A TREATKE /j& // 4. STRtCTTRE, FUNCTIONS AND DISEASES OF THE HUMAN SYMPATHETIC NERVE. ILLUSTRATED WITH PLATES. BY JOHN FRED. LOBSTEIN, ,' PROFESSOR OF CLINICAL MEDICINE, AND PATHOLOGICAL ANATOMY, IN THE MEDICAL FACULTY OF STRASBURG, FIRST OBSTETRIC PHYSICIAN TO THE CITY HOSPITAL, AND MEMBER OF MANY LEARNED SOCIETIES. TRANSLATED FROM THE LATIN, WITH NOTES, BY JOSEPH PANCOAST, M. D. t ft". 'A&f&yti PHILADELPHIA. PUBLISHED BY J. G. AUNER, No. 333, MARKET ST. SAMUEL C. ATKINSON, PRINTER. 1831. > ».v WL TO PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, ETC. ETC. Whose elevated principles and private virtues have attached him to all that participate in his acquaintance, AND Whose devoted and most successful cultivation of Anatomy and Pathology, as well as other departments of Medical Science, have reflected the highest honour upon the Institution to which he belongs, THESE PAGES ARE MOST RESPECTFULLY INSCRIBED BY THE TRANSLATOR. AMICIS CONJUNCTISSIMIS RENATO CAILLIOT FACULT. MEDIC. ARGENT. PROFESSORI ATQUE DECANO FRANCISCO DANIELI REISSEISSEN ORPHANOTROPHII ARGENTORATENSIS MEDICO PRIMARIO HASCE PAGELLAS GRATA MENTE OFFERT AUCTOR. AUTHOR'S PREFACE. The subject of which I have undertaken to treat, is in the universal opinion of physiologists one of the most difficult kind, in consequence of the amplitude of the field it embraces, and the arduous investigation, which it necessarily involves. Its due consideration not only requires anatomical research, but also well directed physiological experiments, and correct patho- logical observations. As respects the former, I am convinced, that a general anatomical description or disquisition in relation to the nervous filaments of the organs, would not suffice; but that the investigation should be so extended as to embrace those constituting the internal structure of the nerves, and especially of the ganglia. The nerve denominated Great Sympathetic is com- posed agreeably to the opinion of the most recent phy- siologists, of a nervous system or apparatus, belonging principally to the abdominal viscera, and interrupt- ed by tubercles or nodes, which bear the name of gan- glia. From this arrangement the apparatus, has been long known under the name of ganglionic system, which is wholly different in its uses and functions, from the system of cerebral and spinal nerves. They however, commit the grossest error who refer all the ganglia to the sympathetic nerve, and deny their VI existence in the other nervous system. For it is de- monstrated by anatomical investigation, that at least thirty-six pair of ganglia, appertain to the cerebral and spinal nerves; that is, those under the subjection of the will and entirely foreign to the function of digestion and chylification. It will therefore be right to leave unnoticed the ganglia of the pneumogastric and spinal nerves; as well as the cerebral tubers, &c, which have very recently been denominated ganglia, and to cir- cumscribe this treatise within such limits, that it may embrace only the " Structure, function and diseases of the Sympathetic Nerve." The order of the subject be- fore us, is apparent from the title which I have prefix- ed to this commentary. I have therefore in the first and anatomical section, treated of the situation, course, branches and anasto- mosis of the sympathetic nerve. Afterwards, I have undertaken to investigate the arrangement of the plex- uses, and the structure of the ganglia, having first premised some observations, in respect to the evolution of this system in the embryo and foetus. But in describing the situation and course of the sympathetic nerve, I concluded the right mode to pursue, would be to consider it as a single nervous funicle, extended between the head and the pelvis, inflated indeed into many ganglia, but never or at least very rarely divided and completely interrupted in its course. All anatomists,the celebrated Biciiat excepted,have taken a similar view of this nerve, and such it appears at first sight, to the least skilful inquirer, and to the vii utterly unpractised eye. The other method of de- scription introduced by Biciiat, could only be admit- ted in case the ganglia were irregularly placed, and here and there scattered in disorder; if the plexuses which are situated separately, were not connected to- gether or with any central trunk; if, in fine, this nerve did not exhibit innumerable varieties in its seat, course, and ramifications. I have, therefore, under the name of intercostal, sym- pathetic, great sympathetic, and trisplanchnic (Chaus- sier,) considered and described the nervous cord, as being extended in the length and axis of the body, and possessing two extremities, the cephalic and pelvic. In this way the idle question in respect to the origin or termination of the nerve is avoided. As to the distribution of the intercostal nerve, I have referred the question, involving the reception and emis- sion of its branches, to another head; and in order to avoid all subtle and merely theoretical controversy, I have in the anatomical section of this work, distin- guished the branches of the sympathetic nerve into external and internal. The former consist of those, which situated more remotely from the axis of the body, constitute a connection between this nerve and the spinal nerves; the latter, of those which are distri- buted to the organs, and always accompany the vessels. Though I had previously dissected many bodies for the sympathetic nerve, in which I always observed some variation in the origin and distribution of its branches, yet I considered myself bound, in order to furnish a more perfect production, to make use of the 1 V11I body of a young man, twenty-four years of age, who had been affected with congenital imbecility of mind, and in whom the sympathetic nerve was so perfect and well expressed, as to surpass any I have ever seen in fitness for dissection. From this subject my de- scription is principally derived. I have likewise ad- duced the observations made either by other anato- mists, or myself, which manifest less usual phenomena; but have referred them to the second chapter of the first section, so as to avoid interruption in the order of this treatise. In the second and physiological section, I have en- deavoured to display the use of the intercostal nerve in the animal economy, and its probable functions in a healthy condition. Lastly, in the third and pathological section, I have indicated the abnormal actions or diseases of this nerve, in which it appears to be affected in a dyna- mic manner only: And I have then treated of the organic changes, which have been detected by anato- mical research in the structure of the nerve itself. ON THE STRUCTURE, FUNCTION, AND Q>H8)2A3ia8 OP THE HOlAN SYMPATHETIC NERVE. SECTION FIRST. ANATOMICAL. CHAPTER FIRST. General description of the Sympathetic Nerve". § 1. Concealed in the carotid canal, upon and in company with the carotid artery, and in junction with the cerebral nerves, are Found a few delicate filaments, which are considered the begin- ning or origin of the Sympathetic Nerve. Before Meckel traced out the Vidian nerve and disclosed a small branch running deeply in the carotid canal, anatomists had deduced the Sympathetic nerve of man, from the sixth cerebral pair only. Since then, authors have understood correctly, its double origin, or two roots; namely, from the fifth and sixth cerebral nerves. This mode of description stood its ground in the schools, until within a recent period, when this portion of the Sympathetic nerve ceased to be considered as its origin and source, but only as a mode in which branches proceeding from the uppermost cer- vical ganglion ascended towards the head. Acceding to this opinion, I shall describe what I have myself observed at the cervical extremity of this nerve, and in the second chapter pursue its historical details. § 2. I have seen three small branches running backward from 10 structure of the the sixth pair of nerves, or forming an obtuse angle with it, placed upon the carotid artery near its third flexure, and forming a reddish gangliform plexus, which was increased by a filament from the Vidian nerve. * From this ganglion, beside two fasciculi of soft filaments, two especial branches pass out, upon the coats of the artery, one behind the carotid, the other upon its upper surface, which when they reach the lowest portion of the carotid canal, coa- lesce into one slender cord, to which the name of Sympathetic nerve is given. I have had an accurate representation made of this portion of the Sympathetic nerve, with the branches drawn out a little from the artery, in order to render their course more conspicuous. See plate 6th, fig. 1st of this work. In another subject the following was the relation of the small nerves running in the carotid canal. An olive shaped ganglion, three lines in length, and one line thick, was placed in the middle of the carotid canal, eight lines distant from the first cervical ganglion, with which it was con- nected by a slender cord. Five small branches were given off by this cavernous or carotid ganglion, three of which formed a network round the carotid artery, whilst the two remaining formed an anastomosis, between the sixth nerve and the Vidian. A branch to the first nerve was divided into two filaments, which were reunited directly with the nervous trunk. From an attentive examination of the subject, I have been convinced that the sixth pair of nerves may be separated into two principal branches, superior, and inferior; the first of which forms an anastomosis with the Sympathetic nerve. Formerly it was disputed whether this branch from the sixth nerve of the cerebrum, should be considered as received or emitted. In favour of the former opinion there is, 1st, the ob- tuse angle, which this branch forms with the trunk of the sixth * In a coloured plate of the Sympathetic nerve, with marginal descriptions lately issued under my inspection, from one by M. Manec, by Mr. P. Ancora a distinguished artist of thiB city, this arrangement may also be distinctly seen The Vidian nerve, as there designated, No. 11, occasionally sends two branches into the carotid plexus.—Translator. SYMPATHETIC NERVE. 11 pair which leads to the orbit 2d, Its division near its anasto- mosis, which furnishes additional proof that it proceeds towards the ganglion. 