Fun Fact: Necrosis


Anatomy Def: Necrosis means tissue death, as caused by disease, injury, or loss of blood supply.

Outlander Def: Jamie’s dreadful, blackening wound courtesy of a fang-bang! 🐍

Doubtless, Jamie’s horrific thigh wound in Outlander, episode 509, Monsters and Heroes, caused each of us to cringe! 😣

Learn about necrosis in Anatomy Lesson #37: Outlander Owies – Mars and Scars!

Depending on the species of snake, venoms cause predictable signs and symptoms. Within minutes to hours after the bite, Jamie exhibits most of the following:

    • Puncture marks at the wound ✔︎
    • Redness, swelling, bruising, bleeding, or blistering around the bite ✔︎
    • Severe pain and tenderness at the site of the bite ✔︎
    • Increased salivation and sweating ✔︎
    • Labored breathing (in extreme cases, breathing may stop altogether) ✔︎
    • Rapid heart rate, weak pulse, low blood pressure ✔︎
    • Numbness or tingling around face and/or limbs ✔︎
    • Disturbed vision (?)
    • Nausea, vomiting, or diarrhea (?)
    • Metallic, mint or rubber taste in mouth (?)
    • Muscle twitches (?)

Back at the surgery, Claire quickly ascertains that Jamie’s wound is infected!

What might be the source(s) of the infection? Here are some ideas:

    • Bacteria from the snake’s fangs and saliva
    • Bacteria from Roger’s knife
    • Bacteria in Roger’s saliva, as he drains Jamie like a vampire (Sorry, Bree)
    • Dirty bandage
    • Forest floor
    • All the above? 😲

As recorded in The Fiery Cross (TFC),  Claire determines that Jamie’s infected wound shows signs of septicemia, broadly known as blood poisoning.

The foot and ankle on the injured side were still warm and pink—or rather, red. That was a good sign, insofar as it meant the deeper circulation was intact. The problem was to improve circulation near the wound, enough to prevent a massive die-off and sloughing of tissue. The red streaks bothered me very much indeed, though; they could be only part of the hemorrhagic process, but it was more likely that they were the early signs of septicemia—blood poisoning.

Claire must halt the infection quickly because sepsis is life-threatening! Using the serpent’s fangs she injects Jamie with home-brewed penicillin to kill the blood-borne organisms.

Add insult to injury: the wound  also exhibits necrosis! Claire evaluates the red-black tissue at the bite-site (see above image) –  this tissue is dead. 

What causes necrosis? Most likely, loss of blood supply. Necrotic tissue must be removed to avoid loss of muscle mass, gangrene, and possible amputation! 🦵Removing  the dead tissue is a process known as debridement.  

Alrightie, then. How might Claire debride the wound to remove dead tissue but spare the living? Surgical removal is always an an option but difficult to perform with the precision required. If she accidentally leaves necrotic tissue, it can still turn gangrenous. If she accidentally removes living tissue along with the dead, it further compromises Jamie’s thigh. Hum…. 🤔

Well, here’s an idea….. 💡 How about someone rustles up some fly maggots, blow-fly maggots to be precise – Bree (in TFC) or Josiah (in ep 510)??? 

So, into the wound go the maggots and its suppertime! 😋 As gross as it seems, not only will maggots clean Jamie’s wound of necrotic tissue while sparing the living,  his wound will heal faster. Truth! 

“Nothing but a mouth and a gut,” declares Claire (TFC)!

So, where did Claire get the idea of using maggots in Jamie’s wound? From her medical training, of course.

Maggot therapy is the introduction of live maggots into human or animal wounds to remove necrotic tissue but spare the living. (Psst….Just so you know, in today’s medicine, maggots are disinfected before use.) 🤫

Understand, maggot therapy is not new. Aboriginals of Australia and Mayan tribes in Central America frequently used fly larva to clean wounds. Clearly, these folks were observant of the world around them! 👀

When did Western medicine start to employ maggots? In the 1500s, some field surgeons (e.g. Ambroise Paré) observed that wounds infested with maggots healed faster but failed to credit the wee beasties as healers. The first documented therapeutic use of maggots in the US is credited to Confederate medical officer, Dr. J.F. Zacharias, who reported during the American Civil War that:

“Maggots … in a single day would clean a wound much better than any agents we had at our command … I am sure I saved many lives by their use.

