THE ABDOMINAL AND PELVIC BRAIN WITH AUTOMATIC
VISCERAL GANGLIA WITH REFERENCE TO SEXUAL ORGANS.
"Instinct is a propensity prior to experience and independent of instruction."
"Probability is the rule of life." - Butler.
At this point I desire to call attention to the following
1. The intimate and profound connection of
the genito-urinary organs with the sympathetic (and cerebro-spinal) nervous
2. Its connection with the rectum and relation
3. The relation of the pelvic organs to the
larynx (voice); the fifth (ganglionic) cranial nerve, stomach and eyes.
4. Automatic menstrual ganglia.
5. The menopause.
Every observing physician sees a close connection
between the genital organs and the nervous system. This is not strange
when one considers existing conditions and the long-continued effect of
evolutionary forces. Of all the instincts in the animal race, the
sexual instinct is dominant. This instinct has an all-pervading influence
in every species of animal. It governs their actions. It forms
habits in their lives. It induces new phases of existence.
All through the stages of animal evolution, every other instinct must bend
to the sexual. Physical and mental forces wonderfully combine to
make this instinct the most effectual in its consummation. The sexual
instinct dominates most powerfully the males, and hence the physical and
mental vigor of the best animals in the race survive. The cow in
rut is served, from sheer physical and mental vigor, by the most powerful
bull. In herds of animals the sexual instinct dominates most vigorously
in the finest males, and the weak males are cast aside that the strong
ones may become the parents.
The main study of zoology is reproduction.
The weapons of offense and defense possessed by males are primarily to
cultivate and defend the sexual instinct. The horns of bulls, the
powerful heels of stallions, the eagle's talons, and the claws of powerful
feet are the weapons to defend and to carefully cultivate this dominant
instinct of animal life. When we pass to man, the sexual instinct
is rather heightened than diminished. But in man it is more subtle;
secretly in the depths of man's mental forces lies his sexual instinct.
As he has gained the ascendancy in animal life by his mental activities,
in this light alone can be studied his sexual instincts. Thus in
the lowest form of physical existence sexual instincts dominate, yet in
the higher forms of mental existence these instincts are still more powerful.
From such premises, patent to all observers, it
is quite obvious that evolutionary forces have through long ages established
a very close connection between the nervous system and the genitals - the
organs which gratify the sexual instinct. Forces (mental or physical)
acting through eons of ages establish definite results. The increase
of man's intelligence is not in proportion to the increase of ganglion
cells, but by the increase of conducting cords. Chicago and New York
may each represent a ganglion cell, and a single railroad may represent
the conducting cord. Now, when there was but one railroad between
New York and Chicago, little business could be done on account of the limited
amount of commerce which the single road would accommodate. Chicago
and New York, as the ganglia cells, could dispose of far more business
than the single road would transmit. But when the railroads multiplied
between the two centers, the business increased just in proportion to the
number of roads or conducting lines. Now, ages of natural forces
have established numerous lines, and vigorous lines, of connection between
the genitals and the nervous system. The facts which dissection show
are positive in demonstrating the widespread and intimate connection of
the genitals with the cerebro-spinal and sympathetic system.
The ganglion cells can receive and dispose of far
more mental work than a few conducting cords can transmit; so that the
progress and advance toward a higher nervous system and a higher intelligence
is an increase in the conducting cords or lines to transmit intelligence
or ideas. Also a well developed periphery is an absolute necessity
for the purpose of collecting ideas for transmission. An increasing
sensitive periphery is required to perceive the forces and comprehend ideas
so that they can be sent to the central ganglion. Now, the number
of conducting cords which attach the genitals to the nervous centers is
simply enormous. Besides, the nerve periphery, situated in the external
genitals, is highly sensitive and highly developed, so that it quickly
perceives and quickly transmits the slightest sensation, and evolutionary
forces through the ages seem to increase the sexual instinct with the progress
of intelligence and mental growth.
I base these remarks on years of careful dissection
of cadavers and of animals. If one carefully dissects a male body
he will note the extensive cerebro-spinal nerves supplying the genitals,
especially the penis. Of the spinal nerves supplying the genitals,
the main one is the pudic. But the pudic nerve is composed of nearly
all the third sacral, and branches from the second and fourth sacral.
