frank-netter

“Jamie’s Thighs” or “Ode to Joy!”

Anatomy Lesson 7 - The Thighs and Knees

I’m hoping that Ludwig wilna be insulted by my reference to his Ninth Symphony but it seems verra apropos! Are ye ready for Anatomy Lesson #7: The Thighs and Knees? Perfect timing for the upcoming American Thanksgiving Holiday,ye ken? I am on me own knees right now giving thanks because, aye, I am doing the knees in this lesson even though the title doesna reflect it. Just to prove me own goodwill, take a gander at Jamie’s knees in the photo below. Will it tide ye over while we get on wit’ our lesson? Dinna fash yerselves about us moving on right away, as we’ll be seeing a lot of Jamie today!

So, to start this lesson, I’ll be having ye know a few more things about muscles and bones of the thigh and the knee otherwise some of this lesson is no gonna make sense! The hip and knee joints are sites where bones move relative to each other. Skeletal muscles attach to the participating bones and span the joints; the attachment site that is fixed (doesn’t move) is the origin of a muscle and the attachment site that does move is its insertion. Next, our brains direct these muscles to contract. If muscle contraction brings the bones of the joint closer together, this is flexion (the hip joint has other movements but they don’t concern us today). If muscle contraction straightens the joint, it is extension (Photo A). 

Photo A

Understand that anatomists don’t use the terms upper and lower leg. For the lower limb, the region between hip and knee joints is the thigh, the region between knee and ankle joints is the leg and the foot is the remainder (Photo B). The dashed blue line in photo B represents the vertical midline plane through the body. A medial structure is closer to the midline and a lateral structure is further away from the midline!  Aye, that’s the gist of it!

Photo B

Now, getting into the mood, the very first time we hear about Jamie’s thighs is in the Outlander book as Claire shares his saddle on the way to Castle Leoch. Herself writes:

“My companion seemed to be having little trouble, in spite of being unable to use his right hand. I could feel his thighs behind mine, shifting and pressing occasionally to guide the horse. I clutched the edge of the short saddle in order to stay seated; I had been on horses before, but was by no means the horseman this Jamie was.”

And yet another quote from the Outlander book - this one from Jamie:

”But then that ride through the dark together….with that lovely broad arse wedged between my thighs…”

Weel, now, I wouldna say that our Starz Claire has a broad arse, but it surely is curvaceous and pert and we all ken where it was wedged during this ride – day or night!  Mmmphm! 

Now, to understand the thighs let’s begin wit’ the bones. I love superlatives so here’s the first one for this lesson: the thigh contains the femur, the longest bone of the human body (Photo C –front of right femur). The top of the femur ends in an angled neck and a head that fits securely into the deep socket (acetabulum) of the hip bone.  Unlike the glenohumeral joint (Anatomy Lesson #2) the hip joint is verra stable but it is also less moveable! The far end bears two sturdy knobs, the medial and lateral condyles (Greek for knuckle) both of which help form the knee joint.

Photo C

The leg contains two bones (Photo D – right leg bones from front). The larger tibia is medial (closer to the body midline) and the smaller more lateral leg bone is the fibula. The upper end of the tibia ends in two flat surfaces, the medial and lateral condyles and lower down it bears a midline knob, the tibial tuberosity. Only the tibia helps form the knee joint; the fibula plays no role.

Photo D

One last bone critical to knee anatomy is the patella or knee cap. The patella is the largest sesamoid bone in the body (there are others) meaning it is embedded in a tendon; its deep surface rides in a groove between the medial and lateral femoral condyles as the knee joint extends and flexes (Photo E – right knee joint from the front). 

Photo E

Wit’ the bones accounted for, let’s turn to the muscles of the thigh. Thigh muscles are massive because they support most of our weight and help secure our bipedal state against the pull of gravity. Thigh muscles are divided into three compartments but as this post must be shorter than a bloody master’s thesis, I will address only one muscle of the front compartment: the quadraceps femoris (four-headed muscle of the femur). In reality, the quads as trainers call ‘em, are four muscles per thigh: rectus femoris, vastus lateralis, vastus intermedius and vastus medialis. Three of them are seen in Photo F. The fourth muscle, vastus intermedius, is visible only after rectus femoris is removed (Photo G). Each quad muscle has a different origin but they join to form a common quadracep tendon that inserts on the patella and then continues as the patellar ligament to insert on the tibial tuberosity (Photos F & G).    

Photo F

Photo G

Rectus femoris takes origin off the hip bone and crosses both hip and knee joints (Photo H) before its common insertion. The three vasti (pl. for vastus) muscles take origin from different parts of the femur and cross only the knee joint (Photo H). Thus, all four heads of the quads extend the knee joint but only rectus femoris also flexes the hip joint. In addition, the quads are the only muscles that can extend the knee joints, so they are crucial for walking, running, jumping and squatting. The quads are also called anti-gravity muscles because they contract as we rise from a seated position and as we lower our bodies in reverse, holding our weight against gravity (think of the thighs in snow skiing). 

Photo H

Ye can test your own quads this way. Place your back against a wall.  Drop your tush while walking your legs away from the wall until you assume a squat position (Photo I). Thighs and legs should be at 90° to each other (don’t drop lower even if you can – this is bad for your knee joints!). Now hold your torso in place for 30 seconds and then gradually straighten (extend) your knee joints. If you feel wobbly, then you probably need quad work as these muscles quickly lose mass and strength due to inactivity, sedentary jobs or aging. Quads can be strengthened by wall squats or any exercise that adds weight to the feet while extending the knee joint!

