MEDICAL SCIENCE & CHAOS

application of chaos theory in medical sciences

Dr. ARUNACHALAM KUMAR Director (R&D) Nitte University, Mangalore 575018, India

CHAOS

Is the science of chaos as new as it often presumed? The theory was referred to by other terms and contexts right throughout history, yet, it required an inquisitive and curious few to define it precisely and analyze it as a functional non-linear mathematical science.

Who among us as a children, has not heard or read the following verse?

For want of a nail, the shoe was lost; For want of the shoe, the horse was lost; For want of the horse, the rider was lost; For want of the rider, the battle was lost; For want of the battle, the kingdom was lost; And all for the want of a horseshoe nail.

The simple lines given here is example enough to demonstrate the idea that minor incidents be they trivial and inconsequential when they occur could lead to catastrophic events with far reaching consequences over a period of time. Numerous similar examples chaos in the form of fables or adages, abound in world literature right throughout history across cultures and continents. One does not need much imagination to connect the theory to these examples: Well begun is half done: Why half? A well begun enterprise in only a minor part complete but the proverb talks about it being fifty percent! The half referred here perhaps is to a non-linear literary one A stitch is time saves nine is something we are all familiar with. The import of the saying is that trivial events of today have potential to translate into major cataclysms tomorrow. Chaos theory applied in a nutshell, if anything, this saw. All of us have heard variety is the spice of life, but

few among us know that it is indeed variety that makes life what it is. Diversity and difference, asymmetry and non-congruence, the subtle but definite individualized characteristics- without variety, life is inert. Change is life, randomness if key and erratic behavior is norm. Variety is merely the spice of life, it the very essence of life.

The advent of a revolutionary and exciting new theory that proposes non-linear models and chaos as effective adjuncts to linear mathematics in interpreting long-held scientific tenets has provided novel and innovative designs and methodologies that help the medical world to better understand inferences from laboratory investigations, physiological processes, pharmacotherapeutics and clinical diagnostics.

Oddly, the precursor for non-linear chaotic system science may well have been applied topology. Pioneering researchers such as Waddington, with his epigenetic field theory and Rene Thom and his catastrophe theory and the phenotype cube models were mathematically derived theoretical working applications. The studies were harbingers of a sort of the chaos model, on application of randomness and unpredictability. Waddingtons Epigenetic landscape theory suggested visualizing increasing irreversibility of cell type differentiation as ridges rising between the valleys where the marbles (cells) are travelling. In recent times this Waddington's notion of the epigenetic landscape has been rigorously formalized in the context of the systems dynamics state approach to the study of cell-fate, and a systematic methodology to construct a probabilistic epigenetic landscape of cell-fate attainment

Rene Thoms cusp-catastrophe theory is itself a branch of bifurcation theory in the study of dynamical systems; it is also a particular special case of more general singularity theory in geometry.

Bifurcation theory studies and classifies phenomena characterized by sudden shifts in behavior arising from small changes in circumstances, analyzing how the qualitative nature of equation solutions depends on the parameters that appear in the equation. This may lead to sudden and dramatic changes. Small changes in certain parameters of a nonlinear system can cause equilibria

to appear or to disappear, or to change from attracting to repelling and vice versa, leading to large and sudden changes of the behaviour of the system.

In fact, the physiological reflex fight or flight or the physics model of the limits of elasticity (Hookes Law) were themselves forerunners in concept to the origin of chaos theory much later. The exact point at which behavior of systems changes or does not, is based on a series of seemingly unrelated factors engendering shift one way or other. Will the dog bite or will it run away? Will the elastic string being pulled at its ends return to original shape and length or lose its elasticity. What determines its behavior at which point.

Lorenz an American mathematician and meteorologist was the pioneer of the chaos theory. He studied weather patterns he began to realize that they did not always change as predicted. Minute variations in the initial values of variables in his twelve-variable computer weather model would result in grossly divergent weather patterns. This sensitive dependence on initial conditions came to be known as the butterfly effect

The application of the radically and new nonlinear science of 'chaos' has been slow in finding acceptance in the medical field; each and every diagnostic, investigative and pharmacotherapeutic process involved in health science is dictated by direct Newtonian tenets of cause effect and linear mathematical derivations.

This overview outlines a few salient areas in medicine that have successfully applied the principles of the chaos theory. Chaotic systems have been shown to operate in quite a few physiological processes. The impact and implications of the new science on the future course of medical diagnostics and health science systems as a whole cannot be overstressed.

Exclusive and total dependence on scalar models have compartmentalized patient profiles into rigid cocoons such as age, sex, weight, height, physiological and biochemical evaluations making interventional therapeutic regimens solely dictated by our over-riding choice to use scales of convenience for every single one of our evaluation, assessment and treatment criteria.

The new field of theoretical biology, spawned by the advent and ready acceptance of the 'chaos' model has lead to an explosion in nascent schools of thought that challenge hitherto entrenched linear mathematical Newtonian and Euclidian principles in natural sciences. Fractal configurations and such other non-linear systems have made the need for a second look at physio-dynamic processes of the human biology, mandatory. Despite rapid strides in the alternate chaotic and randomness applications, the world of medicine is still loathe to modify its dependence and confidence in pharmacokinetic therapeutic solutions based on cause-effect and Euclidean extrapolation linear systems, both in diagnosis and treatment.

The theory, an emerging branch of mathematics, has since found application in diverse scientific streams. In essence, the hypothesis postulates that even minuscule and minor variations or differences in initial inputs, over a period of time, can and do lead to extraordinary differences in final output. In effect, wherever and whenever one uses rounded-off or approximated values for calculating outcomes, one errs. The implication of this tenet is monumental in the world of medicine where, almost all inferences, pharmaco-therapeutic regimens and clinical interventions are essentially and exclusively based on averages, means and approximations. Drugs, dosages or surgical procedures are based on diagnosis, which itself is deduced from age, weight, height, readings and almost all values in clinical and laboratory investigations: the value/s of each one of the listed factors being expressed as 'ranges', averages or approximations.

Normal temperature is 98.4, or is it? What if one goes on to 98.45 or 98.458 and so on? The norm would go on and on to n number of decimal places if you calibrate and calculate to accuracies not usually demanded. Would then the normal temperature remain static as it says when it reads 98.4? Most certainly not! Second to second, minute to minute, hour to hour, the temperature would fluctuate albeit a minuscule and minor fluctuation, it shows a random and erratic pattern. How then can a physician accurately diagnose or prognose using 98.4 as a yardstick? The reasoning here may appear silly, yet, it is very pertinent when one also knows that

age, weight, drug dosages, laboratory investigatory laboratory reports, in fact every parameter used in medical therapeutics remains an approximate value rounded off for convenience of scale and application. What if one uses water instead of mercury in the sphygmomanometer ?

