The Abdominal and Pelvic Brain
Byron Robinson, M. D.
A CLASSIFICOMAIN OF THE SYMPATHETIC NERVES.
The sympathetic nerve concerns itself with the
life of the viscera. It presides over the visceral economy.
"A man's power is hedged in by necessity, which,
by many experiments, he touches on every side, until he learns its art."
-- Ralph Waldo Emerson.
We here present the classification of diseases considered
to belong to the domain of the sympathetic nerve by various writers.
The classification has no hard or fast lines, but we present it for the
purpose of securing a general or bird's-eye view of the field of the sympathetic.
The field of definite action, physiologic, anatomic or pathologic, of the
cerebrospinal and sympathetic nerves, is not yet settled. The pathology
of the sympathetic must rest on its physiologic paths. Physiology,
with our present limited anatomical means of tracing nerve fibers, is surer
than anatomy. It is difficult to make a satisfactory classification
of diseases of the sympathetic, for a multitude of symptoms, which may
reasonably be supposed to depend upon the sympathetic nerves, are encountered
without our being able, by minute examination, to recognize the morbid
process upon which they depend. Their chief manifestation is through
reflex action, referred disturbance.
Again, many sympathetic nerves, and especially ganglia,
are found at the autopsy sclerosed, pigmented or possessed of increased
connective tissue, yet the patient left no records of physical complaints
during life. Hence, it is difficult to retrace, in such cases, the
interpretations of Nature's physiologic experiment. Also, one is
not always able to decide whether the pathologic findings at the autopsy
are not secondary. No doubt there is a special pathology of the sympathetic
nerve, or rather ganglia; but it may not be a recognized pathology.
In normal and pathological states the sympathetic nerve is constantly affected
by reflex irritations. The pathology of the sympathetic is chiefly
observed in the cervical and abdominal ganglia, and is characterized by
vascularity, deposit of excessive connective tissue, pigmentation, atrophy,
hypertrophy, sclerosis, fatty infiltration, accumulation of microbes and
leucocytes in the ganglia, amyloid or fatty degeneration. Sometimes
the blood-vessels of the ganglia are found dilated and engorged with white
Classification of diseases which are certainly,
or probably, connected with the sympathetic nervous system:
1. Functional disturbances:
(a) Irritation (hyperesthesia).
(b) Paralysis (anesthesia).
2. Hyperesthesia of the sympathetic (reflex irritation):
(a) The abdominal brain (neuralgia celiaca).
(b) The mesenteric plexus (enteralgia,
(c) Hypogastric plexus (neuralgia hypogastrica).
(d) Gastric plexus (gastralgia, gastrodynia).
(e) Spermatic or ovarian plexus (ovarian
(f) Splenic plexus (splenic neuralgia).
(g) Hepatic plexus (hepatic neuralgia).
(h) Renal plexus (nephralgia).
(1) Pelvic brain or cervico-uterine
ganglia (irritable uterus, uterine neuralgia).
(j) Aortic plexus.
(k) Diaphragmatic plexus.
(1) The cervical ganglia.
(m) The cardiac ganglia (cardialgia,
(n) Trigeminus (facial neuralgia).
3. Anesthesia of the sympathetic.
4. Paralysis or spasmodic affections of voluntary muscles:
(a) Locomotor ataxia.
(c) Diphtheritic paralysis.
5. Progressive muscular atrophy:
(a) Pseudo-muscular atrophy.
(b) Progressive facial hemiatrophy.
6. Visceral neuroses:
9. Addison's disease (bronzed skin),
10. Hemicrania (headache).
11. Trigeminal neuralgia (facial neuralgia).
12. Exophthalmic goiter, Pavy's (1825), Graves' (1835), or Basedow's
13. Angina pectoris or stenocardia (Heberden's disease (1768).
14. Diabetes mellitus (hepatic neuralgia).
15. Diabetes insipidus (renal neuralgia).
16. Unilateral hyperidrosis (sweating).
20. Myxedema (sterodema).
21. Symmetrical gangrene of the extremities.
22. Pathologic changes in the sympathetic in other diseases:
(a) In syphilis.
(b) In old age.