Photo I

Now on to the knee joint, the largest joint of the human body (photo J – knee in partial flexion)! Here the medial and lateral femoral condyles (knuckles) ride atop a flat plateau formed by the medial and lateral tibial condyles - no stable joint here! Then the patella glides between the femoral condyles during flexion and extension. All bony surfaces of the joint are covered with articular cartilage, a bloodless, firm connective tissue that allows for smooth movement. This odd joint also has a medial and a lateral meniscus (made of a different type of cartilage) that create two shallow sockets atop the tibial plateau - one for each femoral condyle; these also act as shock absorbers. 

Photo J

There are also very strong ligaments (Photo K – right knee in full flexion – patella removed) designed to secure the tibia and femur: medial (tibial) and lateral (fibular) collateral ligaments and anterior and posterior cruciate ligaments (there are others too!). Overall, the knee joint is at risk due to our sports prone cultures and because supporting the body weight while in motion is a challenge on these relatively flat surfaces. 

Now, for the fun stuff!  I promised in Anatomy Lesson #3 that I would be returning to the scene where Jamie dismounts to grab Claire (Starz episode 1, Sassenach)!   Yep, that’s the one!  Let’s revisit that scene where we first git to see Jamie’s thighs – aye, readers, there’s a first time for everything! 

Wait fer it…………….(Lost yer way?)

Wait fer it……….. (Jamie’s shifting his weight. He looks a wee bit annoyed!)

Wait fer it.…. (Wit’ a high kick Jamie’s right thigh clears the steed’s neck).

Worth the wait? Jamie’s dropping to the ground.  Gad, this man has really loooooong legs!!!!  Thank gawd that the kilt wasna doing its job here! 

A firm landing and further evidence of those thighs and knees!

This just keeps gettin’ better and better! Geez, Jamie’s a perfect anatomical model! I can clearly see three of the four heads of the quads. The red arrow points to the head of the rectus femoris! I dinna ken why Claire isna splayed out on the leaf-strewn ground in a dead swoon wit’ that breath-taking sight advancing toward her!   

OK, Claire, now yer in fer it! Ye’re gonna get what ye deserve!  Oops, sorry, wrong Starz episode. Heh!

Hey, now, in the above images, what happened to the belt o’er Jamie’s left shoulder? Remember, when Claire reduced Jamie’s dislocated shoulder and after he dumps her off the saddle (head-first BTW!)? Weel, Angus’ belt was o’re his left shoulder.  Here there is only a belt o’er his right shoulder – apparently for his scabbard.  Mayhap he gave the belt back so Angus could keep up his kilt? Just sayin’……………………

Now, let’s identify more of Jamie’s quads in the next image (Starz episode 7, The Wedding – just in case ye forgot). Do you see the major bulge (no, not that one!) on the inside of his thigh (blue arrow)? That is the head of his right vastus medialis muscle! Whew!

I know the light is dim but in the next image the blue arrow marks the bulging head of his left vastus lateralis muscle just peeking out from under his wedding shirt. He is sooo modest!   

Now fer the knees!  I ken that gazillions of ye have been awaiting fer another glimpse of Jamie’s knees so feel free ta take yer time!  Sorry to mess up his gorgeous knees with a quiver of arrows, but just so ye ken: the blue arrow is his lateral femoral condyle, the red arrow is his medial femoral condyle, the green arrow marks his patella and the orange arrow is his tibial tuberosity. So now ye ken the names of all the knuckles and knobs o’ his knees! Claire, lift your eyes girl! He squatted down ta show ye his knees and git in yer face! He knows he is one damn fine looking Scot – grubby shirt or no!

Moving on, darn it! Next, ye should know that all of the thigh muscles are wrapped in a very strong, inelastic sheet of connective tissue, the fascia lata which is reinforced at the side as the iliotibial tract (see Anatomy Lesson #1, Jamie’s Tush) or IT band (Photo L). The fascia lata continues over the leg as the crural fascia (more about that in a later post).

Photo L

Now, fer more applied anatomy! Ye see the thick band of tissue running vertically just under the skin of Jamie’s right thigh (Starz, episode 1, Sassenach)? That is his right IT band! Ye can see it plain as the nose on yer face! The tissue just behind the IT band belongs to muscles that flex the knee joint – we’ll puzzle those out later!


You all should ken that the fascia lata is verra important: it’s a long way for the heart to move venous blood from the foot back to the chest especially working against gravity. Contraction of thigh and leg muscles helps milk venous blood back towards the heart. The fascia lata aids this process by compressing contracting muscles against the deep thigh veins. But if the thigh muscles get seriously injured they swell and the inelastic fascia lata willna stretch to accommodate such swelling. When this happens, it is a medical emergency because the swollen muscles not only retard the return of venous blood but also diminish the flow of oxygen-rich arterial blood to the lower limb – and, as ye ken, tissue dies if deprived of oxygen! 