One does not, not because it cannot read blood pressure, but because the eater using apparatus would be too unwieldy and large so back to the basic argument we choose mercury because we can create an easily portable and compact appliance. Convenience is the keyword not of the patient, but for the clinician, the laboratory technician, the pharmaceutical industry using approximate values makes life so much easier for all all, that is except the patient. Ever wonder why one drug acts better in one patient than it does for a same medical condition in another, even though both patients are of same age, sex, constitution and weight? Maybe some other factor we are less familiar with is at play: that factor could well be chaos.

Chaos: Cardiology & blood vessels

The human heart also has a chaotic pattern. It has been shown conclusively by many that even the heart rate is chaotic. Even the time between beats does not remain constant; it depends on the individuals activity, among other things. Under certain conditions, the heartbeat can speed up. Under different conditions, the heart beats erratically. The analysis of a heartbeat can help medical researchers find ways to put an abnormal heartbeat back into a steady state, instead of uncontrolled chaos. Interestingly tachycardia is less chaotic when studied than the so-called normal rate. So too could be fibrillation or flutter the graphical plots of functioning within a cycle or between cycles could demonstrate a reduction in range of fluctuation or less chaotic.

Using normal ECG recordings and measuring the just the QR spike height wide fluctuations it was observed at 100 times scale, demonstrates the absolute randomness in the electrical activity of the heart even within a single cardiac cycle. The erratic heights, representing the milli-volt electrical impulse from the sinu-atrial node clearly demonstrate that randomness or chaotic behavior is norm and signifies good cardiac health. Indeed, by analogy, the ECGs should be 'most' regular in only when static, as in death - a fact well demonstrated in the absolute flat ECG

record of the dead human heart. The paradoxical and skewed results in seemingly normal processes, when viewed through 'chaos' systems, show how wrong our total reliance on scale and linear applications are! Simplistic interpretations such as this throw up more dilemmas.

Research has demonstrated that a reduced standard deviation of heartbeat intervals can predict increased mortality in a group of cardiac subjects, each of which has a reduced standard deviation, but it cannot specify which of the individuals will not manifest lethal arrhythmogenesis

In a report, observations identical to that from an earlier work (Kumar 1998, Poon & Merill, 1997) analyzed of electrocardiograms from healthy subjects and those with severe congestive heart failure show short-term variations of beat-to-beat interval exhibited strongly and consistently chaotic behavior in all healthy subjects, but were frequently interrupted by periods of seemingly non-chaotic fluctuations in patients with congestive heart failure. Chaotic dynamics in the data collated, exhibited a high degree of random variability over time, suggesting a weaker form of chaos. These findings suggest that cardiac chaos is prevalent in healthy heart, and a decrease in such chaos may be indicative of Congestive Heart failure. However, more sensitive instruments reveal that normal heart rhythm shows small variability in the interval between beat. Our hearts rarely beat the same way twice. Varying opinions on role of randomness and chaos have been proposed, among which one standing ground is that heart function is non chaotic when healthy and turns erratic, with creation of spatial chaos. Kumar however reports that even in the healthy state, heart physiology exhibits random behavior. Research has also proved operation of fractal systems in the blood flow through portal and hepatic veins.

Chaos: Thermoregulation in the testes

The male mammalian gonads, the testes can best function (producing gametes) only in ambient temperatures lesser than body temperature. Towards production efficiency a number of biomechanisms are in operation, especially in the reproductive age male.

Among the factors that enable the testes to maintain or remain in a conducive temperature range, physiologists have proposed the organs venous return process is one of the paramount. The pampiniform plexus of veins, a densely convoluted network of veins ascends from each testis forming a loose sheathe of vessels wrapped around the spermatic cord. Within the pelvis, the veins unite to form either the left or right testicular vein, to ultimately drain into the inferior vena cava, directly or circuitously (as in the left) through the left renal vein. Venous blood being cooler than arterial, the sheath formed by the pampinifrm plexus serves to cool the arterial blood descending into the organ. While the argument is sound and logical, there still remains a hitch: why then do the female reproductive organs, the ovaries too though situated well within the pelvis, possess veins in the form of a pampiniform plexus draining it? The ovary through its locale within the abdomen / pelvis demonstrates it does not have need to cool itself.

Obviously there are more or hitherto unknown mechanisms too that help keep the testes cool: it is claimed that the uneven levels of suspension of the scrotal sac encased gonads is itself an example of exposing more surface area to ambient temperature than if the sacs were on level with each other.

The free suspension of the testicles in a loosely wrapped and hyper mobile sac, contributes to a random swing of the organs. The involuntary up, down, anterior, posterior, right or left, circular and elliptical motions that the hung scrotum exhibits, continuously, induces a chaotic cooling system to operate. The non-volitional erratic excursions of the freely suspended sac, allows for better exposure and fanning of its contents to ambient environmental temperature, more effectively. The scrotum is a classic example of natural chaotic cooling system, and that this may well be the primary contributor to thermoregulatory mechanisms in the metabolically active gonad

That the testicles are pulled up, involuntarily, if and when temperatures go below optimal levels, through a reflex muscular contraction, the retracted scrotum becomes less mobile and more fixed or, far less chaotic in movement. This control of erratic excursions and the subsequent inhibition of the chaotic cooling system, arrests continued cooling. The question is, could prolonged and

continuous restrictive apparel lead to more serious complications than just azoospermia or oligospermia? Could limiting the chaotic cooling trigger malignant testicular tumors?

Chaos: Genetics

In health there is diversity and variety, and in disease that range is narrowed. The more pronounced or long standing an affliction is, the less variation in facial features. Astoundingly too, disturbed hormonal levels too appear to erode physical features, adrenocorticoid disturbances produce Cushing's and every medical of second year can correctly ID a Cushing syndrome without batting an eyelid. Pituitary gland problems, dwarfism, gigantism, achondroplasia. . .the tell-tale face: why, even prolonged exposure to bacteria, toxins or poisonous substances too to engender such a an effect : leonine face of Hansens, lantern jaw in those handling phosphorous, depressed nasal bridge of congenital syphilis.

In fact, many here will be able to recall one condition or other where they have found facial similarities. Craniometry, the science of accurate measurements of the skull, appears to hold the key to disease and its diagnosis. This facial feature variation/uniformity hypothesis of mine needs much more documentation and effort. I am fascinated by its effect and implication. With a little refinement and proper record maintenance, one could spot a patient with syphilis, cancer or HIV just by observing merely by check-listing features that are common. To me the entire facial morphometrics, its variation in normal health and erosion in disease mirrors the postulations of the Chaos Theory.

