Tag: Outlander episode 106

Posted on

Mini Anatomy Lesson: The Belly Wall

Anatomy Def: The belly wall is known by anatomists as the anterolateral abdominal wall (why use a simple word when a complex one will do?). 😉

Outlander Def: Claire’s Despair – Malva’s Mutilation! đŸ˜±

Before we begin this lesson, I have a true story to share
. In 2016, I asked Diana Gabaldon if nominative determinism was involved in her choice of Malva’s name because “mal” is the Latin word root meaning “evil” or “bad,” which clearly could apply here.

Why did I ask this? Think about it…. There’s mal-ware, mal-nutrition, mal-adapted, mal-content, mal-practice, mal-evolent, mal-odorous, and Mal-va! 😳

Diana answered, “No, I got it off a bottle of black malva shampoo!”

Haha. Love it! 😜

OK, anatomy students, let’s get on with our lesson.

Warning: The following images detail the final events of episode 606, “The World Turned Upside Down.” If you couldn’t watch this part of the episode, you might not want to read this lesson! 

Recap: Claire was in her surgery under the influence while someone “stomped through the nasties” with Malva. 

Never dreaming her beloved garden would be the site of a massacre, Claire spies Malva’s lifeless body, throat thoroughly mangled! 😯

Realizing her infant may still be alive, Claire springs into action, slicing open Malva’s gown with her garden knife.

Moving with speed and surety, Claire slices Malva’s belly wall vertically and to the left of her navel, a vertical cesarean section. 

Claire works ruthlessly with such intent and determination that Malva’s lifeless body shutters from her efforts.

Claire releases the infant from the womb and realizing its life is fleeting.  She performs mouth to mouth resuscitation and chest compression using two fingers. But, alas, her efforts fail.

Goodness, this is hard to review, even using still images.

After this episode was over, my husband, who is not a book reader, turned to me and asked, “Is that in the book?” ‘Yes,” I answered. He remarked, “That is going to be hard to explain.” 

He then added, “ Now, they have to figure out who murdered Malva.

”Who do you think it might be,” I asked. 

“Well, I would look to the brother, first,” he said.

Amazed, I asked “Why?” 

His answer: “Because in patriarchal systems, male relatives often kill women who bring shame upon their families.”  (See footnote at end of lesson) đŸ˜Č 

‘Nuff said!

With this horrific scene as backdrop, let’s talk anatomy of the belly wall.

Abdominal Wall: The abdominal wall is a cylindrical region of the body bounded above by costal cartilages, ribs, and sternum (xiphoid) and below by iliac and pubic bones (green area in image below). 

 

Anatomists typically divide the abdominal wall into anterolateral and posterior parts. The term, anterolateral, means the front (antero-) and sides (-lateral) of the wall. The term, posterior, refers to the back of the wall. 

These regions are best demonstrated in a cross-section (horizontal) through the torso. 

The figure below shows the two regions. The area bound by blue lines is the posterior abdominal wall. The remainder of the large pink oval is the anterolateral abdominal wall. (Psst
.Dinna fret about all the names. Will explain below). 

Anterolateral Abdominal Wall (AAW): Succinctly put, the anterolateral abdominal wall is the flexible and expandable part
. a.k.a., the belly. The posterior abdominal wall has limited flexibility and is unable to expand to any significant degree.

The main reason the AAW can expand is because it is made of soft tissue layers (no bones). The layers vary depending on the site. The following image is a cross-section of the AAW above the navel. 

The central area marked as linea alba is a vertical line of connective tissue that unites right and left halves of the AAW. It is a nearly bloodless line and therefore can be cut with little blood loss.

On either side of the linea alba are right and left rectus abdominis muscles. These run vertically. 

Using the image below, at the sides of the AAW, three layers of muscle appear, from outer to inner: 

    • external abdominal oblique (EAO)
    • internal abdominal oblique (IAO) 
    • transversus abdominis (TA). 

The following image shows the muscle pattern  from a frontal (anterior) view. Note the linea alba. Clearly, the belly wall enjoys a good deal of muscular support.

So, how thick is the AAW? Well, that depends on the individual. Moving to the next image, a magnified cross-section through the AAW, we find that the lateral AAW is composed of nine layers (three are muscle layers)! 

    • Skin
    • Fat layer (we accumulate varying amounts of fat in this layer)
    • Superficial fascia
    • EAO
    • IAO
    • TA
    • Transversalis fascia (connective tissue)
    • Extraperitoneal layer (more fat and connective tissue)
    • Peritoneum (membrane lining abdominal cavity

Nearer the midline,  AAW is composed of seven layers because it has only one muscle layer, the rectus abdominis. 

