The Abdominal and Pelvic Brain
Byron Robinson, M. D.
PATHOLOGIC PHYSIOLOGY OF THE TRACTUS URINARIUS.
I belong to the great church that holds the world within its starlit
aisles; that claims the great and good of every race and clime; that finds
with joy the grain of gold in every creed, and floods with light and love
the germs of good in every soul. - R. Ingersoll.
The rising of a great hope is like the rising of the sun. - Charles
The physiology or function of the tractus urinarius
is: (1) peristalsis; (2) secretion- (3) absorption, (4) sensation.
Pathologic physiology is a deviation from the usual physiology without,
however, invading the field of pathologic anatomy. The tractus urinarius
is a fertile field to study pathologic physiology, as it presents a wide
zone of varying degrees, especially since recent investigations have enriched
our knowledge of renal function. What older physicians considered
pathologic anatomy in renal function is now believed to be largely pathologic
physiology. The zone of kidney function is a continually increasing
one. In the study of pathologic physiology of the tractus urinarius
rational and comprehensive views of the renal viscus will be entertained.
The study comprises: (a) the condition or state of the kidney; (b) the
constituents of the blood; (c) the volume of blood that streams through
the organ. The discussion of (a), (b), and (c) in regard to the kidney
lends a comprehensive view to the student in making a diagnosis of the
We will here consider the pathologic physiology
of the urinary tract or some of the common deviations from the usual physiology.
(1) PERISTALSIS (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(a) Excessive peristalsis may occur in the
tractus urinarius from numerous causes. The segment of the urinary
tract subject to peristalsis is the ureter and bladder. The ureter
is an independent organ resembling the heart, uterus, stomach. It
possesses automatic ureteral ganglia as it performs peristalsis and functionates
regardless of attitude or force of gravity. Excessive peristalsis
is most liable to arise from excessive drinking of fluids, from diabetes
or polyuria where excessive volumes of fluid passed through the urinary
tract in limited time. The most marked example of pathologic physiology
or excessive peristalsis in the urinary tract arises from the presence
of an ureteral calculus. The ureter experiences brusk, vigorous,
violent, wild and disordered movements
INTIMATE RELATION OF THE TRACTUS GENITALIS AND TRACTUS URINARIUS
This illustration demonstrates how solidly and compactly the tractus urinarius
and tractus genitalis are anastomosed, connected. At the proximal
arterio-ureteral crossing (11, 11) the ureter and ovarian artery are solidly
and firmly anastomosed by the nervus vasomotorius (sympathetic).
Again at the distal arterio-ureteral crossing (2, 2) a similar but more
extensive anastomosis occurs - hence the balanced relationship between
the tractus urinaritis and tractus genitalis. Every practitioner
realizes the intimate relation of the bladder and the uterus, e. g., in
gestation, through the nervus vasomotorius. This intimately solid
anastomosis between the two visceral tracts by means of abundant nerve
strands aids to explain the vast and interdependent pathologic physiology
observed in practice.
accompanied by excruciating pain. A marked example of excessive
ureteral peristalsis, based, however, on pathologic anatomy, is ureteritis
which may be accompanied by excruciating pain. From experimentation
on dogs one observes that the peristalsis of the ureter is brisk, vigorous,
resembling that of the heart, uterus.
(b) Deficient peristalsis of the urinary tract
arises in connection with limited drinking of fluids, limited quantity
of urine (the pressure of urine stimulates the ureteral peristalsis); a
limited quantity of urine accompanied by a limited peristalsis is liable
to be followed by precipitation of crystals and urinary calculus.
However, a compensatory action arises from the fact that limited urine
is generally concentrated and hence is apt to irritate the ureter, inducing
peristalsis. It is probable that the automatic ureteral ganglia,
similar to the automatic intestinal ganglia (in constipation) may become
sluggish, inducing deficient ureteral peristalsis.
(c) Disproportionate peristalsis is irregular,
unequal peristalsis in different segments of the tractus urinarius, as
bladder or ureter.
(2) SECRETION (EXCFSSIVE, DEFICIENT, DISPROPORTIONATE).
