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Acknowledgments
In addition to the reviewers listed separately, the authors would Cindy R, Comeau, BS, RT(N)(MR)
like to thank the following individuals for their contributions: Advanced Cardiovascular Imaging, NY, NY
Provided images for the cardiac section
Robert DeLaPaz, MD
Professor of Radiology Cover image courtesy of Mitsue Miyazaki from Toshiba
Director of Neuroradiology, Medical Systems Corp.
NYP Columbia Medical Center Caption: The entire arterial vasculature is depicted with
Foreword “MD-Technologist interaction” and ƒMRI section exquisite clarity using noncontrast angiography techniques.
images and context. The fresh blood imaging (FBI) technique was used to depict
the pulmonary system, subclavian arteries, and runoff vessels,
Martin R. Prince, MD, PhD, FACR from the abdominal aorta to the pedal arteries. The time-spa-
Professor of Radiology at Cornell & Columbia Universities tial labeling inversion pulse (Time-SLIP) technique was used to
Foreword and review of the contrast section depict the carotid arteries through the Circle of Willis.

vii
This page intentionally left blank
Contents
Preface Soft Tissue Neck
Patient Preparation Magnetic Resonance Angiography of Carotid Arteries and
Safety Guidelines Carotid Bifurcation

CHAPTER 1 MRI of the Head and Neck CHAPTER 2 MRI of the Spine and Bony Pelvis
Important Considerations for Scan Acquisition MRI of the Spine and Bony Pelvis—Considerations
Routine Brain Scan Routine Cervical Spine
Brain for Pituitary Cervical Spine for Multiple Sclerosis
Brain for Internal Auditory Canals (IACs) Routine Thoracic Spine
Brain for Orbits—Optic Nerves Lumbar Spine
Brain for MS Sacroiliac Joints—Sacrum and Coccyx
Brain for Epilepsy—Temporal Lobe MRI of the Bony Pelvis
Brain for TMJs
MRA—Circle of Willis CHAPTER 3 MRI of the Upper Extremities
MRV—Superior Sagittal Sinus MRI of the Upper Extremities—Considerations
Brain for CSF MRI of the Shoulder
Brain for Stroke MRI of the Humerus
fMRI—Functional MRI MRI of the Elbow

ix
CONTENTS

MRI of the Forearm Cardiac MRI

MRI of the Wrist MRA of the Great Vessels of the Theray
MRI of the Hand and Digits MRI of the Brachial Plexus

CHAPTER 4 MRI of the Lower Extremities CHAPTER 6 MRI of the Abdomen and Pelvis
MRI of the Lower Extremities—Considerations MRI of the Abdomen and Pelvis—Considerations
MRI of the Hips MRI of the Abdomen—Kidneys
MRI of the Femur MRI of the Abdomen—Portal Vein
MRI of the Knee Magnetic Resonance Cholangiographic Pancreatography
MRI of the Lower Leg MRI of the Adrenal Glands
MRI of the Ankle MRI of the Female Pelvis—Uterus
MRI of the Foot and Digits MRI of the Male Pelvis—Prostate
MRA of the Renal Arteries
CHAPTER 5 MRI of the Thorax MRA Runoff—Abdomen, Pelvis, and Lower Extremities
MRI of the Breast
Bilateral Breast
Preface
As both technologists and educators, we strongly believe there
is a need for a comprehensive reference for MR scanning. This
includes not only the accurate and consistently standardized
acquisition of images, but also a place to reference standard
and advanced protocols for imaging the vast range of medical
conditions and body habitus presented.
We feel this book is both basic and broad enough to meet
the needs of students and experienced technologists. It is
intended to provide not only a baseline for MR image acquisi-
tion but also a standard of quality that should be consistently
duplicated to provide the health care team with quality diag-
nostic images.
In our tables we have suggested scan protocols with techni-
cal parameters for both 1.5T and the more advanced 3T mag-
nets. In addition we have provided blank tables to modify your
site protocols to accommodate the capabilities of your specific
equipment. We suggest you enter all data on your site tables in
pencil to modify as protocols and software change.
Of utmost importance, regardless of the field strength of
your specific equipment, is MR safety. MR safety guidelines,
as set forth by your facility and the MR technologist, is the first
xi
line of defense against MR related accidents. Included in this
text is an overview of MR safety including issues related to
administration of contrast agents .We urge all MR personnel to
adhere to all safety protocols to avoid accidents that can injure
patients, staff and equipment.
Organization and Content
• A safety section, including MR suite configuration, patient
screening and personnel classifications, provides a solid
foundation for secure operating parameters within the
highly volatile MR environment.
• A section on Gadolinium Based Contrast Agents (GBCAs)
provides background on safety considerations as outlined
by the ACR, pharmaceutical vendors, including appropriate
dosing and off label use.
• Each section is logically divided into protocols for acquisi-
tion in the axial, coronal and sagittal planes, with suggestions
for scan parameters and sequences for both 1.5T and 3T.
• Tables suggesting protocols and sequences for both 1.5T and
3T magnets.
preface

