303: Hello, Old Friend

I’ll admit I’ve been on team #SaveMurtagh since season two and as soon as the music changed in the prison cell and the bearded face of everyone’s favorite BFF appeared, I was grinning ear to ear!

murtagh

That’s right.  Murtagh is back!

Murtagh Fitzgibbons Fraser seems to have nearly as many lives as Jamie.  He has survived more battles than anyone cares to count and despite abysmal conditions at Ardsmuir, he is still hanging on.  It does seem, though, he could use a little bit of help.

We learn that Murtagh has been struggling in the 9 years since Culloden, suffering frequently from La Grippe as well as festering wounds (from rat bites no less!).

What does this all mean?

La Grippe

La Grippe  

La Grippe is a name for influenza, meaning “to seize suddenly,” likely a reference to violent shaking chills accompanying the fevers of an influenza infection.  The term Influenza comes from the Medieval Latin “influentia,” from the belief that epidemics of this illness were due unfavorable astrological influences.

With influenza season now starting to revisit the northern hemisphere, we often hear the tips and tricks to try to avoid the flu.  In addition to an annual influenza vaccine, we are advised to: avoid close contact, wash your hand frequently, avoid touching your eyes, nose, and mouth, get enough sleep, eat a healthy diet, avoid crowds.  Hmm, that definitely doesn’t bode well for these men living in the squalid, tight quarters of Ardsmuir prison!

And what do these men have to treat influenza?  A diet of thin barley brose and the occasional rat?  The odds are stacked against them.  Jamie is on the right track with his requests for blankets and improved food rations.

Did you miss the Outlander Science Club post and podcast all about La Grippe during the Voyager read along?  Check it out here!

murtagh wounds

What about those festering wounds?  Jamie seems to think greens are the answer.  He is right!

Murtagh (and likely most of the men on the Ardsmuir diet) are suffering from scurvy.  Scurvy is the result of a deficiency in vitamin C, which is required in the production of collagen in the body and plays a significant role in immune function.  Without adequate intake of vitamin C, these men will begin to experience fatigue, malaise, inflammation and bleeding of the gums, bruising, joint pain, and poor wound healing.  Thanks to his education from Claire, Jamie recognizes that Murtagh’s rat bite wounds are not healing and surmises this is due to a lack of greens in his diet.  Watercress to the rescue!

greens for murtagh.png

Always the keen negotiator, Jamie has convinced Major Grey to provide Murtagh with needed medical help.  I’ll admit I was waiting to see that doctor come in and bleed Murtagh dry in typical 18th century fashion, but it turns out that with help from this doctor and vitamin C rich foods from Jamie, Murtagh is back on his way to health…just in time for a long voyage to the colonies.

murtagh leaving.png

See you soon, friend?

 

All images property of STARZ
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Claire’s Soothing Tonic for Margaret Campbell

Outlander Science Club
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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

It’s Green, Major

A Dram of Outlander Voyager Read-Along

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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!

Ambersweet_oranges
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

Highland_cattle_above_Malham_Cove
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!