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



Every thoracic and abdominal organ has its own rhythm (peristalsis).

A little knowledge is a dangerous thing. - Lord Bacon.

    The original investigations of the sympathetic nervous system, in both humans and animals, upon which this work is founded, were begun in 1887, and have been carried on quite steadily since.  The works of Fox, Cbapin, Gaskell, Eulenberg and Guttmann, Patterson, Robert Lee, Lobstein, SnowBeck, Rauber and Frankenhauser have been carefully studied.  A number of physiologies, as well as some fifty anatomies, were searched.  One hundred human cadavers have been dissected with reference to the sympathetic system and also among the lower animals, those of the rodents and solipeds - cow, calf, pig, dog, fish, bird, frog, rabbit, rat and sheep.  The dissections have comprised in addition a considerable number of embryos, human and animal.  The results of this work demonstrate that the ganglia of the sympathetic nerve are much larger in the lower animals than in man.  That is, as the scale of animal life ascends, the sympathetic system proportionately decreases, while the cerebro-spinal system proportionately enlarges.  In short the higher the life the more dominant the cerebro-spinal system, and the lower the life the more dominant the sympathetic system.
    In mammals there exist two brains of almost equal importance to the individual and also to the race: One is the cranial brain, the instrument of mental progress and physical protection; the other is the abdominal brain, the instrument of nutrition and visceral rhythm.  To the casual observer the cranial cerebrum seems to overshadow all other nervous centers.  The anterior brain of mammals, situated in the skull, is so manifest to the practitioner that it seems to do all the business of the nervous system.  It is true that the knot of life is situated at the base of the cranial brain, and by one prick of a bodkin in the medulla, life may be quickly extinguished.  Yet a derangement of the abdominal brain destroys life as effectually, though not so quickly.  A study of the abdominal brain brings to light views which are both important and practical.  In the cranial brain resides the consciousness of right and wrong.  Here is the seat of all progress, mental or moral, and in it lies the instinct to protect life and the fear of death.  But in the abdomen there exists a brain of wonderful powers.  It presides over organic life.  Its great functions are two - nutrition and visceral rhythm.  In this abdominal brain are repeated all the physiological and pathological manifestations of nutrition and rhythm of viscera.  It controls nourishment and secretion.  It initiates, sustains and prohibits rhythm.  It receives sensations and transmits motion.  It is an automatic nervous center.  It is a physiological and anatomical brain.  In short, it is a nervous ganglion; only a ganglion possesses rhythmical power.
The abdominal brain is situated around the root of the celiac axis and superior mesenteric artery.  It lies just behind the stomach, consists of a blended meshwork of nervous ganglia, and is made up of the union of the splanchnics, the two pneumogastrics and the right phrenic.
    There is a difference between the right and left abdominal brain.  The left is more closely packed together; it is retort-shaped, chiefly consists of a large, solid ganglion and is apparently an expansion of the lower end of the left splanchnic nerve and is larger than the right.  The right half of the abdominal brain is more of a meshwork than the left; it is perforated with numerous apertures, in short, is flatter and wider than its fellow.  I am convinced that its flatness is due to the pressure of the inferior vena cava.
    The abdominal brain really consists of two ganglia.  These two ganglia are sometimes called semilunar, but I never saw one of such shape.  The two ganglia are united by cords at the foot of the celiac axis and are known as the solar or epigastric plexus.  This abdominal brain lying along the aorta just behind the stomach is a silent power in assimilation and rhythmical movements, unless some organ is deranged.  Observations of the disturbance of visceral functions in women who were the subjects of pelvic disease led me to follow the work.
    Disease of the viscera is likely to disturb the two great functions of the abdominal brain: nutrition and rhythm.  The abdominal brain distributes its branches to all the vascular system - artery, vein and lymphatic.  The branches of nerves will sometimes surround the artery like a sheath or pass along its parallel strands.  In short, the branches of the sympathetic nerves are carried to all parts of the economy on the walls of the blood-vessels.  The caliber of the blood-vessels, especially the smaller ones, is controlled by these fine strands of nerves.  They may produce by their action the scarlet flush (capillary dilatation) of the cheek, or the marble paleness (capillary contraction) of fright.  Several years ago, from experiments on the pregnant uterus of slaughtered cows, I became thoroughly convinced that the sympathetic nerve is the cause of rhythm, while the cerebro-spinal nerves prohibit rhythm.  It is evident that the rhythmical waves in the fundus and body of the uterus are entirely due to the sympathetic, which almost alone supplies it.  The sober stillness and non-rhythmical motion of the uterine neck is due to the excessive supply of spinal nerves.  The order from the cranial brain for motion is active, direct and reflex, subsiding after action.  But the order from the abdominal brain is rhythmical, and the rhythmical movements play on all vessels and hollow organs, on the circulatory apparatus and the viscera.
    The abdominal brain presides likewise over the glandular system.  Here it holds the balance of power between normal blood-tissues and substances to be excreted.  The abdominal brain controls secretion.  The orders which it sends out to each gland, however, must be reorganized in each separate viscus, i.e.,  in the periphery of the nerves.  The orders to the liver are manifest in the products of bile, glycogen and urea.  The forces sent to the digestive tract from the abdominal brain are obvious from the secretion of the digestive fluids, from the mouth to the rectum.  The sympathetic system holds the glandular system as a unit, e. g., when the ovarian gland is injured or removed, inflammation may arise in the parotid gland.  And mumps and parotitis may be accompanied by orchitis.  The rhythm of glands, such as the liver and spleen, is possible from their elastic capsules.  The orders from the abdominal brain to the digestive glands may become so violent that Auerbach's plexus throws the muscle of the intestine into rigid contraction, and Meissner's plexus may secrete so rapidly that an active diarrhea may arise in a few minutes.  It has been observed that herds of cattle on a ship have been attacked with diarrhea five minutes after the boat was put in motion.  The abdominal brain was suddenly disturbed.  The sweat-glands may be irritated so violently that the entire body becomes suddenly bathed ifi perspiration.  Much execution may be done by inhibiting the sweat-centers.
    Excessive or deficient gland secretion, then, depends on the abdominal brain and its principal machines.  The gynecologist sees wonderful rhythmical movement in the generative apparatus, and he must refer this to the orders of the abdominal brain.  The oviducts and ovaries pass through rhythmical circles due to nervous bulbs situated in their walls.  I named and wrote of these as "automatic menstrual ganglia," several years ago.  The ganglia of the oviduct and uterus which cause the monthly rhythm are entitled to due respect, as well as the peripheral digestive and cardiac ganglia.  Again, there is a mechanism called the vasomotor center, which distributes itself in the medulla and along the spinal cord.  If the abdominal brain is disturbed the vasomotor center becomes deranged and the skin will be waxy pale or scarlet red.  Under this category come the cold, white hands and feet of women, and the flushes and flashes at the menopause.  In some patients I have seen the neck and face show variations of color like that in a revolving electric light.  The wave of redness will gradually pass over one side of the face and neck, and as it slowly disappears (two to four minutes), the paleness which follows is of a marble whiteness.  Then the other side of the face shows that its capillaries go through a slow rhythm of dilatation and contraction.  In ten minutes all the rhythm is over and the nervous, pale face again appears.
Uterine hemorrhage from a myoma is reflex and accomplished by the sympathetic system.  The bleeding is due to loss of tone in the vessels of the endometrium.  The irritation starts in the mucous membrane of the uterus and passes up to the abdominal brain, where the force is reorganized and sent to the vasomotor centers of the medulla and cord.  Now, a continuous irritation soon disarranges a center and the vasomotors sooner or later lose the power to control the blood-vessels of the endometrium and become deficient in tone.  It may be frequently observed that in a myomatons condition the tone of the vessels in the endometrium is restored and the bleeding ceases for a time, only to be renewed on exhausting irritation.  Hence, we consider hemorrhage from a myomatous uterus as reflex.  It consists in irritation followed, through reflex action, by vasomotor paralysis, which harbors congestion.  We note, then, that the abdominal brain presides over significant organs in man.  It controls the forces which hold man's body intact.  It has a very subtle way of enforcing chemistry to subserve its ends.
