Chest 99; Say ninety-nine
This sequence of X-ray pictures has almost reached 100, in fact if we include the small Elements series it is quite a lot more than the century, but I’m satisfied with the present numbering system.
“Say ninety-nine” – a clinical technique known as vocal fremitus in which the vibrations of low frequency sounds like “Oh boy oh boy”, or “Ninety-nine” are transmitted through consolidated lung and is detectable on the surface by the physician’s hand. It is to detect areas of lung consolidation without using an X-ray or CT scan. I wonder how many physicians still percuss the chest, or palpate for fremitus these days? Personally I doubt many new doctors even know these techniques exist, other than as a quaint historical practice, though I may be doing them a disservice.
The photos layered in this picture were taken – with the exception of the chest X-ray – whilst on a short holiday on Magnetic Island off the East Coast of Australia. History says that Captain Cook’s compass went awry as he sailed past and he ascribed this to inherent magnetism of the island. They include a close-up from an oil painting in the apartment of fruit which lends the brush-stroke texture,blended with the photo of a tea-towel to impart the texture of canvas. The style of the picture was inspired by a well-known local painter whose studio I visited earlier in the day, he is one of those fantastic artists who can jab down his brush laden with paint and create an exquisite object in one stroke. What talent! I hope this has captured the spirit of his work.
The underlying X-ray was segmented, I removed the outline of the bones of the spine and warped them to make the white swirl, and the rest remains behind the layers emerging as a very abstract impression. It came from a child with pneumonia – exactly the kind of diagnosis that could be made clinically using vocal fremitus – Say ninety-nine!
Chest 98; The Tangle
The chest X-ray in the teaching files comes from a child with congenital absence of the left lung. The right lung has expanded and grown to take the place and the work of the left, but the chest wall is quite distorted by the congenital condition. The chances are high that if this is the only abnormality – and congenital anomalies frequently come together with others – the child could grow up to lead a relatively normal life, though with less respiratory reserve than his peers.
It is associated with a tangle of lines and natural objects to indicate the complexity of our lives. In this case they’re associated with all the problems of life this child with only one lung may face.
In a situation in which teaching X-rays exists simply as objects in a collection of anonymous cases, I teach my students using them, whilst trying to instil the precept that behind any X-ray photograph there lives a person with the same feelings, needs, and aspirations, as any other human, and they must be treated with respect due; as if they were a person.
The lone tree represents the individual.
Chest 97; The octopus tree
The lungs of this X-ray were left pretty much intact and the effects of diffuse intravascular coagulation (DIC) can still be seen causing fluffy shadows throughout both lungs. The person is being ventilated following a massive infection which caused tiny blood clots to form throughout the blood vessels of the body. These block small capillaries in vital organs such as the kidneys, liver heart, and lungs causing them to stop functioning. Depending on the type of treatment DIC has a 40-50% chance of never recovering. It is a devastating condition. I have at least one friend who died of DIC.
The paired images are taken after the cyclone Yasi swept through our region. Red flower fronds blown down during the storm lying on grass reflect the tiny blood clots. These are from an Umbrella tree (sometimes known as an octopus tree because of the flower bracts) and the overall chaotic nature of this picture echo both the effect of Yasi and effect of this condition as coagulation runs amuck through the body. A friend said the combination of red streak running to the right and the fronds reminded him of a dragon, so I included the beautiful cyclone-like swirls above and sinuous lines below taken from an antique Chinese ceramic pot with a dragon.
My blogging recently has taken a back seat to the influx of family staying with us – some might consider this a natural disaster, but we have enjoyed the additional textures in our lives.
Chest 96; Mirage
This picture shows beef cattle from an area affected by drought in North Queensland where they scrape a living in the hot dry conditions. The photographs were taken on a scorching afternoon where the mirages sat just above the road and the dust devils wandered around chasing twigs and dry leaves. The dusty ground through which the cattle are walking has taken on a blue tinge through the blending process, against the gold, which looks just like those mirages.
Both cattle and humans are hosts for RSV the Respiratory Syncytial Virus, and infected under the same conditions. Cattle have been shown to be at higher risk at times of stress such as drought. This provides the link to the included chest X-ray which was taken from an 18 month old child with bronchiolitis due to RSV. It causes inflammation of the smallest air passages of the lungs known as bronchioles and occurs in children less than two years of age.
Important preventative measures (in humans) to prevent spread of this condition include simple things such as regular hand-washing. One way to improve a child’s immunity is to feed breast milk especially in the first month of life. Although it is not 100% protective breast feeding is more effective than either stopping maternal smoking or passive immunisation with injections, though both help. Unfortunately cows milk and formula do not provide protection.
I have been looking at a lot of museum chest X-rays recently with colleagues who are going to the big examination next weekend, teaching them to analyse the appearances, in order to help them train for the verbal test. One of the pictures was associated with a CT scan of the head showing a cancer secondary deposit in the cerebellum at the back of the brain. The original Chest X-ray showed an almost imperceptible primary cancer hiding behind some of the blood vessels; it must have been a very active malignant tumour because it had spread so quickly to the brain. In my picture the chest X-ray is present, but well hidden, lurking behind other features of the image. When he presented with increasing clumsiness and staggering gait, clinical examination revealed a sign known as past-pointing which occurs when the cerebellum is diseased. If asked to place the fingertip on a spot – they will often miss the spot and point beyond it. Included in the picture is a group of farmers at a cattle auction, one is pointing upwards with a curved finger and the others are watching him.
In this context past-pointing is a medical sign, however for an alternative philosophical discussion of the spooky meaning of the past-pointing phenomenon see the blog http://www.nihonbunka.com/blog/archives/000261.html
This week I shall have my first exhibition. Pictures go up on Monday. I have 11 digital prints to show in the main corridor of the Townsville Hospital. After a protracted period of negotiation with the administration and hospital board, and with lots of support from the art committee it has at last been agreed to allow local artists to exhibit within the hospital for up to three months at a time. It will be a good thing to enliven those long bare corridors, and waiting rooms, and give diversion to the patients who wait. At the same time it allows artists to get their work onto public view. It costs the hospital nothing. The down side is that there is no insurance or security. I was asked to hang a single work as a trial so used small magnets to fix the print to the wall. Within 12 hours six out of the eight magnets had been stolen. Thank goodness for Blu-Tak. I have a philosophy that people who have to steal things from hospitals must be extremely needy, and can only be pitied. So, I’ve learned a valuable lesson, and at the same time don’t regret what happened – good experience comes from bad experience.