The Abdominal and Pelvic Brain
Byron Robinson, M. D.
PATHOLOGIC PHYSIOLOGY OF THE TRACTUS NERVOSUS (ABDOMINALIS).
The man who builds a home erects a temple - the flame upon the hearth
is the sacred fire. - Robert Ingersoll, American (1844-1904).
The peritoneum sheaths and lines. - Dr. P. T. Burns.
The ideal nervous system consists of a ganglion cell,
a conducting cord and a periphery, i. e., a receiver, a transmitter and
a reorganizer. This simple view of the structure of the nervous system
at once suggests its function, viz., that of reception (periphery apparatus
- skin, mucosa), transmission (conducting apparatus - nerve cords), reorganization
(ganglion cell-brain). The nervous apparatus is the highest and most
perfect of known organism. Mental action or nerve force, the most
subtle of all forces, depends on it. The nervous system includes
the most profound secrets of life - it is the climax of organism.
First and foremost, the zone of the physiology of the tractus nervosus
is not exactly defined - it is liberally elastic. Secondly, the pathologic
physiology of the tractus nervosus possesses an expansive, undefinable
zone before established pathologic anatomy can be recognized. The
pathologic physiology of the tractus nervosus comprehends the fields of
neuralgia, hyperesthesia, anesthesia, sensation, motion, melancholia. hysteria,
neurasthenia, with innumerable irritable weaknesses of the nervous system.
Absorption, secretion and peristalsis of viscera are the elements or means
by which we recognize the pathologic physiology. In the numerous
manifestations of symptoms of pathologic physiology of the tractus nervosus
of the abdomen a few considerations may be suggestive and helpful in practice.
First and foremost, many subjects are not perfect physically or mentally.
Such subjects are prone to pathologic physiology. They possess inferior
anatomy and physiology. Structure and function are of minimum perfection.
Their nervous system is not stable. We should consider these defections
or unstable conditions under long-employed or established terms, associated
with which has grown a stately literature, as stigma, habitus, asthenia
congenita, heredity, predisposition , degeneracy.
Nervous persons are afflicted with pathologic physiology.
Nervous persons manifest a defective resistance. They are incapacitated
for sustained effort. Nervous persons present premature exhaustion
on persistent mental or physical effort. The reason of the nervousness
is the anatomy and physiology of the tractus nervosus is inferior, its
structure and function is deteriorated. Their nervous system is irritable,
weak, defective, unstable, functionating muck of the time with disorder
and friction, like some watches which maintain incorrect time. Nervous
subjects are chiefly congenital unfortunates. They are born with
defects, with stigma, a habitus, neuropathic predispositions - a condition
which tends to degeneracy with facility. Nervousness, though frequently
an announcement of an enfeebled nervous system, yet it may be evoked, aggravated,
by some irritation external to the nerve apparatus. Neurotic spells
appear with as much mysticism as they disappear. The only trace is
the memory of the disordered pathologic physiology. There is doubtless
more or less foundation, for these inscrutable neurotic conditions, to
be established in the state of the tractus vascularis, congestion, anemia.
The tone and tension of the abdominal muscles control the abdominal circulation.
Diseases of the tractus intestinalis compromise the tractus nervosus by
damaging its integrity - in structure and function. One of the best
terms to apply to subjects who are persistently afflicted with pathologic
physiology is the word habitus, e. g., we have the habitus phthisicus,
habitus splanchnopticus, habitus nervosus, habitus dyspepticus. The
ensemble of symptoms associated with splanchnoptosia may well be termed
habitus splanchnopticus. It is heredity in so far that the subject
possesses a predisposition and the main defect is inferior anatomy and
physiology. In the habitus splanchnopticus there is the gracile skeleton,
the elongated flat thorax, extensive intercostal space, acute epigastric
angle, the sacculated, pendulous abdomen, limited muscularis and panniculus
adiposus, the labored respiration. The costa fluctuans decima of
B. Stiller, the peculiar habitus in form presenting evident pathologic
physiology. A marked factor in pathologic physiology of splanchnoptosia
is the changed defective circulation, venous congestion. Generally,
any subject with a "habitus" possesses an unstable nervous system.
The dyspepsia accompanying the habitus splanchnopticus is perhaps more
due to the neuropathic disposition than to the splanchnoptosia, hence the
terms dyspepsia nervosa, or stigma dyspepticum. The habitus neurasthenicus
presents pathologic physiology of the tractus nervosus - a condition of
exhaustion or weakness of the nervous system, accompanied by physical and
mental efficiency. Habitus neurasthenicus is a fatigue disease of
the nervous system. It is characterized by the presence of motor,
sensory, psychic and visceral symptoms - all fatigued, tired, exhausted.
