heughligans – Page 2 – Outlander Anatomy

November 7, 2014July 31, 2015

Anatomy Lesson 5: “Claire’s Skin” – “Ivory, Opal and White Velvet”

Greetings, followers of Outlander Anatomy! Today’s Anatomy Lesson #5: The Skin – Part 1 is extraordinarily important (as are all anatomy lessons) and ye wouldn’t want to get skinned for skipping what is vital to yer own well-being as we learn about our skin!

WARNING! This post includes spoiler alerts and the image of a dissected human body. If you are a bit squeamish about such images, you may want to skip it. Dougal will give ye a second warning just prior!

OK, now, about skin….Herself writes about skin throughout all of the Outlander books where it is used to define characters, enhance scenes, and provide a substrate for Claire’s practice of medicine. As ye ken, the Starz Outlander series and the books are told in the voice of Claire, our braw and lovely heroine! Thus, we must rely on images or observations made by others to inform us as about Claire’s skin which I will use to segue into today’s anatomy lesson!

Let us begin…

In Starz episode 1, Sassenach, we see Claire and Frank driving through the Scottish countryside. On a second honeymoon, they are trying to reconnect after serving apart in WW II. We see that Claire has very pale, clear skin framed by a mass of curly, brown hair.

Herself informs us through polished, sophisticated and urbane Frank that Claire’s ”…skin glows like ivory.” Then Frank makes love to Claire in the grass at the base of Craigh na Dun where he tells her that her skin is like white velvet. Because I don’t have images to match these descriptions, I substitute one from a later episode (Starz episode 6, The Garrison Commander), so along with Frank, we may witness Claire and her beautiful skin!

Next, in a very telling scene from Starz episode 3, The Way Out, Mrs. Fitz helps bathe and dry Claire despite to her protestations; Claire avers that she is able to tend to her own ablutions! But a persistent Mrs. Fitz kindly observes:

Such beautiful skin ya’ have! I’ve never seen a woman past 8 or 9 with skin so unmarked by injury or illness. Yer next husband will be a lucky man!

Aye, that he will…chuckle!

To me, Claire’s beautiful skin is most telling (Starz episode 8, Both sides Now) during the assault by the redcoat deserter. She wears virtually no makeup, nor is any required in my opinion! Her skin is very pale, very clear and her nose and cheeks are endowed with a faint sprinkle of freckles. Claire also looks very vulnerable, very young and absolutely LOVELY despite the unspeakable situation she finds herself in! I can say this without prejudice because I am an anatomist! Ye ken?

But, the ultimate proof comes from Jamie himself: in Outlander, he tells Claire that she has skin like an “opal” as he slowly traces a finger along her collar bone making her skin glow beneath his touch! And, again from our hero:

“Mo duinne,” he said softly. “But now I should say mo airgeadach. My silver one. Your hair is silver-gilt and your skin is white velvet. Calman geal. White dove”.

Again, no images to match the words, so let’s use this lovely substitute!

Hey! Mukker! Are ye still wit’ me?! One last image before we git on to our science lesson! In Starz episode 3, The Way Out, Claire is summoned by the MacKenzie. Colum removes his kilt asking her to massage his aching legs. He also asks Mistress Beauchamp if she sews as well as physicks to which Claire responds: “only flesh, a rather poor garment, I’m afraid.” My cue! Weel, I am athinkin’ that Claire’s answer to Colum was deliberately a wee bit coy and evasive because she would know that skin is NO a puir garment at all!

So, now we segue into Anatomy Lesson #5, The Skin…folks, I am here to tell ye that the skin is absolutely a remarkable garment! Ye will no be amiss to think of it as your own personal space suit that enables you to live a terrestrial rather than an aquatic life! It is also the major barrier between a rather inhospitable world and yer insides! Yes, it gets diseased and injured because we are mortal, after all. But, it serves us verra well so please read on!

If ye are squeamish, ye may wish to skip the next image or heed Dougal’s advice…

A few years back, German anatomist, Professor Gunther von Hagens brought his world-renown Body Worlds exhibit to my neck of the woods. I was privileged to deliver the key note lecture before the event and was Professor of Anatomy on opening night where I gave mini-lectures and answered questions posed by attendees. Of the many extraordinary figures at that exhibit was one of a man holding his own skin and gazing at it in awe (Photo A). I hope after reading this post, you too will view your own skin with the awe it so richly deserves!

