Anatomy Lesson #61: Jamie’s Mars and Scars

Hallo, anatomy students. First lesson posted in a while – I have been waiting for new S4 material!

Meantime, “Me keep do.”  So, here’s one last lesson from S3.  Welcome to Anatomy Lesson #61, Jamie’s Mars and Scars!

Getting right to it…. Many events transpired in ep 306, A. Malcolm, wherein Jamie meets Claire after two hundred and twenty-two years apart. Woot!

Like you, the intimate scenes of this episode immediately drew my eyes to Jamie’s body –  Oops, I mean his mars and scars. Come on, I’m a scientist! 

My anatomist’s eye immediately began calculating… Weil, actually not until the second viewing, but you get my drift…. Are Jamie’s scars all present? Are any scars missing? Are they accurately depicted? Did they change?

What say you, Outlander fans, shall we investigate?

This is a chronological list of injuries over three seasons of Outlander TV and most produce scars. All but one appear in the books. Do you ken the outlier?

  1. dislocated shoulder joint
  2. gunshot wound, front
  3. gunshot wound, back
  4. BJR backlash
  5. McDonald’s sword work
  6. BJR hand smashing
  7. BJR burn
  8. BJR Culloden scar

Truly, this red-heided lad has suffered his share of owies! 

We are all too aware of horrific wounds from modern warfare, but battlefield wounds have always been appalling. In the 16th century, French barber surgeon Ambrose Paré became famous for his ingenious repairs of battlefield injuries. One of his famous illustrations is a composite drawing that depictes the range of wounds suffered by warriors of the past (Image A). Seems as if our Jamie may have posed for this image. Gasp!

Image A

Just for fun and because you have nothing else to do <g>, let’s explore the laundry list of Jamie’s Wounds.  We’ll jump backward and forward 20 years as we analyze his mars and scars in chronological order.

Strap yourselves in. Here we go!

1. Dislocated Shoulder Joint:

Claire first spies Jamie perched atop a stool in a crofter’s cottage (Starz ep 101, Outlander). His hunched form cradles right forearm. Her keen nurse’s eye is horrified by his injury. Here from Outlander book:

I gasped, as did several of the men. The shoulder had been wounded; there was a deep ragged furrow across the top, and blood was running freely down the young man’s breast. But more shocking was the shoulder joint itself. A dreadful hump rose on that side, and the arm hung at an impossible angle.

Q: What happened to Jamie?

A: He suffered an anterior dislocation of the right shoulder joint.

His fellow Highlanders move to force the joint into place but Claire-Declares, NO!  No qualified chirurgeon in this grubby group of lads!

The dreadful “hump” is the acromion, a feature of the scapula (shoulder blade). Read about the shoulder joint and Claire’s treatment of its dislocation in Anatomy Lesson #2, When Claire Meets Jamie or How to Fall in Love While Reducing a Dislocated Shoulder Joint!

Footnote #1: In Outlander book, Jamie suffered both a dislocated shoulder and a gunshot wound. Diana wrote that the musket ball knocked him from the saddle and he fell on his hand. Crunch went the shoulder joint! 

Outlander ep 101, Sassenach

Although bruising and swelling often accompany such dislocations, both may resolve without sequelae. Jumping forward 20 years, witness Jamie’s fine form at the brothel reunion in Starz ep 306, A. Malcolm. Evidence of a shoulder dislocation? Nada! Fortunately for Claire, this shoulder works perfectly fine. In fact, everything works perfectly fine. Wink, wink!

Outlander ep 306, A. Malcolm

Before we leave the shoulder issue, several fans have asked if the TV depiction of Jamie’s dislocation is realistic. Well, mostly. An actual anterior dislocation of the shoulder joint looks like Image B (left shoulder). Here, the rounded contour of the shoulder is lost because head of the humerus has been displaced forward into the armpit area (axilla).  The bony knob (red arrow) is the acromion but, clearly, it is not as prominent as depicted in the TV version.

The difference can be explained because in the TV episode, the “dreadful hump” was a prosthetic applied to the top of Jamie’s shoulder. Thus, the hump sits higher and appears more prominent than in life. But, otherwise, kudos to the special effects team!

Image B

Moving on!

2. Gunshot Wound, Front:

Back to the crofter’s cottage! Hightailing it towards home, the Highlanders are ambushed by Redcoats at Cocknammon Rock. But, the English are swiftly dispatched. Hours later, Claire shouts:

“Stop! Help! He’s going over!”

Timber!!! – Jamie topples from his steed.