This habitus is especially characterized by weakness, or inefficiency and
irritability of the tractus nervosus. The physician can detect spots
of hyperesthesia, spinal irritation, fatigue of the special sense, auditory
and retinal hyperesthesia - all pathologic physiology, no pathologic anatomy.
However, if pathologic anatomy exists in the body, it is liable to intensify
the pathologic physiology, the subject of habitus neurasthenicus, precipitating
storms of neurotic spells. The physician can detect the pathologic
physiology, but not pathologic anatomy. The subject is afflicted
more or less throughout life with pathologic physiology. When such
subjects maintain additional strains, as gestation and the care of growing
children, pathologic physiology in the tractus nervosus becomes pronounced
and frequent, e. g., the habitus neurasthenicus may be in abeyance, quiescent,
for a long period of time when the entrance of a pelvic disease, a myometritis,
salpingitis, pelvic peritenitis, - may initiate, aggravate, an intense
neurotic state. It is not due merely to the so-called reflexes, but
because the habitus neurasthenicus, the weak, irritable nervous system,
has been aggravated, traumatized, become unbalanced, exhausted, fatigued.
Its inherent vital power is deficient and readily passes into a state of
A lesson right here may be pointed that surgeons
should operate for surgical indications only, not for function indications.
First and foremost, the gynecologist must learn to decide by an analytic
exclusion diagnosis whether the subject has a habitus neurasthenicus, a
pelvic disease, or the two combined. The test of a gynecologist is
his ability to diagnose the disease - not to do an operation.
The exquisitely, finely balanced nervous system of woman makes it liable
to imperfections of development - stigmata. Such a perfect organism
as the tractus nervosus is prone to disease. The intimate and profound
relation of the tractus nervosus to the tractus genitalis in woman demands
that a gynecologist be a physician of comprehension, or knowledge, understanding
the vast fields of the tractus nervosus and tractus genitalis, as Well
as their profound relation.
The indiscreet and general surgeon announces that
gynecology is "passing," and has become a segment of general surgery.
This assertion presents limited comprehension. Is the oculist and
aurist passing? Is the dermatologist, neurologist and laryngologist
passing? Among the Germans, the most profoundly learned in medicine,
specialists are progressively increasing. The fact is that legitimate
gynecology, like all other specialities, is just beginning. Gynecology
today is practically as broad as the entire medical field of thirty years
ago. The gynecologist must comprehend not only the organs in his
own special field (tractus genitalis), but also the adjacent organs involved
in practice or stimulating gynecological disease, as the tractus intestinalis,
tractus nervosus, and tractus urinarius. In the interest of the patient,
no specialist can be limited exactly to the organs of his own specialty,
for he should study the organs secondarily afflicted or dependent on the
affections of the viscera on which he practices. The specialist must
understand the anatomic and pathologic relations of specialized organs
to adjacent territories, as vomiting (tractus intestinalis) to pregnancy
(tractus genitalis), as albumin (tractus urinarius) to pregnancy (tractus
The more intimate changing relations of associated
organs in structure and function, the more valuable will be the study of
the differential diagnosis in disease. The gynecologist should execute
all necessary technique which will enable him to diagnose and treat diseases,
dependent on or associated with the tractus genitalls - as cystitis, ureteritis,
splanchnoptosia, mammary disease, constipation, nephritis, proctitis, thyroid
disease. The borders of a specialty cannot be marked by the rim of
a circle, but by the diseases dependent on and resulting from the specialized
system of viscera. Every special science gradually unfolds its own
dependent and associated relations.
Gynecology has been a typical example. It forced a divorce from
general surgery, to which it never will return, from sheer magnitude.
One mind cannot master more than one visceral tract with its relations.
The unfolding of gynecology has increased the interest and usefulness of
its domain. It has shown the delicate balance and relations of all
abdominal viscera on the abdominal sympathetic brain. Practically
all progress, new ideas, must come from specialists. The specialist
is a permanent factor in medical progress, from whom will practically emanate
discoveries and rational treatment. However, the present and future
specialist will not be limited to a single visceral tractus for the diagnosis
and therapy of his independent field, but will study adjacent or remote
visceral tracts which may lend aid in the differential diagnosis and rational
treatment. The gynecologist should diagnose and treat all diseases
primarily or secondarily, dependent on the life, function and pathologic
conditions of the tractus genitalis, as sacropubic hernia, rectocele, vesicocele,
splanchnoptosia; dependent on rapid and frequent gestations (nephroptosia,
gastroptosia, coloptosia, hepaptosia - relaxed abdominal walls).
