Wee Bugs And Wonder Drugs

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A Dram of Outlander Voyager Read-Along (Listen HERE)

Chapters 34-37:

Wee Bugs And Wonder Drugs
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“I’ve germs in my arm, have I?”

Yes, indeed.  Courtesy of one Mrs. Laoghaire MacKenzie MacKimmie Fraser, in fact.

Jamie has been shot.  The bullet has pierced his upper arm, exited out the other side, and has come to rest about 1 inch deep in the soft tissue of his chest wall.  Fortunately the bullet has avoided any bones and did not penetrate the chest wall deep enough to damage his lungs and vital organs. Jenny has cleaned the wounds as best she can and has removed the bullet but a serious infection has settled in Jamie’s arm.

The wound itself was a ragged dark hole, scabbed at the edges and faintly blue-tinged. I pressed the flesh on either side of the wound; it was red and angry-looking, and there was a considerable seepage of pus. Jamie stirred uneasily as I drew my fingertips gently but firmly down the length of the muscle.
From Voyager by Diana Gabaldon, Chapter 36

Gunshot Wounds

Gunshot wounds become infected frequently, and are considered to be contaminated wounds, which makes sense:

  • Soiled clothing is forced into the skin and various injured tissues during the penetration of the bullet
  • Debris and foreign material is forced into the wound canal
  • Trauma causes nonviable (dead) tissue which enables the proliferation of bacteria
  • The trauma causes the local blood supply to the area to become disrupted, decreasing the ability of one’s immune system to defend against bacteria

Throughout history, death in combat was more often due to infection than battle injuries. Things are not looking so good for Jamie.  In fact, had young Ian not rode a full day’s journey to beg Claire to return to Lallybroch to help save Jamie, the Outlander story may have had a much more rapid resolution!

Fortunately for Outlander fans, Claire had the wisdom and foresight to include a special item in the pocket of her dress in her travel back through the stones. Or perhaps it was just plain good sense, knowing she was returning to Jamie Fraser, a man whom trouble seems to find!

pcn-box

I laid the small, flat case on the table and flipped the latch.  “I’m not going to let you die this time either,” I informed him, “greatly as I may be tempted.”  I carefully extracted the roll of gray flannel and laid it on the table with a soft clicking noise.  I unrolled the flannel, displaying the gleaming row of syringes, and rummaged in the box for the small bottle of penicillin tablets.
“What in God’s name are those?” Jamie asked, eyeing the syringes with interest.  “They look wicked sharp.”
I didn’t answer, occupied in dissolving the penicillin tablets in the vial of sterile water.  I selected a glass barrel, fitted a needle, and pressed the tip through the rubber covering the mouth of the bottle.  Holding it up to the light, I pulled back slowly on the plunger, watching the thick white liquid fill the barrel, checking for bubbles.  Then pulling the needle free, I depressed the plunger slightly until a drop of liquid pearled from the point and rolled slowly down the length of the spike.
“Roll onto your good side,” I said, turning to Jamie, “and pull up your shirt.”
From Voyager by Diana Gabaldon, Chapter 36

Penicillin

Penicillin was indeed a game changer for Jamie, but also for the entire world, even playing a significant role in the success of the Allies in World War II.  The discovery of penicillin was a fortunate accident and starts with Scottish scientist Alexander Fleming.  The story goes that upon returning to his lab in the basement of St. Mary’s Hospital in London in late September 1928 after a two week holiday, Fleming noted an interesting phenomenon in a petri dish that had been left accidentally open.

The petri dish contained Staphylococcus bacteria he had been studying, but now also contained a blue-green mold which he suspected had contaminated his petri dish from an open window.  Upon closer examination, he noticed that there was a clear zone around the mold where no staph bacteria grew, as though the mold and prohibited the growth of bacteria in that area.

petri
From Alexander Fleming’s Nobel Lecture, December 11, 1945

Fleming identified the mold as penicillium, and thus named the active substance capable of killing the surrounding bacteria penicillin.  He authored a paper describing his findings but this was met with little interest.  Penicillin was unstable and Fleming had difficulty producing it in any significant quantity.  No further progress would be made for another decade.

quote

In 1939, a group of scientists at Oxford including Howard Florey and Ernst Chain developed a method for purifying and producing penicillin, though the yield still remained rather low.  A year later, their experiments showed that penicillin could successfully treat strep infections in mice.

Florey and Chain showed that penicillin could treat infections in human in 1941 when they treated a 48 year old policeman by the name of Albert Alexander.  Mr Alexander had scratched the side of his nose while pruning roses and developed a significant infection with abscesses involving the eye, face and lungs.  He was treated with penicillin and within days had a remarkable recovery.  However, the supply of penicillin ran out after 5 days.  His infection worsened again and he died.

By this time, the world was fully engaged in World War II.  The US drug company Merck started production of penicillin and successfully treated in 1942 a patient with streptococcal septicemia – an infection of strep in the blood.  However, treatment of that one patient required half of the total supply of penicillin available at the time.  Work began in earnest to figure out a way to mass produce large quantities of the drug.

The US government hoped to produce enough penicillin for mass distribution to the Allied troops in Europe.  In 1943, the US War Production Board took over responsibility for the increased production of penicillin with the goal to have adequate supply for the planned D-day invasion in France. Ultimately, 2.3 million doses were available in time for the invasion of Normandy in the spring of 1944.  During the war effort, penicillin was limited to military use, with rare exceptions made for civilians in cases where other treatments had failed.  By 1945, increased production allowed for penicillin to be available to consumers for the first time without restriction.  Fleming, Florey and Chain were awarded the Nobel Prize in Physiology or Medicine in 1945.

(L to R:  Alexander Fleming, Howard Florey, Ernst Chain.  From Wikipedia Commons)

Prior to the era of penicillin, seemingly minor infections were often life-threatening: strep throat, scarlet fever, dental infections, skin infections from simple scratches, etc.  Infections like bacterial pneumonia, meningitis and endocarditis (infection of the lining of the heart and the heart valves) were often death sentences.  In World War I, the death rate from bacterial pneumonia was 18%.  With the availability of penicillin in World War II, that fell to less than 1%.  Untreated skin infections from trauma as minor as a simple scratch carried an 11% mortality rate prior to the discovery of penicillin.

pcn-poster
Credit: Research and Development Division, Schenley Laboratories, Inc., Lawrenceburg, Indiana

Fleming, though, foresaw the risk involved with this miracle drug and in his Nobel Lecture, provided this ominous warning:

But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in under-dosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.

