Fun Fact: Posterior Median Furrow

Anatomy Def: Midline vertical depression in the surface of the back (red arrows).

Outlander Def:  Deep, lovely groove of Jamie’s back!  

Get in the groove and Learn about Jamie’s back furrow by reading Anatomy Lesson #10, Jamie’s Back!

The posterior median furrow (PMF) literally means “back middle groove.” This vertical depression is most visible in thoracic and lumbar regions of the back. It tends to be shallow in the cervical region, diminishes over the sacrum and is continuous with the gluteal cleft (Aye, the sweet cheeks! <G>).

PMF is most visible in those with robust para-spinal (erector spinae) muscles. These muscles flank the vertebral column; the more developed the muscles, the deeper the PMF.

PMF is useful during physical exam because the vertebral spines can be palpated and counted in the groove. Specific vertebral spines mark levels for anesthesia delivery, location of abdominal organs, and vascular anatomy. For example, C3 marks the level of the hyoid bone (wink, wink to book readers).

More Fun Facts: English is replete with idioms about the back. These are  a few of the many:

  • Back away
  • Back me up
  • Back and forth
  • Back to square one
  • Back in the day
  • Back to the drawing board
  • Back down from
  • Back the wrong horse
  • Back to back
  • Back in circulation

Read about Jamie’s posterior median furrow in Outlander book. Yes, Herself describes it! 👏🏻👏🏻👏🏻

Compassionate Claire notes the groove as she describes Jamie’s badly damaged back: 

He sat patiently, not moving as I circled behind him and inspected his back…I was appalled…The scars covered his entire back from shoulders to waist. While many had faded to little more than thin white lines, the worst formed thick silver wedges, cutting across the smooth muscles. I thought with some regret that it must have been quite a beautiful back at one time. His skin was fair and fresh, and the lines of bone and muscle were still solid and graceful, the shoulders flat and square-set and the backbone a smooth, straight groove cut deep between the rounded columns of muscle that rose on either side of it…I tried not to imagine the muscular arms raised…ropes cutting into wrists, the coppery head pressed hard against the post in agony…Involuntarily, I reached out, as though I might heal him with a touch and erase the marks with my fingers. He sighed deeply, but didn’t move as I traced the deep scars, one by one, as though to show him the extent of the damage he couldn’t see.

Och! See Jamie’s PMF in Outlander, episode 105, Rent, after Uncle Dougal rends Jamie’s sark to expose BJR’s handiwork! 😱 Back off, Dougal!

The deeply grateful,

Outlander Anatomist

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Photo Credit: Sony/Starz

Anatomy Lesson #65: Anatomy of a Hanging

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:

    • pharynx for food and air passage
    • larynx for air passage and vocalization
    • trachea for air passage
    • esophagus for food passage
    • common carotid arteries supply blood to head
    • jugular veins drain blood from head
    • cervical vertebrae for support
    • hyoid bone for speech, swallowing, tongue movements
    • cervical spinal nerves, for neck and upper limb innervation
    • muscles for movement of head, neck, scapula and clavicle

Hangings typically traumatize one or more of these neck structures:

    • cervical vertebrae
    • hyoid bone
    • carotid arteries 
    • jugular veins
    • trachea and larynx

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.

Vector illustration of cervical vertebrae. Medical scheme with close-up skull and isolated C1 atlas, C2 axis, C3, C4, C5, C6 and C7 vertebra. Diagram of Intervertebral disc and anterior tubercle.

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:

    • Face becomes engorged with blood
    • Facial skin turns red
    • Facial skin exhibits tiny petechiae/petechia (small blood marks)
    • Bleeding in conjunctiva overlying whites of eyeball (subconjunctival hemorrhage)

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 Lesson #59: Claire the Knife!

“Claire the Knife” is not a usual anatomy lesson. Rather, let’s explore the many images of Claire with a honed edge either in her hands or directed at her person! Such images are taken from S1-S3 of Outlander. There are even more examples in Herself’s books that weren’t translated onto the screen. Please notify me if I miss any fine examples of “Claire the Knife!”  Let’s get started!

