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1 This crayon is made by mixing vaselin with some heavy powder such as bismuth or oxid of lead, or mercury and a little lampblack ; is about one-eighth of an inch in diameter, and covered with paper to give it stiffness. Digitized by Google 6io X-RAY IN MEDICINE. [Medical News correspond to the apex of the heart as seen in the fluoroscope; by means of this instrument we see that it is sometimes lower. On the left side of the sternum the outlines of the ventricles and the pul- monary artery may be seen; on the right side, what is seen depends upon the excellence of the apparatus and also upon the individual examined. Under favorable conditions both the right auricle and the border of the right ventricle are visible. betnovate scalp lotion In disease the fluoroscope enables us to get a much more complete outline of the heart than can be ob- tained by auscultation and percussion, and even in size of the right auricle may frequently be estimated. In cardiac hypertrophy and dilatation the size and position of the heart may be more fully obtained with the fluoroscope than by any other means. The left border of the heart may sometimes extend beyond the nipple and approach so near the left wall of the chest that percussion gives an area of dulness, reach ing, for example, to the anterior axillary line, whereas the fluoroscope may show that the heart is not so enlarged as the former method of examination seemed to demonstrate. The exaggerated idea of size, in such a case, is due to the fact that the heart Fig. i. Diagram illustrating: the appearances seen in the fluoroscope in betnovate online a patient with tuberculosis on the right side and pneumohydrothorax or pneumopyothorax on the left side. The betnovate n right side is encroached upon by the displaced heart and by the dense tuberculous process at the top of the lung; the excursion of the diaphragm between expiration and inspiration betnovate c cream is less than normal (the broken line indicates its position in expiration}. ^On the left side the appearances, when the patient is examined in a sitting position, remind one of a tumbler partly filled with ink. If the patient bends backward or forward the height betnovate c ointment of the fluid on the chest-wall changes; if to the left the beating heart is exposed to view; if the patient is shaken gently the surface of the fluid is seen to be agitated; it is also seen to be disturbed by the pulsations of the betnovate face heart. This diagram is made clearer by a comparison with Fig. a, which illustrates the appearances seen in the fluoroscope in a normal chest. health, although the difference here is not so marked, the advantage is with the fluoroscope. The size of the heart in disease is an important element in estimating buy betnovate cream its condition, and guides betnovate for acne us in prognosis and treatment. It is not necessary to emphasize the cardinal value of this knowledge in cardiac dis- ease. The fluoroscope enables us to determine betnovate scalp application the position of the left and usually the right bor- der of the heart, whereas by percussion, in some pa- tients, the heart may buy betnovate cream online seem to be either betnovate ointment 0.1 larger or smaller than it is. By means of the fluoroscope the is so abnormally near the left wall of the chest that by percussion betnovate buy online its lateral is not distinguished from its ante- rior portion. We may even obtain a betnovate cream 0.1 better knowledge of the size of a distended betnovate gm heart by means of the fluor- oscope than by an betnovate c autopsy. If we look through the body from side to side, on a level with the betnovate scalp solution diaphragm, during full inspiration, we see a light area tri- angular betnovate gm skin cream in shape, the lower side of which is bounded by the diaphragm, the anterior by the heart, and the posterior, which is less defined, by the spine. It is by means of this area, if the lungs are normal, that Digitized by Google May 14, 1898] X-RAY IN MEDICINE. 61 1 we are able to get a view behind the heart and be- tween it and the betnovate n cream spine, and this area will be found to vary in size under different conditions. With an enlarged heart it may be much smaller, or it may be nearly or quite obliterated. Enlargements of the heart may be detected not only by observing the right and left borders, but also by seeing the posterior and betnovate skin cream

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