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This illustration presents the complete sympathetic nerve from the abdominal brain (1 and 2) through the plexus aorticus through the interiliacus to the pelvic brain B. The plexus ovaricus coursing on the vasa ovarica extend to the ureteral crossing only (16a and 16).
of nerves wbich surround the vagina like a
RECTAL NERVE SUPPLY. network of cords surrounding a rubber ball.
l. 1. Plexus hemorrhoidalis superior (from The vaginal nerve plexus and vaginal vein
the arteria mesenterica superior). plexus both rich, complicated and abundant
2. Plexus interiliacus (from the abdominal intertwine and interweare with each other.
er. brain). The rich vaginal plexus is bedecked with nu.
3. Plexus bemorrhoidalis medius (accommerous ganglia at the points of nerve con.
• panying the arteria bemorrhoidalis media). vergence. The meshes of the vaginal plexus,
S. 4. Plexus hemorrhoidalis inferior (from the being occupied by fatty tissue, connective tis
arteria hemorrhoidalis inferior and plexus sue, lymph and blood vessels, its dissection
pudendalis sacralis-mixed vasomotor and is accompanied with difficulty. Infant ca.
spinal nerves). davers should be chosen to facilitate cor
5. Plexus rectalis (from pelvic brain-a rect exposure of the finer constituents of the
powerful rich nerve plexus solidly anasto. vaginal plexus. As the bladder is supplied
mosed to the plexus uterinus aud vesicalis). by a large branch from the third sacral nerve,
6. Plexus sacralis spinalis (branches from so the vagina is supplied from a large branch
the second, third and fourth sacral nerves). of the fourth sacral nerves. The ganglion- 7. Truncus pelvis sympathicus (lateral sac. ated nerve cords from the pelvic brain sur
ral ganglia). round the vagina like a mighty network, 25
The three great hemorrhoidal plexuses ar. ventrally and dorsally. The vaginal plexus
riving at the rectum via the tbree hemor. also emits many large nerves to the rectum
rhoidal arteries invest it with a network of and bladder. The ventral vaginal nerve
rich nerve plexuses. A rich leash of nerves laashes course proximalward and distalward.
passes to the rectum from the plexus interiliaThe larger ganglia of the vaginal leash or
ous. Part of the branches of the plexus pass plexus occur at the proximal ventral vaginal
proximalward on the rectum to anastomose fornix, while on the distal ventral end of the
with the plexus hemorrhoidalis inferior (from vagina the ganglia are numeruus, but more
the inferior mesenteric plexus) while part limited in dimensions. The ganglia of the
passes distalward on the rectum penetrating dorsal vaginal wall is limited in number. The
its coats. Some of the branches of the hemorentire vagina is completely surrounded by a
rhoidal plexus supply the bladder and geni. closely woven ganglionated nerve network.
tals. From this anatomic distribution of the These peri-vaginal and para-vaginal plexuses
hemorrhoidal plexus—to genitals, rectum and stand in intimate relation with the pelvio
bladder-is obvious that the genitals, rectum brain.
and bladder are solidly and compactly anasToward the central longitudinal axis of the tomosed. Clinical work demonstrates this uterus and vagina the genital plexuses dimin- balanced union of organs in the pelvis through isb, simulating exactly the genital blood and nerve connection, as rectal or genital operalymph supply.
tions will induce inability to micturate. The
plexus hemorrhoidal is medius (and inferior) 3. Plexus vesicalis is emitted from the
corresponds to the plexus pudendalis on the pelvic brain to the bladder. The vesical
arteria pudenda. For further description of plexuses is of the powerful rich ganglionated the rectal nerve supply see tractus intestinplexuses or leashes of the pelvic brain. It is
alis. The nervous apparatus ventral lateral solidly and compactly anastomosed to the
and dorsal to the vagina, that supplying the plexus rectalis, but especially to the plexus
ureter, that coursing through the parametrium uterinus inducing the rectum, uterus and and perimetrium, that supplying the bladder, bladder to act clinically or symptomatically
rectum and ureter are solidly and compactly as one apparatus. For description see nerves anastomosed. They form an inseparable nerve of tractus urinarius.
plexus bedecked with ganglia of greater and 4. Plexus rectalis is emitted from the
lesser dimensions surrounding the cervico.
