203 (part deux): A Useful Deception

Murtagh has found diversion and finally something to like about Paris.

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Happy, happy Murtagh! / STARZ

Murtagh’s new situation benefits many, as no doubt Claire is grateful for any excuse to occupy herself with a visit to Master Raymond once more, this time in search of a contraceptive for Suzette.

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Master Raymond notes the irony in Claire seeking a contraceptive for her maid rather than the other way around, and suggests Mugwort.

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Mugwort / source

A member of the daisy family, Mugwort is said to derive its name from its use in flavoring beer and other beverages one might drink from a mug. Others theorize its name originates from moughte (a moth or maggot) as it was also used as an insect repellent. Medicinally, it has been used for gastrointestinal problems like colic, diarrhea and constipation. It has historically been used to stimulate women’s menstrual cycle and was used in the past to induce abortions.

As Claire browses the store, she is very alarmed as she pulls from the shelf a jar labeled “Aconitum napellus” or Monkshood.

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Aconitum napellus / STARZ

Monkshood is a strong, fast-acting poison that affects the heart and nervous system, causing nausea, vomiting, dizziness, muscle spasms, hypothermia, paralysis of the respiratory muscles and heart rhythm disorders. It is so toxic that poisoning has occurred following picking leaves of the plant without wearing gloves. It has been used as arrow poison, including for hunting whales among the indigenous people of Alaska.

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Monkshood / source

Master Raymond assures Claire he does not actually dispense Monkshood to his customers, but often provides them with bitter cascara when they are seeking to poison a foe.

Bitter in taste, the aged, dried bark of cascara stimulates the large intestine and has a laxative effect.  In larger doses it causes severe diarrhea, a well as abdominal discomfort and cramping.  It was available over the counter in the US as a treatment for constipation until it was banned in 2002 over safety concerns.

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Cascara / source

Master Raymond sells this to unknowing customers as a “fake” poison – while long term use can lead to electrolyte abnormalities due to continued fluid loss by diarrhea, short term use will result in diarrhea and abdominal pain, but this will only be temporary.

“Yes, that’s right, cascara.  The rival will fall sick tomorrow, suffer visibly in order to satisfy the Vicomtesse’s desire for revenge and convince her that her purchase was a good one, and then she will recover, with no permanent harm done, and the Vicomtesse will attribute the recovery to the intervention of the priest or a counter spell done by a sorcerer employed by the victim.”

From Dragonfly in Amber by Diana Gabaldon, Chapter 8.

Useful occupations and deceptions, indeed, wise Master Raymond!

Hmm, if the parritch doesn’t do the trick, Master Raymond may have another customer for that bitter cascara!

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203: The Sweet Taste of Urine?

203: Useful Occupations and Deceptions

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L’Hôpital des Anges, Mother Hildegarde and Bouton! Claire is back in her element.

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L’Hopital des Anges / STARZ

Claire proves her skill as a healer and earns Mother Hildegarde’s trust as she diagnoses a woman with diabetes and she does it in part by tasting her urine.  Surprisingly, this is really how it was done!

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Our Claire is fearless! / STARZ

Urinoscopy, or uroscopy, dates back to ancient times and involved examining the urine for color, clarity, thickness, sediment, odor, foam and taste.  Initially this was employed to determine if the four humours were in balance (blood, phlegm, yellow and black bile).  Later, physicians would diagnose diseases such as jaundice (noting a brown tint to the urine), kidney disease (with red or foamy urine), tumors of the urinary tract (with blood in the urine) and diabetes (with sugary, sweet tasting urine).

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Patients presenting urine for urinscopy / source

Diabetes was first described by the Egyptians around 1500BC as a disease causing rapid weight loss and frequent urination. Indian physicians around the same time called the disease “honey urine.” These early healers did indeed taste the urine of these patients and find it to be sweet, which at the time they blamed on excess food and wine.

The name reflects these early findings:

Diabetes “siphon” or “to pass through

Mellitus “honey-sweet

Indeed, diabetes does cause sugar in the form of glucose to be present in the urine and occurs in two primary forms: Type 1 and Type 2. In general, Type 1 diabetics do not have enough insulin. Type 2 diabetics have insulin resistance and their bodies are unable to use the insulin they have.

