The Abdominal and Pelvic Brain
Byron Robinson, M. D.
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.
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
(a) Plexus ramus dexter.
(b) Plexus ramus sinister.
2. Plexus gastricus inferior (sympathetic) (plexus coronarius
(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
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
The following plexuses, important in modem practice,
are branches of the hepatic plexus:
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.
(c) Plexus Lienalis (Unpaired).
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:
(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
(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
(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
(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
(c) The Physiology of the Nerves at the Distal End of the Tract
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.