Anatomy Lesson #54 Typhoid!!!

Posted by Outlander Anatomist | Anatomy Lessons

Greetings, all anatomy students! Today’s lesson explores Clarie’s Conundrum as presented in Starz episode 309, The Doldrums, and Starz episode 310, Heaven and Earth. Turns out, typhoid is not only interesting but timely. Today, western countries report so few cases of typhoid that it has largely faded from our collective consciousness. However, travelers to some parts of the world should beware and be aware!

The Doldrums has Claire confronted with threatening news! British man-of-war, the Porpoise, has hailed the Artemus, demanding she “heave” to (Ha ha! Shades of Jamie!) and be boarded. Captain/acting Captain/formerly third lieutenant Thomas Leonard needs a ship surgeon, post haste!

Described by Herself in Voyager book:

“You are the captain of this ship?” The Englishman’s eyes were red-rimmed from tiredness, but he picked Raines from the crowd of grim-faced hands at a glance. “I am acting captain Thomas Leonard, of His Majesty’s ship Porpoise. For the love of God,” he said, speaking hoarsely, “have you a surgeon aboard?”

Retiring to Captain Raine’s quarters, Leonard declares that Porpoise’s crew is plagued with Ship Fever!

  • 100 men are ill, 80 have died
  • griping pains in the belly
  • terrible vomiting (is there any other kind?)
  • fever
  • belly rash (via Claire’s prompting)
  • blazing shites… What? Gah!

Again, Voyager book offers a vastly more graphic description of the felled Porpoise crew:

Leonard blinked once, but then took a deep breath and nodded. “Yes. Well, it seems to start with griping pains in the belly, and a terrible flux and vomiting. The afflicted men complain of headache, and they have considerable fever. They …”

“Do some of them have a rash on their bellies?” I interrupted. He nodded eagerly. “They do. And some of them bleed from the arse as well. Oh, I beg pardon, ma’am,” he said, suddenly flustered.

With Supercargo overseeing his precious cargo, Sassenach Surgeon curtly dispenses  Rules to Captain Porpoise (Image A): 

  • You should have stayed on your own ship!
  • Do not touch anyone while on board!

Image A

Erm, too late Dr. Claire….. Acting-Capitan Leonardo not only boarded the Artemis, but accepted the hand of Mr. Warren (Image B)!!! 

Oh, dear –  so much for Ben Franklin’s sage advice:  “an ounce of prevention is worth a pound of cure”!

Image B

Soon, Claire is in the belly of the Porpoise, ripe with the foul odors of spilled bodily fluids –  the ship, not Claire! Such sounds and smells would have felled a lesser lass than our Daring Doctor (Image C).

Claire describes the gory scene in vivid detail from Voyager book:

It was dark in the tween-decks, the confined space lit by small oil lamps that hung from the ceiling, swaying gently with the rise and fall of the ship,… The stench was overpowering. Worse than unwashed seamen was the reek of vomitus and the ripe, throat-clogging smell of blood-streaked diarrhea, which liberally spattered the decking beneath the hammocks… My shoes stuck to the deck, coming away with a nasty sucking noise as I made my way cautiously into the area.

Image C 

Approaching a felled seaman, she asks permission to touch. “Aye, mum,” he mutters,  and Claire gently lifts his filthy wrap to find a belly covered with flat rose-colored spots. Such rose spots can appear on the abdominal skin but also on the chest.

Next, she presses fingers into his lower abdomen (Image D). EEK! What is she doing? Well, she is not being fresh. She could be checking inguinal lymph nodes to rule in or out, bubonic plague. Or, she might be pressing down over his cecum (Anatomy Lesson #48, The Big Guy!) or small bowel to gauge bowel pain. In case you do not ken, the cecum (caecum) is the first segment of the large intestine. The suffering seaman from Voyager book:

The occupant groaned and turned away his face as the light struck him. He was flushed with fever, and his skin hot to the touch. I pulled his shirt up and felt his stomach; it too was hot, the skin distended and hard. As I prodded gently here and there, the man writhed like a worm on a hook, uttering piteous groans. I pulled back the eyelid; his pupil shrank in the light, leaving his eyes brown and red-rimmed with suffering.

Image D 

Her survey of the ill complete, Claire delivers the sad diagnosis to Captain Thomas Leonard (Image E). His crew has typhoid, not ship fever! 