Today, some modern hospitals employ medical maggots (Maggots, LLC? 😜) to solve otherwise vexing cases that do not respond to traditional therapies.

One last note – do we believe that a poisonous snake bit Jamie? Nope.

I love Jamie’s (Diana’s) succinct and accurate comparison of venom vs. poison; from Diana’s fourth book, Drums of Autumn:

“Venemous,” Jamie corrected him. “If it bites you and makes ye sick, it’s venomous; if you bite it and it makes ye sick, it’s poisonous.”

Read about Jamie’s horrific snake bite injury and Claire’s therapy in Diana’s fifth book, The Fiery Cross.

“It looks nastier than it is,” I said reassuringly, hearing Marsali’s unguarded gasp at the sight. That was true, but the reality was nasty enough. The slash marks were crusted black at the edges, but still gaped. Instead of the sealing and granulation of normal healing, they were beginning to erode, the exposed tissues oozing pus. The flesh around the wounds was hugely swollen, black and mottled with sinister reddish streaks. I bit my lip, frowning as I considered the situation. I didn’t know what kind of snake had bitten him—not that it made much difference, with no antivenin for treatment—but it had plainly had a powerful hemolytic toxin. Tiny blood vessels had ruptured and bled all over his body—internally, as well as externally—

See Jamie receive maggot therapy for his necrotic wound in Outlander, episode 509, Monsters and Heroes.

Thank you, Claire!

Be well, Jamie! 🙏🏻

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz 

Meet Graham McTavish – OV Party in the Suites

Sunday was a wonderful day for me. I joined Outlandish Vancouver (OV) for a “Party in the Suites” with none other than Dougal-in-Disguise, Graham McTavish!  🤗

What is Outlandish Vancouver? In normal years, OV is an annual event held in Surrey, British Columbia 🇨🇦, independent from but concurrent with Surrey International Writer’s Conference (SiWC). Click the link to find Outlandish Vancouver website or, if you prefer,  the OV Facebook page!

Who is the mastermind behind OV? Well, it is KoKo, a.k.a. Pippi Pipkin (she is a wee lass)!  She came up with this wonderful plan and now enjoys a volunteer staff including Sam and  Karin (see next image).

Fans and OV admin folks gathered on Zoom a few minutes before the start of Graham’s session to share info about appropriate discussion topics, courtesy for virtual events, and filming/audio recording rules.

We were all smiles and delighted to be part of this wonderful event!

Then, Graham appeared exactly on time, looking dashing, as always,  in sweater, beard, smile and mellifluous voice.  We individually introduced ourselves and then we were off on a delightful Q and A trip with Mr. McTavish. Lucky us!

First, Graham was congratulated for Clanlands: Whisky, Warfare, and a Scottish Adventure Like No Other!, the new book authored by Graham and Sam Heughan. Graham is delighted with the book’s reception and its speedy advance to the top of multiple best seller lists! 📚

We learned an interesting fun fact about Graham’s name. One fan had the last name of Thompson. Turns out, Thompson is the anglicized version of McTavish. I didn’t know! 🤔

As a child in the 1960s, Graham lived in Vancouver, B. C. That prompted an invitation to attend the next in-person OV event. He said he would 💓 to come! Fingers crossed that this wish becomes reality once COVID is beaten back. 🤞🏻

One fan had a series of snappy questions for Graham (I think it was Keri). All her questions concerned Sam and Graham on the road for Clanlands book. Here they are:

Q: Who has the messier luggage?

A: Both of us are messy. But, as he thought about it, Sam’s luggage is the messiest!

Q: Who is more of a chatter box?

A: I am! Graham out-chatters Sam!

Q: Who is the more competitive?

