outlander wedding – Page 6 – Outlander Anatomy

August 18, 2015August 19, 2015

“The Savvy Sniffer – Claire’s Nose Knows!”

Welcome, students to Anatomy Lesson #28 – The Nose! Oh, you don’t think the nose sounds very interesting? Well, please read on because this lesson contains surprising, startling and shocking info about the human proboscis.

Is the nose important to society? You bet! There is a mess of English idioms about the nose including: as plain as the nose on your face, nose to the grind stone, turn nose up, brown nose, follow one’s nose, cut one’s nose off to spite one’s face, count noses, nose for gossip, win by a nose, keep nose out of business, no skin off one’s nose, nose about, nose to the ground, look down one’s nose at, nose around, and nose-to-nose. Clearly, the nose is a clever conduit to convey important social messages.

Oh, and let us not forget the nose-out-of-joint idiom! Claire and Jamie are clearly in that realm going at it “Down by the Riverside.” Pretty simple really: Jamie expects an apology and Claire isna giving one (Starz episode 109, The Reckoning)! He told her to STAY PUT but she doesna have to do what he says! She’s his wife and she doesna like that one bit! Whew, their passionate noses are fully engaged in this battle of wills!

Those who read Diana’s books know that Claire is endowed with a very keen sniffer. Her nose catalogues a staggering array of smells including but certainly not limited to: alcohol, bat guano, bitter almonds, blood, clover, feces, grass, herbs, honey, hops, ink, laundry starch, opium, pickled herring, pine needles, pine tar, pitch, pus, raw sewage, resin, road dust, seasickness, soap, sulfur, wine, wood smoke, yeast and last but not least, male sweat! Jamie, Himself offers a fine flattering appraisal of Claire’s nose (Voyager book)!

“’You smell of ink.’” He smiled slightly, stepping back and running his hand through his hair. ‘You’ve a nose as keen as a truffle pig’s, Sassenach.’ ‘Why thank you, what a graceful compliment,’ I said.

At the base of Craigh na Dun we see more proof of her superb sniffing skills. Claire’s knowing nose encounters Frank dressed in 18^th century soldier garb (Starz episode 101, Sassenach). Oops, it isn’t Frank, but his six-time great grand paternoster: Jonathan Randall, Esquire, Captain of his Majesty’s Eighth Goons, er, Dragoons! Ugh, he’s too close for comfort as Claire analyzes his personal plethora of peculiar odors:

“My captor, whoever he was, seemed not much taller than I…. I smelled a faint flowery scent, as of lavender water, and something more spicy, mingled with the sharper reek of male perspiration.”

His miasma of lavender and male sweat doesna appeal to Mistress Claire; her nose knows a real stinker when it sniffs one. But, dinna despair lassie, a braw and bonny laddie is coming your way pronto! Ye will like the whiff of him. No problema!

Anatomy of the human nose is fascinating so let’s get started! Nose and chin are typically the most projecting parts of the face. In anatomy, the nose is divided into external nose, the visible projecting part, and internal nose, the part deep to the surface. In anatomy, the nose belongs to the respiratory system because it serves as a passageway for air flow during respiration: nitrogen, oxygen, carbon dioxide, and argon, along with trace elements and other particles move through the nose on their way into and out of the lungs.

The external nose has a root that is continuous with the forehead (Photo A – red arrow). The tip of the nose is its apex. The paired nostrils are the nares. The bridge is formed of bone and cartilage and the alae (pl. – Latin meaning wings) are the nasal flaps. Nasal skin is typically thin (Anatomy Lesson #5 and Anatomy Lesson #6) and adheres tightly over the alae but elsewhere is quite moveable.

Photo A

The skeleton of the external nose is composed of bone, cartilage and fibro-fatty tissue that mimics the external shape. The bridge includes a pair of small nasal bones (Photo B) that form non-movable joints between themselves and with frontal (forehead) bone and nasal cartilages. Nasal cartilages include a septal cartilage most of which is internal and alar cartilages that form sides and tip of the nose as well as much of the nares. Finally, the nasal flaps are made of fibro-fatty tissue – mostly collagen fibers interspersed with fat cells. There are some small accessory nasal cartilages also, but we won’t concern ourselves with these.

Try this: Grip the upper bridge of your nose and wiggle your fingers. Normally, it won’t budge because the nasal bones are firmly-anchored. Slide fingers toward the apex and wiggle it; this part moves easily because it is formed of flexible cartilage. Now, find the juncture between hard and flexible areas; this is where nasal bones meet nasal cartilages.

Photo B

Clinical Correlation #1: ever seen a broken nose? Not a pretty sight. One may look a bit like wee, wild Willie’s nose after the tavern brawl (Starz episode 5, Rent). It was his first time on the road, but being a true Highlander, the lad held his own. The bloody jagged line across the bridge of his nose lies near the juncture between nasal bones and cartilages, a common site to suffer a broken nose.

As you might imagine, nasal fractures range from mild to severe and symptoms include: pain and swelling that persists after 3 days, crooked nose, difficulty breathing through the nose even after swelling decreases, fever and recurrent nosebleeds. If clear fluid starts leaking from an injured nose, get to an emergency room pronto as this could be CSF (cerebrospinal fluid)!

The external nose also has two muscles (Photo C): nasalis (Latin meaning pertaining to the nose) and depressor septi nasi (Latin meaning pull down nasal septum). The alar part of nasalis lifts and flares the nasal alae to open the nares. A transverse part of nasalis compresses the alae to close the nares. Depressor septi nasi aid the transverse nasalis muscles by drawing down the septum.

Photo C

Do we see examples of the nasalis muscles at work in Starz episodes? Aye we do! Jamie’s grand, garrulous (ha) godfather offers a terrific example for our viewing pleasure. Here, dour Murtagh glares at Claire as they scour Scotland for their beloved Lallybroch Laird (Starz episode 114, The Search)! It’s easy to tell if the nasalia (pl.) muscles are contracted because the alae flare deepening the furrow between them and the sides of the nose.

The internal nose consists of two slit-like nasal cavities separated by a midline nasal septum. Nasal cavities begin at the nares as right and left vestibules, each lined with thin skin and coarse hairs that trap unwanted particles (Photo D – left septum). The nasal cavities extend posteriorly ending at the choanae, a pair of openings on either side of the septum that are continuous with the nasopharynx or back of the throat (Photo D).

Each nasal cavity has floor, roof, septal wall and lateral wall. The floor is made of bony palate that separates nasal and oral cavities (Photo D – blue arrow). The septal wall or nasal septum is flat, smooth and divides the paired nasal cavities (Photo D – left side of nasal septum). A whopping seven cranial bones plus the septal cartilage form the nasal septum but these will not be covered in this lesson. When we are young, the septum is typically straight but trauma, disease or age can create a deviated septum, a condition which may interfere with air flow on the narrowed side.

Photo D

Unlike the septal walls, the lateral walls are complex; each is convoluted into three chonchae or turbinates that project like drooping shelves into their respective nasal cavity (Photo E). Humans also have four sets of paranasal sinuses with openings that drain into the lateral walls but these will be covered in a later lesson. The roof of each nasal cavity is described below.

Photo E

Excepting the vestibule, all surfaces of the nasal cavities are covered with mucous membrane (red surfaces in Photos D and E) so named because all cells of the surface layer are living as opposed to skin wherein the topmost cells are dead. The mucous membrane of floor and septal and lateral walls include a surface layer called respiratory epithelium. Deep to the nasal respiratory epithelium are glands which release mucus and watery fluids forming a surface coat that hydrates and moistens the entire mucous membrane (Note: mucous is adj. form and mucus is a noun – these are not misspellings).