3d, Lastly, the union of this same branch in a common fasciculus with the sixth pair of nerves, (motor externus.) But the whole of this question is vain and idle at the present time, when that portion of the Sympathetic nerve, concealed in the carotid canal (as the expression runs) is no longer considered its origin. § 3. The Sympathetic nerve having passed out of the carotid canal, appears at first as a soft, red funicle. Afterwards it enlarges into the superior cervical ganglion, denominated from its figure, olivary. I have seen this ganglion twenty lines in length, and three in diameter: in another subject, and upon both sides it was thirty- four. It is situated upon the superior part, and towards the external margin of the rectus capitis major muscle, covered at first above by the internal carotid artery, in front of which, however, it quickly appears. Anterior to it descends the Glossopharyn- geal nerve; and exterior, and a little posterior to it, lies the internal jugular vein, the par Vagum, and last of all the Hypo- glossal nerve. I have found the upper cervical ganglion double. The trunk of the Sympathetic nerve in this case immediately after having left the carotid canal, separated into two parts, one internal, and the other external, which communicated together by branches of considerable size. That which may be called the interior ganglion, was fifteen lines long and three in diameter. The exterior ganglion was an inch long and three lines thick, and was joined with the Hypo- glossal nerve, by two anastomosing branches. The branches which were sent downwards by this double ganglion, united into a single cord, about the middle of the neck, and constituted the trunk of the Sympathetic nerve. Of the internal composition of the ganglia, I shall treat farther on; when, too, I will more carefully investigate the condition, 12 STRUCTURE OF THE size, and structure of the olivary ganglion. It suffices now, in a general way, to have indicated its position. § 4. This ganglion having been formed, the trunk of the Sympathetic nerve, is compressed in size, and descends as a small cord, half a line in thickness, perpendicularly behind the carotid, until it touches the inferior thyroid artery, when it is enlarged to form the second ganglion, called the middle cervical, or thyroid ganglion. This ganglion is frequently deficient; I have on the contrary, however, many times found it large and of a remarkable triangular form: it is of a red colour, like all ganglia, but less juicy, and a little harder than the upper cervical ganglion. § 5. The middle cervical ganglion being formed, the trunk of the Sympathetic nerve (intercostal) is again compressed for a short distance, the space of an inch, when it is enlarged a third time, and produces the last or inferior cervical ganglion, which is situated near the internal margin of the vertebral artery, and nine lines distant from the subclavian. The ganglia of the two sides do not always resemble each other: neither do they perfectly correspond in regard to figure, situa- tion, and disposition. For example; the middle cervical ganglion may be deficient on one side, and present on the other. The upper cervical ganglion is sometimes found short upon one side, and long on the other: and Sometimes double upon one, and single on the other, (as I found it in the case cited above.) It appears to me that the first cervical ganglion, when of a greater size than usual, assumes the functions of the deficient middle ganglion. § 6. The Sympathetic nerve, after having formed the last cervical ganglion at the margin of the thorax, passes, after a course of two lines, the head of the first rib, where a large ganglion is formed, which is covered by the vertebral artery, and called from its situation, first thoracic, or great thoracic. It will be proper to pause here for a time, that we may more carefully consider what we have said above in a summary way, SYMPATHETIC NERVE. 13 and investigate the branches sent off in the neck from the Inter- costal nerve. § 7. In returning therefore to the first cervical ganglion, it is well to recall to mind, that that body of close cellular network, is adherent to the par vagum, and hypoglossal nerves, but with- out any intermixture of the nervous pulp. Two white and con- sistent branches are seen to proceed from it, transversely, and which are enlarged by a nervous connection from the first and second cervical nerves. A third, but longer and more slender branch, is sent obliquely downwards, and connects this ganglion with the anterior descending branch of the second pair of cervi- cal nerves. A fourth, yet smaller and longer than the last, having given off some fine filaments to the rectus capitis major anticus muscle, is united to the third cervical nerve. There is a connection, therefore, between the first cervical ganglion, and the three superior cervical nerves, by the means of four intermediate anastomosing branches. § 8. From the same ganglion, beside the filament to the tympanum, which is more fully described in the second chapter, the following branches emerge. The first one we discover is red and firm; it passes upwards, and is distributed to the belly of the rectus capitis major anticus muscle, the inferior part of which it perforates. The second branch is likewise red, and extends to the pharynx. It is divided into three fine filaments, which are spent upon the salpingo-pharyngeus muscle,* but first connected by anastomosis, with the glosso-pharyngeal nerve, and the pharyngeal branches of the eighth pair. Thus a plexus is formed, from which some twigs are sent to the trunk of the external carotid. The third branch, which was formerly considered double or triple, is pulpy, red, thick, and almost pellucid, and called from this circumstance, mollis: having connected itself with the laryngeal branch of the eighth pair, it is subdivided into five branches, that proceed forward to the superior thyroid, laryn- * Salpingo-pharyngeus, is a name given to a few fibres of the Palato-pha-> ryngeus muscle, which assist iu dilating the mouth of the Eustachian tube. Translator. 14 STRUCTURE OF THE geal, lingual, and external maxillary arteries, in company with which their ramifications run. ' § 9. The laryngeal nerve itself, above cited, a branch of the eighth pair, does not in descending over the upper surface of the superior cervical ganglion, cohere with that body of cellular net- work, but receives the soft nervous substance from this ganglion, as I have very distinctly seen by the aid of a microscope. The branch of the fifth pair which adheres at the side of the sella tur- cica to the back part of the ganglion of Gasser, is evidently situ- ated in the same Way. From this we may conclude that the filaments of the laryngeal nerve, in the case described are of a mixed character, partly formed by the par vagum, and partly by the intercostal nerve. This arrangement is particularly important, in regard to that branch of the laryngeal nerve, which is given off near the origin of its own trunk, and received afterwards upon the external caro- tid artery, in its course to the superior thyroid. This branch, connected evidently with the superior cervical ganglion by a yellow semilucid nervous pulp, which the microscope places beyond all doubt, passes immediately to the basis of the larynx, and is spent upon the crico-thyroid muscle, after having sent forward three twigs to the thyroid gland. But in some subjects, I have seen this branch of the laryngeal nerve, proceeding from the cervical ganglion to the crico-thyroid muscle and thyroid gland, without any connection with the par vagum. It should however be observed, that when no intermixture exists at the origin of the nerves from the par vagum and sympa- thetic, it takes place soon after by the anastomosis of their branches. § 10. For whatever may be the origin, number, or diversity, of these nerves, and the inconstancy of their natural division into branches, this may be admitted as invariably true, that the superior cervical ganglion sends off some soft branches, and others of greater consistence, from its anterior face, which al- ways proceed partly to the internal, but principally to the exter- SYMPATHETIC NERVE. 15 nal carotid artery, which they invest in various ways, attend in every direction, and are finally spent in filaments to their tunics. Moreover all these ramifications, the course and complexity of which are diversified with accessory filaments from the glosso- pharyngeal nerve, and the pharyngeal and laryngeal branches of the eighth pair, likewise form a long plexus, which has been di- vided by Haller into pharyngeal and laryngeal, of which some- times one and sometimes the other is more strongly developed. §11. The fourth and last branch from the superior cervical ganglion, which is long and slender, descends along the carotid artery, to the aorta. It is known by the name of the superficial cardiac nerve, and is usually formed in part by the par vagum, or in other words is formed by a root from each. In a case which I examined with close attention to this subject, it was formed (on the right side) by a delicate branch from the par vagum near the laryngeal nerve, which was quickly strength- ened by nervous substance coming off under the form of a dia- phanous filament from the ganglion. The superficial cardiac nerve thus formed, was connected with the par vagum, upon a level with the fourth cervical vertebra by a transverse filament. It then plunged into the middle cervical ganglion, and being again increased in size, advanced at once to the arteria inno- minata, and having supplied some filaments to that artery, anas- tomosed with a branch from the par vagum, and formed a plexus which was connected to the great cardiac plexus, as will be ex- plained below. § 12. The second ganglion of the intercostal nerve, called as I have said, thyroid or middle cervical, is six lines long and four broad, and situated two lines above the inferior thyroid ar- tery. It has a long and very delicate communicating branch with the fourth cervical nerve, and another larger one with the fifth. These branches are the most superficial. Two other branches also exist, which pass out deeply from the same gang- lion. The former of these is soft and succulent, very conspicu- ous, and perforates the muscular space between the transverse apophyses, of the fourth and fifth cervical vertebrae, and then 16 STRUCTURE OF THE divides into two diverging branches; the exterior one is joined to the fifth pair of cervical nerves, opposite to that point which supplies the posterior branch. The interior branch ascends in the canal, formed in the transverse apophyses for the vertebral artery, upon the tunics of which it is spent. The other evidently pursues the same course as the preceding branch, namely, perforates the interval filled up by the inter- transverse muscles; then is divided into two branches, the ex- terior of which communicates with the sixth pair of cervical nerves: the other, internal, attends the ascending vertebral artery. Hence it follows, that the middle cervical ganglion communi cates with the fourth, fifth and sixth cervical nerves, arid with the fifth likewise by two branches one of which, is superficial and the other deep seated. The deep seated communicating branches were seen and described by the illustrious Sabatier* in his trea- tise of Anatomy. §. 13. One of the branches which pass anteriorly from the middle cervical ganglion, extends to the tunics of the primitive carotid artery: another in following the course of the inferior thyroid artery sends some filaments to the thyroid gland, and Others to the subjacent oesophagus; whilst the rest which are inferior, seem agglutinated to the surface of the trachea, and are spent in the vasculo-cellular network, which occupies the seat of the thymus gland in the adult. § 14. The third cervical ganglion is only two lines distant From the first thoracic, with which it is connected in three dif- ferent ways. Firstly, by the continuation of its trunk—Secondly, by two Very small branches forming a kind of loop round the vertebral artery—Thirdly, by a larger branch sometimes double, which has been long known under the name of Ansa Vieussenii, and passes round the subclavian artery. This ganglion (the third cervical) had no connection with the * Traite d'anatomie (Nevrologie) torn. IV. p. 308. Edit. 1792. SYMPATHETIC NERVE. 17 Cervical nerves in mpst of the subjects that I have dissected; therefore the large ganglion which follows next, is called great or first thoracic, the seat of which I have pointed out above. §. 