(d) Excessive secretion from the urinary tract
is observed most typically in diabetes mellitus, insipidis or polyuria,
frequently fields of simple pathologic physiology where no pathologic anatomy
can be detected.
Excessive renal secretion may be marked in change
of temperature from warm to cold weathers difference of a quart of urine
may be noted enduring for six or ten days - simple variation of renal function.
The function of the perspiratory apparatus has experienced a deficient
secretion relatively equal to the pathologic physiology of the excessive
renal action. Cold, contracting the cutaneous vessels, forcing the
blood into the central large vessels, and increasing heart action, will
markedly increase renal secretion. Pathologic physiology, compensatory,
no pathologic anatomy; it is a form of vicarious physiology. Sugar
may appear in the urine for some time (pathologic physiology) without demonstrable
pathologic anatomy - later, however, indigested fats may be found in the
stools, which would call attention to the pancreas. However, the
pancreas may be suffering from pathologic physiology of secretion only
(excessive, deficient, or disproportionate). Pancreatic secretion
may be insufficient to dissolve the fats. So that even at the stage
of diabetes, pathologic anatomy may not yet be afoot. Paresis (sluggishness)
of the renal plexus (ganglia) may allow polyuria. Constipation may
impose increased vicarious duties on the kidneys, compelling them to eliminate
products usually eliminated by the tractus intestinalis. We know
kidney action may be excessive, that is, comprise pathologic physiology
only, for we not infrequently observe one kidney successfully accomplishing
duplicate work. We can produce excessive secretion of urine artificially
by administering NaCl in ample fluids. Certain foods, as water-melon,
produce temporary excessive renal function, with certain subjects, apparently
excessive renal secretion (pathologic physiology) exists for years.
In excessive renal secretion the urinary salts may be excessive or deficient
or vice versa.
ILLUSTRATION OF THE FEMALE URINARY TRACT
This specimen was drawn from nature from my own dissection by the aid
of distending the ureter's veins and arteries with hardening material.
The ureter (calyces, pelvis and ureter proper) is ensheathed with a nodular
fenestrated web, an anastomosing network of sympathetic nerves especially
at the 3 ureteral isthmuses (of Byron Robinson) 3, ,5 and the entrance
in the bladder. Z, Y, 3, uretero-venous triangle (of author).
The nervus vasomotorius richly supplies the tractus urinarius and manifests
itself violently during the presence of a moving calculus or periodic
hydro-ureter, or ureteritis.
(e) Deficient renal secretion may be noted
in limited drinking of fluids, in restricted diet in diarrhoea (vicarious),
in cold weather, in debilitated heart, in fevers, in concentrated foods
(flesh-eaters), in sedentary habits and in numerous nameless conditions.
Deficient renal secretion is, from my experience, a rather common condition.
Deficient renal secretion may present excessive or deficient urinary salts
or vice versa.
In certain subjects apparently deficient renal secretions
exist for years. In general, deficient renal secretions are saturated
with concentrated urinal E:alts which may irritate the mucosa of the tractus
urinarius sufficiently to, produce pathologic physiology. Deficient
renal secretion may lead to uremia.
(f) Disproportionate renal secretion is irregular
in different segments of the kidney. The urine may be excessive and
the salt deficient or vice versa. The renal glomeruli may secrete
deficient or excessive fluids. The uriniferous tubules may secrete
deficient or excessive salts.
What influence has the disturbed renal secretion - the pathologic physiology
- on the general organism? Manifold injuries may occur. The
continual loss in albuminuria is exhausting. The insufficient secretion
of urinal, constituents from the blood leads finally to bodily disturbance.
In other words, pathologic physiology in renal secretion may be the incipient
stage of disease - pathologic anatomy. Disturbed renal secretion
may be accompanied by disease in different organs - uremia, which represents
the accumulated disturbances on various organs.
