Early American Manual Therapy

The Abdominal and Pelvic Brain Byron Robinson, M. D. 1907
CHAPTER VII. THE NERVES OF THE TRACTUS INTESTINALIS (NERVI TRACTUS INTESTINALIS). (A) ANATOMY, (B) PHYSIOLOGY.

"To be or not to be, that is the question." - Shakespare.

"I came, I saw, I conquered." - Caesar's report to the Roman senate.

(A.) ANATOMY.

The abdominal sympathetic emits the great nerve plexuses to the tractus intestinalis (accompanying corresponding named arteries), viz.: (1) plexus coeliacus (unpaired) consisting of: (a) plexus gastricus; (b) plexus hepaticus; (c) plexus lienalis. (2) Plexus mesentericus superior (unpaired); (3) plexus mesentericus inferior (unpaired); (4) plexus haemorrhoidalis medius et superior (paired). The above five nerve plexuses are not only solidly and compactly anastomosed, united with each other but are anastomosed, connected with all other abdominal plexuses. The nerves of the tractus intestinalis are motor (rhythm, peristalsis - Auerbach's plexuses), secretary (tubular visceral glands Meissner's plexus and glandular appendages) and sensory (peripheral reporters to the abdominal brain). The nerves of the tractus intestinalis are preponderatingly sympathetic, however, the cranial (vagi) share in supplying the proximal segment.
The spinal (second, third and fourth sacral) share in supplying the distal segment. While the rami communicantes (spinal) share in supplying the medial segment, the abdominal brain was doubtless a primitive brain for the tractus vascularis and secondarily for the tractus intestinalis.

(1) Plexus Coeliacus (Unpaired).

The coeliac plexus arising from the abdominal brain is about one half inch in length, encases the coeliac artery in a dense plexi-form network of nerves, cords, commissures and ganglia. It is the largest and most luxuriant sympathetic plexus surrounding the arteria coeliaca with a rich, closely fenestrated nerve sheath, solidly united by connective tissue. The origin of the coeliac plexus is the ganglion coeliacum located in the region of the emission of the great visceral arteries including three sources of nerves, viz.: (a) vagus, right (cranial); (b) splanchnic, the most important (spinal cord, rami communicantes); (c) sympathetic. The plexus coeliacus is one of the great assembling plexuses of the abdomen. It divides into three branches of vast importance in medical practice, viz.: (a) plexus gastricus; (b) plexus hepaticus; (c) plexus lienalis.

(a) Plexus Gastricus (Unpaired).

I. Plexus Gastricus Superior. - It is recognized as the plexus coronarius ventriculis superior. The accompanying table illustrates a scheme of gastric nerve supply.

1. Plexus gastricus superior (sympathetic) (plexus coronarius ventriculi superior).
    (a) Plexus ramus dexter.
    (b) Plexus ramus sinister.
2. Plexus gastricus inferior (sympathetic) (plexus coronarius ventriculi inferior).
    (a) Plexus ramus dexter (arteria hepatica),
    (b) Plexus ramus sinister from (arteria lienalis).
3. Vagi plexuses (cranial).
    Dorsal, ventral (cranial).
    The gastric or superior coronary plexus consists of a fine plexiform network which ensheathes and accompanies the curved gastric artery along the lesser gastric curvature. It lies between (however, proximalward) to the two gastric plexuses of the vagi (cranial) dorsal and ventral anastomosing with both, hence solidly and compactly connecting, uniting the gastric plexuses (cranial) with the gastric plexuses (sympathetic).

