The Abdominal and Pelvic Brain
Byron Robinson, M. D.
THE AUTOMATIC MENSTRUAL GANGLIA.
The function of the tractus genitalis is: Sensation, ovulation, secretion,
absorption, peristalsis, menstruation, gestation.
"We are shaped and fashioned by what we love." - Goethe.
Menstruation is a regular periodic monthly rhythm
of the uterus and oviducts. In general it begins at the age of 15
and ceases at 45, continues four days, the bloody flow amounting to two
ounces and should be painless.
Menstruation belongs distinctly to the oviducts
and uterus. It is a singular rhythmic action. It is controlled
by the automatic menstrual ganglia situated in the walls of the oviducts
and uterus. These rhythmic little brains manifest themselves to the
observer by circulatory change and increased motion. Menstruation
might be named oviductal motion. By direct observation in the human,
and also in animals, I have noted the following condition midway between
the monthly periods, or at times far remote from oestrus or rutting: The
oviducts and uterus are of quite a pale pink color. In short, they
are not congested, and are in repose. But at the menstrual period
or season of oestrus the oviducts and uterus are congested and in active
peristaltic motion. The oviducts are of a dark blue color from their
dilated vessels being filled with blood. The congestion of the uterus
is intense but not so manifest as the oviducts. The oviducts are
swollen, thickened and oedematous. They are soft and pliable.
At this time a slight irritation while removing
them soon excites them into active peristaltic motion. After removing
such oviducts and placing them in warm (salt) water they will maintain
vermicular movements for half an hour by gentle irritation. I have
been able to make these observations in women because I operate at any
time in laparotomy, after careful preparation, even if it be in the midst
of a menstrual period. As regards animals I have examined several
hundred genitals of recently butchered sows, and the oviductal congestion
at the oestrus is more apparent in them than in the woman. The sow's
uterus is also probably more congested. Observations and experiments
indicate that menstruation is a regular, periodical rhythm of a blood-wave
in the oviducts and uterus induced by the automatic menstrual ganglia.
The continually moving wave rises to a maximum and sinks to a minimum.
The menstrual wave continues from puberty to the menopause. It is
a nervous phenomenon.
Ovulation is a progressive, non-periodical process.
It begins before birth and continues until the ovarian tissue is atrophied
or worn out. It is liable to occur at menstruation or oestrus because
of the vast blood-supply at that time which hastens the follicle to ripen
and burst. In the lower animals, so far as I can decide, menstruation
and ovulation seem to be coincident, i. e., they occur at the same time.
I have examined the cow, dog and sheep, but my observation is especially
based on the ovular and menstrual process as seen in the sow. By
the examination of some two hundred and fifty specimens of sow's genitals
in all conditions it seems to me that the oestrus of the animal embraces
both menstruation and ovulation in one physiologic process at the same
time. But as the scale of animal life ascends, the processes of menstruation
and ovulation seem to become more and more divorced. To my mind,
the best animal to begin with is the cow. In the cow one can see
more and more distinct processes with the ovaries and oviducts. Their
separate workings become more apparent. In the calf, before and after
birth, ovulation is very manifest. But the oviducts and uterus before
birth and for a considerable time after, are manifestly quiet and pale
and rudimentary, non-functional. In woman it is my observation that
menstruation and ovulation are found distinctly separate from each other.
It is true that ovulation and menstruation may occur together, may be coincident,
but that is an accident. The processes are physiologically separate.
In the woman ovulation has been observed before birth, and I have seen
ovulation in a woman of 70, the specimens of which were presented to me
by Dr. Burgess of Milwaukee. Now, of these two great physiologic
functions, ovulation is a life-long process. It begins before birth
and ends with ovarian atrophy. But menstruation is a periodical process
beginning with puberty and ending with the menopause. Puberty must
be observed as initiating the new exercise of genital ganglia. A
viscus assumes a new rhythm which disturbs the entire system.
The views here contained are that menstruation is
governed by nervous ganglia situated in the walls of the oviducts and uterus.
I have designated these nervous structures as automatic menstrual ganglia.