    A general summary of the abdominal brain is that (a) it presides over nutrition; (b) it controls circulation; (c) it controls gland secretion; (d) it presides over the organs of generation; (e) it influences in a dominant, though not an absolute, control its peripheral visceral automatic ganglia.
Each of the above will again be discussed.
    The ideal nervous system is: (1) a ganglion cell; (2) a conducting cord; (3) a periphery.  The sympathetic nervous system possesses all three in an eminent degree.  The abdominal brain represents the central ganglion cell.  Its thousands of distributing and communicating fibers represent the conducting cord.  The various ganglionic machines located in each viscus represent the periphery.
    In regard to the independence of the sympathetic nerve we wish to say that it is not entirely independent in action, but it may be insisted that it has certain amount of independence which is very manifest in rhythmical motion.  The dependence and independence of the (a) cerebro-spinal axis; (b) the abdominal brain and (c) the automatic visceral ganglia may be illustrated by (1) the federal government; (2) the state government and (3) the city or county government.
    The cerebro-spinal axis typifies the federal government, and is endowed with the chief rule of the animal.  It is the central power and all others must submit to it.  It is, moreover, to a large extent, under the will as far as motion is concerned.
    The abdominal brain is the state government.  In fact, it exercises many functions almost entirely independent.  The abdominal brain sends its physiologic orders to all the visceral ganglia.  If healthy, all obey, but disturbing pathologic changes cause some to stop, or act irregularly.
    The automatic visceral ganglia situated in each organ represent the county or city government.  The city, or county, government, is free from neither state nor federal government, but still it has normal independence which it freely exercises.  The same views may be illustrated by society and labor in general where division of labor exists, and where certain sections exercise almost independent rights.  Thus the sympathetic nervous system may be considered to be independent to, a certain degree.
    After a large number of dissections on man and animals I find that the ganglionic system of the female is larger and more marked than that of the male.  Females seem to have more distinct ganglia and more marked conducting cords.  I have not investigated the peripheral nerve supply sufficiently, so far, to render any opinion.  I have found the abdominal brain and ganglia relatively larger in animals than in man.  The abdominal brain is very large in the dog, in proportion to his cranial brain.  Man's cranial brain has grown relatively faster than his abdominal brain, and I think man suffers more from malnutrition than do the animals, so that he pays dearly for his superior cranial brain power.  Besides, it appears that man's abdominal brain (and superior cervical ganglion) is very liable to deteriorate with age.  Disease is very apt to arise in the above ganglia after forty years of age.  Perhaps no animal suffers so much from indigestion as man and so far as I know he has not only the smallest abdominal brain, but it is attacked the most severely with disease.  The latest researches seem to show that the sympathetic nervous system originates by sprouting from the ganglia on the posterior roots of the spinal nerves.  Some believe that the sympathetic nerve originated from the adrenal.  Some points relative to the sympathetic nerve and the suprarenal capsules are quite obscure.
    The distribution of the sympathetic nerve is peculiar.  It consists of three great parts:
    1.  There exists a double lateral chain of ganglia lying on each side of the vertebral column and extending from the skull to the coccyx.  The ganglia correspond generally in number to the vertebral except in the neck, where the seven are blended into three.  The ganglia, no doubt, represent the original segmentation of the body.  Now, the lateral chain of sympathetic ganglia is connected with the cranial nerves, and with the spinal nerves.  It is strongly connected with the cranial nerves, and also very intimately connected to each side of the vertebral columns, out of the way of pressure.  A notable feature in regard to the lateral chain of the sympathetic is that it is very intimately connected with the cranial nerves, and also very intimately connected with the sacral nerves.  In other words, it blends at the ends very closely with spinal and cranial nerves, but is less intimately associated in the middle with the spinal nerves.  The best way to demonstrate the sympathetic system in the human is to place an embryo or fetus in alcohol and then open the thoracic and abdominal cavities, when the chain can be easily observed through the pleura and peritoneum.  The sympathetic nervous system is relatively much larger in the fetus than in the adult.  In a dog just killed one can see the sympathetic nerves through the pleura very easily and they can be observed also through the peritoneum.
    2.  The second part of the sympathetic consists of four great plexuses of nerves, situated anterior to the vertebrae, called prevertebral plexuses.  One of the pharyngeal, situated around the larynx.  Another is the cardiac and pulmonary plexus.  A third is the solar or epigastric plexus, situated around the coeliac axis and superior mesenteric artery.  The ganglia in the solar plexus are what I am calling the abdominal brain.  A fourth plexus lies in the pelvis, and is distributed to the generative and urinary organs and rectum.
    3.  The third part of the sympathetic consists of the peculiar mechanism at the ends of the nerves situated in each viscus.  It is termed the peripheral apparatus.  In a diagnostic sense the peripheral apparatus is the most important to the physician, as he can often only make his diagnosis by the manifestation of the disturbances of the periphery of a nerve in a viscus: e. g., in dyspepsia, Auerbach's and Meissner's plexus may be wrong; in jaundice the automatic hepatic plexus may be wrong, and bile, glycogen and urea fail in proper quantity.  It is well to remember that there are three more or less distinct splanchnics distributed in the viscera.
    The splanchnics are the inhibitory nerves of the viscera, e.g., of sensation, motion and vasomotor action.  We note the following distribution:
    1.  There are the cervical splanchnics, which arise in the cord from the first cervical to the fourth dorsal.  These splanchnic nerves mainly reach the viscera (heart, stomach, etc.) by traveling up the cervical portion of the spinal accessory and then passing down the vagus (especially the right).
    2.  The second splanchnics arise in the cord from the second dorsal to the second lumbar and pass through the rami communicantes to the three or four abdominal splanchnics, whence they pass to the abdominal brain.  These govern the vascular area of the intestines, etc.
    3.  There is also a third set of these nerves, called the pelvic splanchnics.  They pass from the cord by way of the second and third sacral nerves and do not enter the lateral chain, but pass to the hypogastric and thus supply the genitals.
    From the origin of these three great splanchnics (cervical, abdominal and pelvic), it is clear why irritation or a blister on the lower part of the back of the neck is so effective in dispelling visceral disturbances The blister inhibits the vasomotor centers and thus soon rights the vascular disturbances in the viscera.
    The three splanchnics control the vasomotor region of the viscera.  It may be considered that the sympathetic nerve is endowed with sensation and motion.  But the sensation is dull in the sympathetic, and its motion is rhythmical.  But the utility of the sympathetic in the animal economy is not fully settled.  The reason is, that experiments on this nerve are not perfectly decisive, and also because it is so intimately blended with the cerebrospinal nerves.  But some study has convinced me that it plays a large role in chronic or remote uterine disease, and that is what has called out this paper.  The sympathetic nerve produces involuntary movements.  It is called the ganglionic nerve, from the tendency to the formation of ganglia, or knots along its course.  In using the term, "abdominal brain," I mean to convey the idea that it is endowed with the high powers and phenomena of a great nervous center; that it can organize, multiply and diminish forces.  The views which I wish to bring forward concern the periphery of the abdominal brain, or the mechanism found in each viscus.  I mean by viscera those organs contained in the chest and abdomen.