Photo A

First off, skin is an organ. Yes, it is! It is also the heaviest organ of the human body! Really, ye say? Yup, it accounts for at least 8% of our body weight (some studies claim as much as 16%) and covers a surface area of about 20 ft² or 1.9 m²! Want to determine the weight of your own skin? It’s simple! Just multiply your weight in pounds or kilos by .08 – the answer is the approximately the weight of your own skin!

Skin also produces all of our body hair, fingernails, toenails, sweat glands, sebaceous glands, the female breasts and the male nipples and areolas. All of these appendages are skin derivatives and therefore part of the organ itself. Earlier, I mentioned Claire’s hair and now ye ken why because hair is part of the skin. But, as Claire’s hair makes for an interesting subject in its own right, I will address hair in my next post: The Skin – Part 2! And won’t it be fun to see the Outlander Starz results in it’s “hair as a character” poll this Saturday!

Ok, this next one is a gratuitous shot…sorry I just canna help it! Weel, not entirely gratuitous – it does show hair and skin and one other thing I havna yet told ye: the enamel of the teeth is derived from modified skin of the mouth. Geez, even his teeth are gorgeous! Get a grip prof! Focus!

Ahem…now, back to the lecture! Skin thickness varies throughout the body; some skin is thick for protection such as on the soles of our feet or thin as on our eyelids where thickness is not required. Skin is also more heavily pigmented in some areas (nipple and areola) than in others (belly). Most of the skin bears either fine or coarse hairs but some areas are completely devoid of hair: the so-called glaborous surfaces of the body such as the palms and soles where hair, if present, would interfere with grip.

Skin is composed of two important layers: a thin outer epidermis that sits atop a thicker inner dermis (See photo C). Deep to the dermis is the hypodermis; although not part of the skin, it is important because it helps anchor the skin to underlying structures such as muscle or bone (Photo B). In addition, some skin structures are actually anchored in the hypodermis.

Photo B

The epidermis is composed of skin cells and some other cell types. It also completely replaces itself about every four weeks, with new cells forming at the base and advancing toward the surface where they die and slough. So, cells at the skin surface are flat and dead – these cells exfoliate naturally (did ye know that a large portion of house dust is shed skin cells?) or ye pay for exfoliation by costly products or at expensive salons (Photo C – this 3-D image was taken with a powerful scanning electron microscope or SEM)! The supporting dermis houses two types of sweat glands, sebaceous glands, blood vessels, hair follicles, and special microscopic endings for sensation.

Photo C

So what about sweat glands? The skin actually includes two different types: apocrine sweat glands are present only in the arm pits (axilla in anatomy, remember?) and our private regions (perineum in anatomy). The thicker sweat from these glands is initially odorless but when acted on by skin bacteria, it develops a pungent, acrid smell. This is the unwashed male that Claire muses on while sharing Jamie’s mount (Outlander book) – although females most certainly battle the same issue! A second type, the eccrine sweat gland, is ubiquitous throughout the remaining skin; sweat from this gland is watery and usually exudes an ammonia smell. Photo D shows the multiple openings (pores) of eccrine sweat glands on the finger pad.

Photo D

The process of sweating from eccrine sweat glands is captured in Photo E. Here, following exercise, blue sweat droplets bead on skin from the back of the hand. This 3-D photo was again taken the powerful SEM. The colors, however, are not real – they were computer generated.

Photo E

As fer the sebaceous glands, I’ll be leaving those until my next post: The Skin – Part 2! Next, a question commonly asked by students: what causes the wide variation in human skin tones (see Photo F)?

