The first strike of the whip causes the blood to flow freely because BJR is using the infamous Cat ‘o Nine Tails with lead weights at the tips! He means to bleed Jamie to the bone (You understand that if he had actually done so, Jamie would have been disabled or perhaps dead?)

Ye can see why Jamie dubs him that “mad bastard Randall.” Just take a keek at Randall’s face and eyes. This is hard work, right? And just in case you didn’t notice, the blurry figure in the background is Black Brian, Jamie’s father, so named because of the color of his hair whereas BJR is named for the color of his soul!

By the end, Jamie’s back looks like haggis. Little wonder he could barely sit astride a horse after his friends made shift to rescue him!

Herself provides another intimate appraisal of Jamie’s back in the Outlander book. Here, Jamie removes his shirt in Claire’s surgery after leaving Gwyllyn’s performance. The dressing is chaffing him and he asks her to remove it. Claire observes:

“He sat patiently, not moving as I circled behind him and inspected his back…I was appalled…The scars covered his entire back from shoulders to waist. While many had faded to little more than thin white lines, the worst formed thick silver wedges, cutting across the smooth muscles. I thought with some regret that it must have been quite a beautiful back at one time. His skin was fair and fresh, and the lines of bone and muscle were still solid and graceful, the shoulders flat and square-set and the backbone a smooth, straight groove cut deep between the rounded columns of muscle that rose on either side of it…I tried not to imagine the muscular arms raised…ropes cutting into wrists, the coppery head pressed hard against the post in agony…Involuntarily, I reached out, as though I might heal him with a touch and erase the marks with my fingers. He sighed deeply, but didn’t move as I traced the deep scars, one by one, as though to show him the extent of the damage he couldn’t see.“

Now, I must confess, this post wasn’t much fun because of its grim topic but history teaches us important lessons. During the Napoleonic Wars (1803-1815), soldiers in the British Army could receive up to 1,200 lashes, a number that could permanently disable or kill a man. The US followed a similar code and neither country abolished scourging until the late 19^th century – a blot on both nations to be sure as scourging is intended to demean, humiliate and permanently scar its victims.

Flogging was also used during the US slavery period. The next photo taken at Baton Rouge in 1863 shows the back of Gordon (Photo Q), a scourged slave. His scars are pronounced because of keloid formation.

Photo Q

Lastly, let’s consider the importance of the back, the single largest canvas of the human body. It is the basis for many sayings focused on this area of vulnerability giving rise to idioms such as: “your back is against the wall”, “stab one in the back”, “friends have one’s back”, “watch one’s back” and “back off”. The back is also a symbol of strength and hard work, as in “back to work”, “strong back” and “put your back into it”. Indeed, the practice of showing explicitness on the back has been practiced for centuries through clothing, no clothing, art, tattoos and, in Jamie’s case, flogging.

The back can also be used to telegraph emotion. In the next image, Claire has just snubbed Jamie (Starz episode 105, Rent) because he said her face plainly showed that she was thinking of running like she tried at the gathering. Well, she did ask, but Jamie doesn’t like the brush off so he flaps his plaid over his back in annoyance. It’s very funny! See Claire “back” there? She just slipped into her tent. Darn woman…doesn’t know what’s billowing behind her back!

OK, that’s it for the back. Next time I will post on a lighter topic…like Claire, I promise!

The deeply grateful,

Outlander Anatomist

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Photo Credits: Netter’s Atlas of Human Anatomy 4^th ed., Netter’s Atlas of Human Embryology, 1^st edition, Hollingshead’s Textbook of Anatomy, 5^th ed., Starz, ainsleyjason.wordpress.com, www.sportsmed.or.nz, www.Radiopaedia.org, www.wikihow.com, www.Wikipedia.org, www.massgeneral.org, www.faculty.washington.edu, www.wikipedia.com, www.momarock.wordpress.com, www.imueos.wordpress.com, www.forums.hardwarezone.com.sq, www.pedsoncologyeducation.com, www.stemcelldoc.wordpress.com, www.hercampus.com, www.prevention.com

December 23, 2014March 30, 2015

Anatomy Lesson 9: “The Gathering” or “Gore by a Boar”

Anatomy Lesson #9: Tibialis Anterior, Femoral Artery and Intestines.

Holiday greetings fledging anatomists! Hope ye have been good since my last post. This lesson follows Starz episode 4, The Gathering. It also contains lots o’ anatomy so let’s begin!

Warning: if ye havna seen episode #4 or are a wee bit squeamish, this post contains a graphic photo of Geordie’s innards; ye’ll get a second warning just before it comes inta view.