Nasal respiratory epithelium includes six types of cells but we will cover only the ciliated cell because it is really special. Photo F isn’t an image of heather covering a Scottish Munro; it is a scanning electron micrograph (SEM) of nasal respiratory epithelium. We have seen SEM images before in skin (# 5 and #6) and inner ear (#25) anatomy lessons. SEM micrographs are 3-D images showing highly magnified surface details. Thus, in Photo F, the pinkish shag carpet is actually cilia, motile “hairs” projecting from the surfaces of ciliated cells. Cilia of the front of the nasal cavities beat toward the nares to kick out mucus and unwanted debris; cilia toward the back of the nasal cavities beat toward the pharynx where debris and mucus can be swallowed or coughed out. Cool, huh?

Photo F | Photo credit: Steve Gschmeissner

Now, let’s return to the scroll-like lateral walls of the nasal cavities. Why the complex shape? First, the shelves increase surface area of mucous membrane to help warm and humidify inspired air before it reaches the delicate lungs (Photo G). Second, air is tumbled as it flows over the chonchae trapping air-borne particles in the mucous film so cilia can move this stuff toward the nares or the pharynx. An ingenious design indeed!

Clinical Correlation #2: Cigarette smoking (are you weary of this topic?) causes respiratory epithelium to be replaced with a more durable type such as lines the mouth. Unfortunately, the replacement epithelium lacks cilia so particles and mucus cannot be properly removed. Further, these changes are not limited to nasal respiratory epithelium but occur throughout the airways even into the lungs and are the basis for smoker’s cough. And, in case you are wondering, yes, routine marijuana smoking causes similar changes to respiratory epithelium. As for e-cigarettes, the jury is still out on this practice because it is new. However, early results indicate that it is also deleterious to respiratory epithelium. Don’t mean to preach… just sayin’! It’s my job, ye ken?

Photo G

Now, a moment for something truly fascinating: deep in the nasal mucous membranes are structures known as swell bodies. It’s true! Would I lie to you? Here’s what they look like. Och, sorry students, wrong image! These are swell bodies but not the swell bodies of nasal mucous membrane (Starz, episode 107, The Wedding)!

Lost me train of thought…Oh, there it is! The mucous membranes of both nasal cavities contain an extensive plexus of vessels labelled “network of veins” in Photo H, a LM (light micrograph) taken of a thin section of nasal mucous membrane after staining with pink and blue dyes.

This extensive plexus of veins constitutes swell bodies of nasal mucosa (in each nasal cavity), a type of erectile tissue like that of male and female phalli (pl.). During sexual arousal, the venous spaces of the phallus fill with blood causing the organ to become turgid and erect. Well, something very similar occurs to the swell bodies of the nasal cavities. YES, it does! Regulated by the brain (hypothalamus), the swell bodies of one nasal cavity fill with blood while those of the opposing side drain. Known as the nasal cycle, every so often the sides flip such that swell bodies of the opposing side engorge with blood while the former full side empties. How long is the interval? Well, it varies from about 30 minutes to a few hours. Normally, we are unaware of the nasal cycle because overall airflow remains constant. Why do we have a nasal cycle? Well, air flow is reduced through the engorged side allowing it to rest and rehydrate. Then the sides flip so the other nasal cavity can recuperate. Isn’t this wondrous? It boggles the mind!

Try this: Slowly inhale and exhale. Can you feel air moving more freely through one nasal cavity? This is the side with empty swell bodies whereas swell bodies are filled with blood on the closed side. Wait an hour or so and see if the sides flip. Note: if you have a deviated septum, active allergies or a cold this phenomenon will be difficult to demonstrate.

Photo H

Lastly, we must consider the roof of the nasal cavities. The roof is endowed not with respiratory epithelium but with olfactory epithelium (Photo I – blue area). Taste buds of the oral cavity detect five distinct qualities of taste, but our noses distinguish hundreds of substances even in minute quantities. Being more diversified, olfaction (smell) also aids our sense of taste. And to further refine the issue, we detect odors during inhalation but the taste boost occurs during exhalation.

Photo I

Olfactory epithelium is composed of numerous olfactory neurons (nerve cells) which collectively form the olfactory nerve or Cranial Nerve I (Photo J). Airborne molecules bind to the surface of the olfactory neurons causing them to depolarize. This electrical response travels along the olfactory bulb (Photo J) before distributing to olfactory areas of the brain where smell is perceived and interpreted.

Lastly you should know that our ability to detect odors decreases with age, a change usually more pronounced in men than in women. People often do not recognize the loss unless they also experience a decreased sense of taste.

Photo J

Clinical Correlation #3: Neurons are terminal cells meaning early in life they cease to divide and proliferate. Olfactory epithelium is exceptional because these neurons retain the amazing ability to divide and replace themselves throughout life.

You all ken that major spinal cord injuries do not repair because surviving neurons cannot divide to replace damaged or dead neurons. Well, recently, Polish doctors transplanted olfactory neurons (his own) into the spinal cord of a man paralyzed from the chest down in the world’s first attempt to reverse paralysis using this technique. The hope is that olfactory neurons transplanted to the spinal cord will proliferate, connect with and stimulate his paralyzed muscles. You can follow his progress at Spinal Cord Injury Zone. Let’s send him and his health care team our best wishes for success!

Now, for more fun stuff: let’s peruse Starz images and book quotes for more about splendid noses; there are many!

After being whacked on the heid by Murtagh’s dirk, Claire awakens astride a horse and immediately analyzes his fine fecund funk (Starz episode 101, Outlander):

“I knew it wasn’t a dream. My erstwhile savoir fairly reeked of odors too foul for any dream I might conjure up.”

Claire meets Jamie in a stone cottage and a whole lot of “playing doctor” ensues enabling Jamie to erm, mount a steed. Snort! Dougal jerks puir Claire around and then hoists her up on Jamie’s horsie (Starz episode 101, Sassenach and Outlander book)!

“With a slight grunt, he boosted me into the saddle in front of Jamie, who gathered me in closely with his good arm… He smelt strongly of woodsmoke, blood, and unwashed male, but the night chill bit through my thin dress and I was happy enough to lean back against him.”

Next, Claire uses her knowing nose after Dougal and his merry men lay waste to a raft of redcoats at Cocknamon Rock (Starz, episode 101, Sassenach and Outlander book).

“Someone passed a flask to Jamie, and I could smell the hot, burnt-smelling liquor as he drank. I wasn’t at all thirsty, but the faint scent of honey reminded me that I was starving…”

Fast forward to swell bodies! Going nose-to-nose with her young gallant on their wedding night, Claire considers Jamie’s splendid nose (Starz episode 107, The Wedding)! Herself writes in Outlander book:

“’My mother was a MacKenzie, though. Ye’ll know that Dougal and Colum are my uncles?’ I nodded. The resemblance was clear enough, despite the difference in coloring. The broad cheekbones and long, straight, knife-edged nose were plainly a MacKenzie inheritance.

Now, here’s Jamie’s 18^th century colorful counsel about sharing one’s armpit aura with another creature (Starz episode 107, The Wedding and Outlander book):

“He raised one arm, displaying a soft tuft of cinnamon-colored hair. ‘You rub your oxter over the beast’s nose a few times, to give him your scent and get him accustomed to you, so he won’t be nervous of ye.’ …’That’s what you should have done wi’ me, Sassenach’….’Then I wouldn’t have been skittish.’”

Snort!