vaginal junction. The vast plexuses of the pelvic brain to the rectum as rich network
pelvic brain, rich in ganglia, extend from the of nerves bedecked with ganglia limited in number and dimension. The rectal plexus
cervico-vaginal junction distalward to the
pelvic floor surrounding with a luxuriant emitted by the pelvic brain is a fine plexiform
closely woven network, uterus and vagina leash of nerves which passes distalward on
(tractus genitalis), the rectum (distal tractus the lateral borders of the rectum intimately
intestinalis), the bladder and ureter (distal blending with the tissues of the rectal wall.
tractus urinarius). The rectum has not only a rich and complicated nerve supply, but it has a mixed nerve supply. The following table presents a general view of a rectal nerve supply:
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color and less translucent and assumes vari.
ous shapes, that of strands, bands and memW. T. KNOX, M. D.
Prof. von Noorden does not tbink it wrong MANCHESTER, ILL.
to assume that the loose glairy form of muAn inflammatory affection of the intestines cous constitutes the fresh product of the mu. characterized by a feeling of discomfort and cous membranes, whereas, the tough and solid pains in the abdomen with chill and fever, masses of mucous constitute older secretions and more or less movements some little time that were produced some time before the previous to the onset, and the frequent pas. evacuation occurred, and that were kept for sage of mucous of a ribbon-like character, of some time, no one knows how long-on the a grayish-wbite appearance and of a mem- surface of the mucosa, mucous attached this branous form.
way to the mucosa loses water by absorption, It occurs much more frequently in women and consequently becomes tougher in conthan in men. That the nervous element plays sistency, at the same time the pressure exera great factor in the origin of this trouble, we cised by the scy bala that pass over this mu. have no doubt. If neurasthenic patients be cous through the bowel luren moulds it into closely questioned, very few will be found bands, strands and membranes. That this who have not bad at some time the charac. actually occurs will readily be conceded by teristio passage of stringy mucous, associated any one who has had occasion to inspect with more or less abdominal pains; these ab. such mucous in autopsies on such cases. dominal sensations may be especially marked Rothmann and Hemmeter state that the some time after the ingestion of food; there mucous is very tightly adherent to the is almost constantly a feeling of tension or mucosa, and has in his possession a speci. of bloating in the abdomen, belching or the men in which the strands of mucous were passing of wind alleviates these symptoms. attached so tightly to the intestine that they Our experience is that patients greatly lose in could only be removed with difficulty with a Hesh and present an appearance of suffering pinchette. In typio cases no mucous what. -have fever, cold extremities and cold sweats, ever may be evacuated for long periods of nausea and anorexia constantly present, espec- time, and then at once large quantities of ially is this the case in those due to autoxi. mucous (10 to 100 grams) that is apparently cation from the bowel. There may be ten. old are passed at once, we may assume that derness all along the colon, occasionally the these old adherent masses of mucous are freed ascending colon can be felt as though a from their attachment by the mechanical aclarger round tumor contained therein of a tion of the bowel that is induced by the at. bard mass, this part of the colon is especially tack. tender. During the time, in particular, that The following case presents an instance of immediately preceded the development of the the above described condition, even more exdisease we find that the patients suffered for treme in degree. Mrs. H., aged 39 years, some weeks from obstinate constipation, and gives a history of having suffered with diar. they report that they noticed the passage of rhea eleven years ago; under treatment of al. mucaus together, with hard masses of feces most seven years ago by the writer, this trou. on several previous occasions, and some ble disappeared at that time, and patient entime before the disease proper developed, joyed good health, having gained much in and before they were prostrated. Painful weight, until the attack of a year ago. Pa. sensations in the abdomen could be made tient was apparently well until the middle of to disappear when the evacuation of the July, when she experienced pain and distenbowel contents was promoted artificially by sion of the bowels, with some diarrhea and the administration of castor oil, or by the soon followed with periods of obstinate con. use of enempata; these severe attacks of pain stipation, alternating with diarrhea, pass. can be explained by assuming stasis of fecal ages contained at various times large quan. material. There is either an evacuation of tity of mucous of the character described, mucous without pain, the mucous passing un. these passages were very offensive. Patient mixed with feces or the evacuation of the lost in weight during this attack of six mucous is accompanied by a feeling of extreme weeks twenty-five to thirty pounds, her distress in the abdomen and pain. In the strength greatly failed. The most trouble. former the mucous is usually very loose, more some feature in this attack was the intense of a jelly consistence, and resembles fish eggs, nausea and the weakness induced by them, and is translucent; while in the latter case her color was bad, almost that of an olivethe mucous is more solid, more of an amber green. Patient had another attack in August
of this year, her condition was much the * This paper was prepared for the annual meeting of the
same as that of a year ago, with the excep
Western Lilinois District Medical Society at Alton, Ill.