Photo F

Weel, it turns out that there are a number of reasons for our individual skin color. One cause is the number of blood vessels in the dermis and the color of blood surging through them (bright red arterial blood versus duskier venous blood). Just fer fun, let’s compare and contrast the color of Claire skin wit’ that of Jamie’s in this image from Starz episode 1, Sassenach. We clearly see Claire’s naturally cool and pale complexion but partly because she is royally pissed, holding herself aloof from all the male funnin’ goin’ on around her. But, Jamie’s skin is strikingly different! Although Jamie is splattered in blood and he has naturally ruddy skin, it is enhanced in this scene having exerted himself in battle and during Claire’s recapture so ye can bet at this point there’s a whole lot of bright red arterial blood circulating through the vessels of his dermis!

Another contribution to overall skin color depends on how much carotene we consumed in our diets: carotene is an orange pigment prevalent in fruits and veggies such as cantaloupe, sweet potato and carrot (Photo G). Carotene absorbed from our food gets deposited in the epidermis where it adds to skin color and also helps protect epidermal cells from damage by UV light.

Photo G

But, the most significant contribution to skin color comes from special cells of the epidermis, the melanocytes (Photo H). These scattered squid-like cells produce and package the pigment, melanin, into granules that are released into surrounding skin cells. Interestingly, the number of melanocytes in a given region of the skin is the same regardless of skin tone or gender. So, differences in skin color are due mainly to differences in the number and size of the melanin packets produced and this in turn is determined by genetics! In darker skins, the melanin granules are larger, more numerous, persist longer and are distributed throughout the epidermis. Pale skin has fewer, smaller melanin granules that are confined to cells at the base of the epidermis and degrade more quickly.

Photo H

Ye can deliberately increase the production of melanin granules and darken existing melanin in yer own skin by exposure to UV light either from the sun or from tanning beds. I ken the beds are a very popular trend, but I want to WARN ye: For some very sound medical reasons, ye should NOT expose yer skin to UV light from tanning beds and ye should also be judicious about tanning from the sun’s rays too, especially if ye are fair of skin like Claire! I urge ye to get informed about it!

Now, ye are all are probably aware of albinism (Photo I), a condition affecting animals (humans, spiders, snakes, apes, etc.) where the sufferer lacks an enzyme needed to make melanin (albinism occurs in plants too but is due to an absence of chlorophyll). Albinos (Latin: albus for white) do NOT make any melanin in the skin, hair or the irises of the eyes! This is a difficult condition because their eyes are highly sensitive to light (photophobia) and they have difficulty tracking the eyes normally. The skin is also highly susceptible to skin cancers! It is a condition which, at present, has no cure but there are steps that can be taken to protect the skin and aide the eyes.

Photo I

Finally our skin has a battery of sensory endings specialized to detect changes in our environment and transmit these to our nervous system. The fingertips alone have about 2500 of these receptors per cm² (about 0.2 in²) of skin! I’ll not show pictures of these endings because they are a wee bit too technical. In summary, then, here is a short list of what skin does for Claire and for us all!

It is an anatomical barrier against pathogens and damage.
It provides sensation in the form of pain, touch, pressure, heat, cold and vibration.
It regulates our body temperature by dilating or constricting blood vessels in the dermis and cooling the skin by the evaporation of sweat.
It helps control fluid loss.
Helps synthesize vitamin D via UV radiation.
It aids in excretion of waste products.
It aids in communication: others assess our mood, physical state or attractiveness by the state of our skin.

Impressed yet? I know I am and I’ve been teaching this subject for a verra long time!

Speaking of mood, let’s close wit’ this touching image from Starz episode 7 The Wedding, where Jamie pays homage to the skin of his bride of astonishing beauty with a soft murmur and a tentative touch!

Aye, Jamie, ye are ready! And, so is Claire – she sure took long enough! Snort!

I do hope ye have a better understanding and appreciation of the skin ye are in and have an increased desire to take verra good care of it!

A wee note of explanation: I will also continue my convention of typically using the character’s names rather than the names of the actors. This gives the cast at least one degree of separation and a wee bit o’ respect as I dissect their bodies on a blog! I hope ye all understand.