15. This ganglion, situated near the last cervical, and very frequently continuous with the second thoracic, forms a large elongated node, shaped like the letter S turned horizontal, from which many branches internal and external pass out. The internal, about five in number, form an anastomosis with the seventh and eighth* cervical, and first dorsal nerves; the first of these nerves indeed receives only one branch from the gan- glion; The two remaining on the contrary, receive five branches which are short, round and succulent. The external, seven in number follow the subclavian (right) though there are other filaments inosculated with branches from the par vagum and the recurrent nerve, which descend around this vessel towards the arteriainnominata, and increase the number to about thirteen. The internal, collected at first into a broad fasciculus through the intervention of loose cellular tissue, soon separate as they advance, are spread upon the arteria innominata, and receive the external branch of the superficial cardiac nerve near the origin of the primitive carotid: After which a large plexiform loop is formed round the subclavian, innominata and primitive carotid arteries, and the trachea, proceeding from within as it were towards the surface, to which the name of cardiac plexus is given. In order to furnish a complete history of the cardiac plexus, it will be necessary now to repeat the description of the superficial cardiac nerve given above (§.11.) For repetitions are by no means objectionable when they diminish the obscurity of a subject. ,§. 16. The superficial cardiac nerve, arises either separately from the intercostal or pneumogastric nerve or from both together, and descends upon the carotid under the form of a white consis- tent filament, which appears somewhat increased in size after its conjunction with the middle cervical ganglion. * Here the suboccipital is counted as the first cervical, making eight nerves to the neck.—Translator. C 18 STRUCTURE OF THE In whatever manner the Superficial cardftic nerve is formed, as it passes to the arteria innominata it is divided mto five branches, three of which proceed to the arteria innominata and aorta, and form a simple plexus, called the superficial cardiac, whilst the two remaining external branches anastomose with a branch from the par vagum, and with another from the first thoracic ganglion descending under the subclavian artery. The plexiform nervous loop is strengthened by this double anastomosis, and is now denominated the cardiac plexus, from the convexity of which many branches descend to the base of the heart. Although the great cardiac, or deep seated plexus, is of very, intricate construction on account of the anastomosis and division of its nerves, yet we know from analytic investigation that all its branches have a triple origin, and that they pass to the heart, v §. 17. From what has been said above it may be coUected that the cardiac plexus has a triple origin. 1st. At its interior part near the carotid and innominata, from the superficial cardiac nerve, and by some accessory filaments from the par vagum. 2d. At its middle part, from nerves proceeding from the infe- rior cervical ganglion and first thoracic, after they have formed an anastomosis with the recurrent and with the superficial car- diac nerve. 3d. At its exterior part, from branches sent off from the trunk of the par vagum itself. Hence it follows that the interior and anterior cardiac nerves, proceed chiefly from the superficial cardiac nerve; the middle, principally from the last cervical, and first thoracic ganglion; the exterior and posterior, chiefly from the par vagum, although no branch of the cardiac nerves can be traced simply from the In- tercostal free of all connection with the par vagum. §. 18. Two of the branches of the middle nerves of the cardiac plexus are more conspicuous than the rest, having their chief source from the lowest cervical and first thoracic ganglion though some accessory filaments are also derived from the superficial cardiac SYMPATHETIC NERVE. 19 and recurrent nerves. These which it will be proper to name the deep-seated nerves of the hearty one of which is the principal and the other a collateral branch, descend at their upper part between the trachea and aorta; they pass immediately to the heart, and are received between the aorta, and the right branch of the pulmonary artery, where they are interlaced with branches from the par vagum, and the principal cardiac nerve of the left side. The anatomical history of the cardiac nerves near the heart next claims our attention, and which I will dwell somewhat upon as it now excites the attention of many distinguished men. We will commence with a description of each branch, and afterwards treat of them in general. §. 19. The principal cardiac nerve which Wrisberg* calls maximus or novus, as it arrives at the origin of the arteria inno- minata, swells into a ganglion, that may be called the cardiac, from which three branches emerge in different directions, viz. anterior, posterior and middle: This last from its thickness and direction is considered the co^ttinuation of the trunk. The first of these branches, the anterior and right, is of consi- derable size; is reflected round the aorta to the posterior surface of which it seems at first agglutinated, passes into a sulcus between the base of the right ventricle and right auricle, and forms an anas- tomosis with the right branch of the left cardiac nerve, by which a kind of coronet is formed around the base of the aorta. Then after having received the filaments from the left cardiac nerve, it gives off two ascending branches to the auricular appendix of the right sinus, which evidently go to the muscular fibres. It after- wards attends the right coronary artery in its course, divided into two branches, which are placed between the trunks of the artery. All the ramifications which proceed from these branches, form a lesser plexus which may be properly denominated the right cor- onary. §. 20. The middle branch of the cardiac ganglion or the * De Nervis, arterias venasque comitantibus Comment }. 25; Sylloge comment, anat. Gcetting, 1786, in 4to. p. 59. 20 STRUCTURE OF THE continuation of the trunk, descends to the lowest part, between the aorta and pulmonary artery, and there with an adjuvant branch from the left principal cardiac, constitutes a considerable plexus, consisting generally of eight small branches: The external of which, appertain to the base of the aorta; the middle to the origin,_ of the pulmonary artery, whilst the posterior and more impor- tant branches, descend behind the pulmonary artery, and being finally subdivided into six filaments form a sort of secondary - plexus, which may be denominated, the left coronary. The following branches from this plexus particularly deserve j^ attention ; 1st. One posterior to the rest, ascending over the "'* origin of the left coronary artery, and passing to the auri- cular appendix of the left sinus of the heart, in the substance of which it is spent unaccompanied by any vascular branches. " 2d. A branch of considerable size descending over the base of the left ventricle, which penetrating within is terminated in the papillary muscle of the heart, ^Iso without any accompanying artery. 3d. Two principal branches passing down with the left coronary artery. One of the filaments of these branches, leaving the artery, proceeds very evidently into the muscular \< structure of the left ventricle. J §.21. The posterior branch of the cardiac ganglion, apper- tains chiefly to the pulmonary artery ; the right division of which consists of four or five filaments joined together by ner- vous loops; the left, but of two or three, as an anastomosis is formed with the branches of the left cardiac. §. 22. The collateral branch of the principal cardiac nerve, {%. 18.) proceeds from the deep-seated cardiac plexus; it runs' an equal distance with the preceding nerve, and is con- nected with it behind the arteria innominata, by a transverse anastomosing branch. It afterwards attends the left branch of the pulmonary artery, to which it distributes filaments, and having passed behind it, is finally immersed in a plexus situated above the left ventricle. §. 23. The description of the cardiac nerves of the right side being completed, the entire history of the nerves of the heart SYMPATHETIC NERVE. 21 »■ would yet be defective, were we to leave unnoticed the nerves which proceed from the left side of the body. It is likewise the more necessary to indicate them, as the nerves of both sides most frequently run together upon the base of the heart, and have a close connection with each other. In examining accordingly with the greatest care, the subject above described, the origin and course of the nerves belonging to the left side of the heart, appeared as follows. No superficial cardiac nerve existed, either from the superior cervical ganglion or the eighth pair. But the middle cervical ganglion sent off a very conspicuous strong filament, which de- scended behind the carotid artery, and having formed an anasto- mosis with the recurrent nerve of Galen, as the principal cardiac nerve advanced immediately to the base of the heart. On the contrary the first thoracic ganglion, supplied the super- ficial cardiac nerve which descended indeed behind the sub- clavian, but sent small superficial branches to the carotid artery and aorta. An inverse relation therefore clearly exists in the origin and disposition of the cardiac nerves of the left and right side. The principal cardiac nerve in its ulterior distribution descends towards the base of the heart, upon which it is received between the concavity of the aorta and the left branch of the pulmonary artery. An anastomosis is then formed between this cardiac nerve and the collateral cardiac nerve of the right side. Afterwards it is divided into two principal branches: the first of which or external, having anastomosed with the posterior branch of the right deep-seated cardiac nerve, gives off three or four small branches to the left pulmonary artery. The second or internal, apparently a continuation of the trunk, situated deeply between the aorta and pulmonary artery, again divides into three branches. 1st. One for the left coronary plexus. 2d. A second for the subjacent trunk of the pulmonary artery. 3d. A third, which in union with the circumflex branch of the right cardiac, surrounds the base of the aorta like a coronet, then 22 STRUCTURE OF THE passes to the right ventricle, strengthens the right coronary plexus, and among others sends two branches to a part of the right ventricle near the pulmonary artery, which in compa- ny with the arteries evidently proceed to the muscular fibres of the heart. §. 24. It is necessary now in order to complete the history of the cardiac nerves, to point out the connection of the par va- gum with the heart and its great vessels. There is no branch directly given off from the par vagum to the ventricle of the heart, although the cardiac nerves in the deep- ^ seated cardiac plexus, are mingled with the par vagum as de- ^ scribed above. But the branches of the pulmonary artery form an exception, as they receive the filaments which are given off I transversely from the par vagum; for one branch only is given off from the par vagum of the right side, previous to the origin of the anterior pulmonary plexus. This branch extends to the right £ pulmonary artery, leaves with it three or four small ramifications, then descends to the right pulmonary vein upon which it is spent in three filaments, the last of which disappears, as it approx^* imates the right sinus of the heart. Though these branches to the pulmonary veins were not seen by the celebrated Sabatier,* yet I must from autopsic examination admit their existence. It is admitted by the distinguished Behrends-I § 25. From the description and course of the cardiac nerves, as above given, this general proposition may be drawn, that the right cardiac nerve alone, chiefly presides over the heart; whilst I the left seems accessory only, and to exist for the purpose of sending off some branches, with which those of the right side are strengthened. Another deduction has lately been made by the celebrated Scarpa,\ viz., "that the ramifications from the cardiac nerves of each side, crossing each other evidently at the base of the heart, spread over that organ in such a manner, that every portion of it, anterior and posterior, receives a filament from * Loc. Cit. p. 218. f Dissert, inaug. qua demonstr. cor. nervis carere; Mogunt. 