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the part of the practitioner to differentiate is the following, viz. : (A) nervus vasomotor. between the putrid intoxications, due to re. ius to the tractus vascularis (blood and lymph tained placental tissues, when the patient is vessels); (B) nerrus vasomotorius to tractus in the least danger, tbe uterus is not softened intestinalis; (C) nervus vasomotorius to tract. and curettement is least dangerous, and the us gentialis; (D) nervus vasomotorius to cases of streptococcic or staphylococcio in tractus urinarius. However, all the abdom. foetions when the curettement can do no pos. inal viscera are solidly and compactly anassible good, and is fraught with the greatest tomosed, connected to the central abdominal danger to life. If this paper shall have caused sympathetic or vasomotor nerve that no one more care in the differentiation, and less in. visceral system can become disturbed, dediscriminate use of the curette in puerperal ranged, without affeoting profoundly all other cases, it will have accomplished its purpose, viscera systems. The durangement arises in and I am sure it will have saved lives.

the several abdominal visceral systems caused by irritation or disease in any one abdominal visceral system is produced by reflexes, resulting in the disturbed common visceral

funotion-peristalsis, seoretion, absorption THE NERVES OF THE GENITAL TRACT sensation. So far as I am able to bbserve the

-NERVI TRACTUS GENITALIS – A. reflexes or irritation in the tractus genitalis ANATOMY. B. PHYSIOLOGY.

produces the most profound and vast derange

ment of function in other abdominal viscera BYRON ROBINSON,

of any single visceral system, e.g., irritation, CHICAGO.

disease in the tractus genitalis passes to A. ANATOMY.

the abdominal brain (over the plexus in.

teriliacus and plexus aorticus) where it is The origin of genital nerves are: I, nervus reorganized and emitted to the tractus in. vasomotorius (sympathetic – abdominal testinalis or tractus urinarius deranging the brain); II, spinal cord (medulla spinalie), common funotion of peristalsis (rhythm), sethrough rami communicantes and rami ner. cretion sensation and absorption-causing vorum sacralium (II, III, IV), cerebrum deficient, excessive or disproportionate peris. (vagi).

talsis, seoration or absorption. The older The three major nerve streams to the tract- anatomists like the philosophic Willis (1622. us genitalis are: (a) the plexus interiliacus 1675) who was the Sedlian professor in Cam. (which is a continuation of the plexus aorti. bridge talked that the nerves supplying the cus) originating in the abdominal brain; (b) tractus genitalis arose from the intercostal the plexus ovarious originating from the nerves (that is by means of the rami com. whole plexus aortious; (c) plexus sacralis municantes, truncus vasomotorius- lateral spinalis (rami nervorum saoralium-II, III, ganglionic chain and nerri splanchnici). IV). The minor nerve streams to the tract. This is as true today as in the days of the us genitalis are: (d) lateral lumbar ganglia ever memorable Willis, however, we ascribed (truncus nervus lumbales vasomotorius); (e) today more to independent, more differentialateral pelvio ganglia (truncus nervus pelvis tion to the vasomotor nerves (sympathetic) vasamotorius); (f) nerves of the uterine ar.' than did Willis. These so-called intercostal tery (nervi arteriae uterinae); (g) nerves of nerves (rami communicantes) form a nervous the hypogastric artery (nervi arteriae hypo. center-the abdominal brain-secondarily to gastricae) richly demonstrated in infant ca. the cranial' brain which has differentiated davers. Also nerves of the round ligament functions of the first magnitude as regards and hemorrhoidal arteries.

existence of life itself. Hence, today we are Practically the nerves supplying the inclined to believe from experimentation and tractus genitalis are solidly and compactly clinical data that the chief origin of the anastomosed conneoted with the whole ab. nerves of the tractus genitalis is the abdom. dominal vasomotor nerves (sympathetio), inal brain-cerebrum abdominale and since especially with the giant ganglion coeiliacum this giant ganglion controls the vascular sup

-the abdominal brain-the great assembling ply of the abdominal viscera it should be center of the vasomotorius abdominale or termed cerebrum vasoulare abdominale. In sympathetic nerve plexus. The anastomosis the consideration of the nerve supply of the or connection of the genital nerves to the traotus genitalis is favorable for conveni. nervus vasomotorius (sympathetic) and cere. ence of description and practical purposes to bro-spinal is vast and profound. The order present a major and minor nerve stream. The of solidarity or compactness of anastomosis following table presents in a bird's-eye view or profundity of ocnnection of the vasomotor the major and minor nerve supply to the gen. nerves (sympathetio) to the abdominal viscera ital tract:

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FIG. 1.-NERVES OF TRACTUS GENITALIS PREGNANT ABOUT THREE MONTHS.

