In episode 805, Send for the Devil, the struggle between Jamie and Captain Charles Cunningham for control over Fraser’s Ridge has been revealed and is about to go from simmer to boil.

Credit: STARZ Outlander Ep805 - Send for the Devil. Jamie meets his faithful Ardsmuir men before the Lodge meeting where he’s learned Cunningham plans an ambush.

Jamie has learned of the plot against him, tipped off by Aaron Whitaker earlier in the episode, and he goes to the Lodge meeting (after which he expects trouble) with a plan in place to foil Cunningham’s aims or at least give himself a fighting chance not to be captured and carted off to be hanged for treason.

Credit: STARZ Outlander Ep805 - Send for the Devil. Jamie, having escaped Cunningham’s ambush, meets up with his men in the woods, instructing them to not shoot to kill. ‘I’ll not be the one to bring death here tonight.’

Jamie’s scheme succeeds, and he and the Ardsmuir faithful successfully diffuse the insurrection,

Credit: STARZ Outlander Ep805 - Send for the Devil. Jamie grapples with Cunningham, winning the upper hand at last, and kicks him out the door of the trading post.

with the final showdown coming in a one-on-one between Jamie and the Captain.

Credit: STARZ Outlander Ep805 - Send for the Devil. Cunningham finds Jamie’s pistol and levels it at him. Jamie realizes he’s in a tight spot, expecting the worst.

After quite a brawl, Cunningham winds up with Jamie’s pistol, which he levels at Jamie, who is wounded and has but a knife to defend himself. It looks as if all may be lost (I will admit here that I was yelling at the screen for him to fling that knife into Cunningham’s black heart with lethal accuracy just like he did to the Redcoat soldier in the woods after the evacuation of Ticonderoga in episode 706, Where Waters Meet).

Credit: STARZ Outlander Ep805 - Send for the Devil. Cunningham’s shock as the ball hits him. Buck with the musket shouldered after shooting Cunningham. Jamie’s surprise at not being killed himself.

But just when it seems Jamie’s doomed, a musket cracks, and Cunningham grunts and falls to the dirt. Behind him, we see Jamie’s salvation has arrived in the person of Buck MacKenzie.

Credit: STARZ Outlander Ep805 - Send for the Devil. Buck and Tom hoist the stretcher bearing Cunningham up and lay it on the exam table.

The men carry the wounded Cunningham in a make-shift stretcher fashioned of interlacing rope and blankets (and wherever did they quickly come up with that, I wondered?) to the New House for Claire to tend to him. Claire examines and questions the man, appropriately, and learns he’s been shot in the back. She asks him, “High or low?” “Low,” he replies.

She sticks her hands under his back and palpates his spine (which she could do by counting vertebral processes from a known bony landmark, probably up from the sacrum or iliac crest, I would imagine) and declares “Between L3 and L4.” Meaning that she’s found the entry wound between the third and fourth lumbar vertebrae. She asks him to wiggle his fingers and move his feet, which he attempts, successfully moving his hands and fingers, but unable to move his feet at all.

Credit: STARZ Outlander Ep805 - Send for the Devil. The men have rolled Cunningham onto his left side and Claire lifts his shirt to expose the musket ball embedded in his back.

“Buck, Tom, help me roll him. Towards you,” she instructs the men. “Slowly. Hold him steady.” All correct and all important to do. She pulls away his bloody shirt to reveal the musket ball embedded to a depth of about half its thickness right in the midline of his low back.

Claire goes to put on her surgical apron and gather her tools, telling Elspeth 'You ought to stay. This won’t take long and I may need your help.’ (Famous last words those would be in many cases of attempting this procedure.)

Credit: STARZ Outlander Ep805 - Send for the Devil. Claire uses a probe to lever the musket ball from Cunningham’s back.

Without any sort of cleansing of the wound — very unusual for a woman who usually splashes alcohol all over everything first — she takes a straight metal probe of some sort and teases the ball free. (Not at all a predictably quick and simple matter, but I’ll expand on that in a bit.) And once the ball is out, she cleans and dresses the wound (or at least tells us she is going to do that.)

Credit: STARZ Outlander Ep806 - Blessed Are the Merciful. Claire picks up a gauze square with her forceps, presumably to dress the Captain’s wound. He responds to her ‘good morning’ with a cantankerous ‘ it certainly is’t good!