The rock and base of medical practice (special or general) is the diagnosis
which enables the physician to employ rational treatment, to act for the
best interest of the patient. Large numbers of women with marked
splanchnoptosia dependent on the work performed by the tractus genitalis,
as gestations, come to the gynecologist. The tractus genitalis, though
primarily the basic cause of splanchnoptosia, itself is no more ill than
the tractus urinarius, tractus intestinalis, or the relaxed abdominal walls.
It is the duty of the gynecologist to treat such cases. The general
surgeon is no more an expert in special departments than is the general
practitioner. The reason for the operation, i. e., the diagnosis,
is a thousand fold more expert than the mere technique of surgical procedure.
Predisposing factors to pathologic physiology in the tractus nervosus are
defective nurtrition, variations of metabolism, chlorosis, anemia, hemorrhages,
deficient or excessive secretion, premature senescence, strained physical
and mental efforts. Heredity transmits defects which are the foundation
for aggravated pathologic physiology. When the subject has an established
habitus, as habitus splanchnopticus, habitus neurasthenicus, habitus phthisicus,
and predisposing factors become imposed to, the subject is burdened with
extreme pathologic physiology. An excellent example of artificial
habitus is the numerous stigmata arising from the total removal of ovaries
in young women, which condition might be termed habitus ovaricae neurasthenicus.
The young woman with castrated ovaries experiences an intense, aggravated,
premature climacterium - she is suffering from pathologic physiology of
the tractus nervosus. The patient is afflicted with flushing (disturbed
circulatory centre), flashes (disturbance of caloric centre), perspiration
(disturbance of the perspiratory centre). She has depression, melancholia,
excessive panniculus adiposus, growths of hair. In some subjects
the sensation of the tractus nervosus of the abdomen is awry. Subjects
complain of animals crawling within the abdomen. This matter may
be explained by supersensitiveness or hyperesthesia of the mucosa of the
tractus intestinalis from gas or contents. More than one operation
has been performed for such condition. It may be incidentally remarked
that it requires much study and discreet judgment to decide neurosis of
the tractus nervosus abdominalis and the nervous disturbances produced
by the dominating nerve-supplied genital tract - both conditions induce,
aggravate, pathologic physiology in the abdominal nerves, e. g., one of
the most characteristic lesions accompanying the habitus neurasthenicus
- producing pathologic physiology - is defective development of the tractus
genitalis. I think among the scores of women I have examined with
defective development of the genitals that at least 95 percent were neurotics
manifesting pathologic physiology of the tractus nervosus. Does the
neurosis precede (congenital), accompany the defective development of the
genitals or is it accidental to it? The most probable view is that
it is congenital, and marks an ill development of the organism. The
habitus neurasthenicus or habitus hystericus are not diseases of the genitals
but of the nervous system with an hereditary burden and perhaps an acquired
burden. These conditions required vast study to differentiate in
gynecologic practice. The habitus chlorosis is another example of
a disease closely
| Fig. 138.
Nerves of the internal genitals.
associated with the tractus genitalis. It is doubtless heredity;
occurs in girls from fourteen to twenty-four years of age, i. e.,
at puberty or the developmental stage; is accompanied by increased panniculus
adiposus and neurotic symptoms. Chlorosis is associated with defective
development of the genitals in 75 percent of subjects. Genital functions
are defective. The nerves governing secretion (ovarian) are perhaps
defective. In diagnosing pathologic physiology of the abdominal nervous
system it is well to determine the etiology, as acquired factors enhance
conditions, e. g., the tractus nervosus of a pregnant woman is more irritable,
more liable to pathologic physiology, than the non-pregnant. The
nursing woman is frequently in a state of pathologic physiology.
TREATMENT OF PATHOLOGIC PHYSIOLOGY OF THE TRACTUS NERVOSUS.
The treatment of subjects with disturbances - pathologic
physiology - in the abdominal nerves is difficult in ordinary practice
because the acquired factors are inseparably associated with continuous
environments, with habitat. The etiology and consequent habitus or
stigma must be diagnosed by careful examination in individual subjects.