Starting off, I nearly choked on me ale when naughty Angus, that shagger of wee beasties, offers Claire a look-see under his kilt! Claire’s no likely to forget that sight! Speaking of kilts, at the end o’ this lesson I’m gonna show ye what is under a Scotsman’s kilt. But, dinna be scrolling to the end just yet! Ye will want ta read through yer anatomy lesson first…

Claire is headed out on the hunt thinking boars are just wee, hairy piggies. Our stylish lassie is outfitted in the latest over-the-shoulder, wicker medical basket wit’ a fine leather strap.

But, her first physicking is fer a young man gored by a boar. Near the knee, a horrific meaty-looking wound gapes the length o’ his right leg (see Anatomy Lesson #7). The gash is huge and Claire applies a nice field dressing while givin’ him holy hell fer messin’ wit’ the pigs. She tells him he will walk with a limp!

Now, let’s puzzle out the anatomy of this wound. Ye may ken from Anatomy Lesson #7 that anatomists divide the lower limb into thigh, leg and foot. Ye also ken that the leg contains two bones (Photo A): the larger, medial tibia and the smaller, lateral fibula. The tibia, or shin bone, has a sharp anterior border and a broad medial surface ye can easily palpate (feel) through yer own skin. Try it. These tibial surfaces are so superficial that they are easily barked on projections such as stair risers.

Photo A

The gash (indicated by the red dashed line in Photo B) runs the length of tibialis anterior (Photo B, black arrow) a fleshy leg muscle just lateral to the anterior tibial border. Test yer own tibialis anterior muscles this way: wit’ the legs side-by-side, stand on yer heels. Ye’ll see fleshy bumps to the side of each tibia – the tibialis anterior muscles. If yers aren’t verra fleshy, read on ta find out how to strengthen them!

Photo B

Tibialis anterior arises (takes origin) from the tibia, turns into tendon, angles across the ankle joint and ends (inserts) on foot bones near the instep (Photo C). It has two major functions: it inverts the ankle (the sole faces the midline) and it lifts the foot at the ankle (dorsiflexion) allowing the toes to be pulled up and held in a locked position. This muscle is critical for walking, running, kicking a ball, or any activity that requires moving the leg or keeping the leg vertical. Now ye ken why Claire warns the young man that he will walk wit’ a limp.

Photo C

Ye can strengthen yer own tibialis anterior using a verra simple exercise (Photo D). Tie an exercise band around an upright, place the loop over the foot (not just the toes) and dorsiflex the foot against tension. Repeat on the other side gradually increasing the number of repetitions over time. Ye can also find tibialis anterior strengthening exercises on YouTube.

Photo D

TAKE NOTE! Flawed running technique, poor athletic shoes, overuse, etc., can cause tibialis anterior muscles to become seriously inflamed (redness, swelling, pain, heat, and loss of function). In Photo E the inflammation is so extensive ye can see the entire course o’ the muscle and its tendon just under the skin!

Photo E

Movin’ on: Claire’s next challenge is puir Geordie whose gory thigh bears multiple lacerations from a boar’s tusk! Claire correctly concludes that the gouges missed his femoral artery because there is no spurt ta the blood flow.

Where is Geordie’s femoral artery? Weel, the (common) femoral artery starts at the inguinal ligament accompanied by a vein and nerve of the same name (Photo F). It bears another name before passing behind the inguinal ligament but it doesn’t concern us just now. Soon, (2-3 inches) it passes behind the sartorius and vastus medialis muscles (see Anatomy lesson #7) too deep fer a boar tusk ta reach.

Photo F

Ready fer a wee bit o’ self-examination? Or, ye can play doctor with a friend!…Snort! Lie on your back and put yer fingers in the groin near the middle of the thigh. Move them up and down. Do ye feel a thick band? This is the inguinal ligament (Photo I – black arrow). Next, place yer middle and ring fingers just below the inguinal ligament and press deep. Ye should feel a strong, even pulse; this is the femoral artery! It lies deep just below the middle o’ the inguinal ligament (Photo G – green arrow). It is often as big as yer thumb because it supplies blood to the entire lower limb (almost).

Hint: ne’er take a pulse with yer thumb or index finger as these vessels have their own pulses that may interfere wit’ yer assessment. The femoral artery is catheterized for diagnostic purposes and medical intervention.