The deeply grateful,

Outlander Anatomist

Images are from Starz Outlander series. Microscopic images and drawings from Netter’s Atlas of Human Anatomy, 4^th ed., Bailey’s Textbook of histology, 10^th ed. or Bloom & Fawcett’s Concise Histology, 2^nd ed, and the National Geographic, Skinned man from Body Worlds exhibit (sans the fig leaf), CGI image of epidermis and dermis from Loyola University Dermatology website, Baby photo from an older United Colors of Benneton ad, Photo of carrots from Gov. of West Australia and fig leaf from ClipArt, Archival photo of albino man taken by an unknown photographer – beginning of the 20^th century.

October 30, 2014October 26, 2017

Anatomy Lesson 4: “Jamie’s Chest – 8th Wonder of the World!”

Greetings friends of Outlander Anatomy and welcome to today’s lesson! Do you recognize the classic seven wonders of the world?

Colossus of Rhodes.
Great Pyramid of Giza.
Hanging Gardens of Babylon.
Lighthouse of Alexandria.
Mausoleum at Halicarnassus.
Statue of Zeus at Olympia.
Temple of Artemis at Ephesus.

The 8th wonder is, of course, James Fraser’s chest!

Getting in a mood, let’s take a wee keek at the breadth (Uncle Dougal, ye are a crud for exposing your nephew like this!)…

And the depth (BJR, man, ye are darkness itself!):

Of this very timely topic!

Now, we all ken that Claire gets her first TV looksee at Jamie’s blest-chest in Starz episode 102, Castle Leoch. But, Herself wrote in Outlander that Claire made touchdown with his chest when he fainted from blood loss after Cocknammon Rock:

“Stop! Help!” I yelled. “He’s going over!” … Jamie slid off headfirst like a sack of stones, luckily landing in someone’s arms. The rest of the men were off their horses and had him laid in a field by the time I had scrambled down. “He’s breathin’,” said one.

“Well, how very helpful,” I snapped, groping frantically for a pulse in the blackness… Putting a hand on his chest and an ear to his mouth, I could feel a regular rise and fall, with less of that gasping note. I straightened up. “I think he’s just fainted,” I said.

He groaned and opened his eyes… “I’m all right,” he said, trying to sit up. “Just a bit dizzy is all.” I put a hand on his chest and pushed him flat.

The instant the bandages were tied, the patient tried to sit up. I pushed him flat and put a knee on his chest to keep him there. “You are not to move,” I said fiercely.

So, leading up to Nurse Claire actually seeing his chest, let’s start with the castle courtyard. I have to begin the lesson here because I LOVE the courtyard scene with all its swirling undercurrents!

After dismounting, our bedraggled Claire stands there saying nothing but watching everything.

Puir lass, the front of her slip and dress have gone bye-bye, having given those up for Jamie’s field dressing. Left in her ruined, oxford walking shoes and hair in straggles, she stands out like a wee sore thumb! She is scairt and confused but tough as nails.

Our stalwart heroine stands completely IMMERSED in a maelstrom of male testosterone and ribald jokes. And, Jamie hovering…

…hovering I say!

Next, we witness a fabulous tete-a-tete between Claire, Mrs. Fitz, and Jamie where a lot is said, but a whole lot more remains unsaid!

Jamie says Murtagh found her and Dougal said to bring her along. But, it’s NO HIS FAULT that Ms. Fitz has another mouth to feed, bed to make, and body to clothe. Tcha! Just like a man!

Mrs. F is shocked at Claire’s scandalous appearance and doesn’t mind saying so!

And, Jamie still hovering in the background finding any inane thing to do with his horsey, even though there are several hostlers to do the work, all the while listening and watching the two lasses size each other up.

As Grand Dame, readies to drag Claire away for cleaning up, Claire is adamant that she must properly care for Jamie’s wound as Jamie brawly boasts “I can fend fer meself!”

Mrs. Fitz upon hearing Claire’s credentials, declares “Jamie, ye need fixin’, git yerself indoors!” Ye heard the leddy, Jamie!

And just like that, Jamie finds himself seated on a stool covered with a blanket and ALONE with Mistress Beauchamp. (Being a wee bit nosey here, who washed Jamie’s face? Whoever it was, thanks – he cleans up nicely!). Claire gently removes the blanket to cleanse the wound and hears the awful truth that her hubby’s sixth, great grandfather gleefully produced the horrific scars on Jamie’s back.