Either way, that is a LOT of layers!

Functions of the AAW: You might ask why is this part of the body designed to be flexible and expandable? Here are some reasons:

    • Maintains upright position
    • Moves the trunk (rotation, flexion, extension, bending sideways)
    • Protects abdominal viscera
    • Absorbs shock (remember BJR punching Claire in stomach in ep 106?)
    • Supports pregnancy
    • Increases intra-abdominal pressure (coughing, vomiting, childbirth, sneezing, defecation)

It is a darn good thing the AAW is flexible, especially for a pregnant woman. The next image shows a fetus during the third trimester. The uterine wall is labelled. The red arrow indicates the muscle layer of the AAW.

It as well as the other layers expand dramatically over the course of a pregnancy. The relatively slow growth of the fetus allows the belly wall to accommodate to the stretching, usually without tears, although these do occur (hernia).  This image is close to Malva’s condition when she was murdered.

So, there we have it in a nutshell, albeit a rather large one. We need an intact AAW to function well in our lives as it serves multiple purposes.

Learn more about the AAW in Anatomy Lesson #16, “The Abdomen.” There is much more to learn about this part of our anatomy – Lesson #16 explores this in greater depth. 

NOTE: The AAW is essentially the same in females and males except the groin region, there we find differences. Lesson #16 explains these.

FX: Now, how well did Starz FX do with Outlander 606? Pretty darn good if you ask me. Here are some examples:

    • As Claire begins her cut, there is a small stream of blood-tinged fluid which is consistent with the location of the cut, that is, very near the linea alba (see above). There would be little blood flow at this point as the cut is only through the belly wall. 
    • Malva’s navel does not look realistic because it appears largely normal. In late pregnancy, it usually pooches outwards due to increased intra-abdominal pressure.
    • The pink tissue underlying the skin is fat. It is a bit thick for Malva who is a trim young woman.
    • After Claire’s knife pierces the uterine wall and she removes the infant, the C-section now appears dark red because the uterus receives a huge blood supply during pregnancy. Well done. 
    • Malva’s infant is covered with blood-tinged material, the vernix, a waxy coating to protect the infant’s skin. Yay!
    • Malva’s belly is slightly concave after the infant was removed. Horrible, but accurate. 
    • Mouth-to-mouth on such a tiny person should be done with less force than Claire used – third trimester lung volume is calculated at less than 2 tablespoons per lung! This can accommodate a very tiny amount of air.
    • Claire doing two finger chest compression to stimulate the heart is spot on.

Yay, Outlander! Kudos to the FX folks!

Read about Claire’s emergency C-section in Diana’s sixth big book, “A Breath of Snow and Ashes!”

I smelled the blood and saw her in the same instant. She was lying in the salad bed, her skirt flown out like some gigantic, rusty flower blooming amid the young lettuces. 

I was kneeling by her, with no memory of reaching her, and the flesh of her arm was warm when I grasped her wrist—such small, fragile bones—but slack, there was no pulse—Of course not, said the cold small watcher inside, her throat is cut, there’s blood everywhere, but you can see the artery isn’t pumping; she’s dead. 

Malva’s gray eyes were open, blank with surprise, and her cap had fallen off. I clutched her wrist harder, as though I must be able to find the buried pulse, to find some trace of life 
 and did. The bulge of her belly moved, very slightly, and I dropped the flaccid arm at once and seized my knife, scrabbling for the hem of her skirt. 

I acted without thought, without fear, without doubt—there wasn’t anything but the knife and the pressure, the flesh parting and the faint possibility, the panic of absolute need


I slit the belly from navel to pubis, pushing hard through slack muscle, nicked the womb but no matter, cut quick but careful through the wall of the womb, dropped the knife, and thrust my hands into the depths of Malva Christie, still blood-warm, and seized the child, cupping, turning, wrenching hard in my frenzy to pull it free, bring it out from sure death, bring it into the air, help it breathe.
 Malva’s body flopped and heaved as I jerked, limp limbs flailing with the force of my yanking. 

It came free with the suddenness of birth, and I was swiping blood and mucus from the tiny sealed face, blowing into its lungs, gently, gently, you have to blow gently, the alveoli of the lungs are like cobwebs, so small, compressing its chest, no more than a hand’s span, two fingers pressing, no more, and felt the tiny spring of it, delicate as a watch spring, felt the movement, small squirms, a faint instinctive struggling—and felt it fade, that flicker, that tiny spark of life, cried out in anguish and clutched the tiny, doll-like body to my breast, still warm, still warm. 