• Each pilot, or scan plan, is followed by a relevant midline Each chapter has
image from the sequence and a detailed anatomical refer- • Scan Considerations
ence of the pertinent anatomy. • Coils
• The parameters for coil type, proper patient position- • Pulse Sequences
ing, consistent and accurate slice placement and ana- • Options
tomical coverage are detailed for each sequence. In • Scanning Tips
addition, a “Tips” section will assist with techniques • Scan Planning
designed to perfect each scan and ensure patient safety • Anatomic Midline Image
and comfort. • Anatomic Drawing
• The fMRI section at the end of Chapter 1 gives insight to
some of the most current techniques and applications of
Ancillaries
MRI.
• The cross-vendor reference acronym chart allows replica- • The images from the book are available online on Evolve at
tion of sequences from one vendor to another. http://evolve.elsevier.com/BurghartFinn/MRI
Patient Preparation
• The patient should be “properly identified” by name, date of
birth and facility medical record number (when appropri-
ate), which should be compared to the patient's requisition
and schedule.
• Have the patient fill out a MRI questionnaire while in
zone 2.
• The MRI questionnaire should be reviewed by the MRI
staff, particularly nurse and the technologist who are the
“gatekeepers”.
• The MRI questionnaire should be discussed with the patient
making sure they understand the questions.
• The patient should be screened for implanted devices, such
as a pacemaker, defibrillator, neuro-stimulator, aneurysm
clip, hearing aid and prosthetic devices.
• Patient should be screened for the possibility of renal ­disease
when contrast is ordered.
• Have the patient go to the bathroom prior to coming into
the MRI suite.
• All patients should undress and put on a gown or scrubs.
Make sure all metal is removed.
xiii
• Many patients are anxious when having an MRI. Make sure
you explain the examination to the patient. A conversation
with the patient prior to scanning usually puts the patient's
fears to rest.
• Explain the importance of holding still.
• Explain that the scanner makes a loud knocking sound and
they should try to relax.
• Explain that you will be talking to them between scans.
Give patient a call bell and instructions to use only when
necessary.
• When they speak to you, make sure you listen to what they
say so you can address their needs if necessary.
• Make sure ear plugs are securely fitted into the patient's ears.
• Secure the head with side sponges, and tape with gauze
across the forehead.
• Secure the patient in a comfortable position, with cushions
under their knees to relieve back pressure.
• Put sponges or sheets along the side of the patient to pre-
vent their arms and torso from touching the sides of the
magnet.
Safety Guidelines
MR environments can pose a wide array of potential risks for
patients, health care workers, and ancillary personnel who
enter the magnetic field. Strict policy and procedures should
be in place and adhered to, to ensure safe operation. Areas to
be considered are zoning of the MR suite, identification and
education of qualified MR personnel, guidelines for screening
patients and accompanying family members, administration of
contrast, implant, and device screening and cryogens.
The inherent risks for accidents caused by the magnetic field
continue to be similar at 1.5T and 3T. However, as the static
magnetic field strength increases, the probability for move-
ment of ferromagnetic material, metallic implants and the pro-
jectile effect become increasingly problematic. To avoid tissue
heating, which is caused by the time-varying magnetic field,
the FDA provides guidance on the rate of energy that may be
deposited in tissue, which is termed specific absorption rate
(SAR). In addition, the time-varying magnetic field can affect
acoustic noise and induce voltage. At 3T, SAR can becomes a
greater concern, particularly with fast spin echo sequences,
especially as the echo train length increases. For this reason, all
3T MR vendors provide SAR monitors with their 3T magnets.
These monitors should be observed while scanning.
As practitioners and educators, we strongly suggest the
American College of Radiology (ACR) Guidance Document
for MR Practices: 2007 (listed in the references to these Safety
Guidelines) be referenced and adhered to for implementation
of safety guidelines in all MRI departments. Further informa-
tion for safe practice can be accessed at the Joint Commission
Sentinel Event Alert on MRI Safety and at NIH.gov/mri (both
links are found in the references to these Safety Guidelines). A
brief overview of ACR guidelines are discussed below.
ZONING OF THE MR SUITE
The architectural plan for the MR suite should support safety
and be designed with barriers to prevent harm to patients
and personnel. The four-zone plan suggested by the ACR is
described below. Whatever system is adopted, it should be
strictly adhered to. The entrance to each zone should be clearly
marked.
 Zone I—All areas that are outside the MR environment and
are accessible to the general public. In this area, no risk is posed
to the general public.
Zone II—This is the area that bridges the contact between
Zone I and the more strictly supervised areas of Zone III and
IV. This is the area where patients are typically screened and
history is taken.
Zone III—This is a restricted area for all who are not MR
personnel. Because the magnetic field is three-dimensional and
may project through walls and floors, this area should be clearly
marked as potentially hazardous. The five-gauss line, which is
the exclusionary zone, should be clearly delineated. Signage
should be posted to ensure that all patients or staff with pace-
makers or defibrillators do not enter this area.
Zone IV—This is the room in which the MR scanner is
housed and is the area that poses the most potential risk. It
should be clearly marked with proper signage stating: “The
Magnet is Always On,” and that you are entering Zone IV.
MR PERSONNEL
Considering the potential dangers that can occur in the MR
suite, all individuals working within this environment should
be annually certified in the completion of safe practice edu-
cational training. These practitioners should be designated as
xv
MR personnel and are typically divided into two categories—
level 1 and level 2 MR personnel.
Level 1 personnel—Anyone who has completed basic MR
training and will be permitted in Zones I–III.
Level 2 personnel—It should be the responsibility of the MR
safety officer to identify the personnel who qualify as level 2
personnel. They should possess comprehensive MR training
and understand the potential for hazardous situations that may
arise from a wide variety of risks associated with Zones III and
IV. Level 2 personnel will primarily consist of the MR technolo-
gist and the MR nurse.
MR Technologist—As stated by the ACR, all MR technolo-
gists should be American Registry of Radiologic Technologists–
certified radiologic technologists (RTs). All MR technologists
should maintain current certification by the American Heart
Association in basic life support at the health care provider
level.
GUIDELINES FOR SCREENING PATIENTS
AND NON-MR PERSONNEL
Several components of patient screening can and should take
place during the scheduling process. Typically at this time, it
is determined whether the patient has any contraindicated
implants such as a pacemaker or internal cardiac defibrillator,
safety guidelines
or whether there is a medical condition such as renal disease
or pregnancy that may need special considerations before
scanning.
All patients and personnel who attempt to enter Zone
III must be formally screened and documented in writing.
Only MR personnel are qualified to perform the screen-
ing process before permitting non-MR personnel into
Zone III. MR screening should be performed by at least two
separate individuals, one of whom should be a level 2 MR
personnel.
Screening should typically take place in Zone II, where the
patients should remove all outer clothing, jewelry, and prosthet-
ics, and change into a gown. The formal institutional screen-
ing questionnaire should include confidential information and
a MR hazard checklist, which would be reviewed along with
comprehensive discussion of the patient's medical history. The
screening forms for patients and non- MR personnel who may
accompany the patient, or enter the scan room, should essen-
tially be the same.
Everyone entering Zone III must be physically screened for
the presence of ferromagnetic materials, which, regardless of
size, can become hazardous projectiles to the patient and the
MR scanner. The use of a ferromagnetic detector and wand
that differentiates between ferrous and nonferrous material is
recommended.
Determination to scan a patient with an implanted medi-
cal device or foreign body should be made by the attending
MR radiologist via plain x-ray films or computed tomog-
raphy. For other implantable devices, further investigation
for compatibility should be made and documented by MR
personnel.
PEDIATRIC CONCERNS
Because children and teens are often unreliable sources of med-
ical history, they should be questioned both in the presence of
a parent or guardian, as well as alone to ensure that a complete
history is disclosed.
Children comprise the largest group of patients for whom
sedation is necessary. Although protocols will vary, strict adher-
ence to guidelines and constant monitoring is mandatory. For
infants, special attention must be paid to monitoring body
temperature for both hypo- and hyperthermia.
PREGNANCY AND MR
Pregnant MR personnel are permitted to work within the
confines of Zone IV during all stages of pregnancy but it is
recommended that they not enter the MR room when the
radiofrequency (RF) is on during the scanning process.
 Because no detrimental effect of MR has been conclusively
documented to the developing fetus, no special consideration
is suggested for any stage of a patient's pregnancy. However,
screening for pregnancy is recommended before MR, particu-
larly when the study may require contrast. MR contrast should
not be routinely injected during pregnancy unless risk versus
benefit has been assessed.
DEVICE SCREENING
As part of Zone III safety protocol, the availability of a hand-
held magnet (≥ 1000 gauss) or target scanner (wand) is recom-
mended to clear and test equipment.
Before MR personnel enter Zone III, all metallic or par-
tially metallic objects must be identified in writing as fer-
romagnetic or nonferromagnetic and safe or conditionally
safe before entering this area. Never assume MR compatibil-
ity unless documented in writing and tested with a hand-
held magnet. Every object entering Zone III must be tested
and the results, including the date and the method of test-
ing, documented in writing. In accordance with FDA label-
ing criteria, developed by American Society for Testing and
xvii
Materials International, all metallic material must conform
to the following standard.
MR
MR MR
MR Safe MR Conditional Not MR Safe
MR SCANNING SAFETY
Both patients and accompanying family members must be
completely screened before entering Zone IV—the scan room.
Both patients and those remaining in the room during the scan
must wear ear protection to limit the noise from the magnet.
Acoustic noise can reach 90 dB; the pain threshold is approxi-
mately 120 dB.
Patients with implanted wires or leads are at a higher risk
when sequences such as echo-planar imaging in DWI, fMRI,
or gradient intense sequences are used. Many factors can affect
the potential for tissue heating. The strength of the magnetic
safety guidelines
field and type of sequences should be taken into consideration.
Time-varying gradient fields can influence nerves, blood ves-
sels, and muscles, which can act as conductors.
Thermal heating is of great concern during the scanning
process. Heat generated by electrical voltages and currents
within the magnet is sufficient to cause thermal injury or burns
to the patient. RF energy transmits easily through open space
from the RF transmit coil to the patient. To avoid excessive heat-
ing or damage to a patient's tissue, avoid placing any conductive
material within the RF field. Only MR-compatible wires or leads
may be used during the scanning process to prevent RF-induced
burns. If electrically conductive materials must be used, posi-
tion them to prevent “cross points” (cables that touch, loop over
themselves, or come in contact with the RF coil).
During the scan process, it is imperative that the patient's
tissue does not come into contact with the walls of the bore.
Most vendors provide pads for this purpose. Caution should
be taken that the patient's anatomy does not form conductive
loops. Instruct patients not to cross their legs or clasp their
hands on their torso during the scan process. These risks are of
special concern at higher field and gradient strengths.
Drug patches that deliver medications may have metallic
backing and are therefore at risk for delivering burns during
the scan process. Consult with the patient's physician before
removing the patch so the dose is not miscalculated.
In the event of a code, the patient should be removed
from Zone IV and brought directly into Zone II. Code
responders should be aware of safety implications within
the MR suite.
In the event of a quench, when cryogens are released and
sometimes form a white cloud in the scan room, it is impera-
tive to quickly remove all patients and personnel and close
the door to the scan room until the vendor engineers are
present.
In the event of a fire, it is important to note that responding
police and fire personnel must be prevented from entering the
scan room with ferromagnetic objects. All MR suites should
have MR-compatible, nonferrous fire extinguishers readily
available.
Follow all manufacturer specifications for safe operation
and maintenance of all patient monitoring equipment used
during MR procedures.
All MR facilities should have a MR safety officer and com-
mittee who oversee and enforce the written MR safety policies
for their institution.
There are many factors to consider for ensuring that a MR
facility is properly prepared to serve patients and support MR
personnel. Adaptation to the ACR Guidelines and strict adher-
ence to the policies and procedures put into place by your insti-
tution will maximize a safe and secure environment.
References
Kanal E, Barkovich AJ, Bell C, et al: ACR Guidance Document
for Safe MR Practices: 2007. Available at: http://www.acr.org/
SecondaryMainMenuCategories/quality_safety/MRSafety/safe_
mr07.aspx
American College of Radiology. Joint Commission Issues
MRI Sentinel Event Alert. Available at: http://www.acr.org/
xix
SecondaryMainMenuCategories/quality_safety/MRSafety/
JointCommissionIssuesMRISentinelEventAlert.aspx.
Mednovus: SAFESCAN Target Scanner. Available at: http://www.
mednovus.com/targetscanner.html.
http://koppdevelopment.com
This page intentionally left blank
 Chapter
MRI of the Head and Neck
1
Chapter Outline
IMPORTANT CONSIDERATIONS FOR SCAN MRA—CIRCLE OF WILLIS
ACQUISITION Magnetic Resonance Venography—Superior
ROUTINE BRAIN SCAN SAGITTAL SINUS
BRAIN FOR PITUITARY BRAIN FOR CEREBROSPINAL FLUID
BRAIN FOR INTERNAL AUDITORY CANALS (IACS) BRAIN FOR STROKE
BRAIN FOR ORBITS—OPTIC NERVES fMRI—FUNCTIONAL MRI
BRAIN FOR MULTIPLE SCLEROSIS soft tissue neck
BRAIN FOR EPILEPSY—TEMPORAL LOBE MRA—carotid arteries and carotid
BRAIN FOR TEMPOROMANDIBULAR JOINTS bifurcation