As one examines this nerve he is forced to the conclusion that it is an
enormous supply for a small organ.
The periphery of the pudic nerve spreads itself
like a fan over the genitals. The branches of this fan-like nerve-apparatus
supply also the bladder and rectum - organs which must act and work in
harmony. Hence the great disturbance which arises in the pelvis (bladder,
rectum or genitals) when any one organ is damaged-e. g., a rectal fissure,
a urethritis, or penile irritation quickly disturbs the whole system.
The connection of the pudic nerve with the external genitals (where sensation
is experienced) is vast. Not less remarkable is the wonderfully harmonious
action of the bladder, rectum and genitals through large branches of the
Another peculiar spinal-nerve connection of the
external genitals is the supply of the pudendal nerve to the lateral walls
of the penis. I have time and again called the attention of medical
men to the peculiar connection between the gluteus maximus muscle and the
external genitals by means of the pudendal nerve or branch of the lesser
sciatic. The gluteus maximus is the real muscle that holds man upright
(physically), but it is also the main muscle of coition. The lesser
sciatic nerve supplies only one muscle, and that is the gluteus maximus,
and then sends off the large pudendal branch to the sides of the penis,
and hence the friction of coition induces active contractions of the gluteus
maximus. The spinal-nerve supply to the external genitals is mainly
the large pudic and pudendal nerves. In woman the pudic nerve is
equally large; but the pudendal nerve is much smaller in woman than in
man, according to my dissections. The lesser size of the pudendal
nerve in woman is in direct accord with the methods of cohabitation.
The vigorous and aggressive activity of man in coition, and the quiet passive
receptivity of woman, explains the larger pudendal nerve in man.
But the reverse nerve supply arises in regard to the glans elitoridis and
the glans penis. I have dissected many a clitoris, and its nerve
supply is three or four times as large as that of the penis in proportion
to its size. The clitoris is a veritable electrical bell, which,
when irritated, rings up the whole nervous system. There is no doubt
that adhesions of the prepuce to the clitoris have led to masturbation
in girls. Every gynecologist should examine the clitoris, and, if
preputial adhesions exist, simply break them up, for the vast nerve supply
of the clitoris gives great chances for profound irritation. The
poor girl, neglected by the mother and possibly by the doctor, is soon
induced to become a masturbator.
But the extensive spinal-nerve supply to the external
genitals, though vast and intimate, is but a small matter relative to the
supply to the internal genitals. The spinal-nerve supply to the external
genitals is mainly sensitive, so that the sexual instinct may be gratified
by the organs. What I wish mainly is to call attention to the profound
connection of the internal genitals with the nervous system by means of
the sympathetic system. It is in this field that the gynecologist
and the genito-urinary surgeon find full play for lucrative operations
- for so-called aggressive surgery. In manipulations and instrumental
examinations of the genitals one sees the nerve storms flash over the system.
These nerve storms radiate over distant nerve plexuses like electricity
over a system of wires. Take, for example, the uterus. Its
sympathetic nerve supply is enormous. The cervix only, so far as
I can see, has spinal nerves, while the body and fundus are supplied by
the sympathetic. One can count some twenty or thirty strands of nerves
in the hypogastric plexus which originate in the abdominal brain and terminate
in the uterus, and the nerves are very large. The ovarian plexus
- a very large plexus - goes from the abdominal brain, and many of the
nerves of this plexus terminate on the oviducts and fundus of the uterus
so that the sympathetic nerve supply of the uterus is enormous. A
large nerve supply to any organ subjects it to the danger of sad complications
and stubborn pathology. I have seen a patient in the gynecological
chair make active efforts to vomit in less than fifteen seconds after careful
introduction of the sound. In those few seconds a complicated nervous
phenomenon had occurred. The irritation of the endometrium had been
flashed up the hypogastric plexus to the abdominal brain, and there it
was reorganized and dashed over the various plexuses to other viscera.
The irritation, no doubt, went to every viscus similarly,
but the stomach manifested itself in motion (vomiting). The heart,
lungs, liver, spleen and digestive organs no doubt suffered similarly,
but they were better able to resist the irritation. A study of the
hypogastric plexus and its action on the uterus convinces me that pressure
on the aorta for postpartum hemorrhage is generally explained wrongly.