The next morning, the Captain, still lying on his back in the same position on the narrow exam table, crossly responds to Claire’s “Good morning, Captain.” With “I have no idea what time of day it is, but it is certainly not good.” Then, accusatorially, “What did you do to me?” To which she replies, “I removed the musket ball from your back, although it had already done quite a bit of damage.” (She knows this because before she did anything at all to him, she ascertained that he couldn’t move his feet.)

And then he barks out, “What is that awful smell!?”

Credit: STARZ Outlander Ep806 - Blessed Are the Merciful. Cunningham lifts his soaked bed linen to find the source of the awful smell.

Claire calmly informs him that loss of bowel and bladder control is to be expected with his type of injury. He lifts the sheet and blanket to see they are sodden with his own waste.

Credit: STARZ Outlander Ep805 - Send for the Devil. Elspeth Cunningham asks Claire if her son will live.

Elspeth Cunningham (the Captain’s mother, who earlier in Ep805 had come to the New House on that evil night of the planned ambush to sit and pray with Claire for the safe return of their respective combatants) asked when they brought her injured son in, “Will he live? Tell me the truth.” And Claire does. “Yes, I think so, but he may never walk again.” She tells her that the ball didn’t fully penetrate and the injuries might heal…and might not.

She goes on to inform the Captain the next morning that he’ll likely not walk again but will retain the use of his upper body, arms, and hands.

Would that be the case? We’ll take a deeper look.

What is the injury here?

The first injury Cunningham suffered (going from outside in) would be that the ball hit his spine and has lodged in the soft tissues and bone at the junction between the two vertebral bodies in question, L3 and L4. We can still see about a half dome of the ball visible at the surface in the photo earlier.

The impact of a ball traveling at 750 to 1000 miles per hour over about what I would estimate as 50 to 60 feet at most would be considerable and could smash and fracture the bone, potentially driving fragments of it deeper into the spinal canal or causing herniation of the disc between the vertebra, pushing it into the spinal canal.

A musket ball in the 18^th Century was typically a bit less than ¾-inch in diameter (16 to 17 mm) and weighed a little less than an ounce. Entering to a depth of half its diameter (8.5 mm say) probably wouldn’t be deep enough to hit the spinal cord itself, no matter what level of the spine it penetrated. But at the L3-L4 level it couldn’t directly harm the spinal cord itself because the cord ends in most adults at about the L1-L2 level.

Credit: OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons. Anterior (frontal) view of the spine and nerve roots, altered to show the location of Cunningham’s gunshot (red star).

You can see in the image above that what goes on down the spinal canal from that L1-L2 end point is not a single ‘cord’ but a loose tassel-like structure of lumbar and sacral nerve roots called the cauda equina (i.e., horse’s tail).

Could those nerve roots be damaged by the concussive blow of the ball strike, by bits of broken bone driven into the canal, or be entrapped and potentially crushed or severed by a fractured vertebra and collapse of the bony spinal canal at that point or by bleeding and swelling within the canal. Yes, they certainly could be. Any or all of these potential scenarios could damage the cauda equina at this level. It’s easy to see that the force of a ball smashing into the spinous processes of L3-L4 (red arrow below) or even slightly off center into the pedicles on either side of it that support the arch from which the spinous process protrudes could damage the structures beneath it.

Credit: Wikimedia Commons. Braus, Hermann - Anatomie des Menschen: ein Lehrbuch für Studierende und Ärzte Illustration of a lumbar vertebra. The orange arrows top and bottom images show where the spinal cord or cauda equina (depending on the level) would run. And the location of the spinal cord (or cauda) in the central orange dot.

And severe damage to these nerve roots would cause neurologic defects in the lower half of the body – temporary or permanent, as Claire said time will tell – ranging from numbness and weakness of the pelvic area (so-called saddle numbness) or of one or both the extremities to radiating or burning pain coursing down one leg or both, to urinary retention or bowel or bladder dysfunction, to a whole laundry list of lesser spottier neurological deficits that might resolve or linger.

Less certain, though possible, would be sudden permanent complete paraplegia (paralysis and loss of sensation from the waist down to the toes) which is what we’re led to believe from the storyline has been the Captain’s fate. A higher entry point (one in the low thoracic vertebral area, say T11-T12) would have been more certain to cause full permanent below-the-waist paralysis and loss of sensation and still leave the upper body functional.