“Don’t go,” I said, “don’t go, don’t go, please don’t go.” But the vibrancy faded, a small blue glow that seemed to light the palms of my hands for an instant, then dwindle like a candle flame, to the coal of a smoldering wick, to the faintest trace of brightness—then everything was dark. 

I was still sitting in the brilliant sun, crying and blood-soaked, the body of the little boy in my lap, the butchered corpse of my Malva beside me, when they found me.

Puir Claire! Puir Malva! Puir wee one!

See Claire as she realizes that all is lost. Mother and child are gone – grief, loss, and futility grip the Good Doctor.

The deeply grateful,

Outlander Anatomist

Follow me on:

Photo Credits: Starz; www.aafp.org; www.anatomyqa.com; www.kenhub.com; www.musculoskeletalkey.com; www.quora.com; www.stanfordchildrens.org

Footnote: In 2017, the United Nations Office on Drugs and Crime reported 87,000 killings of women worldwide – 58% were killed  by family members  or intimate partners! Alarming stats!

Posted on

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 tĂȘte-Ă -tĂȘte, 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! đŸ˜±

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

Follow me on:

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

Posted on

Anatomy Lesson #59: Claire the Knife!

“Claire the Knife” is not a usual anatomy lesson. Rather, let’s explore the many images of Claire with a honed edge either in her hands or directed at her person! Such images are taken from S1-S3 of Outlander. There are even more examples in Herself’s books that weren’t translated onto the screen. Please notify me if I miss any fine examples of “Claire the Knife!”  Let’s get started!

Early in Outlander episode 101, Sassenach, Claire accidentally encounters Frank’s ancestor, Captain Jonathan Wolverton Randall, Esq. From Outlander book:

“Who the bloody hell are you?” I demanded again. 


 He bowed sardonically, hand over his heart. “I am, madam, Jonathan Randall, Esquire, Captain of His Majesty’s Eighth Dragoons. At your service, madam.”

Not an officer-and-a-gentleman, she is soon backed against a stone ridge with his sword pressed to her lovely throat (Anatomy Lesson #12, Claire’s Neck or The Ivory Tower). 

Your honor, I submit, Exhibit #1! <g>

Then, in Outlander episode 104, The Gathering, Claire twice encounters a knife, once in her hand and once shoved into her beautiful face!

Swiftly gliding into Mrs. Fitz’s kitchen, Claire grabs for a butcher knife amid bins of potatoes (Hey, I thought Jenny introduces those to Scotland?), chicken and other delectables. She is gathering provisions for a furtive flight to the stones. Outlander book explains: 

During my hours helping in the kitchens and orchards, I had managed to stow away sufficient food to see me provided for several days, I thought
 I had stout boots and a warm cloak, courtesy of Colum. I would have a decent horse; on my afternoon visit to the stables, I had marked out the one I meant to take.

Her knife grab is thwarted by Ms. Fitz: 

“Claire! You aren’t wearing that to the ceremony, are ye lass?”

No, Mrs. Fitz, she’s not wearing that butcher knife! Hee, hee.

Later in evening as the entire ensemble is either oath-taking or stinking drunk, Claire sidles into the stables to steal away on Brimstone.

Oops! She steps on Jamie cocooned in hay (yay!).  Mistaking her as a threat, he threatens her with his dirk! (wink, wink) 

“Jesus H. Rosevelt Christ!” 

“No, sassenach, just me.” 

(We all ken he is divine, just not that kind of divine!)

From Outlander book: 

The obstruction rolled over with a startled oath and grasped me hard by the arms. I found myself held against the length of a sizable male body, with someone’s breath tickling my ear.

Then, Dougal and his band of merry men head off to collect taxes and conduct other clan “business” in  Outlander episode 105, Rent.  Dougal explains in Outlander book:

“Through the MacKenzie lands. Colum doesna travel, so visiting the tenants and tacksmen that canna come to the Gathering—that’s left to me. And to take care of the bits of business here and there.”

On the road, Claire witnesses “fowl” play by Dougal and his men. Declaring she will not eat yummy-looking birds she thinks were roasted by thieves, Claire quickly faces the point of Angus’ dirk.  Angus is having none of it that kind of name calling, especially from an English sassenach spy! Fortunately, Jamie talks him down and Claire flounces away with left eye intact. 

By episode’s end, Claire and Dougal are accosted by Lt. Jeremy Foster.

In Outlander episode 106, The Garrison Commander, both are delivered to the garrison at Brockton.  There, she enjoys a sumptuous meal (excepting the claret) with Brigadier General Lord Oliver Thomas, et al, until, horror of horrors, Captain Black Jack arrives. Thereafter, things take a distinctly downward turn! 

