Tag: diana gabaldon

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Fun Fact: Conjunctiva

Anatomy Def: Conjunctiva is a clear membrane covering part of the eyeball and lining inside of eyelids.

Outlander Def: Roger’s bloodied and abused tissues as he gazes at the world through his burlap hood!!! 😥

Learn about the conjunctiva in Anatomy Lesson #30, Aye, Eye – The Eyes, Part 2. 

Conjunctiva is a clear, thin mucous (adj.) membrane of the eye. It is a mucous membrane because, indeed, it contains glands and cells which secrete mucus (n.). This sets it apart from serous membranes that do not secrete mucus.

The conjunctiva has two parts:

    • Bulbar conjunctiva: Covers front part of sclera (“white” of the eye)
    • Palpebral conjunctiva:  Lines inner surfaces of eyelids 

Is the conjunctiva useful? Oh, indeed it is!  👏🏻👏🏻👏🏻 It performs two important functions: 

      • Produces mucus and tears to help lubricate the surface of eye
      • Protect against microbes entering the eye which is vulnerable to the outer world

The conjunctiva contains many small blood vessels that are not especially noticeable unless stimulated to dilate. Dilation allows for increased tear and mucus release. What might cause such a response?

    • Allergens, such as pollen
    • Irritants, such as air pollution, makeup, cosmetics
    • infections
    • Contact lenses
    • Fatigue
    • Hypoxia (reduced oxygen supply)

But, Roger’s conjunctivae are bloody! Why??? This occurs because strangling increases pressure in the conjunctival blood vessels and they swell. The vessels then burst from straining for air and against the rope!

Slowly rewatch the color version of the hanging; you will see blood blooming during his conjunctival bleed. Or, more precisely, subconjunctival bleed, as blood collects between conjunctiva and sclera! 

The special effects are excellent, btw! In Rik’s recent Q and A, he explains he was fitted with special contact lenses and thought CGI was also added. I agree, as I see an increase in conjunctival blood during the footage.

Ergo: If Roger every gets his hands on William Buccleigh MacKenzie!!! 💪🏻💪🏻💪🏻

Fun Fact: Some people worry that a contact lens could wander towards the back of the eyeball and reach the brain. For several anatomical reasons, this doesn’t happen. One major reason is the conjunctiva folds on itself forming a closed pouch all the way around the eyeball. The figure explains 👇🏻.

The L panel shows the bulbar and palpebral conjunctiva from a frontal view.  Note: the bulbar conjunctiva stops at the edge (limbus) of the cornea. It does NOT cover the cornea!

The R panel shows a vertical section through the eyeball. The bulbar conjunctiva is shown as blue and the palpebral conjunctiva is red. A red arrow marks the pocket where the two layers meet. This blind pocket encircles the entire eyeball. Hence, a lost contact lens can only travel as far as the blind pocket. Want to know what to do about a “lost” contact lens? This is a pretty good website!

Try This: Gaze into a mirror.  Locate the clear membrane overlying your sclera. Can you see its tiny blood vessels? This is your bulbar conjunctiva. Gently pull down on the lower eyelid. See the glistening surface? This is your palpebral conjunctiva. Got it? Good job!

Herself explains Roger’s horrific ordeal in The Fiery Cross. Accurate details and explanations accompany her descriptions coupled with fantastic story-telling.  Read the books, folks! 🙏🏻

The others had strangled, slowly. The bodies were twisted, held by their bonds in the final postures of their struggle. One man—one body—was cut down as I rode up, and carried past me in the arms of his brother. There was not much to choose between their faces, each contorted, each darkened in its separate agony. They had used what rope was to hand; it was new, unstretched. Roger’s toes trailed in the dust; he had been taller than the rest. His hands had come free; he had managed to hook the fingers of one hand beneath the rope. The fingers were nearly black, all circulation cut off. I couldn’t look at his face at once. I looked at Brianna’s, instead; white and utterly still, each bone and tendon set like death.

See Roger’s bloody conjunctivae in Outlander, episode 508, Famous Last Words!  ❤️ Roger!

The deeply grateful,

Outlander Anatomist

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Photo credits: Sony/Starz; www.aafp.org

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Fun Fact: Petechiae

Anatomy Def: Petechiae are small round spots of blood in the skin.

Outlander Def: Telltale signs of the Roger’s distress as he slowly strangles to death!

Learn about petechiae (petechia) in Anatomy Lesson #65, Anatomy of a Hanging!

What are petechiae?  Petechiae are pinpoint, round spots signaling the leakage of blood from capillaries, the tiniest blood vessels of the skin’s dermis. These often appear in clusters and may look similar to a rash. 

More succinctly, petechiae are:  

  • Small hemorrhages (bleeding) in dermis of skin
  • 1-2 mm in diameter
  • Red, purple, brownish coloration
  • Usually feel flat (not raised)
  • Do not blanch (lose color) when pressed

What causes petechiae? Turns out there are lots of causes. Here are some general categories:

  • Strenuous coughing
  • Vomiting
  • Giving Birth
  • Lifting heavy weights
  • Infections/sepsis from bacteria, fungi, viruses
  • Reactions to some medications
  • Blood and immune disorders
  • Lack of vitamin C (scurvy)
  • Lack of Vitamin K ( needed for blood clotting)

Can petechiae appear elsewhere? Well, yes! Sometimes they appear on the linings of mouth or inner eyelids (palpebral conjunctiva)! The below image compares petechiae of the skin with those of the palpebral conjunctiva. 