1
Chapter 1 MRI of the Head and Neck
Important Considerations for Scan Acquisition
Scan Considerations
• Refer to all vendor specific safety parameters.
• When scanning the brain, the most advantageous scan plane
to cover the entire brain is the axial. Axial scans of the brain
should be acquired with slices angled parallel to the genu and
splenium of the corpus callosum. This enables duplication
for subsequent exams of the brain.
• Be consistent when prescribing scans, i.e., put all axial slices
in identical positions for each scan so the radiologist can
compare one sequence with another.
• Learn to compare the hemispheres of the brain to identify
pathology, paying close attention to symmetry.
• When contrast of the brain is indicated, allow adequate time
before scanning. Contrast enhancement can take several
minutes for maximum visualization. Today’s sequences are
very short and scanning too quickly after the injection will
cause loss of contrast effectiveness. A radiologist may per-
form the T2 fluid-attenuated inversion recovery (FLAIR) or
another pulse sequence after contrast to wait for the gadolin-
ium to become more effective. Others wait a few minutes and
then scan the coronal and sagittal before the axial scan. Other
methods may be used as well.
Coils
• A multi-channel HD head coil or multi channel HNS (head,
neck, spine) coil is recommended.
• A head or neurovascular coil can be used when necessary, i.e.,
some patients cannot fit in the multi-channel HD head coil.
• All multi-channel coils produce excessive signal adjacent
to the coil. This can be compensated for by using vendor-
specific coil intensity correction options to provide uniform
signal intensity.
Pulse Sequences
• At 3T, T1 FLAIR is substituted for T1 spin echo (SE) or fast spin
echo (FSE), to compensate for long T1 relaxation times at 3T.
• T1 FLAIR best differentiates gray and white mater details of
the brain at 3T.
• T1 spin echo and fast spin echo, and T1 FLAIR imaging is
used to best identify anatomical structure, whereas T2 and T2
FLAIR imaging provide detailed evidence of pathology.
• On T1 FLAIR and T1 sequences, cerebrospinal fluid (CSF)
produces dark or hypo-intense signal. T1 FLAIR uses an
inversion pulse to produce dark or hypo-intense signal.
• On T2 sequences, CSF produces bright or hyper-intense sig-
nal. T2 FLAIR uses an inversion pulse to produce dark or
hypo-intense CSF signal, whereas all other abnormal fluid
appears bright.
• BRAVO (BRAin VOlume imaging) are high resolution sub-
millimeter isotropic T1 SPGR sequences that use an IR pulse
to obtain superior gray/white matter differentiation. These
can be acquired in any plane and reformatted.
• IDEAL (GE) is a fat/water separation technique (previously
called 3-point Dixon technique) that can also be used to
eliminate fat or water from the image. A “water image” elimi-
nates fat; a “fat image” eliminates water. An “in-phase image”
can resemble either T1, T2, and SPGR sequences. IDEAL per-
forms all of these options in one acquisition. Applications
include orbits, pituitary, and IACs.
• CUBE (GE) is an isotropic T2 or T2 FLAIR imaging option
with sub-millimeter slices and isotropic pixels, which are
acquired in the sagittal or coronal plain. These isotropic
images can be reformatted into other planes post acquisi-
tion. For MS of the brain, the sagittal plane is performed and
reformats are acquired in the axial and coronal plane.
• Two-dimensional SWI and three-dimensional SWAN are
“susceptibility-weighted imaging,” which are more suscepti-
ble to blood and or blood vessels. These may replace routine
3
GRE imaging for blood or trauma. They should be reformat-
ted in the axial plane, with minimal rendering, to increase
visualization of vessels and blood products.
• Contrast is predominantly used with T1 FSE, T1 FLAIR,
BRAVO, and other T1 SPGR sequences because it shortens
the T1 relaxation rate and T1 effects are maximized.
• MRA (magnetic resonance angiography) are spoiled gradi-
ent and gradient echo sequences that suppress background
tissue while enhancing vascular structures by using low TR,
low TE, and low flip angles (FA). Saturation bands are used
to distinguish between arteries and veins. Above the heart,
superior (S) sat bands visualize arteries and inferior (I) sat
bands visualize veins. For suspected dissection, always add an
axial T1 fat-saturated sequence.
• TOF (time of flight) sequences are 2D or 3D imaging tech-
niques that rely primarily on flow-related enhancement to
distinguish moving spins from stationary tissue. Blood that
flows into the slice will not have experienced RF pulses satu-
ration and will therefore appear much brighter than station-
ary tissue.
• PC (phase contrast) imaging sequences use gradient direc-
tions and flow Velocity ENCoding (VENC) to visualize arter-
ies and veins based on their speed of flow in cm/sec. Because
stationary tissue does not move, it is automatically ­suppressed.
Chapter 1 MRI of the Head and Neck
Vessels are always flowing so they are bright on phase con-
trast scans. Veins flow slower then arteries at approximately
15-20 cm/sec, whereas arteries flow at approx 50-70 cm/sec.
• Enhanced MRA and MRV are high-resolution PC sequences
that can be used to replace TOF imaging. It has the ability to
eliminate vascular susceptibility issues that occur with TOF
sequences, because it uses the velocity of the flow instead of
flow-related enhancement.
Options
• Inferior (I) saturation (sat) band can help to compensate for
CSF and vascular pulsation. Vascular structures should have
a flow void (appear dark) on T1 and T2 pulse sequences.
Saturation bands can be used on all pulse sequences.
• Flow compensation (FC) or gradient nulling should be used
on T2 images to help compensate for CSF flow and vascular
motion. FC should never be used on T1 pre-contrast because
it can cause vessels to appear bright and mimic pathology.
It is often used post gadolinium (GAD) on T1 sequences to
compensate for flow artefacts.
• Fat saturation (FS) options and terminology are vendor spe-
cific. For GE systems, use “fat classic” for fat saturation of the
orbits and internal auditory canals.
ROUTINE BRAIN SCAN
Acquire three-plane pilot per site specifications.

