REPRINTED FROM 
^be Haitian anb Surgeon, 
DETROIT, MICHIGAN. 
THE SYMPATHETIC NERVOUS SYSTEM. 
By W. F. METCALF, M. D., Detroit, Michigan. 
I have some cases to report, but before doing so, with your permission I wish 
to present the picture wre have to-day of the Sympathetic System. 
Two cords, one on each side of the spinal column, containing at intervals 
ganglia, which receive branches from both anterior and posterior roots of 
the spinal cord, and are connected with the cranial nerves. These cords connect 
plexuses, which lie along the spinal column, similar plexuses being continued to 
accompany the vascular trunks becoming smaller and smaller, until the periph- 
ery being reached they are microscopic. Small ganglia are found at the decus- 
sation of the fibres in these plexuses. 
By the newer methods of examination, there are found in the plexuses of the 
intestines, the walls of the arteries, and in the stroma of glandular organs, small 
cells giving off processes that ramify again and again, and end by free extremi- 
ties among the muscular and epithelial elements, each cell always giving off a 
long process which enters into the formation of the interganglionic cord. These 
cells apparently resemble in character those which collect impressions from the 
retinal rods and cones, and from the mucous membrane of the auditory 
passage. 
Now, leaving this picture of the sympathetic system as a whole, let me call 
your attention to some of its parts. 
(1) Continuations of the cervical plexus accompany the vessels which enter 
the cranium. 
(2) There are fibres arising from each of the cervical ganglia, and some- 
times one from the first thoracic ganglion, uniting with branches of the pneu- 
mogastric and extending to form an intricate plexus around the base of the 
heart, and under the arch of the aorta. From this plexus fibres pass along the 
coronary arteries, the descending aorta, and to the pulmonary arteries, uniting 
with the pulmonary plexus. Many microscopic ganglia are found on the fibres 
which pierce the heart muscle, and are apparently the controlling agency in its 
action, which explains the heart's pulsating after being removed from the body. 
(3) The greater splanchnic is formed by branches derived from the sixth, 
seventh, eighth, and ninth thoracic ganglia, the lesser splanchnic from the 
tenth, eleventh, and twelfth thoracic ganglia. The root from the twelfth is some- 
times independent, and is known as the renal splanchnic. Occasionally a 
splanchnic is formed from the first thoracic, or from the cardiac plexus. From 
this irregularity in formation we may infer irregularity in distribution, which 
may explain some clinical phenomena. 
These splanchnics pass through the diaphragm and join the largest plexus of 
the system, the solar plexus or the abdominal brain, containing the largest 
ganglia. Off-shoots from this plexus accompany the vessels which supply the 
abdominal viscera. 2 
One of the terminal plexuses of this division lies between the muscular lay- 
ers of the intestines and of the stomach, the plexus myentericus externus, which 
probably controls peristalsis. In the submucosum is found the plexus myen- 
tericus internus, which controls the calibre of the small vessels, and the muscular 
fibres of the mucous membrane, and therefore controls secretion. 
The solar plexus being continued downward along the abdominal aorta is 
over the last lumbar vertebra, known as the hypogastric plexus, and over the 
sacrum as the inferior hypogastric plexus, which is extended along the internal 
iliac artery. 
These lower plexuses abound in minute ganglia, and are intimately con- 
nected with the genito-urinary organs and rectum, an off-shoot from the inferior 
accompanying the uterine and vaginal vessels. 
At the fundus of the vagina surrounding the cervix uteri a ganglionic mass is 
found. From this is derived all the nerves which supply the lower portion of 
the uterus. They form plexuses within its mass between its muscular layers 
but no ganglia are found there. 
When a sympathetic nerve is cut, the vessels to which it conveys tone-the 
life force-dilate, when the peripheral end is stimulated the vessels which it 
supplies contract. 
I wish you to concede to me, gentlemen, that there is only one force in the 
universe, and the privilege to call your attention to a theory, thinking that by the 
efforts to prove it untrue, we may arrive at a simple method of translating vari- 
ous pathological phenomena. I act upon this theory because it pays. 
There is a force, known only by its effects, which as manifested in the hold- 
ing of material things in relation to common centers, is called gravity; in main- 
taining the animal or vegetable creation, is called life; in man's relating himself 
to his fellow, and to his environment, is known as mind; as it travels along the 
wire, manifesting itself when it meets resistance, we call it electricity. 