-Alexander Fleming, Nobel Lecture, December 11, 1945

Antibiotic Resistance

Some suggest that we are headed to a post-antibiotic era – a time when we once again will be defenseless against seemingly simple infections.  Now we have antibiotic resistant pneumonia, tuberculosis, blood infections and even gonorrhea and few, if any, effective antibiotics against them. The CDC estimates that antibiotic resistance has been responsible for over 2 million illness and 23,000 deaths each year.

Antibiotics resistance happens naturally as the bacteria adapt but we must avoid accelerating this process.

resist
From: Center for Disease Control

As patients, we can minimize antibiotic resistance by:

  • Working to prevent infection with good hand washing, food hygiene and common sense, avoiding close contact with those who are ill.
  • Always finishing the full course of prescribed antibiotics and not taking left over antibiotics or someone else’s

It is scary to think we could be headed toward a time when we are unable to effectively fight bacterial, viral, and fungal infections. Progress continues in the development of new antibiotics, but resistance continues to develop at an alarming rate.

Fortunately, the bacteria infecting Jamie’s wound was no match for penicillin.  With no prior exposure to penicillin or similar antibiotics, the bacteria would have had no resistance and would easily succumb to the novel medication. And good thing, too – without antibiotics, this wound could have been fatal for Jamie. Thus, the Outlander saga could have ended much too early, and at the hands of Laoghaire no less (as though we needed any further reason to despise her)!

mold

 

Title Image: Mold Cultures in Petri Dishes (Public Domain)
References:
About Antimicrobial Resistance. (2015). Retrieved October 29, 2016, from http://www.cdc.gov/drugresistance/about.html
American Chemical Society International Historic Chemical Landmarks. Discovery and Development of Penicillin. Retrieved October 29, 2016, from http://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html
Antibiotic resistance. (2015, October). Retrieved October 29, 2016, from http://who.int/mediacentre/factsheets/antibiotic-resistance/en/
Markel, H. (2013, September 27). The real story behind penicillin. Retrieved October 29, 2016, from http://www.pbs.org/newshour/rundown/the-real-story-behind-the-worlds-first-antibiotic/
Sir Alexander Fleming – Banquet Speech. Retrieved October 29, 2016, from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-speech.html
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The Doctors Are In

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A Dram of Outlander
Voyager Read-Along
Chapters 32-33

The Doctors Are In
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“Jenny Murray had been the nearest thing I had ever had to a sister, and by far the closest woman friend of my life. Owing to circumstance, most of my close friends in the last fifteen years had been men; there were no other female doctors, and the natural gulf between nursing staff and medical staff prevented more than casual acquaintance with other women working at the hospital.  As for the women in Frank’s circle, the departmental secretaries and university wives…”  From Voyager by Diana Gabaldon, Chapter 32.

The past 20 years have been lonely for Claire.  She lived her calling as a physician but no doubt she longs for the close personal connections she knew in 18th century Scotland. Of course she did have Brianna and a close confidant in  Joe Abernathy, but her marriage with Frank was not an emotionally intimate relationship. For the most part, she was without female friends with whom to share the joys, insecurities, failures, and triumphs of motherhood, career, and life.

Female Physicians in the 20th Century

Claire entered medical school in 1955, a time when women made up only about 5-6% of medical students in the US. Realizing her calling as a surgeon, she then found herself even more of the exception as a surgical resident and then as a practicing surgeon.  The American College of Surgeons admitted its first woman in 1913, and thereafter only admitted between 0 and 5 women each year until 1975. While she would have interacted with numerous female nurses in the hospital, the paternalistic dynamic between physicians and nurses during that era would have prevented anything beyond purely professional relationships between Claire and the nurses.

It wouldn’t be until the 1970s, with the passage of Title IX and the Public Health Service Act, as well as the changing cultural tide, that the number of female physicians would begin to increase significantly.  We now have nearly equal numbers of men and women entering medical school, though the percentage of women entering surgery remains disproportionately low. According to the American Medical Association, as of 2006, women accounted for 12% of general surgeons in the US.

It is no surprise our stubborn, brilliant, tenacious, and brave heroine chose this path. Claire finds herself in good company with the trailblazing women of modern medicine.

Brave Women Paving the Way

Throughout history, women have played a central role in caring for the ill and injured, providing remedies at home, and working as nurses, midwives, and herbalists.  They were also physicians, dating as far back as ancient Egypt through medieval Europe.  However, when the education of physicians became more formalized, with the establishment of universities in the 1400s and the development of licensure for physicians, women were excluded.

Margaret Ann Bulkley, AKA Dr. David Barry

james_barry_surgeon05

Prior to the admittance of women into medical schools and inclusion in the licensing programs, women of course still found a way to practice medicine, whether by practicing informally within their communities or in some cases, attending medical school and practicing medicine while disguised as a man!  Margaret Ann Bulkley, born at the end of the 18th century in Ireland, lived her life as James Barry in order to practice medicine.  After receiving a medical degree at University of Edinburgh, Dr. Barry became a military surgeon in the British Army and practiced medicine for over 50 years in India, South Africa, and the Caribbean.  It wasn’t until an examination after dying of dysentery that it was discovered that Dr. Barry was actually a woman!

Dr. Elizabeth Blackwell

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Elizabeth Blackwell was the first woman physician in the US.  Upon receiving her application, the dean of New York’s Geneva Medical College presented her application to the students.  He asked the all-male student body to vote on whether the college would accept a female student.  Thinking this a great joke, the students unanimously voted to admit Ms Blackwell and she graduated in 1849, passing the qualifying exam with the highest average.  She would go on to co-found the New York Infirmary for Women and Children.