Figure 1-1 Sagittal brain Figure 1-2 Axial brain Figure 1-3 Coronal brain

COIL: Multi-channel head or neurovascular*

POSITION: Supine, head first, cushion under knees
LANDMARK: Glabella
IMMOBILIZATION: Secure head with sponges. Shield patient from touching sides of magnet

*Reference safety parameters specific to each coil.

5
Chapter 1 MRI of the Head and Neck

Acquisition of Sagittal Images of the Brain

F PL TV
CC CP

PG
FL

OL

C
PtG

P MO
FV
SC

Figure 1-4 Coronal-midline brain with Figure 1-5 Sagittal-midline brain

sagittal locs Figure 1-6 Sagittal anatomy-midline brain

SLICE ACQUISITION: Plot left to right covering both temporal margins
SLICE ALIGNMENT: Parallel to third ventricle and midsagittal fissure
ANATOMIC COVERAGE: C2 to convexity, anterior to posterior cranial margins
TIP: Make sure C2 is included in the scanning
range to demonstrate best the cerebellum tonsils.
Key: C, cerebellum; CC, corpus callosum;
CP, choroid plexus; F, fornix; FL, frontal lobe;
FV, fourth ventricle; MO, medulla oblongata;
OL, occipital lobe; P, pons; PG, pineal gland;
PL, parietal lobe; PtG, pituitary gland; SC, spinal
cord; TV, third ventricle.
Acquisition of Axial Images of the Brain
AHLV
GCC

SCC

PHLV

Figure 1-7 Midline sagittal image with axial

locs
Figure 1-8 Axial image of brain Figure 1-9 Axial anatomy of brain

SLICE ACQUISITION: Plot inferior to superior, foramen magnum to vertex Key: AHLV, anterior horn of lateral ventricle;
GCC, genu of corpus callosum; PHLV, posterior
SLICE ALIGNMENT: Parallel to genu and splenium of corpus callosum
horn of lateral ventricle; SCC, splenium of
ANATOMIC COVERAGE: Nasion to occiput, cerebellum to vertex covering the cranial margin corpus callosum.

TIP: Angle to the genu and splenium so that

duplication for subsequent examinations is possible.

7
Chapter 1 MRI of the Head and Neck

Acquisition of Coronal Images of the Brain

FC SSS
CC CN
LV T
LN
MCA
SNiCP
TV
P
TC
MCP
PR
C MP
MO OC
SP S

R L
I
Figure 1-10 Midline sagittal image with coronal Figure 1-11 Midline coronal image Figure 1-12 Midline coronal anatomy
locs
Key: C, cerebellum; CC, corpus callosum;
CN, caudate nucleus; FC, falx cerebri;
SLICE ACQUISITION: Plot anterior to the posterior, frontal sinus through occiput, cervical LN, lentiform nucleus; LV, lateral ventricle;
to vertex MCA, middle cerebral artery; MCP, middle
SLICE ALIGNMENT: Perpendicular to the genu and splenium of corpus callosum cerebellar penduncle; MO, medulla oblongata;
ANATOMIC COVERAGE: C2 to vertex, covering cranial margins MP, mastoid process; OC, occipital condyle;
P, pons; PR, petrous ridge; SNiCP, substantia
nigra in cerebral penduncle; SP, spinal cord;
TIP: Coronals should be acquired with slices SSS, superior sagittal sinus; T, thalamus;
angled perpendicular to the corpus callosum to TC, tentorium cerebelli; TV, third ventricle.
ensure duplication.
Table 1-1 Routine Brain
Pulse
Sequence ETL or F Ph Slice Inter­ Sequence
1.5 TR TE FA Bandwidth Matrix Matrix FOV Thick space NEX TI Options
Sag. T1 500 Min 3-4 31.25 320 224 24/24 5 0 1 Sat I
FSE
Cor. T2 4550 102 13 41.67 320 224 22/.75 5 0 2 FC
FSE
*Ax. DWI 8000 84 62.5 128 128 22/22 5 0 2 EPI, Diff,
Asset, SPF,
BV1000
Ax.T2 8000 135 35 41.67 288 288 22/22 5 0 1.5 2000 FC,
Flair Propeller
Ax.T2 FSE 4000 129 27 41.67 320 320 22/22 5 0 1.5 FC,
Propeller
Ax SWI 5000 Min 90FA 192 320 22/22 2.4 0 4 EPI, FC,
Freq R-L
Post GAD
Cor. T1 FSE 500 Min 3-4 31.25 320 224 22/.75 5 0 1 Sat I, FC
Sag. T1 FSE 500 Min 3-4 31.25 320 224 24/24 5 0 1 Sat I, FC
Ax. T1 FSE 600 Min 3-4 31.25 256 224 22/.75 5 0 1 Sat I, FC
(Continued)

