The Abdominal and Pelvic Brain
Byron Robinson, M. D.



The sympathetic nerve presides over rhythm, circulation, sensation,
absorption, secretion and respiration -- nutrition.

    The cloud capped towers, the gorgeous palaces, the solemn temples, the great globe itself, yea all which it inherits shall dissolve and, like the baseless fabric of a vision, leave not a wreck itself behind." -- William Shakespear's epitaph, written by his own hand, placed on his statue in Westminster Abbey.
    The sympathetic system of nerves was discovered by Claudius Galen, who was born 131 and died in 201 to 210 A. D. He lived first at Pergamos, and finally at Rome.  Galen considered that the sympathetic nerves acted as buttresses to strengthen themselves as they proceeded from their origin.  He studied them in animals and evidently did not know that the sympathetic nerves were a part of the cerebro-spinal system.  It appears that before his time the sympathetic ganglionic system of nerves was entirely unknown as to their function or nature.  Yet doubtless Aristotle viewed them many times in his dissections, and wondered what such white cords and nodules signified.  It appears that the Arabians had some ideas concerning the sympathetic system.
    Galen was the author of the dogma that the brain was the place of origin of the nerves of sensation, and the spinal cord of those of motion.  In general medical literature he has the credit of discovering the sympathetic nerve, and as Galen was a practical anatomist (learning his anatomy, however, almost exclusively from animals) he perhaps gave a quite accurate account of the sympathetic, and this became quoted, until he was finally announced to be its father and discoverer.  Galen gave correct views of the omentum and peritoneum.  He seems to have been quite well acquainted with the ganglia of the abdominal nerves.
    It is claimed that the sympathetic was known to the Hippocratic school. Hippocrates (460-370 B. C.), who practiced medicine at Athens, Greece, doubtless saw the sympathetic many times, at least in animals, but did not interpret its functions.  Yet he was one of the first to cast aside tradition, which, by the way still lingers, and to practice medicine on a basis of inductive reasoning, just as a carpenter takes careful measurements before building a house, or as a physicist studies astronomy.
    Erasistratus (340-280 B. C.) believed that all nerves arise from the brain and cord, but doubtless did not recognize the sympathetic nerves as such.  It appears, however, that he separated nerves into those of motion and sensation.  He studied particularly the shape and structure of the brain.
    Herophilus (800 B. C.), it appears, dissected more than all his predecessors, both in man and animals.  He was the first to distinguish nerves from tendons, which Aristotle confounded.  Herophilus gave the duodenum its name because it is twelve inches or finger breadths in length.  He, like Erasistratus, distinguished nerves of motion from those of sensation, and added a careful study of the brain.  We all remember his "Torcular Herophili, " or wine-press.
    Aristotle (384 B. C.), who widely dissected animals while instructing Alexander, the son of King Philip, no doubt saw the sympathetic system frequently, yet did not interpret its significance, for he confounded tendons and nerves.
    B. Eustachius, an Italian anatomist, who died in 1574, considered that the sympathetic nerves originated from the abducens or sixth cranial nerve.  It was not until the name of Thomas Willis (1622-1675), an English physician, appeared in anatomical records that the proper significance of the sympathetic nerves was recognized.  Willis looked on the sympathetic system of nerves as an appendage of the cerebrospinal system and represented them as growing from the cerebrospinal nerves.  Many neurologists hold the same opinion today as did the able Willis two hundred and fifty years ago.  He looked, upon the sympathetic nerves as, a kind of diverticula for the animal spirits received from the brain.  In 1660, while Sedleian professor of philosophy at Oxford, he described the chief ganglia.
    Rene Descartes (1569-1650) was one of the first to describe reflex movements from ganglia.
    R. Vieussens (1641-171), a French anatomist, wrote a work entitled "Neurograph" in 1684, in which he adopted the views of Willis, that the ganglionic nerves were appendages of the cerebrospinal system.
    Vieussens wrote of the ganglia of the solar plexus.
    Prochaska described the reflex channels.
    Duverney (1643-1730) discovered the ciliary ganglia.
    J.  M. Lancisus (1654-1720), an Italian anatomist, wrote a monograph on the sympathetic nerves, agreeing with the keen Willis as regards structure.  His monograph was entitled "Opera Omnia."         Lancisus looked upon the sympathetic nerves as a kind of forcing pump adapted to propel the animal spirits along the nerves.
    The senior Johann Friedrich Meckel (1714-1774), in his "Memories de Berlin," 1745, held views on the subject of the sympathetic nerves similar to those of Willis, as did also Johann Gotfried Zinn (1727-1759) in a publication in 1753.
    J.  B. Winslow (1669-1760), a Dane, professor of anatomy in Paris, insisted in his writings on the independence of the sympathetic nerves.  Since that time writers have wavered between the opinions of Winslow (independence) and Willis (dependence) in regard to the sympathetic nervous system.    Yet up to one hundred years ago actual physiologic and experimental data were quite limited.  Bichat, who widely influenced the anatomic world, vigorously proclaimed the independence of the sympathetic ganglia.
    Hoare wrote a publication in 1772 on the sympathetic system entitled "De Ganglia Nervorum."
Antoine Scarpa (1752-1832), the Italian anatomist of " Scarpa's Triangle" fame, wrote an essay on the sympathetic system entitled "De Nerv.  Gangl." in 1779.  This work of course contained the views of previous writers.
