numbers of nerves to the genitals in the infant. It also emits branches to the ureter and bladder. With atrophy of the hypogastric artery many nerves fade with the artery.

(H) Nerves of the round ligament artery (nervi arteriea ligamenti rotundi) pass from the external common iliac artery to join with the plexus ovaricus and plexus uterinus.

(I) Nerves of the hemorrhoidal artery superior and medial (nervi arteriae hemorrhoidalis superior et medius) emit nerves to the genitals. It will be observed that the major and minor nerve supply of the genitals is so extensive, so solidly and compactly anastomosed that severing the genital nerves for experimentation is incompatible with life, and consequently reports of such experiments are of limited value only.

THE PLEXUSES OF THE PELVIC BRAIN.

The pelvic brain practically emits the nerves to the pelvic viscera, but especially the plexuses of the genital tract. The table represents the scheme

Plexuses of the Pelvic Brain.-1. Plexus uterinus. 2. Plexus vaginalis. 3. Plexus vesicalis. 4. Plexus rectalis.

1. The plexus uterinus is emitted to the uterus from the pelvic brain. In infant cadavers I have counted as many as eight different strands of nerves passing from the pelvic brain to the uterus. In the infant cadavers one can observe several nerves passing from the pelvic brain over the external border of the ureter to penetrate finally the myometrium. The first proposition to assert is that the uterus is practically supplied by two plexuses, viz.: (a), the plexus interiliacus (hypogastricus) sends one (two or three) branches directly to the uterus without first entering the pelvic brain; (b) the plexus uterinus which passes directly from the pelvic brain to the uterus where it anastomoses with the branches of the plexus interiliacus. Hence the uterus is supplied by branches of the plexus interiliacus directly from the abdom. inal brain and the plexus uterinus directly from the pelvic brain leaving the abdominal brain as the chief ruling potentate of the abdominal viscera, while the pelvic brain is a subordinate, local, ruler of the pelvic viscera. The plexus uterinus accompanies the uterine vessels in general only-not in particular like the intimate relation of the plexuses of the abdominal brain to its visceral vessels. The

plexus uterinus presents large, strong branches to the cervix uteri which is unusually rich in nerve supply. The order of richness of nerve supply to the uterus is (a) cervix, luxuriant; (b) corpus, rich; (c) fundus uteri, abundant. The form of the nerve s up

ply to the uterus imitates it-fan-shaped. In the illustrations of the nerves of the uterus what is presented is the main superficial branches of the plexus interiliacus and plexus uterinus which accompany the major uterine arteries the most intimately along the lateral uterine borders (see figure 3).

The branches from the plexus interiliacus (one to three) is distributed on the dorsal wall of the crevix becoming distributed on the dorso-lateral border of the fundus uteri, where they anastomose with the branches of the plexus ovaricus at the junction of the uterus and oviduct, where is located (especially marked in infants) a ganglion. The dorsal surface of the fundus also receives numerous branches from the branches of the plexus interiliacus. Finally the branches directly from the plexus interiliacus (which is directly from the abdominal brain through the plexus aorticus) supply strong, large nerves which are richly distributed to the cervix, corpus, fundus and oviduct. They anastomose solidly and compactly with the plexus ovaricus and plexus uterinus from the pelvic brain. The plexus uterinus-major nerve supply to the uterus-originates in the pelvic brain. The plexus uterinus like the plexus interiliacus approaches the uterus from the neck and lateral border. This leash of ganglionated uterine nerves from the cervicouterine ganglion in contradistinction to the branches of the plexus interiliacus, supplies the ventro-lateral border of the uterus, and courses more intimately in relation with the uterine segment of the utero-ovarian artery. Many of the large nerves of this plexus are superficial simulating the superficial position of the artery. As the branches of the plexus interiliacus (direct from the abdominal brain) richly supply the dorsal surface of the surface, ccrpus and fundus uteri so that the plexus uterinus (directly from the pelvic brain) luxuriantly supplies the ventral surface of the cervix, corpus and fundus uteri. Branches from the vesical ganglia pass to the plexus uterinus, thus aiding to make the uterus and bladder act clinically as one organ. The solidly anastomosed plexuses of the uterine nerves continually increasing their area of distribution and their number of multiplying peripheral branches as they proceed toward the fundus, finally sends branches to anastomose with the plexus ovaricus, especially at the oviductal junction, where lies a on appears to be the nerve center from which marked ganglion. This utero-oviductal gangliradiate nerves to the fundus uteri and distal oviduct as well as to the muscular plates lying in the ligamentum latum. The entire uterus is surrounded and traversed by a closely woven network of ganglionated nerve