THOS. A. HOPKINS.
JOHN MCHALE DEAN, Surgery.
F. P. NORBURY. Nervous and Mental Diseases.
tion that the constipation was more severe, the ascending and transverse colon was espe. cially tender to the touch; a few hours preceding an evacuation of the bowel, especially Issued Tenth and Twenty-Fifth of Every Month. when the contraction of the bowel was such
Under the Editorial Direction of as to dislodge a large quantitig of mucous,
FRANK PARSONS NORBURY, patient would experience a sinking period
CARL E. BLACK. with intense pausea, cold extremites, cold
With the following staff of Department Editors sweats and subnormal temperature. I may 0. E. LADEMANN, Internal Medicine. say the cold sweats and cold extremities were present to some extent most of the time.
WALDEMAR FISCHER, Ophthalmology. One peculiar feature during this attack,
A. LEVY, Pediatrics. which was related by those in attendance as
W. T. HIRSCHI, Therapeutics.
A. F. KOETTER, Otology. nurse, that what appeared to them as large as
HERMAN STOLTE, Laryngology and Rhinology. a good sized orange was noticed to travel from
T. A. HOPKINS, Genito-Urinary Diseases.
ROBERT H. DAVIS, Dermatology. and across the transverse colon and disappear, to be soou followed by an evacuation of a large mass mostly mucous of the darker
EDITORIAL character described.
Patient suffered with “oramps of the stomach," especially during the convalescent per. At the meeting of the St. Louis Medical So. iod. She is affected also with multiple fib. ciety, December 230, 1905, Dr. Mary Mo. roid of the uterus, and this may bave added
Lean, in a paper, “Med. to the gravity of the case. During extreme
ical Observations in the
Observations in distention these tumors would beome prom.
Far East," discussed
the Far East. inent, and to apparently disappear so soon
conditions as she found as relieved by an evacuation of the bowel.
them in the several cit. Her temperature ranged from 97 to 103.3; ies of China and Japan in the order in which pulse ranged from 86 to 140. At only one sbe visited them. At Shanghai there are two time, early in the attack, did the temperature fourisbing hospitals, Dr. Boone's hospital reach the highest mark stated, 103.3.
for men and boys, and the Woman's Hospi. Treatment was supportive, narcotics, anti. tal. The Chinese bare contributed some septics, and meeting depressed conditions $65,000 to the support of Dr. Boone's hospi. with stimulants as indicated.
tal, and this physician never charges a fee, finding it pays better to trust to the liberal.
ity of his patients. The essayist concludes COMPOUND FRACTURE DISLOCATION OF THE that the Chinese character is on a much ULNA.-L. B. Henkel, Annapolis, Md.(Jour. more generous plan than the American. In A. M. A., Deo. 23), reports the case of a the Woman's Hospital tbere is a daily clinic workman who fell from a ladder a distance of of 100 to 300 women and girls. Some of the about fifteen feet, landing on the palm of his cases in this bospital are so desperate that in right hand, left wrist, knees and face. He this country early death could be safely pre. suffered a lacerated injury of his right band, dicted.' There they recover with but little requiring six sutures, contusions of the attention, owing to their power of reouperaknees and face and a dislocation of the ulna, tion. Dr. MoLean saw but little of the Chi. the free end being splintered and penetrating nese methods, but she did see a kit of surgi. the soft tissues and skin of the wrist so that cal instruments in Korea. These instruments the wound bad to be enlarged about three were merely a number of needles varying in inches to reduce the dislocation. This was size. The afflicted person is supposed to be done, the wound sutured and a plaster band. possessed of an evil spirit and one of these age applied with a window over the wound, needles is inserted into that part of the body which was dressed with 10 per cent iodo nearest the pain in the hope of releasing this form gauze after bichlorid irrigation. The evil spirit. Even the heart is sometimes plaster was removed in three weeks and pierced in this way. Dr. McLean referred anterior and posterior splints applied for ten to one case in which a piece of flesh from a days longer. The sutures were removed after woman's arm was cooked and given to her four weeks, the wound having bealed by third sick child. There is no such thing as sani. intention. After removal of the splints, tation among the Chinese. In illustration of massage and passive movenients were ero. this the doctor cited one instance that came ployed and the patient discharged at the end to her notice. In a little pond, the water of the seventh week with fairly good move. greenish-black, a woman was soaking her ment.