Claire’s Treatment, Prudent or Not?

Claire begins prudently enough, determining where the injury is located in his back and asking if he can move his hands and feet to crudely assess the level of neurologic impairment. (By modern standards, which I would apply to her since she was a practicing surgeon in Boston in 1968, we would have expected her to remove his boots and pants and check for presence or absence of reflexes and any sensation or the least movement from toes on up to be doubly sure of the extent of the damage, but that would have taken too long for a high pressure tv scene, so I get it.)

A physician pledges to ‘first do no harm’, so knowing you have an injury to the spine, you tread carefully endeavoring not to make matters worse. Claire has to get him turned over to see the wound directly and be able to tend to it, and she rightly enlists a pair of big, strong men to turn his body as a unit, trying not to flex or extend the spine in the process. Shifting an unstable vertebral fracture or a loose bone fragment could worsen the damage. Granted the cord itself isn’t probably in peril, but the nerve roots of the cauda equina are potentially so, and especially when we factor in the rough ride he took in a sling-type stretcher from the trading post over two rough miles to the New House that could easily have caused an unstable fracture to shift. So whatever the ball did, the damage may already have been worsened by the men who brought him in.

On Claire’s part at least, so far so good.

But then she uses a straight metal probe to attempt to lever a slippery round embedded object out of its hole. And here’s where things break down. If you’ve ever tried to do such a thing (I have) you’ll know it is no easy task to get any sort of purchase on a round hard slippery object to make it ‘pop’ out by prying at it like she does. And putting the inward or lateral (sideways) pressure to do that on this particular slippery round thing could destabilize a fracture of the vertebra beneath the ball.

I see the lure of getting it out – it’s right there, visible; it’s not like you’re probing blind into the abdomen under the liver or through the flank up under the kidney or something. So maybe you attempt removal.

However, there’s the opposite case to be made (and at the time many doctors might have made it) to leave the ball alone if it’s stable.

But if you’re going to try to go after it, the way to approach it is to make an incision with a scalpel on either side to widen the entry wound in the skin, so that you have enough room to get both jaws of a ball (or bullet) forceps (so named because it’s the right instrument to use to extract such things) around the ball without undue inward pressure, grasp it securely, and pull it straight out. Less risk of causing further damage that way.

I’m sure at some point Claire has had bullet (or ball) forceps; I can’t imagine she wouldn’t have. I know they existed at the time. They’re first mentioned in medical history in the 1530s, entering the scene not long after firearms were adopted widely as a weapon of war in the 15^th Century and were a staple in the surgical field kits of Revolutionary era America.

Credit: STARZ Outlander Ep805 - Send for the Devil. Denzel Hunter uses a typical ball or bullet forceps to remove a ball from a battlefield wound.

We see Denzel Hunter use one to remove a ball (in a scene I’ve yet to write about but will) earlier in episode 805, so at the same point on the historic timeline. We know, too, that Claire had such a kit in a leather roll at Saratoga in Season 7 when she repaired Jamie’s saber-split hand. One would assume she still does and that it would have had ball/bullet forceps in it.

Having chased various foreign bodies in emergency rooms and our clinics in my past (a BB embedded in a boy’s palm comes to mind) I know firsthand how difficult this maneuver would actually be. Even with ball or bullet forceps it can be frustratingly tricky, and all the more so with a straight probe.

But Claire succeeds quickly in getting the ball out, and then she tells us she cleans and dresses the remaining wound. Extremely important step, that, since it might actually be an open channel from the outside environment directly into the spinal canal, so I do hope she cleaned it very well and bandaged it securely. All the more urgent since positioned as she has him, on his back, he’ll be potentially be lying in his own excrement as a consequence of his loss of bowel control.

From a purely medical standpoint, it might have been more prudent (and more stable) to have rolled him all the way over onto his stomach to remove the ball initially (though considerably less comfortable for the Captain after a time) and that way she’d have had easy access to check on and re-dress the wound without having to roll him again each time increasing the risk of shifting something. And putting the wound up instead of down would have been less risky for fecal contamination. But then he wouldn’t have been facing the camera for his conversations with her and with Jamie later, so I get the tv requirements.

