The Abdominal and Pelvic
Byron Robinson, M. D.
APPLIED ANATOMY AND PHYSIOLOGY OF THE ABDOMINAL
VASOMOTOR NERVE (NERVUS VASOMOTORIUS).
A complete nervous apparatus consists of nerve or ganglion
cell (e. g. cerebrum), a conducting cord (e. g. spinal cord, peripheral
nerve), a periphery (e. g. Touch corpuscle).
"Defeated o'er and o'er but ne'er disgraces." -- From the London
Times and placed on a monument to Lord Beaconsfield.
The sympathetic system of nerves (nervus vasomotorius)
has experienced a variety of names. Synonyms: The vasomotor nerve
(nervus vasomotorius) (Benedict Stilling, 1840 - German anatomist and surgeon,
1810-1879). The sympathetic nervous system (systema nervorum sympathicum).
The vegetative nervous system (systema nervorum vegetatorum). The
ganglionic nervous system (systema nervorum ganglionicum). The nervous
system of organic life (systema nervorum vitae organicae.) The nerve system
of nutritive life (systema nervorum vitae nutritiae). The great sympathetic
nerve (nervus sympathicus magnus). The intercostal nerves (nervus
intercostalis, Thomas Willis, 1622-1674, English anatomist). The
great intercostal nerve (nervus intercostalis ma-nus). The trisplanchnic
nerve (nervus trisplanchnicus, Francois Chaussier, 1746-1828, French anatomist).
The ganglionic nerves (nervus gangliosus). The visceral nervous system
(systema nervorum visceralis). The trunk nervous system (systema
nervorum trunci) (Rumpf nerven system, K. F. Burdach, German anatomist,
1776-1847). Grand sympathetic. Since this system of nerves
rules the motion of the heart and blood-vessels I shall assume with Stilling
that the most appropriate term is the vasomotor nerve (nervus vasomotorius).
The term "sympathetic" nerve is without signification and hence should
be discarded for a term significant of function; therefore, nervus vasomotorius,
since the blood carries nutrition to all organs, the term "nerves of nutritive
life" is included in the term nervus vasomotorius.
The Vasomotor Nerve
(nervus vasomotorius) or unfortunately the meaningless term sympathetic
nerve consists of: I, nerve ganglia, II, nerve cords, III, nerve plexuses.
I. The nerve ganglia, for practical purposes, present
three grand divisions, viz.: (1) the bilateral chain of trunk ganglia (trunci
nervi sympathici) extending from the base of the skull (ganglion of Francois
Ribes, 1800-1864 - French professor of hygiene in Mont Pieler) to the distal
end of the coccyx or coccygeal ganglion. (2) Three great ganglionated plexuses
or aggregations of ganglia known as (prevertebral plexuses) the prevertebral
plexuses of the thorax, abdomen and pelvis. (3) Automatic visceral ganglia
or peripheral ganglia located in relation with the thoracic, abdominal
and pelvic viscera. The ganglia composed of nerve cells receive,
reorganize and emit nerve forces. II. (Afferent and efferent apparatus.)
The nerve cords composed of nerve fibers consist of conducting, communicating
or distributing apparatus. III. The vasomotor nerve possesses
peculiar ganglionated plexuses and nonganglionated plexuses. The
vasomotor nerve is connected to the spinal cord through the (a) rami communicantes;
(b) nervi sacralia and (c) to the cerebrum by the vagi.
GENERAL VIEW OF THE VASOMOTOR SYSTEM.
The vasomotor nerves or nervus vasomotorius originate
in the cerebrospinal. The bilateral halves of the vasomotor nerves
(sympathetic) anastomose at the proximal and distal ends in the medium
plexuses, especially through the cardiac plexus, the abdominal brain and
pelvic brain, thus solidly and compactly anastomosing, connecting all viscera
into a balanced system. The vasomotor or sympathetic nerves are practically
the visceral branches of the spinal nerves. At the origin of the
visceral vessels from the aorta, vasomotor ganglia as a rule exist
according in size with that of the vessel, e. g., at the origin of the
aorta from the heart is located the cardiac ganglia or plexus of Wrisberg
(German anatomist [1739-1808], professor at Gottingen). At the origin
of the coeliac axis is located the abdominal brain. At the origin
of the common iliacs originally existed the pelvic brain. As a rule
large vasomotor or sympathetic ganglia are located at the origin of large
visceral vessels from the aorta.
