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the part of the practitioner to differentiate between the putrid intoxications, due to retained placental tissues, when the patient is in the least danger, the uterus is not softened and curettement is least dangerous, and the cases of streptococcic or staphylococcic infcetions when the curettement can do no possible good, and is fraught with the greatest danger to life. If this paper shall have caused more care in the differentiation, and less indiscriminate use of the curette in puerperal cases, it will have accomplished its purpose, and I am sure it will have saved lives.

THE NERVES OF THE GENITAL TRACT -NERVI TRACTUS GENITALIS — A. ANATOMY. B. PHYSIOLOGY.

BYRON ROBINSON,

CHICAGO.

A. ANATOMY.

THE origin of genital nerves are: I, nervus vasomotorius (sympathetic abdominal brain); II, spinal cord (medulla spinalis), through rami communicantes and rami nervorum sacralium (II, III, IV), cerebrum (vagi).

The three major nerve streams to the tractus genitalis are: (a) the plexus interiliacus (which is a continuation of the plexus aorticus) originating in the abdominal brain; (b) the plexus ovaricus originating from the whole plexus aorticus; (c) plexus sacralis spinalis (rami nervorum sacralium-II, III, IV). The minor nerve streams to the tractus genitalis are: (d) lateral lumbar ganglia (truncus nervus lumbales vasomotorius); (e) lateral pelvic ganglia (truncus nervus pelvis vasamotorius); (f) nerves of the uterine artery (nervi arteriae uterinae); (g) nerves of the hypogastric artery (nervi arteriae hypogastricae) richly demonstrated in infant cadavers. Also nerves of the round ligament and hemorrhoidal arteries.

Practically the nerves supplying the tractus genitalis are solidly and compactly anastomosed connected with the whole abdominal vasomotor nerves (sympathetic), especially with the giant ganglion coeiliacum -the abdominal brain-the great assembling center of the vasomotorius abdominale or sympathetic nerve plexus. The anastomosis or connection of the genital nerves to the nervus vasomotorius (sympathetic) and cerebro-spinal is vast and profound. The order of solidarity or compactness of anastomosis or profundity of connection of the vasomotor nerves (sympathetic) to the abdominal viscera

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is the following, viz.: (A) nervus vasomotorius to the tractus vascularis (blood and lymph vessels); (B) nervus vasomotorius to tractus intestinalis; (C) nervus vasomotorius to tractus gentialis; (D) nervus vasomotorius to tractus urinarius. However, all the abdominal viscera are solidly and compactly anas tomosed, connected to the central abdominal sympathetic or vasomotor nerve that no one visceral system can become disturbed, deranged, without affecting profoundly all other viscera systems. The derangement arises in 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 function-peristalsis, secretion, absorption sensation. So far as I am able to observe the reflexes or irritation in the tractus genitalis produces the most profound and vast derangement of function in other abdominal viscera of any single visceral system, e.g., irritation, disease in the tractus genitalis passes to the abdominal brain (over the plexus interiliacus and plexus aorticus) where it is reorganized and emitted to the tractus intestinalis or tractus urinarius deranging the common function of peristalsis (rhythm), secretion sensation and absorption-causing deficient, excessive or disproportionate peristalsis, secretion or absorption. The older anatomists like the philosophic Willis (16221675) who was the Sedlian professor in Cambridge talked that the nerves supplying the tractus genitalis arose from the intercostal nerves (that is by means of the rami communicantes, truncus vasomotorius- lateral ganglionic chain and nervi splanchnici). This is as true today as in the days of the ever memorable Willis, however, we ascribed today more to independent, more differentiation to the vasomotor nerves (sympathetic) than did Willis. These so-called intercostal nerves (rami communicantes) form a nervous center-the abdominal brain-secondarily to the cranial brain which has differentiated functions of the first magnitude as regards existence of life itself. Hence, today we are inclined to believe from experimentation and clinical data that the chief origin of the nerves of the tractus genitalis is the abdominal brain-cerebrum abdominale and since this giant ganglion controls the vascular supply of the abdominal viscera it should be termed cerebrum vasculare abdominale. the consideration of the nerve supply of the tractus genitalis is favorable for convenience of description and practical purposes to present a major and minor nerve stream. The following table presents in a bird's-eye view the major and minor nerve supply to the genital 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 arteriae uterinae).

G. Nerves of the hypogastric artery (nervi arteriae hypogastricae).

H. Nerves of the round ligament artery (nervi arteriae ligamenti rotundi).

I. Nerves of the hemorrhoidal artery superior et medius (nervi arteriae hemorrhoidalis superior et medius).

The major nerve supply consists of (A) plexus ovaricus; (B) plexus interiliacus (vasomotorius); (C) plexus sacralis spinalis rami nervorum sacralium (II, III, IV).

(A) PLEXUS OVARICUS.