Claire swiftly discovers a gunshot wound. Jamie, why didn’t you fess up? Now, Claire must deal with a nasty hole left by a musket ball plowing a path through Jamie’s trapezius muscle! Claire explains to Dougal’s merry band of men (Outlander book): 

“The gunshot wound has been bleeding again, and the idiot’s been knifed as well. I think it’s not serious, but he’s lost quite a lot of blood. His shirt is soaked through, but I don’t know how much of it is his. He needs rest and quiet; we should camp here at least until morning.” 

Fat chance Dougal will stop for his nephew to rest; not with Captain Randall prancing through the heather.

“On your feet, soldier!” 

Footnote #2: The TV version shifted the gunshot wound later in the episode and completely ignored the knifing. Probably figured Claire had enough on her plate. Hah!

Outlander ep 101, Sassenach

Fast forward 20 years: Delightful! Starz FX team remembered to include a faint scar as evidence of that entrance crater left by the musket ball. 

Can’t you just see a Starz employee with a wound list?

  • Dislocated shoulder joint, check!
  • Front gunshot wound, check! (
  • etc.

Outlander ep 306, A. Malcolm

3. Gunshot Wound, Back:

Back to the past. Next morning, in Castle Leoch’s keep, wary Claire meets-and-greets wary Mrs. Fitz – immortalized  in this masterful excerpt from Outlander book:

“But he’s hurt. He was shot yesterday and stabbed last night. I bandaged the wound for riding, but I didn’t have time to clean or dress it properly. I must care for it now, before it gets infected.” 

“Infected?”

“Yes, that is, I mean, inflamed, you know, with pus and swelling and fever.”

“Oh, aye, I know what ye mean. But do ye mean to say as ye know what to do for that? Are ye a charmer then? A Beaton?”

“Something like that.”

This terse little tête-à-tête, wherein WWII combat nurse and 17th century castle housekeeper face-off, reveals Claire’s nimble brain! The term infected, meaning invasion by micro-organism, won’t come into common use for another century. Oops, she quickly course-corrects! 

Then, off she goes to properly tend Jamie. (One might think the lad is accident prone!)

The wound at back of shoulder marks the exit site of the musket ball. Serious bruising from gunshot wound and dislocated shoulder and horrific criss-crossing scars (see below) definitely catch her eye. Eek!

Outlander ep 102, Castle Leoch

Spring forward 20 years. Was the exit wound depicted at the brothel reunion? Aye, it was. Take a really close keek at Jamie’s back….there it be (red arrow).

Psst…let’s just ignore the unfortunate pleating of Jamie’s back prosthesis – best save those pleats for his kilt.

Outlander ep 306, A. Malcolm

Next!

Back to Castle Leoch. We can consider Rupert’s hearty beating of Jamie who gallantly choses fists over strap (enough straps) to protect loose-behaving Missy Laoghaire. Once again, mars are treated by Outlander Nurse. But, none of these blows caused permanent damage, so let’s move on!

Outlander ep 102, Castle leoch

4.  BJR Backlash:

Just right for Hallowe’en – foul work by a foul one! Fast forward to ep 106, The Garrison Commander, wherein Captain Blackguard informs Claire of his beautiful masterpiece. Produced four years earlier, BJ floged Jamie’s back into a bloody mess using a cat-‘o-nine tails with lead tips. Yep, these do leave scars!  And, dinna forget, Jamie already had been flogged days earlier! 😳

If you can stomach more flogging details, read Anatomy Lesson #10, Jamie’s Back – Aye, Jamie’s Back!

Described by Dougal in Outlander book: 

Dougal grimaced. “A pitiful sight, it was, too—still raw, no more than half-healed, wi’ the weals turned black and the rest yellow wi’ bruises. The thought of a whip comin’ down on that soreness was enough to make me blench, along wi’ most of those watching.”

Outlander ep 106, The Garrison Commander

So naturally, the back scars persist two decades later.

A splendid quote from Voyager book; Jamie’s scars have healed and contracted as scars normally do. 

I curled up behind him, knees fitting neatly behind his own. The firelight shone dully from behind me now, gleaming over the smooth round of his shoulder and dimly illuminating his back. I could see the faint lines of the scars that webbed his shoulders, thin streaks of silver on his flesh. At one time, I had known those scars so intimately, I could have traced them with my fingers, blindfolded. 

Footnote #3: To my eye, the prosthesis at Madam Jeanne’s establishment appears identical to the original. Over a 20-year span, such scars should contract and thickness diminish.  I suggest a new prosthesis to document these changes, an expected progression of wound healing and scar formation.