40.

of nerves which surround the vagina like a network of cords surrounding a rubber ball. The vaginal nerve plexus and vaginal vein plexus both rich, complicated and abundant intertwine and interweave with each other. The rich vaginal plexus is bedecked with numerous ganglia at the points of nerve convergence. The meshes of the vaginal plexus, being occupied by fatty tissue, connective tissue, lymph and blood vessels, its dissection Infant cais accompanied with difficulty. davers should be chosen to facilitate correct exposure of the finer constituents of the vaginal plexus. As the bladder is supplied by a large branch from the third sacral nerve, so the vagina is supplied from a large branch. of the fourth sacral nerves. The ganglionated nerve cords from the pelvic brain surround the vagina like a mighty network, ventrally and dorsally. The vaginal plexus also emits many large nerves to the rectum and bladder. The ventral vaginal nerve leashes course proximal ward and distalward. The larger ganglia of the vaginal leash or plexus occur at the proximal ventral vaginal fornix, while on the distal ventral end of the vagina the ganglia are numerous, but more limited in dimensions. The ganglia of the dorsal vaginal wall is limited in number. The entire vagina is completely surrounded by a closely woven ganglionated nerve network. These peri-vaginal and para-vaginal plexuses stand in intimate relation with the pelvic

brain.

Toward the central longitudinal axis of the uterus and vagina the genital plexuses diminish, simulating exactly the genital blood and lymph supply.

3. Plexus vesicalis is emitted from the The vesical pelvic brain to the bladder. plexuses is of the powerful rich ganglionated plexuses or leashes of the pelvic brain. It is solidly and compactly anastomosed to the plexus rectalis, but especially to the plexus uterinus inducing the rectum, uterus and bladder to act clinically or symptomatically as one apparatus. For description see nerves of tractus urinarius.

cus.

The three great hemorrhoidal plexuses arriving at the rectum via the three hemor rhoidal arteries invest it with a network of A rich leash of nerves rich nerve plexuses. passes to the rectum from the plexus interiliaPart of the branches of the plexus pass proximalward on the rectum to anastomose with the plexus hemorrhoidalis inferior (from the inferior mesenteric plexus) while part passes distalward on the rectum penetrating its coats. Some of the branches of the hemorrhoidal plexus supply the bladder and genitals. From this anatomic distribution of the hemorrhoidal plexus-to genitals, rectum and bladder is obvious that the genitals, rectum and bladder are solidly and compactly anasClinical work demonstrates this tomosed. balanced union of organs in the pelvis through nerve connection, as rectal or genital operations will induce inability to micturate. The plexus hemorrhoidal is medius (and inferior) corresponds to the plexus pudendalis on the arteria pudenda. For further description of the rectal nerve supply see tractus intestinalis. The nervous apparatus ventral lateral and dorsal to the vagina, that supplying the ureter, that coursing through the parametrium and perimetrium, that supplying the bladder, rectum and ureter are solidly and compactly anastomosed. They form an inseparable nerve plexus bedecked with ganglia of greater and lesser dimensions surrounding the cervicovaginal junction. The vast plexuses of the pelvic brain, rich in ganglia, extend from the cervico-vaginal junction distalward to the pelvic floor surrounding with a luxuriant closely woven network, uterus and vagina (tractus genitalis), the rectum (distal tractus intestinalis), the bladder and ureter (distal tractus urinarius).