II. Plexus Gastricus Inferior. (Unpaired). This is recognized as plexus coronarius ventriculi inferior. (The inferior gastric or coronary plexus supplying the greater curvature is mainly from the hepatic and splenic plexuses accompanying the arteria gastro-epiploica dextra et sinistra). The stomach is supplied by the cranial (vagus), right phrenic (spinal) and the sympathetic nerves from the plexus coeliacus. However, since the sympathetic nerves dominate in supply to the stomach it possesses a rhythm or peristalsis. The nerves of the sympathetic plexuses at first course beneath the peritoneum and finally penetrate the gastric muscularis, becoming Auerbach's plexus, destined to rule the gastric rhythm. The ultimate termination of the gastric sympathetic nerves becomes the Meissner-Bilroth plexus destined to rule the gastric secretion and absorption. The gastric rhythm is modified by the vagi (cranial) and spinal (ramus communicantes and phrenic). The location of the gastric nerves is important by reason of the diagnosis of gastric disease from pain and reflexes.

(b) Plexus Hepaticus (Unpaired).

    The hepatic plexus (sympathetic) arises from the coeliac plexus and joining with the hepatic plexus (cranial) from the right (and left) vagus accompanies the arteria hepatica as a coarse plexiform sheathed network of nerves and ganglion (ganglia hepatica).
    The hepatic plexus consists of strong flattened nerves arranged in the form of a closely Fenestrated meshwork, surrounding the hepatic artery on its journey through the liver. A peculiarity of the hepatic plexus is that it emits plexuses to ramify on the vena porta and its branches in their course through the liver. The hepatic plexus is the largest and coarsest of the three branches of the coeliac plexus. The sympathetic nerves preponderate in the liver, hence it possesses a rhythm (through its elastic capsule, parenchymatous cells, vessels, biliary ducts).
    The following plexuses, important in modem practice, are branches of the hepatic plexus:

PLEXUS HEPATICUS.

1. Plexus arterive hepaticee.
    (a) Plexus ramus communism
    (b) Plexus ramus dexter.
    (c) Plexus ramus sinister.
    (d) Plexus arteriae pylori.
    (e) Plexus arteriae gastricae epiploicm dextra.
2. Plexus ductus bilis.
    (f)   Plexus ductus choledochi.
    (g) Plexus ductus cystici.
    (h) Plexus cholecysticus.
    (i)   Plexus ductus hepatici.
3. Plexus venae portee.
    (j)   Plexus ramus communism
    (k) Plexus ramus dexter.
    (1) Plexus ramus sinister.

    The hepatic nerve plexus accompanies the three important apparatus of the liver, viz.: (a) artery; (b) biliary channels; (c) portal vein; (d) the liver is supplied by nerves directly and indirectly from the abdominal brain.
    (a) Plexus arterice hepatice consists of numerous strong gray nerve fibres arranged in a plexiform network ensheathing the hepatic artery. At the points of nerve crossing or anastomosis occur flat enlargements - ganglia hepatica. The plexiform network is a closely fenestrated sheath.
    The branches of the hepatic plexus accompanies richly the branches of the hepatic artery through the five liver lobes; they accompany the pyloric artery to the lesser gastric curvature; they ensheath the arteria gastro epiploica dextra to the greater gastric curvature; they supply the duodenum and caput pancreatica and encase the two arteries which supply the lateral borders of the cholecyst. In short, the nerve plexuses accompany the hepatic artery and all its branches.
    (b) Plexus ductus bilis. Nerves of the biliary channels consist of a rich plexiform network which accompanies and ensheaths each segment of the biliary passages, viz.: (1) ductus choledochus communis; (2) ductus cysticus; (3) cholecyst; (4) ductus hepaticus. Each of the segments of the biliary channels possess a fine meshed, grayish red, nongangliated nerve plexus. The localization of the nerve plexuses of the biliary passages, the direction of their reflexes with the position of reorganized focal symptoms are extremely important in the modem practice of cholelithiasis and inflammatory processes in the segments of the ductus bilis. In dissecting with a magnifying lens it is evident that the ductus bilis is rich in nerve plexuses. The nerve plexuses of the biliary channels are chiefly derived from the plexus artericae hepaticae; however, large numbers of nerves pass to the biliary channels independent from the abdominal brain. Especially rich and abundant nerve plexuses are found accompanying the ductus choledochus communis, ductus cysticus and cholecyst, which explains the severity of the pain from infection of any of its segments inducing disordered, wild, violent peristalsis of the bile channels. Recent advances in surgery of the biliary passages have directed attention to the nerve supply of the bile channels. Dissection demonstrates that they are richly supplied with numerous nerve strands and ganglia which accounts for the terrible pain in cholecystitis calculosa. The different segments of the biliary passages are so abundantly supplied with nerves that they have assumed the name plexuses. The significance of the nerves of the biliary channels is evident in pain during the passage of a calculus or in pain from localized infection of any segment of the bile channels.
    (c) Plexus venae portae consists of a strong plexiform network of nerves surrounding and accompanying the portal vein and its branches through the liver parenchyma. The portal vein is a voluminous tube with extensive ramifications in theliver and hence possesses an enormous nerve supply. The sympathetic nerve is destined for the arteries; however, the portal vein is a marked exception, as it receives an abundant sympathetic nerve supply. (I have traced large sympathetic nerve supplies to the vena cava distal).
    The liver is supplied directly from the abdominal brain (sympathetic): (a) by nerves accompanying the arteria hepatica; (b) by nerves originating from the abdominal brain and passing directly to the liver; (c) by nerves originating in the abdominal brain and accompanying the venae portae; (d) (cranial) vagi, right (and left); (e) (spinal) right. phrenic.