Type 1 diabetes is characterized by deficiency of insulin. Most commonly, this results from autoimmune destruction of the insulin-producing beta cells of the pancreas – the body’s immune system mistakenly destroys these cells. Normally, when we eat, the body breaks down starches and sugar into a simple sugar called glucose which the body uses for energy. The hormone insulin is needed to get the glucose from the bloodstream into the cells of the body. Without insulin, the cells of the body cannot access the glucose in the bloodstream and instead, glucose accumulates in the blood and the cells are left without that energy source. This leads to a number of dangerous problems:

1. Dehydration: Elevated glucose in the blood leads to increased glucose excretion in the urine. This excess glucose pulls more water out of the blood stream to be urinated, leading to dehydration.

2. Weight loss: Unable to use glucose as energy because of the lack of insulin, the body breaks down fat and muscle.

3. Diabetic Ketoacidosis (DKA): The cells of the body cannot access all of the glucose in the bloodstream, so instead the body begins to break down fat cells for energy. This creates chemicals called ketones to be circulating in the body and leads to fruity-smelling breath, vomiting, drowsiness, lethargy, significant dehydration and abnormal electrolyte levels such as potassium, sodium and phosphate.

4. Damage to the eyes, kidneys, heart and vascular system: Over time, high glucose levels in the blood harm the nerves and small blood vessels throughout the body, leading to loss of vision, kidney failure, hardening of the arteries, heart attack and stroke.

Type 1 diabetes is most often diagnosed in children, though 25% of cases are diagnosed as adults. The most often scenario is a patient presenting with complaints of polyuria (urinating excessively), polydipsia (excessive thirst) and weight loss. Also common is presentation already in DKA and other times, presenting silently, by the discovery of elevated glucose in the blood or urine.

Throughout history, a number of treatments were recommended. The ancient Greeks prescribed exercise, preferably on horseback. Healers of medieval Europe prescribed wine, opiates and even aphrodisiacs. On the other hand, in China, physicians advised avoiding sex and booze. In the 19th century, physicians discovered that periodic fasting and starvation did help to some extent, as it would lead to lower blood glucose levels, though this might only buy a few years. Type 1 diabetes would remain a death sentence until the 1920s.

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Claire’s diabetic patient / STARZ

Claire examines an ill woman in L’Hopital.  The woman reports she has been very thirsty and very hungry, though “no flesh gathers on my bones no matter how much I eat.”  She appears to be lethargic and dehydrated and in DKA (diabetic ketoacidosis).  Claire then confirms her diagnosis by tasting the urine:

The vessel was brimming with a yellow fluid–urine, undoubtedly. I was mildly surprised; without chemical tests, or even litmus paper, what conceivable use could a urine sample be? Thinking over the various things one tested urine for, though, I had an idea.

I picked up the vessel carefully, ignoring Sister Angelique’s exclamation of alarmed protest. I sniffed carefully. Sure enough; half-obscured by sour ammoniac fumes, the fluid smelled sickly sweet–rather like soured honey. I hesitated, but there was only one way to make sure. With a moue of distaste, I gingerly dipped the tip of one finger into the liquid and touched it delicately to my tongue.

From Dragonfly in Amber by Diana Gabaldon, Chapter 12

Though Claire, nor anyone at that time, can cure this patient, Mother Hildegard is impressed by Claire’s assessment and promotes her from emptying chamber pots to helping tend to patients’ wounds.

The cause of diabetes remained a mystery until the late 19th century.  A German medical student by the name of Paul Langerhans found in 1869 that the pancreas contained clusters of cells whose function was unknown. These would later be shown to be the insulin-producing beta cells and these clusters of cells would come to be named the islets of Langerhans in his honor. Germans Oskar Minkowski and Joseph von Mering showed in 1889 that a dog would develop diabetes if its pancreas was surgically removed, but if the pancreatic duct was simply tied off so that the digestive juices of the pancreas couldn’t reach the intestine, the dog did not develop diabetes. They showed that the pancreas had two functions:

  1. Exocrine function:  production of digestive juices that are released into the pancreatic duct and into the digestive tract to break down food
  2. Endocrine function:  production of a substance that regulated blood sugar and is released into the bloodstream.