She explains to Captain Leonard the vagaries of typhoid symptoms (Voyager book):

That seaman didn’t have the characteristic belly rash, nor the next, but the third one did. The light red rosettes were plain on the clammy white skin. I pressed firmly on one, and it disappeared, blinking back into existence a moment later, as the blood returned to the skin

“It’s typhoid,” I told the Captain.

Devoted Doc that she is, Considerate-Claire offers to stay aboard the Porpoise a wee bit longer to instruct healthy crew members on how to manage and contain the epidemic.

Image E

Sure, thinks Tricky-Thomas, stay aboard just a wee bit and off we go! Once we are done with Mistress Claire, we’ll dump her on Jamaica!  Skunky Captains Leonard and Raines “porpoisely” strike an under-the-sails deal, and Claire is swept away – abducted against her will! Sails unfurl and the ship flees (Image F). Ta ta, Artemus!

Claire speaks her mind about being swept away in Voyager book:

I burst onto the deck to find a cloud of sails overhead, set and drawing, and the Artemis falling rapidly behind us. Captain Leonard was standing by the helmsman, looking back to the Artemis, as the master bawled commands to the men overhead. “What are you doing?” I shouted. “You bloody little bastard, what’s going on here?”

Apologists will say Captain Leonard had no other choice than to abduct Claire but I don’t buy that. Make no mistake, he had other options, he just chose the one that suited him and his ship the best. Wait until Jamie gets hold of him….. yikes!!!!

Image F 

Lesson Time!  Notebooks out – pencils sharpen. Let’s go, students! <G>

What is Typhoid:  Terrible Typhoid, a.k.a. typhoid fever, is a highly contagious bacterial infection!

What causes Typhoid: A fuzzy-looking bacterium known as Salmonella typhi causes typhoid fever. First, it attacks small intestines and then enters the bloodstream and disperses through liver, spleen and bone marrow (Image G – purple rods). The long strings seen in Image G are flagella, motile, whip-like appendages that propel the organism.

Unfortunately, some people (3-5%) have no idea they have had typhoid but continue to carry the bacterium, harbored in protective cells (macrophages) and other body sites (Anatomy Lesson #49, Our Liver – The Life Giver!). They may have a brief, mild flu-like bout, dismissing it as insignificant. Although asymptomatic, they can spread the disease to others!

Image G 

Symptoms of Typhoid: A “nice” visual of typhoid symptoms is summarized in Image H. Captain Leonard accurately reported five of these nine symptoms in his crew. 

Notice one seemingly paradoxical symptom? How is it that typhoid produces either “blazing” shites or constipation? Well…

Different strokes for different folks. Truth!

Image H

How is Typhoid Spread? Although typhoid is caused by a bacterium, it is transmitted among people by eating food or drinking water contaminated with waste from an infected person. Yuk!  Poor sanitation, bad drinking water and awful personal hygiene help spread the disease (Image I).

Also, only humans can contract typhoid. As there are no animal vectors for this disease, only humans can spread the disease.  If a person becomes infected, they should not prepare food for others until the infection is proven to be cured (via blood or stool tests)!

Good mamas taught us – wash those hands!

Not only does Claire identify the cagy culprit, she is clear about how it is spread. Again, from Voyager book:

Caused by a bacillus of the Salmonella genus, it was normally spread by ingestion of the bacillus, carried on hands contaminated by urine or feces.

Image I 

Are Typhoid and Typhus Identical? No! Claire correctly ‘splains to Jame: typhoid and typhus are not the same disease (Image J).

Oh, really, Claire? Then, why are the names soooo similar?

Because: the word “typhoid” was coined in the early 19th century; derived from the English typhus + oid meaning “to look like.” Ergo, typhoid literally means “typhus-like.” Why? Because both diseases share similar symptoms making them difficult to distinguish. Nevertheless, these are distinct diseases caused by different bacteria. And, typhoid is spread by contaminated food and water, whereas typhus is spread by body lice, fleas and chiggers! Feeling itchy? Scratch! Scratch!

These similar symptoms led Porpoise’s now deceased ship surgeon to diagnose its crew with ship fever, an old name for epidemic typhus (spread by body lice), which was fairly common aboard old sailing ships.