After aiding the amputation of a soldier’s arm, she returns to the dining room to find puir Corporal Hawkins performing ablutions on BJR! Claire recognizes the stropped blade as a family heirloom – the very one she used to shave first hubby, Frank.

If only, she held that blade to BJR’s neck – could have saved she and Jamie a world of hurt! Another blade – another time. From Outlander book: 

“Yes, I thought so. It had to be you, from MacKenzie’s description.” The door closed behind me, and I was alone with Captain Jonathan Randall of His Majesty’s Eighth Dragoons. He was dressed this time in a clean red-and-fawn uniform, with a lace-trimmed stock and a neatly curled and powdered wig.

But the face was the same—Frank’s face. My breath caught in my throat.

This time, though, I noticed the small lines of ruthlessness around his mouth, and the touch of arrogance in the set of his shoulders. Still, he smiled affably enough, and invited me to sit down.

Escaping BJR’s clutches, Dougal stops off at St. Ninian’s spring for a wee nip of sulfurous water. Known in the highlands as a liar’s spring, he waits to see if the magical waters will burn Claire’s gullet (Anatomy Lesson #45, Tremendous Tube – GI System, Part 2)!  He draws a dirk to finish her off should massive heartburn set in. From Outlander book: 

“No!” Something occurred to me. “So at least you believe me when I say I’m not an English spy?”

“I do now.” He spoke with some emphasis. 


“St. Ninian’s spring.


They call it the liar’s spring, as well. The water smells o’ the fumes of hell. Anyone who drinks the water and then tells untruth will ha’ the gizzard burnt out of him.”

Fast forward one episode, Dougal finally gets his wish as his dirk bites into Claire’s wrist!

Blood vow at a wedding she never sought, but well worth the scar!

Ye are Blood of my Blood, and Bone of my Bone. 

I give ye my Body, that we Two might be One.

I give ye my Spirit, ’til our Life shall be Done.

Outlander Episode 108, Both Sides Now: Still on rent-collection duty, the MacKenzie band is raided by Clan Grant! Rent, horses, food, what-have-you, everything is fair game. In the aftermath, Jamie is scolded for giving his wife a dirk for protection but not teaching her how to use one. Time for Claire to get a knife-life lesson. Ned Gowan extracts a small sgian dubh drawn from a more private part of his, ahem, breeks. So, she takes a knife-wielding lesson from TV Angus/book Rupert. Willie is the sacrificial lamb: 

He poked a blunt forefinger under the lower rib on the right, 
 “This is the spot in back—either side. See, wi’ all the ribs and such, ’tis verra difficult to hit anythin’ vital when ye stab in the back. If ye can slip the knife between the ribs, that’s one thing, but that’s harder to do than ye might think. But here, under the last rib, ye stab upward into the kidney. Get him straight up, and hell drop like a stone.” 

Fab advice as hours later, Jamie and Claire slip into the heather for a quick tryst, soon to be disturbed by two Redcoat deserters (coitus interruptus –  snort!). Thwarting her assaulter, Claire thrusts the sgian dubh – into the spot – as she was taught. The lass learned her lesson well!

Then, comes Outlander episode 109, The Reckoning: Captured by the Redcoats, assaulted (again) by BJR, rescued and then skelped by her second husband, they seek their way back to each other. As an act of penance, Jamie swears fealty to Claire, this time the dirk is pressed against his bosom (Outlander book):

I swear on the cross of my Lord Jesus, and by the holy iron which I hold, that I give ye my fealty and pledge ye my loyalty. If ever my hand is raised against you in rebellion or in anger, then I ask that this holy iron may pierce my heart.

And, they are off to the races! Oops – not so fast, my lad. In the midst of “reconciliation,” Claire threatens Jamie’s chin with his dirk (Anatomy Lesson #26, Jamie’s Chin – Manly Mentus).

“If,” I said through my teeth, “you ever raise a hand to me again, James Fraser, I’ll cut out your heart and fry it for breakfast!” 

Och! Parritch sounds much, much bettah!

Then, things quiet down for a bit and we see little of “Claire the Knife.” That is, until BJR gets his hands on Jamie. He has coveted the lad since the first flogging. After Murtagh scraps what is left of Jamie off the dungeon stones, they flee Wentworth, returning Jamie to his lawful wife.  There she mends his mangled hand, courtesy of BJR and giant Marley.

Blades again, this time in the form of scissors, clip sutures used to mend his broken skin (Outlander ep 116, To Ransom a Man’s Soul).

