479SYMMETRY OF DISEASE.

was designed, in the current number of

THELANCET.

We cordially congratulate both Mr.

CHURTON and the county on their victory.There must even be many members of the

profession of the law who, abandoning pre-judices and undue feelings of self-interest,would rejoice at the new advantage gainedto that important institution, the Coroner’s

Court, by this election.

ROYAL MEDICAL AND CHIRUR-GICAL SOCIETY.

Tuesday, December 14, 1841.

Dr. WILLIAMS, President.On the relation between the Symmetry and theDiseases of the Body. By JAMES PAGET,Esq., Demonstrator of Morbid Anatomyin St. Bartholomew’s Hospital.

THE author relates several cases in whichmorbid changes exactly similar in natureand extent were found on correspondingspots on the opposite sides of the body ; andargues from these and from the more nume-rous instances in which there exists a gene-ral similarity in the signs and results of dis-ease on the two sides of the body, or on cor-responding spots in each, that the law ofconstitutional diseases is to affect both sidesof the body equally and simultaneously. Heurges that although the exceptions to thislaw are more numerous than the observancesof it, yet since each of the latter involves acoincidence of two very delicate processes,such as could not often happen by chance,a few facts affirmative of the law shouldhave more force than a great number whichseem to negative it.

In explanation of symmetrical diseases, hesupposes that some depend on a disorder ofthe blood or nervous system affecting thenutrition of every part of the body ; others,on such a disorder of one or the other, asaffects their relation to the nutrition of onlyone tissue or pair of organs, or of only sym-metrical spots previously altered in a tissue ;and that others, which are connected withmetastasis, depend on a reflection of anormalnervous excitement at the nervous centres,from one set of nerves to those of the corre-sponding part on the other side of the body.

On Diseases which affect CorrespondingParts of the Body in a Symmetrical Manner.By WILLIAM BuDD, M.D., Bristol. Com-municated by Dr. BUDD.

The writer begins by stating that his atten-tion was first called to this subject by seve-

ral cases of rheumatic fever, in which, as thedisease passed into a chronic state, corre-sponding parts of the limbs became affectedin pairs, in such manner that the affectionsof the limbs of one side repeated itself inthose of the other, not merely with a generalcorrespondence of situation, but joint for

joint, bursa for bursa, sheath for sheath.These facts occurred to the writer in 1836

at the Middlesex Hospital. Soon after this,having seen in Bizot’s announcement thatthe atheromatous deposits of arteries are

likewise distributed in corresponding arte-ries in a perfectly symmetrical manner, Dr.Budd began to look out for instances of thesame fact in other diseases. These sooncame before him in great number and va-riety ; and in the course of a short time hewas enabled to ascertain that in most dis-eases of the skin, many diseases of the joints,in the disease of the arteries just alluded to ;in diseases of the eyes, ears, and many otherstructures ; in fact, that in a great numberand variety of diseases of constitutional ori-gin, the lesions peculiar to each affect cor-

responding parts of the body with altera-

tions, whose likeness in form and situationis often of the most singular exactness.Particular examples of this taken from aconsiderable variety of diseases were exhi-bited in a series of casts and drawings laidbefore the society in illustration of this paper.As this fact repeats itself in diseases dif-fering so widely in many other important re-spects, and especially in the aspect of theirlesions, and the nature of the textures in-

volved, the writer infers that it is a fact of

high order, and one which is justly entitledto the rank of a law.

In order to arrive at the true interpreta-tion of this law, he proceeds to inquire at

great length into the nature of the diseasesin which it occurs.The result of this inquiry leads him todivide all diseases of this kind into two prin-

cipal groups. *First. Diseases in which the morbidchanges depend on fault originating in thesolids affected ; and

Second. Those in which the lesions origi-nate in morbid states of the blood.As an extreme case, and a fit type of

changes originating in the former way, Dr.Budd refers to instances of monstrosity af-fecting corresponding parts of the body withexactly similar deformities ; and many otherexamples of the same fact in other forms arealso adduced.The second group is again divided into

two others.The first of these includes diseases inwhich the morbid state of the blood probablyconsists in deficiency of natural ingredients ;the second, those in which it depends on thepresence of morbid matters of special kindin that fluid.As a distinct example of the former, Dr.