Outlander ep 306, A. Malcolm

5. MacDonald’s Sword Work:

Back to the early years. Ye ken the MacDonald clan with its three nasty-mouthed bros? Best ignore them, Jamie.

Nope. He gives them sass and in return, suffers a slice and dice Big Mac Attack! Three against one? No fair!

Outlander ep 110, By The Pricking of My Thumbs

The moral to this event is arguable, but consider something along the line of: dinna get mouthy with the MacDonald clan, especially if three well-armed laddies are against one!

But, Jamie exacts his revenge as he slices the hamstrings of one attacker, who from henceforth will hobble. And, who is cowering behind the tree? The cowardly Duke, who soon has a fate-date with The Godfather! Yes!!!

Outlander ep 110, By The Pricking of My Thumbs

Later, Claire stitches Jamie’s sword wound using the biggest needle she can find – royally POed!  Most of you ken that she accidentally stuck that needle into “Jamie’s” skin during filming. Och! 😱

Footnote #4: If you chose this as the only injury not in the books, score! Although Diana didn’t write the MacDonald fight, Jamie does suffer a saber-slash at Prestonpans. Here from Dragonfly in Amber:

It was a saber-slash, slanting across the ribs. A lucky angle; straight in and it would have gone deep into the intercostal muscles between the ribs. As it was, an eight-inch flap of skin gaped loose, red beginning to ooze beneath it again with the release of pressure. It would take a goodly number of stitches to repair, but aside from the constant danger of infection, the wound was in no way serious.

Outlander ep 110, By The Pricking of My Thumbs 

Did the Outlander FX team include the scar from the Sandringham kebby-lebby? Yep! There it is basking in Claire afterglow!

Outlander ep 306, A. Malcolm

6. BJR Smashing:

You ken about smashing pumpkins? BJR has his version, whacking Jamie’s hand with a mallet, smashing metacarpals and phalanges.  

Read more about BJR atrocious pastimes in Anatomy Lesson #22, Jamie’s Hand – Symbol of Sacrifice!

Outlander ep 115, Wentworth Prison

Once again, Claire to the rescue! She stitches Jamie’s wounds and splints broken metacarpals and phalanges. Herself clearly explains the fate of Jamie’s paw after BJR’s maniacal ministrations (Outlander book):

I began to lose myself in the concentration of the job, directing all my awareness to my fingertips, assessing each point of damage and deciding how best to draw the smashed bones back into alignment. Luckily the thumb had suffered least; only a simple fracture of the first joint. That would heal clean. The second knuckle on the fourth finger was completely gone; I felt only a pulpy grating of bone chips when I rolled it gently between my own thumb and forefinger, making Jamie groan. Nothing could be done about that, save splint the joint and hope for the best.

The compound fracture of the middle finger was the worst to contemplate. The finger would have to be pulled straight, drawing the protruding bone back through the torn flesh. I had seen this done before—under general anesthesia, with the guidance of X rays.

Outlander ep 116, To Ransom A Man’s soul

And, heroically repairs his mangled hand. Not a surgeon yet, but she did well!

Outlander ep 116, To Ransom A Man’s soul

Are Jamie’s finger scars visible after 20 years? Oh, indeed they are! Look closely; nothing shows them better than eating grapes.

FX peeps were on their game. Plain as the back of your hand. Not that Claire was paying much heed to those scars, mind ye. Snort!

Outlander ep 306, A. Malcolm

7. BJR Burn:

Oh, and among those grim hours in the hands of a mad man, let’s not forget the ghastly image of BJR directing Jamie to burn initials into the flesh overlying his heart. Randall offers a red hot wax stamp to “seal” the job! Gah!

Outlander ep 116, To Ransom A Man’s Soul

Those initials do not survive because TV Godfather excises them and casts  into the fiery pit. Go Murtagh! Rah! 

Footnote #5: In Outlander book, Sir Marcus removes the offending button of skin: 

“Best let me help ye, man. Ye’ll fall on it in a moment.” After a moment’s pause, Jamie reluctantly surrendered the knife and lay back against the wadded blanket. He touched his chest an inch or two below the nipple. “There.” 