Dr. Elizabeth Garrett

eganderson

Inspired by Dr. Blackwell, Elizabeth Garrett was working to gain acceptance to medical school.  After she was denied medical school admission, she entered Middlesex teaching hospital as a student nurse, and began attending medical school courses.  Despite receiving outstanding marks, just before it was time to graduate, she was dismissed.  None of the other universities in England would allow her to continue her studies and earn a medical degree.  Out of options for continuing her medical studies, she decided to focus her efforts on studying to become an apothecary.  She completed an apprenticeship, but following this, official university matriculation was necessary to complete her apothecary education.  Again, England’s universities were closed to her.  Likewise, she was rejected at St. Andrews University and University of Edinburgh in Scotland.  Undaunted, she continued on, attending rounds with a number of practitioners in London, accumulating the required proof of training for her application to the Society of Apothecaries and taking the qualifying examination. She passed and became the first woman licensed by the Society of Apothecaries, officially becoming a physician.  After building a large private practice and proving care to the impoverished, she taught herself French and was permitted to take the exam for a medical diploma in Paris, finally earning an MD in 1870.  Dr. Garrett went on to serve as the dean of the London School of Medicine for Women for twenty years and is thought to be the first women in history to perform an oophorectomy (surgical removal of the ovaries).

Dr. Sophia Jex-Blake

sophia_jex-blake_aged_25

Many women experienced similar road blocks in their journey to become physicians.  Sophia Jex-Blake was officially accepted to study medicine at the University of Edinburgh, though it appeared that she was accepted her in error. Quickly realizing the application was submitted by a woman, the university blocked her from entering classes.  Undeterred, Ms Jex-Blake, along with other physicians, created the London School of Medicine for Women in 1874.  However, women graduating from the new women’s medical college found that despite earning an MD, they were refused privileges to work at all of the reputable hospitals. These pioneering women therefore founded their own hospital, the New Hospital for Women.

Women in Europe and in the US founded women’s medical colleges and women’s hospitals and most women physicians in the late 19th century received their medical education and training in these institutions.  Public opinion did begin to change, finally, and by the early 20th century, women were accepted into traditional medical colleges and women’s medical colleges began to close.  It would be another century, however, until women and men attended medical school in equal rates, and women physicians are still fighting the gender gap in pay and academic promotion.

No doubt Claire would have fought similarly for the right to practice medicine, should she have found herself in the same situation.  She surely faced much discrimination on her own path to becoming a surgeon. However, once back in the 18th century, she generally finds herself practicing in areas in dire need of her help, and once her expertise is witnessed, roadblocks are few. Of course, she is not one to worry overmuch about the opinions of others!

Claire has found herself in the 18th century right back where she belongs: living her calling as a physician with the support and companionship of family and friends.

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References:
Lorber, J., & Ecker, M. (1983). Career development of female and male physicians. Academic Medicine, 58(6), 447-56
Lyons, A. (n.d.). Medical History — Women in Medicine – Health Guidance. Retrieved October 23, 2016, from http://www.healthguidance.org/entry/6355/1/Medical-History–Women-in-Medicine.html
Ulrich, B. (2010). Gender Diversity and Nurse-Physician Relationships. Virtual Mentor, 12(1), 41-45.
Young, A., Chaudhry, H., Pei, X., Halbesleben, K., Polk, D., & Dugan, M. (2015). A Census of Actively Licensed Physicians in the United States, 2014. Journal of Medical Regulation, 101(2), 8-23. Retrieved October 16, 2016.
14-086 Physician Specialty Databook 2014. (n.d.). Retrieved October 23, 2016, from https://members.aamc.org/eweb/upload/Physician Specialty Databook 2014.pdf
Header Image: STARZ, Other Photos: Public Domain
wellbehaved

Claire’s Soothing Tonic for Margaret Campbell

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A Dram of Outlander
Voyager Read-along
Chapter 29:  Culloden’s Last Victim
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Once a Physician, Always a Physician

After spending her entire adult life as a healer, first as a combat nurse and then as surgeon, Claire soon finds herself once again doctoring in 18th century Scotland.

Claire’s discussion of herbs and remedies with the apothecary reveals her extensive knowledge, and overhearing this, Reverend Campbell asks Claire to recommend a remedy to help with his sister’s “nervous complaints.” Never one to refuse a person in need of help, Claire of course offers to visit Margaret Campbell to evaluate her for herself.

According to her caregiver, Margaret suffers from mysterious episodes of silently staring off into space for as long as nearly two weeks at a time, followed by screaming to exhaustion, and falling asleep, only to awake unaware of what has happened.  Claire finds Margaret in a state of silent staring, seemingly oblivious to her surroundings. However, aside from evidence of vitamin C deficiency and physical inactivity, her examination of Margaret reveals no significant physical ailments.

What Has Happened to Margaret Campbell?

Margaret’s symptoms began after she was brutally attacked by English soldiers. She had been searching for her beloved, Ewan Cameron, in the aftermath of the Battle of Culloden, when she fell into the hands of a group of English soldiers.  Margaret was attacked, raped, and left for dead.  Later reunited with her brother, she was never the same and spent the next 20 years alternating between a normal state of mind, a catatonic state of silently staring, unaware of her surroundings, and continual screaming.

The description of sitting, staring off into the distance, not speaking, and being seemingly unaware of the people around her is consistent with catatonic behavior. Once a diagnosis of its own, catatonia is now a descriptor of rare subtypes of other disorders such as schizophrenia, bipolar disorder, major depression and PTSD.  Margaret may be experiencing catatonic symptoms as part of a rare form of PTSD as a result of the trauma she sustained at the hands of the English soldiers. It is also possible that she developed schizophrenia and began to display symptoms at this time (the peak period for the onset of schizophrenia is late adolescence and early adulthood, and she would have been around 17 years old at the time of the attack).

How Can Margaret Be Helped?

Treatment options for catatonia include antipsychotic medications, benzodiazepines, electroconvulsive therapy as well as supportive therapy.  The physical inactivity and refusal to eat in catatonia can result in muscle contractures, pressure sores, blood clots, weight loss, dehydration, electrolyte disorders, and vitamin deficiencies.  Some patients will require IV fluids and tube feedings to provide adequate hydration and nutrition, as well as anticoagulants to avoid blood clots.

With the resources available to her, Claire suggests a “soothing tonic” for Margaret, containing chamomile, hops, rue, tansy, verbena, and peppermint.

Claire’s Soothing Tonic for Margaret Campbell

Chamomile
chamomile
AKA German Chamomile
Used for: flatulence, travel sickness, nasal mucous membrane inflammation, nervous diarrhea, GI spasms, inflammation of the GI tract, restlessness, insomnia
Used topically for: hemorrhoids, leg ulcers, mucous membrane inflammation
Interesting fact:  Chamomile is a member of the Asteraceae/Compositae family which includes ragweed, chrysanthemum, marigold and daisy.  As a result, people who are sensitive to these may these (especially ragweed!) by experience allergic reaction to chamomile!

