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tions of the left ventricle, the left auricular appendix, the entire right appendix, and part of the right auri- cle. It is bound below by the sharp anteroinferior border (margo acutus), on the left by the oblique convex and slightly rounded left anterior border (the left border of clinicians), and on the right by the nearly vertical and convex right anterior border (the right border of clinicians). Its superior angle marks the anatomical apex, and here the surface merges in the anterior walls of the aorta and pulmonary artery. Its left inferior angle forms the clinical apex. On this surface are seen the anterior or right coronary artery in the anterior auriculo-ventricular groove, viagra sale witbank while its marginal branch runs viagra sale witbank along the viagra sale witbank anteroinfe- rior border, and in the anterior interventricular groove is the descending branch of the posterior or left coro- nary artery accompanied by the great cardiac vein. Separated from it by the pericardium are the margins of the lungs and pleura, the sterno-pericardial liga- January 18, 1896] MEDICAL RECORD. 99 merits, triangularis stern i, internal mammary vessels, and sternum. The right surface is markedly convex, quadrilat- eral, lies almost vertically, and is directed toward the right. It includes the greater part of the right auricle. Its anterior, posterior, and inferior borders are onlv slightly rounded, and arurface to enter the left extremity of the coronary Mnus. viagra sale witbank It is only partially invested by the serous laver of the pericardium; it is separated by the peri- cardium from the bronchi, oesophagus, vagi, descend- ing aorta, vena azygos major, and thoracic duct. The inferior surface (diaphragmatic surface or base) is quadrilateral, slightly convex, or almost flat when the ventricle contains blood. . . . It viagra sale witbank is formed by a small portion of the right auricle and the opening of the inferior vena cava ; the rest of the surface being about equally divided between the right and left ven- tricles. ... In addition to the inferior caval opening it presents the inferior extremities of the 1 ight(anterior) and left (posterior) viagra sale witbank interventricular grooves with the right cheapest canadian viagra coronary artery embedded in the former and the coronary sinus in the latter. Crossing it diagonally i^ the inferior interventricular groove with the de- scending branch of the anterior or right coronary ar- tery and middle cardiac vein. The posterior cardiac vein runs along its posterior border. The apex of the pyramid is formed by the aorta, pulmonary artery. and superior vena cava. These structures arise from the heart on a level with the upper margin of the " third costo-sternal articulation, extending an inch and a half to the left and one inch to the right of the mid- dle line. The clinical apex is indicated by a point between the fifth and sixth ribs, three and one-half inches to the left of the middle viagra sale witbank line. The antero-inferior bor- der may be viagra sale witbank indicated on the chest wall by an oblique line extending from the clinical apex on the left across and slightly upward to a point one inch to the right of viagra sale witbank the middle line at the level of the sixth chon- dro-sternal articulation. Along this line the cardiac blends insensibly with the hepatic dulness. . . . On a level with the fourth chondro sternal articulation the area of the heart's dulness cheapest canadian viagra extends three inches to the left and one and three-quarter inches to the right of the middle line. It would seem more consistent with the above de- scription to make certain changes in the cardiac no- menclature. Thus the interventricular grooves are seen to be superior and inferior, the right coronary artery might be called anterior, and its branches re- spectively infundibular (as at present), right ventricu- lar (now marginal), and inferior interventricular (now- descending) ; the left coronary artery would be better named posterior, and its branches superior interven- tricular (now descending), left ventricular (now mar- ginal), and auriculo-ventricular (now transverse). NEW YORK ACADEMY OF MEDICINE. Stated Meeting, January 2, i8q6.