As a deduction of this theory, oviductal - motion and oviductal changes
will be considered the most marked phenomena of menstruation. The
question may be asked: What is a nervous ganglion? A nervous ganglion
is a collection of nerve cells. Its constituents are nerve cells
and nerve fibers. It is an ideal nervous center having a central,
conducting and peripheral apparatus. A ganglion is a little brain,
a physiological center. It has the power of receiving sensation and
transmitting motion. It is automatic in itself. It possesses
the power of nourishment and controls secretion. Reflex action can
be demonstrated in it. What are called motor, sensory, and sympathetic
nerve fibers are found in its composition. The peculiar feature of
a nervous ganglion is rhythm. It performs cyclical movements.
It has a periodic function which continually waxes to a maximum or wanes
to a minimum. It lives a rhythmic life. Its periods of action
vary from a few seconds to a month. It is beyond the control of the
1. The proof of the existence of the ganglia
in the oviducts and uterus is from analogy. All hollow viscera have
ganglia in their walls. Histologists have long known that many viscera
possess ganglia which have automatic power. The names of Bidder,
Schmidt, Ludwig, Remak Meissner and Auerbach are associated with the discovery
and description of these viscera ganglia.
(a) I have satisfied myself many a time, in
vivisection on dogs and other animals, that the heart has nervous centers
or ganglia, which will continue to act independently of their cerebrospinal
connection. It is not only clear that the heart has automatic ganglia,
but that nearly all these ganglia are centered in the walls of the auricles.
I have often watched the heart's action gradually die out from apex to
base. We know by experiment that the heart will perform its cycle
of contraction independently of its external connection. These automatic
nervous ganglia situated in the wall of the heart keep up its rhythm, its
cyclical action, its periodic movements. They explode oftener than
once a second. I have severed the heart from its attachments in some
animals and watched its beating cease, when, if left alone, it would be
still forever; but by applying stimulus to the ganglia the heart would
again perform its rhythm. It would beat and explode just the same
as when it was connected to the cerebrospinal system. Hence few observers
doubt that the ganglia of Remak, Bidder, Ludwig and Schmidt sustain and
control the rhythm of the heart. One can prove by experiment that
there are several ganglia situated in the auricle by cutting pieces out
of its wall. If these pieces are stimulated they will go through
a distinct rhythm.
(b) A large number of experiments on the intestines
of animals (especially the dog) convinced me distinctly that the intestines
are endowed with automatic ganglia in a similar manner to the heart.
These ganglia are called the plexus of Auerbach and the plexus of Meissner-Billroth.
If a dog is killed and the abdomen is opened in a room of 75 degrees F.,
the intestines can be induced to perform peristalsis for an hour after
death by tapping them occasionally with a scalpel. As soon as the
intestines are exposed to the air or tapped with the scalpel, they begin
to go through wonderful vermicular movements resembling a moving bundle
of angle-worms. I have often demonstrated the peristaltic movement
of the intestines more than an hour after death, so that it can be stated
that the automatic ganglia of the bowels will perform their rhythm independently
of the cerebrospinal center. In autopsies I have found the
intestines invaginated, and from the non-congested and non-inflammatory
condition of the intestinal wall I had no doubt the invagination occurred
entirely after the patient's death. The non-inflammatory telescoping
of the intestines in dying subjects is called the "invagination of death."
It can be perfectly demonstrated in a dog's intestines fifteen to thirty
minutes after he is dead. Hence the nervous bulbs studded over the
plexus of Auerbach and the plexus of Messner-Billroth are the automatic
ganglia which induce, sustain, and control the rhythm of the intestines.
The vigorous rhythmic exercise or explosion of the intestinal ganglia is
what causes colic, and in bowel constriction occurring in patients having
thin belly walls I have observed this with perfection. The intestinal
rhythm caused by the ganglia can be beautifully seen in the defecating
intestine of a patient on whom colotomy has been performed.
I have never seen the causation of the very severe
pain in angina pectoris very satisfactorily explained. I would suggest
that it is colic of the heart, caused by abnormally vigorous action of
the heart's automatic ganglia; that the desperate pain in angina pectoris
is due to the excessive exercise or abnormally vigorous, irregular rhythm
of the automatic ganglia situated at the base of the heart. Hence,
clinically, no doubt, we see the abnormally vigorous rhythm or irregular
rhythm of the heart in what is called neuralgia or spasm of the heart,
or angina pectoris. The ganglia offer the best explanation. Clinically,
we see in the intestines the exercise of Auerbach's and Meissner's ganglia
in various diseases.
