Episode 102: Castle Leoch
Claire and the Highlanders arrive at Castle Leoch to a warm welcome.
Does anyone else see a bit of Mrs. Patmore in Mrs. FitzGibbons?
After giving Claire the once over, Mrs. Fitz guides Claire inside and allows her to tend to Jamie’s wound. In addition to the shoulder dislocation, Jamie has suffered a gunshot wound to the shoulder which Claire tells Mrs. Fitz has not been cleaned or dressed properly.
Mrs. Fitz brings supplies to Claire including rags, garlic and witch hazel with which to boil the rags, and comfrey and cherry bark as what seems to be a compress for the wound.
Garlic has anti-inflammatory properties, as well as antibiotic, anti fungal and antiviral properties, which make it a good choice for the treatment of a wound. Witch hazel is used as a remedy for skin sores, bruising and swelling. Comfrey contains allantoin which is a substance thought to aid in wound repair and possess anti-inflammatory activity. Cherry bark as well is used to soothe rashes and skin ailments. Mrs Fitz is a wise woman and healer in her own right!
Claire examines Jamie’s wound and begins to clean it.
Claire dresses the wound and puts Jamie’s injured arm in a swathe, wrapping fabric around Jamie to hold his arm against his body to immobilize it.
A very travel weary Claire (travel weary may be an understatement after where she has been!), Mrs. Fitz dresses Claire. It is time to meet The MacKenzie.
Claire is brought to Colum’s chamber where she meets him for the first time. She sees the deformity of his legs and identifies that he likely suffers from Toulouse-Lautrec Syndrome. Despite years of medical school, residency and medical practice, I had some learning to do myself regarding this disease! It is impressive that Claire is able to retrieve from her mind the name and characteristics of the disease. My guess is she must have had a reason to remember it, perhaps from caring for a patient with it during her years as a nurse.
Toulouse-Lautrec Syndrome is a disease which causes abnormality in the process of breaking down and rebuilding bones. Throughout our lives, bones are continuously undergoing remodeling, with osteoblast cells forming new bone and osteoclast cells breaking down bones in a process to maintain bone mass. In adults, approximately 10% of bone mass is replaced each year.
Also called Pycnodysostosis (sometimes spelled Pyknodysostosis), this disease is caused by an abnormal gene responsible for an enzyme called cathepsin K. Cathepsin K is important in the cells of normal bone that are responsible for bone reabsorption. Without the normal function of this enzyme, bones do not undergo their normal process of bone reabsorption and they become dense and brittle. This leads to fragile bones and frequent fractures with poor healing, as well as other hallmark findings such as large skull, short stubby fingers, dental abnormalities, small chin, hooked nose and an open fontanelle (or soft spot as we are familiar with in infants) in the skull.
The disease is named for one of the most famous patients to suffer of it, artist Henri de Toulouse-Lautrec.
Shortly thereafter, Claire meets Geillis Duncan, who seems to share Claire’s love of botany and medicinal plants.
“Those kind are poison,” Geillis notes of the mushrooms Claire is examining.
As I am not a mycologist, I haven’t positively identified the mushroom which Claire is holding in this shot. And in fact, she is not holding a mushroom of the same variety described in the book, this one being whitish in color and the book referring to the bright red Ascaria variety.
It was on one of the fruit-picking expeditions to the orchard that I first met Geillis Duncan. Finding a small patch of Ascaria beneath the roots of an alder, I was hunting for more. The scarlet caps grew in tiny clumps, only four or five mushrooms in a group, but there were several clumps scattered through the long grass in this part of the orchard.
“Those kind are poison,” said a voice from behind me. I straightened up from the patch of Ascaria I had been bending over, thumping my head smartly on a branch of the pine they were growing under.
As my vision cleared, I could see that the peals of laughter were coming from a tall young woman, perhaps a few years older than myself, fair of hair and skin, with the loveliest green eyes I had ever seen.
“I am sorry to be laughing at you,” she said, dimpling as she stepped down into the hollow where I stood. “I could not help it.”
“I imagine I looked funny,” I said rather ungraciously, rubbing the sore spot on top of my head. “And thank you for the warning, but I know the mushrooms are poisonous.”
“Ooh, you know? And who is it you’re planning to do away with, then? Your husband, perhaps? Tell me if it works, and I’ll try it on mine.” Her smile was infectious, and I found myself smiling back.