 

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Finally in 1921, Canadian surgeon Frederick Banting and his medical student assistant Charles Best began experiments showing that when a diabetic dog was injected with extracts of the tissue of a healthy pancreas, the symptoms of diabetes resolved. They went on to perform further animal testing, then injected themselves with the extract. Both felt weak and dizzy from it but they were not harmed. They worked to purify the substance, which they called “insulin” and in 1922 successfully treated 14-year-old diabetic Leonard Thompson successfully. Banting and his team patented their insulin extract but gave away all of their rights to the University of Toronto, paving the way for rapid adoption of the treatment worldwide.

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Charles Best and Fredrick Banting, c. 1924.  source

Bouton lovers will appreciate this story about a modern day Bouton.  7 year old Luke has type 1 diabetes but is hypoglycemia unaware – he cannot tell when his blood sugar is dropping dangerously low.  His Diabetic Alert Dog, Jedi, is able to sense when Luke’s blood sugar has dropped too low or has risen too high and he alerts Luke’s parents who can then give him he proper treatment.  Amazing!

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Bouton! / STARZ

 

 

202: Master Raymond’s Apothecary: Catnip and Crocodiles

202: Not in Scotland Anymore

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There are a few interesting medical discussions to be had in this episode but we’ve got to start with the amazing Master Raymond!

We are introduced to the much loved Master Raymond and his amazing apothecary.  I do hope we see more of this amazing space.

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He is exactly as expected from Claire’s description:

For Master Raymond resembled nothing so much as a large, genial frog.  A touch over four feet tall, barrel-chested and bandy-legged, he had the thick, clammy skin of a swamp dweller, and slightly bulbous, friendly black eyes.  Aside from the minor fact that he wasn’t green, all he lacked was warts.

From Dragonfly in Amber by Diana Gabaldon

 

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Jamie suffers from terrifying nightmares as he works through healing from his experiences at Wentworth. Claire has sought out Master Raymond in hopes of obtaining something to help him sleep.

Claire initially requests Nepeta cataria, which is actually catnip!

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Nepeta cataria / source

The flowering tops of catnip are medicinal and known to have calming effects on humans.  It has been used for insomnia, anxiety, gastrointestinal ailments and migraine headaches.  Catnip is famous for the euphoric state it induces in cats, though some question whether this same effect occurs in humans.

Instead, Master Raymond suggests an alternative: Valeriana officinalis combined with a touch of Humulus lupulus.  I suspect he has chosen a more potent medicine for Jamie.

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Known as “herbal Valium,” due to its ability to calm the central nervous system and relax muscles, valerian root acts in a similar fashion to benzodiazepines like Valium and Ativan. These enhance the effect of the neurotransmitter GABA in the brain, resulting in sedative, hypnotic (sleep-inducing) and anxiolytic (anti-anxiety) effects.  Claire, of course, is familiar with valerian root as this is the same herb she used at The Gathering to sedate Angus and Rupert so she could attempt escape from Leoch!

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Valeriana officinalis / source

Master Raymond has combined the valerian root with Humulus lupulus, or common hops.

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Humulus lupulus / source

Hops is a species of flowering plant in the Cannabaceae family, along with Cannibis.  In addition to its use in most beers, when taken orally, the dried fruiting part of the plant provides sedative and hypnotic effects.  Indeed, Master Raymond knows his business!

What about Master Raymond’s “Sang de Crocodile” (crocodile blood)?  While his was not true crocodile blood and was used more for impressing the French nobility, perhaps by claiming to enhance virility, freeze-dried crocodile blood capsules are sold in Asia today as a supplement.  Supporters of it claim it increases hemoglobin levels in rats and is advertised as a supplement for patients with anemia.

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More interesting though is the fact that crocodile blood actually holds promise for the development of medications to fight antibiotic-resistant bacteria!

Crocodiles sustain significant wounds in the course of hunting and killing prey and in fights with each other for territory, food and mating rights, but as scientists noted, despite these significant wounds, the crocodiles return to their habitat of bacterial laden swamp water and never seem to become ill from wound infections.  Researchers took samples of crocodile blood and exposed it to 23 different strains of bacteria, including antibiotic-resistant MRSA.  It turns out that while human blood could only kill off 8 of these strains, the crocodile blood killed ALL of the samples of bacteria!   Further tests showed it was also effective at killing HIV!  The potential application of this in developing antibiotics is pretty amazing.