9
Chapter 1 MRI of the Head and Neck

Table 1-1 Routine Brain—cont’d

Pulse
Sequence ETL or F Ph Slice Inter­ Sequence
3T TR TE FA Bandwidth Matrix Matrix FOV Thick space NEX TI Options
Sag.T1 Flair 3000 17 10 31.25 288 224 24/24 4 0 1 1200 Sat I, FC,
Seq,
2 Acq
Cor. T2 4700 100 14 62.50 288 224 22/.75 4 0 1 FC
Ax. DWI 7000 Min 250 128 192 22/22 5 0 1 EPI, Diff,
Asset,
SPF, BV
1000
Ax.T2 9500 132 36 83.33 320 288 22/22 5 0 1.5 2375 FC,
Flair Propeller
Ax.T2 6500 128 32 100 416 288 22/22 5 0 1.5 FC, Prop
FSE
Ax T1 Flair 3000 17 10 31.25 288 192 22/22 5 0 1200 FC, Seq,
2 Acq
 Table 1-1 Routine Brain—cont’d
Pulse
Sequence ETL or F Ph Slice Inter­ Sequence
3T TR TE FA Bandwidth Matrix Matrix FOV Thick space NEX TI Options
Ax SWI 5000 Min FA90 192 320 22/22 5 0 4 EPI, FC,
Freq R-L
Post GAD
Cor.T1 375 Min 62.50 288 224 22/22 5 0 1 Sat I, FC,
SPGR Zip 512
Sag.T1 375 Min 62.50 288 224 24/24 5 0 1 Sat I, FC,
SPGR Zip 512
Ax.T1 375 Min 62.50 288 224 22/22 5 0 1 Sat I, FC,
SPGR Zip 512
Angle to anterior (genu) and posterior (splenium) of the corpus callosum. DWI is used for possible stroke, B Value 1000.
Add FLAIR post gadolinium for suspected meningeal disease.
TRF (Tailor Radio-Frequency) should be used with all FSE sequences to increase # of slices per TR.
Prop (Propeller) pulse sequences reduces motion artefacts and should be used when available.

11
Chapter 1 MRI of the Head and Neck

Table 1-2 Site Protocol: Routine Brain

Sequence F Ph Slice Inter­ Pulse Sequence
1.5 TR TE ETL Bandwidth Matrix Matrix FOV Thick space NEX TI Options

Post GAD
 Table 1-2 Site Protocol: Routine Brain—cont’d
Sequence F Ph Slice Inter­ Pulse Sequence
3T TR TE ETL Bandwidth Matrix Matrix FOV Thick space NEX TI Options

Post GAD

13
Chapter 1 MRI of the Head and Neck

BRAIN FOR PITUITARY

Acquire three plane pilot per site specifications (see Figs. 1-1 through 1-3).
Acquisition of Coronal Images, Thin Slices Through Pituitary

ON
DS
H
FEoTC
SaS
CS
III
E
IV
SS
Vi
Vii
GWoS VI
ICA SF
Figure 1-13 Sagittal image with coronal locs Figure 1-15 Coronal anatomy of pituitary
for pituitary
Figure 1-14 Coronal image of pituitary Key: CS, cavernous sinus; DS, diaphragma
sellae; E, endosteum; FEoTC, free edge of
tentorium cerebelli; GWoS, greater wing of
SLICE ACQUISITION: Plot anterior to posterior sphenoid; H, hypophysis; ICA, internal carotid
SLICE ALIGNMENT: Parallel to sella turcica artery; ON, optic nerve; SaS, subarachnoid space;
ANATOMIC COVERAGE: From anterior corpus callosum through pons, cerebellum SF, sympathetic fibers; SS, sphenoid sinus.
to vertex
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 CHAPTER VIII
UAP FRIENDSHIPS

A
good method of learning a language, where there is neither
dictionary, textbook, nor grammar, is to begin, in the primary
class, with the children. Accordingly, to the children I devoted
my earliest attention; in the guise of a playmate, I let them unwittingly
instruct me. One game, with its marvellous amplifications, I found to
be exceedingly popular: our nursery game of cat’s-cradle. It is,
indeed, a game and pastime not only of the children, but also of
youths, maidens, matrons, and old men. All were familiar with figures
which, at first made my head swim by their intricacy and the lightning
rapidity of the wriggling brown fingers. I was already familiar with one
or two figures which I had learned from a delightful paper in The
Journal of the Anthropological Institute, by my friend, Dr. A. C.
Haddon, and I was keen for more.
My first lesson came from the hands of Kakofel, the young
daughter of Lian, Chief of Dulukan. Curly-headed, little Pooguroo
was my earliest and most faithful friend; and Kakofel came next. Her
father brought her with him, or rather she trudged after in his train,
the first morning after Friedlander and I arrived at his village. We
were busy getting our various “traps” ready for the day’s work;
Friedlander with his merchandise, and I with my photographic outfit,
when Lian, a handsome man with a somewhat negroid face, but light
in colour, solemnly ascended the ladder and silently squatted cross-
legged on the floor a short distance from the door. Directly behind
him a closely cropped little head arose; at first, just on a level with
the threshold; next, there cautiously peered forth a pair of wide open,
wondering, snappy black eyes, framed all round in long, jet-black
lashes, making the whites look larger and whiter; then uprose a little
brown body girdled with a straggly skirt of dried leaves hanging down
to the knees; last of all two little brown legs, and lo, there stood
Kakofel! She immediately seated herself cross-legged beside her
father, conveniently near the doorway, however, in readiness for an
instant retreat down the ladder at a second’s notice. Not a word did
the dignified, impassive Lian utter; Friedlander took no notice of him,
and I, like “Br’er Rabbit,” kept on saying nothing. Greetings are not
“good form” in Uap, and nowhere is it diplomatic to blurt out at once
the object of a visit. A row of little brown heads, following Kakofel’s
example, now appeared on the level of the threshold, but remained
there, motionless, like little tropical cherubim with the wings moulted.
Of course, Lian had his betel basket with him, and so did Kakofel,
and the embarrassing pause was bridged by the preparation of a
bolus, which they both performed mechanically, while their eyes
narrowly examined us and every corner of the room. The little maid
was about twelve years old, an exceedingly round and healthy little
body for one brought up on coconuts; according to the Uap standard
of beauty, the little girl gave promise of a highly attractive future
belle.

GURUNGEN. MATENAK. POOGUROO.

