Tag: Outlander episode 401

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Anatomy Lesson Outlander Trauma-Drama, Part 2

Hey, all.

Hope you had a grand couple of weeks awaiting part two of Outlander Trauma-Drama… Here it is. Yay! 🤗

Our last Anatomy Lesson, Outlander Trauma-Drama, Part 1, showed the system pathologists use to classify trauma. In that lesson, we covered different types of mechanical trauma including contusion, abrasion, laceration, incision, avulsion, projectile injury, and puncture wounds.

Remember? Yasss! 😊

    • Mechanical trauma
      • Contusion
      • Abrasion
      • Laceration
      • Incision
      • Avulsion
      • Projectile injuries
      • Puncture wounds
    • Thermal Injury
    • Radiation Injury
    • Personal Exposure (tobacco and alcohol)
    • Therapeutic Drugs
    • Air Pollution
    • Industrial Exposures
    • Agricultural Hazards
    • Natural Toxins
    • Oxygen Deprivation
    • Infectious Agents
    • Immunological Diseases
    • Genetic Derangements
    • Nutritional Diseases

Today’s lesson continues with the trauma-drama theme ‘cos there are still loads of Outlander owies to uncover and discover!

Again, examples from Diana’s big books and the Starz Outlander series will serve as anatomical models for the injuries. 👍🏻

Today’s lesson will cover thermal injury and alcohol abuse. So, let’s get started!

There are six types of Thermal Injury:

    • Thermal burns
    • Hyperthermia
    • Chilblains
    • Hypothermia
    • Frostbite
    • Electrical injury

Here we go!

Thermal Burns: Thermal burns are caused by harmful exposure to heat, electricity, chemicals, or radiation.

Thermal burns are usually classified as first, second, or third degree burns. Occasionally, we hear of fourth degree burns, but do you ken there are also fifth and sixth degrees? Indeed there are! 🤓

Some students may have read Anatomy Lesson #5 and Anatomy Lesson #6 wherein we learned that skin is composed of epidermis (surface layer of skin cells) and dermis (underlying connective tissue). Thus, another useful way of grading thermal burns is to describe their relative depths.

Partial-thickness Burn: This type damages the epidermis or both the epidermis and outer dermis; it includes first and second degree burns. Such burns are red and may blister and are very painful. Most partial-thickness burns heal without scarring because hair follicle cells regenerate to cover the damaged surface. Even here, if a partial-thickness burn is too large, a skin graft may be required.

Full-thickness Burns: Full-thickness burns extend through both epidermis and  dermis and into underlying tissues. Such wounds are typically aesthetic (painless) because nerve endings are destroyed, although the rim of such a burn is usually painful. Full-thickness burns include third, fourth, fifth and sixth degree burns which may pass into muscle and bone. Fifth and Sixth degree burns are typically fatal.

We can imagine fifth and sixth degree burns suffered by poor Father Alexandre and Johiehon, his love interest in Outlander episode 412, Man of Worth.

Diana’s fourth big book, Drums of Autumn details the sad and horrific conflagration as the lovers burned to ash.

When the Indians had nearly finished with the priest, they untied him from the stake and fastened his hands instead to a long pole, held above his head, from which to suspend him in the flames….

… It was then that he had seen the Indian girl standing on Claire’s other side, with a cradleboard in her arms. … “She didna look to left or right, but walked straight into the fire.” … The flames had embraced the girl in moments. 

… “Her clothes caught, and then her hair. By the time she reached him, she was burning like a torch.” Still, he had seen the dark silhouette of her arms, raised to embrace the empty body of the priest. Within moments, it was no longer possible to distinguish man or woman; there was only the one figure, black amid the towering flames.

…The smell of burnt things hung in the air. We passed close by the pit and I couldn’t help seeing from the corner of my eye the heap of charred fragments, shattered ends frosted white with ash.

Hyperthermia: Hyperthermia  occurs if body temperature rises significantly above normal (>104 °F / 40 °C ). Many challenges, including infections, cause excessive body temperature.

Typhoid fever,  a.k.a. enteric fever, is caused by food and water contaminated with salmonella bacteria. Symptoms include:

    • High fever
    • Headache
    • Stomach pain
    • Constipation or diarrhea

A great example of hyperthermia appears in Outlander episode 310, Heaven and Earth. You remember Claire’s splendid  wee aide, Elias, who falls ill with typhoid? Claire is comforts him as he bravely succumbs to fever and dehydration. 😭

Cold temperatures 🥶 also cause thermal injury because the human body is poorly equipped to regulate and prevent heat loss; this is especially true of children and the elderly. Normally, fat deposits, heart, blood vessels, brain, skin, and muscles help combat cold. These organs provide insulation, induce shivering, re-direct blood flow from skin to vital organs, and reduce energy consumption.

