Tag: jamie fraser

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Fun Fact: Puncture Wound

Anatomy Def: Puncture wound are deep injuries caused by sharp and pointed objects.

Outlander def: Och! Jamie’s painful bite-site! 🐍🐍🐍

Learn about puncture wounds in Anatomy Lesson #35, Outlander Owies.

Puncture wounds are a specific type of injury caused by sharp, pointy objects such as animal teeth/fangs, metal nails or thorns.  This wound has very specific characteristics: 

      • Small opening(s)
      • Little bleeding
      • Difficult to clean
      • Easily infected

Why are puncture wounds are prone to infection? Because: 

      • Bleeding helps cleanse a wound
      • Little oxygen reaches deep wound
      • Some organisms flourish in low oxygen environments

Important Fact: If the injured person hasn’t had a tetanus shot in the past five years, if the wound is deep, and if it is difficult to clean, a tetanus shot/booster is usually recommended – within 48 hours of the puncture!

Snake: Are you curious about which snake sunk its foul fangs into the vastus medialis of Jamie’s splendid quadraceps muscle?

I am not a herpetologist, but a quick Internet search reveals that North Carolina currently has six types of venomous snakes. ( I assume North Carolina’s current population of venomous snakes is the same as in the 1700s): 

      • Copperhead
      • Timber rattlesnake
      • Pigmy rattlesnake
      • Eastern diamondback rattlesnake
      • Eastern coral snake
      • Cottonmouth (water moccasin) 

Read Diana’s description from The Fiery Cross of the snake:

It was motionless now, quite obviously dead. Still, it took some effort of will to pick the thing up. It was as thick around as his wrist and nearly four feet long. It had begun to stiffen; in the end, he was obliged to lay it across the armload of firewood, like a scaly branch. Seeing it so, he had no trouble imagining how the snake … had escaped notice; the subtle browns and grays of its patterns made it nearly invisible against its background.

Diana’s description and the appearance in the show seems most consistent with the cottonmouth:  Subtle grays and browns, indeed!

Problem is, cottonmouths are only found in eastern North Carolina and not in Fraser’s Ridge territory. So, hard to be sure. But, here is what one looks like. 

Moving on!

Roger’s Efforts: So, how did Roger do at treating the snake bite? 

Weil…….

    • Roger cut the wound! 

He braced himself to the necessary force, stabbed hard and cut quick—two X marks over the punctures, just as the first-aid guides said. The wounds were bleeding a lot, blood pouring down in thick streams. That was good, though, he thought. He had to go deep; deep enough to get beyond the poison. He dropped the knife and bent, mouth to the wounds.

    • Roger sucked out blood and venom!

There was no panic, but his sense of urgency was rising. How fast did venom spread? He had no more than minutes, maybe less. Roger sucked as hard as he could, blood filling his mouth with the taste of hot metal. He sucked and spat in quiet frenzy, blood spattering on the yellow leaves, Fraser’s leg hairs scratchy against his lips. With the peculiar diffusion of mind that attends emergency, he thought of a dozen fleeting things at once, even as he bent his whole concentration to the task at hand.

    • Roger gave Jamie alcohol!

 “I’m pleased to hear it,” Fraser said. “But I think I’ll take a bit o’ the whisky now. Draw the cork for me, aye? My fingers willna grasp it.”

    • Did Roger (or Jamie) apply a tourniquet? Does it matter?
    • Jamie’s sock and boot remain on the injured leg.
    • His heart is above the wound.

Snakebite Experts: Now, what do today’s experts have to say?

Experts recommend snake bite victims, DO NOT:

      • Cut the wound 🚫
      • Suck out the venom 🚫
      • Apply a tourniquet, ice, or water 🚫
      • Give alcohol, caffeinated drinks, or any other medications 🚫

Experts recommend, DO the following:

      • Note the snake’s appearance and describe to medical unit (Roger saved head) ✅
      • Move victim beyond striking distance of the snake (no need!)
      • Lay victim down with wound below the heart ✅ (he did)
      • Keep person calm and at rest ✅ (he did)
      • Cover wound with loose, sterile bandage ✅
      • Remove any jewelry from area that was bitten (no need) 
      • Remove shoes if leg or foot is bitten 🚫 (oops!)
      • Get the victim medical help (Claire’s surgery!) ✅

Grading time! Hum…. 🤔 Looks as if Roger got 5 of 10 possible actions or 50%!  Erm, even grading on a curve, this is a failing grade! 😱

Can Roger’s performance be explained? Should we be upset with Roger?