Hops
hops
Used for: restlessness, anxiety, sleep disorders, tension, excitability, nervousness, irritability, indigestion, as an antibacterial, as an appetite stimulant.  Also has been used for dysentery, leprosy and pulmonary tuberculosis.
Interesting fact:  Hops comes from the family cannabinaceae (hemp, marijuana)

Rue
rue
AKA Herb-of-Grace, Garden Rue, Common Rue
Used for: menstrual disorders, loss of appetite, heart palpitations, nervousness, hysteria, fever, headaches, weakness of the eyes.  Has been used for Multiple Sclerosis, Bell’s Palsy and cancers of the mouth.
Used topically for: skin inflammation, earaches and toothaches, as well as arthritis and sprains.  Has been used as an insect repellant.
Interesting fact: used as a bitter flavoring for food and beverages and as a fragrance in soap and cosmetics

Tansy
tansy
AKA Bitter Buttons, Daisy, Tansy Flower, Parsley Fern, Stinking Willie
Used for: regulating menstrual flow, treating roundworm infestation, migraines, neuralgia, epilepsy, rheumatism, stimulating appetite, flatulence and bloating, stomach ulcers, calming nerves, hysteria
Used topically for: scabies, bruises, sprains, sunburn, toothache and as an insect repellant
Interesting fact:  Thujone, a component of tansy, is thought to have a mind-altering effect similar to THC (the active component of marijuana).  It can be toxic to the nervous system and liver and can lead to seizures.

Verbena
verbena
AKA Pigeon’s Grass, Pigeonweed, Herb of Grace, Herb of the Cross, Juno’s Tears
Used for: sore throat, respiratory diseases like asthma and whooping cough, depression, hysteria, seizures, melancholia.
Used topically for: poorly healing wounds, burns
Interesting fact: used as a flavoring agent in alcoholic beverages

Peppermint
peppermint
AKA Brandy Mint, Lamb Mint
Used for: loss of appetite, spasms of the GI tract, flatulence, gastritis, enteritis, nausea and vomiting, morning sickness and soothing for cough and colds
Interesting fact: common culinary spice in foods and herbal teas

Benzodiazepines are one of the main treatments for catatonia today.  They are thought to have their action by binding to GABA receptors in the brain and increasing the efficiency of GABA in the brain.  Interestingly, chamomile also binds GABA and its sedative effects may be due to the same mechanism! Along with the sedating and calming effects of the other components of this soothing tonic, Margaret may well have some improvement in her symptoms.

 

Scurvy : The Ever-Present Scourge

scorbutic-gums

Margaret is also suffering from scurvy, as evidenced by her bleeding, spongy gums. Once the Campbells reach the West Indies, citrus fruits will be plentiful and will satisfy this need, but for now, Claire prescribes a tea of Rose Hips to provide vitamin C to reverse Margaret’s symptoms of scurvy.

Rose Hips
rose-hips
AKA Dog Rose, Hip Fruit, Hip Sweet, Hipberry, Wild Boar Fruit
Used for:  supplemental source of dietary vitamin C
Contains 1250mg of vitamin C per 100g of rose hip, making it one of the richest plant sources of vitamin C!
Interesting fact: itching powder (often used by pranksters to cause dreadful itching to their victims) is made from the fine hairs inside rose hips!

Check out the post It’s Green, Major, all about scurvy and Claire’s affinity for all things green!

All photos: Wikipedia Commons

 

References:

1. Sienaert, P., Dhossche, D. M., Vancampfort, D., Hert, M. D., & Gazdag, G. (2014). A Clinical Review of the Treatment of Catatonia. Frontiers in Psychiatry Front. Psychiatry, 5. doi:10.3389/fpsyt.2014.00181
2.  Jellin, J. M. (2003). Natural medicines comprehensive database. Stockton, CA: Therapeutic Research Faculty.
3. Srivastava, J., Shankar, E., & Gupta, S. (2010, November 1). Chamomile: A herbal medicine of the past with a bright future (Review). Molecular Medicine Reports, 3(6), 895-901. doi:10.3892/mmr.2010.377

Mr Willoughby’s Healthy Balls

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A Dram of Outlander Voyager Read-Along
Chapters 25-26

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This week’s installment of Outlander Science Club is inspired by Mr. Willoughby and his healthy balls. Ahem. No, not those. We are discussing Mr. Willoughby’s hangover remedy, Chinese Medicine Balls. (Need a refresher on the science behind hangovers? Check out this post from season one!)

Mr. Willoughby suffers from a hangover and an intense headache, and Claire apologizes, telling him she doesn’t have any medicines with her to help. He assures her he will be just fine because he has healthy balls.

Huh? Hold on a minute. Did we all miss the lecture in medical school discussing the connection between testicular health and headache?

Claire comes to learn that Mr. Willoughby is referring to a pair of jade spheres, “larger than marbles and smaller than baseballs,” – Chinese Medicine Balls or Baoding Balls.

baoding-balls
Photo: Wikipedia Commons

Baoding Balls are thought to have likely first originated in China during the Ming Dynasty (1368-1644). Initially made of iron, they came to be made from varied materials including steel and tungsten, and stones such as jade, agate and marble. Many contain a chime that rings as the balls are moved.

Both balls are held in the palm and rotated, initially maintaining constant contact, and eventually rotating without contacting each other at all as hand strength improves.

Health benefits attributed to the use of Baoding Balls:

  • improved strength and dexterity of the hand muscles
  • improved brain function and reduced stress
  • improved circulation in the body
  • relief of the pain and stiffness of arthritis
  • decreased blood pressure
  • increased energy levels
  • improved concentration

Mr. Willoughby found relief from hangovers by using the Baoding balls. An accupressure point called Joining the Valley is located on the hand in the web space between the thumb and index finger. Stimulation of this point is thought to relieve pain, especially frontal headaches related to hangovers.

In addtion to using the Baoding balls, Mr. Willoughby likely applied other remedies of Traditional Chinese Medicine, including the use of herbs:

  • Cayenne to reduce pain and improve blood flow
  • Meadowsweet for its anti-inflammatory properties
  • Chamomile for relaxation
  • Valerian for sedation (a favorite of Claire’s)
  • Chrysanthemum or Yarrow to soothe the liver

What else could Mr. Willoughby have tried? A quick search for Hangover Cures yields all sorts of remedies, some more appetizing than others…

Outlander Science Club encourages responsible drinking. These remedies are presented for your entertainment and general education and is not intended as medical advice!