Plexus lienalis, a branch of the coeliac plexus, a fine and wide-meshed network of nerves accompanying the spiral splenic artery as a sheath to the spleen. The accompanying table presents the nerve supply of the spleen:

PLEXUS LIENALIS.

    (a) Plexus arteriae lienalis.
    (b) Plexus ramus gastricus.
    (c) Plexus ramus pancreaticus.

The plexus lienalis is less in dimension than the plexus hepaticus. The splenci plexus is joined by branches from the right vagus, which modifies the splenic rhythm. It furnishes a branch plexus to the arteria gastrica epiploica sinistra which courses along the major curvature of the stomach to meet the right artery of corresponding name. It emits branch plexuses to the pancreas. The splenic plexus emits branches from the omentum majus. The splenic plexus anastomoses with the plexus suprarenalis. Practically the splenic plexus supplies the left half of the stomach, the spleen, and the pancreas.
The main nerves of the plexus lienalis, much diminished from omission of branches, enters the hilum of the spleen with the sheath of the splenic artery to be distributed to the splenic parenchyma to the Malpigian bodies.

(2.) Plexus Mesentericus Superior (Unpaired).

    The superior or proximal mesenteric plexus consists of large, coarse, dense, whitish gray nerve fibres which arise in the abdominal brain at the root of the arteria mesenterica superior, which it accompanies as a plexiform network of nerves and ganglia. Branches of right vagus joins the plexus. The superior mesenteric plexus is composed of thick, flat, ganglionated masses (ganglia mesenterica superior) of oval, crescentic or stellate form, which, woven into thick sheath, surrounds the superior mesenteric artery and accompanies it to the enteron (with the exception of the duodenum) and colon (with the exception of the left colon, sigmoid and rectum). The plexus mesentericus superior not only arises from the entire abdominal brain but from the plexus renalis, bilateral. It also arises by several cords from the plexus aorticus abdominalis.
    The plexus mesentericus superior contains ganglia relatively less in number and dimension than the plexus coeliacus.
    A smaller portion of the plexus mesentericus superior accompanies the arteria pancreatico-duodenalis inferior proximalward to the duodenum and caput pancreatica (rami pancreatici duodenales).
    The greater portion courses on the arteria mesenterica superior distalward in the form of a long white closely fenestrated plexiform sheath to the enteron, coecum, right and transverse colon (rami enteron and rami colici).
    The nerves course between the blades of the mesenteron and mesocolon partly closely adjacent to the artery and partly at adistance from the same. The nerves anastomose here and there more irregularly than the arteries as curved arches. The termination of the plexus mesentaricus superior is : (a) between the longitudinal and circular muscles of the enteron and colon ruling rhythm - (plexus myentericus externus - Auerbach's, Leopold Auerbach, German Anatomist Prof. at Breslau, 1823-1897); (b) in the intestinal submucosa - ruling secretion - (plexus myentericus internus - Meissner-Bilroth, George Meissner, 1829-1905, German Anatomist Prof. in Goettongen. Theodor Bilroth, German - Prof. surgery in Vienna, 1829-1894. German Surgeon Prof. in Vienna). The meshwork of the plexus myentericus internus is not so regular nor the ganglia so large or numerous as that of the plexus myentericus externus. On the nerve plexuses which accompany the vasa intestine tennis and on the nerve plexuses more distantly removed from the vessels may be found diminutive plexuses and ganglia. The nerves end in the wall of the tractus intestinalis as automatic visceral ganglia. Ganglia exist at the origin of the arteria mesenterica superior which endow the enteron with several, three or four rhythms, daily (three meals). There may be more or less. The superior mesenteric plexus is fan-formed, is the largest plexus in the abdomen. It accompanies the mesenteric artery coursing dorsal to the pancreas. The mesenteric nerves are remarkable for strength, number, length and thickness of their neuri lemma. They are placed in contact with the vessels and also at variable distances from the same. They course toward the intestine in straight lines without emitting branches. At a limited distance from the concave intestinal border they pass directly toward the enteron and colon, or they anastomose with an adjacent nerve at an angle or in an arch. From the convexity of the anastomotic arches the branches pass directly to supply the enteron and part of the colon. There is only one series, row, of nerve arches in the plexus mesentericus superior regardless of the number of series, rows, of arterial arches (in the vasa intestine tennis). The simple nerve arch corresponds to the vascular arch, the most adjacent to the intestine. The superior mesenteric plexus anastomoses with the renal ganglia, plexus mesentericus inferior and ovarica. Practically it is a continuation of the plexus coeliacus and aorticus abdominis.

(3) Plexus Mesentericus Inferior (Unpaired.)

    The inferior mesenteric plexus consists of a rich plexiform network of nerves and ganglia ensheathing and accompanying the inferior mesenteric artery to the left colon, sigmoid and rectum (as nervi colici sinistri et haemorrhoidales superiores). It arises from the aortic plexus and especially from the ganglion located at the origin of the arteria mesenterica inferior (ganglion mesenteric inferior) as well as from the lumbar lateral ganglionic chain (plexus lumbales aorticus). The fenestra or meshwork of the inferior mesenteric plexus are not so compact or close as that of the superior mesenteric plexus. The nerves of this plexus form in its course subordinate plexuses, accompanying or lying between the arterial branches, and produce curved, arc anastomoses. They terminate the colonic muscularis as Auerbach's plexus (rhythm) and the colonic submucosa as Meissner-Bilroth plexus (secretion and absorption).
    The plexus mesentericus inferior arises from: (a) abdominal brain (plexus mesentericus superior); (b) plexus aorticus; (c) ganglion mesentericum inferior.
    The plexus mesentericus inferior is not only solidly and compactly anastomosed in all its branches, but solidly and compactly with all other abdominal sympathetic plexuses. There exist nerve nodes - ganglia mesenterica inferior - along the course of the plexus. At the origin of the arteria mesenterica inferior there is located a mass of nerve tissue - ganglion mesentericum inferior - which doubtless endows the faecal reservoir (left colon, sigmoid and rectum) with a daily rhythm for faecal evacuation. The inferior mesenteric plexus anastomoses or is connected with: (a) second lumbar ganglion in the lateral chain; (b) plexus aorticus abdominalis; (c) plexus mesentericus superior; (d) plexus ovaricus; (e) plexus hypogastricus; (f) plexus haemorrhoidalis (medius and inferior) from the arteria pudendalis. The plexus mesentericus inferior ends in the colonic wall as automatic visceral ganglia, Auerbach's (plexus myenteric externus) and BilrothMeissner's (plexus myentericus internus).
    The nerves of the inferior mesenteric plexus are remarkable for their tennity, length and general noilbranching state. The nerves of the inferior mesenteric plexus are not the most numerous in the mesosigmold. The plexus mesentericus inferior terminates, like the inferior mesenteric artery, by bifurcating the two divisions of this bifurcation are called the haemorrhoidal plexus superior. They course bilaterally distalward on the rectal wall accompanying two lateral superior haemorrhoidal, terminating partly in the rectum and partly in the plexus hypogastricus.