    Alexander Monro (Monro secundus, 1733-1817), a Scotch anatomist of Edinburgh University, published an essay "On the Structure and Function of the Nervous Ganglia," in 1783.  The later writers analyzed more in detail and generalized in a manner superior to that of previous writers, yet all agreed or disagreed with Willis or Winslow.
    Johann Friedrich Blumenbach (1752-1840), a German anatomist, in "Institutes of Physiology," published views on the sympathetic nerves in 1786.
    Francois Chaussier (1746-1828), a French surgeon and anatomist, wrote an "Exposition" of the sympathetic nerves in 18O7.
    In 1812 Le Gallois wrote "Sur le Principe de la Vie," containing views on the sympathetic nerve.
    In 1823 views of the sympathetic nerve appeared in Beclard's "El. d'Anat.  Gen."
Georges Cuvier (1769-1832), a famous French naturalist, espoused the doctrine of the independence of the sympathetic nervous system as published in his " Lecons d'Anat.  Comp., " 1799.
    Xavier Bichat (1771-1802), the master intellect of his day in Paris, professor of anatomy and physiology, the associate and rival of the priestly physician, Pinel, may be heard insisting with his accustomed eloquence upon the independence of the sympathetic nervous system, as noted in his "Sur la Vie et la Mort.," 1802.  Bichat represented all the ganglia of this system as the particular centers of organic life, that not only were all the ganglia collectively independent, but that each ganglion was independent of every other ganglion, that each nerve proceeding from such a ganglion was in a great measure independent from that ganglion, and even that each point of such a nerve was independent of all the rest and consisted of a distinct focus of nervous influence.  Bichat's influence is distinctly traceable through subsequent writings on the sympathetic system.
    Wilson Philip wrote "On the Vital Functions, " in 1817, analogous to the grand center of animal life.  He also held views referring to the sympathetic system.
    In Mason Good's work "On the Study of Medicine, " 1825, views are expressed in regard to the sympathetic nervous system.
    Writers on the sympathetic system became more numerous in the period subsequent to 1800.
    Richerand (Phys. 1804), and Gall (Anat. et Phys. du Syst.  Nerv., 1810), adopted tenets concerning the sympathetic nervous system similar to those of Bichat.
    Wurtzer in 1817 (De Corp. Hum.  Gang.) further inculcated Bichat's, Winslow's and Cuvier's views.
    Broussais, whose name is indelibly connected with inflammation - of the peritoneum as Bichat's is with establishing the independence of the sympathetic, describes a peculiar kind of sensibility or irritability belonging to the sympathetic nerves with which it immediately endows all organs destined for nutrition, secretion and the other organic functions, and, by means of its repeated connections with the cerebrospinal system, all organs of the body.
    Brachet, in his "Sur les Fonctions du Syst.  Nerv.  Gang.," 1823, in an especial manner, distinctly represents the ganglionic system of nerves as the seat of "imperceptible sensation" and as presiding in an especial manner over the several viscera of the body.  The author, though not acquainted with Richerand's and Bichat's views, worked out the same views from original studies and experiments, but added the idea that the abdominal brain (solar plexus) is the chief organizing center of the abdominal sympathetic.
    The preceding views are simply some of the chief landmarks in the progress of the evolutionary development of the knowledge of the sympathetic nerves, in the direction of their function and signification.
    The most significant names among the brilliant galaxy of students of the sympathetic nerves are Willis, Bichat, Cuvier, Winslow and Brechet.
    In 1835 articles on the sympathetic nerves began to appear from the pen of James George Davy, of London, England, which study and writing on the sympathetic he continued for about thirty years.  In 1858 the same author published a book "On the Ganglionic Nervous System." The work is composed of 109 pages, is interestingly written and contains about all the real knowledge of the subject up to that date (1858).  Davy claimed that much of his book was original, and doubtless this industrious worker produced many new views in thirty years of labor.  Yet Davy, as we view him forty years past, appears very honest in that he credits the gifted Bichat with so many original views and vast conceptions.  The writer can only hope that readers forty years hence will view this present little volume with similar candor and charity.
    Bichat's genius established in medical literature the sympathetic nerves under the names "organic and vegetative" system, because he saw analogies between the nerves which preside over viscera (and hence nutrition) and the life of plants.  He considered that the sympathetic nerves induce an animal to live, assimilate and nourish, induce circulation and excretion - in short to have an habitual succession of assimilation and excretion sufficient to preserve life's integrity  by a vital inherent process.  No effort was required of the animal - all was done in the so-called sub-conscious region, by what we might call today unconscious or imperceptible sensation.  It is especially the sub-conscious, the imperceptible traumatic insults of pathologic processes among viscera, which the writer will attempt to elucidate.