1792 p. 10. J De nervis cardiacis, } vii. SYMPATHETIC NERVE. 23 the cardiac nerve of each side." But I cannot agree with this illustrious man, when he pronounces the cardiac nerves to be of a very soft, gelatinous character.* I have indeed found them very small and delicate, but not softer than those derived from other sources. But among the cardiac nerves themselves, there appeared to me some difference in regard to the character of the distributing branches, viz. that the deep seated cardiac nerves, situated between the aorta and v pulmonary artery, were less round and cylindrical, and less succulent than the rest, but ap- peared rather to be flattened down and agglutinated to the pari- etes of the vessels. § 26. The history of the cardiac nerves now being completed, we will return to the trunk of the intercostal nerve, which we relinquished at the first thoracic ganglion. That ganglion which bears a very large share in the produc- tion of the cardiac plexus, emits, beside the cardiac nerves, some slender filaments to the voluntary muscles; viz. to the inferior part of the longus colli muscle. Another very slender filament appeared to me to proceed to the anterior longitudinal fascia of the vertebral column, and ob- scured by the ligamentous fibres of the latter to penetrate into the bone itself. v § 27. The first thoracic ganglion being completed, the inter- costal nerve is again compressed in size, and having passed a short distance, swells out again anew into the second ganglion. In some subjects, however, these two ganglia are inflated into one. t The trunk afterwards descends near the vertebral column, passing deeply along the superior part of the dorsal spine, but emerging a little upwards, near the last thoracic vertebra. In each costal interval, the trunk forms a small ganglion, called from its figure, hordeiforme; hence (with the above) twelve ganglia are formed, of which some, like those of the * Loc. Cit. § xxiv. f flPhis articulation of the ganglia, also occasionally occurs between the first thoracic, and the inferior cervical, an instance of which is given in the plate to which I alluded, page 10. In that plate also will be found a good delineation of the cardiac nerves of the right side; those of the left side being necessarily con- cealed by the position of the body.—Translator. 24 STRUCTURE OF THE neck, are connected with the spinal nerves. For each of the costal spinal nerves emit one, two, or three small branches, which descend obliquely to the adjoining ganglion. From the first of these hordeiforme or thoracic ganglia, nu- merous small branches proceed, which by following the inter- costal arteries extend to the aorta, upon the cellular coat of which they are evidently spent. § 28. But from the sixth thoracic ganglion, to the tenth or eleventh inclusive, three or four branches arise, which, passing forwards and downwards upon the dorsal vertebrae, coalesce into one trunk called greater splanchnic, which penetrates into the cavity of the abdomen, through the hiatus between the first and second crura of the diaphragm. Wrisberg* has never found the roots of the splanchnic nerve, less than three, or more than eight in number. This splanchnic nerve is called greater, because another nervous cord, smaller in size, proceeds from the ninth and tenth ' thoracic ganglia, passes into the abdomen through the same hiatus with the greater splanchnic, and immerses itself in the solar plexus, as is yet to be described. Lastly another branch is constantly found arising from the eleventh and twelfth ganglia, which penetrates into the abdomen through an hiatus of its own in the crura of the diaphragm, and extending to the kidney, is mingled with the renal plexus, and therefore called the renal nerve. Wrisbergt first gave this nerve the name of lesser splanchnic, which is likewise cited by -, Walter, though he did not devise it. § 29. In one instance I observed an unusual ganglion, situated upon each side of the dorsal spine, and formed by the greater splanchnic nerve, before it had emerged from the chest It was two lines in diameter, and in the form of a crescent, from the convexity of which, six or eight delicate filaments emanated; they accompanied the aorta but were all spent in the muscular substance of the crura of the diaphragm. * Loc. Cit.$21. + L. C. $19. SYMPATHETIC NERVE. 25 In another instance I found in the body of a male idiot, a supernumerary ganglion, but which differed somewhat from the preceding, as it was placed between the filaments of the splanchnic nerve, from some of which it was formed. The ganglion of the right side, six lines long, and two lines thick, gave off three branches; two of which penetrating into the abdo- men, terminated in the semilunar ganglion: the third passed into the superior mesenteric plexus. On the left side, the supernu- merary ganglion, was only two lines long, and one thick. The semilunar ganglion of the same side was indurated, and redder than usual. § 30. The greater splanchnic nerve, penetrated into the abdo- men, and was immediately lost in a large ganglion, called semilunar, but often of an irregular, variable form, situated upon the crura of the diaphragm, between the capsula renalis, and the aorta. Instead of one large ganglion, we frequently find three or four nervous enlargements, connected by branches of considerable size, so that the congeries of ganglia, represent a species of islands. In a case detailed by Wrisberg, the splanchnic nerve was immediately converted in an inextricable and almost indescribable manner, into a purely nervous network, in which eleven smaller ganglia, could be counted, spread out in a broad surface. Whatever is the arrangement of these enlargements of the splanchnic nerve, there is always a connection through the medium of transverse branches, between the two larger ganglia of each side, which forms that singular and intricate network, called the caeliac or solar plexus, because branches emanate from it into different regions of the body, like rays from the sun. The organs which receive branches from the solar plexus, are the diaphragm, stomach, liver, spleen, small and large intestines, kidneys, suprarenal capsules, and the spermatic vessels in both sexes. For all these nerves there is one general and invariable law, that their branches always accompany the arteries. § 31. The diaphragmatic nerves forming the phrenic plexus, proceed from the superior part of the solar plexus, a long the crura of the diaphragm, with the great or inferior phrenic artery 26 STRUCTURE OF THE and terminate finally in the fibres of the muscle, in conjunction with the branches of the phrenic nerve. § 32. The gastric plexus, arises from the middle and superior part of the solar plexus, where the two semilunar ganglia, arc connected together through the medium of transverse branches. The-branches which form this plexus, surround like a nervous net- work, the coronary artery of the stomach, and as they accom- pany its posterior branches meet with the par vagum of the right side with which they are connected in a manner to be described below. By this union the gastric plexus is rendered larger, and more remarkable; eight or ten small nervous trunks proceed from it, creeping among the muscular fibres of the stomach by which they are at length concealed, until they reach the middle region of the stomach, and are finally exhausted in the cellular webwork of the villous membrane. The remaining gastric nerves, are disposed in the following manner, according to the observations I have made. The left par vagum, which is anterior to the stomach does not communicate at all with the solar plexus; but passing along the lesser curvature is divided into about fourteen branches, spread upon the anterior face of this organ, towards its inferior curva- ture, where having become very small, they disappear in the cellular membrane which connects the muscular and mucous coats. No branches appeared to me distinctly to be sent to the fleshy fibres, except in the region of the insertion of the oeso- phagus, where one branchlet was evidently spent upon the superficial muscular stratum of the cardia. To conclude, it may be observed generally of the gastric nerves, that in proportion as they are more numerous in the cardiac and pyloric regions, there are fewer to be found in the middle portion of the viscus. § 33. The hepatic nerves, pass off from the solar plexus in a double series, and according to Walter may be divided into two secondary plexuses, anterior and posterior. The anterior coming from the solar plexus, and chiefly from the left semilunar ganglion, and right gastric branch, accom- SYMPATHETIC NERVE. 27 panies the hepatic artery, consisting of about seven thick round strong and reddish branches, two or three of which are connected (; ■*' with the right semilunar ganglion. Before these branches, properly called the nervi comites of the hepatic artery, reach the liver, a fasciculus of five or more branches from this plexus, descends with the right gastro-duo- denal artery, to the pancreas and duodenum. Of the nerves properly called hepatic, one conspicuous trunk divided in three branches, extends to the ductus choledochus, upon which it is spent, whilst the remainder, passing through the portse of the liver, follow the branches of the hepatic artery, to the third or fourth division, and at length disappear in the external cellular coat of these vessels. Nevertheless, with the i microscope I have detected twigs in the right lobe of the liver at the depth of four inches in the cellular coat of the arteries. In another beside two branches attending the cystic artery to i the gall bladder, I found three provided for the hepatic duct, at Bt , the place where it bifurcates in order to supply each lobe of the Wr liver. There were some other filaments appropriated to the *.' ' biliary ducts, inclosed a little more deeply in the substance of the liver. I found no branch to the hepatic veins. The posterior, arises chiefly from the right semilunar ganglion, and accompanies the vena portarum, to which it loosely adheres. There are two or three branches it is said, united with the branches of the anterior hepatic plexus, which are reddish and f cylindrical, and enter into the viscus, in a similar way along W' with the branches of the vessels. The anterior hepatic plexus is therefore composed chiefly, 1st, of the right par vagum (funiculus stomachicus dexter); 2d, of that part of the solar plexus which is derived from the left semi- lunar ganglion; and 3d, partly of filaments from the right semi- lunar ganglion. The posterior hepatic plexus is formed almost entirely from the right ganglion. It is known in a general way, that the nerves distributed tc the liver, belong principally to the arteries which they accom- 28 STRUCTURE OF THE pany with their branches. In regard to the vena portarum, 1 had long considered it doubtful whether that vessel received any nerves peculiar to itself. I had frequently followed the branches of this vein as far even as the obtuse margin of the liver, but '« could never detect any nervous meshes about them, or any es- pecial filaments of their own. However, by diligently investiga- ting the subject, I discovered in the right lobe of the liver, three small branches from the anterior hepatic plexus attending the right branch of the vena portarum, each of which being divided into three or four filaments, proceeded into the external cellular coat of the vessels, and after a course of an inch disappeared from view. § 34. The intertexture of the nerves of the spleen, or splenic plexus, is evidently composed of two nervous fasciculi, one of »< which is a branch from the right par vagum, and the other pro- ceeds from the left semilunar ganglion. The right ganglion has no branch connecting it with the splenic artery. These two fasciculi, connected by anastomosing filaments, sur- Hi round the splenic artery with a network, which loosely embraces the tunics of the vessels. When arrived at the fissure of the spleen (hilum lienis) two nervous filaments accompany each branch of the artery. They do not, however, proceed beyond the second division but deserting the arteries, bury themselves in the parenchyma of the spleen. Some finer branches pass under the outer mem- brane of the spleen, and disappear there. The finer filaments of the spleen, appear to me in all respects like those of the other organs. The veins get no nervous fila- ments. Numerous firm, though very fine filaments descend from the solar plexus to the subjacent pancreas. Those for the head of the pancreas, may be traced from the right semilunar ganglion; ^ and those which belong to the body of that gland from the left ganglion, about the middle of the splenic plexus. § 35. A plexus now arises more remarkable than all the rest, which, surrounding the superior mesenteric artery attends its SYMPATHETIC NERVE. 