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That Master Raymond is a man ahead of his time.  Or before it?  Hmm…

 

Further Reading:

BBC News – Crocodile Blood Antibiotics Hope 19 August 2005

201: Claire Fraser, Champion of Public Health

201: Through a Glass, Darkly

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So what is Claire making all this fuss about at the docks?

At the harbor in La Havre, Claire finds a man carried off a ship on a stretcher appearing quite ill and with a very concerning rash. She follows the crowd into a warehouse where she is able to examine the ailing sailor a bit more, finding him covered with lesions and suffering from a high fever. It is smallpox, she declares.

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On hearing this, and with a large crowd watching on, the harbormaster does what he must and declares that the ship and its entire cargo must be destroyed. Unfortunately for the Frasers, the owner of this ship is the Comte Saint Germain, who does not take the news well nor does he seem the type of guy one would like to make an enemy of.

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The ship and its cargo are burned in the harbor and completely destroyed.

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What’s the big deal? Certainly the harbormasters of Europe were not burning every ship that came into port carrying unwell sailors with fevers, coughs or gastrointestinal ailments.

Smallpox, though, is another animal.

Known as smallpox to differentiate it from  “the great pox” (syphilis), smallpox killed 400,000 people annually in 18th century Europe and was justifiably and greatly feared.

Smallpox is thought to have emerged in human populations around 10,000 BC. The earliest evidence of the pustular rash is seen on the mummified body of Pharaoh Ramses V of Egypt.

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It is thought to have been responsible for killing a third of Japan’s population during an epidemic in 735-737. Smallpox was brought to the New World by Spanish and Portuguese conquistadors and was instrumental in the fall of the Aztec and Incan empires. Smallpox devastated Native American populations with a 90% mortality rate among native groups.

Smallpox is caused by the variola virus which is in the same family as cowpox, monkeypox and vaccinia viruses. It is highly contagious and transmitted between people, primarily by direct and fairly prolonged face-to-face contact (i.e. within 6 feet of each other for at least 3 hours or so).  This occurs via inhalation of airborne droplets from the mouth, nose or throat or an infected person. It can also be spread through direct contact with infected bodily fluids or contaminated objects like bedding or clothing.

Following exposure, a person will go through an incubation period of about 2 weeks during which they are not contagious. After about two weeks, the patient will begin to experience symptoms of a prodrome like fever to 101-104 F, malaise, body aches, headache and sometimes vomiting. Once the fever and prodrome symptoms begin, the patient is contagious. The most contagious stage occurs as the rash develops. Small red spots develop on the tongue and in the mouth which develop into sores that break open and spread large amounts of virus into the mouth and throat. A rash of red spots appears on the skin starting at the face and spreading out to the arms and legs and then hands and feet. The rash covers the body within 24 hours. Over the next few days, the spots become raised and then appear to be filled with pus, raised, round and firm to the touch, as though there is a small round object under the skin. These pustules scab over and by around day 20, the scabs fall off, leaving pitted scars. Once all of the scabs have fallen off, the patient is no longer contagious.

smallpox progression cdc
source:  CDC

 

Mortality for patients with small pox is around 30%, but higher for young children.

Those who survive can be left with permanent scars over large areas of the body, especially the face, blindness and limb deformities.

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Smallpox lesions / source

The devastation of this disease led to the experimentation with the practice of inoculation as early as the 10th century.  This was an effort to immunize against smallpox whereby infectious material from a smallpox lesion was rubbed into a superficial skin scratch of a healthy person. This would often result in more mild smallpox infection than that naturally acquired and confer lifelong immunity. However, it was not without risk and sometimes caused severe smallpox infection and death.

A safer alternative was developed and popularized by Dr. Edward Jenner in England. In 1796, Jenner discovered that immunity to smallpox could be produced by inoculating a person with material from a cowpox lesion. Using infectious material from a lesion on the arm of young dairymaid Sarah Nelmes who had a mild case of cowpox, he inoculated 8 year old James Phipps on the arm. James developed mild fever and nine days alter he was completely recovered. To prove that this would confer immunity against smallpox, 2 months later, he inoculated James again, this time with smallpox virus. James developed no symptoms or disease.

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Vaccination using Jenner’s approach was widely adopted and paved the way for worldwide use of the vaccine, ultimately leading to the global eradication of the disease.

