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that the excursion of the diaphragm on the left side was less than half an inch, and on the right side one and one-quarter inches. In some cases it is possible by means of the fluoro- scope to anticipate, especially in acute tuberculosis, the knowledge gained later by auscultation and per- cussion, and also, to better appreciate the amount of lung-tissue involved in the different stages of the disease. I have detected signs of tuberculosis in the lungs by means of the fluoroscope after a physical ex- amination had failed to show coupon for celebrex them. In cases in which the suspicions of the practitioner are aroused by the first examination, a second one celebrex celebrex should be made, after celebrex price an interval, to verify or disprove the first. It is essential in tuberculosis to use every possible means to determine the condition of the celebrex coupon lungs in order to decide upon the course the patient should pursue, and, by the aid of the information obtained from the fluoroscope, a long and costly journey in a celebrex online fruitless search for health may, in some cases, be avoided — that is to say, we may find by means of the fluoroscope 200 celebrex that the lungs are more diseased than the usual physical examination indicate; or, on the other hand, we may detect, it is too soon to say in what proportion of cases, an abnormal condition of the lungs before it is suggested in any other way and so early that the best opportunity for arresting the disease is afforded. It is unnecessary to emphasize the value of early recognition in a disease often so amenable to treatment in the beginning. I advise young adults with a tubercular family history to have 200 mg celebrex an X-ray examination from time to time, or imme- diately if they are out of condition. In other papers l I have discussed at length the appearances 1 44 A Study of the Adaptation of the X-rays to Medical Practice," Medical and Surgical Reports of the Boston City Hospital* celecoxib celebrex Janu- ary, 1897. "The Rdntgen-Rays in Thoracic Diseases," American Journal of the Medical Sciences, December, 1897. seen in the fluoroscope in pulmonary tuberculosis, and therefore will not go further into detail here. In pneumonia the affected areas 200mg celebrex are easily recog- nized in the fluoroscope, and in a central pneumonia, may be seen when auscultation and percussion do not reveal them. The excursion of the diaphragm is also restricted, and the heart may be much displaced to the right, if the pneumonia is pnly on the left side. As the patient what is celebrex improves the dark areas are seen to disappear and the movement of the dia- phragm to lengthen. A celebrex 100 diminished respiratory movement and areas darker than normal may be seen after an abnormal condition of the lungs ceases to be detected by auscultation and percussion. An empyema, as is well known, may follow pneumonia, but may be overlooked for some time; we can, how- ever, find evidence of its presence by means of the X-ray. The pleuritic effusion which sometimes ac- companies pneumonia may be suspected in a given case and yet proved not to celebrex coupons exist if a bright area and the outline of the diaphragm below the dark pneu- cost of celebrex monic portion are visible in the fluoroscope. In pleurisy with effusion, or in empyema, the out- lines of the lower part of the chest are dulled or ob- literated, especially the diaphragm line. If the celebrex purchase effusion is large, the whole chest is dark, and the heart and mediastinum are displaced. In a circum- scribed pleurisy or empyema an exploring needle may fail to reach the desired spot, but we may celebrex 100mg some- times, by means of the fluoroscope, exactly outline the limits of the fluid. In one patient I drew such an outline, and its correctness was confirmed at the autopsy. If the lungs are less dense than normal, as in emphysema, the area is brighter than in health and the distended lung or lungs may reach lower in the chest than normal. The maximum excursion of the diaphragm is much less than in health, as this muscle does not rise so cost celebrex high in expiration. These two signs are characteristic of emphysema, and in the later stages the enlarged ventricles celebrex mg and also the di- lated right auricle are .seen; the heart also lies in a more vertical direction and its position is not much changed by a deep inspiration. In young people, especially, an emphysema may be overlooked on auscultation and percussion, but is readily detected in the fluoroscope. I recall a girl of fifteen years who had dyspnea on exertion, the result of an em- physema. An appreciation of this condition was obtained only by coupons for celebrex an X-ray examination. On the other hand, the fluoroscope may show that there is little emphysema when auscultation and percussion suggests that it is present to a considerable degree. In pneumothorax, the diaphragm is very low, loses its normal curve and movement on the affected side, Digitized by Google 614 X-RAY IN MEDICINE. [Medical News and the heart and mediastinum are seen to be dis- placed to the celebrex buy healthy side. The fluoroscope is also useful in pneumohydrothorax when the patient is ex- amined sitting up. (See Fig. i and Fig. 2.) It is unnecessary to further refer to special dis- eases; it is obvious that certain pathologic conditions

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