    During the investigation of the sympathetic I selected a spare female cadaver, that of a woman about thirty years of age, amputated the thighs close to the body, and then placed it in full strength alcohol.  For nearly two years I dissected on this cadaver, as I found time, and finally, after tedious labor, dissected out all the visible sympathetic nerves which lay on the dorsal region, in both chest and abdomen, returning the cadaver to the alcohol when not using it.  I then secured a skilled artist, who worked on the drawing of the sympathetic nerve about five weeks, sketching it as nearly according to nature as it was possible, and exactly life size.  The most important portions of the nerve are represented in the cuts accompanying this work.
    Before discussing other subjects I wish to make a few remarks on three exaggerated ganglia of the sympathetic nerve, viz. : the cervical, the abdominal and the pelvic.  It is easy to dissect out the cervical, and especially the large upper cervical, which is about one and one-half inches long.  It is very variable and appears to shrink a little with age, after forty.
    The middle cervical is often so small that it is difficult to expose.  The lower cervical is often difficult to dissect and isolate on account of complicated relations, and also because it is so widely spread out, so fenestrated and because its parts vary so much.  The abdominal brain is quite easy to isolate, especially in a fresh cadaver.  The best way to dissect and expose it well, without mutilating the body badly, is to tear through the ligamentum gastrocoelicum and pass to the coeliac axis.  Then, with a forceps, clear away the tissue just above the middle of the upper border of the pancreas, i.e., at the right and left of the coeliac axis.
    In searching for the abdominal brain it is best to strike for the entering great splanchnic nerve and then follow it to the side of each ganglion.  On the left will be found a large retort-shaped solid ganglion of a pinkish gray color.  On the right of the coeliac axis is found a wide, flattened, much fenestrated ganglion.  Both are well supplied with blood, The most difficult great ganglion to isolate and expose in a natural condition is the uterine ganglion or pelvic brain.  It is very large, much fenestrated, quite flattened and richly attached to the second and third sacral (spinal) nerves.  It is situated close to the neck of the uterus and sends numerous nerves to this organ and the bladder. It requires much uninterrupted leisure to isolate the pelvic brain and such efforts are almost always a failure in fat subjects.  The cause of this difficulty in isolating the pelvic brain lies in the fact that it is whiter than the other great ganglia and more like the surrounding connective tissue, with which it is intimately blended and in which it is imbedded; also because it is so much flattened out.  Probably more disputes have arisen over the cervico-uterine ganglion than any other in the body.  However, the cut of the pelvic brain, here presented, the author considers quite close to nature.
    In each of the viscera are found small nervous ganglia scattered through the organ, or the nervous bulbs are gathered in distinct localities of the viscus, as in the heart or digestive tract.  Now it may be understood that these little ganglia found in the organs have the power to maintain movements to some extent.  These peripheral ganglia may be looked upon as little brains which are capable of developing nerve force and communicating it to the organs without the aid of the cerebro-spinal axis.  They can multiply or diminish nerve force, which is sent to a viscus where they exist.  Diseases of any viscus or disturbance of its rhythm must be due to them or to abnormal forces passing through them, arising from the abdominal brain.  Again, the rhythm and function of a viscus are involuntary, i.e., beyond control of the will.  They are automatic nerve centers placed in the viscus in order to isolate it from the control of man's mind.  These little brains induce the viscera to perform their functions independent of the state of mind. They exclude the mind from speculating on the viscus so far as regards function.  The will cannot induce the ganglia to do two years' work in one, or one year's work in two.  The peripheral ganglia of every viscus assumes its own time of rhythm.  The ganglia of each viscus rise to a maximum and sink to a minimum according to their own law of existence.  They go through a rhythmical movement, a peculiar cycle.  There are explosions of nervous energy from the ganglia during regular periods of time.  For example, the heart ganglia thus explode a little oftener than once a second, while those of the oviducts and uterus explode once a month.  They are automatic visceral ganglia.
    We will consider the peripheral apparatus of the heart, lungs, uterus and oviducts, liver, spleen, kidneys, bladder and digestive tract.  A study of the ganglia in each organ will enable one to diagnose disease in the said viscus.
    1.  The peripheral ganglia have been well studied and some of the more important ganglia of the heart substance have received definite names.  The little brains in the heart are called automatic cardiac ganglia.  They are named the automatic centers of Remak, Bidder, Ludwig and Schmidt.  These are simply some of the more important automatic motor centers of the heart.  In many experiments on dogs I have repeatedly satisfied myself that the automatic cardiac ganglia are mainly aggregated in the auricles and auricular-ventricular septum.  Wherever the automatic motor centers are located in the heart anyone can satisfy himself that these ganglia excite and maintain the rhythm of the heart.  The frog's heart can be kept in rhythmical motion by stimulation in warm salt water for hours after it has been removed from the body.  A few experiments on animals will soon convince one that the peripheral ganglia of the sympathetic nerve located in the heart are a very significant apparatus as regards the cardiac functions.  The disturbance of the heart's rhythm by uterine disease is what we shall attempt to demonstrate in its appropriate place.  The most striking peripheral apparatus of the sympathetic nerve is found in the heart.  Its rhythm is so perfect, its cycle is so apparent and its explosion so manifest, that men sought its origin outside the cerebrum.  The dominating influences of the automatic motor-centers on the heart are shown by the idea that in the living fetus, without brain or spinal cord, the heart keeps up its rhythmic beat.  In such fetuses the heart ganglia are well developed.  One-half of the spinal cord has been removed in pigeons without disturbing the cardiac beat.  Besides, the inferior cervical ganglion has very intimate connections with the great ganglion of Wrisberg.
    2.  The peripheral apparatus of the sympathetic nerve is very prominent in the digestive tract.  The digestive tract consists of a muscular and a glandular apparatus.  The muscular apparatus of the digestive tract consists of  a  longitudinal and a circular layer, and between these two muscular layers lies a system of nervous ganglia known as Auerbach's plexus.  Auerbach's plexus is the peripheral apparatus that induces muscular movements in the gastro-intestinal passage.  These little brains lying between the muscular layers are the cause of intestinal peristalsis or vermicular movements of the bowels.  Undue stimulation of Auerbach's plexus causes colic, and insufficient stimulation is followed by constipation - a muscular paresis.  An insufficient activity in Auerbach's plexus induces a kind of ileus paralyticus.
    Just under the mucous membrane of the digestive tract there lies a still more delicate system of nerve ganglia called Meissner's plexus.  Dr. D. D. Bishop, late histologist to Rush Medical College, has prepared for me very beautiful specimens of Auerbach's and Meissner's plexus from dogs, by the gold-staining method.  These plexuses preside over the production of the secretions of the gastrointestinal passage.  The office of these little brains is really to control glandular secretion.  They induce the secretion of digestive fluids.  They assume the office of regulating the proper amount of fluids to digest the various foods, which office requires a nice balance.  Hence, Auerbach's and Meissner's plexuses are the distinct and marked peripheral apparatuses of the digestive tract.  Now these little brains, situated in the intestinal wall, have an action quite independent of the cerebro-spinal axis.  I have often chloroformed a dog and then watched the intestines perform their peristalsis after being tapped with a scalpel.  If the dog is kept in a warm room, the intestine will go through its peristaltic motion for an hour and a half after death.  The peristalsis will be strong and very marked.  Half an hour after death, it will be so strong that the circular muscles of the intestine will contract so as to look like pale white cords, or bands, around the intestine.  Auerbach’s and Meissner's plexuses are what induce rhythm in the bowel.  The presence of food, of course, gives the occasion for rhythm.  Hence, we must look to the peripheral nervous apparatus of the digestive tract when colic, indigestion, diarrhea and constipation arise, for these little brains induce motion and secretion in the bowel.  Of course they are under the physiological and anatomical orders of the abdominal brain - a higher central organism.  The pathology of Meissner's plexus is shown in (a) deficient secretion, (b) excessive secretion and (c) disproportionate secretion; that of Auerbach's, in paralysis or contraction (colic).