Image J 

Travel and Typhoid: Today, those who travel to certain countries may be at risk for exposure to typhoid. If journeys take you to red and/or orange regions shown in Image K, a typhoid vaccine is recommended. The CDC (https://wwwnc.cdc.gov/travel/diseases/typhoid) has great advice regarding travel to regions where cases of typhoid are high.

But, be aware! The typhoid vaccine isn’t permanent! The vaccine should be administered a month before intended travel with boosters every two to three years for repeat travelers to at-risk regions.

Thus, although Dr. Claire is good-to-go on the Porpoise, after a few short years, her immunity will wane, as does ours.

In the event that unvaccinated individuals or those with waning immunity contract typhoid, antibiotics to the rescue! About ten antibiotic compounds are used to treat typhoid.

Warning! Lest we become complacent, Salmonella typhi is developing antibiotic resistance! Thus, it is best not to risk traveling unvaccinated.

Image K 

History of Typhoid: History is chock-full of typhoid fever; its sticky fingers have plagued humans for a very long time.

  • In 430 BCE, typhoid likely killed one-third of the population of Athens.
  • Probably destroyed the English colony of Jamestown, Virginia
  • From 1607-1624, killed more than 6,000 New World settlers.
  • During American Civil War, killed 81,360 Union soldiers, far more than died of battle wounds.
  • During Spanish–American War, killed more soldiers than battle wounds.
  • Almost killed Edward VII of England (1871).
  • English novelist, Arnold Bennett died of typhoid, two months after drinking a glass of water in a Paris hotel to prove it was safe!
  • Killed William Wallace Lincoln, 11 y.o. son of President Abraham Lincoln.
  • 2014 data shows 21 million worldwide cases annually with 222,000 deaths.

In the early 20th Century, western countries mounted public campaigns to teach the benefits of good hygiene, dramatically curtailing the incidence of typhoid (Image L). Public water works helped provide safe drinking water. Some students may not be thrilled to read this, but chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in UK, US and other western countries. Today the US reports only about 400 cases per year; Great Britain, less than 100.

Image L

Mary-Mary Quite Contrary: Let’s turn to the tale of notorious, Mary Mallon (1907)! Better known as Typhoid Mary, she was the first carrier of typhoid to be identified in the US.

Mary was employed as a private cook in NY state (Image M). Over the course of a few short years, she infected 53 people and caused 3 deaths! Why? Because, health officials argued, Salmonella typhi took up “squatters rights” in Mary’s gallbladder – so, she continuously shed bacteria into the food she prepared for others! Eek! 

Her personal habits contributed to her “trail of tears:”

  • She eschewed hand washing! Considered the practice unnecessary.
  • She declined to use soap – again, not interested.
  • She loved serving desserts, such as fresh sliced peaches over ice cream (cooking kills the bacterium).
  • When employers fell ill, she moved on without a forwarding address.

As if this wasn’t enough, Mary had major authority issues. After a sanitary engineer tracked her down, she was given several options but refused all:

  • She decline cholecystectomy (gallbladder removal) – the bacterial reservoir (nowadays, we know the bacteria also harbors in other body sites).. 
  • She declined to live in permanent quarantine. 
  • She promised not to work as a cook but resumed as soon as health officials looked away.
  • She assumed aliases and slipped away, causing more infections. 

Apprehended again, she spent the last 26 years of her life in quarantine. To the very end she belligerently denied she caused typhoid because she, herself, was healthy. 

Some modern-era folks have since questioned the ethics of the NY Board of Health, but before we apply our current sensibilities to early 20th century health practices, we might recall that antibiotics against typhoid were not available; Fleming (he was Scottish) didn’t discover penicillin until 1929 and it really didn’t become used for medical treatment until the 1940s.

Image M 

Back to the Porpoise: Let’s return to HMS Porpoise, this time to Starz episode 310, Heaven and Earth

Claire, sleuthing the captain’s log book,  informs Captain Leonard that Porpoise has its own kitchen carrier! Typhoid Joe (Howard), working in the galley, outsources the disease in the crew’s food and drink! 

Like Typhoid Mary, he cries “I am fine and dandy!” (Image N). No problemo – madam!

Cranky Cook Cosworth jumps into the fray – he doesn’t want his grub-gopher quarantined, especially on the word of a cursed woman who speaks gibberish! He points out the obvious: men are still dying despite her efforts, to which Clare crisply comments:

Men are still dying because the source of the disease is serving the food! 