 

Poland

pickles
Photo:  Wikipedia Commons

Drinking pickle juice or eating sauerkraut – the high sodium content is thought to replenish electrolytes

 

 

 

 

 

Ecuador

800px-oregano_1
Photo: Wikipedia Commons

Oregano tea to settle the stomach

 

 

 

 

 

South Korea

korean_soup-bogeo_haejangguk-01
Photo: Wikipedia Commons

Haejangguk, “a soup to chase a hangover,” containing dried napa cabbage, vegetables, beef broth and congealed ox blood. Said to soothe the stomach.

 

 

Japan

umeboshi
Photo: Wikipedia Commons

Pickled ume fruit, very sour in taste, is thought to help digestion and liver function and to prevent nausea.

 

 

 

Germany

fischbro%cc%88tchen
Photo: Public Domain

Rollmops – Raw pickled herring wrapped around pieces of gherkin and onion, thought to restore electrolytes.

 

 

 

USA

prairie_oyster_
Photo: Wikipedia Commons

The Prairie Oyster – a whole raw egg with hot sauce, salt, pepper and a few dashes of Worcestershire sauce, the thinking being that the spices will combat the alcohol toxins and the egg provides nutrients.

 

 

 

 

Haiti

doll_with_pins_in_it_museum_of_witchcraft
Photo: Public Domain

“Curse the Bottle” – stick 13 black headed pins into the cork of a bottle to curse the sickness that the bottle is attempting to curse you with!

 

 

 

 

 

Italy

linea_doubleespresso
Photo: Public Domain

Several cups of strong espresso to provide caffeine for headache relief.

 

 

 

 

 

 

Mongolia

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Photo: Wikipedia Commons

Tomato juice and pickled sheep eyes. Likely some hydration and electrolytes from tomato juice but it is unclear what the sheep eyes provide!

 

 

 

Bangladesh

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Photo: Wikipedia Commons

Coconut water provides hydration as well as a supply of potassium, magnesium and antioxidants

 

 

 

 

Las Vegas, Nevada

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Photo: Wikipedia Commons

Mobile hangover cure buses (and house calls) providing IV fluids, vitamins, and medications for nausea, pain and inflammation.

 

 

 

 

 

 

And my personal favorite, Eggs Benedict.

eggs_benedict
Photo: Wikipedia Commons

The story goes that in the late 1894, wealthy socialite Lemuel Benedict, hurting from a night of excess, ordered at the Waldorf Hotel “buttered toast, poached eggs, crisp bacon and a hooker of hollandaise,” the dish that would evolve into the beloved Eggs Benedict!

 

 

 

Mr. Willoughby’s remedy seems to be an easily tolerated and readily portable method to potentially treat some of the symptoms of a hangover, and greatly preferable to some of the less savory options outlined above (sheep’s eyes, anyone?). Always learning and generally quite open-minded, it is evident that Claire will appreciate learning a few new techniques from Mr. Willoughby, so long as she can keep her shoes on!

Who else is eagerly awaiting the casting news of Mr. Willoughby? Can’t wait to see these scenes on screen!

 

cahonasscotland

We here at Outlander Science Club encourage healthy balls of all kinds! Encourage the men in your life to do regular self exams and check out Cahonas Scotland, a Scottish charity working to increase awareness and decrease the stigma surrounding male cancers!

 

 

 

La Grippe – Influenza at Ardsmuir

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A Dram of Outlander

Voyager Read-Along

Chapters 10-13

Ardsmuir Prison, May 15, 1755.
60 men are suffering from La Grippe. 15 are badly off.
Jamie is desperate to help his men but resources are scarce.

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An 18th century prison (source)

What is La Grippe?
La Grippe is a name for influenza, meaning “to seize suddenly.”
The term Influenza comes from the Medieval Latin “influentia,” from the belief that epidemics of this illness were due unfavorable astrological influences.

Influenza
Influenza follows a seasonal pattern, peaking each year in the winter months. Additionally, worldwide pandemics occur approximately three times per century. Most famously, was the pandemic of 1918, termed the “Spanish Flu.” This illness had an extremely high rate of infection, with half of all those exposed developing symptoms, and generally severe ones. This epidemic killed approximately 2.5-5% of the world’s population. Many pandemics have been documented over time, including ancient Rome, Russia in 1580, asian influenza in 1958 and most recently the H1N1 (swine flu) pandemic of 2009. Whether termed epidemic catarrh, La Grippe, sweating sickness or the flu, influenza has plagued humanity for at least thousands of years.

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Symptoms of Influenza (source)

Symptoms
As we are all too well aware, influenza is a viral infection that causes fever, runny nose, body aches, headache, coughing, and fatigue.  Symptoms begin about 2 days after one is exposed to the virus. For most people, symptoms last about 1-2 weeks and resolve, sometimes with a lingering cough. However, complications can occur such as viral pneumonia, secondary bacterial pneumonia, worsening of chronic medical infections, and in some cases, death. Those at high risk for complications include young children, the elderly, pregnant women, people with compromised immune systems and those who have chronic lung or heart disease.

Catching Influenza
The problem with influenza is that a person is infectious for about a day before symptoms arise, so quarantine is not going to prevent transmission. The influenza virus is spread when an infected person sneezes, and another person in close proxmity comes into contact with those droplets or inhales them. It can also be transmitted from contaminated surfaces or direct personal contact like a hand shake, when a person then touches his or her own eye, nose or mouth with a contaminated hand. The virus can persist outside of the body on contaminated surfaces like light switches and door knobs for 1-2 days.

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(source)

Influenza outbreaks occur seasonally in the winter. This is thought to be because people spend more time indoors and thus in more close contact, promoting person to person transmission. Additionally, the virus survives longer on surfaces at colder temperatures.

How to minimize risk?
The annual influenza vaccine is recommended by the CDC to everyone over 6 months of age, and especially for those at high risk for complications of the flu including the young, the elderly, pregnant women and those with chronic diseases. The influenza virus has a high mutation rate so each year a new vaccine is developed to provide protection against the particular strains predicted to be circulating each season. When well matched to the strains circulating during an outbreak, the vaccine reduces the risk of influenza illness by 50-60% in the general population. The influenza vaccine reduces the risk of becoming infected with influenza and also decreases the severity of the symptoms of those infected.

