“Jamie’s Thighs” or “Ode to Joy!”

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

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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. 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”

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! 

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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!”

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!

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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!

“The Gathering” or “Gore by a Boar”

Claire is headed out on the hunt thinking boars are just wee, hairy piggies. Our stylish lassie is outfitted in the latest over-the-shoulder, wicker medical basket wit’ a fine leather strap. 

But, her first physicking is fer a young man gored by a boar. Near the knee, a horrific meaty-looking wound gapes the length o’ his right leg (see Anatomy Lesson #7). The gash is huge and Claire applies a nice field dressing while givin’ him holy hell fer messin’ wit’ the pigs. She tells him he will walk with a limp! 

Now, let’s puzzle out the anatomy of this wound. Ye may ken from Anatomy Lesson #7 that anatomists divide the lower limb into thigh, leg and foot. Ye also ken that the leg contains two bones (Photo A): the larger, medial tibia and the smaller, lateral fibula. The tibia, or shin bone, has a sharp anterior border and a broad medial surface ye can easily palpate (feel) through yer own skin. Try it. These tibial surfaces are so superficial that they are easily barked on projections such as stair risers.

Photo A

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