Jamie’s Kryptonite

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Chapter 41:  We Set Sail

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     The completest of landlubbers, he was not just prone to seasickness, but prostrated by it. He had been violently ill all the way from Inverness to La Havre, though sea and weather had been quite calm. Now, some six hours later, safe ashore in Jared’s warehouse by the quay, there was still a pale tinge to his lips and dark circles beneath his eyes.
From Voyager by Diana Gabaldon, Chapter 40

“Sailing on the sea shows that motion disorders the body.” – Hippocrates

762px-thomas_buttersworth_-_h-m-s-_victory_in_full_sail_and_in_a_squall_2

Source: Wikipedia Commons

 

What is seasickness?

First described by Hippocrates, seasickness is a group of unpleasant symptoms occurring in response to real or perceived motion.  It is thought that the mismatch between what the eyes see and the movement the body feels. A classic example is a person sitting  in the interior of a cabin on a ship, which seems to be stationary to the eye as one looks about the room, but the body senses ongoing movements of the ship. These conflicting messages to the brain are thought to be cause of motion sickness. This also can occur when when a person is not moving at all, but the eyes see motion, such as when looking at movement on a slide under a microscope or engaging in virtual reality games, though the body perceives no movement.

Symptoms include dizziness, nausea, belching, increase salivation, warmth, sweating, general feeling of malaise, hyperventilation, and feelings of impending doom.  While thought to be due to this mismatch of input from the eyes and from the body, the exact mechanism by which this happens is not fully understood.

sea-sickness_-_published_by_g-s-_tregear_96_cheapside

Source: Wikipedia Commons

 

How does the body perceive motion?

We are able to sense motion via the input of cues from the eyes, the muscles and joints, and the vestibular system. Sensory receptors in the eyes send information to the brain that provide visual cues specifying how the body is positioned relative to other objects (Am I lying flat compared to the room around me? Am I upside down compared to the furniture in this room?).

Sensory receptors in the skin, muscles, and joints are sensitive to stretch and pressure and report back to the brain information about how the body is positioned in space. For instance, cues from the ankles and feet may indicate whether I am standing on solid ground or if I am on a tilting surface (like a boat) requiring the muscles of my ankles and feet to work against the sway of the boat to keep me standing.

Information about motion and balance is provided by the vestibular system via structures in the inner ear including the utricle, saccule, and three semicircular canals.  The utricle and saccule sense linear movement via the movement of tiny hairs within, or cilia, as the head moves.  The semicircular canals contain fluid and as the head moves in a rotational pattern, the fluid within moves, stimulating receptors that sense the movement of the head.

Anatomy_of_the_Human_Ear_en.svg.png

Source: Wikipedia Commons

 

The brain then receives all of these signals from the eyes, muscles and joints, and the two sides of the vestibular system (one in each ear), and must make sense of it. Motion sickness symptoms are thought to arise when the input from these sources conflict with each other, such as when the input from the muscles and joints suggest the rolling movement of a boat while the eyes simply see the walls and furniture of a ship’s interior cabin.  Interestingly, people who are blind can have motion sickness, but people who are completely deaf (and lack peripheral vestibular function in the ear) cannot!  This would suggest that the vestibular system is playing the major role here.  The exact mechanism by which this occurs is not well understood.

Why are some people so much more susceptible to motion sickness?

Motion sickness can be induced in nearly all adults, but certainly under typical situations of travel by boat, air, or car, or rides on roller coasters, not all are affected.  Children under 2 are typically resistant to motion sickness.  Symptoms seem to peak at approximately age 12 and then decrease (though of course this isn’t the case for all).  Women are more commonly affected and pregnant women in particular are quite susceptible, raising the question of the role of hormones in motion sickness.  Interestingly, migraine sufferers are also more susceptible to motion sickness.

Motion sickness tends to improve for most with repeated exposure to the stimulus.  After 36-72 hours of continuous exposure, symptoms typically subside or resolve for most people.  However, symptoms can occur upon returning to the pre-exposure environment (e.g. returning to land after a period of time at sea).

Treatments for Motion Sickness

Environmental Modification

Minimizing the discrepancy between the different cues from vision, muscles and joints, etc. can help. Looking at the horizon from the deck of a ship rather than remaining in an interior cabin allows the visual input to more closely match the other sensory input.  Sitting in the front seat of the car and looking out the window, or better yet – being the person driving – can minimize symptoms.  Self-generated movements don’t cause motion sickness, so those prone to motion sickness can avoid symptoms of car sickness by taking the wheel.

Medications

These are most effective when taken as a preventative before the symptoms start.  The most frequently used medications include antihistamines like Benadryl, Meclizine, and Dramamine and the anticholinergic medication Scopolamine which is available in a skin patch form. Other medications that are used in the prevention and treatment of motion sickness include nausea medications, as well as medications like baclofen and gabapentin which influence the neurotransmitter GABA, thought to play a role in the development of motion sickness.