A: Sam!!! He is competitive to a ridiculous level –  very, Very VERY competitive! 😆

Q: Who can do the most pushups?

A: Graham couldn’t answer because he doesn’t how many Sam can do. He also did not tell us how many he can do.

Q: Who is the most shy?

A: Both of these fellows are shy, but Sam is more so. Graham pointed out that many actors are shy, by nature. Acting probably gives them license to express themselves while taking on another identity.

Q: Who is more of a diva?

A: Ha, ha. It’s Graham! He qualified that response, pointing out neither of these lads are divas and Sam puts up with more discomforts than he should. Graham perfers his creature comforts! 😃

Q: Who forgets their lines more?

A. Sam. 😲

Q: Who was the most demanding of the Clanland crew?

A: Graham! 😇

Q: Who best wears the kilt?

A. Graham, of course!!! 😜

How many Clanlands book plates have he and Sam signed? Graham thought for a moment and then replied – he thinks it is 8,000 – 9,000! 😳

In answer to the question, did you read Outlander book before accepting the role of clan war chief, Dougal MacKenzie? Graham replied, “No.” However, he noted, almost none of the cast had read the books before filming but did so in very quick order. Furthermore, Graham was offered the part and felt Dougal was a perfect fit for him.

Have roles been easier to snag since Outlander? Graham answered, yes, it is easier now.  He likes to work and keep busy. He prefers roles which involve horseback, swords, guns, cloaks, and candles. He has never played a lawyer.

Now, wait just a minute! 🖐🏻 As I recall, William Buccleigh (Buck) MacKenzie is a lawyer!!! 😉

What did you think of your wig as Buck? His daughter prefers him in the wig (she is young). I, for one, like his full beard and bald pate! 😄

What is your favorite form of exercise? Long distance cycling, says Graham…as in many miles. He has cycled all over Scotland, Ireland, and England. Since it is an outdoors activity, he has been able to continue unabated during COVID. Although he didn’t mention it, I wager he has also cycled all over New Zealand! 🇳🇿

What role would you like to play but haven’t as yet?  Graham said he is not interested in rolls in procedural dramas such as a lawyer (too late – see above!) or a doctor. Most of all, he would love to play a cowboy in a bona fide, hay-burner western! 🤠

In  Preacher, he did play a sort-of cowboy, starring as The Saint of Killers –  complete with guns, horse, saber, and Stetson hat! He was thrilled that the saber he carried was of Civil War vintage and even bore the marks of battle!

Graham pointed out that a Scotsman playing a cowboy isn’t farfetched.  At least two Native American tribes were lead by Highlanders: Alexander McGillivray led the Creeks, and Duncan McDonald’s family were leaders of the Nez Perce tribe.

Q: Are audible and printed versions of Clandlands identical?

A: No, indeed, they are not!  The audio version was created over a three day span in a London studio, where as the written version was a collaboration that lasted a number of weeks. Ergo, they are very similar but not identical.

After visiting various Scottish museums with Sam, Graham became enchanted with the weaponry. He was able to handle them and assured us that Highlander weapons were perfectly balanced, well-designed killing machines! The dirk could pierce a Kevlar vest! And, the basket hilt of the broadsword not only protected the dominant hand, it was used like a metal fist to smash bones. (Pssst….. maybe it’s a guy thing) 😉

Graham was so impressed with the weapons, he commissioned a New Zealand swordsmith to make him a Scottish broadsword. He thinks it might come in handy when suitors of his eldest daughter come around – she just attended her first ball. 😆

BTW: The below image (Outlander, episode 209, Je Suis Prest) was written by Matt B. Roberts. The script called for Dougal, Angus, and Rupert to run butt naked in a Highland charge! This is based in history, as fighting naked has been attributed to Celtic warriors as early as 225 B. C. E. And, Highlanders carried on the tradition, dropping the kilt and fighting in sark or birthday suits. In the end (haha), Outlander opted for kilts, only! 😅

I  can personally vouch for Highlander weapons. Yours truly posing with spiked targe, broadsword, and dirk in 2016, Scotland! Targe and dirk were held in the non-dominant hand and broadsword in the dominant. Note the steel spike extending from the targe? That thing was almost a foot long. As the warrior struck with the broadsword, he also stabbed with dirk and slashed with targe spike!  Are you scared? 😜

Are you and Sam really friends? Yes! They enjoy a terrific friendship. Age difference is not a factor. 🤗

And, the last question was excellent: When you think of Outlander, what is the first thing you think of? Without hesitation, Graham answered, “laughter!” Especially with season one combo of characters!