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MUCO-COLITIS.*

W. T. KNOX, M. D.

MANCHESTER, ILL.

AN inflammatory affection of the intestines characterized by a feeling of discomfort and pains in the abdomen with chill and fever, and more or less movements some little time previous to the onset, and the frequent pas sage of mucous of a ribbon-like character, of a grayish-white appearance and of a membranous form.

It occurs much more frequently in women than in men. That the nervous element plays a great factor in the origin of this trouble, we have no doubt. If neurasthenic patients be closely questioned, very few will be found who have not had at some time the characteristic passage of stringy mucous, associated with more or less abdominal pains; these abdominal sensations may be especially marked some time after the ingestion of food; there is almost constantly a feeling of tension or of bloating in the abdomen, belching or the passing of wind alleviates these symptoms. Our experience is that patients greatly lose in flesh and present an appearance of suffering -have fever, cold extremities and cold sweats, nausea and anorexia constantly present, especially is this the case in those due to autoxication from the bowel. There may be tenderness all along the colon, occasionally the ascending colon can be felt as though a larger round tumor contained therein of a hard mass, this part of the colon is especially tender. During the time, in particular, that immediately preceded the development of the disease we find that the patients suffered for some weeks from obstinate constipation, and they report that they noticed the passage of mucaus together, with hard masses of feces on several previous occasions, and some time before the disease proper developed, and before they were prostrated. Painful sensations in the abdomen could be made to disappear when the evacuation of the bowel contents was promoted artificially by the administration of castor oil, or by the use of enemata; these severe attacks of pain can be explained by assuming stasis of fecal material. There is either an evacuation of mucous without pain, the mucous passing unmixed with feces or the evacuation of the mucous is accompanied by a feeling of extreme distress in the abdomen and pain. In the former the mucous is usually very loose, more of a jelly consistence, and resembles fish eggs, and is translucent; while in the latter case the mucous is more solid, more of an amber

This paper was prepared for the annual meeting of the Western Illinois District Medical Society at Alton, Ill.

color and less translucent and assumes various shapes, that of strands, bands and membranous structures.

Prof. von Noorden does not think it wrong to assume that the loose glairy form of mucous constitutes the fresh product of the mucous membranes, whereas, the tough and solid masses of mucous constitute older secretions that were produced some time before the evacuation occurred, and that were kept for some time, no one knows how long-on the surface of the mucosa, mucous attached this way to the mucosa loses water by absorption, and consequently becomes tougher in consistency, at the same time the pressure exercised by the scy bala that pass over this mucous through the bowel lumen moulds it into bands, strands and membranes. That this actually occurs will readily be conceded by any one who has had occasion to inspect such mucous in autopsies on such cases. Rothmann and Hemmeter state that the mucous is very tightly adherent to the mucosa, and has in his possession a specimen in which the strands of mucous were attached so tightly to the intestine that they could only be removed with difficulty with a pinchette. In typic cases no mucous whatever may be evacuated for long periods of time, and then at once large quantities of mucous (10 to 100 grams) that is apparently old are passed at once, we may assume that these old adherent masses of mucous are freed from their attachment by the mechanical action of the bowel that is induced by the attack.

Pa

The following case presents an instance of the above described condition, even more extreme in degree. Mrs. H., aged 39 years, gives a history of having suffered with diarrhea eleven years ago; under treatment of almost seven years ago by the writer, this trouble disappeared at that time, and patient enjoyed good health, having gained much in weight, until the attack of a year ago. tient was apparently well until the middle of July, when she experienced pain and distension of the bowels, with some diarrhea and soon followed with periods of obstinate constipation, alternating with diarrhea, passages contained at various times large quantity of mucous of the character described, these passages were very offensive. Patient lost in weight during this attack of six weeks twenty-five to thirty pounds, her strength greatly failed. The most troublesome feature in this attack was the intense nausea and the weakness induced by them, her color was bad, almost that of an olivegreen. Patient had another attack in August of this year, her condition was much the same as that of a year ago, with the excep