Herbal Remedies

  • Ginger
    • A traditional remedy for nausea, also has been found to be effective in motion sickness.
    • Was found to be beneficial in a study of naval cadets when given as a pre-treatment, resulting in less vomiting and cold sweats than placebo.
    • Thought to affect gastric motility as well as on serotonin receptors in the brain
    • Patients on certain medications, particularly blood thinners, should discuss this with their doctor before taking ginger, as ginger may also increase the risk of bleeding.
  • Peppermint
    • Frequently used to treat nausea
    • Works as an antispasmodic in the gastrointestinal tract
  • Black Horehound
    • A traditional remedy for motion sickness, nausea, and vomiting

Biofeedback and Relaxation Techniques

It turns out that even pilots and astronauts are not immune to motion sickness. Biofeedback and relaxation therapy have been used by NASA to help mitigate the effects of motion sickness.

Acupuncture and Acupressure

Originating in China over 4000 years ago, acupuncture is the application of fine metal needles to particular areas of the body to maintain health and to prevent and treat certain ailments. After a thorough evaluation, a practitioner inserts thin needles into precisely defined points along the 14 main channels (or meridians) along the body associated with specific organs.  Acupressure is similar in principle, involving the application of pressure, rather than needles, to specific points along the body.  In particular, the P6 acupuncture point located above the wrist has been studied extensively and many find the use of this point is effective for reducing nausea and vomiting.  Acupressure wrist bands that apply pressure to this point are widely used to prevent and relieve the symptoms of motion sickness.

 

body
Source: Shutterstock
     His face relaxed slightly, making the slender gold needles that protruded from behind his ears twitch like ant’s feelers.
     “It’s all right,” he said gruffly.  “It’s only some rubbish of the Chinee’s, to cure the puking.”
     Wide-eyed, Marsali came up to him, gingerly extending a finger to touch the needles embedded in the flesh of his wrist below the palm.  Three more flashed from the inside of his leg, a few inches above the ankle.
     “Does – does it work?” she asked.  “How does it feel”
     Jamie’s mouth twitched, his normal sense of humor beginning to reassert itself. “I feel like a bloody ill-wish doll that someone’s been poking full o’ pins,” he said. “But then I havena vomited in the last quarter-hour, so I suppose it must work.” He shot a quick glare at me and Mr. Willoughby, standing side by side near the rail.
From Voyager by Diana Gabaldon, Chapter 41

Jamie’s Experience with Acupuncture

Jamie has regained his sense of humor, a reassuring sign that he is feeling better, alarming though he may look to Marsali with needles protruding from various spots.  Acupuncture needles are described on his wrist and lower leg and behind his ears.

Wrist:

Pericardium 6 (P6), the best known acupuncture point for preventing and treating motion sickness, is located 2cm above the wrist in the inner forearm. Used for treating vomiting, dizziness, and vertigo, motion sickness wristbands apply pressure to this point.
Lower Leg:
Spleen 6 (SP6) is a point in the inner lower leg, about 3 cm above the ankle that is said to help with digestive symptoms and dizziness.
Behind the Ears:
Gallbladder 8 (GB8) is a point on the head directly above the ear which is said to help with ceaseless vomiting.  Other locations in this area also help with dizziness and vertigo.

 

544px-acupuncture_needles

Source: Wikipedia Commons

 

How Does Acupuncture Work?  

In Traditional Chinese Medicine, it is believed there is a universal life energy called qi (“chee”) present in every living being.  This energy travels throughout the body along specific pathways called meridians. Health is maintained when the energy flows freely throughout these meridians.  However, when the flow of energy is blocked, disrupting the system, pain and dysfunction occur.  Acupuncture is thought to restore normal function by stimulating certain points on the meridians to free up the energy.

In Western medicine, some theorize that pain relief from acupuncture is due to the release of endorphins that occurs when needles penetrate the skin.  It is also thought that acupuncture affects gastrointestinal disorders by effecting the parasympathetic and sympathetic nervous systems, promoting gastric and intestinal motility.  Studies involving neuroimaging reveal that acupuncture has the ability to activate and deactivate particular areas of the brain.  Research funded by the National Institutes of Health  has indicated that acupuncture is effective in treating migraines, arthritis, and chronic pain.

Acupuncture was mostly unknown in the United States until the 1970s. When President Nixon’s Secretary of State Henry Kissinger travelled to China in 1972, he was accompanied by journalist James Reston.  Reston developed appendicitis while in China and required an emergency appendectomy.  He reportedly remained awake during the operation, with his pain controlled with acupuncture (though further reports, and Reston’s own account seem to suggest he had an epidural for anesthesia during the procedure, and acupuncture was used for post operative pain 2 days alter).  Word spread, and US physicians began studying acupuncture and its use in anesthesia for pain control as well as other applications.