Claire takes time to properly clean Jamie’s gunshot and apply an ingenious dressing involving a pressure bandage and strips of linen crossed under both oxters, an excellent technique for anchoring a shoulder dressing. Jamie tries moving the injured shoulder and winces, so Claire promptly straps his arm to his chest by the golden glow of firelight. Why? Claire knows the arm must immobilized for at least a week to promote wound healing, a truly complicated process! By next day, someone has replaced the strap with a sling, which is not the same at all!

Sadly, we must leave this tender scene to start Anatomy Lesson #4. Sniff!

Terms: Let’s come to terms with it, anatomists do not use the terms upper and lower arms. Instead, the entire upper appendage is called the upper limb. The region between shoulder and elbow joints is the arm and the region between elbow and wrist joints is the forearm (Image A). This is important to know for this lesson.

Image A

Rib Cage: The bony foundation of the chest is the thoracic (rib) cage, including 12 pairs of ribs, their costal cartilages (blue structures), sternum (breast bone) and 12 thoracic vertebrae (Image B). This spring, bony enclosure not only protects heart, lungs, airways, esophagus, and great blood vessels, it also provides attachments for important chest muscles! Above the thoracic cage lies the clavicle (collar bone) which articulates (forms a joint) with it.

Image B

Pectoralis Major: The chest muscles or “pecs” as trainers call them, actually include two pairs of muscles on each side of the chest. The word pectoralis derives from the Latin pectus meaning “breast.”

Pectoralis major muscles are the largest, most superficial, and most powerful of the two pairs. Each fan-shaped pec major covers half of the chest and is divided into three heads. The clavicular head (Image C) arises from the clavicle.

Image C

The larger sternocostal head arises from 1 through 6 costal cartilages and sternum (Image D).

Image D

A smallish, third part (Image E) arises from an abdominal muscle. This is a fairly insignificant part unless torn in which case, the pain surpasses all conscious thought. Just kidding, except it does hurt!

Image E

Pectoralis major muscle fibers converge toward the arm inserting into the humerus or arm bone (Image F).

Image F

Heh! Wake up, fledgling anatomists!

Yep, we can do pretty much anything for the Great Scot!

On their way to the humerus, pec muscle fibers create the anterior axillary fold (Image G). This fold forms the front border of the arm pit, oxter, or axilla! (I still want to see Claire stick her foot in Jamie’s oxter!) Grab this fold on a pal or sibling and give it a wee pinch. Gives them a jolt, so not a fab idea to try someone without a sense of humor!

Image G

In this horrifying image from Starz episode 6, The Garrison Commander, Jamie’s massive right anterior axillary fold is very easy to spot. Our darling hero near freezes to death as BJR parades, preens, and prepares for his fav outdoor sport!

Function: Each pec major is a very hard working muscle. And, because it has three heads, they do quite a bit of work!

raises arm forward (as in lifting a child)
returns arm against the torso (as in setting down the child)
pulls arm from spread eagle to the sides of torso (as in standing in mountain pose)
rotates arm (internally) toward the chest

And, for those who wonder, pec major is best developed by standard pushups (not triceps type!), bench presses and weighted flyes.

Try This: You can see the tendons of your own pec majors this way: place palms together about 6” in front of your chest as in prayer mode. Now, press the palms firmly together. Your own pec majors should stand out strongly as the anterior axillary folds. Just don’t get them pinched!

Pectoralis Minor: In anatomy (like baseball), if there is a major – there is a minor. So, deep to each pectoralis major is a pectoralis minor muscle (Image H). This smaller fan-shaped muscle is also very important. It arises from the ribs (2, 3 & 4) and inserts on a small bony knob of the should blade known as the coracoid process (Greek for “like a raven’s beak”). Its contraction pulls forward on the corcoid process aiding in shoulder mobility and stability.

Image H

Applied Anatomy: OK, with the thoracic cage and two pairs of pecs done, let’s find them on our wonderful warrior! After Claire trusses Jamie up, the only parts of his chest still showing are the verra fine sternocostal heads of his pec major muscles, covered with skin, of course (blue arrows). Ye can see them fair keeking out from under the dressing. Awesome sauce! And, good reason to consider them the 8th wonder of the world.