This illustration presents the nerves on its genital vascular circle at about three months gestation. The uterus is drawn distal ward exposing its dorsal surface A, abdominal brain. The pelvic brain is poorly represented. The plexus ovarices is carefully presented.

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An illustration of the pelvic brain (B) and the nerve supply in the pelvis uretus and bladder. The nerves supplying the ureter are from (a) the I sacral ganglia (see u on ureter); (b) hypogastric plexus (at P); (c) the III sacral nerve (at X); (d) the pelvic brain (at B). The pelvic brain (B) ends the plexus uterinus plexus vaginalis, plexus rectalis. Suggestions for this drawing were gained from Frankenhausen. Ut, uterus; Vs. bladder; Ov, ovary; Od, oviduct; GS, great sciatic nerve ; 5L, last lumbar nerve; I, II, III, IV, sacral nerves,

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F. Nerves of the uterine artery (nervi ar- the following ganglia, viz. : (a) ganglion teriae uterinae).

ovaricum (proximal); (b) ganglia renalia; G. Nerves of tbe bypogastric artery (nervi (c) ganglion mesentericum inferior; (d) gan. arteriae hypogastricae).

glia lumbalis. The above ganglia are solidly H. Nerves of the round ligament artery and compactly conneoted with the ganglion (nervi arteriae ligamenti rotundi).

coeliacum. I. Nerves of the hemorrhoidal artery su. (Note.-It should be remembered that the perior et medius (nervi arteriae hemorrhoid. numerous pains of which woman complains alis superior et medius).

as being in the ovaries are not located in the The major nerve supply consists of (A) ovaries, but reside in the cutaneous distribu. plexus ovaricus; (B) plexus interiliacus tion of the ileo-inguinal and ileo-hypogastrio (vasomotorius); (C) plexus saoralis spinalis nerves. It is hyperesthesia of the skin.) rami nervorum sacralium (II, III, IV).

The plexus ovaricus arises from the follow.

ing plexuses: (a) plexus aorticus; (b) plexus (A) PLEXUS OVARICUS.

renalis; (o) plexus mesentericus superior; Oriģin. According to my dissection the (d) plexus mesentericus inferior; (e) plexus main origin of the ovarian nerves is from the ureteris (where the vasa ovarica cross ventral ganglion ovaricum proximal, a definite gangli. to the ureter the plexus ovarious become anason of irregular form and dimension located at tomosed with the plexus ureteris, further the origin of the arteria ovarica on the aorta. solidly anastomosing the plexus ovaricus However, the plexus ovaricus arises also from with the plexus renalis); (f) plexus interiliac. the adjacent regions in the plexus aorticus U8; (g) the plexus ovarious receives branches both proximal and distal to the ovarian gan. form the genito-crural nerve, again solidly glion especially it may be noted that the anastomosing the plexus lumbalis (spinal) renal ganglia contribute ovarian nerves. with the plexus ovarious (sympathetic). Frankenbauser (1867) in one of his tables marks the origin of the ovarian nerves ex

Course. The plexus ovaricus accompanies tending from the root of the arteria renalis to

the vasa ovarica in their extended journey to the interiliac nerve diso located on the sacral

the pelvis in erect animals in the form of promontory. He notes the ovarian nerve

sheathed network of nerves with extremely composed at the origin of some twelve sep.