(3) ABSORPTION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(g) Excessive absorption of the tractus renalis
would constitute extracting unusual material from the blood. In a
certain sense, excessive renal absorption might induce excessive secretion:
e. g., on urinalysis albumen may be found which would suggest an inquiry
as to the quantity of egg albumen the: subject is consuming. Considerable
ingesta of albumen may lead to rich albuminuria. Hence, the state
or composition of the blood should be investigated to decide the amount
of albuminuria. If there be excessive sugar in the blood and sugar
being absorbed by the renal apparatus will present excessive secretion
of sugar. This suggests inquiry into the quantity of sugar ingested.
(h) Deficient absorption would indicate that
the renal apparatus does not extract from the blood the proper amount nor
the proper material. The pathologic physiology has a wide range in
deficient absorption, for some times we may observe an adult person eliminating
8 or 10 ounces of urine daily.
(i) Disproportionate absorption constitutes
irregular disordered absorption of the different segments of the renal
apparatus, as the glomeruli and the uriniferous tubules.
AN ILLUSTRATION OF THE ABDOMINAL SYMPATHETIC NERVE OF THE MALE,
ESPECIALLY PRESENTING THE NERVES OF THE TRACTUS URINARIUS (4) SENSATION
(EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
An illustration of the nervus vasomotorius (sympathetic) drawn from a
specimen which I secured at ail autopsy through the courtesy of Professor
W. A. Evans. The relation of the nervtis vasomotoritis to the tractus
urinaritis is evidently intimate and abundant. The network of nerves
on the arteria renalis and ureter are apparent. The enormous supply
of nerves to the adrenal is remarkable - 7 in number. The solid
anastomosis of the plexus ovaricus with the plexus ureteris is noticeable,
where the vasa ovarica (spermatica) pass ventral to the ureter.
The arteria renalis is enslieathed in a rich, plexiform, gangliated nerve
plexus. I dissected this specimen under alcohol, and the nerve relations
are practically correct. The artist, Mr. Zan D. Klopper, followed
the fresh dissection as a model. The ureter (calyces, pelvis and
ureter proper) is dilated bilaterally. Even the 3 ureteral isthmuses
(of author) are dilated.
It is evident on watching an exposed ureter of a
sleeping dog that the sensation of the mucosa in the urinary apparatus
is of vital importance, for each and every time that a certain quantity
of urine collects in the dog's ureteral pelvis, the ureter proper executes
its brusque, vigorous peristalsis with remarkable rapidity. The automatic
ureteral ganglia rule the ureteral peristalsis. We do not realize
the exquisitively poised sensory apparatus of the tractus urinarius until
some catastrophy occurs, as ureteral calculus, to apprise us of the wild,
disordered peristalsis and excruciating pain. Pathologic physiology
of sensation in the tractus urinari us may well comprise excessive, deficient
or disproportionate states for sensation much depends on the composition
of the urine and the state of the urinary visera. Inordinate meat
eaters produce concentrated, irritating urine, exciting excessive ureteral
peristalsis with consequent pain - diluting the urine relieves the patient.
In excessive sensation of the tractus urinarius
we will include the so-called "Irritated bladder," because, though cystoscopy
has lessened the actual number of irritable bladders by eliminating pathologic
anatomy, it can not exclude the subject - pathologic physiology.
Irritable bladder exists without demonstrable pathologic anatomy.
The subjective symptoms of an irritable or excessively sensitive bladder
are frequent evacuations (peristalsis). The bladder may require evacuations
several times an hour. There is an increase in frequency and intensity
in the desire to urinate - excessive visceral peristalsis. Irritable
bladder may persist day and night. The desire to urinate may be so
intense that insufficient time is allowed to prepare the dress and hence
"wetting of the clothing" occurs. Excessive vesical peristalsis,
irritable bladder may be sufficient to cause vesical colic, which may radiate,
reflexly to the tractus intestinalis or genitalis, disordering the function
of peristalsis, absorption or secretion. E. g., the patient may evacuate
feces and urine simultaneously - so-called nervous diarrhea.
