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Immaterial, irrelevant, incompetent. - Attorney's objection to evidence in law trials. Industry wins living, honesty wins respect. Extending from the abdominal brain (the coeliac axis)
to the pelvic brain (cervico-uterine junction) there exist two rich and
mighty nerve plexuses, plexus aorticus and plexus interiliacus.
(a) INTERILIAC NERVE DISC. The proximal end of the plexus interiliacus, which I shall term the interiliacal nerve disc of the sacral promontory, is practically a plexus of nerve cords compressed or flattened dorso-ventrally. The interiliacal disc is the result of coalescence of the distal end of the plexus aorticus, located at the aortic bifurcation, practically on the sacral promontory and the distalward movements of the tractus genitalis producing traction and extension on the nerve disc of the sacral promontory. The interiliac nerve disc is practically a plexiform nerve mass located at the proximal end of the plexus interiliacus. The arrangement of the interiliacal disc consists in the coalescence on the same promontory of the afferent nerve-plexus aorticus and branches from the distal bilateral lumbar ganglia - and the emission of efferent nerves: (a) two bilateral large plexuses to the pelvic brain; (b) branches to the tractus intestinalis (rectum hoemorrhoidal); (c) branches to the tractus genitalis (uterus, vagina, oviduct); (d) branches to the tractus urinarius (ureter, bladder). POSITION. II. Holotopy (relation to general body).
The interiliac nerve disc is located on the median line in the space between
the major bifurcation and the distal end of the abdominal end cavity immediately
proximal to the lesser pelvis. It is a coalesced unpaired organ situated
extraperitoneally on the sacral promontory, dorsal to the peritoneum.
It is strongly ensconced in connective tissue at the most accessible portion
of the abdomen for palpation.
GENERAL REMARKS IN REGARD TO THE INTERILIAC NERVE DISC. It consists of a flattened, band-like nerve plexus in a sheath of firm, dense, connective tissue, located in the interval between the two common iliac arteries. It is formed by a continuation of the plexus aorticus plus prolongations from the ganglia lumbales. It is a flat plexiform nerve mass at the junction of the distal lumbar and proximal sacral vertebrae. I have termed it the interiliac nerve disc, as it contains no constant distinct ganglia. Some authors claim it contains no ganglia, while others claim it contains some ganglia, the latter being the more probable. The interiliac disc is significant as it emits (efferent nerves) from its distal border, the two nerve plexuses which rule the pelvic viscera. The interiliac nerve disc is an example of the principle elsewhere noted that at every emission of a major (visceral) artery from the abdominal aorta there exists a ganglion (or nerve disc). Practically there should be two ganglia at the aortic bifurcation. However, coalescence occurred and one ganglion or disc resulted - the interiliac nerve disc (or ganglion). Efferent nerve branches from the interiliac disc not only accompany the two common iliac, ovarian, superior haemmorhoidal and sacral arteries but emit the two great interiliac plexuses (for the pelvic viscera) as well as branches to the ureters, left colon and sigmoid. The interiliac nerve disc is important in practice because it is practically accessible to manipulation, massage. By gentle irritation or massage of the interiliac disc in post partum hemorrhage the plexus interiliacus will be stimulated, which, supplying the uterus, will induce the elastic and muscular bundles of the myometrium to act like living ligatures, limiting the uterine vessels, and checking haemorrhage. It is not the supposed constriction of the aorta that checks the haemorrhage. (b) TRUNCUS PLEXUS INTERILIACUS SYMPATHICUS. The trunk or central segment of the interiliac plexus (paired) extends from the interiliac nerve disc to the pelvic brain. The plexus interiliacus consists not merely of nerve strands, for it is composed of nerve plexuses the commissures and cords of which are band or ribbon-like in character surrounding apertures or fenestra of various dimensions which increase in area toward the distal end. The plexus interiliacus increases in breadth from proximal to distal end, i. e., from interiliac nerve disc to pelvic brain. The proximal end is relatively small and composed of a few nerve cords, the distal end is broad and divides into numerous branches. The course of the interiliac plexus is proximally along the internal side of the pelvic vessels while distally it courses along the dorsal and rectal wall with which it is intimately connected by connective tissue and, when it again resumes intimate association with the pelvic vessels the length of the trunk of the plexus interiliacus averages some 3 ½ inches. Numerous nerve branches from the V lumbar ganglion and from the I, II, III and IV sacral ganglia join the external border of the plexus interillacus. From the internal border of the plexus interiliacus numerous branches pass to the rectum, ureter, uterus, vagina, bladder. From the plexus pass numerous nerves to the pelvic vessels. The trunk of the plexus interiliacus is profoundly associated with the rectal wall, sharing in its movements or contraction of and dilatation. The intimate and profound connections of the trunk of the plexus interiliacus with the rectal wall explains the favorable therapeutic value of the rectal enema due to stimulation of the plexus. The rectum is practically surrounded, ensheathed by two great bilateral interiliac plexuses, i. e., the rectum lies in the boot-jack angle produced by the divergence of the plexuses. The plexus interiliacus possesses a remarkable anatomic feature, which is that it sends some two strong nerves directly to the uterus without first passing through the pelvic brain (demonstrated with very extraordinary facility in infant cadavers). (c) DISTAL END OF THE PLEXUS INTERILIACUS OR PELVIC BRAIN. The broad distal end of the plexus interiliacus, a plexiform fenestrated nerve mass, unites with the branches of the II, III and IV sacral nerves to form the pelvic brain (ganglion cervicale). The resulting