Anatomy Def: A triangular hollow on the back of hand, at the base of thumb
Outlander Def: Up-to-snuff divot of Jamie’s hand – holds Claire’s kisses! 💋
Students, before we delve into our mini-lesson, it is worthwhile to consider the word snuff, which enjoys many meanings – some old, some new:
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- charred part of a candle wick
- umbrage or offense
- huff (chiefly Scottish)
- extinguish
- execute or kill
- a type of film
- forcible inhalation
- sniff
- powdered tobacco
The last definition refers to a smokeless tobacco made of pulverized tobacco leaves. In the late 15th century, members of Christopher Columbus’s crew observed indigenous peoples of the Lesser Antilles inhaling ground tobacco. Labeled snuff, the practice of sniffing the snuff-stuff took hold in Europe in the 1500s. 👃🏻
Warning: Similar to other tobacco products, snuff contains nicotine and numerous carcinogens. Snuffing is also addictive and associated with increased risk for certain cancers. 🚫
Now, onward and upward with our Fun Fact!
Learn about the awesome hand and its components in Anatomy Lesson #22: Jamie’s Hand – Symbol of Sacrifice and Anatomy Lesson #23: Harming Hands – Helping Hands – Healing Hands, both lengthy and detailed lessons. Why? Because, the hand is one of the most elegant and detailed regions of human anatomy, and the anatomical snuff box (ASB) is a fascinating bit of its story.
Found on the back of the hand, at the base of the thumb, the ASB was used to snort snuff, hence its name! A pinch of the stuff was placed into the divot and then brought to one nostril and forcibly inhaled. Ditto on the other side. Reportedly, it gave the inhaler an instant and significant nicotine ‘hit’.
The ASB has a range of appearances. In some people, the divot is deep and obvious (below image); in others, it is less noticeable. Either way, the divot is most evident with the thumb extended (as in hitchhiking).
ASB is formed by three tendons of the back of the hand, extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus, as shown on this image from Grey’s Anatomy:
Why is the ASB important, other than for snuffing? Because, two crucial structures are associated with it:
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- radial artery
- scaphoid bone
The all-important radial artery passes through the floor of the ASB, where its pulse can be detected; it is a major contributor to blood circulation of the hand. Its loss compromises roughly half of the hand’s the blood supply.
The scaphoid bone (Latin, meaning boat-shaped), a bone of the wrist helps form the base of the ASB. This oddly-shaped, small bone confers mobility but not stability, to the wrist.
A person who “falls onto an outstretched hand” experiences a FOOSH, wherein the heel of the hand is forcefully driven into a surface by the body weight. Thus, the scaphoid bone is at high risk for fracture.
Below, the L x-ray shows a broken scaphoid (green arrow); the R x-ray shows a screw securing the fragments. Scaphoid fracture is common and is a leading cause of medico-legal challenges.
Try This #1: Want to see your own ASB? Lay your non-dominant hand on a flat surface, palm down. Fully extend your thumb. You should see two tendinous ridges on the back of your hand. The tendon nearest your little finger is extensor pollicis longus, the other will be both extensor pollicis brevis and abductor pollicis longus.
Try This #2: You may be able to feel the pulse of your radial artery by placing the tip of the middle finger into the ASB and pressing toward the thumb tip. Can you feel it? Do not use your index finger to test the radial pulse as the index finger has its own pulse which may fool you.
Try This #3: You may also palpate the mound of scaphoid bone by pressing the same finger into the ASB but toward the wrist. This is the wee bone often injured by a FOOSH.
Hopefully, you now understand the history and importance of the Anatomic Snuff Box!
Read about Jamie’s ablutions in preparation for war in Diana’s fifth big book, The Fiery Cross:
I had done it often enough to recognize this particular ritual when I saw it. Jamie was not merely washing; he was cleansing himself, using the cold water not only as solvent but as mortification. He was preparing himself for something, and the notion made a small, cold trickle run down my own spine, chilly as the spring water.
Sure enough, after the third bucketful, he set it down and shook himself, droplets flying from the wet ends of his hair into the dry grass like a spatter of rain.
He took his dirk from its discarded sheath, and with no hesitation, drew the edge across the fingers of his right hand. I could see the thin dark line across his fingertips, and bit my lips. He waited a moment for the blood to well up, then shook his hand with a sudden hard flick of the wrist, so that droplets of blood flew from his fingers and struck the standing stone at the head of the pool.
See Jamie’s anatomical snuff box as he conjures up his uncle, War Chief, Dougal MacKenzie! Visibility of his ASB indicates the tension in his hand as he prepares for battle in episode 507, The Ballad of Roger Mac!
Anatomy, Anatomy, everywhere,
So exciting when we share! 🤗
The deeply grateful,
Outlander Anatomist
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Photo Credits: Sony/Starz; Grey’s Anatomy; www.assh.org; www.oceanortho.com; www.teachmeanatomy.info; www.wikipedia.org;