Image N

Bottom line, Joe-the-foe is quarantined and new cases cease, except for one. Claire’s boy-champion, Elias Pound, passes away in Claire’s arms (Image O). 

Herself recorded the sad event in Voyager book:

Elias Pound died of the typhoid four days later. It was a virulent infection; he came to the sickbay heavy-eyed with fever and wincing at the light; six hours later he was delirious and unable to rise. The next dawn he pressed his cropped round head against my bosom, called me “Mother,” and died in my arms.

Her sorrow, and ours, is profound! He was a lovely lad!

🎼Sing me a song of a lad that is gone…………………..!🎼

 

Image O

Let the take home message for today’s lesson be:

  • Typhoid is a nasty disease that, to this day, remains a killer-at-large.
  • This is an indiscriminate disease that strikes young, hale, frail, the middle-aged, the old, the pregnant, etc.
  • Obtain a typhoid vaccine before traveling to countries with iffy water supply, food sources, and sanitation.
  • People can be carriers of typhoid while appearing completely asymptomatic.
  • Antibiotics can cure typhoid but strains are becoming resistant.

Let’s stay vigilant and healthy, people!

A deeply grateful,

Outlandish Anatomist

Photo Creds: Starz Outlander episode 03×09, The Doldrums (Images A, B, C, D, E, F, J); Starz Outlander episode 03×10, Heaven and Earth (Images N, O); www.cnn.com (Image K); www.compliancesigns.com (Image I); www.dovemed.com (Image G); www.hidoc.com (Image H); www.slideshare.com (Image L); www.youtube.com (Image M)

 

FF Dilator Pupillae Musculus

Posted by Outlander Anatomist | Anatomy Lessons

Anatomy Def: Dilator pupillae (pl.) are muscles inside the irises. They are arranged spoke-like around the pupil opening. As they contract, the pupil opens (dilates).

Outlander def: Dilator pupillae are Claire voice-activated muscles! What? Who? A voice, not heard in 20 years, activates Jamie’s pupil dilators: the iris narrows, the pupil expands! 

Learn about the dilator pupila (sing.) muscle of each iris in Anatomy Lesson #31, An Aye for an Eye.  

Don’t you think it very odd that the Latin for pupil means “little doll?”  Actually, there is a sensible explanation. This word refers to tiny reflections visible in the pupils (really on the corneal surface) and can be traced back to 1398 when, John Trevisa, in his translation of Anglicus’s De Proprietatibus Rerum, wrote:

The blacke of the eye is callyd . . . Pupilla in latyn for smalle ymages ben seen therin.

Were you able to figure out the old English? The sentence reads:

The black of the eye is called pupilla in Latin for small images been seen therein.

This statement is the earliest known English translation for the word origin of “pupil.” 

Read about the effect of dilator pupillae on Jamie’s pupils in Voyager book. Diana explains:

I opened my mouth to reply, but he was still talking, eyes fixed on my face, pupils dilated to pools of darkness. “My love,” he said, almost whispering. “God, ye do look so lovely, wi’ your great eyes all gold, and your hair so soft round your face.”

See the effect of dilator pupillae muscles on Jamie’s pupils in Starz, ep. 306, A. Malcolm. Dark pools, are they!

A deeply grateful,

Outlander Anatomist

Greetings, anatomy students! Several of you have asked for an exploration of the “skeleton scene” shown in Outlander episode 305, Whiskey and Freedom. Although Anatomy Lesson #39, Dem Bones – Human Skeleton, examined the entire human skeleton, this lesson focuses on skeletal analysis performed by Dr. Abernathy with input from Clairevoyant – Claire. No spoilers within!!!

 The “skeleton scene” is a great adaptation of Chapter 20, “Diagnosis,” from Voyager book, by Diana Gabaldon. So, put on your forensic cap and let’s begin with a summary of that scene.

Here, the anthropology office at Harvard seeks Dr. Abernathy’s expertise to determine cause of death using skeletal remains. In the book, the skeleton arrives at his office in a box labelled “PICT-SWEET CORN.” Yummy – I remember that brand!  In the episode, bones are laid out on a desk top (Image A). From Voyager:

 Horace Thompson was probably someone from the coroner’s office, I thought. Sometimes they brought bodies to Joe that had been found in the countryside, badly deteriorated, for an expert opinion as to the cause of death. This one looked considerably deteriorated.