Credit: STARZ Outlander Ep806 - Blessed Are the Merciful. Jamie comes in to speak to Captain Cunningham the morning after he’s been shot. Telling him when he bemoans not being able to stand becoming anything other than an able bodied man. ‘You have made your bed, Captain. And now you must lie in it.’

Serious post-extraction infection of the wound (or worse the cerebrospinal fluid in the canal) would be of highest concern, because in a time before antibiotics, it would often prove fatal (or normally it would but for the death bed prophesy of Captain Cunningham’s son who promised he would see his father in seven years, of which there’s still five years remaining on what Cunningham believes to be his can’t-be-killed-til-then, get-out-of-jail-free card.)

You may have wondered why, if Captain Cunningham was unable to move his legs and feet or feel anything in them (as he affirms to Claire the following morning when she asks if he still has no sensation in his legs) that it would have hurt and made him cry out in agony when she tried to remove the ball. Why wouldn’t that area be numb, too?

And the answer is that there is a good deal of overlap in the nerve supply to the skin and muscles of the low back and even the posterior (back part) of the vertebrae (refer to that lumbar spine and nerve root diagram above) that would still be able to transmit painful signals up to the brain from around the area of the wound. The nerve supply coursing down to supply sensation and motion to the legs and feet would be disrupted by injury to the cauda equina nerve roots but the overlapping more superficial nerve supply would not be affected. Nor would anything higher up.

Might Cunningham’s injury resolve?

Claire had it right when she told Elspeth, “It might resolve; it might not. Time will tell.”

If the nerve roots of the cauda equina were merely concussed (banged and bruised) by the impact or perhaps impinged on by swelling or bleeding that quickly resolved, over time they might heal and function again. If, however, some roots were severed by a shard of bone driven through them or crushed by the shifting of an unstable vertebral fracture, then the damage might be permanent. But it’s not likely, as I said earlier, that injury to just some of the cauda roots alone would result in complete permanent paraplegia. It would pretty well have to involve most of them, which points to a destabilized vertebral fracture shifting into the canal and crushing or severing a bunch of them. (And might tie back to shifting during that rough stretcher ride.)

What we do see is Elspeth petition Jamie to let her take her son back to England, so that if she has to spend the last years of his life and hers wiping his bottom and changing his sheets, she can at least do so in a place that is known to her.

Credit: STARZ Outlander Ep806 - Blessed Are the Merciful. Elspeth loads her son into a carriage for the trip home.

And when Jamie grants her the grace to take him, she loads the Captain into the back of a open carriage and begins the jolting ten-day, cross-country journey to the coast and from there five or six weeks on a rolling ship to home. All of which, I’ll add, wouldn’t be conducive to keeping an unstable spine immobile.

So, it’s hard to say what might have happened with Cunningham’s injury over time; his storyline remains unresolved, but my humble opinion is that his injuries would be permanent and that he died of some sort of infection, if not from the wound itself, from the kidney or some other malady to which paraplegic patients are prone. Perhaps five years down the road.

Overall Medical Verity Score: For medical authenticity I’d have to give this one about a C. Claire couldn’t likely have extracted the embedded ball so easily with the straight probe. For authenticity’s sake, I think she could have at least mentioned that she wished for a ball forceps if she no longer had one among her surgical tools, then made do with what was to hand. But to my mind, in a time when every living soul carried a gun, a ball forceps would be high on my list of important surgical tools to have acquired post haste and it’s odd she wouldn’t have one.

And I’ll give a tiny demerit for the demonstration of this specific injury; a wound at this level of the spine wouldn’t likely have caused full paraplegia absent the forward displacement of an unstable vertebral fracture, and they could easily have specified the wound higher (or not specified a level at all) to more correctly align the wound with their desired outcome of complete paraplegia.

But I’ll give it an A for an exciting storyline and the guilty pleasure of seeing a rat get caught in his own trap. Yes, perhaps the self-sure Captain will not die for five years, but as he sees it and said to Jamie ‘I’m not dead, but I might as well be.’ How much more unkind a fate for a man whose whole identity is ‘being a soldier’ to be alive but incapacitated and beholden to his elderly mother for basic daily care. Karma.