    Bichat paved the way for a more ready appreciation of the physiology of the sympathetic system.  Dr. Grant, a writer of some sixty years ago, said that "the sympathetic nerves, appropriated to the more slow and regular movements of organic life, form a more isolated system" (than the cerebrospinal).  It appears that Dr. John Fletcher wrote learnedly on the sympathetic system in h is "Rudiments of Physiology," published in 1837, for in May, 1853, Dr. Davy read an essay "On the Physiologic Uses of the Ganglionic Nervous System" before the London Medical Society, whereupon M. Walford, of Reading, addressed a curt note to Dr. Davy informing him, politely, that it was Dr. Fletcher who deserved the credit of "establishing on an immutable basis the function of the great sympathetic nerves." Davy very honestly relates how he sent a paper on the sympathetic nerve to the Lancet, but the editor not only rejected it, but did not return the manuscript.  This was in 1836.  The strife concerning priority in regard to views upon the divisions of the nervous system was very active some sixty years ago.  Among the participants might be named Marshall Hall, Robert Reid, Davy, Gall, Brechet, Blane, Mayo and others.  However, one and all bowed before the magnificent intellect of Bichat.  Bichat located the passions in the "epigastric center," and believed that they belong to the sympathetic nerves.  Bichat's opinion dominated medical ideas for three-quarters of a century after his death.  Buffon, Cabanis, Reil and Broussais, contemporaries of   Bichat, located the passions in "the Viscera of the Chest and Belly," or represented them as belonging to the ganglionic system of nerves.
    The labors of Morgagni and Petit (1827) should be mentioned, as well as those of Bergen (1731), Walter (1783), Huber (1774), Gerald (1754), Weber (1831), Rudolphi (1818), Lobstein (1823) (nerve tables), Manee (1828), Radcliff (1846), Hall (1847), Moses Gunn, inaugural thesis (1846), Robin (1847), Wagner (1847), and Axmann (1847).  Valentin, Kraus (1857), Bourgery (1845), Arnold (1826), Andersch, Haller, Wrisberg, Sommering, Remak, Muller, Lee (Frankenhauser, 1867), and Baker are but some of the many workers in the field of the sympathetic.
    Todd and Bowman named the solar plexus 'the abdominal sympathetic system" (1847).  Solly called the solar plexus "the center of the cyclo-ganglionic system" (1848).  There is little doubt that to Bichat is due the credit of originating the doctrine of the entirety and independence of the sympathetic nervous system.  Later writers, as Cuvier, Richerand, Gall, Wurtzer, Broussais, Brechet, Solly and Fletcher, have taught similar views.  Many older neurologists divided the nervous system into three distinct divisions, viz.: (a) cerebral, (b) spinal and (c) sympathetic.
    Led Gallois, a noted neurologist, taught that the spinal cord was the source of a part of the ganglionic nervous system, but Davy strenuously denies Led Gallois' assertion and remarks that the medical profession never acknowledged it.  About 1840 no less distinguished a person than Marshall Hall asserted that in the removal of the frog's viscera "every portion of the ganglionic system" would also be removed.  This showed lack of anatomical knowledge.  But by 1840 such writers as Cuvier, Solly, Bichat, Richerand, Wurtzer, Gall and Broussais claimed that every ganglion of the sympathetic was independent of the remainder and that each ganglion is a distinct focus of nervous influence.  It was Broussais (the founder of the idea of independent peritoneal inflammation) who claimed that the ganglia presided over the viscera and their functions.
    Prochaska and John Hunter asserted that the ganglia of the sympathetic nervous system generate and control nervous power.  Any one can witness this fact by separating a frog from its heart.  The heart will beat for hours alone.  The cerebrospinal nerves together perform the animal functions which prove us to be feeling and thinking and willing beings.
    The ganglionic system of nerves, with the abdominal brain as their central organ, performs the vital functions, which are independent of mind and present to us the idea of life.  The sympathetic system of nerves presides over the viscera-over secretion, nutrition, gestation, expulsion, respiration and circulation; over sub-conscious phenomena.
    Muller, Bayly, Rolando, Akermann, Blumenbach and Gall agreed to the following views (by 1840), viz.: The sympathetic system of nerves of the chest and abdomen are fully formed while the brain is yet a pulpy mass.  Now, these ganglia of the sympathetic would hardly be formed before the brain and cord if it were not for the sake of the organs which they supply and rule.  Besides, it may be added that the sympathetic controls the viscera, which are as perfect at birth as in the adult.  But the mind and brain are very slowly perfected.  The priority of the sympathetic nerves over the cerebrospinal is evident and signifies their import in the continuance of the vital forces of life.  Babies are born alive with no brains.  Dr. Ball, of Ohio, writes me that he found one baby fully formed without even a medulla oblongata.  Marshall Hall records that a fetus was born "without either a brain or spinal marrow, without a particle of either of those organs, yet perfectly developed."     Blumenbach furnishes an equal example, when he says, "In fetuses without brain or spinal marrow the circulation, nutrition. secretion, etc., proceed equally as in others, who, besides spinal marrow, nerves and ganglionic nervous system, possess a brain."
    Children are born quite well developed without the vestige of a cerebrospinal system, - only possessing a sympathetic system.  It might be argued that often these children originally possessed a cerebrospinal system, but that through pressure, as hydrocephalic conditions, the fluid had pressed the nerve-cells out of existence.  Yet this does not explain all the cases.
    In 1872 there appeared one of the best and most reliable books on the sympathetic system of nerves up to that date.  The authors are Guttmann and Eulenberg.  It was translated from the German into the English in 1878 by Dr. C. Napier.  This work was based on physiologic and pathologic labors.  It was for this essay of Eulenberg and Guttmann that the Astley Cooper Prize for 1877 was originally awarded - a decision which was subsequently overthrown, however, on the technical ground that the essay was the work of two authors and not one only, as the terms of Sir Ashley Cooper would seem to require.