The word vaccine actually originates from this process from vacca ‘cow’.

The smallpox vaccine is not administered by injection like other immunizations. For smallpox vaccination, a live virus preparation of infectious vaccinia virus is made – this virus is of the same family as smallpox and cowpox and confers the same immunity. A two-pronged needle is dipped into the vaccine solution and then used to prick the skin of the upper arm a number of times in a few seconds. A red and itchy bump arises at that location in 3-4 days and then develops into a fluid filled blister. The blister drains and during the second week a scab forms. In the third week, the scab fans off, leaving a small scar.

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Two-pronged needle for smallpox vaccination / source

A very characteristic scar!

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The mark of the devil? / STARZ

Smallpox was declared eradicated worldwide in 1980 and vaccination ceased, aside from use now for some military troops and for laboratory scientists who work with the virus.

So, was it worth it, Claire?

Smallpox was devastating in the 18th century and killed 400,000 Europeans a year.  Transmission occurs both but direct face-to-face contact AND with contaminated objects (bedding, clothing, the cargo of a ship!)   It would not have taken long for disease to spread in the conditions of the time. Claire is a healer and her instinct will be to protect these people from this terrible disease, though no doubt there will be a cost (cue haunting Comte Saint Germain theme from Bear McCreary!)

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Hurray for the end of Droughtlander!  Looking forward to many medical discussions to come as Claire the Healer finds her way in Paris!

Further Reading:

The Sickly Stuarts – the Medical Downfall of a Dynasty

CDC – Smallpox Information

112: Was BJR Responsible for the Death of Brian Fraser?

112: Lallybroch

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We come to learn more about Jamie’s father, Brian Fraser, as Jamie shares with Claire his last memories of his father. Brian was present at Fort William when Jamie was flogged a second time and collapsed as he witnessed the torture of his son.

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“It was…hard. I didna call out, or let them see I was scairt, but I couldna keep my feet. Halfway through it, I fell into the post, just – just hangin’ from the ropes, ken, wi’ the blood…runnin’ down my legs. They thought for a bit that I’d died – and Da must ha’ thought so, too. They told me he put his hand to his head just then and made a wee noise, and then…he fell down. An apoplexy, they said.”

“Mary, Mother o’ God, have mercy on us,” Ian said. “He – died right there?”

“I dinna ken was he dead when they picked him up or if he lived a bit after that.” Jamie’s voice was desolate. “I didna ken a thing about it; no one told me until days later, when Uncle Dougal got me away.”

From Virgins by Diana Gabaldon

apoplexy

What exactly is a stroke?  A stroke is an acute injury to the brain that occurs one of two ways:

  • 1.  An ischemic stroke in which too little blood is delivered to a part of the brain, depriving the  area of necessary oxygen and nutrients
  • 2.  A hemorrhagic stroke in which bleeding is present in the brain or within the closed compartment of the skull, exerting pressure on the brain.

Ischemic strokes generally occur when there is a blockage in the arteries that supply the brain, whether from a clot occurring in the artery or traveling to the artery from other locations in the body such as the heart or the aorta.  The brain which is supplied by that blood vessel is deprived of blood supply, leading to symptoms correlating to the processes that area of the brain controls.

Hemorrhagic stroke is a result of bleeding in the brain itself or into the cerebrospinal fluid within the subarachnoid space that surrounds the brain.  When a hemorrhage occurs within the brain, brain tissue is destroyed as pressure is exerted on the brain by the expanding mass of blood.  Symptoms involve dysfunction of the portion of the brain that contains the hemorrhage.

When bleeding occurs within the subarachnoid space, the intracranial pressure (the pressure within the skull) rapidly increases, leading to devastating consequences.

The description we are given of Brian Fraser’s collapse aligns most closely with fatal subarachnoid hemorrhage.  These are characterized by a very sudden, severe headache, pain spreading to the neck, often with vomiting.  Altered level of consciousness, coma and sudden death can occur due to the severely elevated pressure on the brain.  10-15% of these patients die before arriving to the hospital and overall, the mortality rate of a subarachnoid hemorrhage is close to 50%.

According to Jamie’s account of Dougal’s description of the events, Brian put his hand to his head, let out a “wee noise” and collapsed.

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Is BJR to blame?