    3.  The peripheral nervous apparatus of the generative organs is located along the oviducts and uterus.  I named these fifteen years ago, "automatic menstrual ganglia." These ganglia can easily be demonstrated by taking a fresh oviduct from the abdomen and putting it in warm salt water.  If the oviduct is teased and stimulated it will go through a peristaltic motion for half an hour.  It is easy to observe the longitudinal muscles of the oviduct elongate and contract, still easier to watch the circular muscles of the oviduct contract and dilate.  I have made this experiment often enough in men and animals to be thoroughly satisfied of the existence of the peripheral ganglia in the oviducts and uterus.
    The automatic menstrual ganglia have a monthly rhythm.  They rise to the maximum and sink to the minimum every four weeks.  The ganglia exist in the uterus, and I have found the proof of this to be most easily demonstrated in the pregnant uterus of slaughtered cows, where my attention was first directed to the matter.  Anyone can witness it in a slaughter-house.  When a well-advanced pregnant uterus of a cow is cut off between the body and the internal os, a most wonderful rhythmic phenomenon is observed.  The cow may have been dead half an hour, yet the two muscular layers of the uterus can be seen to act separately and vigorously.  At one time the circular muscles will contract vigorously, and then the longitudinal muscular fibers will contract with equal vigor.  Then, again, both the layers will work harmoniously together.  The irregular action of the muscular layer is due to the irregular traumatic stimulus applied to the uterus.  The rhythmical motion applies only to the oviducts and uterus.  The neck of the uterus does not go through rhythmical motion, because it is highly supplied by sacral spinal nerves.  The spinal nerves prohibit rhythm.
    The sympathetic nerves which supply the neck do try to make rhythm, but the spinal nerves to the neck predominate and sober down all rhythm.  Hence, the predominating spinal nerve-supply holds the neck in sober, quiet subjection and allows no such wavy rhythm as goes on continually in the pregnant uterus.  In this idea lies a great principle in gynecology.
    The neck of the uterus acts as its guard when pregnant.  The waves of its rhythm may dash and sport as they choose, yet the neck stands on sober guard and permits no expulsion of the contents.  The neck is never prepared for an abortion, but stands like an unmoved sentinel, so that no storm-waves of the uterus can drive out its contents or allow foreign invasion.  The offices of neck and uterus are quite different.  The neck has a different blood supply, a different nerve supply, a different muscular supply, and a distinct mucous membrane.  It keeps out foreigners and prevents desertion.  The nerve supply of the ovary is mainly from the ovarian sympathetic, but as I have so far been unable to determine the rhythm of ovulation, I will investigate that later.  Suffice it to say that menstruation and ovulation, so far as I have studied, are different processes, and hence have a different rhythm.  The menstrual rhythm is a matter belonging entirely to the monthly movements of the oviducts and uterus.  Menstruation might be called oviductal motion or the rhythmic effect of the action of the automatic menstrual ganglia.  The menstrual rhythm is an occasional process of the uterus and oviducts, but ovulation is a constant process of the ovaries, whose distinct rhythm is yet to be determined.  So far I have been utterly unable to determine the age and duration of the life of a Graafian follicle, for I have seen ovulation in unborn babes and in women of seventy.  I have examined pigs, cows and sheep and found that all ovulated before birth.  Ovulation continues from before birth until the ovarian tissue is worn out.
    I assume, then, that the peripheral nerve apparatus in the organs of generation is a distinct affair, which I designated fifteen years ago as the "automatic menstrual ganglia." Its mechanism is such as to subserve the function of reproduction through a peculiar rhythm.  The monthly rhythm in pregnancy is held in abeyance on account of the direction of energy to fetal nutrition.  The derangement of the function of the automatic meristrlal ganglia will engage our attention later.  Any disturbance in these ganglia gives us a clue to the diagnosis of the disease.
    We will term the small nerve bulbs situated in the walls of the bladder the automatic vesicular ganglia.  The peripheral nervous apparatus located in the bladder is markedly sympathetic, and hence will, like other viscera, have its rhythm.  The rhythm of the bladder is its contraction and dilatation.  It has a diastole and systole.  Its rhythm is, to some extent, lost sight of, because the diastole is so much longer than the systole.  It requires hours for the diastole to complete itself, while the systole may be completed in a few minutes or less.  But the rhythm of other viscera, as the heart, is not dissimilar.  The heart has a diastole and a systole, and the diastole of the ventricle is two-tenths of a second longer than the systole.  The diastolic wave of the heart is the time when the heart gets its rest - physiologically and anatomically.  The bladder has just as much rhythm as the heart, only it is not so strikingly manifested.  The bladder gets an effectual rest during its long diastole.  By careful dissection of a goodly number of bodies it can be clearly seen that the third sacral nerve of each side sends quite large branches to the bladder.  The fourth sacral nerve also sends branches to the bladder.  Under such circumstances the bladder is highly supplied with spinal sacral nerves, which would sober down the rhythm and prevent it as much as possible.  The sacral spinal nerves distributed to the bladder go mainly to the neck, while the sympathetic mainly supply the fundus - the rhythmical portion.
    This rhythm is easily demonstrated by taking the bladder from an ox and filling it with fluid.  The contraction of its muscular wall will soon change the shape and gradually expel its contents.  The neck of the bladder is more supplied with sacral spinal nerves than the body.  In short, the great nerve center of the bladder is in the trigone.  Hence, in pregnancy the disturbance in the bladder is due to the uterus dragging on the neck of the bladder where its sensitive (spinal) nerves exist.  The female bladder is capable of retaining urine longer than the male bladder, as the neck of the former is not so fixed and hence is not dragged on as much when filling.  The neck of the male bladder is fixed with the prostatic capsule, and when filled drags more or less on a fixed neck and so irritates the attending nerves.  The peripheral ganglia of the bladder are mainly distributed to the fundus and body.  The diastole of the bladder during sleep is prolonged on account of the quietude of the sympathetic.  The peripheral ganglia in the bladder, the automatic vesical ganglia, have not received much study so far.
    4.  The peripheral nervous apparatus of the lung I have not especially investigated.  That the lungs have an established rhythm is plain, which no doubt is maintained by the ganglia situated in their substance.  The peripheral ganglia should be called the automatic pulmonary ganglia.  No doubt there also exists a conjoined cerebro-spinal center.
    5.  The peripheral nervous apparatus of the liver may not at first sight seem manifest.  But the liver is enormously supplied by the sympathetic, the nerve of rhythm.  The liver is a gland, and one who has made a study of the peripheral ends of the sympathetic will have noticed that where it ends in muscular organs the ganglia are large and manifest.  But when it ends in glands it forms a fine and delicate plexus of nerves.  In the liver, the ganglia are less apparent than the plexus which follows the fine vessels all through the liver.  The caliber of these small vessels is subject to dilatation and contraction-rhythm.  Every visceral organ during activity is in a state of vascular congestion - a condition of turgescence or enlargement.  The surrounding of each viscus in the abdomen is such that it can be rapidly enlarged during its functional activity, and it returns to normal without loss of integrity.  Now, the rhythm of the liver consists of its enlargement during functional activity and its return to normal during rest.  The rhythm of the liver is made possible by (a) the elasticity of the peritoneum which surrounds it; (b) by its surrounding elastic capsule; (c) by the elastic tissue in Glisson's capsule which surrounds the vessels throughout the liver, and (d) by the dilatability of the blood vessels.