A skittish Scottish Scot? Har, har! Ready for something truly amazing! Experiments show that mice chose genetically diverse mates based on smell. Fine and dandy, but what about humans? Have you heard of the “sweaty T-shirt” experiment? In 1995, a Swiss zoologist devised an experiment to determine if women prefer the odor of some men over others. Male volunteers wore clean T-shirts and female volunteers blindly smelled shirt odor to evaluate it for intensity, pleasantness and sexiness. Overall, the women preferred the smell of men whose MHC genes differed from their own. Whaaat? What is MHC? MCH (major histocompatibility complex) genes generate molecules that enable our immune system to recognize and destroy invaders; the more diverse the parental MHC genes the stronger the immune system of their offspring, an advantage in destroying pathogens. The study results suggest that evolution has provided humans with a transmitter (odor/pheromone) and receiver (olfactory epithelium) of genetic information that could influence mate choice. Wow!

Now, you might think Claire is just resting her face against Jamie’s back to recuperate after hiking around this braw Scottish mountain (Starz episode 107, The Wedding)! But, she was clearly sniffing to detect his MHC. Her nose knows he is the King of Men! Yup, he’s a keeper! Herself explains (Outlander book):

“His pleasant musky smell mingled with the harsh scent of linen. “Take off your shirt,” I said … He smelled faintly of soap and wine…”

And he did! Take off his shirt, I mean. Yerp!

Hey, hey, come back! In summary, the external nose adds contour and expression to our faces while the internal nose cleanses and humidifies the air we breathe as well as provides us with the ability to smell a broad and fascinating array of molecules. Do you appreciate your sniffer? Is it as keen as Claire’s? Let’s be grateful to the sense of olfaction for the richness and joy it adds to our lives!

Be Glad Your Nose is on Your Face

Jack Prelutsky, 1940

Be glad your nose is on your face,
not pasted on some other place,
for if it were where it is not,
you might dislike your nose a lot.

Imagine if your precious nose
were sandwiched in between your toes,
that clearly would not be a treat,
for you’d be forced to smell your feet.

Your nose would be a source of dread
were it attached atop your head,
it soon would drive you to despair,
forever tickled by your hair.

Within your ear, your nose would be
an absolute catastrophe,
for when you were obliged to sneeze,
your brain would rattle from the breeze.

Your nose, instead, through thick and thin,
remains between your eyes and chin,
not pasted on some other place–
be glad your nose is on your face!

A Deeply Grateful,

Outlander Anatomist

photo creds: Netter’s Atlas of Human Anatomy, 4^th ed., Sony Pictures, Starz, www.rci.rutgers.edu (schematic of olfactory epithelium), www.sciencephotolibrary.tumblr.com (SEM of respiratory epithelium)

August 4, 2015August 3, 2015

Colum’s Legs and Other Things, Too!

Thanks for running to class today, Outlander anatomy students! Today’s Anatomy Lesson #27 is on the Leg. Upper and lower limbs are both fascinating and complex puzzle pieces of our human anatomy (Photo A). Four Anatomy Lessons (#19, #20, #22, #23) have covered the upper limb but only one dealt with the lower limb (Anatomy Lesson #7). This leg-a-thon has been slooow in coming, but Colum’s legs are begging for some well-deserved attention!

Photo A: Dream Object by Jim Shaw

We all know that Colum’s legs captured Claire’s attention from the get-go. Here, her glass face shows what she thinks “plain and clear” (Starz episode 102, Castle Leoch). She’s surprised when the laird catches her riffling through his personal letters and books and then she is startled by his unusual physique.

Herself records Claire’s thoughts (Outlander book):

“At the moment, though, my discomfort arose from the fact that the beautifully modeled head and long torso ended in shockingly bowed and stumpy legs. The man who should have topped six feet came barely to my shoulder. … ‘I welcome ye, mistress,’ he said, with a slight bow. ‘My name is Colum ban Campbell MacKenzie, laird of this castle.’ ”

Colum’s bowed and twisted legs burden him with two “gifts that keep on giving”: pain and discomfort. Scientific explanations for his disability are coming up soon but first we must learn normal anatomy of the leg. So let’s get a leg up and start trotting!

In Anatomy Lesson #7, “Jamie’s Thighs or Ode to Joy,” we learned that anatomists define the leg differently than is common. In anatomy, the lower limb is divided into thigh, the region between hip and knee joints; leg, the region between knee and ankle joints; and foot, the remainder of the limb (Photo B). Colum’s entire lower limbs are affected by his disability but as that entails too much anatomy for a single lesson, we will focus on the anatomical leg.

Photo B

As always, we begin with the bony foundation. The lower limb contains 29 bones, one fewer than the upper limb: the thigh contains one bone, the leg contains two and the foot has 26.

The femur or thigh bone is the longest and by most measures the strongest bone of the human body (Photo C – right femur). Its bony details (and Jamie’s thighs) were covered in Anatomy Lesson #7 so we will skip them today.

Photo C

Each leg contains two bones, the tibia situated medially (closer to body midline) and the fibula positioned laterally (away from body midline). Although not shown in Photo D, strong ligaments bind tibia and fibula to each other and also to femur and a few foot bones.

Parts of the sturdy tibia are subcutaneous thus its sharp anterior border and medial surface are easily palpated. Its proximal (near) end forms a bony plateau for the knee joint and its distal (far) end forms the medial malleolus or inner ankle bone (Photo D).

The needle-shaped fibula (Latin meaning clasp – as the pin of a brooch) is difficult to palpate except at its ends: the head forms a bony knob at the outside of each knee and the lateral malleolus is the outer ankle bone (Photo D). Fibulae are useful because surgeons can harvest most of their lengths for bone grafts (e.g. mandibular reconstruction) with little deficit as long as both fibular ends are left intact.

Try this: Place fingers on the front of your leg. Palpate the sharp anterior border of tibia or shin bone, the part that gets barked on projecting surfaces. Ouch! Move fingers toward the inside of your leg and feel the hard, flat medial surface of tibia. Move fingers to the inner ankle and tap the bony medial malleolus of tibia.

And try this: Next, move fingers to the muscle mass at the side of your leg; it covers most of fibula except at each end. The bony knob you feel near the knee is the head of fibula. Find the bony outer ankle or lateral malleolus of fibula. Together, medial and lateral malleoli (pl.) form a strong box-like frame for a foot bone which will be covered in a later lesson (Photo D- green arrow).

Photo D

The leg contains 12 muscles; we’ll cover four. The first muscle is tibialis anterior (Anatomy Lesson #9), the muscle savaged by a boar’s tusk at the tynchal (Starz episode 104, The Gathering). Tibialis anterior is a strong fleshy muscle that hugs the outer surface of the tibia. It arises from the tibia and inserts into a foot bone (Photo E – right tibialis anterior). Contraction dorsiflexes the foot meaning it lifts the toe-end of the foot toward the sky, an action critical for walking and running. It also helps invert the foot, meaning to turn the sole of foot toward the midline.

Try this: Plant a shoeless foot on the floor. Leave the heel planted but lift the toe-end of your foot skyward. This is dorsiflexion. Replant the foot and turn sole inward to face the midline; this is inversion (some practitioners call this supination). Return the foot to dorsiflexion and palpate the tense fleshy muscle just lateral to your tibia; this is tibialis anterior.

Photo E

Want to see a really cute tibia (red arrow) and tibialis anterior muscle (blue arrow)? Of course ye do! Here is Claire the morning after (Starz episode 107, The Wedding). Yep…her curvaceous legs are beautiful and her crossed toes make her look soooo innocent but we all ken what those toes did last night! Jamie, weel, he’s hungry. How about a bite, Claire?