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Influenza vaccine (public domain)

Treating Influenza
Also available today are antiviral medications. When started in the 48 hours of illness, these medications can shorten the duration of symptoms, reduce the severity of symptoms, decrease the length of hospital stay, and decrease mortality. This is of particular importance to those at high risk for complications of influenza.

In general, people with influenza are advised to keep themselves healthy and avoid infection by:

  • Avoiding close contact
  • Staying home when you are sick
  • Covering your mouth and nose when coughing or sneezing
  • Washing your hands
  • Avoid touching your eyes, mouth, or nose
  • Getting enough sleep
  • Reducing stress
  • Eating a healthy diet
  • Avoiding crowds

That doesn’t seem to be too difficult – eat well, rest, avoid close contact – unless of course, you are a prisoner of Ardsmuir Prison!

Keeping Healthy at Ardsmuir
Described by Jamie as “crowded cold squalor,” the prisoner cells of Ardsmuir seem an ideal breeding ground for an influenza epidemic.

  • Avoiding close contact – this is impossible with cells packed with as many as 46 men, huddled together for warmth.
  • Staying home when you are sick – not when “home” is a crowded cell with dozens of other men.
  • Covering your mouth and nose when coughing/sneezing – well, yes, they can cover, but there are no disposable tissues and likely no extra cloths/rags to use as a handkerchief. And what cloth there was to use for this would not be washed regularly, if at all.
  • Washing your hands – bathing occurred rarely, if ever. Water for washing was likely not much more readily available.
  • Avoid touching the eyes/nose/mouth – again, unavoidable without the ability to wash regularly, and disease transmission would easily occur.
  • Getting enough sleep – in a cold crowded cell, sleeping on the floor among dozens of other men, with the noises and movement inherent in a group that large, quality sleep would be hard to come by.
  • Reducing stress – these men are in prison. On the contrary, they likely live with a persistently high level of stress – stress of not controlling their fate, of worry about their families, of no privacy, of insecurity about the future, about lack of food and warmth and their basic needs.
  • Eating a healthy diet – According to Jamie, each Ardsmuir prisoner received 1 quart of oatmeal parritch and one small wheaten loaf of bread daily. Twice a week they would have thin barley brose and one a week on Sunday, a quart of meat stew. This is roughly 1600-1700 calories per day, supplemented twice a week with brose and once a week with stew. The daily calorie requirement for these men working 12-16 performing physical labor cutting peat would likely approach 4000, so clearly these men are significantly undernourished! Jamie does convince Lord John to allow the healthy men to set snares to catch additional meat to supplement the diets of the ill men.
  • Avoiding crowds – impossible, as outlined above.
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Starz

What would Claire do?
Rest, good hydration and nutritious diet would have been a good place to start.

Additionally, for those not in prison, it would be easier to provide a less crowded, warm environment, protected from the elements. Claire would have insisted on good hand washing, no doubt, and regularly washed handkerchiefs. She also would have had a few other tools at her disposal in the form of her collection of herbs and healthy foods.

Vitamin D plays a role in immune function, and flu season coincides with the time of year when vitamin D stores are low due to limited sun exposure. Vitamin D enriched foods would be important to include in the diet, perhaps in the form of fish or eggs, if possible.

Vitamin C has been used as a treatment for the common cold, though with conflicting evidence. However, some studies suggest vitamin C may be helpful in preventing colds in people who are exposed to cold weather or undergoing extreme exercise (sounds like our men of Ardsmuir!), though it is unclear that this would also be a benefit in preventing influenza as well. Eating plenty of greens is an easy enough task and won’t hurt!

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The Outlander’s Vitamin C: Watercress (source)

A number of other plants and herbs may have been beneficial as well, and it is likely that Claire would have employed many of the following which have been used over time in the treatment of respiratory ailments:

To decrease the severity of symptoms: andrographis, echinacea, elderberry

For cough and nasal congestion: eucalyptus, golden seal, peppermint

For soothing of a sore throat: licorice, marshmallow, slippery elm

For fever and pain: willowbark

In general, Claire’s approach would be similar to what we do today: stay home, get plenty of sleep, drink lots of fluids and take some symptomatic remedies, whether it be cough syrup and pain medicine, or eucalyptus and willowbark tea!

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Willowbark (public domain)

Sadly, Lord John reports to Jamie that there are no medications to be had at Ardsmuir but does send word to a cousin who is married to an apothecary to see about acquiring some. Lord John’s kindness is evident but we are reminded of the desperation and despair that is imprisonment in the “crowded cold squalor” of this Highland prison.

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Learn More:

Information about Influenza – from the CDC
Herbal Remedies for Influenza – from University of Maryland Medical Center
The History of Influenza

It’s Green, Major

A Dram of Outlander Voyager Read-Along

Outlander Science Club

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This week’s installment of Outlander Science Club is inspired by the many times we have heard Claire discuss the need to eat green leafy foods to avoid scurvy.

First, in Dragonfly in Amber, Jamie learns why Claire is “verra well preserved”…

“No bread?” he asked
“There may be some in the other bag.  Eat those first, though; they’re good for you.”  He shared the Highlanders’ innate suspicion of fresh fruit and vegetables, though his great appetite made him willing to eat almost anything in extremity.
“Mm,” he said, taking a bite of one apple.  “If you say so, Sassenach.”
“I do say so.  Look.”  I pulled my lips back, baring my teeth.  “How many women of my age do you know who still have all their teeth?”
A grin bared his own excellent teeth.
“Well, I’ll admit you’re verra well preserved, Sassenach, for such an auld crone.”
“Well nourished, is what I am,” I retorted.  “Half the people on your estate are suffering from mild scurvy, and from what I’ve seen on the road, its even worse elsewhere.  It’s vitamin C that prevents scurvy, and apples are full of it.”
He took the apple away from his mouth and frowned at it suspiciously.
“They are?”
“Yes, they are,” I said firmly.  “So are most other kinds of plants – oranges and lemons are best, but of course you can’t get those here – but onions, cabbage, apples…eat something like that every day, and you won’t get scurvy.  Even green herbs and meadow grass have vitamin C.”
“Mmphm. And that’s why deer dinner lose their teeth as they get old?”
“I daresay.”