“GAGAI,” OR CAT’S CRADLE
 At length Lian spoke, and just as though he were of the highest
culture and fashion, began with the weather and the prospects of
rain, just then much needed for the coconut trees and the tanks, or
rather water holes, on the island; then, of course, the next subjects
broached were coconuts, copra, and trade; I could not understand
what was said, but Friedlander, always courteous and kind, included
me in the conversation by translating from time to time. The peculiar
appearance of the little damsel’s cheeks was, however, what I was
most anxious to have explained. She looked as if she were suffering
from an extraordinarily severe attack of mumps combined with
jaundice. At the earliest opportunity I begged my host to permit me to
ask by what mysterious malady she had been attacked; and I
extended my hand to touch the strange excrescences; she shrank
back timidly with a little cry and her feet darted for the first rung of
the ladder; thereupon all the cherubim instantly disappeared. I at
once tried to make amends by stepping back a few paces; her father
then explained that what I had mistaken for mumps were merely the
halves of a coconut shell worn to protect her poor, little ears, which
had been recently punched in conformity with the feminine fashions
of Uap. These shell protectors had been scraped smooth and
powdered thickly with saffron, or reng-reng, an ornamental cosmetic
in universal use and the stain had been so smeared over the little
girl’s neck and cheeks that the skin and shells were all the same
colour.
 KAKOFEL, THE DAUGHTER OF LIAN, WITH
COCONUT SHELLS TO PROTECT HER RECENTLY
PERFORATED EARS
When she saw, however, that my interest was friendly, she
loosened the strings that held the coconut shells in place and
showed me, as a special favour, her terribly swollen ears, whereof
the lobes had been punctured and a wad of oily green leaves, as
thick as a dentist’s thumb, inserted in the wound to keep it from
closing up. Her spirits were not, however, in the least depressed by
her afflictions, and after I had, as a fair exchange, displayed to her
some elaborate Japanese tattooing on my arms and she had
contributed to it many smudges of black and yellow from her
inquisitive fingers, we became excellent friends. To change the
subject, I produced a string and inquiringly showed her one of my
cat’s-cradle figures. She watched my awkward movements with
open-mouthed wonder and then, taking the string, made a figure,
which she called melāng,—coral,—representing a stalk of coral with
two side branches; of course, I was eager to learn it, and in my
attempts I increased my vocabulary with several words or phrases,—
dakafel, meaning “not right,”—kafel, “all right,” and piri amith, “very
painful,” which I was told to say when she nearly twisted my fingers
out of joint in forcing them through tight loops or in hooking them
over each other at impossible angles. Manigil, “excellent, very good”
was the last word I learned.
By this time the cherubim had dispelled both their fears and the
illusion, by crawling up stealthily and sitting down on the floor near
us. Of course, little Pooguroo was there close beside me, and gave a
smile meaning “we’re old friends, aren’t we?” In a few minutes they
were all at cat’s-cradle, competing with each other in making the
figures rapidly and grunting at me for applause. Before this first
lesson was over, Lian, the chief, became so lost in watching us that
he stopped talking copra, and, taking the string from his daughter,
tried to show off his own skill in some wonderful pattern, but he was
so shaky with a palsy of his hands, that his efforts were vain and his
disrespectful daughter jeered at his failure, and in high glee shouted
“dakafel! dakafel!” until he gave it up and, with a provoked smile,
flung the string at her merry little face and resumed his talk about
trade.
Kakofel was the tomboy of Dulukan; there was no mischief afoot
that she was not in it, and where the boys were making the most
noise and playing the roughest games, there was Kakofel, always in
the midst, and her rippling laughter, ending in a prolonged high note,
was always distinguishable above the others. But I grieve to say our
friendship did not last long; it was my inadvertent rudeness that
caused the breach. One resplendent moonlight night, the shouting of
boys and the shrill screams of little girls playing in the coconut grove
seemed to be more boisterous than usual, and Kakofel’s voice
frequently rose high above the rest. Friedlander and I strolled forth to
see what was going on, and were astonished to see firebrands flying
in all directions, scattering trails of sparks, like comets. “Hang the
little imps,” shouted Friedlander, “they’re at their fiendish fire-game
again!” They had built a fire of dried coconut husks which smoulder
slowly, and, armed with these glowing embers, were hiding behind
coconut trees, awaiting a chance to launch the fiery missile at some
unwary playmate. Friedlander was not concerned for the blisters on
tough little hides, but he was justly fearful lest a misdirected brand
might lodge on the thatch of his storehouses. Off he dashed into the
darkness, hurling broadcast some awful Uap words; the pyrotechnic
display fell at once to earth, and the shouts and laughter died away
in the patter of little bare feet and the rustle of grass skirts. Like wild
animals they knew how to run to cover, and in a trice the grove was
still and dark and silent, as at midnight, and deserted; merely the
persistent embers, that kept on glowing where they had been
dropped, were left to tell of the escapade.
 COCONUT GROVE
But Friedlander was rendered so anxious over the risk to his “go-
downs,” stored full with several months’ accumulation of copra, that
when he became convinced that it was impossible to run to earth the
will-o’-the-wisps, he strode over to the failu, where several men and
boys were still sitting around a fire, and there vented his wrath upon
them, assuring them that if they didn’t restrict those little devils, and
especially that little “Kakofel Kan” (that is: “that little demon of a
Kakofel”), whom he suspected by her tell-tale laughter to be the ring-
leader, he would hold them all responsible for any damage by fire,
and would confiscate their largest and whitest fei till the loss was
made good.
Their eyes and mouths opened wide in astonishment and, when
his harangue was concluded, several of them jumped up and started
out in the darkness to catch and chastise the culprits; as well might
they have attempted to catch the frigate bird that soared over the
house the day before.
By the next morning Friedlander’s rage and anxiety had subsided
and the night’s adventure had apparently faded from his memory, as
all other annoyances of his life always vanished whenever his lighter
with a full load of coconuts pulled up to the jetty. While I was
tinkering at my cinematograph or my camera, I glanced up and
happened to see Kakofel sauntering toward me, swinging in one
hand her inseparable betel basket, and in the other holding the white
spongy heart of a sprouted coconut, known as “būl, which is about
the size of an apple and of the consistency of pith, but with a very
pleasant, sweet taste, and a favourite delicacy with children. The
process of munching this būl, from time to time, eclipsed and
disarranged the sweet and innocent smile with which she saluted me
as she approached. There was, of course, her usual accompaniment
of small boy and girl-satellites and when she stood at my side, I
shook my finger at her and said in the merest joke, “Hullo, Kakofel
Kan!” Her expression changed in a flash! She stopped short, the
smile vanished, her eyes opened wide, as she stared at me, with an
expression of almost horror on her face; the half eaten būl dropped
from her hand, she turned quickly, and with one backward glance at
me over her shoulder, ran swiftly out of the enclosure and up the
path toward her home, her little brown legs swinging out sideways
from the knees, as, in native, girlish fashion she turned her toes in to
get a better grip upon the loose sand. That was almost the last I ever
saw of Kakofel; nothing would induce her to come near me again;
when the phonograph was played to large audiences, she was
present, but always in the furthest row of listeners, and often sitting
solemnly alone outside the light bamboo fence; when I caught her
eye and smiled, she responded with a stony stare, and turned away;
if I called to her, she paid not the slightest attention, except to
quicken her pace to a run. Indeed, she was a mournful loss in my
circle of small friends; she was always a merry little thing; a
wonderful adept at cat’s-cradle, and a patient, although derisive,
teacher.
However deeply I may have wounded Kakofel’s feelings, her
mother by no means shared the affront; for she was always the first
to arrive and the last to leave whenever a phonograph “recital” was
on hand; moreover, she invariably managed to secure a seat as near
as possible to the instrument, whence she could command the best
singers to come forward to sing or speak into the brass horn; I
usually dropped three or four imported cigarettes in her lap by way of
thanks. She was not what even an ecstatic imagination could
describe as beautiful, but she had a gentle, plaintive expression, and
this rueful look was emphasised by a droop at the left corner of her
mouth caused by the loss of all her teeth on that side. She was
extremely thin, every bone of her chest stood out almost in alto-
relievo, but she seemed, withal, to be very cheerful and, whenever
the phonograph showed off well its power of mimicry to some
surprised new-comer, she emitted “the loud laugh that speaks the
vacant mind.” The dim blue tattoo marks on the back of her hands
and on her legs bore witness that in her youth she had been the
fêted belle of some failu, before Lian took her to himself as wife. I
once paid her a visit when she happened to be busy boiling some
dal (yams), and lak (taro), for the midday meal, and she showed me
all over her kitchen by allowing me to thrust my head within the
doorway. It was merely a little outhouse of palm leaf close beside
their large house and only about six feet long, by three or four wide;
the floor was really neatly swept up, although the thatching of the
sides and rafters was well coated with soot. The fireplace was a
large iron bowl,—purchased of course, from Friedlander,—banked
up in a mound of sand; in this the fire was built, without any draught,
and over it an iron tripod, whereon was hung another iron bowl in
which the food was cooking. She had to sit by and watch the fire
constantly because, as she explained, it was exceedingly ill-omened
for a spark to fly out and lie burning on the floor, so while the fire
burned brightly, she must be close at hand to push back embers that
might fall, and to catch flying sparks.
 The little house wherein the women cook their own food is called
pinfi, meaning “woman’s fire,” and is always for their exclusive use;
no man can eat food cooked in utensils that have been used in
preparing food for a woman, and I doubt if a man would use even the
same fire; I know that they will not light a cigarette from the same
ember or match that a woman uses; this is true even of husband and
wife. Once, at Friedlander’s instigation, to make a test, I picked some
areca nuts out of a woman’s betel basket as if to examine them, and
then in an absent-minded manner, dropped them into the basket of a
man who had seen me take them from the woman; instantly he
snatched them out of his basket and flung them from him as if they
had been live coals. I questioned Lian about this custom; he
admitted that nothing would induce him to eat food prepared in a
woman’s bowl or chew a betel nut that had been in a woman’s
basket. He assured me solemnly that it would inevitably bring ill luck
or sickness. When I visited Lian’s wife, all utensils used in the
preparation of her husband’s food were in a small vestibule or
antechamber near the door of the house, and there also was the
fireplace used exclusively for him. This taboo, as I suppose it may be
termed, does not, however, prevent a husband from eating
voraciously of the food which his poor wife, slaving over the fire (in
the tropics too!), has cooked for her high and mighty lord;—here is
just where the charming flexibility of the taboo is in evidence. The ill
omen attached to the flying sparks is devised to frighten poor women
into taking care lest they set the house on fire; and, by the way, it is,
indeed, almost miraculous that they do escape daily, nay hourly
conflagrations, even with this dread omen hanging over them. In the
first place, their skirts are composed of four or five layers of dried
leaves and strips of bast, and are so voluminous and distended that
they stand out all round the body, outrivalling the old-fashioned
hoopskirts; even when sitting down, the women are surrounded by a
mound of veritable tinder. In the second place, they are for ever
striking matches to light their cigarettes, nay, worse even, they carry
about with them for the sake of economy the glowing husk of a
coconut, and neither to matches nor husk do they give the slightest
heed, striking the one recklessly over their own skirts or absent-
mindedly resting the other against the skirts of their neighbour. Yet in
spite of this utter recklessness never did I see a skirt catch fire,
although I confidently awaited it every time they assembled to hear
the phonograph. When the female audiences had dispersed after
these exhibitions, Friedlander’s neatly swept little compound was
wont to look like a threshing-floor, so covered was it with fragments
of pandanus leaves, the relics of female attire. One month at longest
is the life of a woman’s dress; then the old skirt is burned and a
brand-new one plaited, with no tedious fittings at the dressmaker’s,
nor depressing bills to pay.
When dressed in their best for visits or feast days, the women
don skirts prettily decorated with wide strips of pandanus leaves
bleached for the purpose and stained a bright yellow with reng, and
about the waist-band are inserted brightly variegated leaves of
croton. The effect is, indeed, extremely pretty on the background of
their smooth, brown skin. The women do not, as a rule, adorn
themselves with necklaces or other ornaments; some, who do not
work very hard in the taro patches, wear bracelets of coconut shell or
tortoise-shell, and sometimes finger rings of the same material. The
long strips of hibiscus bast, stained black, which they all wear
knotted about their necks after they have come to maturity, seems to
take the place of all other finery. This cord, known as marafá, must
be always worn by a woman, young or old, when she is away from
her home; to be seen in the open air without it would be as immodest
and disgraceful as to appear without any clothes at all. Within the
dwelling house, however, it may be discarded with perfect propriety.
Standards of beauty vary so widely among different races, from
the fat, round-faced beauties alleged to predominate in Turkish
harems, to the thin oval-faced belles of Japan, and to the long-eared,
black-toothed maidens of Borneo, that I was anxious to learn what in
masculine eyes of Uap constituted feminine beauty. One day, after a
phonograph recital for the men, fifteen or twenty from different parts
of the island lingered behind to watch the putting of the tom-tom in its
box; I then took the opportunity of asking them who, in their opinion,
was the prettiest girl of all they knew on the island. They seemed to
take a great interest in the discussion which followed, and several
girls were named and their charms discussed and compared, but
finally a unanimous voice was given to Migiul the mispil of
Magachagil, in the south of Uap. Their good taste may be verified by
turning to her photograph on the opposite page.

