. Radiography, X-ray therapeutics and radium therapy . e stages ofsecondary carcinoma may be shown in the same case if examinations aremade during the progress of the disease. The various progressive stages ofthis form of malignant disease are well worthy of careful study, for all theseforms are sure to require investigation. In the earlier stages it is extremelydifficult to establish a diagnosis on radiographic evidence alone ; all the factsof the case require careful consideration, and other methods are helpful,particularly in some cases where tuberculosis may be the alternative diag-nosis,
. Radiography, X-ray therapeutics and radium therapy . e stages ofsecondary carcinoma may be shown in the same case if examinations aremade during the progress of the disease. The various progressive stages ofthis form of malignant disease are well worthy of careful study, for all theseforms are sure to require investigation. In the earlier stages it is extremelydifficult to establish a diagnosis on radiographic evidence alone ; all the factsof the case require careful consideration, and other methods are helpful,particularly in some cases where tuberculosis may be the alternative diag-nosis, or where it may be an accompanying condition. The combination ofthe two diseases is rare, but they may occur in the same patient. Haemo-ptysis may be a determining factor in the diagnosis, especially if it occur toany extent. Haemorrhage to a marked extent from a secondary carcinoma iscomparatively rare, whereas in tuberculosis it is often the first symptom tocall attention to the disease. Simple Tumours of the Lung.—These are very rare. Tumours of. I - 1- ~ ■ -~ - aa x If .- — - — tr. a - — — iL, g 3 5 g1 -r- S o o g c3 1J g| O ,2 x DIFFERENTIAL DIAGNOSIS IN DISEASES OF THE LUNGS 199 the chest wall are fairly common, and may give rise to shadows which haveto be differentiated from tumours of the pleura and lungs. Such tumoursmay be enchondromata of the costal cartilages and bones. Osseous tumourswill give dense shadows, and should present no great difficulty in diagnosis. Primary Malignant Growths of the Lung-.—These are rare, but theydo occur, and when a shadow is seen in the thorax, in a case which gives noevidence of a primary lesion elsewhere, the assumption is that it may be aprimary malignant growth. Before the diagnosis is made, however, everycare should be taken to investigate for a primary lesion, and the whole thoraxshould be carefully examined, particular attention being paid to the larynx,trachea, and oesophagus. Primary growth in the oesophagus is fr
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