However, exposure to cold temperatures over long periods of time overcomes our coping mechanisms and produces a range of thermal cold injuries such as chilblains, hypothermia, and frostbite.

Chilblains: Chilblains is a 16th century term for skin trauma due to repeated expose to cold, but not freezing, air. Digits are most commonly affected. The skin becomes red, swollen ,and itchy (next image), but usually heals without permanent damage.

Outlander TV episodes do not feature chilblains. But have no fear, our amazingly witty and resourceful Diana writes about it in her second book, Dragonfly in Amber, wherein Claire treats imprisoned men with chilblains.

She’s a wonder! Which “she” do I mean? Take your pick – either woman works!

I talked my way into the cells of the prison, and spent some time in treating the prisoners’ ailments, ranging from scurvy and the more generalized malnutrition common in winter, to chafing sores, chilblains, arthritis, and a variety of respiratory ailments.

Ouch, that looks a wee bit uncomfortable!

Hypothermia: Hypothermia occurs when the body’s core temperature drops below 95°F / 35°C as a result of extended cold exposure. Symptoms include low core temperature, vigorous shivering, confusion, sleepiness, slurred speech, shallow breathing, weak pulse, low blood pressure, changes in behavior, and slowed reactions.

Put simply, the victim of hypothermia experiences  the “umbles” meaning grumbles, mumbles, stumbles and fumbles because cold affects muscle and nerve response.

If the core temperature drops to 90º F / 32.2º C, then bradycardia (slow heart rate) and atrial fibrillation (fast and irregular contraction of the heart’s two upper chambers) may ensue.

The teenager, bad-lass Laoghaire, wasn’t suffering from hypothermia when she exposed her “ladies” to Jamie  in Outlander episode 109, The Reckoning, but she was well on her way!

Take a keek at that goose flesh! 😉

Frostbite: Frostbite is cold injury in which the body’s surface is exposed to freezing temperatures; it affects mostly feet, hands, noses, cheeks, and ears. And, as Prince Harry points out in his tell-all book, “Spare,” the todger must be protected from frostbite. This makes sense since it is also an appendage. 😉

Frostbite occurs in three stages:

    • Frostnip: Frostnip is a mild form of frostbite. Continued cold exposure leads to numbness in the affected area. As the skin warms, the sufferer feels pain and tingling but no permanent skin damage.
    • Superficial Frostbite: Superficial frostbite causes slight changes in skin color. The skin may begin to feel warm — a sign of serious skin damage. Rewarming at this stage causes the skin to appear mottled. The victim may notice stinging, burning and swelling. Fluid-filled blisters may appear over the next 12 to 36 hours (next image).
    • Deep Frostbite. As frostbite progresses, it affects all layers of the skin and underlying tissues. The skin turns white or blue-gray; all sensation of cold, pain, or discomfort is lost in the affected area. Joints or muscles may stop working. Large blisters form 24 to 48 hours after rewarming. The tissue turns black and hardens as it dies. Amputation is usually warranted.

Claire teasingly relates how she and Jamie avoid getting frostbite in this steamy tidbit from Drums of Autumn.

His mouth was warm and soft, and whether he approved of what he was doing or not, he did it awfully well.

…“Ooooh,” I said, and shuddered ecstatically as his teeth sank delicately into my earlobe.

….“Oh, well, if it’s like that,” he said in resignation, and taking my hand, pressed it firmly between his thighs.

..“Gracious,” I said. “And here I thought the cold …”

…“It’ll be warm enough soon,” he assured me. “Get them off, aye?”

…It was rather awkward, given the cramped quarters, the difficulty of staying covered in order not to suffer frostbite in any exposed portions, and the fact that Jamie was able to lend only the most basic assistance, but we managed quite satisfactorily nonetheless. 😅

Electrical Injury: What is this? Electrical injury is damage to the skin or internal organs after a person comes into direct contact with a high-voltage source. An electric shock can be life-threatening.

Good advice: Get emergency help if the source of the injury is a high-voltage wire or lightning. Even those with minor injuries or no symptoms should be checked by a physician for internal injuries because these may not be evident to the non-professional.

Rare but life-threatening symptoms include severe burns, muscle pain and contractions, seizures, and unconsciousness. In some cases, heartbeat and breathing may be difficult to detect.