…from the anthropology department at Harvard,” he said… “asked me would I have a look at this skeleton, to tell them what I could about it.”

Image A

Dr. Abernathy reaches into the box and removes a skull (Image B).

Image B

 Examining the skull, the good doctor concludes it belonged to a pretty lady who was mature and middle-aged (Image C). And, from Voyager:

“Oh, pretty,” he said in delight, turning the object gently to and fro. “Pretty” was not the first adjective that struck me; the skull was stained and greatly discolored, the bone gone a deep streaky brown. Joe carried it to the window and held it in the light, his thumbs gently stroking the small bony ridges over the eye sockets. “Pretty lady,” he said softly, … “Full-grown, mature. Maybe late forties, middle fifties.”

Image C

Claire picks up the skull, which speaks to her (Image D).  Well, not really –  that would be weird – though Hallowe’en does draw nigh! Another quote from Voyager:

Then I held it close against my stomach, eyes closed, and felt the shifting sadness, filling the cavity of the skull like running water. And an odd faint sense—of surprise?

“Someone killed her,” I said. “She didn’t want to die.”

Image D

Dr. Abernathy fixes Dr. Claire with a gimlet eye. Lady Jane, have you lost your scalpels???  After all, how could she possibly conjure such details using a touchy-feely method of scientific inquiry? Well, the lass does harbor some awesome powers that seem to grow with time (Image E)? Again, from Voyager:

… “Where did you find her?” I asked….

“She’s from a cave in the Caribbean,” he said. “There were a lot of artifacts with her. We think she’s maybe between a hundred-fifty and two hundred years old.”

Image E

Next, Dr. Abernathy plucks two pieces of bone from the corn box (Image F). “You were right,” he says. Looking at them, he observes that a fracture plane runs through the centrum, although he doesn’t identify which bone has been fractured. Voyager book reveals the fractured bone as a vertebra (bone of spine) – more specifically, as the axis.

The wide body of the axis had a deep gouge; the posterior zygapophysis had broken clean off, and the fracture plane went completely through the centrum of the bone.

Joe’s finger moved over the line of the fracture plane. “See here? The bone’s not just cracked, it’s gone right there. Somebody tried to cut this lady’s head clean off. With a dull blade,” he concluded with relish.

Image F

Then, Dr. Abernathy notes that although the burial site was a cave filled with slave artifacts, this lady was not a slave! He points to two leg bones (Image G), the tibia (Anatomy Lesson #9, The Gathering or Boar Gore) and the femur (Anatomy Lesson #7, Jamie’s Thighs or Ode to Joy!).  Ahhh, Claire sagely nods, “the crural index.” Back to Voyager, again:

“Not a slave,” he said… “No,” Joe said flatly. He tapped the long femur, where it rested on his desk. His fingernail clicked on the dry bone. “She wasn’t black.”

“Take a look at this,” Joe invited. “You can see the differences in a lot of bones, but especially in the leg bones. Blacks have a completely different femur-to-tibia ratio than whites do. And that lady”—he pointed to the skeleton on his desk—“ was white. Caucasian. No question about it.”

…“If you want to think blacks and whites are equal under the skin, be my guest, but it ain’t scientifically so.” He turned and pulled a book from the shelf behind him. Tables of Skeletal Variance, the title read.

Image G

 OK, that pretty much summarizes the salient scientific points of the scene. I see three issues that warrant comment:

  • Can bones reveal sex, age and/or beauty of the owner? 
  • Does the fractured bone match with “pretty lady’s” death? 
  • Can crural index determine race? 

Issue #1: Can bones reveal sex, beauty and/or age of the owner?

The answer is a qualified yes

When Claire arrives at the office, Dr. Abernathy has already laid out most of the skeleton and presumably, has already examined those bones. It’s pretty iffy to hazard a reliable guess with one measurement. But, if a series of measurements tend to fall within a given range, a forensic scientist can venture an educated guess. So, assuming he examined the skull and pelvis, then sex can be surmised with a resonable degree of confidence. Here’s why.

Sex & Skull: “Typical” female and male skulls exhibit differences (Image H). A female skull is usually smaller, with rounder orbits (red dot), prominent frontal eminences (yellow dot), smaller mandible (pink dot), less prominent temporal lines (green dot), smaller brow ridges (dark blue dot), and less pronounced glabella (turquoise dot). There are also other, more subtle differences, but understand that not all skulls show all structural differences, regardless of sex.