29 numerous branches, and is bestowed upon the small intestine, and part of the large. It is named from its situation and distri- bution, the superior mesenteric plexus. The nerves which form this plexus have a triple source. 1st, from the right semilunar ganglion, which distributes five nervous farciculi to the trunk of the superior mesenteric artery. 2d, from the left semilunar ganglion, out of which seven fasciculi, at least proceed. 3d. From a branch, sent off from the right par vagum. This branch no one yet to my knowledge has described, though it is very conspicuous when the stomach is remov- ed and the trunk of the right par vagum is followed with care, which should be left intact. This fasciculus is then seen to extend straight downward from that trunk, and adhering slightly to the branches of the pancreas, passes to the arteries of the small intestine and the middle colic ar- tery. The superior mesenteric plexus itself, sends down a fasciculus at the left side of the column, which passes to the inferior me- senteric artery, and is joined by anastomosing branches, from the renal plexus, and from the trunk of the intercostal: the congeries of all these nerves, has obtained the name of inferior mesenteric plexus which will be treated of below. §. 36. The plexuses next in succession, renal and suprarenal can not be directly derived from the solar plexus. But each is immediately produced from the semilunar ganglion of the same side, although some filaments come from the superior mesenteric and cseliac plexuses by which the renal plexus chiefly is strengthened. This plexus is formed on the right side, by nerves emanating from the right semilunar ganglion. It forms a network with which the lesser splanchnic or renal nerve mixes. Having made an accurate investigation, I discovered that the branches forming the renal plexus, were six times connected to- gether, or formed six plexuses called secondary whence the 30 STRUCTURE OF THE branches attending the arteries afterwards emerged, and passed on in a right line. When one or two ganglia exist in the renal 'plexus, the num- ber of secondary plexuses is found diminished. The branches constituting the first plexus, accompanying the trunk of the emulgent artery, part before and part behind it, having afterwards formed a plexus, two principal nerves attend each arterial division, which they surround with their branchlets, and accompany into the kidney. No nervous branch is sent to the renal veins, nor to the pelves of the kidneys ; but a small firm branch may be distinctly, and constantly observed, given off from the last fasciculus of renal nerves, following the ureter, upon the tunic of which it is spent. Before the renal nerves enter the fissure of the kidney (hilum renis) some slender branches are sent off which are evidently exhausted in the parietes of the arteries. We cannot on the contrary follow those branches of the nerves which enter the kidney itself, beyond the third division of the arteries: having become exceedingly minute they disap- pear in the external cellular coat. §. 37. Three to four filaments are given off from the renal plexus, which descend with the spermatic vessels and constitute therefore the spermatic plexus. This plexus is the least of all, as it is formed out of a few very fine filaments, one of which extends to the ureter, whilst the others disappear in the cellular net-work which surrounds the spermatic vessels, not appearing in the least to proceed to the inguinal ring or to the ovaria in women: which however is the case as I shall demonstrate below in the organic diseases of the testicles. Walter* distinguishes from this superior spermatic plexus, another which he calls inferior, and which he derives from the plexus surrounding the aorta, with which the spermatic ganglia, are intermingled. * L ?\ ^altF' tabuke nervorum thoracis et abdominis, Berol 1783, fol. max. tol. 1. No. 305. SYMPATHETIC NERVE. ol I am well acquainted with the nervous intertcxture of which Walter speaks, and which is chiefly formed by filaments from the intercostal trunk ; but it emits no ramifications peculiar to the spermatic vessels. §. 38. As respects the suprarenal plexus, I have enume- rated eight nervous branches, which extend to the (right) suc- centuriate kidney (capsula renalis) three of which proceeded from the semilunar ganglion and five from the renal plexus. The course of these nerves was in a right line, not divided or connected together by anastomosis, before they entered the gland (capsula renalis ;) they did not closely embrace tb.e arte- ries which they attended, but were very loosely united to their cellular coat. These nervous branches are generally white, not red nor soft, but quite firm. They are not less in diameter than the arteries themselves ; sometimes indeed they seem larger. There are some things worthy of note, respecting the nervous plexuses of the abdomen as well as the branches of the greater and lesser splanchnic nerves. At present the order of this trea- tise leads us back to the trunk of the intercostal, where we last carefully examined its course and ramifications. §. 39. Two splanchnic nerves having been given off, the trunk itself penetrates into the abdomen through its own hiatus be- tween the second and third fasciculi of the crura of the diaphragm. It descends upon the sides of the bodies of the lumbar vertebrae, in a direction towards their anterior part, whence the more remote it is from the intervertebral foramina, the longer are the anastomosing branches, between it and the lumbar nerves: but when it has arrived at the pelvis, it again approximates the foramina of the sacrum, and finally reposes at their margin. It receives in its course, from each of the lumbar nerves, two or three branches which descend obliquely upon the sides of the vertebrae, and where they touch the sympathetic nerve form small ganglia, generally of a Hat compressed figure from which filaments shortly to be described, proceed to the organs. 32 STRUCTURE OF THE §. 40. In the pelvis on the contrary, the anastomotic branches of the spinal nerves are very short, and form small round gan- glia upon the trunk of the sympathetic nerve. The two last sacral ganglia are frequently deficient, although the intercostal nerve itself is connected with the fourth and fifth sacral pairs, by a very short and slender branchlet. This nerve as it descends, becomes gradually smaller, and towards the apex of the sacrum, the sympathetic nerve of each side converges to- wards its fellow, till at length they terminate together. For each nerve ends in a very small ganglion called from its situation coccygeal, from which small branches are emitted to the cellular texture in front of the point of the coccyx, or the two ends of the nerves, by converging together, inosculate and form a loop, from the convexity of which some fine branchlets are sent to the cellular texture. The former mode of termina- tion I have most frequently observed. (jj. 41. Those branches next claim our attention, which arise from the abdominal and pelvic portion of the sympathetic nerve, and are distributed to the viscera and organs. As the trunk of this nerve escapes from its hiatus in the diaphragm, and is placed behind the kidney, it emits one or more small branches to the renal plexus. Afterwards branches emerge from the lumbar ganglia of each side, which environ the aorta in its descent, and constitutes the aortic plexus, which is derived from the class of simple nerves, and does not belong to the most intricate divi- sions of the sympathetic: but two principal generating branches of nerves emanate from this plexus the roots of which are de- rived from the lumbar ganglia, one called the inferior mesenteric or meso-colic plexus, and the other the hypogastric. fj). 42. The former having received a nervous fasciculus from the superior mesenteric plexus, entangles itself around the trunk of the inferior mesenteric artery ; some small branchlets then attend each ramification of the artery, sub-divide like the latter and are at length found upon the colon of the left side, and the rectum, while one fasciculus having passed into the pelvis, is immersed in the following plexus. SYMPATHETIC NERVE. 33 §. 43. This plexus (hypogastric) having a compound origin from the preceding plexus, from the lumbar ganglia, and from the trunk of the intercostal nerve of each side, is placed like a broad fasciculus between the primitive iliac arteries, de- scends deeply in the pelvis, and is connected by a few branches with the third and fourth sacral nerves: whence a conspicuous in- terlacing of filaments arise, which in following the branches of the hypogastric artery extend to the rectum, ureter, urinary blad- der, to the vesiculae seminales in man, and to the uterus and vagina in woman. §. 44. Into the substance of the uterus whether empty or gravid nervous filaments seem to be very rarely sent. I examined with the greatest care the uterus of a woman, dead twelve hours after parturition, but in which I found no nerves, from either the spermatic or hypogastric plexuses, al- though the sanguineous and lymphatic vessels were very distinct. I availed myself of the same opportunity, to examine with the microscope whether any nervous twigs were connected with the tunics of these vessels ; but with the closest attention could de- tect none. * Notwithstanding the labour that has been bestowed by various anatomists on the structure of tncuterus, the history' of its nerves is still imperfect. It may not therefore be amiss to insert here the opinion of Professor Tiedeman of Heidelberg, one of the most eminent of living anatomists, though his opinion is somewhat different from that of the distinguished author of this work. In his Tabuhe nervorum uteri, M. T. has enumerated six plexuses, three on either side, supplying the uterus, ovaries, and fallopian tubes. The 1st. is the spermatic, descending with the spermatic artery, to the ovary and fallopian tube and sending also a few.branches into the uterus, the 2d. the great superior lumbar plexus or common uterine, which sends many filaments to the uterus in company with the uterine artery, 3d. the inferior, lateral hypogastric which al- ways sends branches to the uterus, vagina, bladder and rectum, in a network around the uterine artery. These numerous nerves of the uterus,are small, soft and reddish, and closely applied to the arteries. On entering the substance of the uterus, they disappear all at once, and cannot be distinguished even with a good glass; they appear to terminate in the cellular or mucous texture, in- termediate between the blood vessels and lymphatics, no less than between the fleshy fibres, or even to be converted into these. This anatomist has also es- tablished other points of no*less importance; thus he states that the number and size of the uterine nerves vary at different periods of life; they are very small in young girls, larger at the aire of puberty, and again become very small in old women. He has likewise found by the examination of many wo- men who had died a short time after delivery, that these nerves really become larger and more numerous during the period of utero-gestation, as stated by Hunter.