I explained that though the raw mushroom caps were indeed poisonous, you could prepare a powdered preparation from the dried fungi that was very efficacious in stopping bleeding when applied topically. Or so Mrs. Fitz said; I was more inclined to trust her than Davie Beaton’s Physician’s Guide.
From Outlander by Diana Gabaldon, Chapter 9
I’m unable to identify the Ascaria mushroom in my research and I wonder if it was indeed the Amarita muscaria mushroom which is a poisonous mushroom of bright red color.
The A. muscaria mushroom contains the toxins muscimol and ibotenic acid. Both compounds mimic neurotransmitters in the brain, and ingestion of them causes nausea, low blood pressure, sweating, auditory and visual hallucinations, mood changes and loss of equilibrium. Severe poisonings can cause coma and seizures.
There is no antidote for A. muscaria poisoning. These patents are treated with supportive care, meaning supporting the function of the body until the effects have worn off. Today, this may include activated charcoal and gastric lavage (“pumping the stomach”) to prevent absorption of the toxins, if presenting for emergency care early in the course of illness. Benzodiazepines like Ativan or Valium may be given for agitation or seizures. Intravenous fluids and electrolyte replacement are generally needed. With good supportive care, the outcome is often good.
The end of this episode once again finds Claire tending to a wounded Jamie. This poor man. After taking the beating in the hall for Laoghaire, Jamie has sustained lacerations and contusions to his face.
Again, Mrs. Fitz has arrived with useful medicines for our injured Jamie. Willow bark tea would be the 18th century version of aspirin. Willow bark tea contains salicin which is a chemical very similar to acetylsalicylic acid, the active ingredient in aspirin. These wise Highlanders recognized the ability of salicilates to reduce inflammation and relieve pain.
Those who have seen the deleted scenes from episode 102 on the Season 1 DVD may remember an extended scene in which Mrs. Fitz applies leaches to Jamie’s swollen face.
She examines his eye and says, “Still bleedin’ under the skin. Leeches will help. Too many folk misuses leeches. Very helpful sometimes but you must understand how. When you use them on an old bruise, they just take healthy blood and it does the bruise no good.” She allows the leeches to remain on Jamie’s face for a bit and upon removing them, the swelling is markedly improved.
While modern medicine has moved past blood letting as a method of balancing the humours, leeches are indeed still used in healthcare! Hirudotherapy, or the application of leeches, is used in reconstructive plastic surgery to aid in situations of venous congestion postoperatively to clear excess blood until normal blood flow is restored in the venous capillaries of the surgical site, generally over 2-6 days. It would seem that Mrs. Fitz’s use of the leeches here to clear the excess blood in the contusions on Jamie’s face would be a very reasonable approach and will allow him, as she says, to see out of that eye tomorrow, rather than have it swollen shut! I’m foreseeing potential applications for this technique on victims of bar room brawls that end up in the ER!
The episode closes with Colum informing Claire that she will not be transported back to Inverness but instead will remain at Castle Leoch. The previous healer in residence has died and Leoch is in need of a healer. Or so he says. Claire finds herself more or less a prisoner now of the MacKenzie. A prisoner in the surgery. A victim of her own success?
http://www.medicinenet.com/pycnodysostosis/article.htmAdams C. Herbal Medicine: 100 Key Herbs with All Their Uses as Herbal Remedies for Health and Healing, 2014.
Fauci, AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL. (Eds.). (1998). Harrison’s Principles of Internal Medicine (14th ed.). New York, NY: McGraw-Hill.
Mumcuoglu KY. (2014). Recommendations for the use of leeches in reconstructive plastic surgery. Evidence-Based Complementary and Alternative Medicine. Volume 2014.
Porshinsky BS, Saha S, Grossman MD, Beery PR, Stawicki SP. (2011). Clinical uses of the medicinal leech: a practical review. J Postgrad Med. 57, 65-71.
Xue Y, Cai T, Wang W, Zhang Y, Mao T, Duan X. (2011). Clinical and animal research findings in pycnodysostosis and gene mutations of cathepsin K from 1996 to 2001. Orphanet Rare Dis. 6, 20.
Zaftig P, Hunziker E, Wehmeyer O, Jones S, Boyde A, Rommerskirch W, Mortiz JD, Schu P, Von Figura K. (1998). Impaired osteoclastic bone resorption leads to osteopetrosis in cathepsin-K deficient mice. Proc. Natl. Acad Sci. USA. 95, 13453-13458.