    Hence, the liver gland is capable of enlargement and contraction - rhythm - from the possession of elastic tissue, and by engorgement.  When the liver is functionally active it becomes turgescent, or engorged, and its envelopes or capsules expand from elastic properties.  When the liver goes through its active rhythm its vascular excitement attracts large quantities of fluid, from which it makes bile, glycogen and urea; it then returns to its normal condition because the elastic capsule forces the newly-formed products through the tubules to be employed in digestion.  The liver in its quiet, reduced form gets self-repair.  Thus the liver goes through its rhythm of enlargement (functional activity) and of ontraction (self-repair, rest).  The occasion of a rhythm of a liver is food in the digestive tract.  It is the derangement of the rhythm of the liver by uterine disease which we will call attention to later.  The derangement of the liver rhythm will change the three great functions of the gland, which are to make bile, glycogen and urea.  The derangement is brought about by disturbing the equilibrium of the abdominal brain.  We will term the peripheral nerve apparatus in the liver the automatic hepatic ganglia.  The derangement of these is manifested by (a) a deficient secretion (bile, glycogen and urea); (b) excessive secretion, and (c) by disproportionate secretion, especially the last.
    6.  The spleen has a peripheral nervous apparatus which enables it to do its duty in a rhythmic wave.  In the case of the spleen the elastic capsule, to which is added involuntary muscular fibers, enables the organ to enlarge during functional activity and then to be reduced by elastic pressure to its normal size.  Engorgement and elasticity are the two elements which aid to complete the rhythm of the spleen.
    Vascular excitement, with dilatations and turgescence, characterizes the functional activity and enlargement of the spleen.  Its capsule expands.  Contraction of the elastic capsule and muscle fiber in it characterizes the reduction of the spleen.  Its rhythm is made up of its active enlargement end its passive reduction.  In the maximum stage of the rhythm, the spleen performs its functions, and in the minimum stage it gets its rest and self-repair.  A curious feature is added to the spleen in the form of a tortuous artery.  The object of this spiral artery must be to withstand sudden motion or enlargement, for when the spleen is large the artery is just as spiral as it is in the enlarged uterus.  But it may be that the tortuous artery allows a greater flow of blood.  Hence, the spleen performs its rhythm from the  peripheral nervous apparatus situated in its substance.  The occasion of its rhythm must be the same as that of the stomach and liver - fresh food.  We will term this nervous apparatus the automatic splenic ganglia.
    7.  The same reasoning applies to the rhythmic functions of the pancreas and kidney, and also, probably, to the ovary.  They come under the law of vascular engorgement and elastic capsule, which enable the automatic peripheral ganglia to produce and sustain a rhythm.  We thus have the automatic renal, and also the automatic pancreatic, ganglia.
    (1)  We have tried to establish the view that the abdominal brain is the great nerve center of the abdominal viscera and perhaps of the thoracic viscera; (2) that it is the cause of visceral rhythm; (3) that each viscus has its own automatic peripheral ganglia or plexuses in the organ; (4) that the duration of the rhythm of each viscus is determined by the mechanism of the automatic ganglia situated in the organ.
    The rock and base view maintained in this book is, that the abdominal brain is a reorganizing nerve center - a brain, a cerebrum.  The abdominal brain is capable of reception, reorganization and emission of nerve forces involving the life of viscera (which consists of rhythm, absorption and secretion).  The emission of nerve forces will travel as a maximum to organs possessing the greatest number of nerve strands, e.g., the genitals, kidney, heart and stomach, and as a minimum to organs possessing the least number of nerve strands.
    Having planted our orchard we will examine its fruits.  We now come to the application of these views to the subject of disease.  Disease of any of the viscera will very often be preceded by some derangement of their rhythm, absorption or secretion.  The common functions of viscera are peristalsis (rhythm), absorption and secretion - all dominated by the sympathetic nerve, i.e., the abdominal brain.  To the common functions of viscera (peristalsis, absorption and secretion) must be added, in the genital tract, ovulation, gestation and menstruation.
    The two great factors in visceral diseases, so far as regards the sympathetic nerve, are (1) impaired nutrition, and (2) reflex action, referred pain or disturbance.  An important central point around which much of the abdominal sympathetic turns is the female generative organs.  They are the one cog in the wheel which makes the watch keep defective time.
    The pathology of the sympathic nerve is not so distinctly settled as that of the cerebro-spinal. (1) The most significant pathology of the sympathetic is reflex irritation, referred disturbance. (2) Pigmentation and sclerosis.  The origin of the pigmentation is primarily in the spleen and liver.  Pregnancies, menstruation (periodic congestion), fever (malarial), etc., etc., are accompanied by pigmentation.  This may be due to a diseased state of the blood.  It is more frequently due to reflex irritation from the distant organs.  Some consider violent emotion as a cause of pigmentation, but it is likely that it refers to some unrecognized lesion.  (3) The third kind of pathology of the sympathetic would be lesions secondary to those of the cerebro-spinal system. (4) The fourth would be recognized and nonrecognized lesions of the sympathetic.  I have not space here to discuss these interesting and wide pathological fields, but simply mention them.
    Disturbances in the Digestive Tract from Uterine Changes. - In this case we have immediate and remote troubles as regards time.  The chronic uterine disease will produce remote malnutrition and remote reflex changes.  In these cases I mean diseases of the entire, or part of the generative apparatus - pudenda, vagina, especially the uterus, oviducts and ovaries.  Take, for example, a case where the digestive tract is deranged on account of pregnancy.  In the first place the vomiting arises from trauma, stretching on the uterine nerves by an expanding foreign body (contents) and, the dragging of the neck of the uterus on the neck of the bladder.  This dragging or pressure on the neck of the bladder disturbs the spinal and sympathetic nerves massed there. The irritation is carried up the hypogastric plexus to the abdominal brain.  When the irritation arrives at the abdominal brain the forces are reorganized and sent out on the various nerve plexuses which radiate from this nerve center.  If the force is emitted along the gastric plexus, which is liable to happen on account of its large size, the stomach receiving sympathetic nerves from the three branches of the celiac axis, the stomach will suffer and vomiting is likely to occur.  Now, in the troubles of the stomach resulting from reflex disturbances from the uterus by way of the hypogastric plexus, it may be considered that the stomach is affected in two distinct parts; (a) its muscular wall (Auerbach's plexus), (b) its glandular or secretary apparatus (Meissner's plexus).  When the irritation from the generative organs travels up the hypogastric and ovarian plexuses to the abdominal brain it is then reorganized and emitted along the gastric plexus to the automatic gastric ganglia, known as Auerbach's plexus.  It affects Auerbach's plexus first because it first meets it in the muscles.  The result of irritation of Auerbach's plexus is irregular action of the muscles of the stomach - nausea or vomiting.  When the irritation goes farther along the gastric plexus it meets Meissner's plexus, which lies just beneath the mucous membrane, and controls gastric secretion.  If Meissner's plexus is considerably irritated it may cause excessive or deficient secretion of the fluids, or the fluids may be secreted in disproportionate quantities.  The result will be indigestion and fermentation, causing the development of gases.
    The reflex irritation from the uterus may be of such a nature that Auerbach's plexus may be insufficiently stimulated, causing paresis of stomach wall, or that Meissner's plexus is so little stimulated that it will not secrete sufficient gastric fluids.  But the track of the nervous irritation is definite from the generative organs, through the hypogastric plexus, to the abdominal brain, where it is reorganized and emitted to the various viscera.  This is the interpretation of the old story that uterine disease creates stomach trouble, and vice versa.  By reference to a cut showing the pelvic brain, or cervico-uterine ganglion, one can see at once the extensive nerve supply which attends the uterus.  It may be observed in cases of violent vomiting that digestion and nourishment are quite good.  The reason must be that Auerbacb's plexus is the main one affected (muscular), while Meissner's (glandular), the one which really digests the food, is not much affected.  In the case of chronic uterine disease the whole subject is plain and practical.  Such patients have malnutrition for several years.  In short, it is noticeable that a woman will apply for treatment of uterine disease some four years after the cervix has been lacerated.  The illness was increasing all the time, the last part being more apparent.  In stomach troubles from chronic disease of the generative organs, it appears that Meissner's plexus is aff ected the most, as such patients seldom vomit; but they do not digest their food, which is performed by the gastric fluid secreted by the influence of Meissner's plexus on the cardiac and pyloric glands.