(4) Plexus Haemorrhoidalis Medius et Inferior (Paired).

The sources of the median and inferior hemorrhoidal plexuses are: from the dorsal part of the plexus hypogastricus; (2) the nerves accompanying the middle (vaginal) and inferior haemorrhoidal artery; (3) from the pelvic brain (ganglion cervicale). The numerous nerves course bilaterally through the mesorectum to the rectum. The proximal portion of the two haemorrhoidal plexuses curve proximalward to anastomose with the plexus haemorrhoidalis superior. The distal portion passes distalward to supply the rectum and vagina. Small swellings may occur at the nerve crossings or anastomoses, however, ganglia heemorrhoidalia are doubtful nervus haemorrhoidalis medius and inferior are branches of the plexus pudendus. The nerves of the tractus intestinalis are not an independent system as it is solidly and compactly anastomosed with all other abnormal systems. However the haemorrhoidal nerves are a spur which complicates the distal end of the intestinal tract and separates the great partially independent nerves of the tractus intestinalis for the rectum. The change is due to the distalward movement of parts of the tractus genitalis and tractus urinarius and their function with the rectum. In general I think the older anatomists with the exception especially of Henle represented the nerves and ganglia supplying the tractus intestinalis rather too rich, too abundant. Tedious dissection will lessen the number of nerve strands by eliminating white fibrous connective tissue.

(b) Physiology of the Nerves of the Tractus Intestinalis.

The physiology of the nerve plexus supplying the tractus intestinalis is important both theoretic and practical. The sympathetic nerves dominate, rule, the intestinal tract, hence it possesses a rhythm, peristalsis - only sympathetic ganglia possess the power of rhythm. In the physiology of organs the course of nerves must be considered. First, the vagus (as cranial nerve) supplies the proximal end of the tractus intestinalis as well as its appendage; especially the liver with numerous fibres. The vagus aids to check rhythm, especially of the stomach. Second, the spinal nerves at the distal end of the tractus intestinalis particularly the middle and inferior haemorrhoidal nerves supplying the rectum and interfering with its rhythm or peristalsis. The spinal nerve attending the rectum places it partially under the will in controlling to some extent the evacuation of faeces or gas. Third, there is the great splanchnic nerves, chief delegates in the function, rhythm or peristalsis of the tractus intestinalis (median) especially in the enteron or business segment. The splanchnic nerves though preponderatingly sympathetic possess a rich source in the spinal cord. Therefore though the tractus intestinalis is preponderatingly supplied with sympathetic nerves (hence rhythmic) it is supplied at its proximal end by cranial nerves (vagi) and at its distal end by spinal nerves (haemorrhoidal). The general function of the tractus intestinalis under the sympathetic nerve is: (a) peristalsis (rhythm); (b) absorption; (c) secretion. Its object is digestion. The business of a physician is chiefly to aid in maintaining normal functions, i. e., peristalsis, absorption and secretion in the intestinal tract. In the general application of the physiology of the nerves of the tractus intestinalis for practical - purposes there should be considered: (a) those of the proximal end, stomach and appendages; (b) the nerves supplying the medial region (enteron) and (c) the nerves supplying the distal end (colon). The great sympathetic nerve plexuses accompany the arteries.

(a) The Physiology of the Nerves of the Proximal End of the Tractus Intestinalis
(Stomach, Liver, Spleen and Pancreas).