Image H

Sex & Pelvis: The bony pelvis also supplies important clues to sex. “Pretty lady’s” bony pelvis lies in three pieces (two hip bones plus sacrum). The pelvic width, shape of sacrum, sub-pubic angle and shape of obturator foramen (two front holes) are consistent with a female pelvis (Image I – obturator foramen not labeled).  Pelvic inlet and outlet are difficult to demonstrate in a dissembled bony pelvis but, assembled they would be similar to those shown in Image I, lower figure. Ergo, pretty lady’s pelvic features are consistent with those of a female.

Age:  Age can be estimated if cranial sutures (sites where cranial bones meet) are thin, bone ends are fused to bone shafts (growth plates are ossified), teeth are mature and bones are hard, along with the presence of wear-and-tear diseases, etc. So, yes, with careful analysis, general age can be estmated. Presumably, Dr. Abernathy considered these before Claire’s arrival. So far, so good!

Beauty:  As we all ken, beauty is in the eye of the beholder. Dr. Abernathy expresses an opinion when he dubs the owner a “pretty lady.” Of course, he cannot know how flesh draped those bones, but he considers the skull to be delicate and beautiful to his practiced eye. This is a subjective response on his part, but it is arguably consistent with the appearance of the skull. 

Thus, sex and age can be assessed with a fair degree of confidence if and only if multiple measurements and observations are considered, collectively. But, as beauty remains in the eye of the beholder, this issue receives a qualified yes.

Image I

 

Issue #2: Does the fractured bone match with “pretty lady’s” death? 

Because I have some issues with this issue, the answer is mostly yes for the book but no for the episode. Here’s why.

Dr. Abernathy holds up a wee bone, which is broken vertically into two nearly symmetrical pieces. Voyager identifies these fragments as belonging to the axis. The axis is one of seven neck bones (numbered 1-7 from skull downwards); it is also designated as C2, meaning it is second of the seven cervical vertebrae. The purpose of cervical vertebrae is to support the head and supply flexibility to the neck, augmenting movements of the head.

Voyager book states:

The wide body of the axis had a deep gouge; the posterior zygapophysis had broken clean off, and the fracture plane went completely through the centrum of the bone.

Although the bone fragments are supposed to represent a vertebra, the fragments do not  appear to be an axis. The axis is an atypical, weird-looking vertebra (Image J – gif):

Image J

Please appreciate that the axis is a splendid bone, that allows us to rotate our head from side-to-side in a “no-no” gesture (Anatomy Lesson #12 Claire’s Neckthe Ivory Tower!). 

Try this: Cervical vertebrae are buried rather deeply in the neck and difficult to demonstrate. But, if you able, sit up straight with chin level, place a finger in the groove of your neck just below the skull. You may feel a small bulge under your fingers. This is the spine of the axis. 

Let’s examine the parts of the axis (Image K – front view) to help us understand the quote from Voyager.

  • The axis has a robust body, located at its front surface.
  • Inside the body is a centrum, a remnant of embryonic development. You cannot see the centrum from the surface.
  • Dens is a tooth-like structure perched atop the body.
  • Superior articular facets are flat surfaces where C2 forms joints with C1 above.
  • Inferior articular facets are flat surfaces where C2 forms joints with C3 below.
  • Joints are sites where movement occurs between bones – between vertebrae these are called zygapophyseal joints.

To reiterate, Voyager book states:

The wide body of the axis had a deep gouge; the posterior zygapophysis had broken clean off, and the fracture plane went completely through the centrum of the bone.

Analysis: The book statement is a wee bit awkward because if the fracture plane passed through the centrum, it also must necessarily cleave the body, so a deep gouge would not have been left to discern. It also means the dull blade cut horizontally (as in cutting off a head), breaking off the inferior articular facets (forming zygapophyseal joints with C3), and passing through the axial body and its centrum. Otherwise, the description makes sense.

One may also conclude, the blade must have passed through the lower part of the axis. Had the blade passed through the upper part of the axis, the stroke would have sheared off dens and superior articular facets but completely missed the centrum! Make sense? Good!