In this paper I am dealing only with that phase of the force called life, 
which passes along the fibres of the sympathetic system in the human body, and 
which governs the caliber of the arteries, the action of the heart and lungs, and 
excretion of the waste products. This force manifests itself in the individual 
first when the spermatozoon comes in contact with the ovum, in sequentation, 
differentiation and development. It governs all the organic functions until dis- 
solution or death. We would be unconscious of the presence of electricity in 
the wire were it not for some resistance to, or break in, the circuit. Man would 
have a feeling of physical well-being, all his parts would work in harmony, were 
there no irritation to his sympathetic system, over which the force, life, flows. 
Health is a condition of equilibrium of the force functioning as life, and as 
mind, and of the two related. Disease is a disturbance of this equilibrium. 
This thought is the logical outgrowth of the idea of the physical organism, 
which, as other organisms, must have a law governing it. To give credit to all 
those who have developed the different phases which made possible the observ- 
ance of this law would require a volume, and we will leave that to the historian. 
Disturbances to the mind may cause it to leave its natural channels and pass 
into and disturb the sympathetic centers, or disturbances to the force, life, may 
cause it to pass out of its natural paths to enter and disturb the cerebro-spinal 
centres, and therefore the function or movement of the mind. 3 
Thus, we have tears produced by an emotion, or by a cinder in the eye. We 
find perspiration produced by mental exertion, or by the passing of a catheter 
into a sensitive urethra. 
We may thus explain the failure of a remedy to cure a diarrhea or a dyspep- 
sia in cases subjected to commercial disaster, disappointment in love, or unfor- 
tunate domestic relations. 
The pathway of the mind is the cerebro-spinal nerve. Its central office the 
brain, which controls every action. There cannot be diseases of the mind, any 
more than there can be diseases of life, light, gravity, electricity, affinity, love, 
but this force in any of its functions may be disturbed by a defect in its circuit. 
The pathway of life is the sympathetic nerve fibre, its central office the solar 
plexus. A cerebro-spinal system is not essential to organic life, and depends 
directly upon the sympathetic for its nutrition. In man the cerebro-spinal sys- 
tem has to do with the procuring of food, but the sympathetic takes care of it 
after it enters the esophagus. 
Afferent sympathetic fibres convey from the different tissues to the sympa- 
thetic centres intelligence of their condition ; the efferent fibres control the 
calibre of their blood-vessels, and therefore their nutrition. Messages from many 
or all of the tissues demanding nourishment overflow the sympathetic centres 
into the cerebro-spinal and are recorded in the cerebrum as hunger, a condition 
which the cerebro-spinal seeks to remedy. 
If colloid degeneration or miliary sclerosis or other pathological changes in 
the cerebrum produce primary dementia, why may we not, in a case of a patholog- 
ical solar plexus, have insanity of action in the organs of the human body, 
controlled by this force, life? If we have rupture of blood-vessels in the cere- 
brum under circumstances of great excitement, when the brain is most active in 
receiving messages, and making great effort to order and transmit them, why 
may we not find apoplexy of the abdominal brain, when messages are overflow- 
ing it, especially when it has already been over-worked for months. 
To report cases relating to the preceding facts and deductions would require 
more time than is allowed me. I therefore shall report but one case and a few 
others, which tend to prove its translation. 
Case I.-Mrs. H., aged thirty-nine years, came to my office November 14, 
1893, complaining of pruritus vulvse. Her pulse was rapid and complexion 
sallow. She said that she frequently suffered from headache. 
Examination showed irritated labia, also a tumor of the anterior uterine 
wall. I ordered hot antiseptic douches and told her to return in a few days. I 
was called to see her December 1, found her having intense pain in the pelvis, 
the uterus with its tumor being fixed between and pressing upon the pubes and 
sacrum, the tumor having increased markedly in size since the first examina- 
tion, two weeks previously. I advised consultation with a view to operation. 
She was removed to the Woman's Hospital, where on December 7, Doctor Long- 
year removed the uterus with a soft myoma in its anterior wall. After the 
abdomen was opened, and the organ lifted from the pelvis, incision was made 
across at the upper part of the cervix uteri, the sutures in the stump serving as 
ligatures to the vessels. A drainage tube was passed through the vaginal vault, 
in the posterior cul-de-sac, and the abdominal wound closed. The operation 
was expeditiously, neatly and well done. 4 
Under chloroform the pulse improved. A few hours after the operation a 
pain shot across the upper part of the abdomen, indicating the receipt of a mes- 
sage in the plexus myentericus externus, causing contraction. In a few hours 
the pain ceased and tympanitis began in the upper part of the abdomen, indi- 
cating the absence of tone or life-force, due to paralyses of the terminal ganglia. 