Extrapolating, one can even interpret the mutations that engender evolution. Variety is perpetuation of the species: stagnation, as is evidenced in the 'face uniformity' in evidently confers a recognizable template visage and physique (phenotype). Genetic pool permutations are not infinite as the template gene is finite and numbered. When the stage of gene pool saturation is neared or reached, mutations occur: with spontaneous mutations, the total available gene pool

is once again multiplied many times over, allowing for new combinations of genes allowing evolutionary biology to spawn new species and subspecies.

Hegde (2012) in a personal communication however, cautions that applying chaos model to human genetics could be faulted as the genes in human metagenome are a microscopic minority, about thousand, compared to two to three trillion genes in germinomes, virinomes and metabolome.

The theory proposed here is that infancy, senility, or disease (congenital or acquired and chronic) reduce resistance, lower immunity and compromise health systems. Further, the functioning of cerebration is compromised hugely in any one of the above listed conditions. Memory loss, inability to control the sphincters, susceptibility to infections, all demonstrate that 'chaotic' randomness is health and randomness or erraticity are evolutionary norms. Reduce the variability and quantum - increase the chance of disease.

Chaos: Neurology & gerontology

Specialists in non-linear dynamics are doing their best to understand the workings of the brain, heart and immune system using chaos theory. Chaos in the brain is a sign of health, not disease. During an epileptic seizure, the disorderly jumble of brain activity suddenly becomes abnormally regular. Preliminary experiments suggest that the erratic activity of white blood cells is a form of chaotic behavior. By applying chaos theory's mathematical predictions to events such as proteolysis or lipid peroxidation and by using concepts based on fractals to explore the structural changes which happen with ageing, a better insight can be gained into the details of these mechanisms. Many age-related processes can now be quantified and the effects of the treatment can easily be anticipated. For example, in stroke with arm paralysis, it would be functionally advantageous to re-establish an increase of the range of movement of the arm joints (i.e., to increase the fractal, space-filling dimension of the movement), rather than merely increase the strength of the muscles.

Conventional treatment with extraneous hormones aims at re-establishing the deficiency of the hormone (a linear approach), but contributes little to the synchronicity of the secretion. If the frequency of the stimulus is incorrect, then a response will not take place, or it will occur suboptimally. Therefore, it is necessary to use non-linear approaches during hormonal replacement therapies. Simple linear processes can also be influenced but the result may not always be remarkable or clinically relevant

Chaos: Anatomy and physical anthropology

Chaos is evident in structural and functional human anatomy. The human foot is admirably adapted to withstand the heavy demands that bipedal gait imposes on it. This compact mass of bones, muscles, fascia and ligaments is superbly adapted to biped locomotion and stance. In this brief study we report out observations on the changes, if any, in weight bearing adaptations and modulations of feet caused uninterrupted and prolonged standing. We continuously monitored footprint pattern alterations and changes in an adult male volunteer. Our inferences show that, that the weight bearing surface of the foot, the sole, constantly varies its area of surface contact during extended weight bearing.

The constant shifting and altering in different points of weight transfers are best explained through application of the principles of chaos theory. The random and irregular variations show that the science of chaos plays a vital role in extended bipedal static stance and maintenance of posture by randomly and continuously re-distributing foci of weight-bearing on the soles of feet. Anatomically, the strongest joints are the sutural where the number of protrusions and indentations on the edges of the abutting bones dovetail dramatically to raise the total length of contact between bone and bone. The understanding could have a huge impact on fracture healing, unions or non-unions Fractal formulations are found more often in human of capillary vascular flow.

Figure 1: showing wavy sutures increase the contact between cranial bones

Anatomical Structure Fractal Dimension Bronchial Tubes very close to 3 Arteries 2.7 Brain 2.73 2.79 Alveolar Membrane 2.17 Mitochondrial Membrane (outer) 2.09 Mitochondrial Membrane (inner) 2.53 Endoplasmic Reticulum 1.72 http://library.thinkquest.org/26242/full/ap/ap11.html

In Anatomy, more than we acknowledge, whether it be the branching pattern of an artery or the division of the bronchial tree, extensions of chaotic science through fractal science, topology or cusp-catastrophic models are rife in human structure and function.

Chaos: Endocrinology

As an extension of the above study, application of chaos in the development of diabetic neuropathies and foot ulcers have been identified months earlier with a remarkable degree of accuracy by some researchers analyzing weight-bearing capability of the foot. Innovative appliances using computer generated graphical data on serial comparisons of 'time series analysis' of microcirculation (or its compromise) on a multiplicity of weight bearing foci on the sole of the foot applying mathematical models.

Some researchers have described the menstrual cycle itself as an example of a complex system, namely, one that is nonlinear, dynamical, and chaotic.

Chaos: Surgery

In surgery, N - plasty, W - plasty and M - plasty techniques have been in vogue for long. Irregular lengthening of an incision or scar has been seen to produce better results, both surgically and aesthetically. Why should a laceration heal better when its edges jagged or serrate and not aligned straight and side by side has been a question never raised or answered by any pathologist. Unknowingly perhaps, plastic surgeons have been applying techniques described as chaos systems. The reason why N, W or M procedures produce less scar tissue could be due to operation of the chaos theory the more the irregular the input the healthier the output.

By implication, compound fractures with jagged edged bones should heal and unite faster than smooth-edged breaks in bones. Anatomically, the strongest joints are those having longer or rougher edges and articulations the sutures of the skull are classic examples of how increasing the contact lengths of contact between adjacent bones through dovetailing, raises the strength of the union.

Chaos: Physiology

According to some, even cyclical and periodic physiological processes such as menstruation including the transition to menopause, results from a specific kind of complex system, namely, one that is nonlinear, dynamical, and chaotic. The dynamics of fluid flow and turbulence are areas that have engaged medical researchers applying 'chaotic systems' to study cardiovascular physiology and the biophysics of blood flow. In fact, this area has much potential for research in the world of medicine. Blood pressure and the heamo-dynamics of vascular biomechanisms throw up challenges that defy conventional physics and linear mathematical analyses. Cerebral and renal circulatory physiology and their alterations remain yet to be fully unraveled or understood. Chaos may yet prove to be the answer to many vexing questions.

Chaos: Dermatology

Almost a hundred years ago it was discovered that dermal characteristics were unique and individualistic. More specifically, dactylography fingerprint study demonstrated that the whorls, loops and arches that were found on the palmar surface digital pulps were dependable identity markers. The study of dermatoglyphics has since grown leaps and bounds. Vast data banks storing retrievable fingerprint records of millions of people are now maintained by governments and justice departments.