The irritable bladder may produce cold perspiration,
emesis, chills, and produce mental depression, hypochondria. The
main objective symptom of irritable bladder - pathologic physiology of
vesical sensation and peristalsis - is hyperesthesia which manifests itself
chiefly in the trigone where nerves congregate. The neck and
fundus may present irritability. The hyperesthesia may occur as an
increase in normal sensibility to tensions or as abnormal sensibility to
pressure. The abnormal sensibility may be manifest on the presence
of solid feces in the rectum, digital examination or on cytoscopy.
The urine may present nothing abnormal in quantity, in reaction, chemical
or physical characteristics; no hyperacidity, no excess of salts, concentration
of urine, or glycosuria. What causes the hyperesthesia of the vesical wall
- pathologic physiology, no demonstrable pathologic anatomy - is unknown.
| Fig 131.
The nerve supply to the tractus urinarius is best remembered, perhaps by
recalling its arterial blood supply; for the nervus vasomotorius accompanies
the arteries. The arteries to the tractus urinarius are: (a) arteria
adrenalis; (b) arteria renalis; (c) arteria ovarica (spermatica); (x) arteria
media ureteris; (y) arteria ureteris, distal (from iliac); (z) arteria uterina;
(w) the three vesical arteries, each of which is accompanied by it own nerve
plexus. The upper part of illustration is from corrosion anatomy.
NERVES OF THE TRACTUS URINARIUS - CORROSION ANATOMY
This specimen presents quite faithfully the circulation, the kidney, calyces
and pelvis. The two renal vascular blades I present opened like
a book. The corrosion was on the left kidney and the larger vascular
blade is the ventral one. The vasomotor nerves accompanying the
urinary tract may be estimated by the fact that a rich plexiform network
of nerves ensheath the arteries, the calyces, pelvis and ureter proper.
When the renal vascular blades are shut like a book their thin edges come
in contact, but do not anastomose. The edges of the vascular blades
are what I term the exsanguinated renal zone of Hyrtl, who discovered
it in 1868, and we, at present, employ it for incising the kidney to gain
entrance to the enterior of the calyces and pelvis with minimum hemorrhage.
This specimen presents excellently the capsular artery - Cap. A. Think
of the vast amount of pathologic physiology which could be created by
disturbing the rich sympathetic nerve supply to the kidney.
Cystoscopic examinations and autopsies and examinations
demonstrate that in irritable bladder no pathologic anatomy may exist or
that a condition of hyperemia may exist in the bladder wall. The
subjects of irritable bladder in which no demonstrable pathologic anatomy
exists are simply nervous in character, typical
pathologic physiology. The subjects possessing merely hyperemia of
the vesical wall are of non-inflammatory type or non-detectable inflammation.
The irritable bladder is influenced especially by two factors, viz.: (a)
psychic or mental disturbances; (b) tendency of blood to the pelvic organs
(bladder). The prognosis of irritable bladder, especially of the
severe type. is unfavorable - almost every case I have observed was or
has been practically life long. The treatment is hygienic, dietetic
- visceral drainage, preserving maximum state and contents of visceral
tracts. For more extensive views of the subject of irritable bladder
see the excellent article by Hirsch, Centralbllatt f. die Grenzgebete Medizin
u. Chirurgie, Vol. VIII, Nos. 13 and 14.
NERVUS VASOMOTORIUS OF THE TRACTUS URINARIUS
I dissected this specimen under alcohol. It presents excellently
the solid and compact anastomosis of urinary nerves to all other abdominal
vasomotor nerves. Observe the solid anastomosis at M and N. The
reflexes observed in practice may well be interpreted by this illustration.
Note the multiple, giant, ganglia accompanying the arteria renalis.
The nerves of the tractus urinarius presents a rich field in pathologic
There are still apparently unsolved problems in the
physiology of the tractus urinarius and hence multiple unsolved problems
in the pathologic physiology of this important visceral tract. For
example, the urine (an acid fluid) is derived from the blood (an alkaline
fluid) by a filtration process. What changes the urine into an acid
fluid from the blood, an alkaline fluid? The explanation must be
that the blood is practically and chemically an acid due to the presence
of bicarbonates which are acid salts.