Early in Outlander episode 101, Sassenach, Claire accidentally encounters Frank’s ancestor, Captain Jonathan Wolverton Randall, Esq. From Outlander book:

“Who the bloody hell are you?” I demanded again. 

… He bowed sardonically, hand over his heart. “I am, madam, Jonathan Randall, Esquire, Captain of His Majesty’s Eighth Dragoons. At your service, madam.”

Not an officer-and-a-gentleman, she is soon backed against a stone ridge with his sword pressed to her lovely throat (Anatomy Lesson #12, Claire’s Neck or The Ivory Tower). 

Your honor, I submit, Exhibit #1! <g>

Then, in Outlander episode 104, The Gathering, Claire twice encounters a knife, once in her hand and once shoved into her beautiful face!

Swiftly gliding into Mrs. Fitz’s kitchen, Claire grabs for a butcher knife amid bins of potatoes (Hey, I thought Jenny introduces those to Scotland?), chicken and other delectables. She is gathering provisions for a furtive flight to the stones. Outlander book explains: 

During my hours helping in the kitchens and orchards, I had managed to stow away sufficient food to see me provided for several days, I thought… I had stout boots and a warm cloak, courtesy of Colum. I would have a decent horse; on my afternoon visit to the stables, I had marked out the one I meant to take.

Her knife grab is thwarted by Ms. Fitz: 

“Claire! You aren’t wearing that to the ceremony, are ye lass?”

No, Mrs. Fitz, she’s not wearing that butcher knife! Hee, hee.

Later in evening as the entire ensemble is either oath-taking or stinking drunk, Claire sidles into the stables to steal away on Brimstone.

Oops! She steps on Jamie cocooned in hay (yay!).  Mistaking her as a threat, he threatens her with his dirk! (wink, wink) 

“Jesus H. Rosevelt Christ!” 

“No, sassenach, just me.” 

(We all ken he is divine, just not that kind of divine!)

From Outlander book: 

The obstruction rolled over with a startled oath and grasped me hard by the arms. I found myself held against the length of a sizable male body, with someone’s breath tickling my ear.

Then, Dougal and his band of merry men head off to collect taxes and conduct other clan “business” in  Outlander episode 105, Rent.  Dougal explains in Outlander book:

“Through the MacKenzie lands. Colum doesna travel, so visiting the tenants and tacksmen that canna come to the Gathering—that’s left to me. And to take care of the bits of business here and there.”

On the road, Claire witnesses “fowl” play by Dougal and his men. Declaring she will not eat yummy-looking birds she thinks were roasted by thieves, Claire quickly faces the point of Angus’ dirk.  Angus is having none of it that kind of name calling, especially from an English sassenach spy! Fortunately, Jamie talks him down and Claire flounces away with left eye intact. 

By episode’s end, Claire and Dougal are accosted by Lt. Jeremy Foster.

In Outlander episode 106, The Garrison Commander, both are delivered to the garrison at Brockton.  There, she enjoys a sumptuous meal (excepting the claret) with Brigadier General Lord Oliver Thomas, et al, until, horror of horrors, Captain Black Jack arrives. Thereafter, things take a distinctly downward turn! 

After aiding the amputation of a soldier’s arm, she returns to the dining room to find puir Corporal Hawkins performing ablutions on BJR! Claire recognizes the stropped blade as a family heirloom – the very one she used to shave first hubby, Frank.

If only, she held that blade to BJR’s neck – could have saved she and Jamie a world of hurt! Another blade – another time. From Outlander book: 

“Yes, I thought so. It had to be you, from MacKenzie’s description.” The door closed behind me, and I was alone with Captain Jonathan Randall of His Majesty’s Eighth Dragoons. He was dressed this time in a clean red-and-fawn uniform, with a lace-trimmed stock and a neatly curled and powdered wig.

But the face was the same—Frank’s face. My breath caught in my throat.

This time, though, I noticed the small lines of ruthlessness around his mouth, and the touch of arrogance in the set of his shoulders. Still, he smiled affably enough, and invited me to sit down.