Yes and not at all!!!

Snakebite instructions from the 1960s, when Roger went back through the stones, were very clear. All first aid manuals listed the same advice. Even Boy Scout manuals contained these instructions:

      • Cut the wound
      • Suck out the venom 
      • Apply a tourniquet

But, science marches on and knowledge improves! We now know what to do and what not to do in the event of a venomous snake bite.

See Roger wrestle with Jamie’s snake bite in Outlander episode 509, Monsters and Heroes!

Roger is a hero….and, Himself is still here! 👏🏻👏🏻👏🏻

Fangs to Roger!

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz; www.ncwildlife.org

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FF: Camptodactyly or Clinodactyly?

Anatomy Def: Camptodactyly is a condition wherein one or more fingers are permanently bent; the little finger is always affected.

Outlander Def: Steeped in post-coital bliss (Voyager), Claire reflects on her crooked pinky finger, informing Jamie, it is a genetic gift from her mum that she passed onto Bree (see below).

Learn about the pinky finger (5th digit) in Anatomy Lesson #23, Harming Hands – Helping Hands – Healing Hands. Warning! This is a very long lesson because, well, because the hands are anatomically very complicated!

I wager book readers forgot about Claire’s crooked pinky finger – I did! 😜 A follower on Twitter reminded me just days ago! So, here goes:

Humans typically have five digits on each hand.  But, naming these appendages presents a dilemma: 🤔

    • US anatomists name a thumb and four fingers (index is #1 – pinky is #4).
    • Some European anatomists consider the thumb to be a finger (thumb is #1 – pinky is #5).

Ergo, how many fingers does a hand usually have? Clearly, the answer depends on who does the counting!

Stating the obvious, it is safest, especially in a medical setting, not use the term, “finger.” Instead, name the appendages “digits” and sequentially number them as digit #1 (thumb) through digit #5 (pinky).

Hand surgeons who helped teach my gross anatomy course didn’t use any numbers when preparing a patient for surgery to avoid mixups and mistaken surgeries! 😱 Rather, they used thumb, index, middle, ring, and little.

Now, for some quick anatomy:  The little finger (plus index, middle, and ring fingers) has three bones (phalanges). Each adjacent pair of phalanges meet at an interphalangeal (IP) joint. The IP joint nearest the wrist is the proximal interphalangeal joint (PIP); the one furtherest from the wrist is the distal interphalangeal joint (DIP).

The thumb is different because it has only two phalanges and one IP joint. Hence, US anatomists don’t consider the thumb to be a finger because of these anatomic differences.

Try This: Find the PIP and DIP joints on your index, middle, ring and little fingers. Find the IP joint on your thumb. Got it? Yay! 👍🏻

As mentioned above, camptodactyly always involves the 5th digit (pinky finger) which is permanently flexed at the  PIP joint (see image, below)!

Claire’s mother had the crooked little finger, Claire has it, and her daughter has it, too. This is not surprising as the gene for camptodactyly may be passed to the next generation by either parent.  If a person carries the gene, it may be expressed in one hand, both hands or neither.

And, if the permanent flexion is 30º or less, the hand usually functions normally.

Just to throw a monkey wrench into the issue….. Claire may have had a different condition known as clinodactyly (Greek: to bend + finger), another inheritable trait involving a crooked 5th digit.

However, clinodactyly is characterized by the pinky finger bending toward the adjacent ring finger. Yet another difference between the two conditions is that clinodactyly may occur at the DIP joint or the PIP joint, or both!

Because Claire became a skilled surgeon, we can safely assume that no matter which condition she had, the crooked right little finger did not create a hinderance to her handiwork!

Clinodactyly of the hand.
Clinodactyly is a congenital trait that is present at birth. It can occur on its own or as part of a genetic syndrome.

See: Claire’s right little finger in Outlander episode 306, A. Malcolm. The episode does not include Claire’s musing about her crooked pinky finger for good reason: It would be difficult to display such a condition throughout all seasons of Outlander!

Read: But Claire does acknowledge her finger to Jamie in Voyager book.