It is said the pressure obstructs the blood, but in reality the pressure
on the hypogastric plexus irritates the peripheral ends in the uterus,
and induces it to contract.
This is more reasonable. The dominating influence
of uterine disease is due to the vast and intimate connection of the uterus
(oviducts and ovary) with the sympathetic nervous system. Besides,
a great and complicated network of nerves is easily deranged. The
importance of the uterus demands a vast and complicated nerve supply.
It may be laid down as a general proposition that the viscera have their
normal function in rhythm, and the disturbance of the rhythm induces disease.
The main pathology of the sympathetic is reflex action from some distant
The ganglia controlling the viscera are entirely
out of the control of the will. If the visceral movement was not
involuntary or out of the mental sphere men would speculate and experiment
on their viscera. This fact no doubt explains the curious action
of neurotic women. The nerve storms which emanate from a pathological
uterus flash over the whole system by distinct nerve plexuses, and, as
the will does not control any of such reflexes, the patient acts on the
induced feelings. The close nervous connection of the uterus with
the nervous system is at once seen in the great changes which uterine disease
induces in both the mental and physical life of a woman. But anatomical
facts, physiological experiment, and clinical study all show that the genitals
and nervous system are more highly and intimately connected than any other
system. No organ influences a woman mentally or physically to such
a degree as the uterus - the autocrat of menstrual life even in its normal
physiological and anatomical condition, while its pathological condition
is still more manifest. It is owing to the very distinct connection
of the genitals with the cerebro-spinal and sympathetic system. Let
a woman's genitals become pathological and she acquires liver disease and
indigestion and becomes anemic and neurotic. Uterine disease also
induces eye disease and heart trouble, and the joints and muscles do not
escape. Pelvic diseases are often accompanied with hip, knee or ankle
trouble. This is no doubt due to the intimate connection of the uterus
with these joints through the sacral plexus; e. g., the sacroiliac joint,
the hip joint, and the knee joint are all supplied by three distinct nerves
- the great sciatic, the anterior crural, and the obturator. Now,
these three nerves are really the sacral plexus. A cold contracted
at the monthly period from wet feet is explained no doubt by close connection
of the uterus with the sacral plexus, for the lower end of the sacral (the
sciatic nerve) supplies the feet. The disturbed circulation in women
afflicted with uterine disease is owing to the powerful reflexes sent over
the great hypogastric plexus, and the normal rhythmical contractions of
the heart and its blood-vessels are broken by reflex due to uterine disease.
But it is not the woman only who is afflicted with
reflexes from the genitals. The genito-urinary surgeon who deals
with men afflicted with urethral disease knows the effect often of the
mere introduction of a sound into the bladder. A healthy man will
frequently faint from the introduction of a sound, and if the urethra or
genitals are long diseased he will be profoundly shocked. This means
that the urethra is extraordinarily supplied with nerves. I do not
see, so far, any better explanation of so-called urinary fever after the
introduction of a catheter than that it is "reflex." The urethral irritation
may travel in two ways and act in two ways: (1) It may travel up the spinal
cord, to the heat center either by the sacral plexus through the cord or
by the splanchnics through the cord and thus disturb the heat center. (2)
But more probably the urethral irritation is transmitted up the hypogastric
plexus to the abdominal brain and is reorganized and emitted on the various
It travels on the renal plexus more vigorously,
owing to the more intimate connection existing between the kidney and the
genitals - e. g., the ureter has a plexus, the testicle has a plexus, and,
also, a part of the hypogastric plexus forms part of the renal plexus;
furthermore the kidney and genitals originally arose from the same body
- the Wolffian.
Now, the reflex irritation induced by the catheter
on the urethra then flashes up the hypogastric plexus, and the reorganized
forces are sent to the kidney and the irritation acts on the kidney to
change its circulation; it is congested and urinary fever follows. The
fainting of patients on the introduction of a catheter is explained on
the same principle. The high nerve supply to the urethra being disturbed,
the irritation is transmitted to the abdominal brain, where it is reorganized.