This illustration presents a fragment of the luxuriant nerve supply of
the uterus, oviducts and ovaries.
In colic and also bowel obstruction we see an excessively
vigorous, irregular action of the ganglia. We note an excessively
irregular action of the ganglia in the desperate, painful colic of children,
which I believe amounts in many cases to an invagination with subsequent
spontaneous disinvagination. It may be noted that irregular action
of the bowel ganglia occurs in children where the cerebrum is insufficiently
developed to force the ganglia of Meissner and Auerbach into subjection
and thus secure a regular rhythm of the intestine. We also see irregular
ganglionic action in the bowel where the cerebrum is diseased and hence
has lost a controlling influence. In chronic constipation, and in
the paralysis of the intestine during peritonitis, we see disease of the
ganglia producing such loss of power that the ganglia cannot initiate or
sustain sufficient peristalsis to expel the bowel contents.
(c) The same statement can be made relative
to the bladder. It is supplied with two kinds of nerves. One
kind is the cerebrospinal. The other kind is the sympathetic nerves,
which especially go to the body and summit of the bladder. These
nerves are studded over with ganglia which may be styled automatic vesicular
ganglia. These ganglia are closely associated with the blood-vessels
and walls of the bladder, and have an influence in controlling the rhythm
of this cyst. As an example to demonstrate the action of the automatic
ganglia in the bladder, I took from a stag weighing fourteen hundred pounds,
the bladder, penis and rectum. Twelve hours after it was contracted
quite small. I then dilated it, and thirty-six hours after it had
again contracted smaller than ever and would not contain half a pint of
fluid. This bladder continued its rhythmic action for more than forty
hours. It is not mere elasticity, as one can watch the rhythm of
segments. It can be well demonstrated by injecting its blood-vessels
with red fluid and then watching it for a day, when the slow, cyclical
rhythm can be plainly seen. The sacral spinal nerves preponderate
at the neck of the bladder and endow it with sensation. They likely
hinder it from rhythm, while the body and summit of the bladder are mainly
supplied with sympathetic nerves. They give it blunt sensation and
rhythm. But the summit and body of the bladder are the parts endowed
with ganglia, and they are also the parts endowed with cyclical rhythm.
If a rubber bag is inserted into the bladder and
then filled with fluid, having its external end connected with a mercury
gauge, it can be plainly seen that the bladder undergoes intermittent contraction.
It will demonstrate its rhythm. Clinically, this rhythm can often
be observed in retention of urine. The filling bladder will periodically
make vigorous efforts to expel its contents, and the pain felt at those
times can be easily mistaken for colic. Hence the bladder is endowed
with automatic vesical ganglia, which are mainly situated in the walls
of the body and summit, especially localized along its highways of nutrition
(blood and lymph tracts). These ganglia preside over the rhythm of
(d) The analogies of the heart, intestines
and bladder are quite apparent, and can reasonably be carried to the uterus
and oviducts. They are all hollow organs. The oviducts and
uterus are no exception to the other abdominal viscera. What is said
in this paragraph is the result of examination of over seven hundred uteri,
oviducts and ovaries, of woman, cow, pig, sheep and dog. Some of
the examination was carried on during the life of the animal, and in quite
a number of cases I noticed the action of the oviducts in the living woman
during operation. Much of the work was done on freshly butchered
animals, where the organs were removed before the general muscular twitching
had ceased. My first distinct attention was drawn to the idea that
the heart, intestines, uterus and oviducts acted similarly, by observation
in the slaughter house. Dr. C. S. Miller and myself were watching
the slaughter and evisceration of a cow weighing fifteen hundred pounds.
The cow was in the eighth month of pregnancy. The butcher amputated
the large uterus, containing the calf, a little above the internal os.