Most subarachnoid hemorrhages are caused by ruptured aneurysms (bulging or ballooning) in an artery supplying the brain.  Risks for development of these aneurysms include high blood pressure, smoking and family history of aneurysms.  Approximately 5% of the US population have these aneurysms but most of them will not rupture and cause bleeding.

Cerebral_aneurysm_NIH
from NIH

Bleeding of these aneurysms often follows identifiable triggers such as physical exertion or acute elevation in blood pressure.  There is an association of ruptured aneurysms following a rise in blood pressure caused by caffeine consumption, sexual exertion and acute anger or startling.

Would Brian Fraser ultimately have suffered from this type of hemorrhage without the trigger of acute emotional distress and anger brought on from watching Jack Randall torture his son?

Maybe.  Or maybe not.

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Further Reading:

Virgins by Diana Gabaldon – an Outlander prequel novella

 

111: What Was Ailing Arthur Duncan?

111: The Devil’s Mark

What was ailing poor Arthur Duncan, who always seemed so uncomfortable?

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Claire and Geillis are unceremoniously dropped into the thieves’ hole where they have a bit of time to bond as they await their fate. Claire confronts Geillis about Arthur’s death and Geilis admits that she did poison him with cyanide but only after trying for months to kill him with arsenic!

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Indeed, Arthur appears ill every time we see him, suffering from various stomach ailments and discomfort. Even Claire was stumped as to what may have been causing his trouble.

The symptoms were rather puzzling; not like ulcer, I thought, nor cancer- not with that much flesh still on his bones- perhaps just chronic gastritis, as Geilie insisted.  

From Outlander by Diana Gabaldon, Chapter 24

But now it is all so clear. Arthur has been suffering the effects of chronic arsenic poisoning all these months.

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poor arthur 2poor arthur

Arsenic is ubiquitous in the environment, found in ground water most commonly, and also a byproduct of mining and smelting metals. It has been used medicinally for over 2400 years in traditional Chinese medicine and also used to treat syphilis in the western world before the development of penicillin. In the Elizabethan era, women used a mixture of vinegar, chalk and arsenic which they applied to their faces in hopes of preventing aging and creasing of the skin. Arsenic is an ingredient in green pigments used to color most anything – wall paper, textiles, paint.

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Arsenic has been a favored poison throughout history. Tasteless and odorless, it was an easy choice. It is particularly known to have been used by the Borgias in Italy and is also thought to have been responsible for the death of Napoleon Bonaparte. In the 19th century, arsenic was dubbed “inheritance powder” because it was suspected that many impatient heirs ensured or accelerated their inheritance by means of poisoning with arsenic.

The most toxic form, white arsenic, or arsenic trioxide, is of course what Geillis chose.

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Arsenic poisoning is due to ingestion most often, but also occurs via absorption through the skin and by inhalation. Arsenic is readily taken up by the red blood cells and distributed throughout the body, and is particularly toxic to the gastrointestinal system, kidneys, bone marrow, skin and nervous system.

White arsenic binds to and interferes with numerous enzymes in the cells of the body, wrecking havoc on normal cell function.

Symptoms after acute poisoning develop in minutes to hours and generally begin in the gastrointestinal system causing nausea, vomiting, abdominal pain and severe watery diarrhea. It can cause a garlic odor on the breath and in the stool. Severe poisoning leads to abnormal heart rhythm, shock, acute respiratory distress and death.

What Arthur suffered, however, is chronic toxicity – long term exposure of lower levels of arsenic. The symptoms come on more slowly but still have significant consequences. Chronic exposure leads to abdominal pain, nausea and diarrhea as well, but also skin lesions, peripheral neuropathy (numbness and tingling, then intense burning pain to the hands and feet), cancer of the skin, bladder, lungs and liver, type 2 diabetes, and respiratory problems.

We’ve witnessed Arthur suffering with abdominal distress just about every time we’ve seen him. He’s been treated with peppermint by Geillis and fennel from Claire for his discomfort. These provide temporary relief but won’t cure him.

But alas, when that doesn’t do poor Arthur in, Geillis employs another technique and Arthur meets his end by cyanide poisoning.

