Tag: Monsters and Heroes

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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 tissues. 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 

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Fun Fact: Inflame

 

Anatomy Def: To inflame is the body’s response to injury.

Outlander Def: Ow! Jamie’s puir, inflamed leg after the horrid fang-bang! 🐍

Learn about inflammation in Anatomy Lesson #37, “Outlander Owies – Mars and Scars.” Just to be clear, inflammation is the process of being inflamed. 

Inflammation is an crucial defense mechanism the body employs to combat physical injury.  There are two main types:

    • Acute – rapid but short-lived response to injury
    • chronic – prolonged response to injury (different types) 

Just so you know, acute inflammation is not the same as infection, although these may occur simultaneously.   

Fact: Nearly 2,000 years ago, the Roman, Aulus Cornelius Celsus, wrote prolifically about medicine, pharmacy, surgery, agriculture, law and military arts! 😲 Celsus was not a physician, but he was the first to described the four cardinal signs of acute inflammation. Later, in the 19th century, Rudolf Virchow, the father of modern pathology, added a fifth.

The five signs, in Latin, followed by their English equivalents, are:

    • Rubor = redness
    • Tumor = swelling
    • Calor = heat
    • Dolor = pain
    • Functio laesa = loss of function (Virchow)

How does inflammation happen? It is a process rather than an event. Simply put, if tissues sustain an injury, inflammation quickly appears due to dramatic changes in small blood vessels of the injured region. Blood flow increases. Small vessels become leaky allowing fluid (plasma) and some white blood cells (WBC) to enter the injured tissues. So:

    • Increased blood flow causes redness 
    • Leaked plasma causes swelling 
    • Leaked WBCs release chemicals that induce more redness, swelling, pain, and increased temperature (heat)
    • Finally, pain causes decreased function of the injured area (Ouch! Using it hurts!)

Inflammation may seem harmful, and sometimes it is, but it is designed to:

    • Eliminate the cause of tissue injury
    • Remove damaged cells
    • Pave the way for tissue repair

Just to be complete, a venomous snake bite usually produces (there can be other symptoms depending on venom):

    • Severe burning pain at the site 
    • Swelling
    • Redness and bruising all the way up arm or leg
    • Nausea
    • Labored breathing
    • Weakness
    • Odd taste in mouth

Try This: The next time you get cut or scratched, look carefully at the wound for redness and swelling. Is it painful? Gently place the wounded area against the lip to detect an increase in temperature. Yup, there are the four signs. And, if you are like most folks, you will avoid using that area until it heals, hence, loss of function!

Read about Jamie’s inflamed leg in The Fiery Cross! Yes, it’s in there!

“That’s enough, aye?” Jamie said mildly. “You’ll drain me dry.” He gingerly wiggled his bared foot, grimacing at his leg. The slashmarks were vivid, still oozing blood, and the flesh around them was swollen from the sucking, blotched and bruised.

The leg was noticeably swollen near the bite, and the blue tinge had spread; it showed like a faint fresh bruise on either side of the encircling handkerchief.

See Jamie’s inflamed thigh in Outlander episode 509, Monsters and Heroes! Och, this is only the start of his thigh-high response to that vicious fang-bang! Monster, indeed!!! 😳

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz

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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