This condition is known as compartment syndrome and the next photo (Photo M) shows the result of medical intervention. This is the right thigh of one of my former students (aye, I have his permission). After injuring his thigh muscles, the swelling threaten necrosis (death) of his lower limb so surgeons slit his fascia lata (at the margin of the IT band) to relieve the pressure and reestablish blood flow. Now, when he contracts his right thigh muscles, they bulge through the slit in the fascia lata! Gives ye a pretty good idea of just how strong and tight the fascia lata truly is!

Photo M

OK, wit’ that, we have come to the end of our thigh and knee anatomy lesson! But, I’m no gonna leave ye bereft. Here is one last image designed to increase yer admiration and respect for Jamie’s anti-gravity quads!  In this modest scene from Starz episode 7, The Wedding, Jamie bears Claire’s entire weight (9 stone or 126 lb - Herself wrote in Outlander). Then he slowly lowers their combined weight (I am guessing around 16 stone, 100 kg or 220 lb) to the bed afore he flips her over (BIG grin)! That takes a whole lot of quad strength!  I am duly impressed and I’m a guessing ye are too!

Ok, mukkers, that’s it fer now. Please stay tuned for my next post.  There is still a lot of anatomy to cover as I work my way through the first eight episodes of Starz! I am deliberately taking a slow pace to keep us occupied until we see what Jamie’s going do to about BJR’s (or was it Claire’s?) knife at Claire’s breast!  It won’t be very pretty fer BJR, of that I am reasonably sure.  Signing off! Happy Thanksgiving to those who celebrate it!

Oh, almost forgot. You can now follow me on Facebook and Twitter.

A deeply grateful,

Outlander Anatomist

Image credits: Starz, Grant’s Atlas of Anatomy, 10th ed., Netter’s Atlas of Human Anatomy, 4th ed., Clinically Oriented Anatomy, 5th ed, www.AuthenticFX.com, Wikipedia, OA archival photos, AAOC Website, Tumblr.com

Frank Netter, MD: The Michelangelo of Medicine

To generations of medical students, from mine to the present, the name Frank Netter has a magical connotation. He was the doctor who drew the remarkably lifelike images that we all used to learn anatomy. They were so lifelike, we joked, that we trusted them more than what we actually saw in our cadavers or on CAT scans.

Who was Frank Netter and how did he come to be the world’s most famous medical illustrator? Fortunately, his daughter Francine has written a forthcoming biography of her father, entitled Medicine’s Michaelangelo

As we learn, if Netter’s mother had had her way, Netter would have retired his paintbrush in favor of a stethoscope.

Read more. [Image: Copyright Elsevier Inc. All rights reserved]

To generations of medical students, from mine to the present, the name Frank Netter has a magical connotation. He was the doctor who drew the remarkably lifelike images that we all used to learn anatomy. They were so lifelike, we joked, that we trusted them more than what we actually saw in our cadavers or on CAT scans.

Who was Frank Netter and how did he come to be the world’s most famous medical illustrator? Fortunately, his daughter Francine has written a forthcoming biography of her father, entitled Medicine’s Michaelangelo

As we learn, if Netter’s mother had had her way, Netter would have retired his paintbrush in favor of a stethoscope. It is because he did not, though, that we have timeless illustrations like this.

Copyright Elsevier Inc. All rights reserved.

Netter was born in Manhattan in 1906 and showed aptitude for art at an early age. During high school, he studied at the prestigious National Academy of Design, where he drew nude figures. At New York’s City College, Netter drew portraits and cartoons for the school’s yearbook and spent the summers as an artist and set designer at a hotel in the Catskills.

But despite his remarkable talent, he had promised his mother he would go to medical school and, in 1927, he enrolled at New York University Medical College. While his fellow classmates spent their spare time studying for examinations, Netter drew haunting images of Bellevue Hospital, where he would eventually complete his internship and, in a harbinger of things to come, a picture entitled “Healing Hands,” in which a doctor applied a bandage to a patient’s fingers.

“I do not know of anybody in the past several hundred years who has done anything like this.”

Netter did practice medicine briefly but, as Francine writes, “the demand for Frank’s sable brush grew faster than the demand for his scalpel.” His portraits, drawings of body parts and, at the behest of pharmaceutical companies, images of new drugs and how they worked were simply too vivid and unique to ignore. In 1934, Netter saw his last patient.

It would be Netter’s relationship with drug manufacturers that propelled forth his career as a medical artist. In 1937, the Ciba Company asked him to prepare an illustrated flyer for its version of digitalis, a heart drug. A remarkably long marriage was born. Over the next five decades, Netter worked with the company, later known as Ciba-Geigy, to produce the Ciba Collection of Medical Illustrations and the Clinical Symposia, beautifully illustrated books that depicted both normal anatomy as well as the pathology associated with specific diseases. The over 4,000 illustrations made by Netter during his career also depicted patients (drawn from models) suffering from conditions like bronchial asthma, angina and major depression. One picture showed a patient with end-stage liver disease on water restriction desperately drinking from a toilet. When Netter required surgery for an aortic aneurysm near the end of his life, he used the occasion to make diagrams of the operation he needed. Netter’s work was voluminous, covering a vast array of topics and diseases. Ciba distributed his illustrations far and wide to medical students and physicians—usually for free—as a marketing tool.