The degree of the acidity of the urine is a measure
of the degree of the acidity of the blood. The acidity of both urine
and blood is due to acid phosphates or salts of phosphoric acid (H3PO4),
i. e., salts resembling acid sodium phosphate (NaH2PO4), acid calcium phosphate
(CaHP04), and acid magnesium phosphate (MgHPO4,), which may assume more
atoms in the bone.
CORROSION ANATOMY (HYRTL'S EXSANGUINATED RENAL ZONE)
In this specimen of corrosion anatomy the renal vascular blades (ventral
and dorsal) are closed like a book. It presents (left kidney) on
the margin of the dorsal lateral surface the exsanguinated zone of Hyrtl
- the line of minimal hemorrhage for corticle renal incision. A
rational method to estimate the quantity of nerves of the tractus urinarius
is to expose the number and dimension of the arteries and other tubular
ducts which are ensheathed in a plexiform networks fenestrated, nodular,
neural vagina of nerves. The nervus vasomotorius rules the physiology
of the renal apparatus. Modern investigation demonstrates an extensive
zone of pathologic physiology in the domain of the kidney.
"It is, therefore, obvious that the real urinary
acidity is phosphoric acidity." (Editorial, New York Medical Journal, May
| Fig. 135.
This specimen I dissected with extreme care under alcohol, and the artist,
Mr. Zan D. Klopper, followed the dissection as a model. It well illustrates
the nervus vasomotorius in relation with the tractus urinarius.
TREATMENT OF PATHOLOGIC PHYSIOLOGY OF THE TRACTUS URINARIUS.
Since pathologic physiology is the zone between physiology
and pathologic anatomy it should be practically amenable to treatment.
First and foremost the diagnosis should be made, and the cause removed,
as ureteral calculus, anal fissure, hepatic calculus or any point of general
visceral irritation. The most general essential feature of a subject
suffering from pathologic physiology of the tractus urinarius is deficient
visceral drainage. The blood is excessively waste laden from elimination.
The secretions are scanty. The urine is concentrated, its crystallized
salts are evident to the eye. The skin is dry from insufficient perspiration,
sleep is defective from bathing of the innumerable ganglia with waste laden
blood. Constipation, deficient urine, limited perspiration, capricious
appetite, insomnia and headache characterize subjects with pathologic physiology
of the tractus urinarius.
For many years I have applied a treatment to such
subjects which I term visceral drainage. Visceral drainage signifies
that visceral tracts are placed at maximum elimination. The waste
product of food and tissue are vigorously sewered before new ones are imposed.
The most important principle in internal medication is ample visceral drainage
for every visceral tract. The residual products of food and tissue
should have a maximum drainage in health. I suggest that ample visceral
drainage may be executed by means of: (A) fluids; (B) food.
(A). VISCERAL DRAINAGE BY FLUIDS.
The most effective diuretic is water. One of
the best laxatives is water. One of the best stimulants of renal
epithelium is sodium chloride (1-2 to 1-4 physiologic salt solution).
Hence I administer eight ounces of half normal salt solution to a patient
six times a day, two hours apart. (Note - NaCl is contraindicated in parenchymatous
nephritis.) 48 ounces of 1-2 normal salt solution daily efficiently increases
the drain of the kidney. It maintains in mechanical suspension the
insoluble uric acid, it also stimulates other matters. It aids the
sodium, potassium or ammonium salts to form combination with the uric acid
producing soluble urates.
The half normal salt solution effectively stimulates
the epithelium of the tractus intestinalis, inducing secretions which liquefy
feces, preventing constipation.
(B). VISCERAL DRAINAGE BY FOODS.
The great functions of the tractus urinarius - peristalsis,
absorption, secretion, sensation - are produced and maintained by fluids
and food. To drain the tractus urinarius the adjacent visceral tracts
should be excited to peristalsis, hence foods which leave an indigestible
residue only are appropriate, all other visceral tracts must be stimulated
to maximum peristalsis, secretion, absorption in order to aid that of the
tractus urinarius. Rational foods must contain appropriate salts
whose bases may form combinations which are soluble, as sodium, potassium,
and ammonium combined with uric acid and urates to form soluble urates.