    But I wish rather to note the effect of chronic disease of the generative organs on the enteron intestines, which is the location of real digestion.  The business part of the digestive tract is the enteron, the small intestines - the jejunum and ileum.  The enteron is supplied by the superior mesenteric artery, and along this artery goes the great superior mesenteric plexus of nerves.  What we will observe is the mechanism at the end of this superior mesenteric nerve, viz., Auerbach's plexus.  This produces bowel peristalsis, rhythm.
    Take, for instance, a case of chronic endometritis, salpingitis or ovaritis of several years' duration.  Disease of the female organs is a slow, continuous, progressive process.  It is a kind of evolutionary process and generally should be read endometritis, plus myometritis, plus endosalpingitis, plus ovaritis, plus as much peritonitis as the infection produces at the ends of the oviducts.  Because of this slow, evolutionary progress of female disease the effect through this sympathetic nerve is of slow progress and gradual.  The irritation from the generative organs will travel to the abdominal brain by way of the ovarian and hypogastric plexuses.  It is a common observation that gases may develop in a few minutes so that fermentation is not the explanation of their origin.  Some attempt to explain the origin of this intestinal gas by noting that it collects because the bowel muscle has lost its power to contract; but the gas develops too suddenly for this theory to fit.  If the irritation from the uterine disease causes Meissner's plexus to secrete deficient fluids, indigestion and constipation arise.  So reflex irritation from the generative organs, by way of the abdominal brain to the small intestine or enteron can act in two ways: (1) It may so stimulate Auerbach's plexus in the intestinal wall as to produce colic, and (2) so stimulate Meissner's plexus as to induce excessive secretion, deficient secretion or disproportionate secretion.  The result here will be development of gases and diarrhea.
The abnormal stimulation of Auerbach's and Meissner's plexuses may result in deficient bowel peristalsis and secretion which ends in constipation.  The final result of these is indigestion or malnutrition.  Hence, chronic uterine disease creates its disasters on the system really by malnutrition.  It disturbs the normal visceral rhythm.  Malnutrition is manifest in pregnancy, in perceptible disease of the generative organs, and at the menopause.  The explanation lies in the abnormal irritation of the nerves in the generative organs, which is reflected through the abdominal brain to the digestive tract.  I have never heard or read of the method herein used to explain the action of the abdominal brain on the digestive tract, but I think it is a practical explanation.  These views explain why animals or man lose control of the bowels under fright.  The violent forces emitted from the abdominal brain induce excessive activity of Auerbach's plexus (colic) and Meissner's plexus (secretion) and a sudden diarrhea results in the animal.  In other words, under high emotional influences the animal's rectal sphincters are unable to resist the violent bowel peristalsis.  Peristalsis is stronger than the orificial sphincters.  Involuntary defecation is common among children and animals from fright.  In older animals the cranial brain assumes more influence over the abdominal brain, i. e., it sobers down its violent and irregular rhythm.  Chronic disease of the generative organs creates malnutrition in the digestive tract by disturbing its normal functional rhythm and by reflecting irregular rhythms into the digestive tract during its times of rest and repose.  It does not matter what the disease of the generative organs is, so that irritation arises and is reflected to the abdominal brain.  Inflammation, tumors or the local manifestations of the menopause, will act similarly, according to the degree of irritation.  The subject may be considered in the following short summary:
    The reflex irritation of the abdominal brain will cause Meissner's plexus to secrete (a) too much secretion (diarrhea), (b) too litte secretion (constipation) or (c) disproportionate secretion (fermentation).  The same thing will occur in any secondary organ, i. e., too much, too little or disproportionate secretion.  Now, I will point out a matter which long puzzled me, viz., a woman who has a lacerated cervix will go through various pathological stages for some five years and end as a confirmed neurotic.  I have observed it for years, and the order of occurrences is as follows:
    1.  The first stage is irritation.  The irritation does not arise so much from the lacerated cervix as from the endometrium (infection atrium).  The irritation keeps up for years, endometritis, myometritis, endosalpingitis.
    2.  The second stage is indigestion.  The long-continued irritation arising from the
genitals and passing up to the abdominal brain, and being there recognized and sent out on the plexuses of Meissner and Auerbach of the digestive tract, soon causes too much secretion, too little secretion or disproportionate secretion, which results in indigestion.
    3.  The third stage is malnutrition.  Long-continued indigestion simply results in malnutrition.  The reflex irritation goes on continually.
    4.  The fourth stage is anemia, resulting from the indigestion and malnutrition.
    5.  The fifth and last stage is neurosis, which is due to the nervous system having been bathed in waste-laden blood for years, neurosis, psychosis.
Hence, a patient with laceration of the cervix passes through five stages:
    (1) irritation (infection); (2) indigestion; (3) malnutrition; (4) anemia; (5) neurosis, psychosis.
We will now consider the liver as disturbed by disease of the generative organs., whether it be acute or chronic.  We noted that the liver was highly supplied with sympathetic nerves; that it had a peripheral plexus in its substance.  This we will style the automatic hepatic plexus.  We noticed that the liver was induced to perform a rhythm by its automatic plexus, and that its rhythm was made possible by the elasticity of its capsules, the tissue which governs its expansion and contraction (rhythm) being elastic and contractile.  Rhythm of the liver is made up of two distinct stages, a time of activity (parenchymal secretion) and a time of repose.  Its stage of functional activity is when its capsules are expanding under the vascular excitement of turgescence, the products of cell-work, bile, glycogen and urea being secreted.  Its stage of repose and self-repair is when its capsules are contracting, and the blood-vessels are being depleted, the contracting capsule having partly forced the cell products (bile, glycogen and urea) into other regions and organs to accomplish their final object.  By means of this rhythm the liver secures a stage of activity and a stage of rest.
    It is plain why the liver suffers so badly among liquor drinkers.  The drinker has no regard for the time of rest of his liver, so he takes his stimulant especially at times when the liver is at rest.  The irritating fluids pass by way of the gastric portal veins into the quiet, resting liver and of course excite it to go through a rhythm at any time.  Thus the drinker deprives his liver of the needed rest.  The rhythm of the liver is irregularly disturbed and that calls up disease.  It is precisely the same in diseases of the generative organs.  Irritation starts from a diseased pelvis and travels up the ovarian and hypogastric plexuses to the abdominal brain.  Hence, the irritation is reorganized in the abdominal brain and emitted along the hepatic plexus.  The automatic hepatic plexus is unduly and irregularly stimulated at times of activity and rest.  The result is that the rhythmical function of the liver is deranged.  The nice balance of its formation of bile, glycogen and urea is destroyed.