“Her nails are like yours; square, not oval like mine. But she has the crooked little finger on her right hand that I have,” I said, lifting it. “My mother had it, too; Uncle Lambert told me.” My own mother had died when I was five. I had no clear memory of her, but thought of her whenever I saw my own hand unexpectedly, caught in a moment of grace like this one. I laid the hand with the crooked finger on his, then lifted it to his face. 

Which condition did Claire have – camptodactyly or clinodactyly? Only Herself knows for sure! 😉

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz; www.congenitalhand.wustl.edu; www.healthline.com

 

 

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Fun Fact: Leech

Anatomy Def: The leech is a segmented parasitic worm, closely related to the earthworm. Leech also means a doctor or healer. Who knew? 😜

Outlander Def: “Get-them-off!” William Ransom, eighth Earl of Ellesmere, demands Claire free his limbs of the ghastly creatures!

Learn about blood, the sumptuous repast of leeches, in Anatomy Lesson #37, “Outlander Owies Part 3 – Mars and Scars.”

Ahhhh, now you may think leeches boring, if so, I think you could be wrong. Here are fascinating fun facts about leeches:

      • More than 700 species
      • Soft, muscular bodies that lengthen and shorten during movement
      • Most have front and back suckers
      • Three sharp blades to cut flesh sit under front sucker
      • Saliva contains  hirudin, anticoagulant peptide (short amino acid chain)
      •  Used in bloodletting for at least 2,500 yrs
      • Hemaphrodite – each has one female organ and 9 pairs of testes. 😳
      • Appear in Proverbs 30:15 as an archetype of insatiable greed!

Bloodletting via leech is a time-honored practice dating to ancient Greece and India. Throughout Europe, the medicinal leech, Hirudo medicinalis, was used on ailing patients to rebalance body humors.

Yet more reasons this episode was titled “Blood of My Blood!!!” 😱

In 18th and 19th century Britain, leech-gatherers travelled the marshes gathering leeches from the wild. The practice became so widespread, the population was decimated in many areas. Bloody little buggers! 😈

In Old English, lǣce, was not only the name of the animal but also referred to a physician, and lǣcecraft or leechcraft described the art of healing. Hum….

Beginning in about 1980, leeches enjoyed a resurgence in modern medicine. Today, many hospitals stock them to treat:

      • Joint disease such as epicondylitis and osteoarthritis
      • Vein diseases of the extremities
      • Microsurgery
      • Blood-clotting disorders using hirudin

WARNING! If you sport a strong wame, watch this PBS video of how a leech attaches, how it feeds and its use in modern medicine. Watch at your own discretion.  There will be blood!!!  😷

Important! A leech can be removed by breaking the seal of front and back suckers with a fingernail or other flat, blunt object, flicking the leech away. Irritating the leech with a cigarette, vinegar, salt or soap may cause it to regurgitate stomach contents into the wound and transmit pathogens to its victim. Not common, but it has been reported. 

Read about leeches in The Drums of Autumn as Lord John Grey and his “son,” William Ransom, arrive unannounced at Fraser’s Ridge. Make no mistake, Claire recognizes Jamie’s get! 😉

Blundering out of the stream, I shoved my way through the tangled branches, and burst through into the clear space beyond. A boy was dancing on the bank above me, slapping madly at his legs and howling as he hopped and fro.

“What—?” I began, and he glanced up at me, blue eyes wide with startlement at my sudden appearance.

…“Leeches,” I said, professional calm descending by habit over personal tumult. It couldn’t be, I was telling myself, at the same time that I knew it damn well was. “It’s only leeches. They won’t hurt you.” 

“I know what they are!” he said. “Get them off me!” He swatted at his calf, shuddering with dislike. “They’re vile!” 

“Oh, not so terribly vile,” I said, beginning to get a grip on myself. “They have their uses.” 

“I don’t care what use they are!” he bellowed, stamping in frustration. “I hate them, get them off me!” 

“Well, stop whacking at them,” I said sharply. “Sit you down and I’ll take care of it.” 

He hesitated, glaring at me suspiciously, but reluctantly sat down on a rock, thrusting his leech-spattered legs out in front of him. 

“Get them off now!” he demanded.

See leeches feasting on Willie’s blood in Outlander episode 406, Blood of My Blood. 🚫 Leeches for this Lord!

The deeply grateful,

Outlander Anatomist

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Photo and Video Credits: Sony/Starz, PBS