The tongue became dry and heavily coated with a deposit of bile-pigment, per- 
haps owing to the ganglia of the liver failing to coordinate the messages which 
were rushing in upon them. Vomiting or contraction of the muscular stomach 
walls caused by stimuli reaching the ganglia between its coats, was an early 
symptom. At first the vomitus was simply mucus, then either because of the 
current overpowering the ganglia in the submucosum or because of the incompe- 
tent solar plexus, the vessels in the stomach lining became dilated, red blood 
corpuscles exuded through their paralyzed wall, and the vomitus became black. 
Irritating enemata caused the passage of some gas and fecal matter, yet the 
upper part of the abdomen remained distended. The passage of the stomach 
tube showed that the gas was not in the stomach. Post-mortem showed it to 
be in the transverse colon. The substances injected influenced only the local 
ganglia, the abdominal brain having apparently lost the power of being influenced. 
There was therefore contraction only of the coats of the descending colon. 
Hypodermic injections of digitalin and nitro-glycerine had little or no effect 
upon the heart's action, tending to show that the centres had no communica- 
tion with the peripheral stations. There was slight elevation of temperature. 
We suspected peritonitis. She died about fifty-four hours after the operation. 
Autopsy showed no peritonitis, no sepsis, stump appeared healthy. There had 
been no hemorrhage, but we found an ecchymotic condition of the solar plexus. 
Circumstances would not permit the examination of the other plexuses. 
What would be the rational treatment of such a condition? Perhaps all efforts 
would have been futile. It may have been a fatal apoplexy, but until autopsy 
reveals the fact we cannot know but that it is simply a temporary functional dis- 
turbance. It may be that we should go to the station where the confusing mes- 
sages are being started, to prevent their being sent. It may be necessary to cut 
this station off from the general system. But in this particular case where did 
the murderous irritation originate? I have already referred to the mass of 
ganglionic tissues surrounding the upper part of the cervix uteri. Through 
this tissue the ligatures were passed. Perhaps this ganglionic mass should have 
been dissected out, or perhaps when untoward symptoms appeared, the stitches 
should have been cut. But this proposed treatment is apparently founded upon 
a supposition. Permit me to report other cases tending to show this, the source 
of irritation. 
Case II.-January 27,1891,1 operated upon Mrs. A., aged thirty-seven years, 
for epithelioma of the uterus, removing the organ with its appendages per vaginam, 
using twisted silk as ligatures, and doubtless constricting some of this tissue in 
question. There was no hemorrhage, no symptoms of peritonitis, kidneys and 
bowels acted naturally, highest temperature 99.5, no chills. The heart suddenly 
failed on the fifth day. Stimulants hypodermically had apparently no effect 
upon its action. No autopsy was permitted. 
Case III.-In operation for lacerated cervix, January 1, 1891, the cicatrix 
on the side extended downward from the internal os, and outward to the vaginal 5 
attachment. The stitch which approximated the tissues, after the cicatricial 
mass was dissected out, caused constant pain in the back, and rapid pulse until 
it was removed on the seventh day. 
Case IV.-Mrs. S., June 16, 1891. Vaginal hysterectomy for cancer of the 
uterus. Used clamps. There followed moderate fever, some tympanitis and 
rapid heart action. I applied the.cold water-coil to the abdomen. On the fifth 
day after operation when all the symptoms were favorable she suddenly col- 
lapsed, pulse at the wrist disappeared and the respiration became labored. I 
ordered hot water-coil over the solar plexus and digitalin, strychnine, and small 
doses of morphine, hypodermically. She recovered after a tedious illness. 
Case V.-Mrs. B., about September 15, 1893. Vaginal hysterectomy, at the 
Detroit Sanitarium. 1 wish to report this case more fully as it presents a point 
of special interest. 
About a year previous to this operation she had an ovarian tumor removed. 