Since the arterial branches of the coeliac axis (hepatic, gastric and splentic) are solidly and compactly anastomosed at their peripheries by means of circles and arcs the three branches of the coeliac plexus which accompany the hepatic, gastric and splenic arteries are solidly and compactly anastomosed on the arterial circles and arcs. This anatomic fact solidly and compactly anastomoses the nerve plexuses of the liver, stomach, pancreas and spleen as well as that of the duodenum and pancreas forming a single apparatus thus inducing the nerve arrangement of the liver, stomach, duodenum, pancreas and spleen to act as a unit or single apparatus with the abdominal brain as a reflex, focal or reorganizing center. In practice this is found true, e. g., the irritation of a calculus in a segment of the biliary passages from inflammation or irritation will be transmitted to the abdominal brain as a focal center, become reorganized and emitted over the gastric plexus, inducing nausea or vomiting, thus disordering the gastric rhythm. Irritating food or liquid (alcohol) in the stomach quickly disorders the hepatic rhythm and if gall stone be present hepatic colic is liable to arise. Again, the introduction of food and fluid into the stomach incites the rhythm, peristalsis and secretion of the stomach, liver, duodenum and pancreas, demonstrating the anatomic and consequently the physiologic connection and anastomoses of the nerve plexus apparatus of the stomach, liver, duodenum. pancreas (and spleen). The nerve apparatus of the viscera in the proximal abdomen is a finely balanced structure with the abdominal brain as a reorganizing, focal, center. Subjects with hepatic calculus are ample evidence of the solid and compact anastomoses of the nerves of the stomach and liver, for they avoid many kinds of food, as their experience has taught that stimulating foods in the stomach will excite hepatic colic. The rhythm of the proximal end of the tractus intestinalis (stomach) being supplied by two powerful cranial nerves (vagi) is the most irregular of any segment of the intestinal tract.

(b) Physiology of the Nerves Supplying the Middle Region of the
Tractus Intestinalis (Enteron).

The superior mesenteric plexus is the largest and richest sympathetic plexus in the body. It has an extensive and an enormous surface area (a truncate cone, the base of which is twenty-one feet; apex six inches; height six inches - covering an area of many square feet). The superior mesenteric plexus consists of a closely fenestrated meshwork of powerful nerves and ganglia ensheathing in a plexiform manner the superior mesenteric artery which practically supplies the digestive portion of the tractus intestinalis.
The first factor in the physiology of the superior mesenteric plexus is that it controls the volume of blood-supply of the enteron. It is nervus vasomotorius of the enteron. Stimulation of the splanchnics (which constitutes the major portion of the superior mesenteric plexus) produces hypereemia of the enteron. The function of the enteron depends on its blood supply. The stimulus which induces necessary blood supply to the enteron for digestion is the irritation that the food produces on its mucosa. A full enteron is hypereemic, active one. An empty, evacuated enteron is an anaemic, quiet one. The three great manifest functions of the superior mesenteric plexus is to produce in the enteron rhythm, peristalsis, secretion and absorption. There can be little doubt that included in the rhythm of the enteron (dependent on hypereemia) is the factors of secretion and absorption. So long as enteronic rhythm is not interfered or especially the enteronic (faecal) current is not obstructed the enteron performs its function (rhymth, secretion and absorption.) However, as soon as mechanical obstruction to the enteronic (food) current occurs (as flexion, volvulus stricture) the nondrainage induces residual deposits resulting in accumulation of bacteria and consequent infection. The enteron possesses a periodioc rhythm about every six hours (ingested meals and fluids) which enables absorption and secretion to complete itself and the rhythm to transport the residual debris to the colon.