Escaping BJR’s clutches, Dougal stops off at St. Ninian’s spring for a wee nip of sulfurous water. Known in the highlands as a liar’s spring, he waits to see if the magical waters will burn Claire’s gullet (Anatomy Lesson #45, Tremendous Tube – GI System, Part 2)!  He draws a dirk to finish her off should massive heartburn set in. From Outlander book: 

“No!” Something occurred to me. “So at least you believe me when I say I’m not an English spy?”

“I do now.” He spoke with some emphasis. …

“St. Ninian’s spring.

…They call it the liar’s spring, as well. The water smells o’ the fumes of hell. Anyone who drinks the water and then tells untruth will ha’ the gizzard burnt out of him.”

Fast forward one episode, Dougal finally gets his wish as his dirk bites into Claire’s wrist!

Blood vow at a wedding she never sought, but well worth the scar!

Ye are Blood of my Blood, and Bone of my Bone. 

I give ye my Body, that we Two might be One.

I give ye my Spirit, ’til our Life shall be Done.

Outlander Episode 108, Both Sides Now: Still on rent-collection duty, the MacKenzie band is raided by Clan Grant! Rent, horses, food, what-have-you, everything is fair game. In the aftermath, Jamie is scolded for giving his wife a dirk for protection but not teaching her how to use one. Time for Claire to get a knife-life lesson. Ned Gowan extracts a small sgian dubh drawn from a more private part of his, ahem, breeks. So, she takes a knife-wielding lesson from TV Angus/book Rupert. Willie is the sacrificial lamb: 

He poked a blunt forefinger under the lower rib on the right, … “This is the spot in back—either side. See, wi’ all the ribs and such, ’tis verra difficult to hit anythin’ vital when ye stab in the back. If ye can slip the knife between the ribs, that’s one thing, but that’s harder to do than ye might think. But here, under the last rib, ye stab upward into the kidney. Get him straight up, and hell drop like a stone.” 

Fab advice as hours later, Jamie and Claire slip into the heather for a quick tryst, soon to be disturbed by two Redcoat deserters (coitus interruptus –  snort!). Thwarting her assaulter, Claire thrusts the sgian dubh – into the spot – as she was taught. The lass learned her lesson well!

Then, comes Outlander episode 109, The Reckoning: Captured by the Redcoats, assaulted (again) by BJR, rescued and then skelped by her second husband, they seek their way back to each other. As an act of penance, Jamie swears fealty to Claire, this time the dirk is pressed against his bosom (Outlander book):

I swear on the cross of my Lord Jesus, and by the holy iron which I hold, that I give ye my fealty and pledge ye my loyalty. If ever my hand is raised against you in rebellion or in anger, then I ask that this holy iron may pierce my heart.

And, they are off to the races! Oops – not so fast, my lad. In the midst of “reconciliation,” Claire threatens Jamie’s chin with his dirk (Anatomy Lesson #26, Jamie’s Chin – Manly Mentus).

“If,” I said through my teeth, “you ever raise a hand to me again, James Fraser, I’ll cut out your heart and fry it for breakfast!” 

Och! Parritch sounds much, much bettah!

Then, things quiet down for a bit and we see little of “Claire the Knife.” That is, until BJR gets his hands on Jamie. He has coveted the lad since the first flogging. After Murtagh scraps what is left of Jamie off the dungeon stones, they flee Wentworth, returning Jamie to his lawful wife.  There she mends his mangled hand, courtesy of BJR and giant Marley.

Blades again, this time in the form of scissors, clip sutures used to mend his broken skin (Outlander ep 116, To Ransom a Man’s Soul).

Up pops Season 2. Claire, being pregnant with Faith, isn’t into knife heroics.  An exception is her work at the Paris charity hospital, L’Hôpital des Anges. There, the scalpel blade slips nicely into her hands. Consider a workman’s festered wound due to an embedded splinter. She opens the wound and removes the offending object (Outlander episode 203, Useful Occupations and Deceptions). That knife has a life of its own!