The other ovary and tube were so bound down by inflammatory adhesions, that 
the operator did not think it wise to attempt its removal, since the operation had 
already been a tedious one. Following this operation the pain in her head and 
back and across her abdomen continued; her malnutrition was marked. I 
found the endometrium degenerated and the cervix presenting the appearance of 
epithelioma. Guided by the fact that one ovary was gone, and the other was 
probably useless, I decided to remove the uterus. I did so without ligating a 
single vessel by dissecting beneath its areolar covering. I then endeavored to 
remove the remaining ovary, but it was fixed so high and the pelvis was so 
narrow that I failed. No clamps, forceps, or ligatures were used. The patient 
had no shock, pain, fever, nor increase in pulse-rate, and was taken home six 
days after the operation, where she was kept in bed ten days. That inflamed 
ovary is still in the abdomen, yet she says she is perfectly well. She had been 
constipated for fifteen years. Her bowels now move regularly. Nothing was 
done to the rectum. I burned the pathological part, the physiological is here. 
I will have her brought in that you may see a picture of good health. She has 
gained twenty-one pounds since the operation. She is apparently as feminine 
and shows as much affection for her people and for children as she did when 
she had pelvic organs. I attributed success in this case to the fact that no 
nerve tissue was ligated. 
In contrast to this case, let me report briefly: 
Case VI.-Mrs. M., at Sanitarium, November 9, 1893. I endeavored to 
remove uterus by same method as in Case V. The uterus being large and very 
vascular, the dissection was tedious, as it was difficult to follow the surface of 
the uterine tissue. I entered the abdomen anteriorly and posteriorly and dis- 
sected up along the sides about four inches. Upon passing my hand into the 
abdomen posteriorly, I found very strong adhesions about two inches long, 
binding the fundus uteri to the promontory and crest of the sacrum, subinvolu- 
tion being marked. These bands were formed after the removal, last March, of 
large abscesses, the pus of which lay in contact with both sides of the organ. I 
thought it unwise to dissect further, and therefore amputated the organ at the 
upper part of its cavity. While dissecting, I had accidentally opened the uter- 
ine artery on each side, and left a pair of forceps on each. 
About twenty-four hours after the operation, the nurse telephoned that the 6 
patient's pulse was 160, and temperature 103.8. As soon as possible I put her 
upon the table and removed the forceps, which were locked upon some of the 
tissues in question, douched in large quantities of hot water, gave digitalin 
hypodermically, and whisky per stomach, returned her to bed, and placed the 
hot water-coil over the solar plexus. In five hours her temperature was 102.6, 
and pulse 150. Twenty-four hours later temperature was the same and pulse 
126. Five days later temperature was 101, pulse 110. During the next week the 
pulse and temperature became normal. There .were no sysptoms of peritonitis 
or sepsis at any time. While dressing the wound I found when I touched the 
tissue which had covered the upper part of the cervix, the patient would invari- 
ably complain of violent pain in the back. 
Case VII.-Mrs. L. I removed the uterus, ovaries and tubes February 2, 
1894, per vaginam. No ligatures, forceps or clamps were used. Highest tem- 
perature, 99.6; lowest, 97.3. Highest pulse-rate, 128; lowest, 72 (pulse-rate 
during the week preceding operation, 100-126). Patient sat up at end of first 
week, and left the Sanitarium on February 15. It is now one month since 
operation. I will have her brought that you may see that she is well. 
With limited opportunities for observation, I cannot hope to establish any 
fact, but I wish to elicit a general discussion of the subject. 
The point at which the irritation originates may be in the stomach, the 
colon, in the bronchial mucous membrane explaining the profuse sweating and 
diarrhea of lobular pheumonia, explaining the extreme exhaustion following the 
grippe, in which case the irritating impulses may start from the whole mucous 
surface, overflowing the sympathetic ganglia into the cerebro-spinal centres. It 
may temporarily throw out of function the sympathetic centres, causing profuse 
outbursts of perspiration and in some cases complete prostration, or collapse. 
In short the irritation may originate in any part of the body, or in its environ- 
ment, in the mind or in the social conditions which are a part of the mind. 
The first effect of the transmission of messages from a pathological tissue 
to a distant tissue, is a constriction of the capillaries in that distant tissue fol- 
lowed by their dilatation, and hence congestion results, thus in mumps when 
the irritation is transferred from the salivary glands, to the testicles, we have 
swelling of the testicles with usually a subsidence of the swelling in the neck. 
When the swelling disappears suddenly from the neck, we find a profound gen- 
eral disturbance of the system sometimes collapse from the irritation passing 
to the peripheral ganglia everywhere. As the central ganglia in a measure get 
them under control, they pass out to the glandular tissue and swelling begins 
in the testicles or mammae, and the general symptoms disappear. 
It may be that the condition of the nutrition of a tissue determines the lodge- 
ment of these reflected irritations. Thus, the symptoms of a chronic arthritis 
subside with the onset of acute bronchitis. 