Thus ended our happy hour with Graham McTavish. Thank you, Graham,  for providing us with the splendid characters of Dougal and Buck! Until next time. 🤞🏻

PS: Remember, if you wish to find out more about OV, you can find them on FB or their website.

PSS: Some OV images were taken by my iPhone from my iPad . Thus, they are a wee bit blurry. 🙄

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz, Outlandish Vancouver, KoKo Pipkin, Outlander Anatomy

Meet Paul Gorman – OV Party at the Suites

Oh, happy day! Saturday morning (Oct. 24), I joined Outlander fans for an Outlandish Vancouver Party in the Suite with Paul Gorman! 

You remember Paul?  He appeared in Outlander Season five, playing the Beardsley twins, Joshia (Jo) AND Keziah (Kezzie)!

What is Outlandish Vancouver (OV)? OV is an annual event held in Surrey, British Columbia, independent from but concurrent with the Surrey International Writer’s Conference (SiWC). 

I have been attending both events since 2016, although I missed 2017;  forgivable, because I was touring Scotland!  😃

A wee bit about SiWC. For more than two decades, SiWC  has included Diana Gabaldon as speaker, teacher, and panelist. One year, she served as organist for Michael Slade’s Shock Theater!  Shock is supposed to be silly and mysterious, hence the creepy music, but who knew she also plays the keyboard?

OV has focused entirely on Outlander, hosting celebrities and cast members. Over the years, I have met John Bell, Cèsar Domboy, Lauren Lyle, Steven Cree, Carmen Moore (S4, Wahkatiiosta), Braeden Clarke (S4, Kaheroton), and Trevor Carroll (S 4, Ta’wineonawira or “Otter-Tooth”), known in the 20th c. as Robert Springer!

Every interaction I have had proved to be delightful and well worth the long drive from Oregon to British Columbia!

This is me with Outlander’s Gaelic consultant, Àdhamh Ó Broin, who offered a rousing presentation and Gaelic lesson at OV 2016!  

You might wonder, who is the MasterMind behind the OV creative venture? Why, it is KoKo! Also known as the wee pocket dynamo!  

Both SiWC and OV were cancelled this year, but OV came to the rescue with virtual interactions between attendees and Outlander guests. Many thanks to her and her crew for their heroic efforts putting Outlander fans and cast in contact during a global pandemic. Kudos to all! 🙏🏻

Now, on to Paul! He joined the  Zoom group precisely at 10am PT,  to a bevy of adoring fans.

What a cutie!  Have you ever seen a more generous and genuine smile? Adorable! (psst…I can safely state this because I am old enough to be his grandmum!) 🤗

BTW, his somber IMDb photo does little to reflect this funny, articulate, and expressive young man!

As we each introduced ourselves, he greeted each attendee with enthusiasm, interest, and curiosity.

Understand, we came from near and far to meet Paul! Scotland, Washington, Oregon, Florida, New Jersey, California and as far away as Lebanon – the country!

And, this lucky lass, Carrie Needham, joined us from the Fraser’s Ridge set. Yep! She was actually there!!! 👍🏻

Paul offered a brief introduction including the tidbit that Lizzy finds BOTH brothers verra interesting. 😉😉

Next, each attendee was given the opportunity to ask Paul a question.

Tell us what your first day was like on the Outlander set? He thought for a moment and then responded that his prior acting experiences had been limited to theater so he was extremely nervous about filming!