(e) Infectious diseases.
(f) Cardiac diseases.
(g) Malignant diseases.
The above table records diseases which are certainly
or probably connected with the sympathetic nervous system. However,
some of them are much more doubtfully connected than others.
We will here consider briefly the hyperesthesias
(neuralgias) of the abdominal brain and its closely related plexuses of
nerves. In regard to the functional disturbances, or reflex irritation,
we have hyperesthesia or exalted irritability of the sensory nerves.
The hyperesthetic nerve manifests itself first by pain, secondly by a reflex
act on a motor apparatus. Hyperesthesia, or exalted irritability
of the sympathetic nerves, is liable to manifest pain irregularity, periodically,
paroxysmally, and yet retain some irritability during the intervals.
The symptoms of hyperesthesia are generally uniform and persistent throughout
the duration of the disease. Early life is very free from hyperesthesia
of nerves and it does not endanger life. Anatomically, we know little
of the characteristic changes in structure in hyperesthesia. The
etiology of hyperesthesia is obscure; however, malnutrition is perhaps
a bottom factor. The presence of certain substances, such as lead,
will induce hyperesthesia or lead colic (neuralgia saturnine). Climate,
sex and age play a role, as does anemia or plethora. Checking of
secretions induces hyperesthesia, as does rheumatism or congestion.
Hyperesthesia generally runs a chronic course, is periodic, is seldom completely
recovered from, is often a forerunner of organic disease, is very persistent
individually, and is doubtless accompanied by tonic spasm of vessels.
Hyperesthesia of the nerves of special sense is
manifested by phantasms. One of the objects of this little volume
is to attempt to show anatomically and physiologically how reflex irritation
in one diseased viscus will unbalance the rest. For example, what
gynecologist has not personally observed that a tender, irritable uterus
will unbalance the other viscera (abdominal and thoracic) year after year.
From some form of malnutrition or other morbid process the uterus has become
chronically hyperesthetic, and the result is that the secretions and excretions,
visceral rhythm and circulation, are disturbed, while malnutrition results
with an accompanying neurosis, which is due to the nerve apparatus being
bathed in waste-laden blood.
It is not easy, practical or even useful to discriminate
between hyperesthesia and a visceral neurosis, as one may blend into and
become identical with the other. The active hyperesthesias of the
great ganglia of the sympathetic system are characterized by an overpowering
sense of prostration, a sense of impending dissolution, as if the center
of life itself would be destroyed. This is the essential and common
story of neurotic women. A blow on the pit of the stomach makes one
stand with overwhelming awe of a coming danger, a sense of death-like anxiety
and annihilation. These profound impressive
sensations are characteristic of the sympathetic nerve. He who has
once fainted need not be told of profound sensations. It may be stated
here that the indefiniteness of the symptoms and findings in the sympathetic
tracts have induced theoretical writers to offer placebos to the profession
in the form of a profusion of terms, such as gastralgia, gastrodynia, gastric
neuroses, and gastric neuralgia, terms some of which mean nothing to the
diagnostician, and are confusing to physicians.
From a careful study of visceral neuralgia it is
evident that it is a secondary disease. It consists of a peculiar
malnutrition of a sensitive nerve apparatus. The treatment of visceral
neuralgia consists in improving nutrition, relieving present distress by
harmless means and removing all depressing causes. The cause producing
the reflex irritation of different viscera must be discovered and the appropriate
remedial agent employed.
AN ILLUSTRATION OF THE ABDOMINAL SYMPATHETIC NERVE OF THE MALE
It is accompanied by ureteral dilatation.
Drawn from a specimen under alcohol which
I secured at an autopsy through the courtesy of Dr. W. A. Evans and Dr.
C. O' Byrne. 1 and 2, abdominal brain; 10 and 12 represent the spermatic
ganglia emitting their plexuses along the spermatic artery; H represents
the coalesced hypogastric ganglia. 11, inferior mesenteric ganglia.
Note the network of nerves ensheathing the ureters and also the anastomosis
of the plexus spermaticus with the plexus ureteris, hence, the testicular
pain is explained in ureteral calculus. Observe the numerous and
marked dimensions of the ganglia renalia.