Sir Marcus reached to the sideboard and snagged a lamp, setting it on the stool he had vacated. At this distance, I couldn’t see what he was peering at; it looked like a small red burn, roughly circular in shape. He took another deliberate pull at his whisky glass, then set it down next to the lamp and pressed the tip of the knife against Jamie’s chest. I must have made an involuntary movement, because the Lady Annabelle clutched my sleeve with a murmured caution. The knife point pressed in and twisted suddenly, flicking away in the motion one uses to cut a bad spot out of a ripe peach. Jamie grunted, once, and a thin stream of red ran down the slope of his belly to stain the blanket.

Talk about branding! Deeply grateful, today’s entrepreneurs never met Johnathan Wolverton!  

Outlander ep 116, To Ransom A Man’s Soul

Back at the brothel, the burn scar is on full display (red arrow), looking a bit like a supernumerary nipple! He, he. The Starz crew didna forget!

Outlander ep 306, A. Malcolm

And, finally, the last wound!

8. BJR Culloden Slash: 

Black Jack is at it again – fiendish fiend! At Culloden, Jamie glances away from a fallen Randall and swish, the blackguard’s blade strikes and bites verra close to Jamie’s femoral artery! 

Outlander ep 301, The Battle Joined

Twenty years later after the reunion-union, Claire espies the long thigh scar. Not quite as described in Voyager, but close. Outlander team snagged this one, too!

The scar ran from midthigh nearly to his groin, an eight-inch length of twisted, whitish tissue. I couldn’t repress a gasp at its appearance, and dropped to my knees beside him. I laid my cheek on his thigh, holding tight to his leg, as though I would keep him now—as I had not been able to keep him then. I could feel the slow, deep pulse of the blood through his femoral artery under my fingers—a bare inch away from the ugly gully of that twisting scar. 

….Soft as a moth flying in the dark, my hand skimmed his leg, and found the thin deep runnel of the scar. My fingers traced its invisible length and paused, with the barest of touches at its end, wordlessly asking, “How?”

His breathing changed with a sigh, and his hand lay over mine.

“Culloden,” he said, the whispered word an evocation of tragedy. Death. Futility. And the terrible parting that had taken me from him. 

Foot Note #6: In Voyager book, the scar extends to Jamie’s groin. The TV scar is closer to the knee – offering a modicum of modesty as millions take notice??? 😉

Outlander ep 306, A. Malcolm

So, eight wounds and FX folks nailed them all. Go team!

Think about it: BJ delivered almost 40% of Jamie’s wounds. However, if one counts each back scar, he owns well over 90% of Jamie’s mars and scars!

Oh, and here’s a wee bonus! Dinna forget loving Laoghaire’s contribution to Jamie’s landscape when the mad matron peppers him with bird shot. Of course, this event occurs after the reunion so those scars must await Season 4! Whew!  

Starz ep 308, First Wife

Let’s close with this lesson with a snippet from big book seven, An Echo in the Bone, which aptly describes Claire as Jamie’s healer and helpmeet. Not really a spoiler as it reveals no plot points.  So, safe to read.

A shadow fell across the floor in front of me and I looked up. Jamie was standing there with a most peculiar look on his face. 

“What?” I said, startled. “Has something happened?”

“No,” he said, and advancing into the study, leaned down and put his hands on the desk, bringing his face within a foot of mine.

“Have ye ever been in the slightest doubt that I need ye?” he demanded. It took roughly half a second of thought to answer this. “No,” I replied promptly. “To the best of my knowledge, you needed me urgently the moment I saw you. And I haven’t had reason to think you’ve got any more self-sufficient since. 

Outlander ep 308, First Wife

Final Points: Generally, society considers scars to be unwanted and unsightly. However, from anatomy and pathology POVs, scar formation is a normal process. Yes, indeed!  This is the way mammalian creatures typically repair tissue disruption –  like a biological bandaid. Although a scar may not perform as well as the original tissue, it keeps the body functional and responsive. To learn more about injury and repair, visit these anatomy lessons:

Recall the start of this lesson?

  • Were all scars accounted for? Yes.
  • Are any scars missing? No.
  • Were they accurately depicted? Mostly.
  • Did they change? Mostly.

Jamie’s mars and scars paint a poignant history. Claire was there for him from the get-go, treating broken bones, gunshot wounds, contusions, lacerations, incisions, dislocations, burns, and emotional abuse. Cheers to the gallant lass and her braw lad (and their creator)!

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz , adc.bmj.com (Image A); sghs.org (Image B)  

Fun Fact: Carpal Bone

Anatomy def: Carpals are eight small bones forming the wrist.

Outlander def: Rocking aboard the Artemis, Claire checks her soaring temperature with the back of wrist. Oh, the lass is on fire! … psst … so is Jamie! He, he!