The physiology of the sympathetic nerve at the distal end of the tractus intestinalis is interfered, complicated by the addition of the spinal nerves (as the proximal end is complicated by the addition of the cranial nerves - vagi). The physiology of the distal end of the tractus intestinalis (left colon, sigmoid and rectum) is chiefly included in the so-called hemorrhoidal nerves - a developmental addition, an imposition on the original markedly independent sympathetic nervous system of the intestinal tract, through the coalesce of the tractus intestinalis, tractus genitalis and tractus urinarius - the coloaca has disappeared and its place is supplied by a rectal, vaginal and urethral sphincter. The haemorrhoidal nerves are a spur which complicates anatomically and physiologically the distal end of the intestinal tract and separates the great practically independent nerves (plexus mesentericus inferior) of the tractus intestinalis from the rectum. The haemorrhoidal nerves can not manifest definite action on the tractus intestinalis (left colon, sigmoid and rectum) which I shall term the faecal reservoir, which has a daily rhythm. It is practically, for local purpose, under the rule of the inferior mesenteric ganglion. Numerous phenomena of the rectum in disease, in pain, do not belong to the sympathetic nerve but to the spinal nerves accompanying it, as the sharp pains in the anal fissure.
The expiratory moan resembling the bray of an ass in rectal dilatation is explained by the irritation being transmitted over the haemorrhoidal plexuses (inferior medius and superior) to the abdominal brain, whence it may pass: first, over the diaphragmatic plexus (right side) to the right phrenic nerve (contracting the diaphragm); second, over the splanchnics to the inferior cervical ganglion, which is connected to the phrenic by a nerve cord, whence the route is direct to the diaphragm (inducing the diaphragm to contract); third, the irritation from the rectal dilatation may pass over the third and fourth sacral nerves, proximalward of the spinal cord to the cranial cerebrum where reorganization and emission occurs over the cord and phrenic nerve to the diaphragm, inducing contraction and an expiratory moan or bray. The disordered functions of the digestive canal are chiefly excessive (diarrhoea, colic), deficient (constipation), or disproportionate (fermentation). In the excessive rhythm (colic) or secretion of the tractus intestinalis, we possess effective remedies, as anatomic and physiologic rest; with the holding of food and fluids and the administration of anodynes (opiates). The treatment consists in securing normal rhythm, peristalsis, absorption and secretion. In deficient rhythm (constipation) and secretion in the tractus intestinalis we possess effective remedies in the restoration of the normal rhythm and secretion as diet. Coarse food, as cereals and vegetables, leave ample faecal residue to stimulate the colon, intestine to vigorous peristalsis; the evacuation of the colon at regular intervals; exercise and massage of the abdomen; electricity. It is a known physiologic principle that regular habits of bowel evacuation daily will maintain the rhythm normal, but that neglect of regular evacuation will destroy the rhythm; in fact, induce constipation. The normal rhythm of bowel evacuation is a delicate matter and mental disturbance, change of habits, different environments, may viciate the rhythm of the foccal reservoir (left colon, sigmoid and rectum). In disproportionate peristalsis (colic) and secretion (fermentation), the effective remedy is to regulate the diet and fluid to restore normal rhythm and secretion; to introduce disinfectants to check fermentation, as sulphocarbolates. It will be observed that the sympathetic system of the entire tractus intestinalis, consisting of six great plexuses (nerve cords and ganglia), viz.: (a) gastric; (b) hepatic; (c) splenic; (d) superior mesenteric; (e) inferior mesenteric; (f) haemorrhoidal, is not only profoundly connected with the coeliac plexus or abdominal brain, but the five plexuses are all solidly and compactly anastomosed, bound together and also anastomosed (connected) with all other plexuses of the abdominal visceral tracts, in order that the chief potentate - the abdominal brain - may rule as a single unit of power. No conflict of power arises, as all ganglia, of the tractus intestinalis are subordinate to the abdominal brain - however, local rulers, as the ganglion mesentericum inferior, are allowed to rule, to dominate, with a daily rhythm, the faecal reservoir (left colon, sigmoid and rectum). The nerve plexuses of the various abdominal visceral tracts are anastomosed, connected, solidly and compactly, in order to maintain a balanced system and for local and general physiologic reports to the abdominal brain.