Photo G

Weel, if Geordie’s femoral artery wasna gored, where did all that dark blood come from (ye ken that arterial blood is bright red and venous blood is deep red). It came from tributaries of the great saphenous vein (GSV), the longest vein in the body (Photo H)! Saphenous is from the Greek meaning “to manifest” because often it can be seen through the skin. The GSV begins in the foot and courses up the inside of the leg and thigh ending in the femoral vein. It receives numerous tributaries (dashed oval in Photo H) along its path and these are the sources of Geordie’s blood. Claire stems the bleeding with a tourniquet knowing that she can stitch the lacerations and save his leg.

WARNING: The next image shows Geordie’s gut wound. Scroll past if ye dinna wish to see it!

Photo H

But, sadly, Claire kens puir Geordie’s other wound: a hugh gash through the belly wall exposing globs of yellow fat (green arrows) and loops o’ intestine! This wound will be fatal in the 18^th century and can be today because it exposes a normally sterile space to the outside world wit’ its teeming hordes of bacteria! She canna do anything fer him except take him ta a peaceful place! Kind Claire!

As anatomists, we should learn from Geordie’s wound. The loops shown are o’ small intestine; how do we ken that? Easy! Inspect the loop surfaces and see that they are smooth so this is small intestine; if the loops have pouches (haustra) then it is large intestine (see Photo I – black arrows). The small intestine is divided into duodenum, jejunum and ileum but we see only jejunum and ileum as the duodenum lies too deep.

Photo I

BTW, again verra good special effects because globs of yellow fat show just under Geordie’s belly skin. Anatomists call this layer the superficial fascia of the anterior abdominal wall. But, a shorter name is Camper’s fascia (Photo J). The depth of the fatty layer depends on us. The more belly fat, the thicker Camper’s fascia; the leaner we are, the thinner Camper’s fascia! Clearly, Geordie is a slim-Jim.

Photo J

After Claire telegraphs puir Geordie’s fate, Dougal cradles him gently in his arms (finally a kind deed!) – we hear them reliving fun times together…stealing kine, terrorizing the neighborhood, swiving Geordie’s bonny sister Doreen. What’s a guid friend fer, aye?

Next, Dougal arrives at the shinty field leading a horse carrying puir Geordie wrapped in a plaid death shroud (the great kilt scores again!). A rough but good-spirited game is in progress. Is it Geordie’s death or seein’ his damn nephew playin’? Either way, a black-clad Dougal roars onto the field like an 18^th century Darth Vader (and boy! Isn’t he in braw, shinty-fighting form!)! He is filled wit’ rage and looking fer victims!

OK, time fer an anatomy review pop quiz! So, please git out paper and pencil and keep score…

First, Dougal clips an unwitting player from behind! Dirty pool! (Hey, who’s that running ahead o’ Unca D. and victim #1)? Clipping in the US version of football has been banned for almost 100 years (one type is still permitted in the NFL and CFL). Why is clipping so dangerous? Can ye puzzle it out?

Anatomy quiz question #1: Clipping puts what knee structures at risk?

If ye answered the medial or collateral ligaments and/or the medial or lateral meniscus (see Anatomy Lesson #7) then give yerself 15 points!

A wee aside: why doesn’t Dougal ever wear a kilt? He’s always dressed in breeches. I’d love ta know what the dickens that is all about! Mayhap he gits saddle sore or is jealous of Jamie’s knees? He seems jealous of everythin’ else about the lad!

Next, Dougal shoulders a friend or foe into the fire pit!

Anatomy quiz question #2: What body part(s) does Dougal use to shove the man into a fiery pit?

If ye answered acromion, point of shoulder and/or arm (see Anatomy Lesson #2 and Anatomy Lesson #3) then give yerself another 15 points!

Then, Dougal goes after Jamie big time. Whoa! Watch out Big Red! Yer ever lovin’ uncle is after ye!

Then, Angus (he looks so funny in his poufy kilt) joins the fray ta help Dougal beat up on Jamie. Murtagh, Jamie’s ever watchful god-father, stops Angus in his tracks wit’ a shinty stick to the nether regions! Sorry Angus, but ye shouldna ha’ been so cheeky strutting yer stuff to Mistress Beauchamp!

Anatomy quiz question #3: What body part(s) did Murtagh hurt?

Weel, ye dinna need an anatomy lesson ta’ figure this one out! If ye answered testicles, baws or any of at least 100 other names, then gie yerself 50 points! Yep. Ye ken these parts are super important and worth a whole lot more points! Ouch! Nothin’ does it like a good whack ta the stones – and I don’t even ha’ any! I havena taught an Anatomy Lesson yet on these goodly body parts but I likely will.

Then Dougal and Jamie go at it over the shinty ball followed by a mess o’ blows ta Jamie who remains the high born Scottish gentleman that he is! Finally, Jamie has enough and wit’ a great heave, hoists Dougal o’er his right shoulder!