Establishing identity is not only individually accurate, larger patterns of uniformity within diversity, allow physical anthropologists to identify sex, ethnic groups, occupations and disease profiles from studying large numbers of fingerprints. Many congenital afflictions can be confirmed and diagnosed using characteristic palm / finger prints. Downs syndrome with its readily identifiable transverse palmar crease comes to mind. Studies on the AtD angles (angle formed by the proximal and distal tri-radii) of the palm is now used to confirm or diagnose quite a number of diseases and afflictions.

Specialists in the field of medical dermatology can now after an initial assessment of lesion symmetry have observed that asymmetrical lesions offer clues on presence of skin malignancies. The hallmark of malignancy is disordered growth that nearly always equates to a lesion growing asymmetrically.

Although chaos is often thought to refer to randomness and lack of order, it is more accurate to think of it as an erratic randomness that results from complex systems and interactions among systems. (The concept is revolutionary in that it requires us to adopt a different frame of reference which, at times, may move us away from previous concerns and methods of data analysis.

Chaos has already had a lasting effect on science, yet there is much still left to be discovered. Many scientists believe that twentieth century science will be known for only three theories: relativity, quantum mechanics, and chaos. Aspects of chaos show up in the fractal blood vessels to the branches of trees and the effects of turbulence: However, a word of caution is mandated here: Although it is easy to get swept and go overboard over the impact and applications of 'Chaos Theory' for the theory it still remains just that, a theory.

Anatomy: FRACTAL & FIBONACCI The term fractal is a geometric concept related to, but not synonymous with chaos. A key characteristic of fractal structures is self-similarity. In human anatomy, this self-similar characteristic is observed in surfaces that have folds, producing unexpectedly huge total surface areas. For example, the loops of the intestines have circular folds of mucosa, which in turn have villi, which in turn have microvilli, which in turn have membranes embedded with bumpy molecules. An example of how folds and bumps are norm is exemplified when they are lost or eroded in the intestines. Pathological processes that Iron out intestinal haustrations cause malabsorption syndrome to develop. With reduction in the surface area of absorption in conditions such as

regional ilieitis, ulcerative colitis or Crohns disease the typical lead pipe appearance in radiographs confirm erosion of folds, creases and undulations in the alimentary canal. The fractal self similarity that maintains the integrity of increased surface area is disrupted. The surface of the brain, where the highest level of thinking takes place, contain a large number of folds. Because of this, a human, who is the most intellectually advanced animal, has the most folded surface of the brain as well. The mathematical ratio of natural order, known also as golden mean (1: 1.63) is the underlying principle. First mooted by Fibonacci, it has since found ready and widespread acceptance as the geometry of life. Though not chaotic, the Fibonacci number sequence and its orderly applications extend from the simple floral formula, to scales of music to the shapes of cosmic galaxies. The ratio, is in a way, the forerunner of fractal and bifurcation theory . Flexion and extension of are simple to and fro movements of the digits. The articulations producing the fully extended or flexed finger are simple condyles. Analysis of the kinetics of the exercise shows that despite its seemingly rudimentary biomechanical sortie, flexionextension of the fingers follows a characteristic mathematical precision and geometric equilibrium, circumscribing a cochlea spiral. Moreover, linear measurements of each osseous elements of the individual digit show a sequential series of increments in dimension, a rise that strictly adheres to the Fibonacci ration. To exemplify the principles of motion, this brief paper describes the movements at example this study describes the flexion-extension complex of the index finger of the hand.

The human hand is a biomechanically efficient functional unit. The manus is a complex made up of a score of intrinsic muscles, twenty seven individual osseous elements articulating through a series of joints. With inputs by ligaments, tendons, bursae assisting the movements, the hand is indeed a marvel in kinetic engineering, Gifted through evolution to perform the 'opposition' exercise, the phalangeal, metacarpal, and carpal condylar, saddle and gliding plane joints of the palm flex, extend, abduct and adduct .

Prone to injury and malfunction, the loss of 'man days' due to hand lesions, cause serious economic loss to industry and economy in many agrarian and industrial nations. Much analytical

work has been done by kinesiologists on the function and disabilities of this often used component of the upper limb. In this brief paper we present yet another interesting observation on the biomechanics of the digit.

Fig: Cochlear pattern of digital flexion-extension

To scale measurements were made of the shadow of a supine hand during performance of simple flexion and extension of the digits, especially, the index. The shadow of the arc described by the exercise in the form of excursion of the flexing index tip projected on a wall mounted white screen board was traced.

Fig: Computerized modeling of data on flexion-extension of index digit

The resultant arc was analyzed and linear measurements (in mms) of each individual bone element were recorded, from distal phalanx to base of second metacarpal for index digit. Mathematical models from values obtained were graphically reproduced through Computerized Assisted Designing (CAD). Measurements of individual bones show that, despite the soft tissue elements that bar precise and accurate measures, the inter-articular distances between the distal, intermediate, proximal phalanges and the metacarpal ends, repeat the Fibonacci sequence. That is the lengths were 17 mm, 28 mm, 45 mm and 72 mm respectively. Put in Fibonacci sequence series, 17 +28+42+73, or at every joint, an increment of 1.6 to 1 was evident).

Up to 120 mms. the arc described by the index tip shadow forms a cochlear spiral pattern, beyond which it becomes erratic (chaotic). Flexion at index inter phalangeal and metacarpopahalangeal joints spiraled across a hub or axis, which was horizontally mobile for about 10 mms in a complete range of flexion-extension.

Taking the midpoint of the axis, as referral point, when the arc was plotted through CAD, the spiral created displayed a splayed-out form, akin to the molluscan shell. Measurements at fixed reference points along the spiral show a progressive increment at angulation or its reverse, in extension and flexion of index. Approximately, the increment followed the 'golden mean' ratio first enunciated by the European mathematician, Fibonacci, centuries ago, which is around 1: 1.63 The need for better utilization of biomedical devices and mathematical models, coupled with a more comprehensive interdisciplinary input, could lead to a better understanding and there-from, a better rehabilitation, of the kinetics of the human hand. The two measurements presented here demonstrate that function follows precise mathematical formulae, and that such mathematically sound base for movement is probably directly related to the ratios, in the very construction of the skeletal components.

Comparing such recreated spirals drawn from disabled or treated hands, to normal ones, could aid the rehabilitation physiotherapy procedures . It is quite evident that a normal hand functions

in a synchronized and predictable mathematical model, a fact of much significance to biomedical engineers.