In the US, there are approximately 1000 deaths per year, as a result of electrical injuries. Of these, approximately 400 are high-voltage electrical injuries and lightning causes 50 to 300. There are also at least 30,000 shock incidents per year that are non-fatal.

If you think these stats are grim, consider the UK: Faulty electrical equipment and sockets cause approximately 70 deaths and 350,000 injuries in UK homes every year (RHA, 2022). Such figures show how important it is to follow electrical safety guidelines.

Outlander book and TV don’t really contain much about electrical injury. the closest I can come is Claire’s eerie encounter with Otter-Tooth’s ghost in Outlander episode 403, The False Bride. Here, she experiences the aftermath of a lightning strike.

Diana describes the scene in vivid detail. Again, from Drums of Autumn:

Sheet lightning shimmered far away, across the mountains. Then more bolts, sizzling across the sky, each succeeded by a louder roll of thunder. The hailstorm passed, and the rain resumed, pelting down as hard as ever. The valley below disappeared in cloud and mist, but the lightning lit the stark mountain ridges like bones on an X ray.

I woke all the way to the smell of burning, and sat bolt upright. The rain had stopped; it was the silence that wakened me, I thought. The smell of smoke was still strong in my nostrils…

…The ground rose in front of me to a small ridge. At the top of this stood a large balsam poplar tree, the source of the smoke. The tree had been struck by lightning; half of it still bore green leaves, the canopy bushy against the pale sky. The other half was blackened and charred all down one side of the massive trunk. Wisps of white smoke rose from it like ghosts escaping an enchanter’s bondage, and red lines of fire showed fleetingly, glowing beneath the blackened shell.

Echoes of the shock of impact wavered through my flesh, and I tried frantically to fit myself back into my body. Then I drew breath, a painful gasp, and found myself shaking, the shock turning to the first intimations of damage. I lay still, eyes closed, concentrating on breathing, conducting an inventory. 

…The rain was still pounding down onto my face, puddling in my eye sockets and running down into my ears. My face and hands were numb. My arms moved. I could breathe a little easier now.

Drenched in cold, relentless rain, Claire spies the spooky ghost of Otter-tooth. Careful, lest you get hyperthermic, Claire!

And, there he is. Sharp as an Otter’s Tooth!

That is it for thermal injury. But….

Here’s some exciting thermal news: The US Department of Energy is developing clothes with thermal properties that adapt to the environment and to the wearer’s body. By changing the make-up or shuttling heat to and from the body, the garments can keep people comfortable whatever the external temperature (30 January 2016, New Scientist). I’m ready for one of these jackets, how about you?

Onward! 

Alcohol: Alcohol is a colorless, volatile, and flammable liquid that is the intoxicating element of wine, beer, and other spirits (duh!); it is also used as a fuel and is an industrial solvent! 😮

How the body handles alcohol: The stomach lining contains alcohol dehydrogenase (ADH), an enzyme which metabolizes alcohol. The liver also has ADH plus other enzymes that help break down alcohol. But, bad news for the lassies: Women naturally have lower levels of GAD than men and often develop higher blood alcohol levels after drinking the same or even less alcohol. So, be wary if ye are an XX!

Claire offers a pithy analysis of alcohol in this quote from the big book, “Drums of Autumn,“wherein Jamie gets John Quincy Myers drunk in preparation for his hernia surgery.  (Psst…Non-book readers ken Claire performed this surgery on Edmond Fanning in episode 408, Wilmington.)

“Alcohol isn’t a good anesthetic at all,” I said, shaking my head. “It’s a poison. It depresses the central nervous system. Put the shock of operating on top of alcohol intoxication, and it could kill him, easily.”

And, there we have it in a nutshell!

Not surprisingly, alcohol is the most widely used and abused toxic agent in the world. (Not meaning to preach as I enjoy a wee bit now and then)

Alcohol injury ranges from binge drinking to full on alcoholism with a myriad of accompanying ailments. Most of us are well-versed on the effects of excessive alcohol intake and realize some effects are acute and others are chronic.

Acute Alcohol Intoxication: In the US, there are over 3,000,000 reported cases of acute alcohol intoxication (AAI) from drinking too much, too quickly. Symptoms include slurred speech, incoordination, mood and behavioral changes, and poor judgement. Acute alcohol intake effects breathing, heart rate, body temperature, gag reflex, and can lead to coma and death. (psst… I wager many more cases go unreported) 🫢

Risk factors include:

      • Injuries, such as motor vehicle crashes, falls, drownings, and burns.
      • Violence, including homicide, suicide, sexual assault, and intimate partner violence.
      • Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
      • Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
      • Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.
Alcohol intoxication is managed with rest, hydration, and abstaining from alcohol. It is worth noting that severe cases may require hospitalization, intravenous fluids, observation, and supportive care.