But, wait, here’s more! The clavicular heads of Jamie’s pec major muscles are unusually well developed! Check out this image (Starz episode 5, Rent) for prominent bulges just under those bonny clavicles (blue arrows). These are the clavicular heads of each pec major, an oft neglected part in body building – but not here! Props to the trainer! Gasp! They’re bloody awesome!

Finally, Claire has done all she can legally do for Jamie – he stands there with his glorious chest peeking through the bandages and his nipped waist and.. GAH! Lord, gimme a dram!

Now, returning to anatomy (I am a professional after all)… about 1 in about 50,000 people are born without some or all of pec major and minor muscles. Known as Poland Syndrome, it may include hand and finger anomalies and shortened forearm bones. Interestingly, people with the syndrome compensate quite well using other arm and shoulder muscles. In fact, there’s a well-known PGA player, an Olympic boxer, and a Formula 1 World Champion (car racing) that have Poland syndrome and, clearly, it didn’t hinder them! The lady shown below (Image I), from a theatrical production, has it; she is missing the sternocostal head of pec major (blue arrow).

Image I

That’s it! Let’s close this lesson with a lovely poem nicely expressing the growing attraction between Nurse and Highlander!

Aug 2014

Cradle

Place your hand upon my chest.
It reminds me how it feels when it’s mended.
Then use it to cradle your head while you rest.
The worst of it, like the day, has ended.

I hope this lesson helps you more fully appreciate the chest muscles and their bony attachments. Fare thee well for now. Am thinking that Claire might be the subject of my next posting! We have ignored our amazing heroine for far too long!

How many days left before Starz episode 9? 156 days or so but who’s counting?! Sigh.

The deeply grateful,

Outlander Anatomist

Photo credits:

All photos are credited to Starz or Frank Netter’s Atlas of Human Anatomy, 4th edition. The lady with Poland’s syndrome is an archival photo from my lectures and I do not know the photographer.

October 19, 2014April 25, 2017

Anatomy Lesson 3: “Bad Day at Cocknammon Rock” or “Wee Bonny Fingers on my Collar Bone!”

Hallo, anatomy students! Anatomy Lesson #2 dealt with Jamie’s dislocated shoulder. Today’s Anatomy Lesson #3 delves deeper into the shoulder region. Why? Because Jamie’s bad-day blues continue with a gunshot wound to his already battered shoulder (Starz episode 1, Sassenach).

Take a wee peek at the lad’s bonny shoulders in Starz episode 5, Rent. Mo’ bettah? The shoulder is fully healed, thanks to Nurse Claire. Jamie is super unhappy here, as Uncle Dougal uses and abuses him for political expediency (some things never change. Hah!). Let’s see the damage done to his shoulder by the musket ball.

To understand Jamie’s gunshot wound, we must explore more shoulder anatomy:

Clavicle: Anatomy Lesson #2 introduced the paired clavicles (collar bones), each a strut holding its shoulder joint away from the torso. Here is how they works: each clavicle lies mostly horizontal at the top of the chest where its near (proximal) end attaches to sternum (breast bone) and its far (distal) end attaches to acromion (Image A – right side). Both ends are secured in place by ultra-strong ligaments.

Image A

Firmly grounded to the torso via the sternum, the clavicles support most of the weight of our shoulders. If a clavicle breaks, then the shoulder joint droops and the patient presents supporting his/her injured side with the good hand. Here is a great example of a broken left clavicle in the form of wee Ferris Bueller (Image B). Oops, mea culpa, Mathew Broderick, not the charming high school con artist. BTW, this photo isn’t movie magic. In 2006, Matthew fell off a horse while riding in Ireland, breaking his clavicle!

Image B

Trapezius: The clavicle is also a landmark for reviewing the second injury to our “king of men!” Below the clavicle lies the chest, above it is the trapezius muscle, here seen overlaid with skin (Image C).

Image C

When the “Mad Bastard Randall” whipped JAMMF for defending his sister, Jenny (episode 2, Castle Leoch), both loverly clavicles are visible in an otherwise unloverly situ! Two flesh ridges are created by the clavicles as Jamie’s poor arms tied in place. Hurtful humiliation for the laird’s son!