So… headshots, and I don’t mean the smile for the camera kind. The 18^th Century was a violent time, and reflective of that truth there are a number of instances in the series where characters are shot in the head (and many more of people shot practically everywhere else). The shot-in-the-head ending happens, I’m sure, to a legion of extras in one battle or another, but there are three more important characters who suffer that fate that I thought might make for an interesting jumping off point for discussion about this type of injury.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. (L to R) After kidnapping her, Bonnet pleads with Brianna to teach him how to comfort his child and subsequently bargains to sell her to a sea captain.

The first headshot we encounter is of Stephen Bonnet, the dastardly yet admittedly at times oddly charming smuggler with a sad childhood. Don’t get me wrong, he was still a sadistic, psychopathic nut job, who in episode 408 (Wilmington) assaulted Brianna then later kidnapped her in episode 510 and made a deal to sell her for £6 as a white slave to a scurrilous sea captain. Fortunately, Jamie, Claire, Ian, and others rescued her at the eleventh hour and apprehended the evil miscreant.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. (L to R) Jamie et al have subdued Bonnet and released the sea captain after permanently dispatching members of his crew. Bonnet lies in the sand bound foot and hand. Bonnet attempts to drink a bit of liquor from the flask Jamie threw down in front of him ‘a drop for his soul’ harkening back to a scene with. poor Gavin Hayes in the jail before his hanging.

After he’s been captured and convicted of his crimes and sentenced to death by water, he’s shackled to a pillar out in the middle of an estuary to be drowned at the next high tide.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. (L to R) Bonnet screams at his fate. The water has risen to his chin. He sees Brianna on the shore.

An assembled crowd of citizens who have come to watch him die has dispersed (the tide was taking too long, I guess), and he’s been left alone to his fate. Then he espies Brianna in the distance on the shore.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. Bonnet shot in the head. His head slumps forward and blood billows into the water.

Brianna dispatches him with a well-placed shot to the forehead, finalizing his sentence. The shot rings out, a wound appears on his left mid-upper forehead; his head slumps forward and a cloud of blood seeps into the lapping water.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. (L to R) Brianna takes aim, sees she’s hit the mark, and passes the gun to Roger.

Roger asks, ‘Bree, was that mercy or to be sure he’s dead?’ And she hands him the musket, turns away, and leaves the scene, never answering the question. My humble opinion (in part based on the episode’s title) is it was both. Since Bonnet had told her about his recurring nightmare of suffering precisely that fate—left alone with the water coming for him and no one coming to save him—and the terror it caused him, she may have felt enough human compassion to spare him that fate, putting stars in her Heavenly crown to be sure after what he’d done to her. But there’s also no doubt that he’d escaped the Grim Reaper twice before and returned to haunt her, so this way she could be absolutely sure he met his just end once and for all.

Credit: STARZ Outlander Ep707 - A Practical Guide for Time Travelers. Lieutenant Sandy Hammond lightens William Ransom’s mood over lunch before the battle, wishing he could trade this meal for a dinner at London’s Beefsteak Club.

The second character who dies from a gunshot to the head is the affable and wholly charming Lieutenant Sandy Hammond, William Ransom’s compatriot Redcoat friend, who in episode 707, A Practical Guide for Time Travelers, takes a musket ball high on the right side of his forehead just at the onset of the first Battle of Saratoga. The hole appears through his tricorn, a trickle of blood slides down his face, and he pitches forward and dies on the spot. We’ll look at it in more detail in a moment.

Credit: STARZ Outlander Ep809 - Lord John Grey (left) has been captured by Ezekiel Richardson (right) who is holding him for ransom in a boathouse near Savannah.

And the third headshot, occurring in episode 809, is Ezekiel Richardson, a former Redcoat Captain and spy who turned his coat to the Continentals but flipped it back over to aid the British in the war because he believes it will end slavery sooner in the colonies. To further his aims he kidnapped Lord John Grey and held him for ransom, threatening to expose Grey’s ‘proclivities’ to the newspapers and the House of Lords unless his brother Hal Grey, Duke of Pardloe, gives a speech to persuade Parliament to continue funding the war effort in America. William, Jamie, and Claire learn of his capture and set about to find him, locating the likely spot by the presence of a lighthouse across the estuary — thus the name of the episode, Pharos, Greek for lighthouse.

Credit: STARZ Outlander Ep809 - Pharos. Claire gets the drop on Ezekiel Richardson as he returns from fishing.

While Jamie and William sneak into the boathouse where Lord John is being held and set him free, Claire gets the drop on Richardson and brings him to the boathouse, where she’s then left to keep an eye on him while the men check out the surroundings and retrieve the boat.