Words do not really do justice to the exquisite nature of Netter’s diagrams. The Saturday Evening Post termed him the “Michelangelo of Medicine” and featured his work alongside that of Norman Rockwell. A reviewer of Netter’s Atlas of Human Anatomy, which compiled hundreds of Netter’s best images, equated Netter’s influence on anatomy to that of Leonardo Da Vinci. 

Copyright Elsevier Inc. All rights reserved.

Medicine’s Michelangelo is less of a page turner than a labor of love. If many famous artists are temperamental, Netter was not. Indeed, he seems to have been humble to a fault. In addition, the book contains lots of names of Netter’s various coworkers that will not be of interest to the average reader.

Nor did Francine Netter situate her father’s career within other relevant developments in the history of medicine. For example, it would have been interesting to explore Ciba’s decision to distribute Netter’s work for free to physicians in light of all of the negative commentary about the marketing techniques of modern pharmaceutical companies. And I would have loved to have heard what Frank Netter thought about the revelations that the famous German atlas of human anatomy by Eduard Pernkopf contained images of Jews killed during the Nazi regime.

But Francine Netter has done an admirable job of documenting her father’s remarkable career. As one of Netter’s many awestruck colleagues wrote, “I do not know of anybody in the past several hundred years who has done anything like this.”

“Jamie Takes a Beating and Claire’s Healing Touch”

Anatomy Lesson #8:  Solar plexus, Respiratory Diaphragm, Kidneys and Cheekbone

Now, that’s a whole lot of anatomy, but dinna get into a swivet; this lesson is dictated by Rupert’s beating of Jamie. Weel, now, Jamie is a warrior who has a knack for getting himself into a mess o’ messes. Claire is a warrior too, only her battle field is healing! 

Getting started, let’s review the healing Claire has given thus far ta young Jamie - showing that she is a real Healer-Dealer and how that rascal Rupert undoes some of her warrior work!

In Starz episode #1, Sassenach, Murtagh captures Claire on Saturday - likely the same day Jamie dislocates his shoulder. Several hours pass before Claire reduces Jamie’s shoulder (see Anatomy Lesson #2). “Tá Dia (I think this is what he says) - it doesna hurt anymore!” exclaims Jamie. Ha, the Highlanders hadna a clue that a feral Sassenach cat could perform such miracles!

Claire and her captors ride through Saturday night and into Sunday when Jamie is shot at Cocknammon Rock (See Anatomy Lesson #3). Later that night, after fainting from lack of blood, Claire securely binds his wound so he doesna have to stay and determine his own fate wit’ a loaded pistol (Starz episode #1, Sassenach).

On Monday they arrive at Castle Leoch (Starz episode #2, Castle Leoch). Claire insists on properly cleaning and dressing Jamie’s gunshot wound (See Anatomy Lesson #3), all the while conducting a thorough counseling session fer the sad lad! She also binds his right arm to his chest (thorax in anatomy) to immobilize the freshly reduced shoulder joint. What a caregiver!

On Tuesday (Starz episode #2, Castle Leoch), Claire brings Jamie comfort in the form of lunch and fresh bandages but accidentally upsets his work at the stables. Jamie falls to his knees. Oooh, this clearly hurts his pride and mayhap messes a wee bit wit’ his injured shoulder? Oops, Claire! After lunch, true confessions and a good deal of “facetime,” Claire begs Jamie not to get stabbed or flogged today.

By Friday, after having been a good lad fer far too long Jamie gallantly steps forth at the Hall to take punishment for “damn-her-eyes” LiarHair who clearly has been a verra bad lassie (Starz episode #2, Castle Leoch). Ye’ll ken this is about six days after his shoulder dislocation and only five days since his gunshot wound! This is important because at this point new blood vessels are growing (angiogenesis), cells are dividing (mitosis) and collagen is forming (fibrogenesis) to help heal pulled ligaments and strained muscles; everything in Jamie’s shoulder is tender and sore. But, braw showman that he is, he chooses fists no the strap!

Laird Colum allows it.  Rupert will administer the fisticuffs (I liked Rupert till now) delivering two consecutive blows to Jamie’s belly! 

 Now fer some anatomy! Both blows strike Jamie in the pit of the stomach (Photo A). This type of blow affects three major regions of the body: the belly wall, the solar plexus and the diaphragm. 

Photo A

As I will cover the belly wall in a future post, I won’t describe its full anatomy now. Suffice it to say that it is defined by the blue area seen in Photo B. In a warrior like Jamie, whose belly is verra strong, two punches wilna do much real damage. But consider the gut punch BJR gives Claire (Starz episode 6, The Garrison Commander) along wit’ the kick by his weenie gopher. I suspect that Claire’s corset stays, several undergarments and that fabulous pleated tartan gown kept any real damage to a minimum; ye ken that each pleat includes three layers of wool? (Aye, Terry and her team create such splendid garments!)

Photo B

Now, just behind the stomach lies the solar plexus (Photo C – surface anatomy), so named because it resembles a sunburst; anatomists call it the celiac (coeliac) plexus

Photo C

To ken the celiac plexus, let’s first visit the aorta the largest artery of the human body (Photo D – posterior abdominal wall - from the front with organs removed). It begins in the chest, pierces the diaphragm and enters the abdominal cavity where it lies in front of the spine.   