Oh, Jamie is in the throes of AAI at Lallybroch (episode 112, Lallybroch). He is stinking drunk as he stumbles into the bedchamber reeking of booze; Claire is not “amoozed.” 

But, he looks marvelous in his da’s splendid leather coat! 😜 

Chronic Alcohol Use: Alcohol Dependence Syndrome (ADS or alcoholism) is a condition characterized by long-term alcohol dependence and alcohol abuse that result in specific physiological and behavioral problems. ADS  includes ten or more different signs and symptoms, but from a medical standpoint, only two are required for diagnosis. Chronic use causes a host of problems, including:
    • High blood pressure, heart disease, stroke, liver disease, and digestive problems.
    • Cancer of the breast, mouth, throat, esophagus, larynx, liver, colon, and rectum.
    • Weakening of the immune system, increasing the chances of illness.
    • Learning and memory problems, including dementia and poor school performance.
    • Mental health problems, including anxiety and depression.
    • Social problems, including family problems, job-related problems, and unemployment.
    • Alcohol use disorders, or alcohol dependence

In season six of Outlander, we witness Fergus falling into ADS as he struggles with the cruelty and intolerance toward his dwarf son (episode 603, Temperance).  Alcohol  is commonly used to cope with personal tragedy and trauma.

You remember Colum MacKenzie back in Outlander, seasons 1 and 2?  Yes, of course ye do! 😊 Claire diagnosed Colum as a sufferer of  Toulouse-Lautrec Syndrome, also known as pycnodysostosis. 

Colum required large quantities of rhenish wine (9% alcohol content) to quell and dispel the agony of his existence (Outlander episode 102, Castle Leoch). 

…  “I beg your pardon?” I turned, having missed Colum’s words in the growing noise, to find him offering me the decanter, a lovely bell-shaped thing of pale green crystal.

The liquid within, seen through the glass, seemed green as the sea-depths, but once poured out it proved to be a beautiful pale-rose color, with the most delicious bouquet. The taste was fully up to the promise, and I closed my eyes in bliss, letting the wine fumes tickle the back of my palate before reluctantly allowing each sip of nectar to trickle down my throat.

“Good, isn’t it?” The deep voice held a note of amusement, and I opened my eyes to find Colum smiling at me in approval. I opened my mouth to reply, and found that the smooth delicacy of the taste was deceptive; the wine was strong enough to cause a mild paralysis of the vocal cords.

“Won—wonderful,” I managed to get out. Colum nodded.

“Aye, that it is. Rhenish, ye know. …”

Clearly, Colum suffered from his genetic disability but also from ADS . Near the end, when rhenish no long offered the needed relief, he turned to Claire to assist him in end of life options (Outlander episode 210 Prestonpans).

ADS is considered a medical emergency because it can lead to coma and death. Guidelines exist about the amount of alcohol the liver can metabolize per hour and these rates should not be exceeded. Again, please get informed if this is an issue in your life.

As a final example, we see wee Flora MacDonald taking a wee nip from her personal hip flask in Outlander, episode 605, Give Me Liberty!  Now, just because she carries a personal flask, it doesn’t mean she is suffering from either acute or chronic alcohol poisoning! 😉

Finally, this is an interesting tidbit. Some people carry a gene variant encoded for alcohol dehydrogenase (ALDH2*2) that stops the enzyme working, so these folks experience flushing soon after drinking. This happens because they have a lowered ability to metabolize alcohol and includes some 8% of the world’s population. Now, a link has been found showing that this gene raises heart disease risk in those who experience alcohol flush (New Scientist, 4 Feb. 2023). The risk of heart disease is four times greater in regular drinkers with the defective gene! if you flush immediately after alcohol ingestion, you may wish to consult your physician?

OK, that is our lesson for today. But before we call it quits let’s have a –

Pop Quiz! 

Name the injury (red arrow) Jamie sports after the Battle of Alamance, in Outlander episode 507, The Ballad of Roger Mac.

What was that you said?

An abrasion?  🚫

A laceration? 🚫🚫

An avulsion? 🚫🚫🚫

What was that you said?

 

 

A contusion? Yep!

Well done, anatomy students! 👏🏻👏🏻👏🏻

Next time, Part 3!

The deeply grateful,

Outlander Anatomist

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Photo creds: Sony/Starz, www.en.wikipedia, www.britannica.com

 

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Cape Fear River Basin and Alamance Battleground!