    In 1802 William Hunter presented the nerves of the uterus.  The Osianders, father and son, also did similar work in 1808-1818.  Tiedemann (1822) made valuable observations on uterine nerves.  Lobstein, in 1823, produced excellent views on the sympathetic.  He carefully described the various plexuses by the names we now give them.
    In 1839 Robert Lee gave some good descriptions of the sympathetic uterine nerves, as also Snow Beck (1845) with Clay, Goetz, Schlem, Swan 1846), Killian (1834) and Lambell (1841).
In 1867 a most excellent work was published by Dr. F. Frankenhauser, entitled: "The Nerves of the Uterus." It contains finely executed tables of the sympathetic nerves of the abdomen.
    The sympathetic nervous system is shown to be supremely evident when we note the body nourished, the viscera perfected and the bony structures finished, without a brain or cord, and still more evident when we observe the finely balanced circulation, delicate absorption and secretion, in full and perfect operation for nearly a year without a cord or brain - only a sympathetic nervous system to rule.  Should the main-spring of life, the abdominal brain, solar ganglion, cease its activity, then life itself disappears.  The sympathetic nerves carry on life's functions during sleep, like the additional spring to a watch which enables it to go while being wound.
    By 1850 the physician had not lost sight of the fact that the sympathetic nerve, being so intimately associated with the vital action of every viscus, could become involved in disease.  For the past fifty years the pathology of the sympathetic has been studied. In the work of Davy may be found numerous diseases attributed to the sympathetic.  Dr. Marshall Hall stated that: "The ganglionic system is that power under which all formation, all nutrition, all absorption and all secretions are performed; therefore, that being affected may affect different acts."
     The opinions of men famous, though dead, still prevail.  Bidder produced a celebrated article, in Muller's Archives for Physiology, in 1844, entitled: "Experience over the Functional Independence of the Sympathetic as the Center of Motion and Sensation for all the Vegetative Organs." Volkmann assumed the same views as Bidder in his well-known article: "The Independence of the Sympathetic Nervous System Demonstrated through Anatomical Investigations" (1842).  Prof.  Albert V. Ko1liker, of Wurtzbur, who is now celebrating his fifty-year jubilee as a medical teacher, assumed an intermediate ground between Bidder and Volkmann, when in 1845 he wrote his article entitled, "The Independence and Dependence of the Sympathetic Nervous System Demonstrated by Anatomical Observation." Budge in 1864 gave some reliable data in regard to the nerves of the bladder, in Henle's and Pfeufer's "Landschrift fur national Medicin, " as did also Gianozzi in 1863.
     The history of the developmental knowledge of the sympathetic is not complete without the names of Schiff, Henle, Ludwig, Heffer and especially the often-quoted experiments of Nasse found in his article: "Lecture on the Physiology of Bowel Motion," Leipsic, 1866.  Henle stated, in 1840, that the peristalsis of the intestines was due to ganglia scattered among the intestinal nerves.  Brown-Sequard, Pickford, Remak (1864), Jastrowitz (1857,) Rochefontaine, Tarchanoff, Pflueger, Bernard, Golz and Knoll aided in the building of the present knowledge of the sympathetic.
     In 1860 DuBois-Reymond inferred that migraine was due to the influence of the cervical part of the sympathetic, i.e., it produced a kind of tetanic contraction of the vessels, showing the influence of the sympathetic over vessels. He styled it Hemicrania sympathetica atonica. Cruveilhier and Aran are credited with discovering muscular atrophy, but Charles Bell (1832) gives several cases.  Bell places muscular atrophy under the domain of the sympathetic.  Parry (1825) discovered a group of symptoms which we now call exophthalmic goiter (Graves' or Basedow's disease) which many place in the field of the sympathetic nerve.  The three great symptoms are (a) cardiac palpitation, (b) goiter and (c) finally exophthalmos.  Basedow (1840) claimed to have first described the disease, but the priority of Graves is now universally known.Angina Pectoris, described by Heberden in 1768, is considered by many as caused by the sympathetic nerves, especially the three cervical ganglia and the cardiac plexuses.  Addison's disease is placed by some in the field of the sympathetic.
    In 1783 Walter presented the best tables of the sympathetic nerves up to his day.  It appears that Walter was the first who represented in his cuts the cervico-uterine ganglia, i.e., lateral ganglia of the uterus.
    The above authors discuss in a very instructive method the various diseases of the sympathetic and attempt to establish, as far as possible, the physiologic, anatomic and pathologic limits of the domain of the sympathetic nerves.  Especially interesting and valuable, though unfortunately limited, are the discussions upon the abdominal parts of the sympathetic.
    Eulenberg and Guttmann discuss as belonging to the domain of the sympathetic system, the following diseases:

1.    Functional disturbances, especially those due to irritation and paralysis.
2.    Unilateral Hyperidrosis (perspiration),
3.    Hemicrania (neuralgia).
4.    Glaucoma (Neuro-retinitis, ophthalmia, neuro-paralytica).
5.    Progressive Facial Hemiatrophy.
6.    Progressive Muscular Atrophy.
7.    Exophthalmic Goiter (Basedow's or Graves' disease).
8.    Angina Pectoris (steno-cardia).
9.    Addison's disease (bronzed skin).
10.  Diabetes Mellitus.
11.  Hyperesthesias of the sympathetic system:
    (a)   Enteralgia, enterodynia, colic.