One of the results of sympathetic irritation is mal-nutrition. It may be of 
the whole body, or of a part of the body distant from the point of irritation. 
Thus an ovarian tumor may cause an eczema of the nose. A nasal polypus 
or an internal hemorrhoid may produce asthma. Endometritis may produce 
cold hands and cold feet. 
Various insects are found in illy nourished plants, varying in kind according 
to the tissue upon which they feed. Bacilli of varied species according to the 7 
tissue which they select as pabulum, are.found in human beings, whose 
capillary circulation is defective. To this thought we may be compelled to 
turn for the successful treatment of tuberculosis. 
As the rods and cones of the optic nerve receive impressions which, through 
that phase of the force called mind, controls the action of the cells of the social 
body, so the rods and cones of the sympathetic nerve may receive impressions 
which go to control the action of some one or all of the cells of the physical 
body. 
DISCUSSION OF PAPER. 
Doctor Longyear: I wish that the neurologist had been called on first to 
discuss this subject as my own ideas on the same are somewhat indefinite. I 
think that as a Society we are indebted to Doctor Metcalf ; we are accustomed 
to consider the sympathetic nervous system in an indefinite way and it is well 
to consider the question in a definite way as the doctor has done. The case in 
which I was particularly interested was the first one which the doctor cited. 
The problem of there existing an affection of the nervous system was considered 
before the operation; the rapid pulse being a symptom which was referred to 
this condition. I hoped that removal of the tumor and the consequent relief 
from the pressure would better the condition of the nervous system. The pulse 
improved under the anesthetic but became worse after the completion of the 
operation. It seems to me that the point about the connection between the 
sympathetic nervous system and the cervix uteri is a very important one. It is 
not alone in surgical cases that we see affections of the sympathetic nervous 
system; they are to be seen in the actions of certain drugs. In a case of lapar- 
otomy at Harper Hospital two years ago, morphine acted very badly. After the 
operation, as the patient was in considerable pain, one-tenth grain of morphine 
was given hypodermically. This was followed by weakness of the pulse. The 
condition was supposed to be due to shock and stimulus was administered. 
The pain still continuing, the dose of morphine was repeated. This was followed 
the second time by circulatory disturbances. Under appropriate treatment the 
patient rallied and ultimately entirely recovered. The peculiar effect of the 
drug in this case might be due, in my opinion, to a peculiarity of the make-up 
of the sympathetic system. I hope that the points which Doctor Metcalf has 
made in his paper can be worked out to the practical benefit of the members of 
the profession. 
Doctor Hitchcock: While not wishing to quibble over the matter, I must 
take issue with the doctor's thesis that there is only one force in nature, and 
that as there are no diseases of electricity, there can be no diseases of mind. 
However, granting for the sake of argument the truth of the statement of 
Doctor Metcalf in this question, what is the benefit therapeutically, or what 
real advance have we made? I had hoped that the doctor would have given us 
some suggestions in the line of treatment. 
Doctor Emerson: I must congratulate the essayist of the evening for the 
thought and originality displayed. I have been much interested, not only on 
account of the cases recounted but also because his theory coincides with a 
theory of my own formulated from clinical observation. The theory is that the 
sympathetic system is a subsidary system allied most closely to the cerebro-* 8 
spinal system. The connection between the two systems is a most intimate one. 
The distribution of the sympathetic system is as wide as possible and its func- 
tions are as wide as its distribution. It might be compared to the commissary 
system in the army. Wherever the army goes, there goes the commissary. 
Unless the commissary is maintained, the army is helpless. I believe that the 
cerebro-spinal system is, if I may be allowed the use of the expression, the 
originating part of the nervous system, where the vital impulses are generated. 
The sympathetic system acts as a coordinate and regulating part. In hearing 
the paper this evening I was reminded of the pamphlet published some years 
ago by Doctor Buck on the 11 Sympathetic Nervous System." In that treatise the 
author advances the theory formed by a process of exclusion and negation that 
the sympathetic system has to do solely with the emotional part of our nature. 
There are certain grounds for this conclusion. Certain emotions are very mark- 
edly controlled by the action of the sympathetic system. It is a matter of some 
surprise to me to note how little space our leading text-books devote to this subject. 