ECG

The application of the radically and new non-linear science of 'chaos' has been slow in acceptance in the medical field; each and every diagnostic, investigative and pharmacotherapeutic process involved in health science is dictated by direct Newtonian tenets of cause effect and linear mathematical derivations. Exclusive and total dependence on scalar models have compartmentalized patient profiles into rigid cocoons such as age, sex, weight, height, physiological and biochemical evaluations making interventional therapeutic regimens solely dictated by our over-riding choice to use scales of convenience for every single one of our evaluation, assessment and treatment criteria.

The paradoxical and skewed results in seemingly normal processes, when viewed through 'chaos' systems, show how wrong our total reliance on scale and linear applications are! As an example of how terribly paradoxical inferences can be, lets check electrocardiography, a common and widely used diagnostic process.

The new field of theoretical biology, spawned by the advent and ready acceptance of the 'chaos' model has lead to an explosion in nascent schools of thought that challenge hitherto entrenched linear mathematical Newtonian and Euclidian principles in natural sciences.

Fractal configurations and such other non-linear systems have made the need for a second look at physiodynamic processes of the human biology, mandatory. Despite rapid strides in the alternate chaotic and randomness applications, the world of medicine is still loathe to modify its dependence and confidence in pharmacokinetic therapeutic solutions based on cause-effect and Euclidean transpolation linear systems, both in diagnosis and treatment. This paper very briefly, illustrates the fallacy in such approaches, using the record of the electrophysiological function of

the heart (ECG) as an example. The paradox in ECG interpretation as clue to functional status of the heart, is demonstrated here when the principles of 'chaos' are applied as diagnostic tool.

Fig: note the spike heights varying with each SA node impulse

Electrocardiographic recordings of three adult, normal males, applying Lead II (bipolar) were made. Twenty contractions of the heart and its record were studied from each volunteer. The ventricular depolarisation wave, QR, was isolated from the PQRST complex from every cardiac cycle. The QR spike was next projected onto a giant wall mounted screen to magnification of 100 (1cm to 1 meter). The projected on-screen spike height was then measured to the nearest mm. The values were tabulated and analyzed.

When measured in its projected magnified form, each and every QR spike of a typical PQRST segment of the ECG record had its own individual and distinct height; the heights varied randomly and erratically even in tandem recordings within a single record-strip of the same individual. No two heights were identical. The characteristic, randomness and erraticity of

variations in heights appeared to be obvious features in any ECG taken in same lead in normal individuals

Electrocardiography, is based on Einthoven's principles, quantify the electrical activity of the heart. The recordings of electrical discharges are from the nodal pacemaker of cardiac tissue are made through different leads. The millivoltages of the depolarisation process of the generation and conduction of electrical impulses form the characteristic PQRST segments of a typical ECG. In observation made from this study, the seemingly regular millivolt strengths recorded as ECGs in normal individuals, are apparently if altered in scale or magnified.

The wide fluctuations in spike heights observed at 100 times scale, demonstrates the absolute randomness in the electrical activity of the heart even within a single cardiac cycle. The chaotic behavior, according to non-linear chaos theory, is normal and signifies good health.

The magnified spike measures clearly show that our long held historic view of the order and pattern of electrocardiographs and their interpretations could well be based on assumptions and presumptions that may well be fallacious. Our dependence on convenience of scale adopted by the ECG instrumentation processes, rather than accuracy and correctness, are dictated primarily by the ease of the facility and simplicity of its usage.

The science of chaos states that irregularity denotes wellbeing of physiological functions. Regularity forebodes ill health. Randomness and unpredictability are natural and innately normal processes: Disturbances and disruptions in erratic activity and behaviors patterns leads to disease and dysfunction.

The simple rhythms and conventional periodic patterns induced by phase mode locking in physiological activities in man, maybe is not be as sacrosanct as held till now. Every function has inherent randomness directly and increasingly proportional to robustness. The oscillation of Poincare (butterfly) graph between health and ill health attractors are said to show regularity in records as outcome of the diseased states. Indeed, by analogy, the ECGs should be 'most' regular in only when static, as in death - a fact well demonstrated in the absolute flat ECG record of the

dead human heart. By interpolation malfunctioning heart, fibrillating or fluttering should produce ECG records, that when magnified, show less erraticity in the entire PQRST.

Though we have, for purpose of demonstration of nonlinear chaotic system application, chosen only a single lead, part of the ECG wave and strip and used only three volunteers with normal hearts, it is our view that, even from the limited data studied, it is obvious that inherent randomness indeed is characteristic in normal cycles of the cardiovascular system and that electrical discharge from the pacemaker is as a norm, fluctuant and erratic.

Medicine, both diagnostic, clinical and treatment both pharmacological and therapeutic, could well reassess its stress on normal ranges and standardization's, averages and means and statistical reliance on convenience derived parameters and instrumentations such as electrocardiography.

CHAOTIC COOLING SYSTEMS

The temperature regulation is cardinal to functional efficiency of the mammalian male gonad, the testis. Anatomically, to provide a cooler environ that better facilitates spermatogenesis: the testicles are housed outside the abdomen, in a separate sac t Anatomically one or the other half of the scrotal sac hangs at a lower level than the other. The testes, housed within the sacs are also situated, suspended, one slightly lower than its other counterpart. While many theories on why and how of the testicular levels have been proposed, including those engendered by vascular, functional, embryological or evolutionary influences, none of the proposed scientific reasons are totally convincing. In our view, one additional, yet overlooked cause for the naturally displaced level could be, simply, to expose more surface area of the active organ to cooler environs. While it is an accepted fact that scrotum outside the abdominal cavity is paramount to the functional efficiency of the testes in a preferred lower temperature it still does not address the question why hang at different levels?

Assuming the scrotum symmetrical, the two medial surfaces of the two testes would face each other, juxtaposed the total surface area of testes exposed to lower environmental temperature would be that provided by the two lateral surfaces only. By modulating, differential rates of descent of the testes in the prenatal developmental stage, the final position of the testis allow for more surface area exposure to environment the additional, being a part of the lower medial surface of the lower testis and part of the upper medial surface of the higher testis. In effect, just by suspension at two levels, nearly one entire extra surface is available for thermoregulation and cooling. That is the surface area available now becomes two lateral, plus two halves of the two medial. This extra area available to the testes, probably is, yet another a significant but overlooked embryonic factors that dictates differential rates of descent and displacement of anatomical levels of twin reproductive male organs. A number of factors have been mooted that engender temperature regulations one of the more widely accepted ones is the arrangement of a much coiled wrap- around arrangement of venous channels that drain the organs. This anatomically odd arrangement forms the pampiniform plexus, which ascends into the pelvis to unite into a single testicular vein. The venous return of the gonad is, therefore in parts, reticular and linear. This mesh like venous arrangement sheathing the testicular artery is held by physiologists as one of the more vital factors cooling the testes. The returning venous blood, through its coiled arrangement, cools the descending arterial blood on its way to the target organ and increases its functional efficiency. A second factor is the very displacement of the sac to below and away from the abdomen, directly exposing the scrotum to ambient room temperature, which is cooler than core body temperature. In our view, while these two factors play significant roles, neither is convincing enough to account dramatic lowering in testicular temperature; In theory we had earlier mooted of increase in total surface areas of testes, due to varying hanging heights of the two gonads in the same individual [1], may contribute to temperature lowering.