Bad Day: Now, on to Jamie’s second owie of a verra bad day! You will recall the wee stramash with redcoats at Cocknammon Rock, where Jamie unceremoniously dumps Claire in the dirt, rips off his belt sling (och, that hurts!), and yells “hide yerself?” Course, ye do.

No Dummy: Being a smart sassy-lass, Claire immediately high tails it downstream where Jamie catches her up. Sliding off his steed (I’ll return to that splendid image in a future lesson), he cautiously approaches: sword drawn, arms extended, speaking gently – corralling her like one of his horses. Whoa, Nellie!

Claire’s Feign: Claire tries distracting Jamie from her aborted flight by changing the subject – she hopes he hasn’t been misusing that shoulder! Geeze, Claire, ya think? Jamie looks like mayhem – bloody, muddy, disheveled and in HIGH DUDGEON! But, her ploy isn’t gonna work on Jamie – the lad’s as bright as a ruddy sunbeam! Glancing at his shirt, Jamie dismisses the bloody mess as belonging mostly to the other guy.

Jamie warns Claire that she is coming with him because Dougal and his band of Merry Men are waiting further upstream. “You don’t look that heavy” he mutters cautiously creeping toward her – LIAR, LIAR Pants on Fire! In Outlander book, Jamie later tells Claire she weighs as much as a good draft horse <G>!

Feral cat that she is, Claire spits that she isn’t going with him. Just look at her face. You gonna make me?

Well, yeah, he is. Jamie warns she better get her sweet arse into that saddle or he is gonna pick her up and thrown her on it!

Now, Mistress Beauchamp, a wee word of advice: we all ken that ye are a braw and fearless lass who isn’t scairt to take a STAND but don’t bait the puir man in his present condition – battle causes Jamie to take his own kind of STAND! Ye ken? So, off they go…clip clop.

After nightfall, Claire yells “Help, he’s going over” and, having fainted, Jamie hits the ground with a mighty thud. Och, he is 6’4” and weighs 15 stone = 210 pounds!

“Help me lift him up!” and “Come on!” our bossy nurse orders the highlanders as they pull his head and shoulders onto a small hillock.

STOP – time for a teaching moment!

Not wanting to create my own stramash, but, writers of Starz episode 101, Sassenach, got this one wrong: no nurse worth her/his grit would ever order the head of a fainted patient to be lifted above the level of the heart! NO WAY! Why? Well, a person faints because blood pressure to the brain falls below the level required for consciousness. So, a competent practitioner either raises the feet or lowers the head or both! Gravity then helps move blood back into the brain and if all goes well, consciousness is restored.

Now, giving credit where credit is due, Herself got it right in Outlander book where Claire orders the lads to put a saddle bag under Jamie’s feet, thus aiding blood flow from the lower body towards the head.

Moving on: Claire pulls aside Jamie’s shirt and quickly diagnoses a nasty gunshot wound. Ew! The shot went cleanly through the trapezius muscle just above the collar bone (In Outlander book, a bayonet does the dastardly deed), but either way, enough loss of blood that our tapaidh (brave) hero faints.

Claire promptly blasts the men with a list of required medicaments to treat the nasty wound but they’ve got nuthin’ ‘cept a cache of beloved whisky – no problemo!

Here ye go!

Now, back at triage, our BAD, SASSY LASSIE breaks into a litany of cussing and swearing and telling the men where they can stick their 18^th century ideas (because, really, they’re no much help at all) and manages to even shock corn-grinding Uncle Dougal!

She none too gently rouses Jamie by pouring alcohol (yikes!) directly on his wound and then declares if he “so much as moves a muscle, she is going to bloody throttle him!”

Our Sassynach later asks Jamie. “Does it hurt now?” as she deliberately tugs the dressing to make damn well sure it does hurt. Learn this lesson, Jamie: when Nurse Claire is on duty, you will take care of that bloody dislocation!

“Aye” mutters Jamie, but he’s really thinking…

tcha, she’s a feisty lass wit’ a tongue like an adder..but verra bonny!