    (b)   Neuralgia celiaca.
    (c)   Neuralgia hypergastrica.
    (d)   Neuralgia spermatica (ovarica).
12. Anesthesias of the sympathetic system (not well established).
13. Sympathetic paralysis and spasmodic affections of voluntary muscles.  Reflex paralysis, diphtheritic paralysis, tabes dorsalis (locomotor ataxia,  progressive).  The above thirteen classes of disease discussed as belonging to the domain of the sympathetic nerves have remained a more or less constant quantity with writers on the sympathetic nerve.  However, some writers add, others subtract, while still others change the names of the above diseases.  The subject is in a state of progress.
    In 1867 Griesinger began investigations on the "Pathology of the Sympathetic." Griesinger's enthusiasm stimulated two physicians, Dr. Paul Guttmann and Dr. Albert Eulenberg, to produce one of the best and most reliable books on the pathology of the sympathetic based on physiologic grounds ever published.  Griesinger's good work and enthusiasm were productive of practical results; for his remarkable words, that "our positive knowledge of the pathology of the sympathetic should be again collected by skilled hands," induced his scholars, Eulenberg and Guttmann, to study and write their prize book on the sympathetic nerves.
     In 1876 a very learned and a very instructive essay appeared from the pen of Dr. Sigmund Mayer, entitled, "Die Peripherische Nerven Zellen und das Sympathetische Nerven System." Dr. Mayer was full five years engaged in the work in his microscopical laboratory and presented many interesting ideas and some of the most suggestive drawings of the nerves and cells.  The essay represents many new views and vast labors.
     In 1881 there appeared the "Fisk Fund Prize Essay," Rhode Island Medical Society-"The Sympathetic Nerve; its Relation to Diseases," by C. V. Chapin, M. D. This is a valuable essay, as it gives many authorities and references which enable us to enlarge our knowledge of this nerve.  Dr. Chapin has sifted out the theoretical and practical knowledge of the nerve quite well.  Chapin has but little deviation from the classification of the diseases which belong to the sympathetic of Eulenberg and Guttmann.  An epitome of Chapin's book would be, that it is a record of opinions on the sympathetic nerve skillfully collected and arranged in a scholarly manner.
    In 1885 Dr. W. H. Gaskell published the results of some excellent labor on the sympathetic system of nerves.  One of the best was entitled: "The Structure, Distribution and Function of Nerves which Innervate the Visceral and Vascular Systems.  " Dr. Gaskell noted some of the following points:

    1.  The visceral nerves issue from the central nervous system in definite sacral, thoracic and     cervico-cranial regions.
    2.  From the above regions the visceral nerves pass through the ganglia into the visceral system.
    3.  From the sacral region they pass in a single stream to the ganglia of the collateral chain.
    4.  From the thoracic region they pass in a double stream, one to the ganglia of the lateral chain, the other to the ganglia of the collateral chain.
    5.  From the upper cervical region they pass in a single stream to the ganglia on the main stem of the vagus and glosso-pharyngeal nerves.
    Gaskell's labors on the sympathetic are of far-reaching value and their utility has been recognized by being copied very generally, and even in detail, in the best modern works on physiology.
    Rauber did some excellent work on the sympathetic, and his labor is recognized by Quain's latest edition borrowing one of his cuts.
    In 1885 Dr. Edward Long Fox published a well-written and very instructive book on "The Influence of the Sympathetic on Disease." This is the most comprehensive of late books on the sympathetic.  He widens the influence of the sympathetic in the domain of disease beyond that laid down by Eulenberg and Guttmann.  He includes insomnia, neurasthenia, pigmentation, myxedema and neuroses of the extremities -symmetrical gangrene.  The writer can highly recommend Dr. Fox's book as instructive and valuable.  Articles of merit and value on the sympathetic nerves have appeared with increasing frequency during the past ten years.
    In 1877 Gubler described a morbid symptom of the peritoneum relate to the sympathetic system.  He called it peritonismus.  He included pain, meteorismus in various degrees, hiccough, vomiting, rapid pulse, cyanosis, lowering of the temperature, cerebral symptoms of great activity, depression of mental powers and decrease of amount of urine.  The nerves of the heart are affected.  This aggregate of symptoms Gubler designated by the word peritonismus.  The abdominal surgeon only too frequently sees this clinical picture, but it is doubtful how much is gained by designating it as peritonismus.


 (A.) Macroscopic.

    From the stately rhythm and periodic peristalsis of the uterus in labor, the early observer must have been impressed with the nerves governing the genitals.  However, from the unfortunate dogma of the church, the light of knowledge of anatomy and physiology was denied mankind by prohibiting human dissection.  So far as I have been able to note almost all observations on the nerves of the genitals (uterus), previous to the fifteenth century, were almost valueless.
    Among the first names I find in literature referring to the nerves of the uterus is that of A. Vesallus, a Belgian by birth, professor of anatomy at the famous school of Padua, Italy.  He was born in 1514 and died in 1564.  Vesalius made the general statement (partly false and partly true) that the cervix was supplied by the sacral nerves (spinal) while the fundus was supplied by the sympathetic.
