210: When Nothing Can Be Done

210: Prestonpans

titlecard
STARZ

After six years of combat nursing in the Second World War, Claire knows what awaits and she is as prepared as she can be.  She has collected what she can in the way of medical supplies including strips of bandages sourced from petticoats and shirts, needles and thread, honey water for hydrating the wounded, alcohol for sterilization, laudanum and whiskey for pain relief and fortunately the medical bag of a Doctor MacPherson which has been left behind, containing useful medical instruments.  Along with her crew of willing and not-so-willing volunteers, she stands in nervous anticipation for an influx of wounded soldiers.

angus carries rupert
Selfless Angus – STARZ

Ever the stoic Highlander and loyal friend, Angus carries Rupert to the field hospital, where he can be cared for by Claire and her ready crew.  Rupert has sustained a large laceration to the left side of the chest.  The wound involves the skin and soft tissues of the chest wall, but remains superficial to the ribs and the vital organs and blood vessels of the thorax.  After a dose of what is likely laudanum for pain, Claire sutures the wound closed.  If he can avoid an infection in the wound, Rupert will recover.

As Murtagh so keenly notes,  “Dinna fash yerself, that blubber no doubt protected his innards.”

Rupert’s wound is actually the same type of wound Jamie sustained in Dragonfly in Amber in the Battle of Prestonpans:

It was a saber-slash, slanting across the ribs.  A lucky angle; straight in and it would have gone deep into the intercostal muscles between the ribs.  As it was, an eight-inch flap of skin gaped loose, red beginning to ooze beneath it again with the release of pressure.  It would take a goodly number of stitches to repair, but aside from the constant danger of infection, the wound was in no way serious.

From Dragonfly in Amber by Diana Gabaldon, Chapter 36.

For the TV adaptation, Rupert sustains this wound rather than Jamie.  The contusion and potential kidney trauma resulting from four-hundredweight of horse stepping on his flank will be plenty for Jamie to deal with for now (though if the show stays true to the book in this regard, he will be fine, pissing contests notwithstanding…).

As the episode progresses, subtle clues suggest Angus isn’t doing so well himself.

Angus is quite subdued and without the normal witty banter we have come to expect from him even in the most trying of times.  He begins to complain of headache and soon after, collapses to the floor.

internal bleeding
Ecchymosis (red/blue/purple discoloration of the skin) – a sign of internal hemorrhage / STARZ

What happened?

On the battlefield, Angus saves Rupert from a charging Redcoat and moments later is blown to the ground by a cannon blast immediately behind him.

angus in blast
Cannon blast just behind Angus as Rupert watches on / STARZ

Blast injuries result from explosions and have the capability to cause significant, life-threatening injuries.  What used to be a pattern of injury seen primarily on battlefields, blast injuries are sadly becoming more common in the civilian population as the result of terrorist acts.

Blast injuries are categorized by the mechanism with which the explosion causes injury:

Primary blast injuries are injuries caused by the direct effect of transmitted blast waves.  The lungs, bowel and middle ear  – air filled areas of the body – are the areas most susceptible to this type of injury.

Secondary blast injuries are those injuries sustained when a vicim is struck by airborne debris from the blast.

Tertiary blast injuries are caused by high-energy explosions when the victim is propelled through the air and strikes other objects or the ground.

Quaternary blast injuries are the injuries that occur as a result of all other forces, such as a resultant fire and building collapse following an explosion.

Angus has suffered a primary blast injury to his abdomen, which can cause perforation of the intestines, hemorrhage, lacerations of the solid organs such as the kidney, liver and spleen, and shearing injury to blood vessels throughout the abdomen.

angus from above with group at end
Angus’ final moments, surrounded by Claire, Jamie and Dougal / STARZ

Angus dies of massive internal bleeding in Claire’s arms, with his last words, “Save me, Mistress.”  She is helpless to save him.  There is nothing to be done, even if he had sought her help immediately.  The knowledge, tools and resources needed to surgically treat the trauma he sustained would not be available for two more centuries, and even today this injury would carry a substantial risk of death.  There is nothing Claire can do but provide comfort as he takes his final breaths.

Perhaps sensing the severity of his wound, Angus chose to spend his final moments by the side of his trusted friend, keeping watch over Rupert.

angus will watch ruperts belly moving
Keeping vigil at Rupert’s bedside, watching him breathe / STARZ

It was truly devastating to lose a member of the Highlander family.  The battle might have been won but not without heartbreaking cost.

“War leaves a bitter taste, no matter the outcome.” – Jamie Fraser

smiling angus
STARZ

Questions, comments, concerns, or suggestions for future Outlander medicine topics? I’d love to hear from you! Leave a comment here or find me on twitter @SassenachDoctor.

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2 thoughts on “210: When Nothing Can Be Done

  1. Pingback: My Conversation with Karen Daugherty – The Sassenach Doctor | A Dram of Outlander

  2. Pingback: If Mary Poppins Had A Medical Bag – Sassenach Doctor

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