The chief manifestation of the vasomotor nerve is
that it is endowed with a peculiar rhythmical phenomenon. The ganglia
of the nervus vasomotorius alone possess rhythm. (Some advocate that muscle
possesses inherent power of rhythm, however, so far it is found in muscle
supplied by the sympathetic nerve, e. g., muscles of the various visceral
The vasomotor nerve is particularly connected to
the cerebrum through the vagi (proximal end) and to the spinal cord by
the sacral nerves (distal end).
The vasomotor nerves may pass directly from the
bilateral chain of ganglia to the viscera without passing through intervening
ganglia or plexuses, viz.: (a) pharyngeal plexuses located at the bifurcation
of the carotids; (b) the cardiac plexus - located at the origin of the
aorta from the heart; (c) the coeliac plexus (abdominal brain) located
at the origin of the coeliac axis from the aorta; (d) the pelvic plexus
(pelvic brain) located originally at the bifurcation of the aorta.
These four great ganglionated nerve plexuses are located intermediary between
the bilateral vasomotor ganglionic chain and the automatic visceral ganglion
located in relation with the organs. The vasomotor ganglia are originating
centers for nerve fibers, hence there is no relation between the number
of nerve fibers which enter (afferent) and the number of nerves which depart
(efferent) from a ganglion. The ganglia of the vasomotor nerve (composed
of ganglion cells) may be viewed as nervous centers, i. e., receive, reorganize
and emit nerve forces to which all the physiologic and pathologic phenomena
of the viscera may be referred. The three prominent systems or series
of ganglia constituting the vasomotor nerve, for convenience of description
and practical purposes, may be termed: (a) primary ganglia (the vasomotor
bilateral chain). They appear assomatic or segmental in location
on the lateral borders of the vertebra; (b) secondary ganglia (the four
great prevertebral plexuses). They appear to be located in relation
to major blood-vessels, ventral to the vertebra; (c) tertiary ganglia (automatic
visceral ganglia). They appear to be locate in relation to viscera;
in or on visceral wall. The vasomotor visceral
plexuses differ as much in arrangement from the vasomotor bilateral chain
as the latter does from the spinal cord.
The prevertebral plexuses form a kind of fusion
between the cerebrospinal and vasomotor nervous systems; also they solidly
and compactly anastomose, unite the bilateral ganglionic vasomotor chain
and the automatic visceral ganglia as well as fuse the lateral halves of
the nervus vasomotorius. The signification of the vagi nerves may
be observed when it was noted that they assist in the formation of three
of the four great prevertebral vasomotor plexuses (see a, b, c, above).
There is a peculiar balanced relation between the
vagi and vasomotor nerves. In animals especially, but also in man,
there is a tendency to fusion of the vagi and vasomotor nerves. They
act vicariously for each other. The greater the dimensions of the
vasomotor nerves the less the dimensions of the vagi and vice versa.
The vagi are practically visceral nerves supplying, viz.: larynx, lung,
heart, gastrium, liver, pancrea. The vasomotor plexuses differ essentially
from nerve plexuses formed by the cerebrospinal nerves. In cerebrospinal
nerve plexuses the afferent and efferent nerves are identical, however
the afferent and efferent cords may be differently combined previous to
entrance and subsequent to the formation of the plexus.
The efferent branches departing from the plexus
are precisely the same as the afferent branches that entered it.
On the contrary, in the vasomotor nerve plexuses there is no relation in
dimension, number and structure of the afferent and efferent nerves with
each other and the vasomotor nerve plexus itself. The mode of distribution
of the cerebrospinal and vasomotor nerves differ.