The reorganized forces are then radiated on the various sympathetic splanchnics
to the three cervical ganglia and are then transmitted by their three nerves
to the heart, which is induced to move in a riotous manner. The heart
is weakened and the patient faints. The irritation of the genitals
being sent to the abdominal brain, it induces dilatation of the abdominal
visceral circulation, and this probably explains the rise of temperature.
Occasionally the introduction of a sound kills a patient, but that may
be due to the weakness of the patient after a long-continned exhausting
disease. Thus the nerve storms arising from the genitals are entirely
due to the abundant and exhausting nerve supply. The irregular nerve
storms arising in . genitals highly supplied by nerves are profound in
their invasion of the whole system. They pervade all active organs
and disturb rhythm and induce further reflexes. Reflex action from
the sympathetic explains much - e. g., when a man begins the "catheter
life" he rings his own death knell; by the use of the catheter he induces
reflexes which will remorselessly follow him until death. Besides,
he introduces infection into the urethra and kidneys by the dirty catheter.
Thus the man goes through three stages on his road
to the grave: (1) He has acquired some form of obstruction to the outflow
of urine from kidney to penis; (2) he introduces the catheter, which calls
up the wide domain of reflexes; (3) he introduces infection, and death
follows. If the genitals were not so highly supplied by nerves, the
terrible reflexes would not arise. As an application of the extensive
supply of sympathetic nerves to the genitals and its wonderful reflexes,
examine for a moment the result of coition.
The role played by the vaso-motor centers should
not be lost sight of. I have found, time after time, that the ganglia
of the lateral chain of the sympathetic, situated at the root of the pudic
(third sacral), were very large, and this will aid in transmission of irritation.
1. The sexual instinct is the most dominant
instinct of animals.
2. Evolutionary forces have linked the abdominal
sympathetic nervous system and the genitals by numerous and intimate bands
which increase with the progress of higher development - i. e., sexual
instincts dominate and influence man, as well as the monkey and the ape,
far more than the lower grades of animals.
3. By reason of the growing and increasing
intimate relations between the genitals and the nervous system, mental
forces play a greater role in the production of disease.
4. I have observed that the monkey is an inveterate
masturbator in confinement, and his persistent attention to the genitals
shows that the sexual instincts keep pace with mental progress.
5. The severe shock arising from hysterocotomy
shows that the uterus has an extensive nervous connection with the abdominal
brain. In this operation one severs the great hypogastric plexus,
and I have seen an alarming rise of temperature (103 degrees F.), disturbed
respiration and circulation, all from cutting the hypogastric plexus.
The disturbance was not due to infection, as almost all of it arose a few
hours after the operations. Occasionally removing the appendages
shocks, but, as the ovarian plexus is small, the shock is limited.
6. The genital and the urinary organs both
arise from the Wolffian body, so they are anatomically and physiologically
connected, and both have an enormous nerve supply, so that damage to one
often injures the other by reflex - e. g., hysterectomy has caused death
by inducing nephritis a few days succeeding the operation, the test-tube
revealing three-quarters albumin under the heat test.
7. The close connection between the genitals
and nerve system is clearly seen from the terrible nerve storms which flash
over the system from irritation (manual, instrumental or pathological)
of the genital e. g., irritation of the clitoris quickly disturbs the whole
8. The great nerve connection of genitals
and centers indicates that all irritation should be at once removed.
All preputial adhesions on the clitoris should be broken up, and the same
with those of the prepuce. In short, all pathological conditions
of the genitals should be at once righted, so that the nerve balance may
The reports of fainting and vomiting and even death
during coition have a scientific interest in view of the present subject.
The celebrated Russian general, Skobeleff, died while cohabiting with a
woman of ill-fame. Attila, king of the Huns, died while holding sexual
relations with his young wife. In a small town in Ohio, a man nearly
70 years of age was reported to have died during coition. Stock men
have made interesting reports in regard to animals. A mare put to
a stallion fell dead at the end of coition. Young male animals have
often fainted when first allowed to serve the female. The dog coition is
prolonged, which limits shock. A dog has no semen sacs. The
boar has an intensely violent coition, with consequent effect on his viscera,
as in respiration and circulation. Young stallions are the most liable
to faint of any of the domestic animals. Young bulls become weak,
exhausted and tremble at first coition. A medical acquaintance related
to me a death in a middle-aged man about an hour after coition.