I noticed that the amputated portion of the uterus containing the calf
went through a peculiar series of rhythmic motions. But the interesting
scene was the amputated stump left on the body of the cow. The stump
was about six inches long and three inches thick. This stump performed
its peculiar rhythm long after the cow was dead. It slowly described
circles and arcs with diameters varying from an inch to four inches.
Each muscular layer of that thick uterus worked in perfect harmony.
No uterine layer of muscles interfered with any other. Every part
of the uterine stump seemed to work with intelligence or a kind of quasi-judgment
during the rhythm. At one time the circular muscular layer would
go through a slow but distinct rhythmic circle before any other muscular
layer would begin. Then, gradually, the longitudinal muscular layer
would. begin to act, and the end of the stump would describe a rhythmic
cycle and thus it continued to repeat the rhythmic action until we left,
an hour after. During the activity of the stump the most striking
example of the action of the two muscular layers of the uterus could be
seen, for while one layer worked vigorously the other remained still.
Another striking example to show that the hollow uterus has its own automatic
ganglia may be observed by removing the uterus from a cow immediately after
death. The uterus should be that of a multiparous cow, because such
have long, thick, tortuous, helicoid arteries. Now carefully inject
the utero-ovarian arteries with red fluid. Observation will easily
detect rhythm in the segments of this uterus for some forty hours after
death, in a 75 degree room. The rhythmic waves that pass over the
uterus will shift the fluid from one segment to another, so that the quantity
of fluid is not uniform in each segment. The rhythm sometimes takes
place very slowly. This phenomenon is not elasticity. But,
clinically, the rhythm of the pregnant uterus has been known since the
art of obstetrics began. My purpose here is simply to draw attention
to the independent action of the uterus from a cerebrospinal connection,
and to show that the uterus has automatic ganglia like other hollow viscera.
Labor will take place under profound anesthesia.
Children have been expelled from the uteri of dead women. All this
is due to the nerve apparatus of the uterus. Some Frenchman severed
the spinal cord of a pregnant sow below the brain, thus paralyzing all
the voluntary muscles which aid in parturition, yet the sow had her pigs.
The uterus drove one fetus into the vagina, but as the abdominal muscles
were paralyzed this fetus had to be driven out by the second fetus, which
was pushed against the first by the contracting uterus.
(e) The oviduct is simply a continuation of
the muscular walls of the uterus, but not of the endometrium. The
endometrium seems to be a temporary gland, whose duration of active life
is the menstrual period. The analogy of the hollow oviduct of the
intestine or heart is very close. Nearly all the original work done
on this subject was in relation to the oviducts, for I consider them the
most important organ in menstruation. The object of menstruation
is to transport an egg from the ovary to the interior of the uterus.
This can be done by a properly prepared oviduct. It seems to me that
menstruation begins and ends in the oviducts, and that the importance of
the oviducts overshadows all other organs in menstruation, however, the
endometrium is the important prepared nest. When the oviducts begin
their rhythm the girl has arrived at puberty. Oviductal motion is
a sign of womanhood. When the oviducts begin their cycles it is a
heraldic sign that the gland called the endometrium is prepared to nourish
an ovum. The endometric gland is no doubt often prepared to nourish
an ovum before the oviductal motion or menstruation, and from the examination
of nearly eight hundred ovaries I am fully satisfied that ovulation goes
on from before birth until the end of life, or till the germinal epithelium
is worn out. Actual observation of animals convinced me of this.
One can see no changes in the ovary at puberty, except that of increased
vascular supply. I never could find any periodicity, nor signs of
it, in the ovulation in the human, cow or sheep. The ovules simply
ripen progressively and burst when they are mature, whether that be at
menstruation or at some other time. I am sure they often burst by
mere mechanical accident. Hence, it does seem that menstruation and
ovulation are two different processes. Two statements may then be made
relative to an egg being carried into the uterus: First, when the oviduct
goes through its menstrual rhythm it may secure an egg, if it happens to
be ready and bursts. Second, the oviduct may secure an egg, if its
fimbriated funnel becomes glued on to the ovary at a point where there
is a maturing ovum.
2. The Proof of the Existence of the Ganglia
in the Oviducts from Direct Observation and Experiment. - If an adult female
dog is taken and well anesthetized, and the abdomen opened, the short white
oviducts can be found just posterior to the kidney, at the abdominal end
of the double uterus. Two important matters will be observed - first,
the condition of the oviduct; second, the position of the oviduct.