From Dragonfly in Amber, Chapter 36: “Prestonpans” by Diana Gabaldon

 In this week’s A Dram of Outlander Voyager Read-along, Jamie enlightens Lord John Grey on the topic of scurvy as well.

 “What are you doing, Mr. Fraser?” Grey asked, in some bewilderment.
Fraser looked up, mildly surprised, but not embarrassed in the slightest.
“I am picking watercress, Major.”
“I see that,” Grey said testily.  “What for?”
“To eat, Major,” Fraser replied evenly.  He took the stained cloth bag from his belt and dropped the dropping green mass into it.
“Indeed? Are you not fed sufficiently?” Grey asked blankly. “I have never heard of people eating watercress.”
“It’s green, Major.”
In his fatigued state, the Major had suspicions that he was being practiced upon.
“What in damnation other color ought a weed to be?” he demanded.
Fraser’s mouth twitched slightly, and he seemed to be debating something with himself.  At last he shrugged slightly, wiping his wet hands on the sides of his breeks.
“I only meant, Major, that eating green plants will stop ye getting scurvy and loose teeth.  My men eat such greens as I take them, and cress is better-tasting than most things I can pick on the moor.”
Grey felt his brows shoot up.
“Green plants stop scurvy?” he blurted.  “Wherever did you get that notion?”
“From my wife?” Fraser snapped.

From Voyager, Chapter 9:  “The Wanderer” by Diana Gabaldon

Throughout the first three Outlander books, we have seen Claire continually recommend fresh fruits and vegetables to avoid scurvy, among them apples, onions, cabbage, oranges, lemons, green herbs, meadow grass, charlock, juniper berries, mustard leaves, rose hips and dill seeds.  To her Highland friends, she likely seems a quirky medicine woman, but given the proof she can show them of a mouth full of healthy teeth, some, including Jamie, heed her advice.

Why was Claire so concerned about vitamin C intake?

Vitamin C is an essential dietary component that humans cannot synthesize and therefore require in their diet.  It is required in the production of collagen, plays an important role in immune function, and improves the absorption of iron from plant based foods.

What is scurvy?

Vitamin C deficiency leads to scurvy.  Adults who have a diet with minimal to no vitamin C will experience symptoms within 1 to 6 months, depending on their previous body stores.  Initially symptoms will be fatigue, malaise, and inflammation of the gums.  As the deficiency progress, collagen synthesis is impaired, and connective tissues become weakened.  This leads to bleeding, bruising, joint pain, and poor wound healing.  Open, draining wounds and loss of teeth follow, and ultimately, untreated scurvy is fatal.

Until the end of the 18th century, sailors on long ocean voyages had little or no vitamin C and many developed and even died of scurvy.  It is reported that in 1499, Vasco de Gama lost 116 of his 170 crew and in 1520, Magellan lost 208 of his 230 crew, all mainly due to scurvy.

In the mid-1700s, British Navy surgeon Sir James Lind performed experiments showing that eating citrus fruit or juices could cure scurvy and by 1795, lemons or limes were standard issue at sea in the British Navy.  Limes were much easier to obtain, as these grew in the British West Indies, leading to the American use of the nickname “limey” to refer to the British.

What foods are good sources of vitamin C?

Fruits and vegetables are the main sources, but in addition, organ meats (especially liver), oysters and cod roe contain vitamin C.  Surprisingly, potatoes are a good source – Claire was protecting the people of Lallybroch from more than simple starvation in advising them to plant potatoes!

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image: public domain
vitamin c foods
Selected food sources of Vitamin C, from the NIH Office of Dietary Supplements (public domain)

Missing from this list is watercress, often a source of vitamin C for Jamie and Claire, and highlighted in the photo at the top of this post.  Watercress contains 43mg of vitamin C per 3.5 oz serving!

Symptoms of vitamin C deficiency arise when vitamin C intake falls below approximately 10mg per day for many weeks.

Recommended daily intake varies by agency.  Experts in the US and Canada recommend 90mg daily for men and 75mg daily for women.  40mg per day is recommended by the UK and India, 45mg per day by the World Health Organization, 80mg per day by the EU and 100mg per day by Japanese health authorities.

How do we fare?  

Surveys show that Americans have a daily vitamin C intake exceeding these recommendations.  However, one thing to keep in mind when assessing this is that smokers and those exposed to second-hand smoke require an additional 35mg per day.

It is likely that living in a small home heated by a peat fire puts our Highlanders in this category of second-hand smoke exposure and would result in a requirement for increased intake of vitamin C.

And what about those Highland coos and their healthy teeth?

With the exception of humans and other simians, fruit bats, and guinea pigs, other members of the animal kingdom actually synthesize vitamin C, so it is not a vital substance they must obtain in their diets.  It seems that although cows consume grass and other leafy greens all day long, their dental health isn’t due to the vitamin C content of their diet, though it does make for a good argument in convincing the men of Ardsmuir to eat their greens!

   “Och, not more o’ the damn thistles,” Morrison protested, seeing MacDubh’s grimace as he groped in the bag.  “I canna make them eat those things; they all say, do I think them kine, or maybe pigs?”
MacDubh gingerly set down a fistful of wilted stalks, and sucked his pricked fingers.
“They’re stubborn as pigs, to be sure,” he remarked.  “It’s only milk thistle. How often must I tell ye, Morrison? Take the thistle heads off, and mash the leaves and stems fine, and if they’re too prickly to eat spread on a bannock, then make a tea of them and have them drink it.  I’ve yet to see pigs drink tea, tell them.”
Morrison’s lined face cracked in a grin.  An elderly man, he knew well enough how to handle recalcitrant patients; he only liked to complain for the fun of it.
“Aye, well, I’ll say have they ever seen a toothless cow?” he said, resigned, as he tucked the limp greens carefully into his own sack.  “But you’ll be sure to bare your teeth at Joel McCulloch, next time ye see him.  He’s the worst o’ them, for not believin’ as the greens do help wi’ the scurvy.”