Hello, Outlander fans!

Season 5 blasts off in one month. I can scarcely wait! You? 🤗

Today, I post about my recent trip to  North Carolina, the US state that is integral to the Outlander saga beginning with Season 4 and beyond.

Now, please dinna run away. This is truly interesting stuff!

I visited several sites that appear in the fifth big book, The Fiery Cross (TFC), the source for Outlander, Season 5.

You will remember at the end of Voyager book and S3, Jamie and Claire survived a hurricane to land in the Colony of Georgia.

Mrs. Olivier smiled indulgently. “You are not on an island at all. You are on the mainland; in the Colony of Georgia.”

“Georgia,” Jamie said. “America?” He sounded slightly stunned, and no wonder. We had been blown at least six hundred miles by the storm.

“America,” I said softly. “The New World.”

At the beginning of  Drums of Autumn book, Jamie.com find themselves in Charleston, SC, and then they travel north to Wilmington. But, season four left out that bit of travelogue and opens in Wilmington, NC.

This quote from Drums of Autumn explains:

Out of the sun, with a large pewter mug of dark ale foaming gently in front of him, Jamie quickly regained his normal self-possession.

“We’ve the two choices,” he said, brushing back the sweat-soaked hair from his temples. “We can stay in Charleston long enough to maybe find a buyer for one of the stones, and perhaps book passage for Ian to Scotland on another ship. Or we can make our way north to Cape Fear, and maybe find a ship for him out of Wilmington or New Bern.”

I really wanted to see Wilmington for myself. So, hounding my son to drive me three hours to Wilmington was a must!

Yes, Wilmington, where Hayes met his sad fate at the end of a hangman’s noose!

Yes, Wilmington, where Brianna was handfast to Roger, on the most magical night of her young life.

Yes, Wilmington, where Brianna paid a horrific price for her mother’s iconic wedding ring, forged from the key to Lallybroch.

Why is Wilmington important beyond the Outlander story? When the Carolina region was divided in 1712, the line between North and South Carolina was established to ensure North Carolina received its own seaport, Wilmington.

Today, Wilmington is a lovely old city, a blend of modern and old including many beautiful homes boasting historic markers.

Wilmington straddles the Cape Fear River, which I filmed from the aft deck of the battleship USS North Carolina, as it (not the battleship 😉) flows toward the Atlantic Ocean. The battleship is permanently moored on this river!

I strolled along the Wilmington Riverwalk, a shop- and eatery-lined pathway following the river.

At Wilmington, the 200-mile-long Cape Fear River is large enough to accommodate sea-faring vessels, cargo crates and tugboats, as is befitting a true seaport. 

The Cape Fear River collects water from streams and rivers of the Cape Fear Water Basin, a 9,000+ sq. mi. area stretching beyond Greensboro, the city I just left!

Water from this massive land area drains into the Cape Fear River, ultimately flowing past Wilmington and into the Atlantic a few miles downstream.

Do you see Fayetteville, NC, on the map below? It sits on the Cape Fear River but further inland than Wilmington.

Fun Fact: Did you know Fayetteville started life in 1756 as Cross Creek, the settlement nearest to Aunt Jocasta’s River Run plantation. Truth! 

During the American Revolution, Cross Creek was a hotbed of wartime activity and home of divided loyalties, many of those conflicts involved Highland Scots! Its name was changed to Fayetteville in 1783.

Lastly,  Cape Fear, might sound familiar to you because Martin Scorsese’s 1991 film of the same name was situated in this region. Cape Fear is a prominent headland jutting into the Atlantic Ocean at the mouth of the Cape Fear River.

Aunt Jocasta’s splendid River Run plantation near Cross Creek (Fayetteville), most likely sat in the Cape Fear River Basin.

Moving on.

A couple of days later, my dear son drove me to the Alamance Battlefield. The Battle of Alamance was the final conflict in the War of Regulation, a rebellion in North Carolina over issues of taxation and control. Some historians and locals consider the Battle to be the opening salvo of the Revolutionary War!

The battleground is a beautiful, serene wooded site bordered by zigzagged split rail fencing and a few miles outside Greensboro .

The woods are quiet now but on May 16,  1771, the countryside rang with shots and shouts from Regulators and Tryon’s militia.

The  image below shows where the Regulators held ground on the rise in the background. Tryon’s forces would have been about six miles in the opposite direction across Great Alamance Creek.

As faithfully recorded in TFC, Herman (Harmon/Hermon) Husband was a leader in the rebellion who left the battlefield early.