We will likely see acupuncture become more widely used in the US, particularly as we seek to minimize the use of opiate medications in controlling pain. It is interesting to see that despite our advances in medicine, we still depend on many of the thousands year old remedies, particularly in motion sickness treatment, in the form of acupuncture, acupressure, herbal remedies such as ginger!

seaband
 

The Sea-Band in action – Wearable acupuressure for motion sickness.  (Source: Personal Photo)

 

 

Title Photo: Shutterstock

 

References:
“Acupuncture: In Depth | NCCIH.” U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 08 Nov. 2016.
Grontved, A.,  Brask, T.,  Kambskard, J.,  Jentzer, E. “Ginger root against seasickness. A controlled trial on the open sea.” Acta Otolaryngol. 1988 Jan-Feb; 105(1-2): 45-9.
Hao, Jason J., and Mittleman, Michelle. “Acupuncture: Past, Present, and Future.” Glob Adv Health Med. 4 (2014): 6-8.
Lu, Dominic P., and Gabriel P. Lu. “An Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society.” Medical Acupuncture 25.5 (2013): 311-16. Web.
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Claire’s Soothing Tonic for Margaret Campbell

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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

111: What Was Ailing Arthur Duncan?

111: The Devil’s Mark

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

titlecard
STARZ

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!

confession
STARZ

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.

caustic arthur duncanpoor arthur 3

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.

Paris_Green_(Schweinfurter_Grün)
source

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.

Arsenic_trioxide
source

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…

red shoes
STARZ

103: Demonic Possession, Woodlice and Tetanus, Oh My!

Episode 103:  The Way Out

title card with title
source:  Starz

This beautiful title card promises an episode about medicine!

The medicine bottle reads “ELIX: PECTOR: WED.”  I found on the Smithsonian Institute website’s online collection a very similar bottle, labeled “ELIX PECTORAL WED” which dates from the 18th century and would have held Wedel’s Pectoral Elixir, made by Georg Wolfgang Wedel (1645-1721) for chest ailments.  This medicine consisted of benzoic acid, ground irises, sugar, fennel oil and sulphur for the treatment of cough and congestion.  I love the attention to detail both in this series of books and the show!

 

Claire spends time exploring the surgery and all of the tools and medicines Davey Beaton has left behind.

davey beatons chest
source:  Starz

 

Among them are slaters which, it turns out, are live wood lice.

woodlice
source:  Starz

Apparently, in the past these have been thought to be medicinal and helpful for digestive ailments when swallowed whole.  No, thank you!

 

Claire busies herself, caring for the residents of Leoch.  Here, she fashions a splint for an injured wrist.

wrist splint close
source:  Starz

 

She is summoned to Colum’s chamber where he tells her that Davey Beaton used to massage him to ease his pain and make movement easier.  He hopes Claire will do the same for him.

colum legs in mirror
source:  Starz
colum legs on table
source:  Starz

Indeed this is likely very helpful to Colum in easing his pain, stretch sore or atrophied muscles and reduce muscle spasms.

 

Claire later visits Geillis Duncan’s home to stock up on medicines she may need when the clan has gathered at Leoch, in particular white willow bark for whiskey headaches!  Aspirin, even its earliest forms, has a long history with hangovers!

geillis study
source:  Starz

Claire witnesses a crowd surrounding the tanner’s lad who has been accused of stealing two bannocks. Geillis Duncan’s husband, Arthur, is the procurator fiscal for the district and must determine the boys fate.

caustic arthur duncan
Poor Arthur is feeling caustic again / source:   Starz

Arthur Duncan seems to suffer perhaps from both indigestion or acid reflux as well as quite a bit of flatulence.  He asks Geillis for peppermint to help.  Peppermint has been used medicinally for over 10,000 years and is often used for digestive problems.  It has anti-inflammatory and antispasmodic properties and also is a cholagogue (promotes discharge of bile from the biliary tract).  We don’t yet know what ails Mr. Duncan (though readers of the book know we soon will), but the peppermint seems to do the trick for him and he leaves in better spirits, much to the benefit of the tanner’s lad who will get to keep his hand today.  Instead, he will be sentenced to “one hour in the pillory and one ear nailed.”

 

pillory ear 2
One ear nailed / source:  Starz

The poor tanner’s lad.  In addition to the risk of bacterial infection of his wound and obvious lasting deformity, this (hopefully rust free) nail through his ear puts him at risk for tetanus.