elongated fenestra. The plexus ovaricus in its arate strands, and as they pass distalward on

course is studied with spare ganglia of vari. the pasaovarioa coalesce into three main

ous size. The nerves of the plexus, like many trunks, studded with ganglia. In dissecting it

other sympatbetio plexuses, are cylindricalwill be observed that the ganglia renalia and

not flat like those of the plexus uterinusganglia ovarica are closely associated in a

and retain their calibre throughout their solidly, fenestrated, network indicating iden- course. Toward the distal end of the vasa tical origin from the Wolfian body. I could

ovarica the vein and artery become more not discover such an abundant orarian nerve

branched, oooupying more space whence the supply neither from such an extensive area of plexus ovarious divides its branches to acthe plexus aortious, as reported by Franken.

company the additional vessels. The distal bauser. However, the explanation may lie

end of the plexus ovarious divides and sup. in the fact that Frankenhauser dissections

plies: (a) the ovary; (b) the oviduct; (c) lig. were from non-pregnant and infant genitals.

amentum latum; (d) the lateral border of the The sections disclosed large numbers of nerve

uterus; (e) it anastomoses with branches of fibres originating in various regions from

e regions from the plexus interiliacus. the plexus aortious, especially the ganglia renalia and ganglia ovarica proximal and di

(B). PLEXUS INTERILIACUS (VASOMOTORIUS.) recting themselves toward the vasaovarioa The interiliao plexus extends from the incoalesce into some three nerve trunks. The teriliac nerve disc to its union with the sacovarian nerves coerce with the ovarian vessels ral nerves of the cervico-vaginal junction. It forming an elongated wide network studded is the major nerve supply of the genitals. It with nerve ganglia limited in number and di. is elsewhere described in detail. mension and located at the crossing, junctiun

(o). PLEXUS SACRALIS SPINALIS (RAMI NERof the nerve strands. The ovarian nerves arise from the ganglion

VORUM SACRALIUM). ovaricum proximal in the form of a plexus or The second, third and fourth saoral, spinal a leash which accompanies and ensheaths nerves emit branches (pelvic splanchnics) the arteria ovarica to the union with the veua wbicb join, coalesce, with the distal branches ovarica where both vein and artery share more of the interiliac plexus to form the pelvic equally the attention of the ovarian nerves. brain (ganglion cervicale--which issues the The plexus ovaricus in general arises from white rami communicantes) practically the

plexus uterinus, plexus vesicalis, plexus rec- torius) results in the pelvic brain-a plexi. talis, plexus vaginalis, plexus clitoridis, form, multiple, nodular ganglionio nerve plexus pudendalis. The spinal saoral nerves mass located where the rectum joins the cerpassing to the pelvio brain gave rise to the vico-vaginal junction and being of irregular idea that they supplied the cervix uteri, and form, dimension, weight. The pelvic brain is that they are sensory nerves of the uterus. So practically the source of the genital nerves. far as I have been able to observe all branches Tbe minor nerve supply of the tractus geni. of the sacral spinal nerves first enter the pel. tals consists of D, E, F, G, H, I.. vic brain before passing to the uterus and vagina. One nerve from the second sacral D. The lateral lumbar trunk ganglia send

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B. bladder: V. vagina. This illustration is drawn from my own dissection executed under alcohol. I, lumbar nerve; I, II, III, IV. sacral nerves; V, coccygeal nerve: GS, great sciatic : Pu, pudic nerve, A, pelvic brain ; D, interiliac disc: R, rectum; P. I, plexus interiliacus. Observe that two distinet nerve strands arise from the plexus interiliacus and pass directly to the uterus without first passing through the pelvic brain. Ur, ureter; Ut, uterus; B, bladder; V, vagina. Note the smaller ganglia adjaceut to the pelvic brain on the pelvic viscera.

passes directly to the bladder without first nerves to the plexus aorticus and plexus interpassing througb the pelvic brain. The branch. liacus. es of the sacral nerve passing to the pelvio (E) The lateral pelvic trunk ganglia send brain, very in number, origin, arrangement, nerves to the genitals by way of the pelvio length and dimension. They are the most brain. It sends nerves to the distal ureter. accurately demonstrated in infant cadavers (F) The nerves accompanying the internal preserved in alcohol. The blending or coal. iliac artery continue their course over the ar. escence of the branches of the sacral nerves teria uterina as the nervi arteriae uterinae. (pelvio splanchnios) (i to iv) with the distal (G) The nerves of the hypogastric artery branches of the plexus interiliacus (vasomo. (nervi arteriae hyposagtricae) carries larger

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