Credit: STARZ Outlander Ep809 - Pharos. Richardson convinces Claire to release him, but Lord John Grey meets him as he exits and dispatches him instead.

Claire and Richardson are verbally sparring when she realizes he is a time traveler, like she is. He persuades her to turn him loose so that he can try to effect the rewriting of slavery’s history, and she does. But when he opens the door to exit the boathouse, he runs smack into a returning Lord John, who puts a pistol ball right between his eyes at close range. Richardson falls to the floor, eyes staring blankly at the ceiling, as a pool of blood widens beneath the back of his head.

These three injuries are so much alike that I decided I’d discuss them all together.

In each instance, death appears instantaneous, and why wouldn’t it? They’ve been shot in the head for pity’s sake! But it got me to speculating about whether it’s really so cut and dried, whether death would actually be instantaneous, what the brain damage would likely be from each one, and whether any one of them could have possibly have survived such a wound. And that sent me down a research rabbit hole to find out.

Let’s start with a bit of the anatomy.

What exactly lies beneath that frontal bone? A brain, obviously, but what specific structures, because some are more vitally important than others. Just so everyone is oriented, here’s a cross-section of the head with the various areas of brain labelled onto which I’ve added the paths of the three gunshots we’re going to discuss.

Credit: Wikimedia Commons via Creative Commons Attribution-Share Alike 4.0 International license. I have altered the original image to add labels for lateral ventricles and corpus callosum and to include the red, blue, and green trajectories of the three gunshots to the head discussed in the post.

The Outlaw Stephen Bonnet

Never was a villain more deserving of hot lead deceleration than Stephen Bonnet. Well, maybe Black Jack was, but he got satisfyingly gutted with cold steel at Culloden Moor, and I won’t quibble about the means to his end. Let’s look closer at Bonnet’s richly-deserved demise.

Convicted, sentenced, and bound to a post in the middle of an estuary, Bonnet was legally doomed to die soon from the rising tide anyway, but Bree made doubly sure he wouldn’t escape his fate with a ball of hot lead to the head.

She was standing on the bank of the estuary at a distance I’d estimate at about 30 or 40 yards with her musket. She takes dead aim and fires. Bonnet’s chin is just at the water line (see earlier picture) so his forehead is maybe 7 or 8 inches above the water line. Bree is standing on the bank with the gun at shoulder height, making the barrel at least 5 feet above the water level (for show Bree, that is, not book Bree, who was described as being 6 feet tall or more), thus the trajectory of the ball would have been tracking slightly downward from leaving the muzzle to the point it entered Bonnet’s head, and absent some sort of deflection it would have continued through on that downward trajectory (see earlier illustration of the head and the gunshots).

Credit: MD Eades illustration. The differences in the trajectories of the three headshots. The gold star representing the shooter's barrel’s position, the pink oval, the victim’s head, and the black triangle or line the downward or upward or level trajectories.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. Stephen Bonnet face over in the water. Back of his head unbloodied.

We see the back of his head when he slumps face first into the water, and there isn’t any obvious blood coming from that area or a visible exit wound. So, we assume the ball remained in his skull. Entirely possible. The extent of the injury caused by such a shot depends on a wide variety of factors: the distance the ball has to travel, the angle at which it enters, the charge (amount of gunpowder used to propel it), how well the charge is packed, the quality of the gun in question, the size, density, and shape of the ball (was it perfectly round or a little off? smoothed well or a bit ragged?), etc.

In Bonnet’s case the musket ball left Bree’s gun traveling something on the order of 750 to 1000 feet per second, based on modern measurements of old muskets or replicas of them. It had to travel only about 90 to maybe 120 feet, so its velocity would not have slowed appreciably in the small fraction of a second from leaving the muzzle to striking Bonnet’s forehead.

The frontal bone, however, is one of the thickest and hardest in the body (designed to protect the skull’s precious contents in the event someone bashes us between the eyes with a stone ax, or we pitch face first onto a rock), and penetrating it would have dissipated a lot of the ball’s energy and slowed it down. Plus, the musket balls were made of soft lead that would flatten on impact with the hard bone, offering a broader profile to go through the tissue and again slowing the forward progress.