480

Budd cites those cases in which ulceration likeness in form, composition, and structure.of the cornea comes on in man and animals, The writer then remarks, that, under thisfed on substances deficient in nitrogen ; ulce- view, the morbid matters of these diseasesration which almost always affects both eyes may be regarded as tests or measures ofin an exactly similar manner. The disease structural likeness, and calls the attentionnamed rickets is also mentioned as being of the society to many cases exhibited in theprobably another case in point. casts and drawings on the table, in whichThe second group, that in which the mor- lesions, exactly alike in form and nature,

bid state of the blood depends on the pre- repeated themselves not only in the samesence of foreign matters of special kind in situations in the limbs of the two sides, butthat fluid, includes a much larger number of also in corresponding parts of the upper anddiseases than either of the others. It is this lower extremities; thus giving, in deviationsgroup which has more especially engaged from the normal state, much curious andthe writer’s attention, and it is made the spe- novel illustration of those laws of symmetrycial subject of the subsequent remarks, and organic analogy, governing the evolu-Having entered into a great variety of tion of opposite regions of the frame, which

considerations, in order to prove that all the anatomists have already established on otherforms of disease of which examples are laid grounds. Having fully proved the verybefore the society fall under this description, general prevalence of a law of symmetry innamely, that all these are diseases which de- disease, the writer next considers the causespend on the presence of foreign matters of which may interfere with its manifestation.special kind in the blood, he then proceeds Three very influential causes of this kind areone step further, and endeavours to show, by recognised : these are, febrile movement,facts and inferences of various kind, that in local injury, or any other cause materiallyeach case the morbid matter peculiar to the affecting the organic state of a single part,disease which may be the object of regard and thereby determining morbid matters inis detained in the seat of each individual the blood to that part in preference to others;lesion, and is there held in affinity with the and, lastly, circumstances having presumedpart affected ; that being, in fact, the essen- relation to the amount of any given morbidtial condition of the origin of such lesion, matter present in the system.A case of eruption caused by the internal The disturbing influence of these several

use of the iodide of potassium, and distri- conditions is illustrated by numerous exam-buted over corresponding parts of the body ples; and it is then remarked that in effectin patches of exactly similar pattern ; the of these causes of interference, which are sopalsy of the wrists affect the same group of frequently in action, and perhaps of manymuscles in each forearm, which is caused by others less distinct to apprehension, nume-the presence and local action of lead ab- rous exceptions of the law of symmetry ne-sorhed into the system ; the detention of cessarily occur, even in those diseases themadder in the bones tinging corresponding most remarkable in general for the con-

bones with the same shade and arrangement stancy and perfectless of its manifestation.of colour, while all other textures are en- In consideration of the powerful disturbingtirely free from it, are cases cited as types of influence of the condition first mentioned, andthe group, and as offering distinct illustrations by observation of particular cases, the writerof both points of the theory maintained by has been led to adopt the following proposi-the writer, tion :-

In relation to this group, therefore, the That in diseases whose lesions have alaw now takes a more specific form, and re- tendency to symmetrical arrangement, thequires a distinct interpretation : for, accord- symmetry will be more perfect as the dis-

ing to these views, it is clear that the agency ease is more chronic in its progress, morewhich here determines the lesions to assume free from febrile movement and local vascu-a symmetrical arrangement, is, in fact, that lar excitement, and in its course and charac-which determines a given morbid matter in ter more nearly resembles the ordinary pro-the blood to fix on one particular part, in cesses of assimilation and in this the writerpreference to any other of the same structure ; finds a very remarkable confirmation of theso that a given part once affected, the mor- particular view he has taken of the nature ofbid matter not yet locally engaged is not the agencies concerned, in determining thefree to fix on this or that part, however like symmetrical arrangements of the lesion into the first in outward appearance, but is these cases.drawn to that very part on the opposite side The source, chemical character, and speci-ofthebody,which is symmetrical with, orana- fic nature of the morbid matter of the dis-logous to, the first. And this agency the eases treated of, are the next subjects consi-writer conceives to be the same, in virtue of dered. But on these abstruse and difficultwhich, in the ordinary exercise of assimila- topics the writer’s speculations becometion, corresponding parts of the body sepa- more vague, and are advanced with muchrate from the blood, and appropriate matters less confidence ; for these reasons, it is im-of identical composition and in equal measure, possible to give a correct view of them in anthus maintaining through life their original abstract.

481

After entering at considerable length intothis part of the subject, the writer concludesby relating a series of cases illustrating theviews developed in the former part of thepaper.