MIGIUL, A “MISPIL”
Migiul was a frequent visitor at Friedlander’s house, being an
intimate friend of his wife, and whenever she came to visit her
parents, who lived close by in Dulukan, she spent the greater part of
the day gossiping in Mrs. Friedlander’s cosy little home and learning
to speak the Marianne Island language. She was an exceptionally
bright girl, about seventeen or eighteen years old, with a sad,
plaintive expression and a soft, gentle voice,—a universal favourite
with the women, and the admiration of all the men. Nor was this all.
Her reputation as a ballad singer was widespread, hence she was
pushed forward on all occasions when a new song “record” was to
be made, and seemed modestly conscious of her proficiency; I
cannot honestly affirm, however, that I sympathised with her
admirers in their ecstasy over her high or low notes, which to my
dull, untrained ears too closely resembled, in all seriousness, the cry
of a cat in agony. Notwithstanding her peculiar position in that small
community, there was no trace of boldness in her demeanour; her
voice in speaking was always low, “an excellent thing in woman;” she
never obtruded herself, but retreated quickly to the background when
she had finished her song; in fact, she was the personification of
unstudied, innate femininity. This may be surely accepted, whether
among primitive people or amid the conventionalities of modern
society, as a high standard of refinement and an essential element of
a thorough lady. Poor little Migiul, according to the exactest code of
propriety is in her own eyes and in those of all her Uap world, a
thoroughly blameless, moral girl.
 FATUMAK