I wondered what brought Hermon Husband here—and whether he was being followed. He owned a farm and a small mill, both at least two days’ ride from the Ridge; not a journey he would undertake simply for the pleasure of our company. 

Husband was one of the leaders of the Regulation, and had been jailed more than once for the rabble-rousing pamphlets he printed and distributed. The most recent news I had heard of him was that he had been read out of the local Quaker meeting, the Friends taking a dim view of his activities, which they regarded as incitement to violence. I rather thought they had a point, judging from the pamphlets I’d read.

Now one bit of history…. militia men did not wear uniforms; these were ordinary citizens on both sides of the conflict. We have all seen and speculated about Jamie Fraser appear in a redcoat in Outlander Season 5 footage.  So why is he wearing that redcoat? Time will tell, but I wager it has to do with advancing the story at the expense of historical accuracy. 😉

Psst… whatever the reason, he looks mighty fine!

Spoiler! The battle was fairly brief and the loss of life modest given that Tryon had 1,000 militiamen and the Regulators, 2000.  Tryon captured 13 Regulators: one was executed at camp and six were executed later in nearby Hillsborough. Hanging was the method of the day.

This bit of history is pertinent to Season 5, so ‘nuf said! 😉 😉

What a trip!

Thank y ou for joining me on my whirlwind tour of book 5 (excepting Fraser’s Ridge, an area I explored in 2015).  This trip, I visited Wilmington, where Bree was handfast to Roger and assaulted by the dread pirate, Steven Bonnet! I walked the Cape Fear River into which most rivers and streams of the Cape Fear Water Shed drain and home to Cross Creek and River Run. And, I visited the Alamance Battlefield, the site where Regulators clashed with Governor Tryon’s militia.

As always, I am deeply grateful. Yay!

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz, Wikipedia, Outlander Anatomy, Wilmington-nc.com, nchistory.WordPress.com

 

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Anatomy Lesson #65: Anatomy of a Hanging

Greetings anatomy students! Hanging is a ghastly topic, but it has a substantial presence in Outlander and is pertinent to anatomy. So, here we go!

The Oxford Dictionary defines hanging as “specifically to put to death by suspension by the neck.” But, in the past, hanging also meant death by crucifixion or impalement! 

An interesting fact…. The appropriate terminology is the person was hanged, not the person was hung.

Outlander’s first traditional hanging appeared in episode 115, Wentworth Prison; crusty Taran MacQuarrie of the Watch and Jamie Fraser face their ends with stirring gallows’ humor: Jamie is afraid “My wife will never forgive me for getting myself foolishly hung!” Hanged,  Jamie…. the word is hanged!

But, Taran aways knew he was fated to die at the end of a rope – his name is read next.

Jamie’s turn! Scribe, Liam McCallum, recorded Jamie as guilty of “a very extraordinary and abominable crime and most atrocious injury against us!” Snort!

Jamie struggles, but is subdued and resigns himself to this ignoble fate. Such an unworthy end for Laird Broch Tuarach!

Then one of Lucifer’s avenging angels swoops in to spare Jamie for a different fate! But, this outcome awaits another lesson. 

No further traditional  hangings, until season four. Episode 401, America the Beautiful, starts off with a bang… Well, with a hangman’s noose, truth be told.

In a drunken state, Gavin Hayes lay with a marrit woman (psst…Jamie warned him!). When the outraged hubby came at him with a pitchfork, Gavin kicked him down the stairs and now, the hangman’s noose awaits. He should have listened to Mac Dubh! (In Drums of Autumn book, Gavin was guilty of stealing six pounds, ten shillings).

Hayes asks Jamie for two favors: 

#1. Whisky! 

Herself described in Drums of Autumn:

“It was what he asked of me,” he said. “And the best I could manage for him.” 

“Brandy or whisky?” asked Fergus, evaluating Hayes’ appearance with a practiced eye. 

“The man’s a Scot, wee Fergus.” Jamie’s voice was as calm as his face, but I heard the small note of strain in it. “Whisky’s what he wanted.” 

“A wise choice. With luck, he won’t even notice when they hang him,” Fergus muttered

#2. May his last sight be the face of a friend.

Again, from Drums of Autumn: 

If Hayes was still sober enough to see anything, the last thing he saw on earth would be the face of a friend. 

He could see; Hayes glared to and fro as they lifted him into the cart, twisting his neck, desperately looking. 

“Gabhainn! A charaid!” Jamie shouted suddenly. Hayes’ eyes found him at once, and he ceased struggling.

