Tag: diana gabaldon

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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

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Fun Fact: Tonsil

Anatomy Def: Tonsils are masses of lymphoid tissue located in oropharynx (behind mouth)  and nasopharynx (back of throat).

Outlander Def:  The “say “ahhhh” tissues!”

Learn about tonsils in Anatomy Lesson #34, G.I. Tract, Part 2 – Tremendous Tube!

Most folks are familiar with a pair of tonsils we see via an open mouth. But, our nasopharynx and oropharynx are equipped with several sets of tonsils.

Anatomists agree there are three sets of tonsils and many add a fourth (see L image👇🏻):

    • Palatine tonsils: Paired masses at back of mouth (blue)
    • Lingual tonsil: Unpaired mass embedded in back of tongue (green)
    • Pharyngeal tonsil: Unpaired mass embedded in back of pharynx (yellow)
    • Tubal tonsil: Paired masses surrounding opening of eustachian tube (violet)

What are tonsils? Tonsils are masses of lymphoid tissue that produce defensive cells known as lymphocytes. If viewed from the front (see R image 👆🏻) , the four sets of tonsils form Waldeyer’s ring, a circle of lymphoid tissues.

What are tonsils for? Tonsils are strategically oriented in Waldeyer’s ring to encounter antigens we breathe in via the nose or swallow through the mouth. The tissues respond by mounting an immune response against the antigens, producing antibodies and pursuing other defensive tactics.

Fun Fact: Tonsillectomies were once the most common surgery done on US children. Today, they are performed mostly to treat breathing problems or chronic issues that are not resolved by other forms of treatment.

Read about Josiah’s tonsillectomy in Diana’s 5th big book, The Fiery Cross!

“All right, then?” I asked.

He couldn’t speak, with the tongue depressor in his mouth, but made a good-natured sort of grunt that I took for assent.

I needed to be quick, and I was. The preparations had taken hours; the operation, no more than a few seconds. I seized one spongy red tonsil with the forceps, stretched it toward me, and made several small, quick cuts, deftly separating the layers of tissue. A trickle of blood was running out of the boy’s mouth and down his chin, but nothing serious.

…The whole thing couldn’t have taken more than thirty seconds per side. I drew the instruments out of Josiah’s mouth, and he goggled at me, astonished. Then he coughed, gagged, leaned forward, and another small chunk of flesh bounced into the basin with a small splat, together with a quantity of bright red blood.

See Claire perform a tonsillectomy on puir Kezzie in Outlander episode 505, Perpetual Adoration! Let’s hear it for the brave laddies!

The deeply grateful,

Outlander Anatomist

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Photo credit: Sony/Starz; www.researchgate.net