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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La Grippe – Influenza at Ardsmuir

Outlander Science Club

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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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Listen to this week’s episode of Outlander Science Club HERE!

Listen to this week’s podcast episode of A Dram of Outlander Voyager Read-Along HERE!

Join in the conversation!  Wednesdays at 6PT/9ET on Twitter, using the hashtag #ADoO!
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Comments, questions, suggestions, etc?  I’d love to hear from you!  Leave comments here or find me on Facebook or Twitter!

 

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!