Jamie musters a wan smile for his auld friend and fellow Ardsmuir prisoner.

Drums of Autumn quote continues:

The captain of the guard stood poised, saber raised. 

Suddenly, the condemned man drew himself up straight. Eyes on Jamie, he opened his mouth, as though to speak. 

The saber flashed in the morning sun, and the drums stopped, with a final thunk! I looked at Jamie; he was white to the lips, eyes fixed wide. From the corner of my eye, I could see the twitching rope, and the faint, reflexive jerk of the dangling sack of clothes. A sharp stink of urine and feces struck…

The rope drops. Hayes death appears mercifully quick! Again from Drums of Autumn: 

The hangman had known his business; there had been no undignified struggle, no staring eyes, no protruding tongue; Gavin’s small round head tilted sharply to the side, neck grotesquely stretched but cleanly broken. 

OK, but, what about non-traditional hangings? Any of these in Outlander. But, of course!

Two Jacobite traitors hang from crossed stakes courtesy of Red Coats in Outlander episode 105, Rent. Dougal and his party find the dead men with “T” for traitor carved into their flesh.  Although we don’t know how they died one can reasonably consider this a variation of a crucifixion hanging.

And, finally! In ep 402, Do No Harm, Jocasta’s slave, Rufus, dangles from a hook thrust under his ribs. This type of hanging is known as impalement.

From Drums of Autumn:

From everything I could sense and feel, I thought that the curve of the hook had gone upward through the liver. Likely the right kidney was damaged, and the jejunum or gallbladder might be nicked—but none of those would kill him immediately. 

So, one may reasonably conclude that Outlander has dutifully presented both traditional and non-traditional hangings!

Now, on to anatomy! Waaay back, Anatomy Lesson #12, Claire’s Neck or The Ivory Tower,  has a section on hanging but today we go deeper into the subject.

So, what does hanging have to do with human anatomy? Quite a lot actually, because hanging destroys normal anatomy. Let’s see how. 

Understanding traumatic events from hanging requires a bit of neck anatomy.  So….

Neck Anatomy: The neck is complex because it contains a mess of structures. These include:

    • pharynx for food and air passage
    • larynx for air passage and vocalization
    • trachea for air passage
    • esophagus for food passage
    • common carotid arteries supply blood to head
    • jugular veins drain blood from head
    • cervical vertebrae for support
    • hyoid bone for speech, swallowing, tongue movements
    • cervical spinal nerves, for neck and upper limb innervation
    • muscles for movement of head, neck, scapula and clavicle

Hangings typically traumatize one or more of these neck structures:

    • cervical vertebrae
    • hyoid bone
    • carotid arteries 
    • jugular veins
    • trachea and larynx

Cervical Vertebrae: The neck contains seven cervical vertebrae numbered from skull downward as C1-C7 (Image A). C1 is also known as the atlas; C2 is the axis.

Cervical vertebrae are smaller and more delicate than thoracic and lumbar vertebrae; this is especially true of C1 and C2. Collectively, all seven cervical vertebrae form the cervical skeleton and are bound together by strong ligaments.

Vector illustration of cervical vertebrae. Medical scheme with close-up skull and isolated C1 atlas, C2 axis, C3, C4, C5, C6 and C7 vertebra. Diagram of Intervertebral disc and anterior tubercle.

Image A

Hyoid Bone: The hyoid bone and cervical vertebrae are the only bones in the neck . The U-shaped hyoid (Image B, red) is unusual because it is the only bone of the body that does NOT articulate with other bones. Rather, it is suspended in the neck via muscles and ligaments connecting to neighboring bones and cartilages. More detail on hyoid and cervical vertebrae in Anatomy Lesson #12, Claire’s Neck – The Ivory tower.

Try This: You can palpate your own hyoid bone. Hold chin parallel to floor. Place thumb and forefinger of one hand on either side of your larynx (voice box). Move fingers upward until just under mandible. Squeeze gently, then swallow. You will feel a thin hard structure on each side, the R and L arms of the hyoid.

And, for book readers, Diana wrote about the hyoid bone in Written in My Own Heart’s Blood.

Image B

Common Carotid Arteries: The neck has a R and a L common carotid artery; each is a primary or secondary branch of the aorta arch (Image C).  Common carotids straddle trachea and larynx (Image C -blue/green structures) before splitting into internal and external carotid arteries which supply blood to neck and head.

Image C

Jugular Veins: The neck has two jugular veins on each side; external and internal jugulars. These drain blood from head and neck structures toward the heart Image D).

