overlooked. It continually occurs, though the fact seems not to have been noticed, that a thin but firm buff, of a pink colour, presents, on slight inspection, an appearance as if no buff were formed. The shades of colour vary, yet are all such as to convey to those who are unaware of the fact, the impression of there being no buff. Yet, if the coagulum be cut through, the buff will be found well defined, and sufficiently firm to support, on a probe passed beneath it, the whole coagulum, the dark portion of this being of the usual loose texture. The condition of the urine, too, demands more careful notice than it generally receives. In dropsical affections it promises to throw much light on the pathological state, and to furnish useful guidance in the exhibition of remedies. Dr. Bright has ably traced a connexion between coagulable urine and certain organic derangements of the kidneys; and his remarks have been amply confirmed by other eminent practitioners. There is reason to believe that functional disturbance alone of the kidneys may produce albuminous urine. These cases are inflammatory; the albumen is much more abundant than in those noticed by Dr. Bright; it varies with the progress of the disease, and disappears as .this retires. In the progress of treatment, too, it furnishes valuable guidance for the due administration of remedies, such as no other indications yield. The object of treatment in all diseases is to excite the constitutional powers to sanative efforts, just so far as is necessary for remedying the existing derangement. To carry the excitement beyond this point, is to waste power and do mischief. This is

well exemplified in dropsy. Mercury, used to a certain extent, corrects the vascular action which produces effusion, promoting also the absorption of what is effused. Carried beyond this, it may break down power and counteract all the good effected. A criterion by which to judge of its adequate administration, so as to avoid its excessive use, must here be valuable. For this the ordinary evidences of mercurial action are insufficient. The state of the urine, when albuminous, supplies a test of much value. The albumen will gradually diminish, and finally disappear under the use of mercury; but a prolonged use of this is liable to reproduce the albumen. Here the urine furnishes the only test by which to judge. I have seen the urine cleared of albumen, the subsidence of dropsy keeping pace with its decline. Anxious to accelerate or to keep the ground gained, I have, in such case, resorted again to mercury, but with the effect of the albumen returning. The mercury was withdrawn, the albumen again ceased to appear. That the guidance here afforded by the urine was most salutary, I have no doubt, and I know of no indication, save that supplied by the urine, that could have afforded it. The specific gravity of urine, too, seems worthy of being ascertained, wherever the existing disease involves a morbid condition of this excretion.

It would be easy to pursue these remarks in more extended and minute detail, but enough, I conceive, has been stated, to shew the kind of scrutiny which both morbid actions and the operation of remedies should receive, in order to render medical reports available for the guidance of the practitioner. With

out advocating a tedious minuteness in the specification of symptons, I would consider it expedient that the condition of every important function of the frame should be clearly and distinctly stated ; in short, that all should be told into which the observer himself deems it necessary to enquire, or which has any influence in directing his own judgment. Every practitioner of experience must know that circumstances apparently trivial enter largely into his considerations, whether of the diagnosis, prognosis, or treatment of disease; and whatever is thus influential, however slightly in degree, it is of importance to record. I ought, perhaps, to notice specially the morbid appearances of the tongue and of the countenance, so various, and so expressive of much which the functions more generally examined may fail to indicate. The importance of the indications which they furnish, and the assistance which they render in the attainment of an accurate diagnosis, is admirably illustrated by Dr. Marshall Hall, in his "Commentaries on some of the more important diseases of females."

The task which I assigned myself is now performed. It sprung from the sense which I entertain of the duty incumbent on every member of the newly formed association, of contributing with his best powers to the ends designed. If the suggestions offered in the preceding pages merit but slight estimation, they will, at least, occupy but little space in the forthcoming volume. Should they, on the contrary, be deemed not wholly unimportant, the subject cannot fail to interest others, so as to ensure its being more worthily and more ably treated.

THEORY

OF

THE FRONTAL SINU S.

BY E. MILLIGAN, M.D., F.S.A.

Ir is not easy to say at what date or period of science, the eminences and various inequalities on the surface of the human skull first became particular objects of attention among medical men. They could not have escaped notice after the operation of trepan, or perforation of the cranium, when its fracture, or other diseases occasioning compression of the brain, had once been introduced; for, in that operation, such inequalities greatly increase its hazard, and call for the strictest attention from the most reckless practitioners. But the trepan, and these inequalities, were familiar to Hippocrates and to Aristotle, who wrote not very long after him, and beyond this period the history of medicine is obscured with fable. In the time of Celsus the attention to these inequalities of the cranial surface had not diminished. He warns us earnestly to attend to them, while delivering his minute precepts for the management of the trepan; he suggests that the prominence of the mastoid process is probably the reason why no hair grows on the scalp immediately behind the ears; and informs us expressly that the

lower part of the skull is made rough with tubercles in order to assist in its nutation. This he may be fairly supposed to have explained, by imagining that they afforded longer handles or levers, into which the muscles performing these motions might be inserted : but so much was the study of these protuberances neglected on the revival of letters, that there is no passage in all Celsus which has occasioned more dispute among his commentators; see Luchtman's Celsus, lib. vii. c. 1. Indeed, there is not much to be learned by them at any time, and Vesalius observing the superstitions that began to be attached to them in his day, did much to lessen their importance. The first Monro, Haller, and Albinus, showed that it is the soft parts that give form to the hard parts in contact with them, and not the hard that give form to the soft; a proposition easily deduced from the absorption naturally effected by the impetus of circulation, and which, consequently, becomes greatest in those tissues which are made to suffer all the shock of a lively circulation, but possess not an equally active reparative force to make restitution for the waste it occasions. Hence those projections on the surfaces of bones being found greatest where the muscular action had been most vehement, were generally imputed to this action alone; till the elegant ideas of Blumenbach on the nisus formativus and of Hunter on the diffused matter of life, brought reasonable men to see that the formation of all such parts is comprehended in the original design of the Author of the animal microcosm, and for the evolution of which, certain springs or forces have been impressed from the beginning upon the embryotic