At the side of the leg is fibularis longus (aka peroneus longus). A long spindle-shaped muscle that arises from head of fibula, its tendon passes under the foot and inserts on a bone near the instep (Photo F). Fibularis longus contracts to evert the foot meaning it turns the sole away from the body midline. Think of a novice ice skater: ankles knock together and soles turn outward – this is eversion of the feet. Fibularis longus also helps plantar flex (point) the foot.

Try this: Plant a shoeless foot on the floor. If you can, turn your foot so the sole faces to the side and your inner ankle moves closer to the ground. This is eversion (some practitioners call this pronation) of the foot. With the foot in this position, feel the tense muscle running down the outside of your fibula; this is fibularis longus. Now point the foot, this is plantar flexion also aided by fibularis longus.

Photo F

The back of the leg contains seven muscles but we will cover only two. First is gastrocnemius (Latin and Greek meaning stomach of the leg); this odd name reflects the bulging shape of the calf created by gastrocnemius. This muscle spans two joints: knee and ankle. It also has two heads, one arising from each side of the femur (Photo G). The heads unite high in the leg but about midway down the calf the muscle gives way to the calcaneal or Achilles tendon. The longest and strongest tendon of the body, it inserts into the calcaneus or heel bone (Photo G, green arrow).

Photo G

Contraction of the gastrocnemii (pl.) flexes the legs at the knee joints and plantar flexes (points) the feet. These are powerful muscles and each is active during fast movements such as running, jumping and dancing.

Gastrocnemii are verra active during a shinty game (Starz episode 104, The Gathering). Run ruaidh Jamie! Big bad Uncle Dougal is hot on your handsome Highland heels! Run, run as fast as you can; you can’t catch the ginger-haired man!

Covered by boots, we canna see the gastrocnemii but they are also busy as Murtagh, um, “executes” his version of the Highland sword dance (Starz episode 114, The Search).

The soleus (Latin meaning sandal) is a large, flat muscle deep to each gastrocnemius. Soleus arises from the back of tibia and fibula and joins gastrocnemius to form the Achilles tendon (Photo H). Because gastrocnemius and soleus share the Achilles tendon, some anatomists consider them a single muscle, the triceps surae (Latin meaning three-headed calf muscle). Soleus crosses only the ankle joint so it helps plantar flex the foot. But equally important, soleus is a postural muscle that helps us stand aright; if not for its constant backward pull, we would do a face-plant!

Now, here’s an interesting factoid: besides plantar flexion and posture maintenance, soleus helps prevent stasis of venous blood. A large leg vein (posterior tibial) passes deep to soleus so when the muscle contracts, venous blood is moved towards the heart against gravity. For this contribution, the soleus is also called the sural pump. This is so important that some health providers recommend soleus exercises for inactive patients to help prevent deep venous thrombosis (DVT or blood clots). And, smart passengers on long air flights should flex and point their feet every couple of hours (activates the soleus pump), walk around, wear loose-fitting clothes, etc., to help prevent blood clots.

Photo H

A comment or two about the calcaneal/Achilles tendon, the most commonly injured tendon of the human body! Explosive actions such as jumping or a sudden pushing off can tear the tendon or avulse it from its insertion on the heel bone. Achilles tendon injury is much more common in males than females and accompanies increased athletic activity (especially after years of sedentary lifestyle), the effects of aging or the use of some antibiotics.

And, just so we understand its origins, the Achilles tendon is named for the mythical Greek hero Achilles who was slain during the Trojan War when Paris’ poisoned arrow hit the heel, his only vulnerable body part (Photo I). As a wee lad, his mom held him by the heel and dipped him in the River Styx to grant him indestructibility but, sadly, that heel didna get baptized!

Photo I

Want to see a manly example of an Achilles tendon (Starz episode 112, Lallybroch)? Weel…Jamie has one! First off, the lad has long tibiae and fibulae (pl.) which lend his calves a lean, lengthy leg-look. Red arrows mark the junctions between Jamie’s gastrocnemius muscles and his Achilles’ tendons which continue down the legs to end at the heel bones (blue arrow). Nice runner’s legs, laddie! Getting into that mill pond? Take good care; Claire willna like it if ye freeze off her fav body part!

Now, we are done with normal anatomy, so let’s apply it to Outlander! Returning to Colum MacKenzie (Starz episode 104, The Gathering), Claire’s considers Colum and his brother, Dougal (Outlander book):

“Now there was a strange man. A cultured man, courteous to a fault, and thoughtful as well, with a reserve that all but hid the steely core within. The steel was much more evident in his brother Dougal. A warrior born, that one. And yet, to see them together, it was clear which was the stronger. Colum was a chieftain, twisted legs and all. Toulouse-Lautrec syndrome. I had never seen a case before, but I had heard it described. Named for its most famous sufferer (who did not yet exist, I reminded myself), it was a degenerative disease of bone and connective tissue.”

Question #1: Does Claire correctly diagnose Colum as suffering from Toulouse-Lautrec syndrome? Let’s take a closer look.

Henri de Toulouse-Lautrec (aka Henri Marie Raymond de Toulouse-Lautrec-Monfa, 1864-1901) was a 19^th century artist who garnered fame as a painter, printmaker, illustrator and draughtsman. A contemporary of Gauguin and van Gogh, his work embraced the colorful, daring and glaring life of Bohemian Paris and his subjects were often members of that social stratum. His works are highly valued. Ten years ago, his painting of a young laundress (La blanchisseuse, 1889) sold for a record US $22+ million (Photo J)!

Photo J

Toulouse-Lautrec was the first born child of an aristocratic French family whose parents were first cousins. By eight years of age, his talent for drawing and painting had surfaced, but problems with growth and development soon followed. At 13, Henri fractured his right femur and a year later, his left, but the breaks never healed properly. His legs ceased to grow such that as an adult, he stood 4’ 8” (1.42 m). His trunk was adult-sized but his legs remained those of a child (Photo K).

Fast forward to 1962; a pair of French physicians (Maroteaux and Lamy) described a rare clinical entity (1.7/1 million births) dubbed pycnodysostosis (Greek meaning dense, defective condition of bone) or Toulouse-Lautrec syndrome. Pycnodysostosis is inherited if a child receives a recessive gene for the disease from each parent, an unlikely outcome unless parents are closely related. However, because genetic testing was unknown during Henri’s lifetime, it is surmised that he suffered from this disease (there are other possibilities).

Photo K

Now, lace up your shoon, gobble down your haggis and bear with me for a bit of microscopic anatomy. We humans think of our skeletons as static structures but this is so not so! Each bone is a living organ that is restructured and remodeled throughout life by action of two bone cells: osteoblasts (bone-forming cells) that make bony matrix and osteoclasts (Greek meaning bone + broken) that breakdown bone. Osteoclasts (Photo L – blue dashed line) are multinucleated giant cells many times larger than our red blood cells (Photo L – red dashed line). A third bone cell, the osteocyte, also has bone activity but we will not cover this cell today. Our bones are remodeled as we grow, age, gain or lose weight, experience pregnancy, change exercise regimes, or mend broken bones; all possible because of osteoblasts and osteoclasts.

It turns out that pycnodysostosis/Toulouse-Lautrec sufferers cannot make an enzyme (Cathepsin K) essential for protein breakdown. Because osteoclasts lack this enzyme these cells cannot break down bone; thus, bones neither remodel nor mend properly. Make sense?