We’re shown that the ball doesn’t exit, but how deeply would it have penetrated? That would depend largely on the power of the charge — did Bree put plenty of powder in and pack it sufficiently? One supposes she would, being her daddy’s girl or should I say her daddies’ girl? — and all those other variables mentioned above. What it would have destroyed along its path depends on its trajectory.

Credit: STARZ Outlander Ep510 - Mercy Shall Follow Me. Bonnet hangs dead (or unconscious and about to drown) from the post.

(And it was a masterful shot to hit that small a target from such a distance with a musket. But then we know Frank nicknamed her ‘Deadeye’ for a reason.)

In Bonnet’s case the trajectory of the ball would have been slightly downward (refer to the illustrations above) so a reasonable path would have taken the ball through the frontal cortex of his brain, likely through the ventricles behind that (probably disrupting blood supply along the way and causing hemorrhage into them), and if there was enough velocity remaining, perhaps even into or near to his brain stem, which would have been quickly fatal since therein lie the centers of respiration control.

The ball might also fragment on impact, driving shards of it and splinters of bone deeper into the brain. Bleeding and swelling of brain tissue along the track of the ball would probably over time (a few minutes to hours to possibly even days depending on how fast the bleeding is accumulating) cause enough intracranial pressure to herniate the brainstem anyway, meaning to drive it down through the foramen magnum (the opening at the base of the skull where the spinal cord exits) crushing it and yielding the same result – death, just not instantly.

There’s an outside chance that it stopped short of hitting those critical brain stem structures at the base of the skull and only disrupted the frontal cerebral cortex where the networks lie that sustain consciousness and arousal. Disrupt them, distrupt consciousness. In Bonnet’s case, because of where he was at the time, his immediately losing consciousness also put his face into the water, and he would have drowned pretty quickly, but at least he’d not have known it. So if mercy was Bree’s aim (or part of it) she succeeded with either instant death or unconsciousness until the end.

Lieutenant Sandy Hammond

As a viewer, this scene was so sad to me; I really enjoyed Sandy as the devil-may-care foil bringing out the playful side of our more serious and proper Lieutenant Lord Ellesmere, and I hated to see him go.

Credit: STARZ Outlander Ep707 - A Practical Guide for Time Travelers. Sandy Hammond (left) stands shoulder to shoulder with William Ransom just before the First Battle of Saratoga, making risqué comments to ease the tension.

In the scene in question in episode 707, the two officers are standing on the front line with their men, facing the enemy, awaiting the start of the battle.

Credit: STARZ Outlander Ep707 - A Practical Guide for Time Travelers. (L to R) The flash of the muzzle fired from the edge of the farmhouse. The bullet hole in Sandy’s tricorn and the trickle of blood down his face. Sandy collapsed on the battlefield, unresponsive to William’s entreaties to get up.

Sandy is joking as usual about mildly lewd topics, when there’s the boom of a musket, and we see the explosive flash and a puff of blue smoke discharged from the barrel of the gun of a rebel kneeling beside the farmhouse maybe 100 yards distant.

With a sickening thunk, the ball smacks Sandy’s hat about an inch above the edge of where his tricorn meets his forehead, and a red trickle of blood flows down from the visible hole in the hat. Like a tree falling, Sandy pitches straight over on his face in the muddy field and doesn’t stir or respond again.

Credit: STARZ Outlander Ep707 - A Practical Guide for Time Travelers. (L to R) William Ransom looks on the face of his dead comrade. Sandy Hammond lies dead, awaiting burial.

William buries his friend in a muddy grave afterward himself, and we can see the bullet hole more plainly in his corpse above. I have to say it appears to be a trifle lower than I would have expected from where it hit his hat but perhaps it’s just the perspective. And that’s a small quibble at any rate.

The difference between this headshot and Bonnet’s is its greater distance and trajectory. The shooter was maybe two or three times as far away and kneeling.

Credit: STARZ Outlander Ep707 - A Practical Guide for Time Travelers. William’s view of the battlefield at Saratoga before the fight. The ground seems to slightly slope downward toward the farmhouse.

The field of battle seemed to slightly fall away from Sandy and William’s position, sloping gently toward the farmhouse, which put the rebel’s shouldered weapon lower than Sandy’s head, meaning he’d have been shooting slightly ‘up’ at his target. (But to be honest even a completely level field would have done the same, since the rebel was kneeling when he fired and Sandy was standing.) So, the ball would have left the muzzle on a slightly upward trajectory, but over this longer distance the track wouldn’t perhaps have been all that upward once it got to Sandy’s skull. (And to be fair could deflect on entry and change course.)