Fast forward to Outlander episode 213, Dragonfly in Amber, wherein Jamie and Claire find themselves mired in a desperate struggle with Dougal – sly Uncle is intent on killing the sassenach witch!

He should have known that Jamie would protect her with name, clan and body!  But, neither reason, threat, nor cajoling stops Dougal’s advance. A blade to the chest is the only remedy  – in which Claire takes an equal hand – she finishes what Jamie cannot do alone!

Then, comes season 3. The next time a knife creeps into Claire’s hand, it is at the teaching theater awaiting her first anatomy class as a medical student (yay!). Arriving early, she feels the heft of the professor’s scalpel and is pleased with the heft; it fits well in her surgeon-to-be hand (Outlander episode 302, Surrender). 

Following the swiftest medical education ever, Claire is soon a practicing surgeon, clipping “necrotic” tissue from a patient’s abdomen (Outlander ep 305, Whisky and Freedom). Time and training has given Claire the license to legally cut another human. Such is her special calling and she fulfills it with grace and skill. Snip, snip. (Pssst… necrotic tissue isn’t pinkish-red in color, but don’t tell anyone.)

Next thing we know, Claire has donned a bat suit and gone back through the stones to seek A. Malcolm of Edinburgh (Outlander ep 307, Creme de Menthe). Confronting an exciseman in nothing but her shift and a hidden knife, Claire stabs his leg. Have knife – will travel!! He falls, striking his head on the hearth.  

Jamie arrives and what to his wondering eyes should appear, but a dying man – oh such is his fear!

Sassenach, what the devil happened????

I step away to do a little smuggling and return to find my wife with her knife and a dying man!!!

Still counting? Trying to save the life of the SOB (she’s a doctor!), Claire sends for a trephine from the local barber surgeon. She opens her medical kit, retrieving her trusty-not-rusty scalpel. Yes!

She makes a swift cut through the scalp – a space is opened through which the trepanning instrument is inserted. Then, she starts drilling for oil.  Not really, she drills to relieve pressure from an epidural bleed. 

Hang on, Snoopy, hang on – we’re almost finished! Then, in episode 308, First Wife, Claire uses her magic scalpel to open a nick near Jamie’s left oxter (Anatomy Lesson #4, Jamie’s Chest” or “the 8th Wonder of the World!). Her goal is to retrieve bits of lead discharged from Laoghaire’s fowling piece. She grasps and retrieve the bits leaving Jamie’s axillary/brachial artery intact (Anatomy Lesson #56: Achy Brachial Artery)! She is super good with a knife!  

The last time we see Claire wield a blade in TV Outlander, she confronts the Bakra (Outlander episode 313, Eye of the Storm)! Picking up a machete (ax in Voyager book), she screams and advances on Geillis Abernathy! She must prevent the witch from her fulfilling her plan to kill young Ian and pass through the time portal to slay Bree. 

Whack! Claire’s blade finds its mark and the wicked witch lies deid! Graphically explained in Voyager book:

Reflections of the fire burned red in the pupils of her eyes. The red thing, Jamie had called it. I gave myself to it, he had said. 

I didn’t need to give myself; it had taken me.

After fleeing Abandawe cave with Ian and Jamie, Claire trembles in the jungle with gore dropping from the machete. 

It is then she realizes, the 200+ y.o. bones she examined in Boston with Dr. Joe Abernathy (Outlander ep 305, Whisky and Freedom) belonged to none other than Geillis Abernathy!  And, Claire herself, ushered in that well-earned fate! Like I said, Claire the Knife!

To summarize, over many episodes, Claire is at one end or the other of a blade; always has been – always will be. <G>

Bobby Darren sang the hit, “Mack the Knife.” I re-imagine it as, “Claire the Knife:”

Oh, the shark, babe, has such teeth, dear

And it shows them pearly white

Just a jackknife is Miss Claire, babe

And she keeps it, ah, out of sight.

Dinna mess with the Sassenach Surgeon!

The deeply grateful,

Outlander Anatomist

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Photo Creds: Starz, Outlander episodes 101, 104, 105, 106, 107, 108, 109, 116, 203, 213, 302, 305, 307, 308, 313