Ah, Geillis, we wanted so much to like you, what with the fabulous red shoes and talk of BBQs…

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110: The Scent of Almonds

110: By the Pricking of my Thumbs

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By the light of the full moon and clearly in her element, Geillis Duncan reveals to Claire that she loves Dougal MacKenzie and is pregnant with his child.  Maura MacKenzie, wife of the war chief has conveniently and suddenly died, leaving only Arthur Duncan in the way of these star-crossed lovers, or so it seems.

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The Duke of Sandringham has arrived at Leoch to take counsel with the Laird and hopefully to be of some help to Jamie in securing a pardon from the murder charges he faces.  A banquet is held in his honor and all associated with the clan enjoy the lavish feast.

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The Laird of the MacKenzie offers a toast to his longtime friend and ally, His Grace, the Duke of Sandringham.  Everyone drinks, the food is passed, and merriment ensues.

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Arthur Duncan suddenly stands, coughing and apparently choking.  His hands grasp at his throat and he collapses to the ground.  Claire rushes to his side to help but quickly it becomes clear that he cannot be saved.  She smells bitter almond and recognizes the scent as that of cyanide.  Arthur Duncan has been poisoned.

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Knowledge of the poison cyanide may date back as far as ancient Egypt, as “death by peach” has been translated from Egyptian hieroglyphics.  In more modern history, cyanide was used by the Nazis in extermination camps and later ingested by the Nazi leaders themselves as they committed suicide as the Russian forces approached in 1945.  The mass suicide of 912 cult members in Jonestown in 1978 was due to a cyanide-laced kool-aid type drink.  Saddam Hussein included cynanide among the chemical weapons used against the Kurds in the 1980s.  The still unsolved mystery of cyanide poisoning in Chicago in the 1980s in which random containers of the medication were spiked with cyanide led to the universal tamper resistant packaging we now have in over the counter medications.

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Cyanide is simply a carbon atom bound to a nitrogen atom and is a very potent poison, found in many foods and manufactured items.  It is found in the pits and seeds of bitter almond, cherry laurel, apricot, plum, pear, peach and apple as well as in cassava root, bamboo and soy.  Some species of centipedes, millipedes, beetles, moths and butterflies synthesize and excrete cyanide for defensive purposes.  When burned, wool, silk, polyurethane and plastics like cyanoacrylate (superglue) emit cynaide gas.  It has even been used as an insecticide and to fumigate ships and buildings.  The major source of cyanide poisoning now is smoke inhalation from residential or industrial fires in which cyanide is released as plastics and textiles burn.

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Cyanide exposure can occur by inhalation, ingestion or even absorption through the skin. It then enters the blood stream and is distributed rapidly throughout the body.  Cyanide irreversibly binds to and inactivates energy pathways in the cells, leaving them unable to absorb oxygen or produce energy, resulting in cell death.  The cells are in effect suffocating, unable to use the plentiful oxygen available.  The heart and brain are especially dependent on the body’s oxygen supply and the effects on these organs is particularly deleterious.

Within minutes, the victim of cyanide poisoning will begin to experience symptoms:  Headache, anxiety and confusion will progress to seizure and coma.  An initially elevated heart rate and blood pressure will progress to severely low heart rate and blood pressure, heart block and cardiac arrest.  Pulmonary edema, or accumulation of fluid in the lungs will cause coughing of frothy sputum and progress to respiratory failure.  Vomiting, kidney failure and liver failure occur.  Death occurs in minutes, depending on the dose.

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Antidotes for cyanide poisoning are available.  Those patients who receive a dose of cyanide that is not immediately fatal and receive prompt medical care can be treated with medication that binds the cyanide in the blood an allows it to be eliminated via the urinary system.  However, cyanide is so quickly acting that those who receive a fatal dose will almost always die before they can reach medical care and receive such an antidote.

arthur frothy sputum better
Arthur with frothy sputum from the mouth, evidence of pulmonary edema.  (Starz)
arthur with convulsion hand
Arthur convulsing as a result of cyanide poisoning  (Starz)

Can’t help but flashback to Angus’ lesson for Claire in self defense with a sgian-dubh…

poison is best weapon for a woman
Murtagh to Dougal: “I still say the only good weapon for a woman is poison.”  Starz

 

The episode ends on a painfully familiar note. Our Claire again sits locked up in the back of a wagon.

 

claire in wagon
Starz

Indeed something wicked this way comes!

leoghaire
Starz

 

Further Reading:

How to Make a Peacock Pye