In this communication we propose that the free suspension of the testicles in a loosely wrapped and hyper mobile sac, contributes to a random swing of the organs. This involuntary up, down, anterior, posterior, right or left, circular and elliptical motions that the hung scrotum exhibits, continuously, induces a chaotic cooling system to operate. The non volitional erratic excursions of the freely suspended sac, allow for better exposure and fanning of its contents to ambient environmental temperature, more effectively. In our opinion the scrotum is a classical example of natural chaotic cooling system and that this may well be the primary contributor to thermoregulatory mechanisms the metabolically active gonad. That the testicles are pulled up, involuntarily, if and when temperatures go below optimal levels, through a reflex muscular contraction: the retracted scrotum becomes less mobile and more fixed or far less chaotic in movement. This control of erratic excursions and the subsequent inhibition of the chaotic cooling system, arrests continued cooling this question is could prolonged and continuous restrictive apparel lead to more serious complications than just azoospermia or oligospermia? Could limiting the chaotic cooling trigger malignant testicular tumors?

Breast Cancers & bras The mammary glands are twin external secondary sexual structures that develop in the human female at around puberty that remain physiologically functional throughout the reproductive span of life. The breasts turn productive during lactation in the postpartum term of the female. A freely suspended mass of glandular tissue supported by fibrous fascia, the breasts sag with age and termination of reproductive phase following menopause. In the quadruped mammals, the mammary glands are often numerous, serially placed along an axial line running from thorax to lower abdomen. They become engorged with secretion after littering swinging freely, suspended between the fore and hind limbs.

In the modern era, women in the reproductive age segment have increasingly turned to wearing of external and artificial supports for their breasts. The undergarments come in differing sizes and cup sizes serving to, not merely support and uplift the pectoral mammary glands, but also served as fashion statements for the figure conscious. Science has often shown that wearing of

tight fitting corsets and undergarments like bras have a negative impact on the user the minuses far outweighing the pluses. It has been observed that there was a 125 fold increase in breast cancer incidence between women who were bra-free and those who wore bras 24 hours daily.

Wearing a bra over 12 hours daily conferred a 113 fold increase in breast cancer incidence! Bras apply pressure to the breasts, especially to the lymphatic system. The lymphatic system consists of tiny, thin-walled vessels that drain from the breast tissue, removing toxins, cell debris, cancer cells, viruses, bacteria, and other products from the breasts. All of our tissues drain through the lymphatics, which is essentially the circulatory pathway of the immune system.

Similar too is the case of rural women in Africa and or Asia. Wearing tight fitting bodices or bras is uncommon in most communities. Not surprisingly here, the incidence of carcinoma of breasts is rare too. Note though that the incidence of breast cancer compares with that in advanced countries, when metropolitan scenarios in Asian and African countries is analyzed.

It is assumed that differing economic status and socio-cultural norms among the city- based, even in third world countries, the modernized populations access and use underclothing such as bra more often and over extended periods.

Although there are quite a few studies and reports on the bra being one of the suspects in engendering cancer, little has been provided by way of clarification on why wearing bas should endanger breast health. Though a correlation between incidence rate and usage has been established, no logical rationale for how or why of the link is explained. The breasts, as already mentioned, a freely swinging suspended structures. The random and erratic movements of the organ are beyond voluntary control. Each and every jiggle, quiver, shake, bounce, or swing of the mammary gland is independent of any underlying activating mechanism. Of course, the breasts do apparently move in concert with stride and gait, but these movements are secondary to limb mobility. In fact, the pattern of swing or oscillation of the gland is different in quadrupeds to that observed in biped. Erect posture and orthograde stance and gait have made secondary movements of the breasts take differing sorties. In the human, the

movement is primarily and predominantly up and down with variations thereof, but in the quadruped, it is usually right to left (or vice versa) The mammary gland in the mammalian female is also subject to similar 'chaotic cooling system for temperature regulation. Apart from the testicles, the only other involuntarily and freely mobile organ in the human is the mammary gland in the female. The breasts too, much like the scrotal sac, is by nature erratically and randomly mobile: Attempts to restrict its mobility through the common and widely prevalent use of brassieres, compromises its chaotic cooling ability, consequence of which is derangement of its temperature regulatory mechanisms. Even the development of breast cancers have been attributed to the compromise or restriction of the normal random and erratic non-voluntary movements of these organs.

In our interpretation the mammary gland in the mammalian female is also subject to similar chaotic cooling system for temperature regulations. Apart from the testicles, the only other involuntarily freely mobile organ in the human is the scrotal sac, is by nature erratically and randomly mobile: attempts to restrict its mobility through the common and widely prevalent use of brassieres, compromises its chaotic cooling ability, consequence of which is derangement of its temperature regularity mechanisms. It was found that the longer and tighter a woman wore a bra, the higher her chances of developing breast cancer. 24/7 bra wearers have the highest incidence of breast cancer of any group, over 125 times that of a bra-free woman. Bra-free women also happen to have about the same low breast cancer incidence as men. On the other hand, three fourths of 24/7 bra wearers developed breast cancer. The bra impedes the circulation of both, lymph and blood, in the breast tissue, specifically, the circulation of the lymphatic system. This system is composed of microscopic vessels that originate in the breast tissue and drain the tissue of fluid, which is directed through these vessels to the lymph nodes. The lymphatic vessels are extremely thin and small, and have no pump, such as the heart, to propel its contents forward. As a result, lymphatic vessels are easily constricted by external pressure, such as that applied to the breast tissue constantly by the brassiere.

It is propose that sporting of such underclothes as one of the cardinal factors that engender breast neoplasms and malignancies. That the affliction is minimally recorded from under developed Asian and African nations, where use such restricting apparel is practically non existent, especially in non metropolitan areas, lends credence to our hypotheses that burning the bra as a gesture symbol for womens liberation movement, may actually free the gender of much more lethal curse than perceived gender bias: it may protect them from breast cancer.