Photo L

Lacking just ONE enzyme, Toulouse-Lautrec sufferers experience these painful and debilitating symptoms:

Stature: adult males stand less than 150 cm (4’ 11’); adult females are shorter.
Bones: bones are dense because osteoclasts cannot resorb them. Bones are brittle and fracture easily especially weight-bearing bones of the lower limbs, mandible (Anatomy Lesson #26) and clavicles (Anatomy Lesson #3).
Skull: bones of forehead (frontal bone), back of head (occipital bone), nose and mandible as well as the teeth do not form properly. The anterior fontanel (‘soft spot” on top of the head) remains widely open, possibly why Toulouse-Lautrec consistently wore a hat.
Hands: skin over the back of fingers is deeply wrinkled; nails are flat and grooved. Distal phalanges are short (Anatomy Lesson #22 & Anatomy Lesson #23).
Spine: defective vertebrae cause the spine (Anatomy Lesson #15) to curve laterally (scoliosis).
Impotency and/or sterility: Toulouse-Lautrec purportedly contracted syphilis from a prostitute who served as his model – his history suggests he was not impotent but he is not known to have sired children. Alcoholism (absinthe for pain), tertiary syphilis and his weakened constitution took his life at 37. Colum was apparently sterile because Dougal ensured his bloodline by begetting Hamish with Letitia (Starz episode 109, The Reckoning). Dougal also assured Colum “that she was tender and sweet as a ripe peach and all that a man could want in a woman” (Outlander book) implying that Colum did not know his wife sexually (impotent).

Answer to Question #1: Yes, Claire very likely correctly diagnosed Colum’s disability as Toulouse-Lautrec syndrome (pycnodystosis).

Question #2: Does Diana’s description of Colum’s symptoms match with those of Toulouse-Lautrec syndrome? You be the judge. Claire reflects in Outlander book:

“Victims often appeared normal, if sickly, until their early teens, when the long bones of the legs, under the stress of bearing a body upright, began to crumble and collapse upon themselves. The pasty skin, with its premature wrinkling, was another outward effect … that characterized the disease. …. As the legs twisted and bowed, the spine was put under stress, and often twisted as well, causing immense discomfort to the victim. … Because of the poor circulation and the degeneration of connective tissue, victims were invariably sterile, and often impotent as well.”

And another quote from Outlander book: Here, Ned Gowan explains to Claire:

“Colum was a whole man to the age of eighteen or so,” … “but soon after the marriage he had a bad fall, during a raid. Broke the long bone of his thigh, and it mended poorly.” …“And then,” Mr. Gowan went on with a sigh, “he rose from his bed too soon, and took a tumble down the stairs that broke the other leg. He lay in his bed close on a year, but it soon became clear that the damage was permanent.

Okay, let’s all be the judge!

Answer to Question #2. My opinion: Claire’s description and the visuals of Colum’s legs almost exactly match the symptoms of Toulouse-Lautrec syndrome or pycnodysostosis. Colum’s thigh muscles are abnormally twisted and grooved (above photo – red arrows) due to his poorly mended femora (pl.). His right fibula also appears to have been broken and mended badly (below photo – blue arrow) and his twisted Achille’s tendon (below photo – red arrow) is displaced laterally. Remember Claire’s offer to massage the base of Colum’s spine rather than his legs? Nerves innervating the legs emerge near the base of the spine explaining why spinal massage of that region might provide temporary relief. Colum suffered greatly with his laird’s legs but make no mistake: “this clan remains under the charge of this man!”

The visual presentation of this terrible syndrome was very convincing and well done. Way to go Colum, Claire, Diana and CGI team!

Here is an interesting and apropos tidbit about a cute cat (Photo M). The Scottish fold cat (aka Highland Fold, Longhair (Laoghaire?), Longhair Fold) is a domestic cat with ears that fold forward toward the nose. They also suffer from distorted limb bones and arthritis. The breed is the result of a genetic mutation in a single barn cat named Susie (Perthshire, Scotland, 1961). But most pertinent here, the Scottish fold syndrome belongs to the same group of cartilage and bone disorders as Toulouse-Lautrec syndrome. Yep, it does!

Photo M

Now, let’s end this lesson with some fun frivolous facts about legs (here meaning the entire lower limb)!

Michael Flatley (Riverdance) insured his legs in 1999 for US $40 million.
In 1836, Mexican General Santa Anna held an elaborate state funeral for his amputated leg.
The average person takes 6,000 -9,000 steps per day: 28,000 – 42,000 miles in a 70 year lifespan. This exceeds the circumference of the globe!
The “legs up the wall” yoga pose relieves anxiety, stress and tired legs (lie on back near a wall. Lift lower limbs up the wall and scoot butt against the wall). It feels marvelous as blood drains from the lower limbs!
Svetlana Pankratova of Russia purportedly has the longest legs of any woman in the world – at 1.32 m or 4.33 ft. (Does the Guinness rep realize that she is wearing heels? Not exactly a scientific measurement). Her hip joints and my oxters are at the same height!

Be grateful! Kick your own legs up in the air if ye can and offer a hand to those whose legs dinna work quite so well!

A Deeply Grateful,

Outlander Anatomist

Photo creds: Netter’s Atlas of Human Anatomy, 4^th ed., Starz, www.greekmyths-greekmythology.com (Achilles), www.montessoricats.com (Buddha cat), www.news.asiatown.net (Svetlana Pankratova), www.praz-delavallade.com (Jim Shaw painting), www.reddit.com (Scottish Fold cat), www.wikipedia.org (La blanchisseuse and Toulouse-Lautrec photos), Robert M. Hunt (B&W osteoclast)

May 26, 2015January 3, 2021

Anatomy Lesson #22: Jamie’s Hand – Symbol of Sacrifice

Welcome, anatomy students, to Anatomy Lesson #22: The Hand. Anatomy of the human hand is daunting because it is complex. The hand is a true engineering marvel, containing four of the six classical simple machines as defined by Renaissance scientists: wedges, planes, pulleys, levers. This structural diversity makes the hand arguably the most mobile part of the entire musculoskeletal system (Photo A).

Languages include abundant references to hands so over emphasizing their importance might be a challenge. One English source on hand idioms records almost 300 common references: bird in hand, give me a hand, firm hand, hand-me-down, safe hands, helping hands, tie ones hands (shade #1 of BJR), throwing up one’s hands, wandering hands (shade #2 of BJR), wash ones hands of, lift a hand, lay hands on (shade #3 of BJR) to name but a few.

Photo A

In human anatomy, structure and function go “hand-in-hand” (another idiom): if a body part performs a particular function(s) its structure reflects that task and vice versa a body part that has a particular structure will reflect the function(s) it is designed to fulfil. There is no finer example of this axiom than the human hand.

More pertinent to our shared interest, holding hands and touching are important elements of the Outlander books and the Starz series (a.k.a. hand sex). Herself’s own words from Jamie and Claire’s wedding night (Outlander book):

Somewhat tentatively, he reached out and took my hands between his own … I felt a slight shock at the touch … “Aye. More scairt than you, I expect. That’s why I’m holdin’ your hands; to keep my own from shaking.” I didn’t believe this, but squeezed his hands tightly in appreciation. “It’s a good idea. It feels a little easier to talk while we’re touching.”

And, from Neil Diamond:

Hands, touchin’ hands

Reachin’ out, touchin’ me, touchin’ you

Sadly, this lesson must include images and analysis of Jamie’s hand after BJR adds his “aesthetic” twist. There will be a WARNING ahead of these images to give you the opportunity to skip them. They appear near the lesson’s end. Look for the warning sign before those images and the kitten when it’s safe to come out. I must also confess, that this chapter in the book and Starz episode 115 Wentworth Prison made it difficult for my usual sass to fly in this lesson. My sass is sad and worried about Jamie and Claire and ready to pull out a can of whoop ass on BJR. Here BJR, this is for YOU!