—Translator. CHAPTER SECOND. Critical observations appertaining to the history of the sym- y pathetic nerve. §. 45. The cephalic extremity of the intercostal nerve, has re- cently exercised the vigilance of anatomists. The Author* of a splendid work in the German Language^ describes the sympathetic nerve, as ascending from the cervical ganglion into the carotid canal. Then dividing into two branches anterior and posterior, which effect an anastomosis, through the medium of a plexiform ganglion : 1st With the deep seated vidian nerve. 2d. With the motor externus (6th pair.) 3d. With the common motor nerve of the eye (3d pair.) The author adds that some twigs are sent to thel cerebral carotid which are spent upon its tunics. RiBEst an adept in anatomical investigations, asserts the same thing, and moreover adds, that a ganglion is sometimes found upon the anterior communicating artery. That contained in the carotid canal, was first discovered by the dextrous Laumonier,J and ^ described under the name of the cavernous ganglion. || From this ganglion two small twigs extend to the third cerebral pair of nerves with which they are united, others are connected with the trunk of the superior and inferior maxillary nerves. These filaments 1 could never find, although I have seen the ganglion distinctly, of which they speak. But Rires, going still further^ in the elucidation of the nerves proceeding from the superior cervical ganglion, says he has seen after he had well washed the brain and vessels, a fasciculus ari- sing from the nervous involucrum of the carotid, which attend- * Bock, Beschreibung des funften Nervenpaars und seiner Verbindungen, mit andern Nerven, etc.; mit Kupfern, meissen, 1817, in fol. f Memoires de la societe medicale d'emulation, Tom. 8. part 2. p. 605. I This ganglion is denominated by the various names, ganglion of Laumo- nier, cavernous ganglion, carotid ganglion.—Translator. H Journal de rnedecine, chirurgic et pharmacie, par Bachcr, torn. 93. p. 205. & Memoires de la Societe medicale d emulation, vol. 7. p. 97. SYMPATHETIC NERVE 35 ed the opthalmic artery and all its ramifications and penetrated with the central artery of the retina into the interior of the eye. He adds moreover that the opthalmic ganglion receives a filament from the sympathetic nerve, whence arises the sympathy which exists between the retina, and the nerves of the iris. H. Cloquet, placing too much reliance * as it appears in the aforesaid observations, has in his excellent work delineated rami- fications of the sympathetic nerve to the orbit and interior of the eye, by which a communication is formed between the retina and the superior cervical ganglion. In the same way he admits a nervous anastomosis between that ganglion, and the opthalmic nerve of Willis or nasal nerve. (3. 46. It is not yet satisfactorily shown that any branches of the sympathetic nerve have been very recently discovered in the carotid canal. WiNSLowt long since recognised the existence of the carotic plexus, saying:—ce nerf (le grand sympathique) "des son entree dans le canal osseux, se divise en plusieurs filets plexiformes, qui environnent, l'artere carotide dans le meme passage, et en 1 accompagnent les courbures,' jusqu'a 1' entree dans le crane etc." * GirardiJ likewise asserts that the intercostal nerve is contain- ed in the carotid canal, divided into many very soft filaments which adhere to the carotid artery in its course. Two or three filaments he acknowledges as sent to the sixth pair of nerves, and others to the fifth pair. .Fontana has published a similar description. He admits three orders of branchlets distributed in the carotid canal and ap- pertaining to the sixth pair of cerebral nerves : some indeed surround this nerve under a form of soft membrane : some se- parate from, but placed near it, passt* the carotid artery: others adhere to it. Finally he found filaments accompanying the sixth * Traite d'anatomie descriptive torn. 2. p. 689, 690. f Exposition Anatomique, Traite des nerfs, $. 368. t Desgenettes, Precis d'une dissertation de M. Girardi, et des recherches de M. Fontana sur l'origine du nerf intercostal: Journal de Medecine, Chir. et Pharm. par, Bacher. torn 93. p. 53. 36 STRUCTURE of the pair of nerves, passing to the opthalmic nerve of Willis and the superior maxillary, to the tunics of the carotid artery, to the pituitary gland, and to the orbit ; and five small branches an- astomosing *with the vidian nerve. {$. 47. My dissections which 1 began a long time ago and have frequently repeated, have not confirmed the number of branch- lets described by the authors above. I have very frequently indeed discovered pellucid filaments of a gelatinous consistence connecting the Aliments of the sympathetic nerve with the motor oculi and other nerves; but when examined by the mi- croscope they cannot be considered as genuine nervous filaments. I then became dissatisfied with the mode adopted by those who by dint of washing, strove to evolve and make a discovery of nervous branchlets. For by this method the common cellular texture, is reduced into white shreds, which may bereadily mis- taken for nervous filaments. §. 48. I pass on to- another question, that of the nervous anas- tomosis lately detected in the tympanum. jACOBSONt the celebrated professor of Copenhagen, describes a nervous union between the fifth pair, the glosso-pharyngeal and sympathetic nerves. According to this author, the superfi- cial vidian or petrous nerve when received in the hiatus Fal- lopii, consists of three delicate filaments. The first, superior is joined to the facial nerve. The middle and inferior which are inclosed in their own canals, penetrate into the tympanum, and be- long to the aforesaid anastomosis. The former of these last, de- scends in a sulcus scooped out in the promontory. This in its course receives the other, or inferior small nerve. " It passes " through its own canal, to the promontory, and then through " a covered way to the branch indicated,' with which it is "united. Below this branch another appears, arising from " the deep seated branch of the sympathetic nerve, which pene- " trates into the cavity of the tympanum, over the tunic inves- ting the carotid canal, and through the osscus lamen, and * Tbid p. 56, 59. t Acta regiae Hocietaus Hafniensis Medicoe, Vol. 5. Hafnia:, 1.-18, p. 292. SYMPATHETIC NERVE. 37 " passes by a horizontal route in the promontory, to the trunk of " the pneumogastric, with which it is united. " The trunk thus formed in the promontory, descends, accom- " panicd by a small artery, and covered by the membrane, invcs- " ting the cavity of the tympanum. " It gives off a few branches ; the superior of which pass to " the membrane, closing the pelvis of the foramen ovale, another, " inferior, to the secondary membrane of the tympanum. Hav- " ing parted with these branches the trunk arrives at the interior " aperture of its canal, and descends through it to a small fossa "where it enters into the ganglion of the glosso-pharyngeal nerve."* This small fossa is nothing but a groove in the petrous bone to receive the smalt ganglion of the glosso-pharyngeal nerve ;— though it is called from this circumstance, receptaculum gan- glioli petrosi nervi glosso-pharyngei by Xlndcrschius,t which he says degenerates into a narrow canal, containing a small nerve continued into the organ of hearing. The discoverer :adds, that this anastomosis, 1st. is never de- ficient, 2d. that no anomalous arrangement ever supplies its place and 3d. that it exists in all animals. &. 49. Ribes,% started a doubt in regard to the true existence of these nerves, as discovered by Jacobson in the Tympanum. Whilst on the contrary H. Cloquet|| admits them, though he does not name their discoverer. He differs from him, nevertheless, in his description, as he says thurt the anastomotic branch of the sympathetic, penetrates through the small foramen of the aque- duct of Fallopius, formed in the tympanum. In a very recent work, F. H. Killian^ a sedulous investigator * A good idea of this minute, and intricate part of neurology may be derived from an inspection of the plate of the sympathetic, to which 1 have above al- luded; in that however the mode of description is reversed, this nerve being supposed to originate from the pneumogastric—Translalor. \ Fra so seldom deranged in diseases of the uterus and other inferior organs of the abdomen, between which there is no direct connexion.—Trumlator. SYMPATHETIC NERVE. 41 umbilicus, I have never seen, although it is described by the celebrated Chaussier. As to the omental plexuses, which are composed of branches following the right and left gastro-epiploic artery, I am inclined to believe that they appertain to the vessels, and not to the mem- brane itself, as Wrisberg* has declared; for if this were admitted, it would follow, that the peritoneum, which all physiologists consider insensible in a healthy condition, received many, though minute nerves, t On this subject, I agree in sentiment with Walter^ that the pleura, pericardium, peritoneum, and lymphatic vessels receive no nerves. Contrary to the opinion of many eminent men, that distinguished dissecter could discover no nerves terminating in the lymphatic glands; sometimes, indeed, the small conglobate glands were perforated with one or more filaments; but these passed out immediately, and terminated at some spot near, for which they were destined. § 54. Many nervous branchlets proceed from the ganglia di- rectly to other parts, beside the vessels and viscera. Many go to the voluntary muscles, viz: to the longus colli, to the inter- costals, according to Walter, and to the diaphragm. Some filaments are spent in the vertebral ligaments, especially in the lumbar region; others following the ramifications of the vessels appear to enter the bodies of the vertebrae themselves. § 55. It behoves us now, to consider more carefully the re- lation which exists between the nerves and the vessels. * De nervis viscerum abdominalium.}. 10. Comment. Goetting. vol. XV. p. 16. f It is now universally admitted that the nervous filaments accompany the ramification of the arteries, which in the opinion of many physiologists Rudolphi, Ribes, etc. do not reach the serous membrane. This membrane is considered a thin facing, composed of condensed cellular tissue, (a sort of inter- nal epidermis) which is nourished by a kind of imbibition from the vessels of the adjacent parts. When highly and suddenly inflamed, blood vessels and perhaps nerves are extended into it, as lymph is secreted abundantly from its inner surface, and intense pain is developed. The rapidity with which many injuries involving the peritoneum, is repaired by the effusion of lymph, is a matter of general notoriety; the intestines were found by Sir E. Home, complete- fully glued to the parietal peritoneum, in eight hours by lymph, in which he was able to inject the vessels, and Serres has satisfactorily shown, that the primitive developement of nerves is from .their capillary extremities towards the cen- tre.