If the animal is not in rut, which is very analogous to menstruation, the
oviducts will be very white, small and still. They are very much
contracted, and the fimbriated end generally lies as far from the ovary
as the fimbria ovarica will permit. In short, in the interoestrual
time non-congestion and quiescence mark the oviductal condition.
The condition and position of the oviduct at the period of rut are wonderfully
changed. The oviduct is very much swollen and elongated; it is dark
blue from, especially, venous congestion. The surrounding blood-vessels
are enlarged, tortuous and distended. The oviduct shows convolutions
and tortuosities plainer now than at other times. The oviduct having
become longer and thicker, its entire position is changed. The strip
of (muscular) tissue which connects the fimbriated end of the oviduct to
the ovary has shortened, and the funnel mouth of the oviduct is closing
on to some portion of the ovary. At the climax of the menstrual rhythm
the fimbriated mouth of the oviduct is often glued or cemented on to the
ovary by a kind of glairy MUCOUS exudate. The careful examination
of nearly eight hundred oviducts satisfactorily demonstrated to me that
the oviducts go through a distinct rhythm at menstruation. Menstruation
is a periodic cycle of the oviducts. The oviducts go through a peristaltic
or vermicular motion exactly analogous to the intestine. Now. there
is only one kind of apparatus which produces a rhythm, and that is a ganglion.
Hence, as the oviducts go through a rhythm, they must be influenced by
The changes in the oviduct at puberty are as follows:
(a) It assumes rhythmic movements; (b) its muscular action increases; (c)
its vascularity is much increased; (d) it becomes extended and loses its
corkscrew or spiral shape of fetal life; (e) its epithelium becomes ciliated;
(f) its gross activity appears mainly at the abdominal end; (g) its lumen
becomes filled with fluid. This fluid is to float the egg or ovum
into the uterus. The cilia whip the fluid in the oviduct into a current,
and this wonderful anatomic and physiological canal floats the ovum to
the nourishing gland - the endometrium. The automatic menstrual ganglia
during their rhythm produce such changes in the oviduct as will best prepare
it to float an egg from the ovary to the uterus. As the rhythmic
peristalsis of the oviduct reaches its climax the oviduct becomes thicker,
longer and its caliber wider. The fimbria ovarica shorten and draw
an oviductal funnel over a part of the ovary. A dry, contracted oviduct
with a narrow lumen offers difficulties for the passage of an ovum.
If the epithelium of the oviduct is so altered by disease that it does
not secrete fluid, the egg may not be able to float through the oviductal
canal, but may become arrested in its passage, causing ectopic pregnancy.
The reason why an egg does not get into a child's uterus is because its
oviduct is deficient in motion; the fluid in its interior and the ciliated
epithelium are deficient. The ciliated epithelium whips an egg into
the uterus by means of a fluid medium. The rhythm of the oviducts,
caused by the ganglia, prepares them for their function. This is
done by first drawing the mouth of the oviduct over a part of the ovary;
and, second, by flooding the lumen of the oviduct with serous fluid.
Of course it will be only accidental that the mouth of the oviduct will
cover a matured ovum. The vast majority ovulate into the peritoneal
cavity. Ovulation is a life-long process, while menstruation, or
rather oviductal rhythm, lasts about thirty years.
The almost entire separation of the oviduct from
the ovary is peculiar to the higher animals, and no doubt lessens the chances
of excessive reproduction. In the hen the ovary and oviduct are continuous.
The active explosion of the automatic menstrual ganglia are the most marked
at the abdominal end of the oviduct. By direct experiment it is easy
to make the oviducts perform their rhythmic, vermicular movements for half
an hour after their removal from the living. The oviducts of a cow,
sheep, dog or pig can be kept moving in a warm medium by stimulating or
pinching them, just in the same manner as pinching the heart or tapping
the intestines will keep up the movements of those organs in vivisection.
I have made this experiment many times on the normal oviducts of women
where they were removed for various causes. While the operation is
progressing one can see the oviducts going through a rhythm from mere manipulation.