Anatomy quiz question #4: What body part might Jamie hae damaged wit’ this mightly effort (Dougal is a big man, aye)?

If ye said shoulder joint re-dislocation (see Anatomy Lesson #2) then gie yerself another 20 points!

When I saw Jamie standin’ there nodding to Claire (he always knows right where she is) with his right shoulder droopin’ and his palm turned backwards me thinks, CRAP, he’s done it again!

What do I mean? Weel, once a shoulder has been dislocated, it’s much easier another time. Also, the position of Jamie’s drooping right upper limb is consistent wit’ an anterior dislocation which looks like this (Photo K – ken the black arrow on the acromion?):

Now adding up the points, what was yer final score? Kudos if it was 100%!

Now, I’m done wit’ this anatomy lesson, but I have more ta say about “The Gathering”. I just canna help meself!

I thought Claire is the only time traveler at Castle Leoch, but no, there are two others! First, there’s the lovely Fiona and Mrs. Fitz is sharpenin’ claws on her!

Then, there’s the elegant, hand wavin’, finger pointin’ Moore! He looks mighty dapper!

Next, I love where Murtagh explains the oath takin’ ta Claire. I swear she is the only woman he ever speaks to. Mayhap ‘tis because her smile is as sweet as Jamie’s mother? And, that gown! OMG! Terry and her team work their magic again!

Then, the hilarious scene between Claire and Angus over the “Spanish” sedative. Ha! She even spits her mouthful of port on the floor. Oh yeah, Claire! That is more like it – she an irreverent leddy wit’ a wicked sense of humor! If she and Angus weren’t at such odds, they’d probably be besties!

Next, I must riff on Claire’s cynical horse dung love potion for an unsuspecting Jamie. Handing it to that nasty lassie LogHair, Claire instructs her to scatter it on his threshold, click her heels together three times and recite “There’s no place like love,” “There’s no place like love.” I dinna ken if ye recognize it but this line is straight out of the Wizard of Oz where the Good Witch of the North tells Dorothy to click her heels together three times and repeat “There’s no place like home,” “There’s no place like home!” Since the W of O was released in 1939 Claire could have seen it at a cinema. If ye believe in time travel, then it’s possible!

Finally, I love the intimate scene where Claire stumbles over Jamie in the stables. Fichu and ribbons not-wit’-standing, she left a trail of bread crumbs to mark her escape route? Ha! People, this is verra funny! I live in a forest and bread crumbs willna last more than a few minutes wit’ all the furry, wee beasties around. Would it be different in 18th Century Scotland?

After some difference of opinion, Claire reveals she walloped Dougal over the head with a chair. Jamie rubs the back o’ his heid sayin’ he hopes she left a good mark so Dougal will remember his error in judgment. Mayhap his rubbin’ is in sympathy fer puir Dougal? More likely, he’s feelin’ a 6” scar on the back o’ his own heid left by a wicked Lochaber ax (from the Outlander book) – likely wielded by his connivin’ uncle Dougal!

Here’s what one o’ those wicked 18^th century things looks like:

OK, I’m leavin’ ye wit’ the photo I promised at the start o’ this lesson: what does a Scotsman wears under his kilt? I added the star, ye ken? Back in 2004 when this photo was taken, Queen Elizabeth did indeed visit the 1^st Battalion of Argyll and Sutherland Highlanders. If ye wish ta see the full monty (I’m bettin’ ye do) then search online fer “Scotsman seated next to the Queen” and up, er, pops the whole kilt and kaboodle! Ha! This photo is a bit o’ an urban legend and Snopes rates it as un-determined authenticity. But, the Colonel (Snopes identifies him) sports such a cheeky grin that I canna help thinkin’ the photo is likely real – but, this man is no saying one way or the other!

I do hope ye enjoyed this post. Please tune in 14 days from now for Anatomy Lesson #10, Jamie’s back! Until then, I wish ye the happiest of holiday seasons. Be safe! Take good care of yer amazing bodies!

Be sure to follow me on Facebook and Twitter!

The deeply grateful,

Outlander Anatomist

All photos are credited to Starz,Netter’s Atlas of Human Anatomy 4^th ed., Hollingshead’s Textbook of Anatomy, 5^th ed., www.wikihow.com, www.wikipedia.org, Bodyspace.bodybuilding.com, www.sportsmed.or.nz, www.Radiopaedia.or, www.Wikipedia.org, www.home.southernct.edu, www.williammitchellsstudio.com, www.bodyspace.bodybuilder, www.thesportsphysio.wordpress.com, www.pinterest.com