Up pops Season 2. Claire, being pregnant with Faith, isn’t into knife heroics.  An exception is her work at the Paris charity hospital, L’Hîpital des Anges. There, the scalpel blade slips nicely into her hands. Consider a workman’s festered wound due to an embedded splinter. She opens the wound and removes the offending object (Outlander episode 203, Useful Occupations and Deceptions). That knife has a life of its own!

Fast forward to Outlander episode 213, Dragonfly in Amber, wherein Jamie and Claire find themselves mired in a desperate struggle with Dougal – sly Uncle is intent on killing the sassenach witch!

He should have known that Jamie would protect her with name, clan and body!  But, neither reason, threat, nor cajoling stops Dougal’s advance. A blade to the chest is the only remedy  – in which Claire takes an equal hand – she finishes what Jamie cannot do alone!

Then, comes season 3. The next time a knife creeps into Claire’s hand, it is at the teaching theater awaiting her first anatomy class as a medical student (yay!). Arriving early, she feels the heft of the professor’s scalpel and is pleased with the heft; it fits well in her surgeon-to-be hand (Outlander episode 302, Surrender). 

Following the swiftest medical education ever, Claire is soon a practicing surgeon, clipping “necrotic” tissue from a patient’s abdomen (Outlander ep 305, Whisky and Freedom). Time and training has given Claire the license to legally cut another human. Such is her special calling and she fulfills it with grace and skill. Snip, snip. (Pssst
 necrotic tissue isn’t pinkish-red in color, but don’t tell anyone.)

Next thing we know, Claire has donned a bat suit and gone back through the stones to seek A. Malcolm of Edinburgh (Outlander ep 307, Creme de Menthe). Confronting an exciseman in nothing but her shift and a hidden knife, Claire stabs his leg. Have knife – will travel!! He falls, striking his head on the hearth.  

Jamie arrives and what to his wondering eyes should appear, but a dying man – oh such is his fear!

Sassenach, what the devil happened????

I step away to do a little smuggling and return to find my wife with her knife and a dying man!!!

Still counting? Trying to save the life of the SOB (she’s a doctor!), Claire sends for a trephine from the local barber surgeon. She opens her medical kit, retrieving her trusty-not-rusty scalpel. Yes!

She makes a swift cut through the scalp – a space is opened through which the trepanning instrument is inserted. Then, she starts drilling for oil.  Not really, she drills to relieve pressure from an epidural bleed. 

Hang on, Snoopy, hang on – we’re almost finished! Then, in episode 308, First Wife, Claire uses her magic scalpel to open a nick near Jamie’s left oxter (Anatomy Lesson #4, Jamie’s Chest” or “the 8th Wonder of the World!). Her goal is to retrieve bits of lead discharged from Laoghaire’s fowling piece. She grasps and retrieve the bits leaving Jamie’s axillary/brachial artery intact (Anatomy Lesson #56: Achy Brachial Artery)! She is super good with a knife!  

The last time we see Claire wield a blade in TV Outlander, she confronts the Bakra (Outlander episode 313, Eye of the Storm)! Picking up a machete (ax in Voyager book), she screams and advances on Geillis Abernathy! She must prevent the witch from her fulfilling her plan to kill young Ian and pass through the time portal to slay Bree. 

Whack! Claire’s blade finds its mark and the wicked witch lies deid! Graphically explained in Voyager book:

Reflections of the fire burned red in the pupils of her eyes. The red thing, Jamie had called it. I gave myself to it, he had said. 

I didn’t need to give myself; it had taken me.

After fleeing Abandawe cave with Ian and Jamie, Claire trembles in the jungle with gore dropping from the machete. 

It is then she realizes, the 200+ y.o. bones she examined in Boston with Dr. Joe Abernathy (Outlander ep 305, Whisky and Freedom) belonged to none other than Geillis Abernathy!  And, Claire herself, ushered in that well-earned fate! Like I said, Claire the Knife!

To summarize, over many episodes, Claire is at one end or the other of a blade; always has been – always will be. <G>

Bobby Darren sang the hit, “Mack the Knife.” I re-imagine it as, “Claire the Knife:”

Oh, the shark, babe, has such teeth, dear

And it shows them pearly white

Just a jackknife is Miss Claire, babe

And she keeps it, ah, out of sight.

Dinna mess with the Sassenach Surgeon!

The deeply grateful,

Outlander Anatomist

Follow me on:

Photo Creds: Starz, Outlander episodes 101, 104, 105, 106, 107, 108, 109, 116, 203, 213, 302, 305, 307, 308, 313