This view of Vesalius generally prevailed for two centuries and was practically confirmed by the following famed eponymic names on anatomy: Eustachius (died 1574), - Reignier de Graaf (1641-1673), Thomas Willis (1622-1675), Albert Haller (1708 -1777), Johann G. Walter (1734 -1818).  With investigation (anatomic and physiologic), and lapse of time, views changed, especially among the French, English and Germans.  Definite records of dissection and observation on the nerves of the tractus genitalis (uterus) begin to accumulate in literature.
    Eustachius, an Italian anatomist of Eustachian tube fame, published at Amsterdam in 1722 Tabulae, Anatomicae.  Eustachius described the nerves connecting the lumbar ganglia with the hypogastric plexus, which in union with branches from the sacral nerves arrived at the side of the uterus.
    Reignier de Graaf, a Dutch anatomist of Graffian follicle fame, published at Amsterdam in 1705 " Opera Omnia.  " He dissected and pursued the nerves to the uterus, ovary, oviduct and ligamentum latum.  The presentations are schematic and description crude.
    Thomas Willis, an English anatomist and philosopher of Circle of Willis fame, published at Geneva in 1680 "Cerebri Nervoru que Descriptio." Willis first described the course of the ovarian nerves, though defectively.  He styled the solar plexus, cerebrum abdominale.
    Albert Haller, a Swiss anatomist of multiple eponymic fame, published at Lausanne in 1778 Elementa Physiologiae.  He limited the origin of the ovarian nerves to the plexus renales and lateral sympathetic chain only.  This error was repeated by Tiedemann in his 1822 publication.  He left no illustration.
    R.  Vieussens (1641-1716), a French anatomist of multiple eponymic fame (the ganglion of Vieussens-solar plexus), left a rough presentation of the sympathetic.
    Johann Gottlieb Walter, a German anatomist of coccygeal ganglion" fame, published at Berlin in 1783 tabulae nerv.  Thoracis et Abdominis.  He presents several excellent copper-plate tables of the thoracic and abdominal nerves, which have become famous for accurateness and careful preparation.  To 1875 Walter's tables were the best presentation of the sympathetic, especially the best and most accurate in their presentation of the sympathetic nerves supplying the female tractus genitalis.  Walter's tables are not schematic but naturally correct, excelling the later much-lauded tables of Tiedemann (1822).  It is the first presentation of the tractus genitalis in its natural position and in connection with the pelvic and abdominal viscera.  Unfortunately the plexus aorticus and especially the plexus hypogastricus is incompletely presented.   Also the course of the nerves in the uterus and ovary is not indicated.  Walter was the first who presented a ganglion on the lateral borders of the cervix uteri.  Hence these nerve masses or nodes should be known by the eponym "Walter's cervico-uterine ganglion." Walter's plates of the sympathetic are superior to those of Tiedemann but are not so well known.  It is a rare book.
    William Hunter (1718-1783), the celebrated English obstetrician, published an atlas on the nerves of the pregnant human uterus which is a noteworthy work.  I could find no presentation of the uterine nerves originating from the sacral nerves in the atlas.  Hunter asserted that the uterine nerves all rise from the intercostal, that they assume the same course as the blood vessels and that therefore on each side will occur a plexus spermaticus and plexus hypogastricus.  A plexus springs from the ganglion semilunare and while it passes to uterus is strengthened by branches from the intercostals.  The plexus aorticus emits nerves to the plexus renalis, which gives origin to the plexus spermaticus.  The plexus aorticus divides into two nervi hypogastrici, distal to the aortic bifurcation.  Each hypogastric nerve divides into a dorsal branch supplying the rectum and a ventral branch which follows the arteria uterina to supply the uterus.  The greatest number of nerve branches tend toward the cervix uteri, according to Hunter.  He believed that the uterine nerves increased in dimension during gestation, furnishing no proof by specimen however.
    John Hunter (1728-1793), the famous brother of William Hunter, asserted that its nerves did not increase in dimension during gestation, also adding no proof by specimen.  William Hunter shows sympathetic nerves supplying the cervix, corpus and fundus uteri.  Previously and subsequently to Hunter's time it was a widespread dogma that the sympathetic nerve supplied corpus and fundus uteri only-not the cervix uteri.
    Johann Friedrich Osiander (son, 1787-1855), obstetrician at Gottingen, published a prize essay in 1808 on Nerves of the Uterus, noting that he believed that nerves were present in the uterus but could not detect them.
    Friedrich Benjamin Osiander (father, 1759-1822), obstetrician at Gottingen, inventor of uterine traction forceps, asserted in his Handbook of Obstetrics, 1818, that he doubted if any man had seen nerves in the uterus.
    Friedricus Tiedemann (1781-1861), German professor of anatomy in Heidelberg from 1816 to 1844, published in Heidelberg in 1822 Tabulae Nervorum Uteri, which has become extensively and favorably known, many times copied, and prized as the best presentation of the nerves of the uterus in connection and with the natural position of the viscera.  Tiedemann's plates are schematic, defective and inferior to those of Walter - his predecessor by thirty-seven years.  Tiedemann's plates, like Walter's and Hunter's, are the most imperfect in presenting the relations of the sacral nerves to the hypogastric plexus and uterus.  Tiedemann advocated that the nerves of the uterus were enlarged during gestation and atrophied during senescence.
     J. G. C. F. M. Lobstein (1777-1815), a French anatomist and obstetrician at Strassburg published at Paris in 1823 nervi sympathetici Humani Fabrici, etc. Lobstein accentuated the plexus mesentericus superior and inferior.  He practically denied the existence of the plexus spermaticus.