Dr. Miller related two instances which interested
him very much because he did not understand the explanation. A man
about 60 years of age, while walking to the door a few minutes after cohabiting
with a strange woman, fell and died immediately. In another case,
at the first coition the young husband fainted, and the sphincters relaxed,
defecation and urination resulting. One can easily observe in domestic
animals that, especially in the male, the respiratory rhythm is disturbed
- slowed for a while and then quickened. The heart will also be disturbed
in its rhythm - slowed for a time and then quickened. The explanation
of these phenomena lies in the sympathetic ganglionic system. The
vesicular seminales are very highly supplied by the hypogastric plexus
of nerves. As soon as the irritation is produced on the nerves of
the semen sacs, it is carried to the abdominal brain. Then the irregular,
stormy irritation accumulated in the abdominal brain is radiated on the
various plexuses of nerves, especially in the direction of least resistance.
The disturbance of rhythm will be most manifest in that organ which is
weakened or most sensitive.
We will consider first the sudden deaths which are
due to rupture of blood-vessels in the brain. Such sudden deaths
are apt to occur in elderly men who have weak arteries, and also death
is more liable to occur when the man is cohabiting with a strange woman
for the first time, when he will be the most excited. Such deaths
seldom occur with men who repeatedly cohabit with the same woman, when
excitement is but ordinary. The explanation is, that the irritation
goes from the semen sacs, during the spasm of expulsion, to the abdominal
brain. Here the irritation is reorganized and radiated to the vaso-motor
center. The irritation may also go up the spinal cord to this center.
The disturbance in the vaso-motor center produces narrowing of the caliber
of the peripheral blood-vessels and thus the blood-pressure is suddenly
raised. At the same time the heart is slowed and hence the force
is increased. It pumps the blood vigorously into the arteries and
the weak wall gives way under the sudden pressure. The weak cerebral
artery yields to the excessive blood-pressure, and death follows immediately
from blood extravasation. It will be noted that all such deaths have
occurred with elderly men who generally have weak, atheromatous arteries,
with degenerated walls.
In cases of vomiting and fainting, the law is just
the same. The irritation due to the emptying of the semen sacs is
conveyed to the abdominal brain or up to the spinal cord. The disturbed
energies are reflected to the heart and stomach, and fainting and vomiting
are apt to arise. It comes under the same law as vomiting in pregnancy.
In domestic animals, fainting, vomiting or death is liable to occur in
those animals which have a short, intense orgasm, as the horse or pig.
The orgasm is much more intense in males, and hence they are nearly always
the subjects of disturbances during cohabitation. Females suffer
very rarely. All this profound impression in the coition of animals
is due to the irritation being sent to the abdominal brain, where it is
reorganized and radiated out on the plexuses of the various viscera.
The sudden, short irritation deranges the normal rhythm, and hence the
pathology of fainting and vomiting. The disturbance of rhythm will
be the most manifest in that organ most sensitive or most essential to
normal life. The same rules apply precisely to man.
Men during coition occasionally faint, vomit, defecate,
urinate, or die. I know of a noted judge who died shortly after connection
with a girl in a brothel. In Chicago, a short time ago, at one of
the principal hotels, a man of probably forty-eight was found dying after
cohabiting with a strange woman. All such deaths that I know or have
read of have occurred in elderly men. The smaller manifestations,
such as fainting, vomiting, urination, and defecation, have all occurred
in quite young men - mainly at the first coition. The elderly men
scarcely ever die while cohabiting with their wives, as they are familiar
with them, and the excitement of the orgasm is not so violent or intense.
It generally occurs with old men (in age, if not in years) in first coition
with a strange woman. Death may occur with an old man who has not
had connection with his wife for a long period, especially if the orgasm
is intense. I do not include in such a subject rupture of some pelvic
tumor, due to coition. The explanation of the matter lies in the
sympathetic nerve and its reflexes. The irritation of the penis is
due to friction, and of the semen sacs to spasm and evacuation, which is
transmitted to the abdominal brain and there reorganized.