Photo D

The celiac plexus (Photo E – black arrows) wraps the front and sides of the abdominal aorta. The white blobs in Photo E are ganglia, swellings that house nerve cell bodies. The white strings are nerves; arising from the cell bodies they connect ganglia and supply organs (viscera). The nerves cause viscera to contract or secrete and also carry pain sensation back to the central nervous system. A blow to the belly can bruise the stomach, shock the celiac plexus, cause pain and potentially interfere with visceral function. 

Photo E

Finally, the last body part vulnerable to a belly blow is the thoracic diaphragm, a dome-shaped sheet of muscle and tendon between the chest and the abdominal cavities that sits surprisingly high under the rib cage  (Photo F – from the front showing cut edge of diaphragm). It is attached to the inner surfaces of breast bone, ribs and vertebrae and is a powerful muscle of respiration: as we breathe in (inspire) it descends, as we breathe out (expire) it rises. Blows to the belly wall cause temporary paralysis of the thoracic diaphragm making breathing difficult – the sensation of “getting the wind knocked out of you" and perhaps the most uncomfortable part of a gut punch! The spasm is accompanied by pain, anxiety and difficulty sitting or standing. But, as with Jamie, the spasm passes, breathing resumes and equanimity is restored.

Photo F

Moving on…Rupert circles around to Jamie’s back and delivers a third blow causing him to stagger! As ye well ken, this is a kidney punch and it is verra painful! 

The kidneys are paired bean-shaped organs that produce urine, extract wastes, balance body fluids and are vital for normal life! Each day they filter about 189 liters (200 qt) of blood but produce only about 1.89 liters (2 qt) of urine because normally most all the fluid is resorbed. The urine flows into paired ureters then to the urinary bladder and is subsequently voided through the unpaired urethra (Photo G).

Photo G

A blow to the kidney is painful but not always serious (unless, of course, Claire’s stabbing ye in the back wit’ her sgian dubh!). Why? Weel, because the 11th & 12th ribs protect much of the left kidney and 12th rib protects part of the right (Photo H – from the back; kidney outlines shown as dashed lines). Also, strong back muscles absorb energy from a kidney punch. Kidney injury from blunt trauma ranges from bruising to serious tearing of tissues. Just so ye ken, blood in the urine is a good indicator of kidney trauma and the kidney punch is one of the meanest places to whack an opponent - although our fiery hero doesn’t seem that worse fer wear.

Photo H

By now Rupert is sweating. So he checks wit’ his heid, “Dougal the Devil Man” ta see if it’s time to stop. Now, we all ken that Dougal is Colum’s war chief. So, take a peek at his menacing stance - splayed legs all covered wit’ his shiny high top boots. But, Dougal has no problem wi’ his nephew getting hurt and hurt badly. After all, the lad is still standing at this point and standin’ in the way of his best-laid plans. So Uncle Dougal directs Rupert to land a 4th blow - this time to Jamie’s face and blood splatters the slates. As there is another punch coming to Jamie’s face, I’m saving facial anatomy until blow #6! Read on! 

Hey, now, I thought the beating was supposed to stop once blood was drawn. Geillis says so and we all know she never lies. Next, Rupert hauls back and lands a mighty one ta Jamie’s right shoulder! 

So, what was Claire thinking through all this physical plundering? Herself writes in Outlander

“I was in agony of apprehension, lest one of the blows re-damage the wounded shoulder…” 

Too late Claire…Och, Rupert, that was brutal, man!

Time fer more anatomy, heh. The shoulder blow is bad news because there’s nay been enough time for the wounds to have healed properly. The next photo shows the proper alignment of a normal glenohumeral joint (Photo I:  x-ray right shoulder). Part of the humeral head (red arrow) sits in the glenoid cavity of the scapula (blue arrow).

Photo I

Nearly a week earlier Jamie suffered an anterior dislocation of the glenohumeral joint (Photo J: x-ray right shoulder). Here, the humeral head (red arrow) is typically displaced forward (anterior) and down (inferior) from the glenoid cavity (blue arrow) as shown in the following radiographic image. Claire restored the normal anatomy of the joint, but as we learned earlier, the whole area remains inflamed and tender. Ouch! It hurts just ta look at it. 

Photo J

Finally, Rupert delivers the last punch to Jamie’s face and knocks him to the ground! 

Now, ye best understand the damage these facial blows can cause! In anatomy, the cheek bone is the zygomatic arch (Photo K). With color-coded skull bones, ye can clearly see that the zygomatic arch is made of two bones: the pink part belongs to the temporal bone and the orange part to the zygomatic bone. The two bones meet at a jagged suture (non-moveable joint). Although strong, the suture is at risk for fracture.

Photo K

Also, the zygomatic bone forms the outer rim of the bony orbit where the eye is housed (Photo L). Both zygomatic arch and bony orbit are subcutaneous structures (see Anatomy Lesson #5 - The Skin) and vulnerable to injury. The fact that Rupert’s blow didn’t fracture either of these bony areas is probably due to the fact that Jamie’s head is harder than an iron pot – or so says his sister Jenny!

Photo L

After the beating, Murtagh helps our hero out of the hall but not afore Jamie casts a look at Claire: “Sassenach. Help!” Well, that does it. Claire has ta’ git outta that Hall - NOW! Make way, Geillis! Ah, have patience Claire, a few more weeks and ye’re going ta get all the healing touches of Jamie ye want. Lucky Lady!