    The diseased pelvic organs have no respect for liver rest and they send their uncertain reflexes to the liver at unseemly times.  Chronic disease of the pelvic organs will excite impulses which travel to the abdominal brain, which resends them to the liver at such uncertain times that the liver never performs its activity or rest, without more or less attempt to induce irregular rhythms.  The final result is that the rhythm of the liver is disturbed and that the cell-products of the liver are formed irregularly.  Bile, glycogen and urea are formed excessively, deficiently or disproportionately, and it ends in malnutrition.  The skin is yellow and sallow, the urinary products are abnormal.  Diseases of the liver are manifest during pregnancy in demonstrable pelvic diseascs, and especially is this true at the menopause.  The anatomical nerve track followed by irritation from the generative organs to the abdominal brain, and thence to the liver, is plain, and the physiological results show the theory to be reasonable.  Right here we may say that liver disease and disease of the digestive tract are quite common at the menopause.  The explanation of this is not difficult.  During the thirty years of seed time and harvest of woman the abdominal brain emits its physiological orders to the automatic menstrual ganglia, situated in the uterus and oviducts, to perform their rhythm of menstruation.  Thirty years of rhythm in any organ will surely form a habit which it will require force to break.  When the menopause arrives, which occurs suddenly, the old beaten paths of the hypogastric plexus, along which the menstrual orders for thirty years had been sent, are suddenly cut off.  This sudden cutting off of old channels, by which forces were formerly emitted, is bound to make the latter accumulate in the central organ or abdominal brain.  Now, these accumulated, unused energies must have some outlet and they will go in the direction of least resistance.  The great channels of easy outlet of pent-up forces in the abdominal brain appear to be the gastric and superior mesentelic plexuses, which supply the digestive tract, and the hepatic plexus.  Hence, in the menopause the accumulated force in the abdominal brain is mainly spent on the digestive tract and liver.  The accumulated energies go to these in an irregular manner and thus aid in disturbing their rhythm.  The result is abnormal products in the liver (bile, glycogen and urea), and for the digestive tract, indigestion (constipation or diarrhea).
    The heart of woman does not escape the influence of the chief wheel of her existence.  It has very manifest peripheral sympathetic ganglia and is largely under the control of the sympathetic nerve, as may be seen from its nice rhythm.  Now, from each of the three cervical sympathetic ganglia on each side of the neck there goes a nerve to the heart (the heart also receives three nerves on each side from the pneumogastrics).  When the pelvis contains diseased generative organs, the irritation arising there travels up the ovarian and hypogastric nerves to the abdominal brain.
    From the abdominal brain two roads lead to the heart.  One road is through the great splanchnics to the cervical ganglia, and as these ganglia act as little brains, the force is here reorganized and sent directly to the heart.  Of course all irritation comes irregularly and so aids in disturbing the heart's rhythm.  But spinal or cranial nerves prohibit rhythm, so I think the main forces from the abdominal brain travel up the pneumogastrics to the fourth ventricle) and the irritation is then reflected directly to the heart.  Irritation, especially that coming along a cranial nerve, quickly affects the rhythm in any viscus.  In like manner irritation from diseased generative organs may reach the heart by first going to the abdominal brain and then through the splanchnics to the pneumogastrics and to the heart.
The result is that the heart is disturbed in its rhythm.  It palpitates, it beats irregularly.  Who has not seen this in female diseases?  I think palpitation is most manifest at the menopause.  In pregnancy the heart prepares for the emergency by thickening its walls and is generally no worse for undergoing the extra work incident to gestation.  But let the heart meet a myoma, which is continually emitting irregular reflections to it, and disturbing its rhythm, and sooner or later it is weakened and degenerated.  The heart rests and repairs itself duing part of the rhythm, but irregular reflections from pelvic diseases do not allow it sufficient rest.  Fatty degeneration or malnutrition results.
    The heart palpitates at the menopause because the accumulated energies of the abdominal brain find an easy outlet through the splanchnics and pneumogastrics.  The menopause often requires several years for its completion, so the abdominal brain can get accustomed to controlling and distributing the accumulated energies which were once expended in the menstrual rhythm.  The trouble is that its accumulated but irregular energies are apt to dash pell mell over some single plexus to some single viscus and then disaster is sure to follow from inability to resist.  If the accumulated energies were evenly distributed, but little visceral rhythm would be disturbed.
    I know of no organ so manifestly affected in the menopause as the heart; perhaps for the very reason that the sympathetic nerves chiefly accompany the blood-vessels.  Hence, when some portion of the sympathetic system is disturbed, it is apt to affect the nearest structures, which are those of the vascular apparatus, the chief portion of which is the heart.
    The same kind of reasoning is applicable to the spleen.  Diseased generative organs reflect their irritation to the abdominal brain and then to the spleen.  Irritation always proceeds irregularly, and so it would disturb the rhythm of the spleen, and thus create malnutrition.  The spleen goes through a rhythm just as do other viscera.  The spleen is no doubt the chief organ concerned in pigmentation.  Jastrowitz, of Russia, first taught that the spleen was concerned in deposit of pigment; for he found that by severing the nerves which pass to the spleen on its vessels, in dogs, irregular pigmentation followed.  Every gynecologist knows that pigmentation of the skin is common at the menopause, in pregnancy and at puberty, i. e., when the sympathetic nerves are more or less disturbed.  Of course little doubt exists that the liver has something to do with the deposit of pigment, as may be noted in malaria, which exercises its brunt on the liver.  Hence, the disturbed rhythm of the spleen in uterine disturbances manifests itself by pigmentary deposit.
    In disease of the uterus it is quite easy to note that the rhythm of the bladder is disturbed.  It is not because the fundus of the uterus rests on the fundus of the bladder, but because the automatic vesical plexus is irritated.  The neck is dragged or pressed and the nervous mechanism suffers.
    Similar explanations might be made relative to the lungs, kidneys, pancreas and ovaries; but I think sufficient has been said to show that each viscus has its automatic peripheral ganglia, that each viscus executes a rhythm, and that the diseased generative organs may disturb the rhythm of any viscus by reflex irritation through the abdominal brain.
    The peripheral nerve supply to the genitals is vast, and no organ can raise such nerve storms as the generative.  They are intimately and intensely connected with all nerve centers, but especially those of the sympathetic.  How often does one see strong men faint from the simple introduction of the sound into the urethra?  The vast peripheral nervous apparatus ending in the urethra is disturbed, and this nerve storm which sweeps up the hypogastric plexus spends sufficient power on the heart alone to cause faintness. Of course it spends a relatively large amount on every other viscus.  Note how pale the man becomes.  The storm dwells with equal force on the whole skin surface.  Of all viscera the genitals are most intimately and closely connected with the nerve centers, both anatomic and physiologic, for the sexual instinct predominates in all races of mammals.  From the very physiologic and anatomic nature of the reproductive organs they demand a close and intimate nervous connection with the great centers, and hence no storms affect adjacent and distant viceras like those arising in the extensive genital nerve periphery.
    Cold Hands and Feet in Women. -  Every gynecologist has witnessed cold extremities in women with diseased generative organs.  In this case we must look to the great dominating vaso-motor center, situated in the medulla oblongata.  Secondary vaso-motor centers also appear to exist along the main length of the spinal cord.  The vaso-motor centers are reached (a) through the pneumogastrics, especially by irritation coming from the abdominal brain; (b) by the lateral chain of the sympathetic which is prone to emit its irritations along the brachial plexus, or the sacral plexus, or the lumbar plexus.  No doubt the irritations are emitted along each intercostal nerve, but vaso-motor contractions are more manifest in the extremities.  In vasomotor contractions the skin is always most blanched at the extremities, as the hands or feet.  When the generative organs are diseased, the irritation goes to the vaso-motor centers in the medulla and cord by two routes:
    1.  It travels over the ovarian and hypogastric plexuses of nerves to the abdominal brain.  Then it is reorganized and sent along the pneumogastrics to the dominating vaso-motor center in the medulla, whence it is reflected over the whole body, especially to the small vessels at the extremities, on which it is the most effective in blanching white the skin and cooling the hands and feet.