The ball hits high on his forehead (see illustration above), and he drops like a rock. I’m not entirely convinced, based on this location, which was at about his hairline, that instant death would have necessarily been the case. An entry there would mainly have damaged the brain’s frontal lobe, which might have been survivable. The horrific historical psychiatric procedure of pre-frontal lobotomy proved people can survive a scrambled frontal lobe (if by survive you mean continue to eat, sleep, breathe, and perhaps move).

The ball would certainly have done damage to the frontal cortex, disruption of which would likely cause him to immediately lose consciousness, and with enough velocity it might have continued on through the parietal and/or temporal lobes of the upper right cerebral hemisphere.

If the ball were traveling on even a slightly upward trajectory, it could very well have missed the ventricles and central structures deeper in the brain and had virtually no chance of directly hitting the brain stem. That’s not to say that bleeding and swelling from the wound in the closed cranium couldn’t still have caused enough pressure to herniate the brain stem and kill him a few minutes to hours or days later, but he might not instantly be killed from this shot. (Though particularly in this time death probably would have ultimately claimed him, either from bleeding and swelling in the brain and herniation of the brain stem or from infection down the way.)

It’s possible he was unresponsive but still technically alive. Doubtful in the heat of battle that William (or anyone else) would have been able to recognize any weak vital signs if that were the case.

Sandy might even have survived this shot with proper neurosurgical care, which both now and at the time would have involved opening the skull to relieve the pressure as Claire tried to do with her trephining of the excise man’s hematoma in episode 307, Creme de Menthe (here).

Granted Sandy was unlikely to get any sort of care during the battle and afterward it might have been too late. But military medical history records a number of cases of soldiers of that time surviving shots to the head and going on to live, perhaps damaged lives—loss of frontal lobe executive functions and possibly motor function of a limb, but alive nonetheless. It all depends, as I said, on the power of the charge propelling the ball, the distance of the shot, and the trajectory of the ball or bullet.

Former Captain Ezekiel Richardson

We come to the final headshot of the ignoble (the adjective Lord John used when describing his captor to modify a much less flattering noun for illegitimate child) Captain Richardson. Same basic injury – a ball in the forehead – but with one important distinction.

Credit: STARZ Outlander Ep809 - Pharos. Ezekiel Richardson lies dead on the floor of the boathouse, shot between the eyes. Blood pools beneath his head.

After he’s shot, we see Richardson lying on the floor of the boathouse with a hole dead center in his forehead. His eyes are open and staring at nothing, and he’s bleeding profusely from an exit wound at the back of his head. Immediately afterward we see Lord John, pistol In hand, take a single step to enter the open doorway. So, my guess is that he fired from no more than about 3 feet away.

The men are of similar height, and both were standing, which would suggest a level shot trajectory. This is the most clearly catastrophic shot of all. It’s fired from close range, so the ball wouldn’t have lost any muzzle velocity moving the 3 feet at 750 feet or more per second. It was Jamie’s pistol (he gave it to John after he and William rescued the good Lord with instructions to go check outside for other guards) so we can be assured it was a firearm of top quality and likely loaded with a well-made ball and a good hot, well-packed charge. It would have done as much damage as a pistol shot nearly point blank could do.

And we see the result is that the ball went through frontal bone, frontal lobe, probably right through the ventricles, and all the way to the occipital lobe (the vision center of the brain) before smashing through the occipital bone and out the back of the skull. The force of it seemed to have knocked Richardson backward so that he landed on his back, face up. And it appeared to have done considerable vascular damage on the way through, judging by the quickly accumulating pool of blood under his head. This shot would have been the most likely of the three to cause instant death.

So three shots, similar but differing, and all ultimately fatal.

Overall Medical Verity Score: I will give all three of these an A for accurate portrayal of the injury. There wasn’t any medical treatment rendered, so nothing to speak to there for or against. And once again copious kudos to the make-up wizards who always do such incredible work. Those entry wounds look real. And also to the Foley artists (those wizards who create the sound effects after the filming is done and sync them in) especially the one when Sandy is hit by the ball.

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