—Translator. t Tabulae nervorum thoracis et abdominies in prsetione. 42 structure of the The lymphatic vessels and sanguineous veins receive no nerves, with the exception of the branches of the vena portarum, the pulmonary vein near the heart, and the jugular vein, accord- ing to Murray*; I have found the nerves of the arteries dis- posed of in three ways. 1st. The nervous branchlets, at first surround the larger arteries but without adhering to them. Thus the vertebral artery at its origin, is encompassed by many small branches, emerging from the cardiac plexus; but these branchlets are placed so close together, that they seem to constitute an investing membrane to the artery. Wrisberg! incorrectly enumerates this condition of the nerves around the vertebral artery, with the ordinary plex- uses. In the same way the facial arteries are surrounded by nerves, but nevertheless, some fine filaments are spent upon the parietes of their trunks. 2d. On the other hand the relation is different in nearly all the arterial branches which the nerves of the ganglia attend. For many plexuses not only bind and embrace the arteries, as the ivy does the trunk of a tree, but becoming enlarged in their tunics, penetrate into the organs with these vessels, become soft and apparently pulpy, and vanish in the cellular texture of the artery, or at least disappear to the unassisted eye. The sagacious Lucje % observed that there was no diversity among the greater and smaller arteries in respect to the connex- ion between the nerves and vessels, which my observations likewise enable me to confirm. When the nerves are examined with the microscope, an agreeable spectacle is presented to the eyes. For the ultimate filaments of the nerves, running to the arteries, split into nume- rous fibres which are closely applied together, and form a cellular network, that almost entirely surrounds the arteries. Thence it is * Observat. anat. de infundib, caus. et variet. quibusd. in part, cervic. nerr. intercost. Ludwig, script, nevrolog. min. t. 2. p. 247. f Observationes, Anatomicae quaedam circa nervos arterias adeuntes et comitantes, Francof ad Moenum, 1810; in 4 ; $. IX. page 26. J Comment, de nervis'arterias venasque coraitantibus, 5 30. Syllog. Comment. anat. Goetting. 1786, in 4 , pag. 64. SYMPATHETIC NERVE. 43 that white streaks are seen in it which have a direction like the branches of a birch tree, and are formed evidently from a ner- vous branchlet. I have very frequently examined the ramifica- tions of the nervi molles which attend the branches of the exter- nal carotid artery, and seen the aforesaid observation confirmed. The cellular texture investing the lingual, external maxillary and other arteries, when examined by a microscope of the power of sixty, was nothing but a nervous network, in which the white coloured streaks run in the manner described, and differing wholly from common cellular membrane, [such, for instance as invests the sterno-hyoid muscle.] In a foetus of seven months I followed a soft branchlet arising from the superior cervical ganglion, which extended to the external carotid, by the aid of a microscope into the cellular texture of the artery, and saw it divided into seven fasciculi or white medullary streaks. What shall I say ? The cellular texture which invests the filaments of nerves and is interposed between them, exhibits to the microscope innumerable nervous fibrilli. Hence from the result of experi- ments Imay pronounce without fear of error, that there is a ner- vous cellular texture given to the arteries chiefly, and to the nervous filaments themselves, separate, and entirely different from the common cellular texture as it exhibits longitudinal fibres running in a right line, and too minute for examination. 3d. It became afterwards a question, whether all the nerves disappeared in the cellular coat of these arteries, or whether there were not some which perforated these vessels, and insinuated themselves into their substance. "It has never yet been shown" says Behrends,* "thatthe ner- vous filaments have passed into the substance of the arteries, I have however seen two small nerves arising on the right side from the superficial cardiac (which nerve receives an increase from the middle cervical ganglion) perforating the external coat of the aorta at its arch, before the origin of the arteria innominata and which were exhausted in the middle or fibrous coat; and in * Dissertatio inauguralis, qua dcmonstratur cor nervis carerc. p. 31. 44 STRUCTURE OF THE the body of a foetus at full time, I discovered very plainly and de- monstrated to others, a small branch perforating the cellular membrane of the aorta, near the origin of the left subclavian ar- tery, which was consumed in its fibrous coat. Walter,* like- wise speaks of branches passing into the same tunic, although he considered it muscular. Finally Lucas, who has already been cited, has lately described and exhibited in a plate many fila- ments to the middle coat of the brachial artery. § 56. When we attentively consider the distribution of the sympathetic nerve, we perceive a difference deserving of notice, between the exterior or communicating branches, and the inte- rior branches which go to the organs. The first never encompass the arterial vessels, though they oc- casionally attend them. Many of them are found without accom- panying arteries. I have never seen the arterial branches at- tended with anastomotic filaments from the cervical and dorsal nerves, etc. (Here we do not allude to the nutritive vessels of the nerves.) These anastomosing nerves, are never minutely subdivided before they inosculate with the intercostal nerve. The latter, on the contrary, give off branches to the organs which according to the common law accompany and embrace the arteries with their meshes, and adhere to their parietes, whence it is, that some very distinguished men have believed, that the sympathetic nerve is fabricated for the use of the arteries, and have designated it by the name of vascular nerve. The former always have the same character. They vary, in- deed, as to length and tenuity; but their internal structure seems to remain the same, as they possess the same colour and density wherever they are examined, in the cervical, dorsal, lumbar or sacral region. Let us consider on the other hand, the branches emitted to the organs; how variable is their character and arrangement. In the carotid canal some slender red filaments are found, flat, rather than cylindrical. * Loco citato. SYMPATHETIC NERVE. 45 In the neck there exist first, some thick, red, soft, succulent, and almost pellucid branches, which are succeeded by white and slender filaments. In the cavity of the chest, the branches preserve a similar cha- racter and condition. But how great is the diversity in the abdomen in regard to the nature of the plexuses, and their relation to the vessels! I have been taught by an attentive examination of the abdominal nerves, that there is a diversity in every plexus, arising from the semi- lunar ganglia. The gastric plexus differs from the hepatic; for its branches are white, shining, firm, and conical. Those of the last are more red, succulent, and cylindrical. The splenic plexus agrees more with the gastric. The branch- lets of these plexuses indeed, envelope the arteries, but without closely adhering to them. The contrary is observed in the superior mesenteric plexus; the filaments of which adhere so tenaciously to the trunk, and ' the larger branches given off from it, that we cannot without some force pull them asunder; the small branches are likewise so in- terconnected, that they rather constitute a nervous membrane, as there is a distinct network in the places between them. The inferior mesenteric plexus adheres less often to its subja- cent artery. But it may be observed generally, respecting these plexuses, that the nervous branches are united closely to the trunks only, and the beginning or origin of the branches: to the smaller branches they adhere more loosely, or rather run parallel with them. A great difference exists also between the mesenteric plexuses, and the renal plexus, which corresponds with the hepatic in this; that its branches are thicker, more succulent, red, and not unfre- quently mixed with ganglia, which I have never observed in the splenic and mesenteric plexuses. The hypogastric plexus in fine appears to me of all the most dry and firm, particularly where the roots assemble from either side, to form a broad trunk, placed in the middle of the sacrum. 46 STRUCTURE OF THE § 57. The ganglia themselves are not every where of the same nature. In each region there is a principal one: in the neck, viz. the superior cervical: in the thorax, the first thoracic: in the abdomen, the semilunar ganglion. These three ganglia differ very much among themselves in regard to figure and density. The superior cervical ganglion is longer and softer than the rest, and exceeds them in redness. The first thoracic ganglion, is found harder and less red than the preceding. The semilunar ganglion is the densest of all; and in variability of figure is different from the rest. At one time it is observed perforated with foramina, at another divided into secondary ganglia, and again, and indeed most frequently, expanded into a plexus, remarkable for its thick branches. Other dissimilarities to be found in their internal structure I shall indicate below. CHAPTER THIRD. Of the Evolution of the Sympathetic Nerve in the Foetus. § 58. In an embryo of fourteen weeks, three inches long, I have found the trunk of the intercostal nerve to be quite conspi- cuous. In the cavity of the chest, it was, in some measure, thick and red, as the thoracic ganglia were placed very near each other. The superior cervical ganglion was well formed—two lines and a half in length, and half a line in diameter. The greater splanchnic nerve formed a very slender thread: the semilunar ganglia were very obscure. ^ 59. A male embryo of five months, six inches long, afford- ed a very distinct view of the trunk of the sympathetic: it formed an uninterrupted cord from the base of the head to the pelvis. The superior cervical ganglion was rounder, that is, less flat than in the adult; it was three lines long and one thick. The greater splanchnic nerve, distinct, though very slender, had three roots. The right semilunar ganglion, which was small and inconspi- cuous, compared with the superior cervical, was neither branch- ing nor round; but obscure, shrivelled, and scarcely half a line long: it adhered to the neighbouring parts; capsular renalis, ves- sels, &c. The second and third cervical ganglia were not visible. I know not whether they were deficient originally in that case, but they were certainly not yet formed. The thoracic ganglia, except the first, formed small nodes about half a line in diameter. § 60. In an embryo of six months, the superior cervical gang- lion, was five lines long, one line broad, and of a red hue; it gave off some slender filaments, but not soft and semi-pellucid, as in the adult, and much less thick. The third cervical ganglion was one line long, and sent off two very delicate branches for the for- mation of the cardiac plexus. 