Learn about carpal bones in Anatomy Lesson #22 Jamie’s Hand – Symbol of Sacrifice. If time is short for a full lesson, consider watching my quickie hand lesson, courtesy of Outlander After the Show. This lesson streamed June 1, 2015, just after the airing of ep 116, Wentworth Prison. The  lesson begins at 16:42 in the following video. Thanks to hosts Keetin, Jen and Ryan for inviting me to discuss the hand’s splendid engineering!

Eight oddly-shaped carpal bones are arranged in two rows to form the wrist. The near row abuts forearm bones and the far row articulates with metacarpal bones. Carpal bones are named for their shapes:

  • scaphoid (boat)
  • lunate (crescent-shaped)
  • triquetrum (three-cornered)
  • pisiform (pea)
  • trapezium (table)
  • trapezoid (quadrilateral)
  • capitate (head-shaped)
  • hamate (hook-shaped)

Carpal bones are arranged in a shallow arch traversed by 9 tendons and a nerve. Small repetitive movements or fluid retention can create pressure on the nerve (median) as it passes through the arch causing tingling and numbness, symptoms associated with carpal tunnel syndrome.

Read about  carpal bones in Outlander book, wherein Claire amuses herself by likening streets and lanes of Cranesmuir to bones of forearm and hand. That Claire – always the doc.  That Diana – always the scientist. We love them!

In fact, I had amused myself on the ride to the smithy by imagining an aerial view of the village as a representation of a skeletal forearm and hand; the High Street was the radius, along which lay the shops and businesses and the residences of the more well-to-do. St. Margaret’s Lane was the ulna, a narrower street running parallel with the High, tenanted by smithy, tannery, and the less genteel artisans and businesses. The village square (which, like all village squares I had ever seen, was not square at all, but roughly oblong) formed the carpals and metacarpals of the hand, while the several lanes of cottages made up the phalangeal joints of the fingers.

See Claire’s wrist in action as she self-diagnoses in Starz Episode 311, Uncharted! Continue watching the episode to see what Jamie does to douse her fever. Wink, wink!

The deeply grateful,

Outlander Anatomist

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Photo credit: Sony/Starz

Anatomy Lesson #60 Let’s Mull the Skull!

Greeting anatomy students, everywhere!  Today’s lesson will examine the marvelous, mystical human skull.

Our first lesson about the skeleton was waaay back in Anatomy Lesson #39, Dem Bones – Human Skeleton, but that discussion was pretty general in nature, whereas, the skull alone is quite specific. We do not have sufficient space to cover all details about the skull, so highlights must do.

First, well-earned homage to our fav author, Diana Gabaldon, who wrote this about her life, pre-Outlander: 

From the late ’70s to the early ’90s, I wrote anything anybody would pay me for. This ranged from articles on how to clean a longhorn cow’s skull for living-room decoration to manuals on elementary math instruction on the Apple II… to a slew of software reviews and application articles done for the computer press. 

Long-horn skulls? Yep. She’s been into head bones for a very long time. 😉

You might not recall, but Outlander has some great scenes involving skulls, so let’s get going!

Beginning with Starz ep 101, Sassenach, a mess of skull stuff happens. Murtagh smartly raps Claire’s skull with his dirk hilt to quiet her. Sorry lass, Redcoats everywhere! And, there’s even more skull stuff:

  • Ep 104, The Gathering, Claire wallops Dougal over the heid with a chair
  • Ep 104, The Gathering, Rupert whacks Jamie on the skull with his dirk. 
  • Ep 104, The Gathering, Rupert whacks Jamie on the skull with his fists! (Ep 104 was mighty rough!)
  • Ep 108, Both Sides Now, Frank, related to Black Jack, beats thugs’ skulls with his own blackjack! 
  • Ep 109, The Reckoning, Murtagh thunks a guard on the skull at Fort William.
  • Ep 204, La Dame Blanche, Murtagh gets a taste of his own medicine from a secret Paris society bent on violating virgins. Skull dunt!
  • Ep 211, Vengeance is Mine, Murtagh separates Duke S. from his skull. Weil, he was asking for it!
  • Ep 305, Whisky and Freedom, Dr. Abernathy fondles a pretty lady’s skull in his office. Claire assists. <G>
  • Ep 307, Creme de Menthe, With help from Claire’s knife, an excise man’s skull strikes stone!
  • Ep 308, First Wife, young Ian is bonked over the heid by pirates!
  • Ep 311, Uncharted, Dermestid beetles clean Arabella’s skull!
  • Ep 312, Eye of the Storm, Claire relieves Mrs. Abernathy’s body of the weight of her skull! 