Soon enough, Claire tenderly soothes Jamie’s bruises: he’ll be sore for a couple of days, but he’s no really damaged. She is dying ta know why he took Miss LongHare’s punishment! In the Outlander book Jamie answers Claire:

“Why not me?”…Why not? I wanted to say. Because you didn’t know her, she was nothing to you. Because you were already hurt. Because it takes something rather special in the way of guts to stand up in front of a crowd and let someone hit you in the face, no matter what your motive.”  

Friends, if you have yet to read the marvelous Outlander books, I urge ye to do so as well as follow the Starz episodes! There are lots more to these vignettes than can fit into a 60 minute episode!

Then Claire delivers the sad news that tomorrow (Saturday) she is headed back to Inverness with Pitre the tinker! Jamie groans as he stands to say farewell. He is devastated. Are ye sobbin’ yet? 

Ah…breathe a sigh of relief - fate has a surprise in store fer Mistress Beauchamp. Yep, Colum and his lil’ Big Bad Bro willna let her go wit’ the tinker. Claire has to stay and take her own Beaton – er, the surgery I mean - that little “chamber of horrors” needs her healing touch too!

Now, looking fer remnants of Jamie’s beating - were the movie detailers attending to details? Yep, they were. Many films show heroes beaten within an inch of their lives but they emerge later wit’ nary a scratch - keeps me up at night!

Here’s a great example. Did ye see Jamie hobble along wit his right arm drooping as the Teenage Trollop hauls him into an alcove ta have her way wit’ him (Starz episode 3, The Way Out)? Yep, he’s still hurting after that thrashing! 

At the pillory (Starz episode 3, The Way Out), we glimpse a dark shadow over his zygomatic arch (red arrow) and mayhap a bit o’ black eye as he helps Claire from a feigned swoon - she who canna stand the sight of blood. Hah. Looks like a big old nasty bruise ta me! Verra nice.

Finally, at the Black Kirk, Claire gives Jamie a botany 101 class explaining the difference between wood garlic and its deadly look-a-like, lily of the valley. This time we see up close the mottled bruising o’er Jamie’s zygomatic arch. Ahhh…he does have a lovely zygomatic arch does he not?

I’ll leave ye now with three wonderful images from Starz episode 3, The Way Out. At Gwyllyn the Bard’s performance, Claire is deep into Colum’s Rhenish. Ever watchful Jamie escorts her safely to her Beaton dungeon under the guise of needing help wit’ his bandage. Jamie, ye are the man! Claire decides to check his gunshot wound anyway and starts ta take off his clothes -weel, she just unties his stock and unbuttons his shirt but…Gah! 

She pulls back the bandage: “Scabbed over nicely; no drainage.” She isna going ta let Jamie leave her surgery without feeling his fair, fresh skin. After all she is the healer and she is in charge! 

And, what is young Jamie’s thinking wit’ Claire half undressing him and putting her bonny fingers on him? Weel, look at his face. Ha’ mercy, lass! Ye are making it verra hard for the puir man. Heh. Jamie, he is silently taking’ the MacKenzie oath – only backwards. Jamie, man, ye BURN not shine!

OK, that does it fer this anatomy lesson. Thanks for joining me as we explored how Jamie’s wounds ne’er fail to bring on Claire’s healing touch! Hope ye all are hunkering down as the winter solstice approaches (in the Northern Hemisphere, anyway). 

And fer those who are new to my blog, a note of explanation: I follow the convention of using the character’s names rather than the Starz actor’s names. This gives the cast at least one degree of separation and a wee bit o’ respect as I dissect their bodies with words! I hope ye all understand!

You can now follow me on Facebook and Twitter!

The deeply grateful,

Outlander Anatomist

Images courtesy of: Starz, www.wikihow.com, www.wikipedia.org, Kidney Health Australia, radiopaedia.org, Netter’s Atlas of Human Anatomy 4th ed., Hollingshead’s Textbook of Anatomy, 5th ed.

A love letter to Frank
Frank H. Netter (25 April 1906-17 September 1991) was an artist, physician, and most notably, a leading medical illustrator. He was also a Fellow of The New York Academy of Medicine. (source)
He went on to create 4,500 paintings, a 13-volume collection of medical illustrations and an atlas of human anatomy that has been translated into 12 languages. (source)
This atlas stays permanently on my bedside table, not as a creepy reminder of my weird hobbies, but from a visual stand of point : as a wonderful work of art.

“Claire’s Hair - Jamie’s Mane” or “Jesus H. Roosevelt Christ!”

Anatomy Lesson #6:  The Skin – Part 2, Hair

Hallo again, friends of Outlander Anatomy! Today’s lesson will continue with the skin but will focus on hair, hair follicles, arrector pili muscles and sebaceous glands, all of which ye learned from Skin Part 1 are made by skin and are therefore part of that organ.

Now, afore we git on with today’s lesson, I must confess that I did a quiet switcheroo on ye in the last anatomy lesson. My first four lessons were confined to a part of human anatomy known as gross anatomy. This field encompasses human dissection. 

Nay…not that kind of gross, Rupert! It is termed “gross” not because it is yucky, but because it deals with structures visible to the naked eye. In Anatomy Lesson 5, I switched (without tellin’ ye) to another field of human anatomy, that of microscopic anatomy. 