Early on,  he met Caitlin O’Ryan (Lizzie Wemyss) for a “chemistry” test – it went very well!

On the first day of filming a van picked him up at 5am and hustled him to the set! Everyone, cast and crew, was extremely friendly and helpful, but he felt a bit overwhelmed by the number of people who periodically descended to fuss with his hair, costume, and makeup.  He explained that Sam and Cait helped calm and reassure him given the newness of the situation. He also said that Sam was always in the background crunching on carrots! 🥕😆

Given that Kezzie is deaf, how was their communication determined? Paul said that sign language wasn’t available to Kezzie and Jo, raised in the back country of North Carolina, so they had to develop their own communication scheme. 

In preparation, he worked with a consultant to develop style and signs unique to Kezzie. Paul recalls about 60 or 70 different signings  – extras in case a director asked something of Kezzie that was not scripted.

Were you outgoing and gregarious as a kid? No, actually he was shy and an introvert (surprising as he came across as a natural people-person in this Zoom).

He also noted that young girls scared him. How about the older ones? 😂

He settled on acting after visiting the Royal College of Art. Eureka! He realized hat he could get a job in the field of acting! And, aren’t we pleased that he did?

Are you musical? Yes! He plays bass and guitar in a band, although he claimed he sings, badly. Ahhh! I am dubious about this, because he possesses a mellifluous speaking voice!

Does he share similar traits with the twins? Paul said, yes. He pointed out that both Jo and Kezzie want to be part of a family. Kezzie, especially, is very affectionate. The twins are aware of the world and strive to put others first; these are traits Paul aspires to emulate. And, working on Outlander has affirmed to him how kind people really are.

Are you a hunter like Jo? Paul responded, “only of hearts!” Clever lad! 🥰

Paul has never hunted animals. Lacking such experience, he did research into Native American hunting styles reasoning that Jo would likely emulate their practices. He studied still hunting, a technique requiring practices such as slowness, patience, covering tracks, taking down the leader of a herd to make it less defensible. Growing up as a Beardsley servant in the back country of North Carolina, Jo also had learned by trial and error.  

He also revealed that in Outlander episode 509, Heroes and Monsters, the rabbit was dead but the maggots were very much alive!!! So, he is gaining experience with game. 😳

How did you film the twins together in one scene? Paul explained that director Jamie Payne had never filmed one actor acting as twins.  For some of the scenes, they used a double for him to interact with. For other scenes, Paul acted to air, but against a blue screen not a green one, as the latter did not work well in a forest setting. He said acting to air was not difficult because this is done in theater work.

Jo (L) and Kezzie from Outlander, episode 503, Free Will

Do you like cats? Turns out, Paul is obsessed with CATS! He likes dogs, but felines are the cat’s meow!

He has two cats and both are Siberian forest cats. He secured them from a breeder near Glasgow.  This breed is hypoallergenic and fetch much like dogs. 

He whipped put his phone and shared images of his furry children. They are sisters!


and Alexi.

If you could have a superpower, what would it be? Well, he has been obsessed with Spiderman since 5 y.o.! As proof, he shared a cute picture from his cell phone: Paul with his Spiderman costume! But, since Spiderman is not a super power, he would choose to be a shape shifter. Great choice, Paul!

Final question: How was the tonsillectomy scene from episode 505, Perpetual Adoration filmed?

He said filming that scene was trying because he spent the entire day with a mouthful of gauze! A bit of filming followed by “cut,” where upon his mouth was decorated with bits of blood or tonsillar scraps! More filming and repeat. The Outlander medical advisor was on hand to add authenticity and pointers.  

After the last question, the session came to a close. A thoroughly charming young man is Paul Gorman. I look forward to more storyline about Kezzie and Jo during Outlander, Season 6! 🙏🏻

Thank you OV and thank you Paul!

PS: If you wish to find out more about OV, you can find them on FB or their website.

PSS: OV images were taken from my iPad by my iPhone. Thus, they are a wee bit blurry. 🙄

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz, Outlandish Vancouver, Outlander Anatomy