Doctor Miner: I have learned to be very deferential to the sympathetic 
nervous system during the last few years of my practice. The action of certain 
drugs upon the nervous system is the basis of homeopathy. In this, our 
brothers of the opposite faith have been very far-sighted. Most of the remedial 
agents used by the homeopaths have a selective action on the sympathetic 
nervous system. The mucous membranes of the respiratory organs are supplied 
with capillaries governed by vaso-motor nerves. Congestion may occur as the 
result of vaso-motor paresis. We have the clinical observations that cases of 
asthma, hay fever, chronic rhinitis, et cetera, are caused by chronic irritation of 
the sympathetic nervous system with the consequent influence on the vaso- 
motor nerves. Many of the cases are to be treated by general tonics. Asthma 
has been caused by a laceration of the cervix uteri where an operation on the 
cervix was successful in removing the respiratory trouble. I believe that 
congestion of these membranes may be caused by irritations from any part of 
the body. It is well known that nasal polypi may cause asthma. I have seen 
at least twenty-five cases where the removal of a polypus from the nose has cured 
the asthma. Ovarian irritation has caused talipes where surgical measures for 
the ovary have removed the foot trouble. In the next ten or fifteen years, in all 
probability, the sympathetic nervous system with its disorders and treatment 
will be classed as a speciality. 
Doctor Sampson : I think that this is the most important paper which I 
have heard read before this Society. I am astonished to find that some of the 
members know as little about the subject as I do. In connection with this 
subject I have been most interested in a paper recently published detailing the 
the reports of six or eight cases of progressive neuritis. The cases steadily grew 
worse and death came very suddenly in each one. Careful dissections of the 
lesions showed that the neuritis passed along to the spinal centres with involve- 
ment of the splanchnics which govern the heart. There is no doubt that there 
is no field in the domain of medicine which offers richer returns for scientific 
investigation than does the sympathetic nervous system. 
Doctor Ives: The only point which I can offer on this subject is to pro- 
pound the inquiry which has so often suggested itself to my mind. Why the sym- 
pathetic nervous system is without the covering which we find about the nerve 9 
fibres of the other nervous system? It may be that the white substance of 
Schwann is an extra insulation which is not needed for the sympathetic system. 
Doctor Metcalf : Perhaps the patient Doctor Longyear refers to was at 
the time in a condition bordering upon shock and the additional depressing 
effects of the one-tenth grain of morphine upon the terminal ganglia caused a 
general dilatation of the blood vessels, thus reducing blood pressure, accounting for 
the peculiar action of the heart. In answer to Doctor Hitchcock I may say that 
my endeavor has been to read unity into the functions of the nerve systems. 
The parts of any science are developed independently of each other but they are 
only fully understood when we have the full development of the science. By 
way of illustration, take a simple example in addition: two and three are five; 
"two and three" has no meaning until the value of "five" is comprehended. 
The tool of unity is necessary to the translation of cases. It is indispensable to 
me. The theory was not founded upon the cases reported, but upon numerous 
and varied cases; upon my experience for years; these cases being selected 
because the original idea of the paper was to report the case operated upon by 
Doctor Longyear. I would like to know Doctor Emerson's reason for thinking 
that the force originates in the cerebro-spinal system. In referring to Doctor 
Buck's article mentioned by Doctor Emerson in which he (Doctor Buck) 
speaks of the sympathetic as the system of the emotions, I wish to say that I 
understand emotion to be a term applied to the mind when it is out of motion 
or incapable of moving round to will or definite related action; but the cerebro- 
spinal system is primarily involved in every movement of the mind. Of course, 
when the mind is out of motion or has lost direction it may overflow into the 
centres of the sympathetic system and cause blushing, changed heart action (as 
occurred on Seventeenth Street last week when a lady died instantly upon the 
receipt of bad news), diarrhea, micturition and various other manifestations of a 
disturbed sympathetic or life force; while on the other hand an irritation to the 
sympathetic may overflow into the cerebro-spinal channels thereby becoming an 
obstruction to the mind and resulting in the production of emotion. The sym- 
pathetic nerve fibre is not exposed to the frictions which endanger the cerebro- 
spinal fibres; they, therefore, do not need the protection of the primitive 
sheath. I thank Doctor Miner for his remarks which go to support the thought 
I have endeavored to express. I do not, however, agree with him that further 
study of the sympathetic nervous system will tend to diminish the use of 
surgical measures. I am convinced that it will increase the frequency of surg- 
ical procedure. I thank Doctor Sampson for his, it may be flattering, though 
encouraging, remarks. If this is a dream as the doctor calls it, it is a day dream 
and has influenced my practice for several years.