The reason the sanatorium is so successful in the treatment of the nervous
patients is the patient is removed from the environments, from the habitat,
in which the disease developed. The provocative or aggravating factors
must be generally eliminated. It may be constipation, deficient drinking
of fluids, the ingesting of improper concentrated foods, which leave insufficient
indigestible residue to provoke intestinal peristalsis. It may be
sedentary habits, insufficient exercise or deficient fresh air. It
may be excessive work and worry, insomnia. In the subject with the
habitus neurasthenicus I am in general opposed to the so-called Mitchell
rest cure. The neurasthenic may possess fatigued nerves but
not fatigued muscles. I attempt to treat the neurasthenic by maintaining
her in the fresh air and muscular activity all day. In the subjects
I administer active visceral drainage and coarse foods which leave a large
undigestible residue. She is improved by the bicycle, by games requiring
muscular activity, rides which massage the viscera, fresh air, appropriate
diet, and ample fluid at regular intervals. Some neurasthenics are
practically unmanageable. I am now treating a woman twenty-seven
years of age who has lain in bed for three years. She says her nerves
could not stand walking in the sunshine. Physically I can detect
no pathologic anatomy - simply pathologic physiology. By forced feeding
she retains ample flesh. During the last six months, by all kinds
of persuasion, we succeeded in inducing her to walk one block daily.
Maximum visceral drainage and appropriate dietetics maintains apparently
a healthy physique. We agree with Dr. John G. Clark that several
kinds of neurasthenics exist. The gynecologist meets with three kinds
of neurasthenics, viz., (a) a neurasthenic of congenital origin - habitus
neurasthenicus congenita - who practice almost continually genital introspection
where the physicians can not detect genital pathologic anatomy. She
is constantly occupied by views regarding genital and sexual life.
The treatment of such neuropathic subjects is lifelong, firm discipline,
hygiene, dietetic, fresh air for twenty-four hours a day, ample fluids,
physical exercise. (b) A neurasthenic with coincident visceral lesion but
each entirely independent of the other, as may occur in the tractus genitalis,
tractus intestinalls, tractus urinarius. In the second condition
the additional treatment is to remove the lesions of the sole visceral
tract; (c) a third kind of neurasthenic is where the neurasthenia is dependent
on an organic, visceral lesion. The tractus nervosus of the originally
predisposed, neuropathic subject was provoked, aggravated, into a state
of pathologic physiology by the organic lesion. The treatment of
this third class is repair of the organic lesion and systematic visceral
drainage by means of fluids and foods.
1. Dietetic. The diet of neurotic patients
should be regulated under strict discipline. It should consist of
cereals, vegetables, albuminates (egg, milk), and limited meals-mixed diet.
The high spices, cakes, puddings, pies, stimulants should be eliminated.
2. Fluids. Ample at regular intervals
- 8 ounces every two hours for at least six times daily. This forty-eight
ounces of fluids daily may be nourishing fluid - as, milk, buttermilk,
eggnog, cereal gruels.
3. Salt rubs, which the patient administers
to herself once or twice daily. at stated times for stated duration.
4. Massage, which should be administered as
much as possible by the patient herself. The patient can be taught
massage of the abdominal muscles, which especially benefits the abdominal
5. Exercise is absolutely necessary for health.
The neurotic patient continually complains of tiredness and fatigue.
The fatigue belongs to the nerves. It is not muscle fatigue, hence
the muscular activity should be vigorously maintained in walking, riding,
games - all distracting the patient's attention from herself. Muscular
exercise influences circulation and hence nourishment.
6. Fresh air should be continuous day and
night. The sleeping-window should be open all night. The window
of the day-room should be continuously open. Cold, fresh air is an
invaluable therapeutic agent in neurasthenic disturbances and tuberculoses.
In order to assist the foods and fluids to secure maximum
visceral drainage I place on the tongue every two hours a tablet containing
3 grains of sodium chloride (NACI) and a part or multiple of an alkaline tablet
[composed of aloes (1/3 gr.), cascara sagrada (1/40 gr.), NaHCO3 (1 gr.), KHCO3
(1 gr.), and MgSO4 (2 gr.),] followed by 8 ounces of fluid. This visceral
drainage method I followed systematically for weeks and months, resulting in
successful maximum visceral drainage, with increased nourishment, improved sleep.
The elimination of waste-laden products benefits the nervous system - the pathologic
physiology is reduced to a minimum and the patient recovers.