ABDOMINAL BRAIN AND COELIAC PLEXUS
Fig. 13. This figure presents the nerves of the proximal part of the tractus intestinalis that is, the nerve plexuses accompanying the branches of arteria coeliaca. 1 and 2 abdominal brain surrounding the coeliac axis drawn from dissected specimen. H. Hepatic plexus on hepatic artery. S. Splenic plexus on splenic artery. Gt. Gastric plexus on gastric artery. Rn. Renal artery (left). R. Right renal artery in the dissection was rich in ganglia. Dg. diaphragmatic artery with its ganglion. G. S. Great splanchnic nerve. Ad. Adrenal. K. Kidney. Pn. Pneumogastric (Lt. left). Ep. right and Eps. left epiploica artery. St. Stomach Py, Pyloric artery. C. cholecvst. Co. clole-dochus, N, adrenal nerves (right, 10, left 10). The arterial branches and loops of the coeliac tripod (as well as that of the renals) with their corresponding nerve plexuses demonstrate how solidly and compactly the viscera of the proximal abdomen are anastomosed, connected into single delicately poised system with the abdominal brain as a center. Hence local reflexes, as hepatic or renal calculus, disturb the accurate physiologic balance in stomach, kidney, spleen, liver and pancreas.

THE SOLID AND COMPACTLY ANASTOMOSING ARTERIES OF THE TRACTUS INTESTINALIS
Fig. 14. This illustration demonstrates that the arteries of the tractus intestinalis are solidly and compactly anastomosed by vascular circles, arcs and arcades. To recall the plexus vasomotorius abdominalis one need to remember the arterioc abdominalis only. The circles, arcs and arcades of the abdominal arteries are richly ensheathed with a nodular plexus of nerves. 10 arteria coeliaca emitting the arterial tripod (tripus Halleri), hepatic, splenic and gastric, presenting circles, arcs and arcades. 5 arteria mesenterica superior with its circles, arcs and arcades. 7, arteria mesenterica inferior with its circles, arcs and arcades. 2-10, gastro-hepatic vascular circle (of author) anastomosed to the circles, arcs and arcades of the superior mesenteric arteries with their circles, arcs and arcades by means of the arteria pancreati co-duodenalis superior (a branch of the hepatic) and arteria duodenalis inferior (a branch of the superior mesenteric artery).

NERVES OF THE HEPATIC ARTERY AND BILIARY DUCT
Fig. 15. Presents the copy of an X-ray of the hepatic artery, binary and pancreatic ducts which are each richly ensheathed by a nodular, plexiform web of nerves. The quantity of nerves may be estimated by the number of arteries and ducts in the liver and pancreas. I, Vater's papilla at duodenal end of ductus choledochus communis. II, junction of ductus hepaticus (III) and ductus cysticus (IV). C, cholcyst, P, ductus pancreaticus, Sa, ductus pancreaticus accessorius. The black conduit coursing parallel to the binary ducts is the hepatic artery.

ARTERIES OF CAECUM AND APPENDIX
Fig. 16. The nerves in the important appendiculo-coecal region may be estimated by observing an illustration of the arteries of this segment of the tractus intestinalis. The nervus vasomotorius richly ensheaths the artery in a plexiform network.

AN X-RAY OF THE DUCTUS PANCREATICUS AND PART OF THE DUCTUS BILIS
Fig. 17. This illustration represents the ductus pancreaticus with its lateral ducts, all of which are richly ensheathed in a plexiform, nodular meshwork of nerves. It is an X-ray of part of the ductus bilis and ductus pancreaticus of a girl of 11 years old. I to II, ductus choledochus communis. II to III, ductus hepaticus. II to IV, ductus cysticus. C, cholecyst. It is easy to observe the segments of the pancreas, viz. : - caput, collum, corpus, cauda. In fact, this beautiful accurate illustration establishes final anatomy. Sa, ductus Santorini functionated as the celloidin projected from its exit duct during the injecting of it. The proper eponym for the pancreatic secretary channel is the Hofman-Wirsung duct. The liver of this patient was advanced in sarcomatous disease but the pancreas appeared healthy. P, ductus pancreaticus.