My observation of Lobstein's book on the sympathetic induces me to think that he obscured and retarded its knowledge rather than advanced it.  For fifty years, to 1875, no special work appeared on the nerves of the tractus of the female.  The general assertion for half a century, on whose authority I know not, was that the sacral nerves supplied the cervix and the sympathetic the body and fundus.  In 1839, in an atlas to the book of Frances Joseph Moreau (1789-1862) entitled Traite pratique des accouchemans, appeared a new illustration of the nerves of the pregnant uterus after J. M. Jacquemier (1806-1879).  It is schematic, defective, imitates Tiedemann's plates and their errors and adds practically nothing new.
    From 1838 to 1846 occurred the fierce polemic on the nerves of the uterus between Robert Lee and Snow Beck, chiefly found in the Philosophical Transactions.  Robert Lee (1793-1877), an English obstetrician, physician to the British Lying-In Hospital, published several papers on the nerves of the uterus from 1838 to 1846.  Lee claimed to find under the perimetrium several nerve plexuses which were connected with the ovarian and hypogastric plexuses as well as the sacral nerves.  Since Lee produced no convincing evidence, no microscopic demonstration as regards the cellular structure of the claimed nervous ganglia, suspicion arose among his colleagues (especially Snow Beck) that he had mistaken elastic fibres, connective or muscular tissue of the uterus for nerve plexuses.  Lee was an Englishman of typical vigor, possessing the spirit of progress and was not easily turned aside by adverse criticism of opposing colleagues.  He said the processes which he had held for nerves branched with the arteries of the uterus, a fact which, according to Lee, occurred nowhere with elastic or muscular tissue.  By an industrious prosecution of his dissecting labors he rediscovered in 1841, Walter's cervico-uterine ganglion (of 1783) and proved it a constant structure.
    Lee's Monograph, the anatomy of the nerves of the uterus, 1841, lies before me.  It is an excellent labor by an earnest investigator.  It contains two plates some 10xlO inches illustrating the dissected nerves and ganglia of two pregnant uteri, one in the sixth and the other in the ninth months of gestation.  Lee said, in short, that his dissections prove that the uterus possesses a great system of nerves, that they enlarge with gestation and return to the original condition subsequent to parturition.
Also, if the nerves of the uterus could not be demonstrated to exist, its physiology and pathology would be completely inexplicable.  Lee repeatedly demonstrated the cervico-uterine ganglion in the pregnant and non-pregnant uterus.  He showed that the plexus hypogastricus ended in the great cervico-uterine ganglion, which he claimed was composed of six or seven smaller unit--d by nerve strands and located on the lateral border of the cervix uteri.  He noted that the branches of the second and third sacral nerves entered the cervical ganglion.  Lee located a ganglion at the junction of the uterus and the oviduct.  He also located a subperitoneal ganglion on the dorsum of the corpus uteri and one on the ventrum of the corpus uteri of the extensive surface dimension.  These subperitoneal ganglia, according to Lee's illustrations, extend over large surface areas of the corpus uteri and stand in connection with the hypogastric plexus and cervico-uterine ganglion.     Modern investigations, especially by the aid of the microscope, demonstrate that Lee's extensive subperitoneal ganglion do not exist.  Later in Lee's dissecting labors he had Dalrymple make microscopic sections of the nerve plexuses which confirmed their nervous structure, but no mention is made of a microscopic examination to confirm the nervous structure of the uterine ganglia.  Robert Lee located three vesical ganglia, viz: (a), external vesical ganglia; (b), middle and (c), external vesical ganglia.  Later he described but two internal and external vesical ganglia.  Dr. Robert Lee made valuable additions to the literature of the nerves of the uterus.  His labors aroused vigorous opponents and valuable polemics by which was instigated extensive additional researches.  He rediscovered Walter's cervico-uterine ganglion, hence, the memory of this earnest investigation should be entitled to the eponym, " Lee's cervico-uterine ganglion."
    T. Snow Beck, an English anatomist, published in 1846 in the Philosophical Transactions, several investigations concerning the nerves of the uterus, which were almost a complete negation of Lee's views.  Snow Beck claimed that Lee's cervico-uterine ganglion was merely a mass of connective tissue containing a few small ganglion cells, that it was due to the union of the branches of the sacral nerves and hypogastric plexus.  He similarly disposed of Lee's other uterine ganglia.  Snow Beck gave detailed descriptions of the uterine nerves, adding some illustrations which contain numerous errors.  He, like Lee, had prepared the specimens on the extirpated genitals-not while they were in situ.  This insured confusion in non-accuracy and supposed schematism.
    In 1894 I advocated that the ganglionated mass located at the lateral border of the uterus should be termed the pelvic brain (cerebrium pelvicum).
