Human Anatomy taught through the lens of the Outlander books by Diana Gabaldon and the Starz television series
Our second installment of Guts of Outlander. Claire teaches us how to reduce a dislocated shoulder joint! She uses the Kocher technique.
Thanks to Mandy Tidwell for the Scottish Gaelic translation! greatscotblog.com/2014/08/03/out… 🤗❤️👍🏻
The deeply grateful
Outlander Anatomist
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Starz episode 101, Sassenach
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:
Hangings typically traumatize one or more of these neck structures:
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.
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:
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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Anatomy Def: Ha, ha – anatomy defines anatomy! No, just joshing. Anatomy is the science of the body (human and other organisms) and its parts.
Outlander Def: Claire’s first day in Dr. Simms’ anatomy theater as the only female first year medical student. Don’t touch my blade, young lady! <G> Grateful Joe Abernathy was at her side and she by his.
Learn the history of this topic in Anatomy Lesson #34, The Amazing saga of Human Anatomy.
Human Anatomy is the oldest of the medical sciences. The word derives from the Greek ana-, meaning up combined with temnō, meaning I cut. It doesn’t take rocket science to recognize this term infers the use of dissection to discern an organism’s design.
Fun Fact: This is important. Do you ken how to pronounce the word, dissection? It is pronounced dis-section not di-ssection. Thus, we dis-sect an organism but we bi-sect a line. Got it? Yay, students!
Anatomy covers the structure of cells, tissues, organs, and organ systems throughout all stages of life. The anatomist is concerned with name, shape, size, position, texture, relationship, blood supply, and innervation of such structures. Classically, physiologists study function and biochemists follow processes, although nowadays, these distinctions tend to blur.
The roots of human anatomy arguably began with the Ancient Egyptians (2,600 BCE), a culture which believed a soul could retrieve its mummified body before journeying to the underworld. These embalmers understood some anatomical regions quite well. But, if we include animal anatomy, first prize goes to creators of Australian Aboriginal rock art, some of which date to 40,000 years ago!
Human anatomy with dissection has been the foundation of western medicine for the last several hundred years. Why? Well, if your beloved computer goes haywire, you don’t want joe blow tinkering with it, do you? Likewise, who places their body in the hands of a practitioner who knows little about its design? Nope!
Early western medical schools used three individuals to present a dissection. A lecturer stood on a raised dais and read from an ancient anatomical text (Galen). A barber surgeon performed the dissection. An individual wearing a black hat pointed to the structures using a baton. Over the years, barber surgeon and black hat fused into a single position, the Demonstrator of Anatomy, a position I held at my institution for almost two decades.
Then, a huge leap in anatomical knowledge occurred in the 16th century, due largely to the genius of Flemish physician and anatomist, Andreas Vesalius (1514-1564), Father of Modern Anatomy. Andreas championed dissection coupled with direct observation, thereby dispelling wrongful ideas that had endured for over 1400 years!
Following the work of Vesalius, human anatomy enjoyed a burst of anatomical discovery and illustration! Today’s anatomical “bible” is, of course, Gray’s Anatomy. My own edition weighs in at 10 pounds, appears in size 8 font, and boasts 1500+ pages. And, it still doesn’t cover the entire breadth and depth of human anatomy!
Read about Claire’s commitment to anatomy, medicine, and surgery in Voyager book. From the “pen” of Herself:
I picked up his right hand and transferred it to my own knee. He let it lie there, warm, heavy and inert, and didn’t object as I felt each finger, pulling gently to stretch the tendons and twisting to see the range of motion in the joints.
“My first orthopedic surgery, that was,” I said wryly.
“Have ye done a great many things like that since?” he asked curiously, looking down at me.
“Yes, a few. I’m a surgeon—but it doesn’t mean then what it means now,” I added hastily. “Surgeons in my time don’t pull teeth and let blood. They’re more like what’s meant now by the word ‘physician’—a doctor with training in all the fields of medicine, but with a specialty.”
“Special, are ye? Well, ye’ve always been that,” he said, grinning. The crippled fingers slid into my palm and his thumb stroked my knuckles. “What is it a surgeon does that’s special, then?”
I frowned, trying to think of the right phrasing. “Well, as best I can put it—a surgeon tries to effect healing … by means of a knife.”
His long mouth curled upward at the notion.
“A nice contradiction, that; but it suits ye, Sassenach.”
See Claire’s anatomy course in Starz ep 302, Surrender. Six scalpels lay before Dr. Simms. Where are the scissors? But the truth is, a scalpel is useful for skin incisions but it is then laid aside and replaced with the finest dissection tool of all: a pair of long-bladed scissors!
The deeply grateful
Outlander Anatomist
Postscriptum: I have had the privilege of teaching dissection using more than 500 donor bodies. I thank them and their families for the privilege of learning from their temples of flesh. Dissecting the human body is an honor that has changed me, forever.
Photo Credits: Starz