As soon as an oviduct is removed, if it be normal, a rhythmic action may
be produced by pinching it. The two muscular layers of the oviduct
will work separately before the eye. The external longitudinal muscular
layer shortens the oviduct, while the internal circular muscular layer
narrows the oviductal lumen. An oviduct will maintain this rhythmic
motion for about half an hour, if pinched or stimulated in a medium (salt
water is a very good medium).
The large range of movement of a human oviduct under
stimulation is very marked, and the vigorous manner in which the two muscular
layers of the oviduct work is very noticeable. If the circular layer
is well stimulated, it will contract with such vigor as to resemble a pale,
contracted band around the point of irritation. The endometrium may
be looked on as a temporary gland, whose duration of life is the child-bearing
period. So the automatic menstrual ganglia which govern the rhythm
of the oviducts and uterus, and make fecundation possible are only temporary
ganglia, at least so far as function goes. The automatic menstrual
ganglia begin their functional life in the incipient oviductal motion.
This is not the only organ that acts merely at a
definite period of life, though the organs exist anatomically during the
whole of life. The thymus gland is largest at birth. The thyroid
gland becomes most active in girls at about fifteen. The sebaceous
glands of males spring into functional activity at about eighteen.
When the menstrual ganglia of woman begin to cease their functions forever,
the sebaceous glands of the face assume an active function, and a beard
results. The salivary glands do not act for three months after birth.
No doubt the facial sebaceous glands existed always, anatomically but not
functionally. It has appeared to me for some time that there exists
some relation between the testicles and sebaceous glands in the male, as
there does between the automatic menstrual ganglia and sebaceous glands
in the female.
Whether the rut (oestrus) of animals and the menstruation
of woman are the same or different processes we will not discuss now.
But the function of the ganglia and their actual rhythmic process would
be precisely the same in either case. In mammals an oviductal rhythm
with its associated changes is almost a necessity to transport an ovum
from ovary to uterus. I could not observe any difference between
the state of the oviduct and the relation of its mouth. to the ovary in
animals in rut and the menstrual process of woman. The gross anatomy
of both processes appeared identical.
Premenstrual Pain. - The pain immediately preceding menstruation is
generally not well understood. I have observed that many gynecologists
of the present day attribute the premenstrual pain to the uterus.
They say the pain is due to the mechanical obstruction to the menstrual
fluid. These views may apply to certain cases. But I maintain
that the premenstrual pain is due to an excessive action of the oviducts
or a too vigorous rhythm. The automatic menstrual ganglia are overexcited
and act irregularly. The excessive stimulation arises mainly from
the fluid which finds its way into the lumen of the oviduct. The
fluid in the lumen of the oviduct, arising out of its congested state,
acts like a foreign body and excites oviductal action. The ganglia
become immoderately excited in oviducts whose lumen is partially or wholly
closed. The vigorous attempts of the oviducts to expel the fluid
confined in their lumen produce well-known agonizing pain. I have
examined women with distended oviducts who would repeatedly tell me that
the pain excited by the examination would last for hours. The oviducts
were simply excited into peristalsis by irritation of their ganglia.
Dyspareunia, so frequent in oviductal disease, is
not merely a story of pain at the time of connection, but of pain that
endures for hours. Part of the pain is due to trauma of irritable
nerves, but the worst pain is caused by setting in motion the vermicular
action of the diseased oviduct. The confined fluid in the oviducts
excites them into peristalsis, just as irritating substances excite the
intestine into painful peristalsis. If an intestine, through obstruction,
cannot expel its irritating contents, the picture of pain is almost identical
with premenstrual pain. In fact, I have often wondered whether I
was dealing with intestinal or oviductal colic. It must be remembered
that muscle, governed by sympathetic ganglia, acts quite differently from
muscle governed by spinal nerves. One is slow and rhythmic, while
the other is rapid and more spasmodic.