Now, just take a gander at the gleam in Jamie’s eyes during this whole scene! What was he thinking of this fierce feline? We learn in the Outlander book that he says to himself to himself says he:

“Jamie, lad, if her touch feels so bonny on your collarbone, imagine what it might feel the lower down…”

Trapezius: OK, the ball pierced the trapezius: what is the trapezius muscle and what is its purpose? The most superficial muscle of the back, each trapezius is large, flat, and shaped like a triangle with its base running from the back of the skull (green arrow in image D – left trapezius only) down the spine to the 12^th thoracic vertebrae (T12). The muscle fibers then converge at the shoulder where they attach to scapula and clavicle. Together with its pair of the opposite side, the trapezii (pl.) create a 4-sided figure, hence the name trapezius (Greek meaning four-sided).

Image D

When viewed from the front the trapezius also forms the slope from neck to acromion (shoulder point). The green arrow in Image E marks the spot where the musket ball traversed Jamie’s right trapezius!

Image E

Understand that the shoulder is not fully functional without an intact trapezius because this powerful muscle lifts, depresses (pull downwards), retracts (pulls back) and rotates the scapula. A warrior could not be a warrior without a working trapezius! This is why Claire is soooo anxious to treat the wound properly and restore the trapezius to good health (because she is a nurse after all and her patient’s wellbeing comes first – never ye mind that she’s feeling a good deal more than just wellbeing for Jamie). Something’s cooking and it isn’t haggis!

So, Claire administers a field dressing using slip strips (pretty much all western women wore them in the 40’s) and off they go, again! They barely arrive at Castle Leoch (Starz, episode 2) ere her bonny fingers are again managing Jamie’s bonny collar bone and trapezius!

But, she purposefully hurts Jamie a second time by pulling his bandage so tight he can scarcely breathe (did you hear the linen strain?). Oooh, Mistress Beachamp…did he get too close for comfort, saying you are a kind woman with a good touch and old Frank was one damn lucky man? Don’t want him making any attachments or asking too many questions, aye? Must stay focused on the patient’s wellbeing and all that blatty-blah!

Now, a note of praise to the details crew of Starz episode 2, Castle Leoch… take a wee peek at Jamie’s shoulder as Claire removes the blanket covering his back. The exit wound is evident on the back of shoulder along with whiplash scars, but did you notice the ecchymosis (purple, blue, green and yellow discoloration) over the shoulder region (blue arrows)? This is mostly due to the dislocation and is absolutely realistic! But, as both wounds tear blood vessels, blood seeps into the soft tissue under the skin with the resultant mottled bruising. Nice job, folks! You hare redeemed for the fainting faux pas <g>.

Lastly, I was delighted by Starz episode 7, The Wedding, where a faint scar from the gunshot wound can be seen just above Jamie’s right collar bone. Och! There goes MY blood pressure again!

Again, kudos to the detail people because most assuredly the scar should have been visible that soon after the injury.

End: Let’s end with a wee history lesson: do you know the University of Edinburgh, Scotland, produced many of the most famous physicians and anatomists of western medicine? One of the better known is John Hunter (1728-1793), who became personal surgeon to King George III.

As a physician, he also revolutionized the treatment of gun shot wounds and made major advancements in the field of OB-GYN, bone growth, etc. As an anatomist, he amassed a collection of over 14,000 anatomical specimens, now housed in the Hunterian Museum at the Royal college of Surgeons of England, London. One of the specimens includes the skeleton of a 7’ 7” Irish giant by the name of Charles Byrne, showing that Herself was not off the mark by imagining a bonny, 6’ 4” Jamie!

Now, fare-thee-well to all of you until my next lesson. Take care of your own bonny clavicles and trapezii muscles!

Like you, I am counting down the days: 165 days until Starz Episode 9! Hang in there friends of Outlander Anatomy! United we STAND!

The deeply grateful,

Outlander Anatomist

All photos are credited to Starz or Frank Netter’s Atlas of Human Anatomy, 4th edition, except Ferris Bueller…I don’t know who took that picture but credit goes to the photographer who did back in 2006.