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.

brian falls
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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.

brian fraser grave
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Further Reading:

Virgins by Diana Gabaldon – an Outlander prequel novella

 

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