Back to the lesson at hand (haha)…Photo B of the upper limb has appeared in several prior Outlander Anatomy Lessons. But, to reiterate: the shoulder is from base of neck to shoulder joint, the arm is between shoulder and elbow joints, the forearm between elbow and wrist joints and the hand is the terminus of the upper limb. More precisely, the hand lies distal to (away from) the forearm.

Photo B

To better understand the hand, we must further consider the forearm. Remember supination? From Starz episode 107 The Wedding, we see a fine example of forearm supination (and elbow joint extension) as Dougal slices Claire’s wrist for her blood vow with Jamie. With the forearm in supination, ulna and radius are parallel, palm faces forward or up, thumb is directed away from body.

Recall pronation? Next is a great example of forearm pronation (and elbow joint flexion) as Claire removes Frank’s gold wedding band prior to marrying Jamie (Starz episode 107, The Wedding). In forearm pronation, distal radius crosses distal ulna, palm faces downward or back and thumb is directed toward the body.

Try this: To review, flex your elbow joint and alternately rotate forearm between supination and pronation. Review positions of radius, ulna and thumb in each of the two movements.

The forearm contains a whopping 20 muscles: eight in a flexor compartment and 12 in an extensor compartment! Flexor muscles lie anterior to ulna and radius and are best demonstrated with a supinated forearm. Photo C shows five muscles of the flexor compartment which arise from the medial epicondyle of humerus (red arrow). I’ll not drown you with the intricate names which reflect function and position. Suffice it to say that although the muscle bellies of the flexors lie in the forearm, they become tendons near the wrist (blue arrow) and then insert into bones of the hand and cause movement.

Photo C

Try this: Examine your wrist with palm up and see or feel various tendons: these are the flexor tendons that arise in the anterior forearm but insert on bones of wrist, thumb and fingers.

The 12 extensor muscles of the forearm lie posterior to radius and ulna and are best viewed from the back of a supinated forearm. Photo D (forearm viewed from the back) shows four extensor muscles which arise from the lateral epicondyle of humerus (red arrow). Again, naming all 12 extensors along with their actions truly would be tedious. However, the same theme repeats itself: the muscular part of the extensors lie in the forearm, they become tendons near the wrist (blue arrow) and insert into bones of wrist, thumb and fingers and cause movement.

Photo D

Try this: Examine your hand with palm down and see or feel various extensor tendons on the dorsum of hand. Next, grip your supinated forearm and make a strong fist. Now bend the wrist toward (flexion) and then away (extension) from your torso. Feel muscles of flexor and extensor compartments alternately contract and relax with wrist movement? Just doing their jobs!

Want to see an excellent example of extensor tendons (Starz episode 109, The Reckoning)? Here Claire threatens a shocked Jamie within an inch of his carotid arteries! The taut tendons (red arrows) on the dorsum of her hand belong to an extensor forearm muscle (extensor digitorum). Mmphm, she doesna even break rhythm. Jamie croaks “You have my word!” No surprise there! Erm, that’s one impressive looking dirk!

You may recognize Rembrandt’s famous 1632 painting The Anatomy Lesson of Dr. Nicholaes Tulp (Photo E – body likely a condemned criminal). As demonstrator of anatomy (a position I held for many years), Dr. Tulp was demonstrating left forearm and hand muscles to eager viewers. The painting records a real event: in that era, public dissections were not uncommon in Europe. But, did you know this fabulous work of art is anatomically questionable? Indeed, its anatomical accuracy has been debated for decades with advocates as well as detractors. One meticulous study recreated Dr. Tulp’s lesson and concluded that the work was anatomically incorrect, but posited that it was intended to be a symbolic rather than an accurate depiction of the dissection.

What is anatomically incorrect about Rembrandt’s masterpiece? Let’s reason together. The body’s right forearm is pronated but the left forearm is supinated (palm up and thumb directed away from body). Now, which humeral epicondyle gives origin to forearm flexors? If you answered medial epicondyle, congrats! But, the painting shows left forearm flexors arising from the lateral epicondyle and therein lays its major (there are minor ones too) anatomical inaccuracy! As such, the work is a valuable teaching aid for lectures and exams to promote observational skills.

Photo E

Now for the hand: in science, the term hand or manus (Latin for hand) is used to identify the termini of our upper limbs.

The front of the hand is its palmar surface (Photo F); it is fleshy because it includes intrinsic hand muscles (in a later lesson), forearm flexor tendons, blood vessels, nerves etc. Palmar skin is thick, hairless and lacks sebaceous glands (Anatomy Lesson #5 & Anatomy Lesson #6). The dermis is thrown into deep ridges which increase friction and help secure grip. Dermal ridges are also the anatomical basis for fingerprints. Compared with other skin, palm skin is lighter in color because its cells have genes inhibiting melanin production and the ability to tan (Anatomy Lesson #6).

Try this: Examine the whorls of one fingertip and realize that dermal ridges create the valleys and elevations of a finger print.

The hand back is its dorsum or dorsal surface (Photo F): this is covered with hair but the skin is thin, soft and pliable and it tans. This surface also has little flesh because it contains no intrinsic hand muscles and contains flat extensor tendons, blood vessels and nerves.

Try this: Alternately supinate and pronate (Anatomy Lesson #20) your forearm to compare and contrast palmar and dorsal skin, the presence or absence of hair and the relative thickness of the skin.

Photo F

The hand is divided into wrist (blue overlay), mid-hand (green overlay) and five digits (Photo G). Fingers can be folded individually or together over the palm allowing objects to be grasped. With the palm facing up or forward, the thumb or pollex (Latin meaning thumb) points away from the body. Also, our thumbs are opposable meaning they can be brought toward each or all fingers as in a pinch.

Photo G

An interesting tidbit about digits: in anatomy, the digits are numbered 1-5 beginning with thumb and ending with little finger (Table 1 -1^st column). But, the English word “finger” includes the thumb (Table 1 -2^nd column) and matches the anatomical digit number. Now in the U.S., digits are defined as thumb and four fingers (Table 1 -3^rd column) meaning the 1^st finger is also the 2^nd digit! This can be a problem. Why? Let’s say a patient is scheduled for a digital procedure – the correct digit must be designated: do written instructions refer to a finger or a digit?

The good news: nowadays U.S. anatomists and clinicians preferentially use the digit name (Table 1- last column): thumb for 1^st digit, index for 2^nd, middle for 3^rd, ring for 4^th and little/small for 5^th. This practice helps minimize medical error and most importantly, protects the patient! In this lesson, I use the digit naming system.

ANATOMICAL DIGIT NUMBER	ENGLISH FINGER NUMBERING SYSTEM	U.S. FINGER NUMBERING SYSTEM	DIGIT NAME SYSTEM
1^st	1^st (thumb)	Thumb	Thumb
2^nd	2^nd	1^st	Index
3^rd	3^rd	2^nd	Middle
4^th	4^th	3^rd	Ring
5^th	5^th	4^th	Little/small

Table 1

Try this: Starting with the thumb, assign numbers to digits and repeat using digit name.

Next, let’s consider nerves of the hand. Three large nerves innervate skin, blood vessels, muscles, ligaments, joints and bone coverings (periosteum) of the hand. Some fibers provide sensory information to the brain while others stimulate muscles to contract and glands to secrete. The three nerves of the hand are: radial, median and ulnar (Photo H).