The pelvic brain (cervico-uterine ganglion) is a
large mass of aggregated sympathetic ganglia situated on each side of the
pelvis at the junction of the uterus and cervix. It doubtless shares
with the abdominal brain in originating, sustaining and inhibiting the
menstrual rhythm. The pelvic brain, like the cervical ganglia, or
that of Wrisberg, occupies a subordinate position in regard to the abdominal
brain. It is, however, a prevertebral ganglion. It is not easy
to dissect and isolate on account of its white color and resemblance to
adjacent tissue. It is three-quarters of an inch long and one-half
an inch wide in some subjects, and is more like a meshwork than the abdominal
brain. Its irregular meshes are pierced by numerous blood and lymph
vessels and connective tissue bundles. No doubt the irritable uterus,
which Gooch described seventy-five years ago, is caused in a great measure
by an irritable pelvic brain. A rhythm produced by a ganglion alone
is a very delicate mechanism, and it is no wonder that during the many
vicissitudes of menstrual life the rhythm becomes disturbed, irregular
and refuses to act. Pressure of the increasing size of the child's
head on the cervico-uterine ganglion initiates labor.
Anatomical. - The distribution of the sympathetic
nerve supply and the spinal nerve supply to the uterus and oviducts strengthens
the theory of automatic menstrual ganglia. Anatomists agree that
the uterine sympathetic plexus branches off to supply the uterus and oviducts
above the point where the sacral spinal nerves join the sympathetic chain.
The sympathetic plexus of nerves with its ganglia supplies the upper portion
(body and fundus) of the uterus and the whole of the oviducts, while the
sacral spinal nerves mainly go to the cervix. Now, it is very likely
that the (sacral) spinal nerves have little to do with any rhythm or cyclical
action. It is quite probable that they hinder rhythm.
They would thus influence the cervix to live a steady
life. The ganglia on the sympathetic uterine and oviductal plexus,
on the other hand, are possessed of a peculiar property called rhythm,
so their ganglia would endow the uterus and oviducts with rhythm.
This agrees with the observation that the body and fundus of the uterus
and the oviducts are the main part of the genital tract involved in menstruation,
while the cervix and vagina, mainly supplied with spinal nerves, remain
fairly still. The cervix is a mere guard to the uterus, and does
not share in menstruation. These ganglia mainly follow the blood-vessels,
and the tortuous helicoid arteries supplying the uterus and oviducts, which,
being long, give much space for ganglia to exist. The ganglia no
doubt control blood-supply by regulating the caliber of the artery and
the stay of the blood in the veins.
3. The microscope, or sometimes a strong lens,
will demonstrate the existence of the ganglia on the plexus of nerves going
to the uterus and the oviducts. The nerves show uneveness.
At places they coalesce into masses, and the microscope demonstrates their
ganglionic character. I have frequently been able to trace the nerves
showing distinct bulbs on the posterior part of the uterus. Histologists
have some time ago shown that little ganglia exist in the walls of the
uteri of animals. But space forbids further discussion here.
Every visceral organ has its own supply of sympathetic ganglia brought
to it on the walls of the blood-vessels. Each visceral organ requiring
it has its own established cycle initiated in primordial life. The
rhythm becomes strengthened by differentiation into special organs, and
It seems to me that knowledge of the various visceral
ganglia will render the function of those organs and their diseases more
intelligible. To intelligibly minister to an organ diseased one must
know its pathology. The treatment of any disease comprehends part
if not all of its pathology. To me the action of the heart under
varying states and pressure of the blood is more intelligible with some
knowledge of the automatic ganglia which control its rhythm and motion.
A knowledge of the functions of the cardiac ganglia clears many an obscure
problem and explains the heart's action under varying conditions.
The same may be said of the ganglia of Meissner and Auerbach in rendering
intestinal peristalsis intelligible. So a study of what may be termed
the automatic menstrual ganglia will perhaps throw more light on the action
of the oviducts and uterus-organs around which woman is built both mentally
and physically. We suggest that the rhythmic function of the endometric
gland, its nidation and denidation, should not be neglected as a part of
The ganglia in the uterus and oviducts of woman
generally induce a cycle once a month during their functional activity.
The ganglia explode monthly. In the lower animals the automatic uterine
and oviductal ganglia explode in periods which correspond to the cycle
of the rut. It is here concluded that whether rut and menstruation
be the same or different processes, they are governed in their rhythm by
the automatic uterine and oviductal ganglia.