Of all my friends among the men, old Fatumak, the mach-mach

or soothsayer, was the most faithful, the most intelligent, and,
consequently, to me, invaluable. In his youth he had fallen from a
coconut tree and so injured his spine, that he was permanently
deformed and had a dwarf-like figure with a pronounced distortion.
One evening, when he had been rehearsing to Friedlander and
myself some of the legends of Uap, I asked him how it was that he
knew so much; he said he had heard these stories from the old
people when he was a boy, and then he added, pointing to a long
row of notches on the handle of a little adze that he always carried:
—“Those marks, each one,—one moon; twenty-eight moons after I
fell, I lay in my house; no one to talk to; I think and think over
everything; I talk to myself; I remember these stories. Some I think
true; some I think foolish.” This had been his school,—two years of
solitary self-communion, and during this time he had pondered on
the problems of nature and the human mind, and solved them in his
simple primitive way, to his own satisfaction. He emerged a wise
man among his own people and endowed, as they believed, with
prophetic foresight. He was ready with an answer to every question
and made his living by interpreting omens and telling fortunes by
mysterious combinations of knots in Bei leaves.
His house, wherein he lived quite alone, never having taken to
himself a wife, was a veritable magpie’s nest, so full was it of odds
and ends of every description, piled in corners or suspended from
rafters, mostly discarded rubbish from the houses of Spanish or
German traders. It was enclosed by an open fence of bamboo, fairly
well built but naturally flimsy; in this fence there stood a gate which
at night and invariably in the absence of the owner, was kept closed
with a ponderous, rusty padlock, although a single, slight push would
have been enough to throw the whole fence flat; indeed, I doubt that
anyone hurrying along on a dark night and happening to stumble into
Fatumak’s fence, would have been aware of it, or recognized any
difference between it and other obstructive patches of thick
undergrowth; but it was a great comfort to the old fellow to feel that
“fast bind” ought to mean “fast find.” In the house his most valued
possessions, such as bits of brass wire, nails, beads, extra blades
for his adze, empty baking-powder boxes, the key-board of an
ancient accordion, and innumerable other articles calculated to set a
Uap’s “pugging tooth on edge,” were kept secure in a large tin
biscuit-box, whereof the top had been cut on three sides, and the
third side served as a hinge. He had contrived to punch holes
through this lid and the side of the box, and through them he had
inserted the hasp of another padlock almost as unwieldy as the one
on his front gate. I think that after locking it he had lost the key,—the
corners of the lid looked as if they had been bent upward to extract
what he wanted without disturbing the lock; in fact, it was through
these openings that I was able to examine the treasures of this safe.
The old man,—I call him old, but I doubt that he was over fifty, yet
seemed older because of his deformed body and his quiet, sedate,
and thoughtful bearing,—had a pleasant, pensive face, with
somewhat negroid features, a broad flat nose and thick re-curving
lips; his hair, just beginning to show grey, was, however, wavy and
curly, with no trace of the wool of African negroes or of Papuans. He
smiled easily and took good humouredly the chaff which we
constantly poked at him for his thrifty devices, which closely verged
on miserliness, and, occasionally, for the prices he charged poor
unfortunates who invoked his skill in foretelling the future. He was
not able, on account of his misshapen back, to paddle his own
canoe, but he had constructed a raft of palm stems and bamboos,
which he called his “barco,” after the Spanish, and many a time I saw
him start off in the early morning to make his rounds of fortune-
telling, poling his “barco” up the coast in the shallow lagoon, and
return again in the evening with his decks almost awash with ripe
coconuts,—his fees for consultation collected on the spot. His
method of foretelling the future by means of bei leaves, he himself
believed in implicitly, and invariably became serious and reserved if
we alluded to it lightly. Many a time when he was squatting beside us
as we ate our lunch or dinner at a little table in the yard under the
palms, he would be called aside by an anxious client to interpret
some mysterious combinations of knots which had been tied at
random in strips of palm leaf. There are only a favoured few who
know the hidden significance of marriages of the kan or demons,
indicated by these knots, and this knowledge is kept sacredly secret
and never revealed until the father, at the approach of death,
discloses it to his son; thus it is handed down from generation to
generation.
On several occasions I noticed these consultations with Fatumak,
but had no idea of their meaning; I supposed that the tying of knots
in a strip of leaf was mere frivolity to fill up the time. One day,
however, a seeker for truth happened to sit close beside me and I
heard him earnestly talking to himself, or to the knots, as each one
was tied; when the four strips were finished, he adjusted them
carefully in his hand and showed them to Fatumak, who merely
glanced at them and murmured a reply. This was repeated several
times; then the man arose and went away contented. Of course, I
asked Fatumak what it all meant and he informed me that the man
wished to find out whether or not a friend of his, in the northern end
of Uap, who was very sick, was going to get well; the answers had
been favourable.
Whoever wishes to consult the omens in this manner provides
himself with eight or ten strips of green palm leaf, preferably the
narrow leaves of the coconut, and in the presence of the soothsayer,
proceeds to tie at random in each strip a series of single knots about
a half inch apart, not counting the knots as he ties them, but all the
time murmuring to himself the question which he wishes answered.
When four strips bear many knots thus tied, he takes the first strip
and, counting off the knots by fours, beginning at the broad end of
the leaf, catches the strip between his thumb and the base of the
index finger of the right hand in such a way that all the knots which
are over an even division by four, stick up above the back of the
hand. On the second, third and fourth strips he counts off the knots
in the same way, and catches them in turn between the index and
middle finger, the middle finger and ring finger, and the ring finger
and little finger, thus leaving the uneven number of knots sticking up
close to the knuckles. If there happens to be, on any strip, an even
number of fours, then four knots are left projecting. The seer then
reads the omen from the combinations of knots in the two pairs of
strips, composed of the thumb and index strip, and the index and
middle finger strip for one pair; and the middle and ring finger strip,
and the ring and little finger strip for the other. Each pair signifies a
different kan, or demon, and it is in accordance with the union of
these kan, that the omens are good or bad. As may be seen, there
are sixteen combinations of the number of knots possible in each
pair; consequently, there are sixteen valuable kan which assist at
this form of mach-mach. For instance, the thumb strip may have four
knots left over and the index strip have two, this is the sign that the
female kan, Vengek, is present for one; the middle finger strip may
have one and the ring finger strip have three knots left projecting
above the knuckles, this is the sign that Nebul, a male kan, is
associating with Vengek, and this indicates a certain answer
according to the drift of the question; which would be also affected
by the appearance of Vengek or Nebul in the first or second pair of
knots, the time of day, conditions of the weather and many other
influences, which Fatumak declared it would be useless to tell me,
as I could not possibly understand them all. I had made the grave
error of showing too rapid a comprehension of one of the mysteries
of the art when he was giving me the signs of the various kan, their
sex, and to whom they were married. This is the list, as he gave it to
me, before explaining anything about sex or marriage among the
kan:
3 and 3—Thugalup
3 and 1—Languperran
1 and 4—Wunumerr
4 and 4—Sayuk
1 and 1—Thilibil
2 and 2—Nagaman
3 and 4—Trunuwil
1 and 2—Saupis
2 and 1—Navai
3 and 2—Fawgomon
1 and 3—Nebul
2 and 3—Musauk
2 and 4—Namen
4 and 2—Nafau
4 and 3—Vengek
4 and 1—Liverr

Of course, he had to give a practical demonstration of each

combination, he could not carry the numbers in his head; and when
he had finished the last one, Liverr, he vouchsafed the additional
information, while the knots were still between his fingers, that this
kan was a woman and was married to Wunumerr. This led me to ask
about the next to the last, Vengek; this also proved to be a woman,
married to Trunuwil; the next, Nafau (four-and-two) also a woman
and married to Namen (two-and-four),—this gave me the key,—the
descending numerical combinations were women and they were
married to their ascending reverse combinations.
Three-and-two would be a woman and married to two-and-three;
three-and-one the wife of one-and-three, etc., etc. Foolishly exultant
over my guessing these combinations, I forestalled Fatumak in
telling off the remaining combinations and named the husbands and
wives; he first eyed me with astonishment, and then became
unmistakably provoked and sullen. But my pride had its fall; I could
not determine the even combinations of four-and-four, three-and-
three, two-and-two, and one-and-one, so I had to appeal to his
superior knowledge again; whereupon he told me rather gruffly that
four-and-four was the chief Sayuk, and his lesser half was Nagaman
(two-and-two), and one-and-one was their son Thilibik, and three-
and-three was the bachelor youth Thugalup; and then he added that
I might be very clever and guess just as shrewdly about the Bei, but
that I would never know any more than what he had just told me, and
that no white man could ever understand it; we had our glasses that
looked beyond the sight of man into the distance, but the men of Uap
had Bei wherewith they could see things that had not yet happened
that were beyond the thoughts of man. With that he gathered up his
betel basket and solemnly walked away. I had lost for ever a golden
opportunity by my vanity,—but I incline to think it was somewhat
pardonable.
I did learn, however, a little more about the mach-mach, or
momok men, from the chief, Ronoboi, also a noted seer and dealer
in charms. Those who practice the art must be aged widowers, or
widows, from whose lives all thoughts of love for the opposite sex
have vanished; they may never eat food that has been prepared the
previous day; they must always be scrupulously careful that the
“quids” of betel nut, which they have finished chewing, are destroyed
either by fire or by throwing them into the sea, where no profane
hands can find them and thereby work charms (consequently their