vegetables, a coolie near by was washing his
feet, while not far away a pig wallowed and a She found the Japanese surgeons skilful and woman was washing her clothes. The people painstaking and she stated, apparently in all are very poor, many of them, in the interior, sinoerity, that they were always good natured subsisting chiefly on grass seeds, roots and and did not even swear. pounded corn, rice being too costly for daily The discussion was opened by Dr. George food. These people believe obicken deadly Gellhorn who related some of his experiences to consumptives, also eggs, none of them during a visit to China several years ago. drink milk or eat butter, both being disgust. He also showed the society two Chinese texting to them.
books on gynecology. In Hang Chow, Dr. Main, of Sootland, Dr. Robert M. Funkhouser and Dr. Rob. has had charge of the medical work for ert Barclay, in connection with these peo. twenty-five years. An immense amount of ple's quiet endurance of pain, discussed the cbaritable work is done here and the several religion and philosophy of the orientals and institutions are almost entirely supported by the value of suggestion in its relation to sur. the Chinese. In the general hospital of 200 gery. beds every patient upon admission is re- The President, Dr. Henderson, agreed quired to have a thorough bath and change with Dr. MoLean that the Chinese must be of clothes, to keep out the vermin so plenti. more generous than the Americans. In proof ful in China. Dr. Main uses a ton of car of this be stated that but three patients had bolio soap in one year. In addition to this ever paid him more than the amount of his hospital he has one partly for men and bill; a German who could speak no English, partly for women, besides an institution for a Hebrew and a Chinapan. lepers, a school for leprous children and a The paper was further discussed by Drs. very fine tuberculosis sanitarium, for both Fleming, Goodloe, Stauffer and Hopkins. Chinese and mission workers.
In Kiu Kiang is a hospital conducted by a young Chinese woman, a graduate of an American university. She has trained her The annual banquet given by the Medical own assistants, and is conducting the institu. Sooiety of City Hospital Alumni at the betion most successfully in every particular.
ginning of each new ad. Dr. MoLean spoke very highly of the medical The Hospital ministration has come educational work being done in Pekin, where Society
to be recognized as one the representatives of the four denominations Banquet.
of the more important have united in the work. The hospitals here
social events of the seaare well equipped. Here, too, she saw the son in which medical men alone are in. Northern Chinese bed, or kang, a raised plat. terested. The banquet this year was given at form of cement and brick, with an opening the Washington Hotel on the evening of Janunderneath for a charcoal fire.
uary 4th, and was an occasion of more than Of the military hospitals in Japan, the usual pleasure to all in attendance. The essayist bad nothing but praise for everything president for 1905, Dr. John Green, Jr., preand everybody in connection with them, in. sided during the feast, and when cigars were cluding the patients. The Red Cross and lighted, in a inost felicitous address gave a Toyama hospitals each have a capacity of resume of the work accomplished during the about 7000. The wards are one-story, long year and work under way and introduced frame structures, with windows on eitber the president-elect, Dr. Louis H. Behrens. side, a ball running down the middle, with President Behrens spoke of the past and fu. a bath-room at each end. The soldiers were ture of the society, dwelling on its accomplishbountifully provided with good nourishing ments and the duties which lie before it and food, many receiving the richest sterilized for the future, the responsibility of each mem. milk in addition to their regular diet. In her to be a factor in the accomplishment of rethe diet kitchen everything was exceedingly forms and improvements which must be clean, and the milk sterilizing plant wonder. effected in St. Louis in the near future. fully complete. In the operating rooms the following Dr. Behrens, Dr. Geo. Gellhorn nursing was far superior to that seen in spoke on Medicine in Europe; Dr. M. G. St. Louis, there were never less than five Seelig, on Medicine in the East; Dr. Walter nurses in the room, each attending strictly B. Dorsett, on Medioine at Home, and the to her duty. In the surgical dressing rooms Old City Hospital; Health Commissioner often as many as twenty soldiers were being Snodgrass, on The New Pathologic Laboraattended to or waiting their turn, yet dur. tory of the City Hospital; Irvin V. Barth, ing the two months over which her observa Esq., on Quackery in Medicine; and Dr. tions extended, Dr. McLean never heard one Merrell and Superintendent Elbrecht (of the of them utter a complaint, not even a groan. Female Hospital) on unassigned subjects.