union of the distal end of the plexus interiliacus and sacral nerves - a plexiform ganglionated mass, the pelvic brain - rules the physiology of the pelvic viscera, especially the vascularity of the genitals. The pelvic brain is elsewhere described in detail. GENERAL REMARKS ON THE PLEXUS INTERILIACUS. The plexus interiliacus, like the plexus aorticus, is one of the great and important nerve plexuses of the abdomen. It practically supplies the tractus genitalis; distal end of tractus intestinalis (rectal, sigmoid) ; and distal end of tractus urinarius (ureter, bladder). The plexus interillacus is double, bilateral, presenting practically no anastomosis. It is accessible to manipulation through the abdominal wall as well as per rectum and per vaginam. Dilatation of the rectum produces its favorable therapeutic effects through the plexus interiliacus by flushing the capillaries and stimulating visceral function, especially respiration. The plexus interiliacus is the dominating plexus of the pelvis. It is the great assembling nerve center of the pelvic organs and is solidly and compactly bound and anastomosed to all other pelvic sympathetic nerves as well as the I, II, III and IV sacral spinal nerves. The following table presents an idea of the vast extent and richness of distribution of the branches of the plexus interiliacus. It should be remembered that the vast majority of the branches of the plexus interiliacus first pass through the pelvic brain before supplying the pelvic viscera (especially those to the tractus genitalis). 1. Tractus Intestinalis (haemorrhoidal)
2. Tractus Genitalis
3. Tractus Urinarius
4. Tractus Vascularis
5. Tractus lymphaticus
A peculiar character of the plexus interiliacus is that it is considerably disassociated from arterial vessels - unlike the plexus aorticus. The pelvic visceral plexus or branches of the plexus interiliacus possess similar features. On the contrary, the visceral plexuses or branches of the abdominal brain notably accompanying the visceral arteries. AGE RELATION OF THE PLEXUS INTERILIACUS. The plexus interiliacus experiences an age relation
according to the sexual phases as presented by the utero-ovarian artery
in: (a) pueritas, (childhood), a quiescent, undeveloped state with limited
blood, ganglion cells and neurilemma; (b) pubertas, a developmental state
(of congestion) of multiplication of ganglion cells and increased neurilemma;
(c) menstrual phase, a functional state of engorgement (of the vaso uterina),
which further increases the neurilemma if not the ganglion cells; (c) gestation,
a state of complete development of the tractus genitalis (continuous maximum
engorgement of the utero-ovarian artery) with the multiplication of ganglion
cells and periganglionic tissue with neurilemma; (d) puerperium.
The elastic and muscular bundle of the myometrium having contracted like
living ligatures, the enormous volume of blood passing through the utero-ovarian
artery is checked, maximum engorgement suddenly ceases, the ganglion cells
perhaps remain the same in number, however, decreasing in dimension; while
the periganglionic tissue, the neurilemma and associated connective tissue
decrease, degenerate; (e) climacterium. This phase of sexual life represents
beginning atrophy from lessening of blood volume in the utero-ovarian artery.
The ganglion cells diminish in size and number as well as the periganglionic
tissue, while the associated connective tissue multiply; (f), senescence.
This is the atrophic sexual phase - death of parenchymatous and increase
of connective tissue framework of viscera. The muscularis and elastic
fibres of the myometrium and oviduct decrease while the connective tissue
increases. The wall of the utero-ovarian artery increases in thickness
while the lumen decreases in dimension. The ganglion cells of the
plexus interiliacus decrease in number and dimension while the ganglion
cell, nucleus and body cell outlines become less distinct.
UTILITY OF THE PLEXUS INTERILTACUS IN PRACTICE. It is accessible to manipulation from proximal to
distal end through the abdomen, per rectum or per vaginam. Massaging
or stimulating the plexus interiliacus induces the muscular and elastic
bundles of the organ which it supplies to contract by controlling the blood
volume. The most typical example for the employment of therapeutics
on the plexus interiliacus is during postpartum haemorrhage. It is
the irritation, massage of the plexus interiliacus, that induces muscular
and elastic bundles of the myometrium to contract and consequently control
the hemorrhages. It is not the obstruction produced in the aorta
by the pressure, the technique of which is almost impossible, for the two
ovarian arteries would still continue to force large volumes of blood to
the uterus. Light abdominal stroking, digital manipulation of the
uterus in postpartum hoemorrhage irritates, massages the plexus interiliacus
and its branches, which induce the elastic and muscular bundles of the
uterus to contract like living ligatures on the blood vessels, checking
haemorrhage. The so-called uterine inertia of long, tedious labor
may be due to paresis of the plexus interiliacus from trauma by the child's
head. Sudden cessation of parturient peristalsis - arrest of labor
- is doubtless due to trauma by the child's head on the plexus interiliacus,
a sudden paresis. Vaginal or rectal injections (hot or medicated)
stimulate the plexus interiliacus, hastening labor. Electricity will
accomplish similar effects. The flat, band-like form of the plexus
interiliacus protects it from trauma during parturition. Massage
of the plexus interiliacus will end all alleviating constipation by stimulating
active peristalsis and secretion of the left colon, sigmoid and rectum.
The plexus interiliacus may be stimulated by means of hot fluid or food
taken, in the stomach. The irritation passes from the stomach over
the plexus gastricus to the abdominal brain, whence it is reorganized and
emitted over the plexus interiliacus, inducing more vigorous uterine contractions.
By appropriate systematic massage of the plexus interiliacus stimulation
of the pelvic viscera may be effected, resulting in a vigorous circulation.
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