The cerebrospinal nerves practically follow blood
vessels; however, they divide by acute angles and do not form plexiform
sheaths around blood vessels.
The vasomotor nerves are generally distributed in
the plexiform network ensheathing vessels and entering with them into the
parenchyma of viscera. From the reason that the vasomotor nerves
are distributed in a plexiform gangliated network intimately ensheathing
vessels (especially arteries) continuously to their destination, i. e.,
to the viscera, it has long originated the idea that the nervus vasomotorius
belongs exclusively to the vascular system (blood, lymph vessels).
This view was especially promulgated by Claude Bernard, a French physiologist
in 1851 (1813-1873). The vasomotor nerves accompany the arteries
not the veins, the trunk of the vena porta forming the exception to the
rule. In this chapter of applied anatomy and physiology of the nervus
vasomotorius abdominalis I shall mention essential features only for practical
reasons. I shall consider in order regardless of any exact system
the following subjects: Chapter IV, truncus sympathicus; Chapter V, nervus
plexus aorticus abdominalis; Chapter VI, nervus plexus interiliacus; Chapter
VII, nervi tractus intestinalis; Chapter VIII, nervi tractus urinarius;
Chapter IX, nervi tractus genitalis; Chapter X, nervi tractus vascularius;
Chapter XI, nervi tractus lymphaticus; Chapter XII, the abdominal brain
(cerebrum abdominale); Chapter XIII, pelvic brain (cerebrum pelvicum).
|Fig. 3. A diagram of the nervus vasomotorius
(sympathetic) from the proximal end (ganglion of Ribes) to the distal end
(coccygeal ganglion of Luschka) presenting a lateral view of the truncus
vasomotorius (lateral chain) and the three prevertebral ganglia (cardiac,
coeliac and pelvic plexuses). Observe the exit of the three cardiac
nerves, the three abdominal splanchnics and the 3 (or more) pelvic splanchnics
|Fig. 4 (Jacob Henle, 1809-1885).
Represents the abdominal brain, the lumbar lateral chain, the inferior mesenteric
ganglion and the hypogastric.plexus; 2, abdominal brain; 3 great splanchnic;
4, small splanchnic; 5, superior mesenteric artery; 6, renal ganglion; 7,
renal artery with its ganglionic plexus surrounding it; 8, superior mesenteric
ganglion; 9, ramus communicans; 10, lumbar lateral chain; 11, inferior mesenteric
artery surrounded by its plexus; 12, 13, sacroiliac point; 14, innominate
vein; 15, innominate artery; 16, ramus communicans to inferior mesenteric
ganglion; 17, ramus communicans; 18, lateral chain; 19, right renal artery;
20, splanchnic minor; 21 , renal ganglion; 22, splanchnic ganglion; 23,
splanchnic major; 24 ad-renal; 25, ganglion phrenicum.
|LUMBAR AND SACRAL PORTIONS OF THE SYMPATHETIC
Fig. 5. 1, incised edge of diaphragm;
2, lower end of esophagus; 3, left half of stomach; 4, small intestine;
5, sigmoid flexure of the colon; 6, rectum; 7, bladder; 8, prostate; 9,
lower end of left vagus; 10, lower end of right vagus; 11, solar plexus;
12, lower end of great splanchnic nerve; 13, lower end of lesser splanchnic
nerve; 14, 14, two last thoracic ganglia; 15, the four lumbar vertebrae
; 16, 16, 17, 17, branches from the lumbar ganglia; 18, superior mesenteric
plexus; 19; 21, 22, 23, aortic lumbar plexus; 20, inferior mesenteric
plexus; 24, 24, sacral portion of the sympathetic; 25, 25, 26, 26, 27,
27, hypogastric plexus ; 28, 29, 30, tenth, eleventh and twelfth dorsal
nerves; 31, 32, 33, 34, 35, 36, 37, 38, 39, lumbar and sacral nerves.