The face in health and disease

All newborns look alike: walk into neonatal ward and every baby looks like every other baby. In fact, to correctly identify them hospital authorities tag the babes to avoid confusion or mistaken identity. Now come with me as I saunter through an old age home. The older the residents are, the more they look similar through an old age home. The older the residents are, the more look similar. Though my statement appears a bit odd, most geriatric individuals, especially as they reach 80s or 90s start looking every much like each other. Just flip through a few photographs of new born infants or of people over 90, you will be amazed.

All morphometric facial and feature variations that establish visual identification are attributes that develop over the years. The older a kid, the more it starts developing individualized facial characteristics and the older an aged one gets, the faster do the individuals feature factors fade. Now come with me again, this time I will walk you through a pediatric ward. See that kid it has Downs syndrome; now look around. What you see another child with Downs? Good, so now we know that every patient with the congenital genetic condition, Downs has features that are so characteristically individualistic that you can identify them at a glance. So too are faces of people with other inherited syndromes Ellis van Creveld, Treacher Collins, Marfans or Rubinsten Taybi.

Each acquired infections such as Hansens leprosy, see now the face of every patients with long standing lepra bacillus infection becomes leonine. Disease, congenital or acquired, does somehow seems to reduce our individuality, at least featured wise, making the afflicted or inherited look more uniform. This brings me an interesting interference. In health there is diversity and variety, and in disease that range is narrowed. The more pronounced and long standing an affliction is, the less variation in facial features. Astoundingly too, disturbed hormonal levels too appear to erode physical features, adreno corticoid disturbances produce Cushings and every medical of second year can correctly ID a Cushing syndrome case without batting an eyelid. Pituitary gland problems, dwarfism, gigantism, achondroplasia... The tell tale face: why even prolonged exposure to toxins or poisonous substances too to engender such a replicate effect (lantern jaw in those handling phosphorous). In fact, many here will be able to recall one condition or other where they have found facial similarities. Craniometry, accurate measurements of the skull appears to hold the key to disease and its diagnosis. This face feature variation / uniformity hypothesis of mine needs much more documentation and effort. I am fascinated by its effects and implication. With a little refinement and proper record maintenance, one could spot a patient with syphilis, cancer or HIV just by observing merely by check listing features that are common. To me the entire facial morphometrics, its variation in normal health and erosion in disease mirrors the postulations of the Chaos Theory new science. Extrapolating the theory, one can even interpret the mutations that engender evolution. Variety is perpetuation of the species: stagnation, as is evidence in the face uniformity in chromosomal disturbances evident confers a recognizable template visage and physique (phenotype). The theory proposed here is that infancy, senility or disease (congenital or acquired and chronic) reduce resistance, lower immunity and compromise health systems. Further, the functioning of cerebration is compromised hugely in any one of the above listed conditions. Memory losses, inability to control sphincters, susceptibility to infections et al., prove that chaotic randomness is health, erratically is an evolutionary norm. Reduce the variability, and you increase the chance of disease or death.

Experiments on chaotic systems have shown that even cardiac function (ECG) measured as electrical spurts, is variable, beat to beat and the sinu atrial node (pacemaker) discharges unequal charges during every beat of the organ. The ECG reading from a malfunctioning heart demonstrates that there is a marked reduction in fluctuation of the SA nodes millivolt discharges. In fact, the ECG of a heart that has stopped would be cooling systems being operational and effective have been proposed by me in the thermo control of testes and in the health of mammary glands. It is a universal fact that mortality rates are always much, much higher in geriatric and pediatric age groups than in any other time - span of human life the interim life span between birth and death provides variations and characteristics in physique and IQ. Chaos science plays a much larger and more significant role in shaping our evolutionary progress and progeny than is credited with. The future to understanding and de-coding of the web of evolutionary mechanisms may well find all the answers through non linear mathematical models like chaos.

Chaos & the foot

Who hasnt suffered the nagging discomfort of pins and needles?- prolonged standing or squatting, still and inert, leads to a numbed sensation in the lower limbs, especially in the feet. The condition is due to compromise in blood supply to the effected parts due to inactivity or compression of vessels. In a bid to actually quantify the changes seen in the foot, the sole of the standing foot was video-graphed continuously over a period of a few minutes to observe changes in color.

Fig: Foot pressure recording in the healthy (above) and in a diabetic (below) The human foot is admirably adapted to withstand the heavy demands bipedal stance imposes on it. The compact unit of bones, muscles, ligaments, fascia and joints is superbly adapted to sustaining body weight for long periods. In order to overcome stress and strain and physiological barriers the exercise brings in its wake, a study was done to determine what adaptive or modulatory mechanisms were called upon and exploited by the lower limbs and feet. The footprint patterns of a standing subject were continuously monitored video-graphically. It was seen that the weight bearing areas of the foot, the sole, showed a constant shift in pressure points on the sole. There appears to be an imperceptible, but continuous and random variation in weight bearing areas. The outlines of the footprint display minuscule but measurable change in shape and contour. Selecting 28 random points (locus) that aligned to bipedal stance on the sole for specific observation, it was seen that there was a clear, definitive and constant to and fro erratic and random shift in weight bearing foci. The seemingly random shift in pressure contact

points on the sole show a chaotic behavior pattern. The constant, in-built chaotic system operating probably prevents a compromise in capillary blood flow. Taking the experiment further, a similar study involving known diabetics In diabetic individuals, neuropathy hinders the redistribution of plantar pressure points thus leading to susceptible areas where there is constant capillary blanching which may develop into trophic ulcers. The redistribution of pressure points may precede evidence of clinical neuropathy. In this study we compare temporal redistribution of plantar pressure points (areas of capillary blanching) between normal subjects taken as controls and DI with no clinical signs of neuropathy.