Image K

Conclusion: Dr. Abernathy holds two bony fragments of the fractured bone and I think, hum… I cannot positively identify the fragments because a close-up view is lacking. However, I can see enough to determine they are unlikely to be fragments of an adult human axis (Image L). And, the fracture line passes vertically dividing the bone into halves. The only way a vertical fracture could occur is if the blade sliced downward, vertically cleaving the skull and its supporting cervical vertebrae. Gah! I think you will agree, this is pretty unlikely plus, the skull remains intact. So, no vertical swipe of the blade!

Ergo, although dramatic and interesting, the bone fragments do not reflect the axis damage as described in Voyager or by episodic Dr. Abernathy. Now, does all this keep me up at night? Hardly – I loved this scene despite its wee issues!

Image L

Issue #3: Can crural index determine race? 

The answer is a qualified no.

Well, this topic is a super sticky-wicket but very important to consider, so bear with me.

Best start with a definition: the crural index, established in 1933, is the ratio of tibia-to-femur (not femur-to-tibia, as this yields different results). The formula to determine crural index is:

 length of tibia x 100 / length of femur  OR  (length of tibia/length of femur) x 100

Using this ratio, many studies showed that individuals of African descent had higher crural indices than those of European descent. Image M is a simplified, summary version of such findings.

In 1968, Dr. Abernathy was positive that a low crural index meant “pretty lady” was white….“No doubt about it.” (BTW, I am pretty sure Claire pronounces this “cruel index;” but, it should be crural <kru-ral>, from the Latin crus meaning “leg”)

Image M

So, can race be determined from the crural index?

When I started graduate school in 1965, we were taught there were three human races: negroid, caucasoid, mongoloid. Fast forward 52 years and much has changed! Today, many biologists say race cannot be determined from bones because there is no such thing as race. These scientists posit that all living humans belong to one species (Image N): Homo sapiens sapiens (the second sapiens denotes the subspecies – that would be us). Many prefer the term ancestry, because race and even ethnicity have confusing connotations and definitions. Furthermore, they point out, more genetic variations can occur within “racial” groups than between them, meaning findings are limited by the sample studied. What a conundrum!

Just to clarify, some bony physical traits are characteristic of ancestry and can be traced to a particular global location. But, bear in mind, people of mixed ancestry may present features which do not fall neatly into any category. Also, humans are so similar that all bone morphologies are present in all  groups, just at varying rates. Despite such variations, skeletal analysis remains part and parcel of human identification especially when numerous skeletal measurements are obtained. Today, using calipers, x-rays, microscopy, DNA, and a mess of other tools, some of which were unavailable in 1968, forensic researchers can make reasoned guesses as to a person’s ancestry based on skeletal remains.

Summary: Nowadays, before a scientist suggests ancestry based on skeletal remains, (s)he makes multiple measurements, never relying on just one. And, prudent scientists avoid stating “we are sure” (even if they are). Instead, they posit, the data suggests or indicates or is consistent with or is likely. Verra prudent!

Hence the qualified “no” regarding the crural index; it is only one skeletal measurement and insufficient to make a judgement if a person was white or a slave. However, Voyager accurately expresses views prevalent in the 1960’s. Make sense? Ta da!

 

Image N 

Bottom line:

  • Today’s competent (my word) scientist cannot/will not declare ancestry using a single skeletal measurement such as crural index.
  • Cutting (hah) Dr. Abernathy some slack, his surety about the skeleton’s “race” was suitable and justifiable for his time (1968), but untenable for ours (Image O)!

Image O

So, this concludes a brief analysis of the “skeleton scene.”  Much more could be added, but would likely be too technical for most students. Hopefully, this summary was enlightening and will generate some thoughtful discussion and consideration in our ever expanding Outlander world. Buh-bye, pretty lady!

Ode to Pretty Lady

Your bones tell a tale.

Who are you?

Were you well?

Were you pretty?

Were you witty?

Were you sweet?

Did you cheat?

Were you bad?

Were you sad?

Or, were you mad?

Your bones tell a tale.

No Spoilers! Who are you “pretty lady?” Mayhap, we will find out during Outlander S.3!

A deeply grateful

Outlander Anatomist

Photo creds: Starz (Images A-G, L, O), Clinically Oriented Anatomy by Moore and Dalley, 5th edition (Image K), www.pinterest.com (Image H), www.medical-dictionary.thefreedictionary.com (Image I), www.premiersourceshopping.com (Image O), www.slideshare.net (Image M), www.wikipedia.com (Image J – gif)