Microscopes are used to magnify structures too wee for us to see with eyes unaided by magnifying lenses. Many of today’s images are drawings made from slides examined through a compound microscope such as this one (photo A):

 photo A

Once again there are 3-D images taken with a powerful SEM- scanning electron microscope (Photo B). I have used both types of microscopes many times in teaching and various research projects! 

 photo B

Now, gettin’ in the mood for today’s Anatomy Lesson: Skin 2 – the Hair! As with skin, Herself often writes about hair in the Outlander books, offering her audience a more intimate glimpse into characters and situations through vivid use of this physical trait. So, once again, I begin our lesson with images from the Starz Outlander series and with words from the Outlander books.   

Let’s begin with our heroine. Early in Starz episode 1, Sassenach, Claire emerges from the roadster standing in the picturesque village of Inverness.  We can clearly appreciate her dark brown hair – very full and very curly.

Later, during a lighting storm, Herself writes

The wind was rising and the very air of the bedroom was prickly with electricity. I drew the brush through my hair, making the curls snap with static and spring into knots and furious tangles!

The humid air makes Claire’s hair wildly curly and disobedient (Starz, episode 1, Sassenach) to which she exclaims: Jesus H. Roosevelt Christ!!

And, all the while, someone is awatchin’ her futile struggles through the window of her room.

 Nay, it isn’a a peeping tom, it is a keeking Jamie! Ha!

This next image of Claire always makes me laugh! In Starz episode 2, Castle Leoch, Mrs. Fitz unceremoniously rouses Claire from her sleep, seats her in a chair and hands her a cup ‘o brakfast fer her empty belly. Mrs. Fitz then whisks it away afore Claire even finishes! Look at Claire’s hair! It is absolutely fabulous! She certainly looks like the “wee milkweed” Jamie affectionately calls her later in the Outlander book.

"Fretful porpentine, was it?” he asked. He tilted his head, examining me inquisitively. “Mmm,” he said, running a hand over his head to smooth down his own hair. “Fretful, at least. You’re a fuzzy wee thing when ye wake, to be sure.” He rolled over toward me, reaching out a hand. “Come here, my wee milkweed.

Wit’ those great images ta set the mood, it is time fer our anatomy lesson on hair and with it a lot of verra juicy tidbits ta share! First, as ye know, the length of body hair varies a lot - from less than 1 mm (.04 in) on the forehead to well over 1 m (3.3 ft) in long scalp hair (Photo C)! But, the wee hairs of the eyelids (not the eyelashes) are so short they barely reach the skin surface! And, ye should ken that hair grows verra rapidly, about 0.3 mm/day or 1 cm/per month.

 photo C

Ye should also know that hair does not grow straight out of the skin; it emerges at a slant (Photo D). Check this on yer own skin as an example: place your forearm on a flat surface with the palm down. Examine yer forearm hairs and see that they are angled toward the little finger side of the forearm. That’s the slant I’m a talkin’ about.

 photo D

Hair is also denser in some areas than in others: the face has about 600 hairs/cm2 (.16 in2) compared to about 60 hairs/cm2 on the rest of the body.  Hair diameter also varies greatly but even the thickest hair is still only about .5 mm (.02 in) in diameter (Photo E). Even so, a scalp hair is strong enough to support the weight of 100 gm (3.5 oz)!

 photo E

Another interesting tidbit: Human hair grows autonomously; each hair cycles at its own pace through periods of growth and periods of quiescence. If all our hair were on the same cycle, we would molt!

And sometimes our hair does unspeakable things and we just have to pull it outta the way like Angus here who does prefer a wee bit o’ purple ribbon fer his scalp hairs!

Now back to microscopic anatomy! Using the same image from Skin - Part 1, I’ll be reminding ye that skin is divided into a thin outer epidermis that overlies a thicker dermis. And, although not part of skin the hypodermis lies deeper still. The dermis and hypodermis also anchor structures that we’ll cover in this anatomy lesson: hair, hair follicles, arrector pili muscles, and sebaceous glands (Photo F).  

 photo F

Hairs emerge from hair follicles which are down growths of the epidermis (Photo G). The internal anatomy of each follicle is verra complex so I’m simplifying it: the hair and its follicle are divided into a hair root and a hair shaft. At the root is a bulb where cells divide and push older cells toward the surface to form the hair shaft! 

 photo G

Along the way, hair cells harden and get plastered together so by the time the hair clears the skin surface, the cells are dead, flat and stiff with their free edges pointing toward the hair tip. They also overlap each other like shingles on a roof (Photo H). This is a SEM image of a single hair!

 Photo H

Ye should also ken that hair follicles are verra sensitive to the influence of hormones! These chemicals produce secondary sex characteristics such as hair distribution. In fact, the distribution of hair between the two sexes play an important role in socio-sexual communications!

In women, estrogens (oestrogens) cause most body hair to develop as short, thin vellus hairs that are anchored in the dermis. Both genders exhibit the coarse terminal hairs of scalp, eyelashes, eyebrows, axilla and pubis that are embedded deep in the hypodermis.

In men, androgens (testosterone being the most important) also convert facial and chest hairs into terminal hairs. Now then, isna this the right place to offer praises to Dougal MacKenzie who won Saturday’s Starz contest with his comely beard? Congrats! It looks mighty fine on ye, man! Tulach Ard!