What else causes petechiae? The answer circles us back to Outlander! 

Gah! Short drop hanging may cause petechiae. In this instance, the condemned sits astride a horse, stands on a barrel or some other support; the support is suddenly removed.

The ghastly short drop may be insufficient to snap the neck so the person slowly strangles to death. They struggle for breath, blood pressure rises in the head, and capillaries burst allowing small pockets of blood to accumulate in the skin and palpebral conjunctiva. Inhumane, for sooth! Roger!!! 😱 

Just so we ken, a long drop hanging (e.g. from a platform) usually snaps the neck resulting in a quick and more “humane” death (if the hangman knows his ”craft”). 

Read about Roger’s hanging and its horrific aftermath in Diana’s fifth large tome, The Fiery Cross: 

On a rise at the far end of the meadow stood a huge white oak, its spring leaves bright in the slanting sun. My horse moved suddenly, dodging past a group of men, and I saw them, three stick-figures, dangling broken in the tree’s deep shadow. The hammer struck one final blow, and my heart shattered like ice.

Too late.

It was a bad hanging. Without benefit of official troops, Tryon had had no one to hand with a hangman’s gruesome—and necessary—skills.

See petechiae of Roger’s facial skin (red arrows) in Outlander episode 508, Famous Last Words. Slow hanging is a ghastly way to die! 😭

Not-So-Fun Fact: Today, we can be grateful that many countries have abandoned hanging as a means of execution. If you are interested, an excellent film is available on this topic: Pierrepoint: The Last Hangman. Bonus! Tobias Menzies plays Lieutenant Llewelyn in this engrossing movie!

The deeply grateful,

Outlander Anatomist

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Photo credit: Sony/Starz;  www.sciencedirect.com

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Fun Fact: Liver

Anatomy Def: Liver is a multi-functional, dense, blood-filled organ of the upper abdomen.

Outlander Def:  Murtagh’s likely cause of death! 😩

Not much fun…. this week, Outlander Fanmily was sucker-punched by the death of Jamie’s beloved Godfather. Wanna know what killed Murtagh (other than Hugh Findlay)? Read on!!!

Learn a lot about the liver in Anatomy Lesson #49, Our Liver – The Life Giver!

Fun Fact: A healthy liver performs more than 500 vital functions for the human body!  This clearly justifies its historic name: lifer.

The Roman anatomist and physician, Galen (200 A.D.), posited that the liver is our most important organ! Thus, springs its descriptor, “liver the life giver.” Understand, liver isn’t our most important organ but most assuredly it is essential for life. 👍🏻

Here are more interesting facts about the liver (consult image below 👇🏻):

    • Reddish-brown hue because it is saturated with blood
    • Right dome of liver abuts right dome of diaphragm
    • Sits high in abdomen, rising nearly to right nipple (in the lean 😜)
    • Right dome of liver and lower right lung overlap one other

The liver is saturated with blood because it receives 25% (1/4) of the entire cardiac output! Two vessels deliver blood to the liver and three drain it:

    • Portal vein – delivers nutrient-rich, deoxygenated blood from GI tract
    • Hepatic artery – delivers oxygenated blood via a branch of the aorta
    • Hepatic veins (3) – drain deoxygenated blood to inferior vena cava

So, what killed Murtagh? Sleuth hats on!

In episode 407 (see red arrow in first image), Hugh Findlay’s musket ball pierces Murtagh’s chest slightly below and to the left of his right nipple.  His wound appears roughly in the location of the green arrowhead in the above Netter image 👆🏻. In this location, the ball will pierce both liver and lung.

Now consider:

    • Blood seeping from his mortal wound is a deep red color, more consistent with liver blood than with bright red lung blood.
    • Flow of blood suggests the wound may have torn a hepatic vein.
    • Wheezing suggests that his right lung was also pierced and beginning to collapse (pneumothorax).

Ergo, our beloved Godfather exsanguinates from a horrific liver wound before Claire can treat either his blood loss or pneumothorax.

Read about one of Claire’s liver diagnoses at the gathering. Here, from The Fiery Cross:

I was a good ten feet from the stool where Murray plied his trade, but could see the man’s eyes, yellow as mustard even in the dim morning light.

“Liver disease,” I said to Brianna, taking no particular pains to lower my voice. “You can see the jaundice from here, can’t you?”

“Bilious humors,” MacLeod said loudly, snapping open his fleam. “An excess of the humors, clear as day.” Small, dark, and neat in his dress, Murray was not personally impressive, but he was opinionated.

“Cirrhosis due to drink, I daresay,” I said, coming closer and looking the patient over dispassionately.

“An impaction of the bile, owing to an imbalance of the phlegm!” Murray glowered at me, clearly thinking I intended to steal his thunder, if not his patient.

Claire is right, Dr. MacLeod. 🚫 excess humors! 🚫 fleam! 🚫 quackery!

See Murtagh’s mortal wound in Outlander episode 507, The Ballad of Roger Mac.  

RIP, Murtagh! 😭

The deeply grateful,

Outlander Anatomist

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Photo credit: Sony/Starz; https://www.netterimages.com