The accumulated irritation in the abdominal brain
is radiated rapidly and on the various directions of least resistance.
It rapidly ascends the splanchnics and is reorganized in the cervical ganglia
and sent to the heart. The irritation sent so suddenly to the heart
at first violently stimulates it to a vigorous action, so that the blood-pressure
is raised to a high tension in the brain, especially in the left cerebral
artery. Old men often have friable, degenerated arteries, and this
sudden rise of blood-pressure induces the middle left cerebral artery to
rupture, and thus arises the death from coition. The primary cause
is the reflexes arising from the semen sacs and genitals. During
the dissection of quite a number of. cadavers, I have noticed that the
connections of the lateral chain of sympathetic ganglia are very large
at the root of the third sacral nerve. It must be remembered that
the third sacral makes up nearly all of the pudic nerve; also that all
the external genitals are supplied by the pudic nerve.
Hence, we find that the pudic nerve connects itself
with one of the largest ganglia in the lateral chain of the pelvic sympathetic.
Irritation of the external genitals is quickly carried to the vaso-motor
center by the close and extensive connection of the cerebrospinal sympathetic.
The rectum and anus have a close connection with
the sympathetic nerve.
The anus is guarded by two kinds of sphincters:
(a) One, the internal sphincter, ruled by the sympathetic, and this accounts
for the fact that rectal disease (fissure, ulcer) creates such intense
disorder and neuroses among the viscera through violent reflexes. (b) The
other anal sphincter, the external, is dominated by the spinal nerves and
does not create such wild disorder among the viscera by reflexes.
I have often noticed that in dilating the rectum
under an anesthetic, the patient would utter a kind of hoarse bray or expiratory
moan, similar to the braying of an ass or mule.
The reason for this violent braying or expiratory
moan in rectal dilatation is, that there is a distinct nerve strand arising
from the inferior cervical ganglion and passing directly to the phrenic,
which controls the diaphragm, e. g., rectal dilatation induces the irritation
to pass to the abdominal brain over the hypogastric plexus, whence it is
reorganized and emitted to the inferior cervical ganglion to the phrenic,
which transmits it to the diaphragm, which rapidly forces the air over
the vocal cords.
The mare in heat will often utter a similar sound. If the mare
is watched, she will be seen to be disturbed occasionally, every five to
eight minutes. When a "spell" or disturbance arrives, she will first
raise the tail, and then begin to straddle and utter a kind of bray, then
the pudenda is spasmodically everted, followed by the emission of fluids
from the pudendo-vaginal gland. The explanation of this phenomenon
must be made through the pudic and sympathetic nerves of the rectum and
genitals on the one hand, and the recurrent laryngeal and sympathetic on
the other. In short, there is a distinct relation between the voice
and the rectum. This connection must lie in the sympathetic nerve.
If one dilates the rectum suddenly the patient's skin capillaries become
flushed with blood and sweating is induced.
One of the most prominent features of patients suffering
from rectal disease is their manifest nervousness. Rectal patients
become irritable and neurotic. The profoundly rich supply of the
hypogastric to the rectum explains why disease of the rectum makes neurotic
There is also an evident connection between pelvic
disease and the voice. Menstruating women are likely to have tonsillitis
congestion, more than non-menstruating women. Chronic irritation
in the pelvic organs will induce chronic disease in the tonsils and throat.
In some women the voice changes at menstruation or during aggravation of
pelvic disease. Not uncommonly young women have difficulty in swallowing
at menstrual times, and their hearing may be a little disturbed, because
of the congestion, times, and the chronic inflammation travels up the Eustachian
tube. The distant relation and connection between the ovary and the
parotid gland is well known, and in mumps and operations on the ovary.