Doubtless, I have missed a few. Help me out here, anatomy students!

Update! A student reminded me of the cave scene wherein Geillis shoots Jamie in the head.  The pistol ball travels under his scalp to end up in the back of his head (occipital region). Claire removes it with a blade. The ball failed to penetrate Jamie’s skull because Geillis had failed to load the pistol with sufficient charge. Thank you, Marguerite!

This is the quote from Voyager book. Sadly, it wasn’t filmed so no image to accompany this splendid description:

… I sat Jamie down with a pan of water, to tend the damage to his head. I washed away the blood from face and hair, to find to my surprise that the ball had in fact not plowed a furrow through his scalp as I had thought. Instead, it had pierced the skin just above his hairline and—evidently—vanished into his head. There was no sign of an exit wound. Unnerved by this, I prodded his scalp with increasing agitation, until a sudden cry from the patient announced that I had discovered the bullet. There was a large, tender lump on the back of his head. The pistol ball had traveled under the skin, skimming the curve of his skull, and come to rest just over his occiput.

I usually resist descending into the macabre, but let’s introduce the skull with this tidbit. In 2016, 454 human skulls (Image A) were offered for sale on eBay with opening bids ranging from one cent to $5,500!  Sources of the skulls were unknown.  Since then, eBay has revised its policy to “ban the sale of all human body parts except hair.” Thumbs up! Without informed consent, the sale of body parts is rife with ethical issues.

As a former Director of the body donation program at my medical university, sales of human parts for non-scientific purposes were deemed unethical – a sound policy.

Image A 

Definitions: Best to begin our lesson with definitions.

The English word “skull” is likely derived from Old Norse “skulle”, whereas the Latin word cranium comes from the Greek root κρανίον (kranion). What do these words mean?

  • Skull – all bones of head including mandible (lower jaw). Teeth are not included because they are not bones.
  • Cranium ( see Image B) – all skull bones (colors) excluding the mandible (white)
    • Neurocranium – cranial bones that encase the brain
    • Viscerocranium – facial bones

Function: 

Q: Why are skulls so important?

A: Because, skulls are critical elements of the human skeleton which serve to protect the brain and house these major sensory organs:

The skull also fixes the distance between the eyes to allow for stereoscopic vision (depth perception), and positions the ears to enable us to localize direction and distance of sounds.

Image B

Pause for another deep breath of Outlander! Whisking us into the ‘little shop of horrors” run by conjurer Master Raymond (Starz, ep 204, La Dame Blanche), Claire beholds strange sights.  Filled with oddities and ancient bones, curios include the skull of a unicorn! What???? He, he. There it is, with its own shaffron (head armor) complete with a hole for the horn. Only fitting to pay respect to Scotland’s National Animal. Clever!

Back to the anatomy grind…..

Skull Development: The human skull passes through amazing transformations during development. At birth, the skull is made of 44 different bony elements and the facial skeleton is 1/7 the size of the calvaria (Image C). In other words, big head – small face.

As bony elements fuse, open areas persist; these are the fontanelles (6 of them). With further age, skull bones fuse into unmovable joints known sutures  – only the mandible retains a pair of moveable joints throughout life. Some sutures contain little islands of bone. Collectively known as wormian bones, these are inconsistent features of the human skull.

Psssst…No cause to fash about this wee skull; it is a plastic model.

Image C

Adult Skull: Once fusion is complete, the adult skull has 22 or 28 bones depending on how they are counted (anatomists differ on this): 28, if ear ossicles (Anatomy Lesson #25, If a Tree Falls – The Ear) are included in the count or 22, if they are not. And, the adult facial skeleton is 1/2 the size of the calvaria, meaning with age, facial bones grow more than cranial bones. Wormian bones are not included in a skull bone count because they are inconsistent features. Remember? Good!

Wow! Image D shows an adult skull which has been “exploded,” exposing its component bones. This view affords an appreciation of the skull and its many varied and complex parts. Such preparations are very expensive but, nonetheless, are rather common exhibits in anatomy labs. Typically, these are encased in glass and unavailable for handling because several bones are paper-thin. Look but do not touch! 