Will these automatic ganglia aid in explaining the
function of the uterus, oviducts or ovary after surgical or other destructive
procedures on any one of the three? I think they will. That
menstruation is closely connected with the nervous system, and that, too,
with the sympathetic (as it has rhythm) is a common observation.
Nerve disturbances disturb menstruation and its rhythm. A sprain
in the wrist has checked menstruation. I knew a patient who, while
menstruating, became frightened by a whistle from a train and did not menstruate
for a year. Sudden changes in temperature will alter its rhythm.
The mere expectation of marriage will occasionally make its rhythm regular.
Marriage, by mental and physical stimulation to the genital apparatus,
will often induce regular menstruation. When the nervous system is
impaired in strength by wasting disease, there may not be enough vital
energy to induce and sustain menstrual rhythms. Tubercular girls
cease to menstruate. It is a common observation that fleshy persons
have weak resisting powers, and fleshy women often menstruate irregularly.
In a precocious, abnormally developed girl we may see early menstruation.
In pregnancy and nursing, menstruation is arrested because the nervous
vitality is expended in nourishment. The miserable and painful failure
of an infantile uterus in menstration is rather from a deficient endometrium.
If vital energies are directed into different channels, or vitality gets
to a low ebb, the remaining powers may be insufficient to initiate and
sustain the regular menstrual rhythm. Non-development occurred from
From the views entertained in this paper, that menstruation
and ovulation are separate processes, and that the automatic ganglia are
situated along the oviducts and uterus and probably closely related with
the ovary, it would not be expected that removal of the ovaries would always
cause menstruation to cease suddenly. The automatic ganglia of the
oviducts and the uterus are still intact and will execute their rhythm.
Many gynecologists testify that this theory agrees with the facts.
Ovaries are extirpated and oviductal motion continues. However, the
destruction of a part of a connected complex organ soon destroys the nice
balance, and nourishment of the ganglia would in time deteriorate, and
then insufficient nerve vitalitv with lack of ganglionic harmony would
fall in starting and maintaining a menstrual rhythm. Also, it may
be considered that the chief, central, sexual organ of woman is the ovary
and the uterus and oviducts are appendages of the ovary. Extirpation
of the oviducts would quite effectually aid in arresting menstruation,
though not entirely, as many ganglia would remain in the uterine wall.
Yet in the very plan of the machinery the oviduct is no doubt designed
to execute more motion than the uterus, which could perform its function
while remaining quite still. By the German gynecologists, during
several years' residence abroad, I was informed that a removal of the oviducts
in a vast majority of cases caused a rap'd checking of menstruation.
Mr. Lawson Tait writes that the total removal of the oviducts arrests menstruation
in 90 per cent of cases. Is it not strange that an oviduct cut off
two inches from the uterus will maintain the rhythm? Actual cases
prove that when only the diseased ovaries are removed from women, with
inflammation existing in the oviducts, they are but little helped in their
misery. The active organ in menstruation is the oviduct, and it will
execute its rhythm unless removed. Ligating the oviducts is not a
rational method, as it will not check the rhythm. Nine years ago
I began ligating the uterine artery at the neck of the uterus after removing
its appendages. This effectually and immediately checked menstruation
and rapidly atrophied the organ.
Finally, the oviducts and most of the uterus being
removed, menstruation will nearly always stop. The ovary, left without
an oviduct, would not sustain menstruation. Cases are reported where
the oviducts and ovaries and most of the uterus were removed, but menstruation
continued. In such cases, no doubt, a sufficient number of automatic
ganglia were left to start and sustain a menstrual rhythm. In such
cases I suggest that investigation of total removal of the organs and also
of the reality of continued menstruation should be carefully done.
Patients often call any bleeding menstruation.
The ovary is the central, essential, sexual organ
of woman (requisite not only for ovulation but internal secretion) and
should be removed for malignancy and grave disease only.
Other theories have been advanced as to the cause
of menstruation. Dr. Christopher Martin claims that the nerve centers
are located in the lumbar cord. This is doubtless based on the labors
of Budge, who located the center of the bladder in the lumbar cord.
I wish to thank Dr. C. S. Miller, of Toledo, Ohio, who worked
long with me on this subject.