From Voyager, Chapter 8:  “Honor’s Prisoner” by Diana Gabaldon

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source

Food for thought this week:  In the absence of modern supermarkets with a year round supply of endless varieties of fruits and vegetables, and without vitamin C supplements, would you be able to find enough vitamin C in the foods seasonally available in your area?  If you found yourself in a situation akin to The Walking Dead on AMC, or perhaps similar to One Second After series of books by William R Forstchen, cut off from the rest of the country, would you be able to obtain adequate vitamin C year round?

Knowing what we do now, perhaps we would all be planting potatoes – to fend off both starvation and scurvy!

Potatoes
image: public domain

Listen to this week’s Outlander Science Club and this week’s A Dram of Outlander Voyager Read-along HERE!

Lallybroch: The Dunbonnet

A Dram of Outlander Voyager Read-Along 

Outlander Science Club

Voyager Chapters 4-6: Lallybroch

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Listen to this week’s Voyager Read-Along with A Dram of Outlander here, including this week’s installment of Outlander Science Club (by yours truly)!

The Outlander Science Club topic for this week was inspired by Jamie’s time in the cave and the psychological and physical effects that may result.

The Dunbonnet – The Effects of Living For Seven Years in a Cave

Following the Battle of Culloden, Jamie’s life is spared thanks to Lord John Grey and his bother Hal. He is brought back to Lallybroch where he is nursed back to health by Jenny, and spends the next seven years of his life living in a cave where he cannot be found by the Red Coats.

Hunting at night to feed himself and to occasionally provide for the family, Jamie spends his days alone in the cave with only some books and his thoughts.  Only once a month, at night, does he creep down to Lallybroch to shave, share a meal, and spend time with Jenny, Ian and the children.

Certainly, this will impact his health, spending his life in darkness and isolated for the most part from any human interaction.  What are the likely effects?

In addition to the uncomfortable conditions he endures with the incessant exposure to the elements and fear of discovery by the Red Coats who would no doubt mean violent punishment for both himself and his family who harbored him, Jamie also faces the effects of darkness and isolation on his health.

Prolonged exposure to darkness results in depression.  Studies in rats have shown that after only six weeks of limited sunlight exposure, the neurons in the brain responsible for producing norepinephrine, dopamine and serotonin already are in the process of dying.  These substances are the same neurotransmitters that are found to be decreased in humans with depression.

Chronic isolation from the company of other people can lead to a number of negative health effects.  Chronically lonely people have elevated blood pressure.  They are more vulnerable to infection and have higher incidence of dementia and Alzheimer’s disease.

A significant problem with chronic sunlight deprivation is a lack of vitamin D. Vitamin D is a fat soluble vitamin that plays an important role promoting the absorption of calcium in the gastrointestinal system and maintaining normal calcium and phosphate levels in the body.  Bone growth and remodeling depends on vitamin D.  Without it, bones can become thin, brittle, or misshapen.  In addition, vitamin D plays a role in cell growth, neuromuscular and immune function, and reduction of inflammation.

This vital nutrient is naturally present in very few foods. Though not available, of course, in the 17th century, vitamin D enriched foods and dietary supplements help to meet this need now.

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Selected food sources of Vitamin D, from the National Institutes of Health Office of Dietary Supplements (public domain)

Foods naturally containing vitamin D include mushrooms, alfalfa, lichen, fish liver oils, fatty fish species, cooked egg yolk, and beef liver.  In the Highlands, in the lean years following Culloden, it was unlikely many would have had access to beef.  While we do know that Jamie hunted deer, it seems that venison liver is not the good source of vitamin D that beef liver is.  Eggs were likely a rare luxury on his monthly visits to Lallybroch, if at all.  Not located in close proximity to the coast, it is doubtful he would have had any regular access to fatty fish while living in the cave. Scavenging for mushrooms and lichen were likely available to him, though only when in season.  Jamie’s diet definitely would not have met all of his vitamin D needs.

While even a modern diet with vitamin D enriched foods does not meet the typical daily requirement of vitamin D, exposure to sunlight makes up the difference.  Exposure to UVB rays from sunlight is a significant source of vitamin D. Vitamin D is produced in the skin when UVB rays from sunlight strike bare skin.  Unfortunately, Jamie likely had very little exposure to the sun during his years as the Dunbonnet, only leaving the cave under the protection of night.  Even if he had a few minutes of direct sun exposure at midday regularly, this still wouldn’t have met his vitamin D need year round. At latitudes north of 40°, as is the Highland region, sunlight is not strong enough to trigger the synthesis of vitamin D in the skin from October to March. With his limited diet and limited sun exposure, Jamie no doubt suffered from vitamin D deficiency.

Interestingly, birds and fur-bearing mammals also require vitamin D but clearly cannot absorb it through their feathered and fur covered skin.  They have adapted such that vitamin D is generated from the oily secretions of their skin and then deposited onto the feathers and fur and obtained orally during grooming.

What effect would inadequate vitamin D have had for The Dunbonnet?

Vitamin D deficiency classically causes skeletal problems.  With severe deficiency, children can develop rickets, a disease in which bone fails to properly mineralize, causing softening of the bones and skeletal deformities.  In adults, vitamin D deficiency can lead to osteomalacia, in which inadequate mineralization of the bone leads to bone and joint pain, muscle weakness particularly in those used to stand up from a seated position or walk up the stairs, and easy fracturing of bones, even from simple weight bearing.

Vitamin D deficiency puts adults at risk for osteoporosis, a condition of decreased bone mass leading to bone fragility and significantly increased risk of fractures.  Adequate levels of vitamin D can reduce the risk of developing a number of cancers as well as multiple sclerosis and rheumatoid arthritis.

With seven years of low vitamin D levels due to inadequate diet and rare exposure to sunlight, Jamie likely suffered from some degree of thinning of the bones.

Even today with vitamin enriched foods and supplements, vitamin D deficiency is widespread.  In the US, 41% of people have insufficient vitamin D.  Rates in South America and Europe are no better.

Are you consuming the recommended about of vitamin D on a regular basis?

recommended intake of vitamin d
Recommended Dietary Allowance for Vitamin D, from the National Institutes of Health Office of Dietary Supplements (public domain)

Just as Claire insists that the Highlanders eat their greens to avoid scurvy, no doubt she wouldn’t hesitate to line them all up and dose each with a spoonful of cod liver oil to keep their vitamin D levels up!

Stay tuned for more about scurvy!

 

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Further Reading:

Chinese Woman who has lived two years in a cave not unlike Jamie’s

Vitamin D Information from the National Institutes of Health