And, no anatomy lecture is ever complete without at least one image of a half-dressed Jamie! So here is his chest hair just in case ye be forgettin’!  No verra damn likely! Gawd!

Something else: When viewed by SEM, straight hair has a round shaft as seen in this photo of scalp hair (Photo I –computer generated color); the surrounding dead skin cells look like scatter leaves on a forest floor.

 Photo I

Murtagh’s scalp offers a perfect example of straight hair – here he is explaining to Claire why Jamie is nowhere to be seen (Starz episode 5, Rent)! Plus, he has mighty fine eyes and braw eyebrows just in case ye been so focused on Jamie that ye havena been noticing!

Scalp hair that is curly like Claire’s…

…has a shaft that is flattened in cross-section as shown in this SEM image (Photo J). The flatter the shaft, the curlier the hair!

 Photo J

Now, onto a couple of other structures associated with the hair follicle. First, stretched between the follicle and the dermis is a thin band of tissue, the arrector pili muscle. Second, between the hair follicle and the arrector pili muscle lays one or more sebaceous glands with ducts opening into the hair follicle (Photo K). Sebaceous glands produce sebum, a complex mixture of fats, waxes and other materials.

 photo K

The arrector pili muscles are made of smooth muscle cells that are not under conscious control. They contract in response to cold or the fright, flight, fight reflex! Contractions of this muscle elevate the hair, forming goose bumps or goose flesh and help squeeze sebum from the sebaceous glands into the hair follicle and onto the hair shaft (Photo L).

 Photo L

Contraction of the arrector pili muscles in animals traps air between the erect hairs to retain body heat or to help the creature appear more fierce (Photo M)! This adaptation isn’t of much use to us short haired humans but the release of sebum does help lubricate and protect the hair itself.

 Photo M

Finally, on to hair color! Like the epidermis, hair color requires the presence of melanin; melanocytes in the hair bulb synthesize melanin and package it into granules that move up the hair shaft as it forms. Now, it turns out that there are a couple of different types of melanin!

Like Claire, most hair color is due to the presence of varying amounts of brown or black eumelanin. But, now, ye are in fer a BIG surprise! I bet ye dinna ken this! Flaming red hair in one such as our Great Scott, Jamie, contains a chemically different type of melanin known as pheomelanin and this molecule is red (or red-brown)! Thus, Jamie’s gorgeous mane of red hair is due to the presence of pheomelanin as seen from the back in this image (Starz episode 7, The Wedding)!

And just so ye won’t ferget it, here is Jamie’s hair from the front! We can literally see the words Herself wrote in Outlander about his hair:  

…a mass of auburn, copper, cinnamon and gold all gleaming together in the morning sun…

And one last point fer yer eddycation: Check out both upper corners of Jamie’s forehead. See how the hair line is squared off? This is known as the temporal notch; it is a secondary sexual characteristic in men brought about by the influence of testosterone. Women typically have an oval hairline in the corresponding areas of the forehead!

And now, folks, our journey through the skin and its appendages has come to an end! I do hope you have enjoyed learning about the skin ye are in and that of the Outlander cast while we are at it! At some point in the future, I will post Skin 3 – The Breast.

In the meantime, I’ll be leaving ye with these lovely words from Herself in the Outlander book and an image from Starz episode 7 (The Wedding):

You’ve the loveliest hair,” said Jamie, watching me.  ….”But it’s so .…curly,” I said, blushing a little….“Aye, of course.” ….He sat up and tugged gently on one curl, stretching it down so that, uncurled, it reached nearly to my breast…

And:

 “Mo duinne?”…“It means ’my brown one.’ ”He raised a lock of hair to his lips and smiled, with a look in his eyes that started all the drops of my own blood chasing each other through my veins. Rather a dull color, brown, I’ve always thought,”….”No, I’d not say that, Sassenach. Not dull at all.”  He lifted the mass of my hair with both hands and fanned it out. “It’s like the water in a bern, where it ruffles over the stones. Dark in the wavy spots, with bits of silver (auburn on Starz) on the surface where the sun catches it.” 

Gah, this man has a way with words! Does he ever say anything wrong?  Just look at the look on Claire’s face! She’s both enchanting and enchanted!

Psst…next time, I will be writing about someone’s thighs and knees…stay tuned!

The deeply grateful,

Outlander Anatomist

Photo credits to: Starz, Cat photo from goosecam Edmonton Journal, Goosebumps from genius.com, Basic Histology by Junqueira and Carneiro, 11th ed., University of Leeds, Rochester education Foundation, Wikipedia, WebMD, Loyola University Dermatology website, Histology Guide, University of Leeds, Wikimedia.org. CSIR - Council for Scientific and Industrial Research, South Africa. OA archival photos, Aersol Research – Washington University St. Louis

What is the science book that has influenced you the most?

The “Atlas of Human Anatomy” by Frank H. Netter.

If I wanted to talk about the best book out there, it would definitely be.. actually, I’m not sure what it would be — but Netter’s life is simply amazing. He went to both art school and medical school, drawing thousands of anatomical images to be used everywhere around the world.

This is his Wikipedia article.

“Dr. Netter’s contribution to the study of human anatomy is epochal. He has advanced our understanding of anatomy more than any other medical illustrator since the 16th century, when Vesalius introduced drawings based on cadaveric dissections.” - Dr. Michael DeBakey

..if only he was still alive!