Photo H

Palmar skin has one of the densest arrays of nerve endings in the human body and is an exquisite source of tactile info to the brain. Here, sensation in the form of pain, temperature, vibratory sense, pressure and touch is mostly provided by median (gold) and ulnar (blue) nerves (Photo I). And, yes, believe it or not sensation to the palmar surface of ring finger is split down the midline between median and ulnar nerves!

Photo I

Sensation to the dorsum of the hand is supplied mostly by radial (pink) and ulnar (blue) nerves but the median nerve (gold) supplies some fingertips (Photo J).

Photo J

Try this: Place index and middle fingers in the groove behind the medial epicondyle of one humerus (Anatomy Lesson #20) and move the fingers up and down. Feel a faint shocking sensation? Congrats! You found your ulnar nerve! Supinate the forearm and press deeply with the thumb just above the wrist. Feel the discomfort? You just found your median nerve (involved in carpal tunnel syndrome)!

Next, let’s examine the hand skeleton: each hand contains 27 bones. Together both hands contain more than 25% of the 206 bones of the entire human skeleton! This is not only amazing it also accounts for hand movements: more bones = more joints = more movements. Hand bones include (Photo K – palm faces the face): 8 carpal bones (purple) of wrist; 5 metacarpal bones (orange) of mid-hand; 14 phalanges of the digits. Finger phalanges are further named by position: proximal phalanges (green) articulate with metacarpal bones and intermediate phalanges; intermediate phalanges (blue) articulate with proximal and distal phalanges; distal phalanges (peach) articulate with intermediate phalanges. Note that the thumb has only two (proximal and distal) phalanges.

Photo K

Try this: Palpate your hand and locate all 5 groups of hand bones.

The carpus (Latin for wrist) consists of eight interlocking carpal bones arranged in two rows of four bones each (Photo L – supinated hand points away from body). The main roles of the carpus are to facilitate effective positioning of the hand, increase freedom of movement at the wrist, and form an arch (carpal tunnel) through which passes tendons and a nerve.

Carpal bones have Latin names meaning moon-shaped, boat-shaped, three-cornered, etc. They are named beginning on the thumb (metacarpal #1) side of the near row and moving to the thumb side of the far row.

Photo L: Figure0435A carpal bones KLS edited

How does one recall carpal names and positions? This is a fun and popular mnemonic used by anatomists and one designed to keep student attention: Some Lovers Try Positions That They Can’t Handle. This one is suitable for public consumption – some are not: anatomists being naughty!

ROW NUMBER	BONE NAME	BONE NAME	BONE NAME	BONE NAME
Proximal Row	Some (scaphoid)	Lovers (lunate)	Try (triquetrum)	Positions (pisiform)
Distal Row	That (trapezium)	They (trapezoid)	Can’t (capitate)	Handle (hamate)

The mid-hand (palm) region contains five metacarpals one for each digit and labelled #1- #5 beginning with the thumb (Photo M).

The digits contain phalanges: proximal and distal for thumb and proximal, middle and distal for each finger (Photo M). Do the math: yep, adds up to 27 bones! The hand also contains a few small sesamoid bones (red arrow) but their numbers are inconsistent and not included in the bone count.

Photo M

The number of joints in the hand is mind boggling! Here they are (Photo N):

Intercarpal (IC) Joints: between and among the carpal bones (purple arrows).
Carpometacarpal (CM) Joints: between distal row of carpal bones and metacarpal bones (blue arrow).
Metacarpophalangeal joints (MP) Joints: between metacarpals and proximal phalanges (green arrow).
Proximal interphalangeal (PIP) joints: between proximal and middle phalanges of fingers (red arrow).
Distal interphalangeal (DIP) joints: between middle and distal phalanges of fingers (orange arrow).
Interphalangeal (IP) Joint: Between two phalanges of thumb (black arrow).

Photo N

Try this: with your own hand, identify as many of these joints as possible.

This is a terrific example from Starz episode 107 The Wedding showing some of hand joints as Jamie reaches into his sporran to retrieve his brooch (green arrow = MP joint; red arrow = PIP joint). Murtagh just wants to spit-polish the pin. To be that pin…sigh…

An interesting and not uncommon congenital condition is the presence of supernumerary digits on hands/feet. Known as polydactyly, the additional digit(s) may or may not be functional. Photo O is an x-ray of a child’s hand with an additional normal metacarpal (red arrow) and digit (green arrow). Here, metacarpals crowd at the CM joints (blue arrow) to make room for the extra bone. Supernumerary digits may be surgically treated. The world record holder was born with 34 digits on hands and feet. Our Jamie could use another one of these for sure!

Photo O

As already noted, the hand is capable of many movements because of the numerous bones and joints. There are 16 classical hand movements although many more combos are possible. Five movements occur at the wrist (Photo P) giving it considerable flexibility: flexion, extension, radial deviation, ulnar deviation and circumduction. Contraction of forearm flexors causes wrist flexion and contraction of forearm extensors causes wrist extension. Interestingly, radial deviation (hand draws toward radius) occurs if radial extensor and radial flexor contract simultaneously. Ulnar deviation (hand draws toward ulna) occurs when ulnar extensor and ulnar flexor contract simultaneously. Circumduction (not shown) occurs as the wrist rolls in a circular motion.

Photo P

Try this: Mimic the four wrist movements as shown In Photo P. Try circumduction which is not shown.

How about examples of wrist movements from Outlander episodes? Here are two to keep you focused!

Claire has one major throwing arm! Here she extends her left wrist and elbow joint for balance (red arrow); her right wrist is also extended (blue arrow) but the same elbow joint is flexed as she launches crockery at Jamie! She’ll not let him beat her (Starz episode 109, The Reckoning) without opening up her own can of whoop ass!

Here in a steamy scene of make-up sex, Claire’s left wrist is in ulnar deviation (hand moves toward ulna – red arrow) as she gently touches the face of her warrior husband (Starz episode 109, The Reckoning). Gah! Scoop me up with a spoon…what a scene!

Next, let’s examine movements of the thumb, an extremely versatile digit. Photo Q shows 6 classic thumb movements: abduction (thumb moves 90° from palm and fingers); adduction (thumb returns to resting position); extension (thumb moves away from the fingers but remains in the same plane); flexion (thumb curls in front of the palm); opposition (thumb pinches one or all fingers). In the resting position or reposition, thumb is adjacent to palm and fingers. One last thumb movement is circumduction (not shown) wherein the thumb is rolled in a circular motion.

Photo Q

Try This: Move your thumb through all 7 movements as described above.

Thumb movements are plentiful in Starz episodes. Here is Claire using her left thumb to steady the beautiful ring placed on her right ring finger by The Big Red One (Starz episode 107, The Wedding). Her thumb IP joint (blue arrow) is flexed; MP joint (red arrow) is mostly extended.

We havena see Dougal for a while so here he executes one of his devious, seal-a-deals with Claire: if she canna free Jamie or he is dead, she will marry him (Starz episode 114, The Search). Uhhh…I dinna think Claire will marry Dougal –no way, no how – but a clever ruse to access his men for a rescue attempt.

Finally there are four finger movements: abduction wherein index, ring and little fingers move away from the middle finger (Photo R –purple arrows). By definition the middle finger abducts no matter which direction it sweeps (think windshield wiper). Adduction is returning fingers to the resting position (Photo R –green arrows). Finger abduction and adduction are carried out by intrinsic muscles of the hand which will be cover in a later lesson.

Finger flexion occurs when one or more fingers are curled toward the palm and includes some or all MP, PIP and DIP joints (Photo R –red arrows). Contraction of forearm flexors (and intrinsic hand muscles) produces these movements. Finally, finger extension (Photo R -blue arrows) occurs when one or more fingers are straightened. Contraction of forearm extensors produces these movements.