Image D

Here are the odd names of the skull bones (Image E): 

  • occipital (1) – royal blue
  • temporal  (2) – orange
  • parietal (2) –  turquoise
  • sphenoid (1) – red
  • ethmoid (1) pink
  • frontal  (1) – lime green
  • nasal (2) – lavender
  • lacrimal (2) – lavender (guess they ran out of colors?)
  • zygomatic (2) – yellow
  • maxillae (2) – purple
  • mandible (1) – dark green
  • vomer (1) – peach (part of nasal septum)
  • inferior turbinate (2)  – yellow (sides of nasal cavities)
  • palatine (2) – not shown (part of roof of mouth)

Image E

Another dram of Outlander!

Ever ponder how skulls end up so clean? Anatomical preparers typically utilize insects to do the job. Dermestid beetles are splendid at this icky task and, believe it or not, they are fastidious eaters because they prefer to dine only on carrion! These beasties can even be purchased on line. Or, if beetles don’t suit you, hydrogen peroxide and baking soda are home remedies for an animal skull which demands a thorough cleaning.

Therefore, Outlander accurately depicts Father Fogden using beetles to clean and preserve beloved Arabella’s skull (Starz episode 311, Uncharted). Talk about gross anatomy. Total yuck!!!

If you really wish to see the process in a scientific setting, this is a good YouTube video. But, I advise you to skip, if you are squeamish.

Neurocranium: A few tidbits about the neurocranium. This part of the skull is commonly known as the braincase because it forms a bony hollow housing the brain (Image F). It is composed of all skull bones except mandible and facial bones. It is like a rounded cubical with ceiling, floor, front, back and sides. The shape is a perfect fit providing solid support for soft brain tissue. Got it? Yay!

Image F

Flat Bones: Bones of the neurocranium come in weird shapes. Some, such as frontalparietal and part of temporal are thin, flat bones. Flat bones are fascinating because they are curved (go figure, <g>) with outer and inner layers of compact bone sandwiching a core of spongy bone. In image G, the top layer of dense bone is the outer surface, adjacent to the scalp; the bottom layer is closest to the brain. Each compact bony layer is known as a table, so there are outer and inner tables. The spongy core, known as diploe, isn’t spongy at all (go figure, <G>). But, it sure looks spongy. Rather, diploe is a delicate network of bone riddled with holes. In life, the holes aren’t empty; they are filled with blood vessels, developing blood cells and fat cells. Hence, the term “fat heid.” Ha, ha – just kidding! 

Image G 

Foramina: Another interesting feature –  the skull is full of holes (Image H)! Known as foramina (sing. foramen), the holes traverse the skull from outside in or inside out depending on your point of view.  Such openings vary from pinpoint size to the largest, the foramen magnum (2.5 – 3.4 cm), at the skull base.

Foramina are ports for the passage of blood vessels and nerves between inside and outside the skull. Foramen magnum is traversed by the spinal cord as it descends to enter the vertebral canal (Anatomy Lesson #10, Jamie’s Back or Aye, Jamie’s Back!).

Try This: Bring palms together with thumbs extended toward the face. Place thumb pads against the eyebrows and move the pads back and forth a bit. They should settle into a pair of divots or depressions. These are the supraorbital notches/foramina through which pass the supraorbital (sensory) nerves. You have just demonstrated the method by which these nerves leave the skull and reach the face. Hurrah!

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Superior view of the cranial base

Image H 

Meningeal Arteries: The brain, nestled inside the neurocranium, is surrounded by three layers of membranes, the meninges. The outermost meninx (sing.), known as dura mater (Latin meaning tough mother), contains several meningeal arteries which supply blood to the dura and adjacent skull. Scroll back to Image H and locate grooves on the inner surface of the bottom table. These imprints are caused by meningeal arteries pressing into the bone.

One such vessel is the middle meningeal artery. This important artery is located deep to the temple region where four neurocranial bones meet at the pterion (Image I).  Here, the bones are very thin.

Now, because the brain is encased in bone, one might expected it to be impervious to harm, but if so, one would be wrong.  A blow, fall or other accident (such as a golf ball to the temple) can burst the middle meningeal artery causing blood to accumulate between the dura and inner bony table, an injury known as an epidural hematoma (a clot between skull and dura mater). The accumulation of blood puts pressure on the brain and interferes with neural function. 

This type of brain injury is usually accompanied by loss of consciousness, brief regaining of consciousness, followed by another loss of consciousness. Confusion is typical; bleeding from the ear may occur. Treatment requires immediate surgery, a craniotomy. Without treatment, death typically ensues.

So, can you surmise where this lesson is headed? Of course you can!