Origin.-According to my dissection the main origin of the ovarian nerves is from the ganglion ovaricum proximal, a definite ganglion of irregular form and dimension located at the origin of the arteria ovarica on the aorta. However, the plexus ovaricus arises also from the adjacent regions in the plexus aorticus both proximal and distal to the ovarian ganglion especially it may be noted that the renal ganglia contribute ovarian nerves. Frankenhauser (1867) in one of his tables marks the origin of the ovarian nerves extending from the root of the arteria renalis to the interiliac nerve disc located on the sacral He notes the ovarian nerve promontory. composed at the origin of some twelve separate strands, and as they pass distalward on the vasaovarica coalesce into three main trunks, studded with ganglia. In dissecting it will be observed that the ganglia renalia and ganglia ovarica are closely associated in a solidly, fenestrated, network indicating identical origin from the Wolffian body. I could not discover such an abundant ovarian nerve supply neither from such an extensive area of the plexus aorticus, as reported by Frankenhauser. However, the explanation may lie in the fact that Frankenhauser dissections were from non-pregnant and infant genitals. The sections disclosed large numbers of nerve fibres originating in various regions from the plexus aorticus, especially the ganglia renalia and ganglia ovarica proximal and directing themselves toward the vasaovarica coalesce into some three nerve trunks. ovarian nerves coerce with the ovarian vessels forming an elongated wide network studded with nerve ganglia limited in number and dimension and located at the crossing, junction of the nerve strands.

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The ovarian nerves arise from the ganglion ovaricum proximal in the form of a plexus or a leash which accompanies and ensheaths the arteria ovarica to the union with the vena ovarica where both vein and artery share more equally the attention of the ovarian nerves. The plexus ovaricus in general arises from

the following ganglia, viz.: (a) ganglion ovaricum (proximal); (b) ganglia renalia; (c) ganglion mesentericum inferior; (d) gan. glia lumbalis. The above ganglia are solidly and compactly connected with the ganglion coeliacum.

(Note. It should be remembered that the numerous pains of which woman complains as being in the ovaries are not located in the ovaries, but reside in the cutaneous distribution of the ileo-inguinal and ileo-hypogastric nerves. It is hyperesthesia of the skin.)

The plexus ovaricus arises from the following plexuses: (a) plexus aorticus; (b) plexus renalis; (c) plexus mesentericus superior; (d) plexus mesentericus inferior; (e) plexus ureteris (where the vasa ovarica cross ventral to the ureter the plexus ovaricus become anastomosed with the plexus ureteris, further solidly anastomosing the plexus ovaricus with the plexus renalis); (f) plexus interiliacus; (g) the plexus ovarious receives branches form the genito-crural nerve, again solidly anastomosing the plexus lumbalis (spinal) with the plexus ovaricus (sympathetic).

Course. The plexus ovaricus accompanies the vasa ovarica in their extended journey to the pelvis in erect animals in the form of sheathed network of nerves with extremely elongated fenestra. The plexus ovaricus in its course is studied with spare ganglia of various size. The nerves of the plexus, like many other sympathetic plexuses, are cylindricalnot flat like those of the plexus uterinusand retain their calibre throughout their course. Toward the distal end of the vasa ovarica the vein and artery become more branched, occupying more space whence the plexus ovarious divides its branches to acThe distal company the additional vessels.

end of the plexus ovarious divides and supplies: (a) the ovary; (b) the oviduct; (c) ligamentum latum; (d) the lateral border of the uterus; (e) it anastomoses with branches of the plexus interiliacus.

(B). PLEXUS INTERILIACUS (VASOMOTORIUS.)

The interiliac plexus extends from the interiliac nerve disc to its union with the sacral nerves of the cervico-vaginal junction. It is the major nerve supply of the genitals. It is elsewhere described in detail.

(0). PLEXUS SACRALIS SPINALIS (RAMI NERVORUM SACRALIUM).

The second, third and fourth sacral, spinal nerves emit branches (pelvic splanchnics) which join, coalesce, with the distal branches of the interiliac plexus to form the pelvic brain (ganglion cervicale-which issues the white rami communicantes) practically the

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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 passing through the pelvic brain. The branches of the sacral nerve passing to the pelvic brain, very in number, origin, arrangement, length and dimension." They are the most accurately demonstrated in infant cadavers preserved in alcohol. The blending or coalescence of the branches of the sacral nerves (pelvic splanchnics) (i to iv) with the distal branches of the plexus interiliacus (vasomo

nerves to the plexus aorticus and plexus interliacus.

(E) The lateral pelvic trunk ganglia send nerves to the genitals by way of the pelvic brain. It sends nerves to the distal ureter.

(F) The nerves accompanying the internal iliac artery continue their course over the arteria uterina as the nervi arteriae uterinae.

(G) The nerves of the hypogastric artery (nervi arteriae hyposagtricae) carries larger

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