Photo R

Try this: Using the fingers, try flexion, extension, abduction and adduction.

Claire is in our sights once again as she circles Jamie (Starz episode 107, The Wedding). Her left fingers are extended and abducted; thumb is extended. Not only is this a great example of hand movement butt, oops, but, it is also…well, we all ken this hand gesture!

Finally, thumb and fingers provide various power grips the muscular force generated by the hands (Photo S). Grip is important in everyday life and for most athletic ventures.

- Cylindrical power grip uses thumb abduction and finger flexion to tightly grasp a rounded object.
- Spherical power grip is similar but thumb abduction and finger flexion is looser as in gripping a larger object.
- Hook power grip uses extended MP finger joints but flexed DIP and PIP joints (thumb may be flexed or abducted) as in carrying the handle of a bucket.
- Precision pinch grip is used to grasp small or delicate items.

Photo S

Jamie exhibits a hook power grip as his right hand clutches his dirk: MP joints extended, PIP and DIP joints flexed. He’s headed for Fort William with an empty gun and his own bare hands to rescue Claire from the redcoats (Starz episode 109, The Reckoning)!

Next, is a great example of precision pinch grip in which right thumb opposes right index finger as Jamie clutches his doomed petition of complaint for the Duke of Sandringham. Humm…wonder what those bloody MacDonalds are doing here…

Next is a terrifying example of a cylindrical power grip with BJR’s left thumb abducted and fingers flexed around Claire’s swanlike neck (Anatomy Lesson #12). He is hurting her and her face is sheened with tears and “the sweat of exertion” as narrated by BJR (Starz episode 115, Wentworth Prison).

Yet another example of the cylindrical power grip. Look familiar (Starz episode 108, Both Sides Now)? Remind you of anyone you know? Puir not-her-name Sally! She messed with the wrong guy…iffy spherical power-grip genes in that line.

As if we need a reminder, our beloved Jamie’s hands are nimble and elegant (Starz episode 107, The Wedding). In fact, his fingers and hands play their own characters just as Claire’s hair does (Anatomy Lesson #6) throughout the books. This was especially evident during his marriage to Claire. Here his left fingers drape gracefully over his right wrist as he utters his blood vow. His left thumb is slight abducted. His right hand executes a loose spherical grip around Claire’s right wrist and forearm. Stunning imagery!

WARNING: the time has come to examine the damage to Jamie’s hand. After the next few paragraphs, his torture will begin so skip to the kitten if you must.

Fast forward to Starz episode 115, Wentworth Prison, an episode thoughtfully rated “graphic violence”!

About midway through the episode, Jack makes an offer Jamie canna refuse: a swift and honorable death in exchange for free use of his body. But, Jamie does refuse: “I’ll not surrender to you or any man.” The foul fiend vows “I will have your surrender before you leave this world.”

Next, a great scuffle ensues given that Jamie is half starved, chained by an ankle manacle and weaponless against two men, one a minor league giant. Black Jack asks “why do you force me to hurt you?” Oh yeah, Jamie’s forcing your hand! As instructed, genius Marley slams Jamie’s left hand on the wooden table as Jack grasps the mallet (aye, he has it in a spherical power grip).

Jack smashes the mallet on Jamie’s left mid-hand followed by about three more strikes. The vulgar villain then launches a volley of totally insane queries: Why do you force me to treat you in such an abominable way? Why do you choose to spend the few hours left to you as a miserable cripple? Why do you force me to hurt you? Och, he’s a delusional devil!

Soon, Claire finds Jamie alone (from Outlander book):

“What has he done to you?” I asked … Moving with exquisite care, he used his left hand to lift the object he had been cradling. It was his right hand, almost unrecognizable as a human appendage. Grotesquely swollen, it was now a bloated bag, blotched with red and purple, the fingers dangling at crazy angles. A white shard of bone poked through the torn skin of the middle finger, and a trickle of blood stained the knuckles, puffed into shapeless dimples.”

But a minor detail, the left hand is mashed, otherwise the destruction is akin to the Outlander book’s version: swollen fingers, black and blue skin, blood, bone/tendon exposed. A heavy mallet messes with delicate hand anatomy!

Unfortunately the effing, sadistic piece of shite and his Igor return to find Claire with Jamie. An engrossing exchange ensues between the black bastard and Claire as Marley adds his own singular brand of visual horror. With a flare of desperate strength and courage, Claire shoves Marley and pushes BJR into a wall in a vain attempt to strangle him. Marley ends up dead and Claire ends up hostage.

Next arrives the pivotal moment in this entire episode: Jamie, accepting that he will die on the morrow offers himself in exchange for Claire’s life. “Let her go in safety and you can have me. I won’t struggle. You, you can do as you wish. You have my word!” His body is the only card he has left to play in this gruesome game and he uses it to ransom Claire. Diana explains (Outlander book):

Randall walked slowly…picking up the mallet as he went. He held it up, ironically questioning. “You’ll allow me a brief test of your sincerity?” “Aye.” Jamie’s voice was as steady as his hands, flat and motionless on the table. I tried to speak, to utter some protest, but my throat had dried to a sticky silence. Moving without haste, Randall… positioned the point with care and brought the mallet down, driving the nail through Jamie’s right hand into the table with four solid blows.

In the Starz episode, Jamie’s left palm faces up as Jack impales it to the table. Intentional or not and regardless of your philosophical bent, the shocking image of Jamie’s palm pierced by a nail driven into wood is the ultimate symbol of sacrifice in the Western world. And, a costly sacrifice it is.

ep 115 Jamies hand 02 KLS edited

peeking

It’s safe to come out now! Had to use two kittens just to make sure…

“I love you, mo nighean donn.”

What bolsters us, is the knowledge that Claire’s loving kiss will help sustain Jamie trapped in the vortex of Jack’s dark madness.

Again, from Neil:

Warm, touchin’ warm

Reachin’ out, touchin’ me, touchin’ you

ep 115 Claires hand KLS edited

Now, a few final comments for the sake of science: take heart all! in Outlander book Claire observes that Jamie handles a fifteen pound Claymore as though it were a mere flywhisk. Jamie is a warrior, an athlete whose limbs are heavily muscled. Many studies have shown that muscular activity thickens bones; ergo, Jamie’s hand bones will tolerate more abuse than most because he is so fit and fine.

Further, will the nail wound greatly damage Jamie’s hand? Actually, not so much! In the living, nerves, tendons and larger blood vessels are slippery and will likely slide away from the nail path. But, the pain is agonizing: pain receptors of the mangled hand are already on fire from the mallet and the nailing adds fuel to that inferno. But, of the two tools, the mallet is by far the greater destroyer.

Farewell for this lesson. Let us join hands in the hope that Starz episode 116 sees Claire redeem Jamie’s hand and his soul!

The deeply grateful,

Outlander Anatomist

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Photo Credits Starz, Gray’s Atlas of Anatomy for Students, 2005, Netter’s Atlas of Human Anatomy, 4^th ed., Clinically Oriented Anatomy, 5^th ed., www.breakingmuscle.com, www.britannica.com, www.cs.cmu.edu (types of grips) , www.pinterest.com, www.physioadvisor.com.au, www.pixshark.com, www.researchgate.net, www.slice-works.com, www.the anatomist.wordpress.com (thumb movements), www.ittcs.wordpress.com (arches of hand with grip), www.wikipedia.org, www.wikiradiography.com, www.webmd.com, www.heroesandheartbreakers.com, www.englishstackexchange.com.