Image I 

OK, now let’s see how anatomy applies to Outlander!

Incise the Excise Man: John Barton, a nasty tax man working for the corrupt Sir Percival, attacks Claire in Jamie’s brothel-nest (Starz ep 307, Creme de Menthe). During his battle with Dr. Dura Mater, she stabs his leg and he falls striking his left temple on the stone hearth. Blood drains from his left ear and Claire (sans modern imaging techniques) quickly diagnosis an epidural hematoma! 

Soon, she acquires a trephine (barber surgeons in Edinburgh would likely have these), in essence, a hand drill. She incises the skin over John’s left temple, positions the trephine and proceeds to drill for oil!

Now, drilling through skull bones of the pterion region means the bit must pass through outer table, diploe and inner table of said bones. The good Doctor detects a slight give as the drill completes the traverse. Then, (and, this was thrilling to me!) Claire correctly backs the drill out by reversing direction of the drill handle and voila, a burr hole! What a braw lassie! 

Now, blood can drain from the injury giving  John a chance at survival. Unfortunately, or fortunately if you belong to team Jamie, he does not. He would surely have died without the surgery, but he died with it, anyway. Warrior Claire fought valiantly for her patient in her own battle joined, but to no avail.

Understand that trephination/trepanation is not a new surgical technique as burr holes been found in prehistoric human remains. In ancient times, holes were drilled into a person’s skull, it is thought, to release evil spirits. BJR surely could have used one! Or how about Geillis?

So, armed with the science of anatomy, we now understand the nitty gritty of what took John Barton’s life!  Don’t you feel ever so much wiser? 

Today, a craniotomy is performed to release the pressure from an epidural hematoma and other types of brain injuries. Although more sophisticated, it works similarly to a trephination. In an abbreviated explanation, 3-4 burr holes are drilled through the skull and connected by saw. The piece of skull, or bone flap, is freed. The hematoma (blood clot) is usually suctioned out, the bony segment replaced and the scalp secured in place.

If you aren’t squeamish, this video shows an excellent demo of a craniotomy for epidural hematoma:

And, Claire’s version:

Now, lest you depart this lesson thinking the Outlander trepanation/trephination is a total fabrication by the series writers, it isn’t. Diana wrote about trephination in Drums of Autumn. Yes, she did. This woman leaves no stone unturned! 

Here is the quote (there is another in An Echo in the bone), but to prevent spoilers, the name of the patient is withheld and another name is blocked out, otherwise the quote is intact: 

She was thinner than he remembered, though it was hard to judge of her figure, dressed as she was in a barbaric leather shirt and trouserings. She’d plainly been in the sun and weather for some time; her face and hands had baked a delicate soft brown, that made the big golden eyes that much more startling when they turned full on one—which they now did.

 ———-says that Dr. Fentiman trephined your skull.” He shifted uncomfortably under the sheets. “I am told that he did. I am afraid I was not aware of it at the time.” Her mouth quirked slightly. “Just as well. Would you mind if I look at it? It’s only curiosity,” she went on, with unaccustomed delicacy. “Not medical necessity. It’s only that I’ve never seen a trepanation.” He closed his eyes, giving up. “Beyond the state of my bowels, I have no secrets from you, madame.” He tilted his head, indicating the location of the hole in his head, and felt her cool fingers slide under the bandage, lifting the gauze and allowing a breath of air to soothe his hot head.

Now, let’s close this lesson with a feeling of satisfaction for knowledge gained and with an appreciation of skull art. The following three images show an intricate and creative carving of a human skull.  I do appreciate the skill although I remain ambivalent about using human skulls in this manner.  And, it is a human skull. I enlarged the images and diploe is clearly visible at some of the cut surfaces. Plastic models don’t exhibit spongy bone in their construct. 

Let’s close with the lyrics of “It’s a Lie,” by the rock band, Fiction Plane:

Underneath my face there is a human skull

Without the living flesh you’d find it pretty dull

Ah, no. With all due respect, I disagree! The skull is a fascinating part of the human anatomy. Fiction Plane guys, read the lesson! <G>

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz; Diana Gabaldon photo, personal collection of Outlander Anatomy; www.3b.scientific.com (Image B); ewww.dreamtime.com (Image E); www.holtanatomical.com (Image C); www.kenhub.com (Image F); www.newscientist.com (Image A); www.news.psu.edu (Image G); https://rachelleeart.bigcartel.com; www.slideplayer.com (Image H); www.teachmeanatomy.com (Image I); www.thehuntnyc.com (Image D)