    2.  It can also travel on the lateral chain from the coccyx, especially by way of the hypogastric plexus.  I found in dissection of cadavers (especially female) that the lumbar lateral chain of ganglia were strongly and liberally connected with the hypogastric plexus by large, thick nerves.  Hence, the irritation from the generative organs will go up the hypogastric plexus and be deflected to the lumbar lateral chain and pass both to the spinal cord and medulla.  Then the vaso-motcr centers in the medulla and cord reflect their irritations to the whole body, but especially to the extremities.  So that irritations from the generative organs reach the vaso-motor centers in the medulla and spinal cord by two routes: (a) by the pneumogastrics from the abdominal brain, and (b) by the lateral chain of ganglia.  The result after following both routes is similar, viz., paling and cooling of the skin, especially of the extremities.  Physiologists have proved that the most powerful vaso-motor constrictions exist in the hands and feet.  The conclusions are the same as those discussed in the viscera.  The end of the whole matter in malnutrition, for the arterioles and capillaries have been disturbed in their rhythm.  The vascular rhythm exists, but it has not been determined as to time.  But when a large area of skin (tissue) is depleted of nourishing blood for a considerable time, malnutrition is sure to result.  The cause and effect in the woman are definite.  The irritation starts in the generative organs and travels by definite routes to end in influencing the sympathetic nerves to contract the vessels which they surround.  I have such women in my practice continually.  Vaso-motor effects on the extremities are generally a remote disturbance of chronic pelvic disease.  The irritation of almost any viscus which will effectually disturb the abdominal brain is liable to cause vaso-motor constrictions.  It is mainly from the generative organs in the female.  By carefully studying patients one can see the immediate and remote effects of pelvic disease.  The immediate effect may be observed to be from the localized, tangible, gross pathology.  It may be pressure troubles, septic troubles or otherwise.  But the remote effect is through the sympathetic nerve, or rather through malnutrition.  A slight, unnoticed irritable focus begins in the pelvis (it may be endometritis).  Months and years go on.  Irritations accumulate in the abdominal brain and may radiate on all its various plexuses.  Nutrition is insidiously impaired through the months and years, unbalanced reflexes gather in the abdominal brain, which, in turn, disturb the normal functional rhythm of viscera.  Accumulated energies, begotten of long continued pelvic disease, are not controlled by the abdominal brain, but irregular, stormy forces are emitted over the plexuses to the viscera, which unbalances their rhythm and ruins their nutrition.  The woman with genital disease becomes an object of wretched despair and a miserable invalid.  The days of her life are passed between pain and sadness.  Our amateur operative gynecologist has forgotten that all her troubles started from a lacerated cervix or endometritis five years ago.  He is sure to extirpate her ovaries, if he can, and lo! how disappointed he is if she does not get well in a month!  Such a woman will not get well for long periods.  The only benefit of extirpating the appendages was that she was compelled to lie still for a month - a dear method of purchasing a few weeks' rest.  The proper method to follow in this numerous class of women is to hunt for the old cause and remove it, and then gradually nourish the woman back to normal health.  Such women are called hysterical, but there is generally some pelvic pathology that precedes hysteria before the abdominal brain suffers derangement.
    Space forbids any discussion as to the dependence or independence of the sympathetic nerve in regard to the cerebrospinal system.  Yet we may assert that the sympathetic is independent to a certain degree.  Babies have been born at full term with no cerebrospinal axis.  The heart will beat some time after death.  I have often noted the intestines performing peristalsis more than an hour after death.  I have watched the uterus going through its rhythm in slaughtered cows an hour and a half after death.  The independence of the sympathetic is seen in vaso-motor neuroses of the extremities.  The tone of vessels is maintained by the sympathetic.  The sympathetic controls secretion.  If the brain and spinal cord of a frog are removed, his skin will show pigmentation.  The viscera have involuntary movements and are out of will control, - are excluded from the mental sphere.  But, like the watch, which requires every cog and wheel to keep, time, so the sympathetic needs the cerebrospinal to maintain the balance of life.
    A few general ideas of the sympathetic nerve may be of interest.  The rhythm of the viscera, due to the abdominal brain, will, no doubt, adequately explain the axial rotation of abdominal tumors.  The emptying and filling of hollow viscera in their continual rhythm is apt to rotate adjacent tumors with narrow styles.  Narrow pedicles are, of course, more likely to rotate than thick ones.  It is a curious fact that when a woman possesses more than one tumor in the abdomen, there is more danger of axial rotation.  A pregnant uterus or tumor doubles the danger of the twisting of the tumor on its axis.  The axial rotation of a tumor is, no doubt, enhanced by the sudden emptying of the uterus, and its change of location at delivery.  But the main point in the matter is visceral rhythm, e. g., of the intestines and bladder.  It is estimated that 10 per cent of abdominal tumors rotate on their axes.  The reflexes of the abdominal brain and sympathetic ganglia are very numerous.
    A blow on the solar plexus causes syncope by reflex action on the heart.  The vagus (right) compels the heart to beat soberly, and two-thirds of the right vagus goes also into the abdominal brain.  But the cervical sympathetic rules the heart in its rapidity and regularity.  The vomiting on the passage of gall-stones, or renal calculi, or that of pregnancy, shows the abdominal brain to be a great reflex center and place of reorganization of forces.  Notice the changed pulse in peritonitis, and the tremendous collapse in intestinal perforation, due to disturbed circulation.  Watch the shock after colotomy, due to trauma on the peritoneum.  The peritoneum is mainly supplied by sympathetic nerves, so it acts through the solar plexus.  It is easy to see how nerve storms shock the heart from peritoneal manipulation.  I have noted depression of the heart.  The peripheral arteries contract and the heart cannot drive the blood home.  It is easily seen that in the abdominal brain and cervical sympathetic, the great regions of reflex action play a great role in neuroses and all emotional phenomena.  When we feel fear or fright, the effect is noticeable in the solar plexus, which lies behind the stomach.  Sorrow and sadness are, frequently, first felt in the abdominal brain.  The good-hearted David said that he "yearned for the young man in his bowels." His is only a common experience that the abdominal brain plays a role in emotional and neurotic phenomena because of its capacity for reflex action.

     Fig. 45 represents the vaso-motor nerves supplying the heart.  The heart is the typical organ of popular demonstration of rhythm or peristalsis in the body.  It is enormously supplied with nervus vaso-motorius besides by the ganglia of Bidder, Schmidt, Remak, Ludwig, Wrisburg, all but one located in the cardiae parietes.


     Fig. 46.  This cut represents the vaso-motor nerve supply to: (a) liver; (b) spleen; (c) 
stomach; (d) kidney.


     Fig. 47.  This cut represents the vaso-motor nerve (sympathetic) supply to the tractus genitalis.


     Fig. 48.  This cut represents an X-ray of the ducts of the liver and pancreas.  Each duct is ensheathed by an anastomosed, nodular, fenestrated meshwork of nerves which demonstrates the enormous nerve supply.  This is in addition to the nerve supply enscathing the arteria hepatica.


     Fig. 49.  This cut represents the rich renal arterial supply.  Each arterial branch is ensheathed by an anastomosed, nodular meshwork of nerves which indicates the quantity of vaso-motor nerves attending the renal organ and its duct (ureter).


     Fig. 50.  This cut represents an X-ray of the ductus pancreaticus with part of the ductus bilis.  Four hepatic calculi are at B, one at C, one at D. Each branch of the ducts are ensheathed by an anastomosed, fenestrated meshwork of vaso-motor nerves which allows an estimate of the amount of vaso-motor nerves supplying the pancreas.


     Fig. 51.  This specimen of corrosion anatomy of the uterus, oviducts and ovary of a new-born infant represents the blood supply of the genitals in a quiescent state.  Each arterial branch is ensheathed by an anastomosed, nodular, fenestrated meshwork of vaso-motor nerves.  This method enables one to estimate the quantity of nerve supply to the uterus.