Fig: Foot pressure reading in the healthy (above) and in a diabetic (below)

It is hypothesized that the loss of redistribution of pressure points may precede evidence of clinical neuropathy. In our current pilot study we aim to we compare and quantify temporal redistribution of plantar pressure points. Pressure changes appear chaotic in nature and do not follow any set pattern. The overall frequency and magnitude of the redistribution of these points is significantly less in diabetics as

compared to healthy individuals, demonstrated by both fractal dimension and statistical measures. There is impaired redistribution of plantar pressure points in individuals with diabetes without signs of clinical neuropathy. This can be due to loss of chaotic mechanisms. Developing on this premise, a few researchers designed a diagnostic instrument, a non-invasive medical device was designed that could, within minutes, pinpoint exact area or zones on the sole of the foot in diabetics likely to turn ulcerous, was fabricated. Field studies using the product showed the device was quite accurate in its ability to locate specific points prone to trophic changes due to prolonged standing and weight bearing on feet. The model was based on recording chaotic changes in circulation at capillary level in a readable and measurable graphic format. In fact, it has been demonstrated that even simple striding or walking up on inclines brings chaotic systems into play

Chaos & vision

Ever observed a wall lizard stalking the moth, its prey? The predating reptile scurries towards the insect fluttering on the wall. The chase is on, hither and thither the moth circles and lands, the lizard relentless in its pursuit. Yet, watch when the moth sits still and immobile. The lizard, which hitherto was a mass of quivering movement and speed, suddenly stops often within inches of the insect, and stand impassive and motionless. As long as the moth stays unmoving, the lizard does so too. No sooner does the insect stir to action, the lizard follows suit, galvanized into action. Strange reptilian behavior this! Why does the lizard make the final dash for that inch more and gobble the moth? Why does it tarry interminably long, before it finishes its hunt? Among the many theories on the ethology of moth-lizard interaction, is one on the visual capabilities of the lizard. The retina is the photosensitive inner wall of the eyeball. Receptive to light, it conveys images of whatever strikes it to higher cerebral centers in the visual cortex of the cerebral hemispheres for interpretation. The sensory layer in the retinal screen is made up of specialized cells known as rods and cones. These react chemically to light to relay information along the visual pathway.

Now comes the question: if the photo-induced reactive process a chemical one what happens when the chemical store of the light stimulated set of rod and cones gets depleted as should after a period on continuous stimulation. Light or image striking the very same area of set of cells on the retina should at some stage deplete the chemicals that react to it in that particular group of cells. Technically when this happens, though light and image are received on the retinal screen, no sensory signals are carried from it to the higher centers.

Could one turn be chemically blind even when the visual apparatus is physiologically and anatomically healthy? The situation is akin to the chemical reaction taking place on a photosensitive film loaded in a camera. One click and the image is formed thanks to chemical elements on the film chemically reacting to light. What if you click again, the same scene with the same segment of the loaded film roll? The image will strike, but as the chemicals that can process the image into are already used up during the first click no new image can be created.

Theoretically at least, there must be another inbuilt bio-mechanism in the visual apparatus that over comes this hitch. Of course, the intra-orbital extra-occular muscles do play a role in constantly adjusting and repositioning the eyeball to expose newer rods and cones to light. Yet, let us assume that the muscles do not function. What happens then? Or, for that matter, if the orbital bony cavity is filled up with cement? The eyeball cannot and will not move. If so, after a few seconds / minutes the eyeball will turn blind as the retinal screen parts exposed to light are rendered fuel-less. Chemically expended.

Probably there is yet another factor involved: at least in the lizard there is! It bobs it head headbobbing has attracted a huge amount of attention from biologists and a number of theories and hypotheses have been proposed and debated on why the lizard bobs its head. In my view, the head bobs not so much as a mating signal (which it is) as an inbuilt counter to chemical blindness. Each time the head shifts, newer areas of retina are brought into focus and fresh images are formed, maintaining a continuum.

Even a minute movement of the orbit brings fresh zones of rods and cones into action; Allowing time for the depleted photosensitive cells to recoup chemically. Much like an exhausted muscle builds up lactic acid and transiently loses contractibility till replenished and rested, the retina too needs time. The time is provided by very slight tremulous trembling of the eyeball itself. This imperceptible quivering motion of the eyeball keeps image formation as an ongoing process. Block this shake-shake mechanically by filling the peri-occular orbital space within the orbit with cement then the lizard is as blind as a bat!

Now we can guess why the lizard stops short of its prey when the prey remains still. The lizard cannot see the moth anymore either it has to bob its head (they do!) to once again spot the moth or the insect itself has to move again to become visible.

The erratic and random movement of the eyeball within the orbit, independent of the extraoccular muscular action is a classic example of chaos. Innate chaos allows us to see!! No chaos, no image. The same mechanisms are probably involved in other species also: maybe mammals too, unconsciously and involuntarily allow movements of the eyeball to prevent transient chemically blindness.

Ancient Hindu ascetics and hermits have often described a sense of vacuity and nonvisualization of objects considered as divinity ordained transition to a higher plane of consciousness.

A simple less divine explanation of the phenomenon could be that the yogi can and does probably block the quiver of his eyeball holds his head still and fixes focus on a small target. Within a few minutes or time lapse, then object he is focused on apparently disappears!

It does not; but as the yogi cannot see it anymore, he considers it a form of deliverance from the mundane - a nirvana of sorts. Hindu ascetics Buddhists Lamas are well known to be able to

control many physiological processes through penance and biofeedback. They could master the fixed focus formula too.

Asymmetry

Even in art masterpieces of yore, it was noted that the incorporation of the off-centric highlighting of focal elements of the frame. This is especially more obvious so in paintings of landscapes or compositions than in portraitures. The so called rule-of-triangles holds the key to aesthetic appeal and overall attractiveness of an art work.

No two halves of the face are identical. In fact no two halves of any individual are so. The weight, size, markings, characteristics of each and every element of ones skeleton is different in the two sides. The shape maybe almost alike, but little else is. A trained anatomist or physical anthropologist can at first glance often, delineate the side to which a bone belongs.

Variations in size, mass, weight and substance of soft tissue parts such as muscles, tendons or bilateral organs of the thorax, abdomen and pelvis are never same. Even the two halves of midline structures like thyroid or the heart are asymmetrical. A study showed that even the two halves of the bony palate, in any one individual showed differences in dimensions.

The human anatomy, excluding some midline structures, is essentially a bilateral one. Paired organs such as lungs, kidneys, ovaries, twin halves of the cerebrum and cerebellum, glands such lacrimal, parotid, submandibular are some examples paraxial structures. Although at microanatomical level, the internal architecture and structure of each of the mentioned parts is identical, be it a left or right sided kidney or lung the gross structure and precise location is often awry. The right lung has more lobes than the left, the left kidney is higher up tan the right, the male gonads, the testes, hang suspended at different levels.

The bilateral asymmetry of physiologically and functionally similar organs is one of the oddities of nature. The so-called oddity is however, less than odd when we consider that asymmetry is one of the hallmarks of nature. Even when the paired structures appear to be mirror images of each other, the individuality is merely superficial. Closer observation will show variations and differences in size, shape and weight between right or left sided structure, be it bone, organs, gland, muscle or anything bilateral.

Bone dimension, weight and muscular impressions, variations in suture patterns, presence of additional bones (Wormian) are well known to be different from left to right side. Though cerebral dominance has been claimed to be one of the major factors that determine difference between sides; chaos could be one of the other determinants.

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