The proper foods are cereals, vegetables, albuminates (milk, eggs), mixed
foods. Meats should be limited as they enhance excessive uric acid
In order to stimulate the epithelium (sensation)
of the digestive and urinary tract with consequent increase of peristalsis,
absorption and secretion in both, I use a part or multiple of an alkaline
tablet of the following composition: Cascara Sagrada (1-40 grain), Aloes
(1-3 grain), NaHCO3 (1 grain), KHCO3 (1-3 grain), MgSO4 (2 grains).
NERVUS VASOMOTORIUS OF THE TRACTUS URINARIUS
This illustration is drawn from a specimen I secured at an autopsy.
The right kidney was dislocated, resting on the right common iliac artery,
with its pelvis (P) and hillum facing ventralward. The adrenal (Ad.)
remained in situ, It was a congenital renal dislocation, and was accompanied
with congenital malformations in the sympathetic nerve, or nervus vasomotorius.
1 and 2 is the abdominal brain. It sends five branches to the adrenal
from the right half (2). Though the sympathetic system is malformed,
yet the principal rules as regards the sympathetic ganglia still prevail,
viz., ganglia exist at the origin of abdominal visceral vessels, e. g.,
3, at the origin of the inferior mesenteric artery; at the root of the
renal vessels, HP is no doubt the ganglion originally at the root of the
common iliacs (coalesced). In this specimen the right ureter was
5 inches in length, while the left was 11 1/2. This specimen demonstrates
that the abdominal brain is located at the origin of the renal, celiac,
and superior mesenteric vessels - i. e., it is a vascular brain (cerebru
vasomotorius). The solid and compact anastomosis of the nervus vasomotoritis
of the tractus urinarius with nerve plexuses of all other abdominal visceral
tracts is evident.
Tablet is used as follows: 1-6 to 1 tablet (or more,
as required to move the bowels freely, once daily) is placed on the tongue.
before meals and followed by 8 ounces of water (better hot). Also
at 10 A. M., 3 P. M., and at bedtime 1-6 to 1 tablet is placed on the tongue
and followed by a glassful of any fluid. In the combined treatment,
1-3 of the (NACl) sodium chloride tablet (containing 11 grains) and (1-6
to 3) alkaline tablets are placed on the tongue together every two hours
and followed by a glass of fluid. The six glasses of fluid may be
milk, buttermilk, cream, eggnog - nourishment. This method of treatment
furnishes alkaline bases (sodium, potassium, and ammonium) to combine with
the free uric acid in the urine, producing perfectly soluble alkaline urates
and materially diminishing the insoluble free uric acid in the urine.
Besides, the alkaline laxative tablet increases the peristalsis, absorption
and secretion of the intestinal tract, stimulating the sensation of
the mucosa - aiding evacuation.
| Fig. 137.
Illustrates the relation of the spinal nerves to the tractus urinarius,
especially to the Plexus lumbalis. The ureter is intimately connected
with the genito-crural nerve (A); hence the pain reflected in the thigh
and scrotum in ureteral colic and other ureteral diseases. (2)
I have termed the sodium chloride and alkaline laxative
method the visceral drainage treatment. The alkaline and sodium chloride
tablets take the place of so-called mineral waters. I continue this
dietetic treatment of fluids and food for weeks, months, and the results
are remarkably successful, especially in pathologic physiology of visceral
tracts. The urine becomes clarified like spring water and increased
in quantity. The tractus intestinalis becomes freely evacuated, regularly,
daily. The blood is relieved of waste laden and irritating material.
The tractus cutis eliminates freely and the skin becomes normal.
The appetite increases. The sleep improves. The patient becomes
hopeful, natural energy returns. The sewers of the body are drained
and flushed to a maximum.
Had space permitted it might have enhanced the clearness
of the above subject to first discuss the pathologic physiology of the tractus
urinarius, and, second, to discuss the pathologic physiology of the contents
of the tractus urinarius.