Image D

Trachea and Larynx: All of larynx plus upper trachea lie in the neck. Both are conduits for air to reach the lungs during inhalation and to leave the lungs during exhalation. In addition, the larynx produces vocalizations. Trachea and larynx provide the only normal route by which air can move to and from the lungs. Of course, a tracheotomy is an exception, but it is also not normal. (Psst…No S5 spoilers from  book readers, please!)

Image E shows trachea and larynx. Tracheal wall is stiff due to cartilage plates. The complex larynx consists of nine cartilages of various shapes and sizes. Learn more about the larynx in Anatomy Lesson #42, “The Voice – No, not that One!”

Image E

Now, for some info about hanging. 

Hanging: One might think hanging is a rather simple act, but it is not. There are many types of hanging although death is typically from either strangulation or neck fracture. Here are three common types of hanging.

*Short Drop: A condemned person is placed on a stool, ladder, cart, horse, etc. with noose around the neck. The object is removed leaving the person dangling from the rope. Although the person is unconscious within 15 seconds, death usually takes 10-20 minutes as the noose tightens causing slow strangulation.

*Standard Drop: A condemned person drops 4-6 feet (1.2-1.8m). This is considered more “humane” than short drop because it typically fractures the neck which traumatizes spinal cord and causes immediate unconsciousness and rapid brain death. 

*Long Drop: Drop varies. Height and weight of the condemned were used to calculate the drop needed to fracture the neck, preferably at C2, the axis. This is known as a hangman’s fracture.

Yes, I know! Horrifying to think about, but charts were developed to augment a swift death, the preferred outcome.

Submental Knot: Submental means “under the chin.”  Careful placement of the eye or knot of the noose under the chin jerks the head backward, contributing to neck fracture. Side and back knots tend to strangle rather than fracture the neck.

For more information about the chin, read Anatomy Lesson #26, Jamie’s Chin – Manly Mentus.

Back to Outlander: So, with knowledge about vulnerable neck structures and types of hangings plus their effect on anatomy, let’s review Outlander hangings. 

What about Taran from ep 115, Wentworth Prison? Taran was pushed off a not-very-tall scaffold – so in effect a short drop. Sadly, it didn’t break his neck and the Watchman kicked and struggled at the end of the noose! A member of the execution squad pulled down on his legs to break his neck, an act that was often required to end the misery. Of course, Jamie and other condemned prisoners witnessed this horror!

And, then there’s Hayes. Although his end was swift in Drums of Autumn book, not so in the episode. He did experience either a standard or long drop but afterward, his face is red and bloated and his eyes bloodshot. These findings are more consistent with strangulation than neck fracture, meaning his jugular veins were obstructed leading to death by brain edema and ischemia, wherein:

    • Face becomes engorged with blood
    • Facial skin turns red
    • Facial skin exhibits tiny petechiae/petechia (small blood marks)
    • Bleeding in conjunctiva overlying whites of eyeball (subconjunctival hemorrhage)

So the FX were very good but not well-matched for this type of hanging.

Just so we know, if the deeper lying common carotid arteries are occluded by strangulation, the face appears pale or white.

And, sphincters do relax spontaneously so urine and feces are evacuated. Thankfully, these weren’t part of the FX scheme! 😱

And poor Rufus! Impalement by hook is a very old punishment occurring in Babylonia! Later, it was used in 18th-century Ottoman-controlled Bosnia and by Dutch overlords in Suriname (South America) who impaled troublesome slaves under the ribs.

An 18th century observer recorded that an impaled person could hang as long as three days before expiring. The primary source of pain was extreme thirst.  Thankfully, this type of hanging has been pretty much abandoned.

As for the hyoid bone…. It fractures in about a quarter of hangings but is not the cause of death. Forensic scientists look for a fractured hyoid in suspected homicides because about 50% of hyoids fracture with manual choking.

Fracturing the hyoid bone depends on applied force, age of victim, nature of instrument (ligature vs. hands) so even if the bone is not fractured, a murder is still possible (Image F –  red arrow).

Image F

Today, we can be grateful that many countries have abandoned hanging as a means of punishment. An excellent film is available on this topic: Pierrepoint: The Last Hangman. Bonus! Tobias Menzies plays Lieutenant Llewelyn!

In Jamie’s time, hanging was an ignoble death. Why, we might ask? Here is one reasonable thought:

“The sword connoted an honourable way of dying, and an honourable return to the earth, but the rope left the body hanging between heaven and earth and was therefore an unseemly death.” 

― Ron Brown, The Art of Suicide

Until next time….Hang in there!

The deeply grateful 

Outlander Anatomist

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