    T. Snow Beck introduced the term pelvic plexus, which is the result of the union of the branches of the sacral nerves second, third and fourth with the distal end of the hypogastric plexus.  Secondary to Snow Beck the second sacral nerve sends one branch to the pelvic plexus, the third sends 12 or 13, the fourth, 5 or 6. Small ganglia are distributed over the pelvic plexus, which sends nerves to the bladder, vagina (10 to 12) and rectum but not to the uterus.  T. Snow Beck indicates that many of the uterine nerves are very fine, threadlike and without plexiform character.  T. Snow Beck's illustrations are obscure, the descriptions contradictory, and doubtless prepared after being extirpated from the body, which increased the errors.  He denied the claim of Robert Lee that the uterine nerves enlarged in dimensions during gestation.  T. Snow Beck's iconoclastic negation of Lee's conclusions in regard to the nerves and ganglia of the female genitals served rather as a sample of medical polemic of those times than to enhance knowledge.  The work of Clay, 1845, and that of Swann, 1846, The Physiology of the Nerves of the Uterus, were not to me accessible, but since I find nowhere citations from them perhaps they contain nothing new.
    Antoine Joseph Jobert (de Lamballe) (170-1867), a French anatomist and surgeon, published in 1841 in Comptes Rendus de Science de I' Academie, T XII, No. 20, his Researches sur la Disposition des Nerfs de I' uteres.  His illustrations are faulty and his work adds little new data.  Jobert announces that no nerves penetrate the portia vaginalis uteri.
    Ludwig Moritz Hirschfield (1804-1876), professor of anatomy at Paris and Warsaw, and Jean Baptiste Francoise, Leville (1769-1829), French anatomist, published in 1853 Neurologic des Cript et Icongraphic du System Nerveaux.  The same illustrations are employed in the Atlas of Savage, 1863.  The illustrations are not clear and visceral positions with nerve relations are incorrect.
     Ferdinand Frankenhauser (died 1894), a German obstetrician, published at Jena in 1867 Die nerven der Gebaermutter.  This book is excellent, accurate, comprehensive, unique and instructive.  Though a book of 82 pages only, it is a monument of industry for all time.  His descriptions are accurate. his illustrations are according to Nature.  I am indebted to Dr. Frankenhauser for his labors in the sympathetic nerves, especially those of the tractus genitalis.  His honor is admirable in crediting justly to every author his share in the developmental knowledge of the sympathetic nerves.  Other authors have labored in the microscopical field of the sympathetic nerve but space forbids further mention.

(B.) Microscopic.

    Reliable microscopical examinations of the nerves of the tractus genitalis are limited in number and separated by long intervals.  Microscopic anatomy began about 1850.  W. M. Hunter (1805), Robert Lee (1846) and Fr.  Tiedemann (1822) claimed that the uterine nerves increased in dimension during gestation.  John Hunter, the brother of William Hunter, denied that the nerves enlarge during gestation, that the thickening was due to multiplication of the connective tissue.
    Herman Friedrich Kilian (1800-1863), a German obstetrician, published in 1851 in the Zeitschrift fur rationelle medicin, a work Die Nerven des Uterus, which founded for all time the microscopic structure of the uterine nerves.  Kilian attempted to determine which part of the uterus was supplied by sympathetic and which by spinal nerves by the aid of the microscope.  He claimed that both sympathetic and spinal nerves supplied all parts of the uterus, but sympathetic nerves only were found in ovarian plexuses.  He claimed that the cervix is richer in nerves than the body.  Ganglion cells lie nowhere in the uterus.  Kilian announced an age relation of uterine nerves.  During pueritas the nerves were limited in number and dimension.  During adolescence the number increased.  During gestation the number and dimension were marked.  During senescence the nerves became lessened in number and dimension.  Kilian concerned himself with: (a) the origin of the uterine nerves; (b) the changes experienced by a nerve passing through the uterus; (c) the age relations.  Frankenhauser of Jena in 1864, Koerner of Breslau in 1864, Kehrer of Giessen in 1864, Polle of Gottingen in l865, Frey, 1867, and Kolliker (1817-living) and Koch (1843 - living,) in 1865 published  accounts of ganglia on the uterine nerves (in addition to the cervico-uterine ganglion).  To 1867 little was added to the great work of Kilian except ganglia on the uterine nerves and special nerve ending in the uterus.   We have thus finished a very limited and meager sketch of the sympathetic nerve.  Vast numbers of worthy names and workers have not been mentioned for want of space.  However, a few of the landmarks in the development of the knowledge of the sympathetic nerves have been noted, from Galen, its discoverer, to the present time.  The sympathetic nerve has long been an unknown field as to facts.  Our knowledge of the nerve is still incomplete and will be for some time to come.
    To the scholar and investigator the steps by which knowledge is gained are not only interesting but of value for further progress.

     Fig. 1.  It presents a general view.  1 and 2, abdominal brain.  B represents the pelvic brain or ganglion cervicale.  Observe the profound and intimate connection between the abdominal brain (1 and 2) and the pelvic brain (B) by means of the plexus aorticus (10 and 12) and plexus hypogastricus (H).  Note the lateral chain of the sympathetic ganglia from the cervical ganglia (1) to the last sacral ganglion (S G).  1 and 2, abdominal brain, is the major assembling point of the plexuses of the abdomen.  Observe the plexus aorticus with its multiple ganglia and two lateral cords extending from the abdominal brain (1 and 2) to the bifurcation of the aorta.  Next note the hypogastric plexus, beginning at the aortic bifurcation and ending practically in the pelvic brain (B).  H, the hypogastric ganglion is a coalesced, unpaired organ.  The major sympathetic ganglia are located at the origin of arteries, hence every abdominal visceral artery has at its origin a definite ganglion.  In drawing the pelvic brain suggestions of Frankenhauser were employed.  The dissection was performed under alcohol.