Few writers have called attention to the relation of pelvic disease to
pharyngeal disturbances, which exist by means of the connection with
the sympathetic. The relation of the tripod in exophthalmic goiter
- heart, thyroid gland and eyeball - will be more readily understood through
the study of the sympathetic nerve. The enlargement of the thyroid
in the menstrual life of women rests on the sympathetic nerve. The
sexual life of woman is her chief life, from a physical standpoint, and
as she has a larger ganglionic system than man, she demands special study;
for form this chief function of her life will arise new structures and
The anus is the last to become insensible under
chloroform. One can arouse a patient who is supposed to be dying
from chloroform anesthesia, by suddenly dilating the rectum; the peripheral
capillaries will also dilate and the cardiac and respiratory action will
again resume. It is possible that the same safety arises in dilating
the cervix and vagina in labor, as then we may give chloroform with impunity.
The heart center lies in the medulla, and one often observes how dilating
the rectal sphincter makes the capillaries flush and the skin sweat.
Now, the very opposite often happens, for very often when a sphincter is
dilated, as in labor, urinating or rectal dilation, the subject has a distinct
chill. This is due to the disturbance carried to the heat center
in the medulla. The kind of irritation which produces chill and the kind
which produces heat are not yet determined, but both arise by means of
the sympathetic nerve.
Reflexes from the rectum, e. g., fissure, produce
just the same disturbance upon the system as do reflexes from the vagina
or uterus. Both arise by means of the sympathetic, and both result,
if persistent, in malnutrition. The reflexes seem to alter (stimulate,
depress or produce irregularity) the circulation in adjacent or remote
It is well known that young girls who have a uterus
badly developed and anteflexed, suffer from constipation and rectal troubles.
It is likely that the constipation and rectal trouble is mainly due to
reflex action by means of the abdominal brain. It is known that long
continued irritation of a voluntary degeneration and finally cicatricial
contraction. Now it is also well known that women possessed of rectal
trouble soon acquire uterine trouble. It is due to reflex action,
the rectal irritation is sent up the abdominal brain and reorganized and
then transmitted to the uterus, inducing circulatory and nutritive disturbance.
The sympathetic nerve, as its name implies, is liable
to be brought in unison with surroundings. For example, when the
young pregnant wife begins to vomit, the young husband may vomit also,
a purely mental impression through the sympathetic nerve. The effect
of the sympathetic on the glands of woman is important. The main
glands are (a) mammary; (b) the sebaceous on the face and (c) those of
the pudendum. As soon as menstruation begins (or a little later)
the girl begins to have facial acne. The sebaceous glands of the
face inflame, enlarge and have a severe exacerbation at each monthly.
Some women look almost as if they were chronic drinkers at the time of
menstruation. A monthly rhythm excites and exacerbates the facial
sebaceous glands into a chronic inflamed condition. (These glands may be
trying to imitate the glands in the boy in enlarging a growing beard.)
The trouble is due to the sympathetic and is especially active in the face
by reason of the presence of the ophthalmic ganglia, Meckel's ganglia,
otic ganglia and sub-maxillary ganglia - all sympathetic ganglia situated
on the fifth cranial nerve. This facial acne, highest at the maximum
of the rhythm of the automatic menstrual ganglia, is very annoying to many
women. At the climax of the menstrual rhythm, there may be noticed
on some women, dark discolorations, or pigmentation, just below the eyes.
This pigmentation of the eyelids is what is so frequently mentioned as
the dark rings about the eyes. It is due to deposit of pigment induced
by venous congestion. The congestion is brought about by the rhythmic
irritation of the ophthalmic ganglia (sympathetic) on the supraorbital
branch of the trigeminus. The congestion and pigmentation of the
eyelids in menstruation must also be connected with the presence of large
glands known as the Meibomian glands. The sympathetic nerve has a predilection
and a dominating influence over glands; so that the eyelid congestion and
consequent pigment deposit during menstruation must be associated with
the ciliary ganglia of the Meibomian glands.
In the pelvic diseases of young girls, I have found
quite frequently an association of weak eyes. This is especially
the case with endometritis, deficiently developed uterus and dysmenorrhea.
They can use their eyes to read but a few minutes at a time, without pain
or the letters blurring. I could find no reference to the subject
in gynecological text-books. Since writing the above I have learned
from Dr. B. Bettman that Dr. Fritsch and others have investigated the connection
between pelvic and eye diseases. It must be that there is some prominent
connection between certain cases of female generative disease and eye trouble.