Dr. COPLAND said, that this " symmetryof diseased action" was only a new name fora principle that had been always acknow-ledged in medicine, viz., that if a depressionof the vital powers, a cachectic state of thesystem, or any other cause which affectedthe constitution generally, produced diseasein any organ which was double, the diseasewould be double likewise. He said that

fever, which Dr. Budd had spoken of as oneof the disturbing causes of this law of sym-metry, was itself, in fact, an instance of thisvery harmony, for we knew that if inflamedkidney, bronchitis, or pneumonia, occurred inthe course of fever, both kidneys or bothlungs would be affected.

Dr. GREGORY remarked, that so manydiseases appeared symmetrical, that he hadbeen most struck during the reading of thepapers with the diseases which were not so.The ophthalmia which followed small-poxscarcely ever affected more than one eye ;he thought that nature probably made an ex-ception to the law of symmetrical disease inthis case, because the eye was such a veryimportant organ. Gonorrhoeal ophthalmiawas always confined to one eye : he thoughtthat this was generally the case with gonor-rhoeal inflammation of the testicle.Mr. LLOYD had had three cases in St.

Bartholomew’s Hospital lately in whichboth testicles were affected.Dr. BARTLETT had had great experience

in gonorrhoeal testitis, and believed that theinflammation always attacked one testicleand then spread to the other.

Dr. BUDD called attention to a drawingof symmetrically-dropped hands from lead,and said, that lead was detected in the mus-cles of the forearm of this patient.Mr. CÆSAR HAWKINS inquired whether

lead had been searched for in the other muscles of the body ; and observed, that malig-nant diseases were an exception to this gene-ral symmetry of diseased action.Dr. BUDD answered, that the lead had not

been sought for anywhere else than in theforearm. Malignant diseases did not dependupon a chemical cause as did all those towhich he had alluded, and that therefore theywere not symmetrical.Mr. PAGET had recently met with some

cases of cancer and other malignant diseasesin which the two sides of the body wereequally affected in exactly correspondingparts, and he considered that these diseasesfollowed the law of symmetry, when therewas no disturbing cause. He was glad tofind Dr. Budd’s paper confirm his own in somany points.The PRESIDENT had recently found the

ergot of rye of great service in some cases of

palsy from lead in St. Thomas’s Hospital.He mentioned two or three cases in which ithad effected a cure after numerous other re-medies had failed ; he gave it in doses of tengrains three times a-day. He had neverseen it produce any unpleasant symptomswhatever, although one patient continued totake it every day for four months.On rising, the society adjourned until the

11th of January, 1842.

MEDICAL SOCIETY OF LONDON.

Monday, Dec. 13, 1841.

Dr. CLUTTERBUCK, President.CAUSE OF THE CONTRACTIONS OF THE UTERUS.

THE discussion on Dr. Alison’s interestingpaper has continued to occupy the societyfor two or three nights. We present theopinions of the different members at one

view, in preference to giving them in a seriesof reports.

Dr. MARSHALL HALL observed, that thesociety was much indebted to Dr. Alison forhaving so ably brought before them the inte-resting subject of his paper. It was diffi-cult to select from the many topics the authorhad discussed; it was the " embarras desrichesses;" but Dr. Hall would briefly noticeone or two. There could be no doubt thatthe action of the uterus in parturition was afunction of the spinal marrow, as distin-

guished from the cerebrum and the ganglia,the other subdivisions of the nervous system.M. Olivier had related a case of parturition,perfect in every respect, in a patient suffer-ing paraplegia ; the disease was one of hy-datid tumour compressing the spinal marrow,between the first and fourth dorsal vertebrae.M. Brachet had detailed a case of paraple-gia in which there was complete inertia orinexcitabilitv of the uterus. and thoughformer accouchements had been speedy, itwas in this case necessary to use the forceps.The seat of the disease was not mentioned,but he (Dr. H.) irnagined it must have beenso low in the lumbar region as to have inter-fered with the reflex uses of the incident andreflex nerves and the spinal marrow. Therewere several interesting facts which bore

upon this subject. In the common hen, anegg was deposited prematurely, if the borderof the cloaca were irritated by a few grainsof salt. If the tail of the turtle were sepa-rated from the rest of the body, togetherwiththe cloaca in the ordinary manner of thecook, and if the cloaca were distended withwater, this water gushed out on irritating theinteguments a little higher than the sphincters.The lower portion of the abdomen of thelibellula deposited eggs in the proper seasonon being shaken about on rough paper.There were cases on record of the humanfoetus born after the death of its parent, the