Tetanus is a life-threatening disease caused by the bacteria Clostridium tetani.  The spores of this organism can survive in soil or on surfaces for years.  Most cases follow an injury such as puncture wound, laceration or abrasion, particularly from a rusted nail or similar object.  Infection occurs at the site of injury and an exotoxin produced by C. tetani, called tetanospasmin, spreads to the nervous system causing muscle rigidity, violent muscle contractions and instability of the autonomic nervous system. Difficulty swallowing, difficulty breathing, heart abnormalities and even sudden cardiac arrest can occur.  Patients will suffer from stiffness and pain in the masseter muscles of the face responsible for chewing, resulting in lockjaw, the common name for tetanus. Symptoms begin in the face and progress downward.

Tetanus is almost completely avoidable with vaccination.  Vaccination for tetanus began in the US in the 1940s, when there were approximately 580 cases of tetanus reported in the US and 472 deaths.  Most recent data shows this has decreased significantly to 41 cases and 4 deaths in the 2000s.

Modern day treatment of tetanus includes administration of tetanus immune globulin to neutralize the tetanospasmin toxin, muscle relaxants, temporary induced coma if needed and medications to mitigate the effects of the autonomic nervous system dysfunction. Mortality of tetanus is around 10-20 percent.  Of the cases reported in the US, about 90 percent had not received appropriate tetanus vaccination and indeed this disease primarily affects non-vaccinated and under-vaccinated people.  Remember to get your tetanus booster every 10 years!

 

Throughout the course of this episode, Claire has been learning that the son of Colum’s chambermaid has died after visiting the Black Kirk.  His friend, Tammas Baxter, who visited the kirk with him is possessed by the devil and near death.

Claire, of course, suspects otherwise.

home of poisoned boy
Young Tammas, seized with evil / source:  Starz

She visits the boy and notes he has no fever and likely does not suffer from an infection. Rather, she notes that his heart rate is slow and his pupils are constricted to pinpoints and she suspects poisoning.

Jamie accompanies her to the Black Kirk where her fears are confirmed.  Jamie explains that the boys who visit the kirk to prove their manhood often eat berries and wood garlic there. Wood garlic is an edible plant related to chives.

black kirk
The Black Kirk, where demons roam free / source:  Starz

Except it isn’t wood garlic.  It is lily of the valley.

black kirk plant 3
source:  Starz

Lily of the valley is a highly poisonous plant that contains cardiac glycosides. These chemicals act by inhibiting cellular function leading to dangerously elevated potassium levels, slowing of the heart rate and potentially fatal abnormal heart rhythms, as well as nausea, vomiting, diarrhea, abdominal pain and confusion.

Allium_ursinum0
Wood Garlic (source)

 

Convallaria_majalis_0002
Lily of the Valley (source)

Claire has identified the poison and now has to figure out a way to counteract the effect of the poison using the tools and medicine she has at her disposal in the 18th century.

 

The cardiac glycosides of lily of the valley are very closely related to the modern day medicine digoxin. Digoxin is used to treat patients with heart conditions like atrial fibrillation, where it controls ventricular rate and in heart failure in which it can increase contractility of the heart. If a child like this young boy presented today with cardiac glycoside poisoning, either from consuming plants like lily of the valley or oleander or from ingesting digoxin, digoxin-specific antibodies would be administered. These would bind to the cardiac glycosides circulating in his body and they would be excreted from his body via the kidneys.

However, this wouldn’t be on Claire’s radar as they were not developed until later in the 20th century.

She must figure out a way to counteract the effects of lily of the valley, in particular his slow heart rate, and our brilliant heroine recalls that another toxic plant, deadly nightshade or belladonna, contains atropine as an active component. She knows that atropine will act to increase the heart rate. Belladonna in this case will potentially act to counteract the slowed heart rate which can be fatal to our patient Tammas.  The hope would be that she can mitigate the dangerous effects of the poison until the boy’s body has metabolized and excreted it.

This is risky business, though, as Claire points out. “…but if I was wrong about the dosage or the original poison, it will cause convulsions and kill the boy just as quickly.”  Indeed belladonna is a poison in its own right. She has no way of knowing the quantity of active medication she is administering and she is taking a big gamble, but it appears the boy will die without her intervention and it is a risk that proves successful in the end.

She administers a concoction of belladonna to the boy and within minutes he is awake and talking and recovering.  A miracle!

Happy Family
source:  Starz

 

Claire hopes that this has garnered favor with the brothers MacKenzie and will persuade them to allow her to travel to Inverness.  Jamie, however, informs her that Colum is taking credit for bringing Claire and her gift of healing to the MacKenzies and likely won’t want to see her leave any time soon.

Yet Claire is determined to get back to the stones and to frank. Or die trying. And we know our girl is stubborn, resourceful and not averse to big risks…

 

Resources:
http://americanhistory.si.edu/collections/search/object/nmah_993857
Adams, C. (2014). Herbal Medicine: 100 Key Herbs With All Their Uses As Herbal Remedies for Health and Healing. CreateSpace.
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