I have noted so many cases that I cannot consider it an accident and believe
there must be some physiological connection. The eyes are worse at
the maximum of the menstrual rhythm. The explanation of this association
must lie in the sympathetic nerve.
I suggested the subject to Dr. Frances Dickinson,
Professor of Ophthalmology in the Chicago Post-Graduate School, who has
carefully followed some of the cases. So far, the doctor has reported
that the eye trouble seems to be in the general circulation of the eye,
the visual apparatus (the cornea, lens and retina) being normal.
The endurance of the eye for work is lessened, and it appears to me that
the chronic defect in the blood canals is accounted for by the disturbance
in the rhythm of the diliary ganglia, and the sympathetic nerve supply
of the Meibomian glands accounts for the pigmentation of the lids.
What role the lachrymal glands play in the matter of eye trouble through
the sympathetic, I am unprepared to state.
The associated disturbances of the mammary glands
in menstruation and gestation, have attracted the attention of many thinkers.
The problem must be solved through the sympathetic nerve. The spinal
nerves supplying the mammary glands come from the cervical plexus and the
six upper dorsal nerves. The arteries which supply the gland are
the long thoracic, internal mammary, the intercostal arteries under the
gland, and a few branches from the axillary arteries. Now, on these
arteries, the sympathetic nerve goes to the gland. The first stage
of milk secretion is a silent process reflected through the cord.
The second stage is a gross reflection through the splanchnic from fetal
irritation in the uterus; the cerebrospinal nerves elaborate milk, but
the sympathetic hastens its secretion.
The original irritation nearly always arises in
the pelvic organs. It travels to the mammary gland in three ways:
First, by the way of the spinal cord; second, by way of the lateral chain
of the sympathetic; third, the main way is through the hypogastric plexus
to the abdominal brain and then through the great sensory nerves of the
viscera, viz.: the three splanchnics. But we must again consider
that the mammary gland has a peripheral nerve apparatus which not only
shares in the genital rhythm, but also has the capacity to form milk.
The mammary gland must be looked on as simply a modified sebaceous gland
and we have noticed above how the sebaceous glands of the face are affected
by menstruation and gestation. The spinal nerves do not induce any
rhythm in the glands as is shown in girls up to puberty. But the
impetus to rhythm must suddenly arise at the peculiar condition known as
puberty, or the period of tubal motion.
The sebaceous glands on the pudendum are large and
the odor at menstruation is chiefly due to their increased secretion.
The pudendal glands are remnants of ancient life when the female, in heat,
attracted the male by the increased odor emitted from the active glands.
The odor during menstruation is often due to the activity of the Pudendale
sebaceous glands and decomposition of their products, not merely to decomposition
of menstrual blood. Here, as in other glandular apparatus, the sympathetic
nerves play an important part.
The sympathetic nerve seems to play a significant
role on the heat centers of the medulla. I have noticed this especially
in laparotomy and vaginal hysterectomy. In short, when certain bundles
of sympathetic nerves are cut, especially the hypogastric plexus, the temperature
will rapidly rise above or fall below normal.
Surgeons are alarmed at these manifestations until
experience teaches their real meaning.
The practical application of the sympathetic nerve
in gynecological work lies in its control over nutrition. Reflex
irritation from a pelvic viscus will remotely, or through several years,
impair the whole visceral economy. Remote effects of pelvic disease
must be traced through the nervous system (sympathetic) due to circulatory
The connection of the cerebral cortex (the seat
of epilepsy), with ovarian diseases, resulting in so-called hystero-epilepsy,
is far from being proven.
The different sizes of the peripheral ganglia in
the various viscera is an important element in studying the sympathetic.
Some viscus may have abnormally small ganglia and hence its rhythm and
nutrition will be defective. Small automatic cardiac or menstrual
or gastrointestinal peripheral ganglia will be unable to do normal, vigorous,
nutritive and rhythmic work, thus making the visceral system defective.
Menstruation and the menopause I shall place in the realm
of the sympathetic nerve. The peculiar cycles and rhythms throughout the
life of woman demands attention. We may call attention to the wide domain
of the sympathetic nerve not only in health, but also in disease. Having
made considerable investigation in this subject, some of the resulting views
may be of interest and may stimulate the study of the sympathetic nerve.