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sound, and that the area of audible conduction for this sound was limited and localized, while the aortic second sound w.as heard far and wide over the cardiac region and beyond it. Sub- seCheap Zenegra has been made: \. Systole, wliieli bringH the pulmonary valve into touch with the chest wall, ilocs not materially alter llie relation of the aorta to tho lat- ter. 2. Since from this point of contact the piilnioiiary artery recedes Upward into the depth of the chest, its bluoil pressure bearing upon the valve would otrike with oblii|uel\ sagittal di- n-etion against the chest wall, which is sometimes seen to ■ liiiver under the slnK-k. The axis of the aorta at it» origin i* very diU'erent from this, loriuliig during systole aliiioM n strnight line with the ventricular sieptiim. :i. Allention should also bo ilrawii to the nnlerior posilion of two of tirv piiliiinnnry llnpn a-i .n tMJve. Tho vnlve Ir lnolattHl at the exire.nily of IIk -u* from llie ttmili biMly of tho right ventricle. S. "ii to the ventricu- 54 i MISCELLANY. [N. Y. Mbd. Jolb. lar siBptuiu, or ratlier to iLe up-.vard pi-nloiifr:.tiuii of tlji- larter, is not vertical, but lateral only. Lastly, it Buy Zenegra is isolated rroiii the massive portion of the ventricular saiptmii, u|it>n wliii-li rosts the aorta, by the entire diameter of that ves-el. 5. Although in contact with the tip of both auricular appendices, the pulmo- nary artery is not in contact with the right auricle, which is therefore nnable to conduct its sound vibrations. Thus the anatomical relations would not facilitate a conduction of the pulmonary sound either along the sseptuin and left ventricle, or toward the right auricle, or even into the right ventricle. In all these points the aortic sound is, on the contrary, greatly favored. 6. The .lortic valve is firmly planted at the top of the broadest part of the s»[)tum, which may be regarded as a first- rate conductor. 7. Its sinuses of Valsalva arc so distributed as to propagate the aortic sound to the entire surface of the heart. One of them forms part of the superior boundary of the right ventricle, which thus receives at a central point direct trans- mission of the valve sound. Zenegra 100 Another projects into the conus arteriosus below the adjoining pulmonary flaps, cutting Zenegra 50 off, as it were, their line Zenegra Online of communication downward into the right ventricle. The third bulges into both the right and left auricle. Moreover, the aorta above the valve is tightly wedged between the four cavities of the heart, to which it must communicate its vibrations. 8. It should not be forgotten that, in the healthy state, at the moment of production of the second sound the ventricular walls of the heart are gathered into a firm mass tightly applied to Zenegra 100 Mg the sieptum, and with it con.stitute a solid plessimeter upon which the valvular succussion plays the part of a hammer. The excellent conduction of the aortic second sound to the ape.x of the heart is thus very clearly explained, and it is equally plain that conduction must also take place to the entire surface of the contracted ventricular cone. 9. More- over, at the .same moment the auricles are gorged with blood and the thinness of their wall enables their contents to receive the vibrations the more fully and to transmit them by fiuid conduction. This, again, tells in favor of the aortic secnrid sound, which is in this way propagated to the lower portion of the sternum and to the Zenegra 100mg right lower parasternal area. 10. Lastly, in eases where the right ventricle tails to discharge its contents completely, the aortic second sound would be conveyed to the ventricular blood and through it to the right ventricular walls from the aortic sinus of Valsalva, which has been de- scribed as forming part of the upper boundary of the right ven- tricle; and the same rea-soning would apply to inefficient .sysiole of the left ventricle. On anatomical grounds it may therefore bi' said that the aortic seccmd sound commands three cavities (the pulmonary urti-ry through its right branch intiuencing oidy the left amiclej in addition to holding the high road tor vilira- tions along the .-jieptum, and to practically excludinu the pulmo- nary sound from propagation into the right ventricle. For the pulmonary sound there renndns only loud and direct conduction to the anterior chest wall immediately covering the valve, as well as to a limited adjacent district, and inaudible conduction into the depth ol the (diest along the pulmomiry artery and its hranclicH. Malignant Disease in Displaced Organs.— .\t a recent mi'eling 111' the (ihisirow .Mi-dic'o-chinirgicid Society, a report of

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