48 STRUCTURE OF THE The first thoracic ganglion, a line and a half broad, and three lines long, was red, and contributed four filaments to the cardiac plexus. The trunk of the sympathetic nerve formed a firm cord in the neck, the third of a line in thickness. In the chest this trunk appeared thick, succulent, and flat, on account of the tho- racic ganglia being a little elongated, and approximating each other very closely. In the intervals of the ganglia, the trunk of the sympathetic nerve was two thirds of a line thick. The splanchnic nerve, firm, though slender, had three roots. It ter- minated in the right semilunar ganglion, which was a little elon- gated, and increased by vessels to half a line in thickness. The renal nerve was very distinct. § 61. A male foetus of seven months, weighing three pounds, sixteen inches long, supplied me with the following facts, which deserve to be noticed. The first cervical ganglion, was eight lines long, and one and a third of a line in thickness: a soft red branch, half a line thick, proceeded from it to the external carotid artery. The middle cervical ganglion, a line and a half long, and two thirds of a line in diameter, gave off the principal cardiac nerve. The last cervical ganglion, which was situated very near the first thoracic, semi-pellucid and half a line thick and one long, sent off a delicate filament to the oesophagus. The cervical portion of the sympathetic nerve, was in general large and red, and if I may so speak, well expressed. The thoracic ganglia were so near together, as to form a broad nervous trunk. But they were whiter than the cervical, and as shining as aponeurotic fibres. The greater splanchnic nerve arose plainly by three roots, from the eighth, ninth, and tenth thoracic ganglia, and termi- nated in the round semilunar ganglion, a line in diameter. In the pelvis, also, the trunk of the sympathetic nerve, as well as the lumbar ganglia, appeared red. I will state in passing, that this foetus which was born of a phthisical mother presented a singular spectacle; after seven hours of existence, protracted with respiration and cries, the SYMPATHETIC NERVE. 49 lungs were still so dense, that when divided in small pieces, they sunk in water; did not crepitate when handled and dissected, nor could a bubble of air be detected in the bronchial vesicles, by the microscope. My surprise was increased when I saw all the frag- ments of the lungs, which had been thrown into water with the liver and spleen, and sunk with them to the bottom, floating nine hours afterwards upon the surface, while the abdominal organs remained below. § 62. In a foetus of eight months, I found the superior cervi- cal ganglion, five lines long, one and a half broad, red and con- sistent; and the middle cervical ganglion, one line broad and red. The intercostal nerve in the lumbar region, was one line broad, red, and formed as it were, a very long ganglion. The greater splanchnic nerve, which was distinct but slender, terminated in the less perfect semilunar ganglion. The superior cervical ganglion, gave out the laryngeal nerve on the left side in that subject, but not upon the right. § 63. A foetus at full time afforded me the following account of the distribution of the intercostal nerve. Four white and slender filaments, but not soft, proceeded from the superior cervical ganglion, which was eight lines long and one and a half thick, to the branches of the external carotid: a fifth filament descended in the direction of the thyroid gland, and was spent in the crico-thyroid muscle. The inferior cervical ganglia did not exist. The thoracic ganglia, twelve in number were well formed. The first was united to the second, and then presented a longi- tudinal diameter, of five lines and a half. The diameters of the remainder averaged a line: they had a reddish colour, and nearly all received two anastomosing branches from the costal nerves. '* ' The trunk of the intercostal nerve was a third of a line thick, in the intervals of the ganglia, and showed no interruption between its thoracic and abdominal portions. There were four lumbar ganglia, of which the second was a line and a half more in diame- ter than the rest. Two sacral ganglia only were to be found. The intercostal trunk, near the sacral foramina, was connected G 50 STRUCTURE OF THE with the nerves by the aid of delicate filaments, without any in- termediate enlargements: This nerve was finally connected at the superior part of the os-coccygis, by a minute filament in anas- tomosis with the nerve of the other side: the coccygeal ganglion did not exist. Four filaments arose from the thoracic ganglia, which attended the intercostal arteries and terminated upon the aorta. The greater splanchnic nerve of the right side, arose by four roots from the seventh, ninth, tenth and eleventh ganglia : the left had three roots only. The lesser splanchnic nerve proceeded by a single root from the twelfth ganglion. The semilunar ganglia were small, compared with the other ganglia of the sympathetic nerve. Upon the left side of the same foetus I also found a branchlet from the superior cervical ganglion, which terminated in the crico-thyroid muscles, after having given off filaments to the thyroid gland. §. 64. It follows from the aforesaid observations, that in the embryo the sympathetic nerve is found distinct; that the trunk included in the cavity of the chest is thicker than its due pro- portion, in consequence of the ganglia being located so near to- gether : that the ganglia are perfect, particularly those with which the trunk itself is marked ; that these ganglia are of the usual colour ; that they are apparently longer and more developed in the foetus than in the adult, with the exception of the semilunar ganglion which is not evolved to the same extent as the rest, but becomes by its growth important, compared with the other parts of the ganglionic system; from which in respect to physiology it will follow, that the functions of the abdominal organs, are either previously more feeble, or act with less energy than the other viscera of the embryo. §. 65. It is worth our while to enquire how the sympathetic nerve is constituted in foetal monsters. I have learned in investigating this subject, that this nerve is well formed in all its parts, provided the foetuses do not differ too SYMPATHETIC NERVE. 51 much from the human form. Thus in a full grown acranial foetus with a double hare lip, the two sympathetic nerves were complete in all their parts. I observed the same in a male foetus of eight months, destitute of cranium and brain, the cere- bral nerves of which were well formed, and adhered to the dura mater investing the base of the cranium. §. 66. Another male foetus, of nearly eight months gestation a foot and six lines long, exhibited the following, deserving of notice. In place of cranium, there was a remarkable sac hanging back- wards, which when cut, presented beside a particular substance, (which was perhaps cerebral and was almost fluid) a fungous ex- crescence, seven lines in length situated upon the sella turcica. There was no christa galli: the left part of the nares was defi- cient, but in its place there was a proboscis as it were eight lines long and four broad, formed solely of the skin and cellular tex- ture, pendulous from the root of the nose, and perforated by a canal which had its termination under the cribriform lamina of the ethmoid bone. There was no vestige of eyes, muscles or nerves ; the orbits indeed existed, but they were closed by the palpebrae and filled with cellular tissue. The lingual branch of the inferior maxillary nerve, and the hypoglossal nerve were deficient, but the sympathetic nerve which was larger than usual, supplied the tongue and its muscles with branches from the su- perior cervical ganglion : nevertheless the distribution of the great intercostal nerve was wn for learning and integrity to allow us to believe that t'icy would hazard such heterodox opinions, wholly without oundation. Whatever truth there is in this ubs- ure subject, it is both interesting an:! important to the devotee of mer'ical science, that it should be made known, and ii it be entirely a fiction, it is quite as necessary that it should be exploded. Electro-magnetism is in itself as displayed in Physics, a subject capable of exciting the greatest curiosity, and of eilecting very surprising re- sul.s. JSot the least singular of the circumstances attending it, is the procuc- tion of an analogous agent in living animals, as in the Electric Fay, (haja tor- pedo) Electric E^i, (Gymnotus eledrkus,) fcilurus e/ectricus, TetroJon electricus, and Trichurus indicus. From these animals, this peculiar principle is discharged much in the same manner as electricity, and from some of them, in - uch power, as tj have caused the destruction of human life, it is produced by a peculiar or^an called th electric,into which a great many nerves are seen to proceed, and from which the singular agent is conveyed by the nerves. Scf.m.merijsg. found the effects of its action was always proportioned to the energy of the vital power and that the interposition of electric nonconductors greatly weakened its action and that the section of the nerves of the organ completely destroyed the faculty. The electric organs are differently situated in the various animals, and present the appearance of numerous strata, cells and prisms, of tendinous partitions, filled with a gelatinous fluid, and, covered in beside the common integuments with a distinct sheath. The number of the cells, of which these organs are in- ternally composed, increase with age, so that Hinter counted 411) in a small animal, (Electric fray) and 1180 in a large one. The blood vessels which run to these organs are very few ; the nerves are of extraordinary size, as well as in great numb3r. Rudoi.phi, found in th>s animal three large branches pro- ceeding to their organs, one from the fifth pair, and two from the par vasum, which also formed plexuses surrounding the vessels of the org in. In the G) m- notus, he counted 224 intercostal nerves, which entered the inner side of the organ from one extremity to the other, inosculating with each other, and with branches from the fifth pair and par vagum. He thought he could discover in the organs of these two animals some resemblance to the voltaic pile in one, and to the trough galvanic apparatus in the other. Considering the number of the nerves and the dependence of this phenome- non upon their activity it is says Carus at least not improbable that the nervous power accumulates in the cells of these organs, whence it can be vo- luntarily discharged, in the same manner that it is capable of being collected in muscles, in order to produce their contraction. It is perhaps unnecessary to occupy much space with these observations,but it appears to me important, that this abundant evolution of electric or some analogous power in liv.ng animals, should meet from some able hand with further illustration, inasmuch as Wil- son Philip, has been able to supply, in all respects in many of the organs, the absence of nervous influence with galvanism; and as it would seem:ijht to take a comprehensive view in deciding upon this obscure subject, even when it seems as in the text, to transcend the bounds of all sober probability.—Trans. SYMPATHETIC NERVE. 103 6th. The sympathetic nerve, then presides over all the ac- tions, which occur in the recesses of the abdominal organs. It imparts power, tone, strength, energy to these organs; ex- cites, sustains and directs their functions: and on the contra- ry when it is abnormally affected, disturbs them. Physiologists admit a continuous nervous influx into the chy- lopoietic viscera, and which they consider it perpetual in the func- tions appropriated to nutrition; whilst on the contrary they ac- knowledge a continual alternation in the actions which belong to the sphere of the cephalic nervous system. How this discrimination can be correctly established, I am truly ignorant. For if the external senses, when fatigued, re- cover their power during sleep, and return to their pristine de- gree of activity; the same holds with the internal organs which are not under the government of the will. The stomach can not continually and uninterruptedly digest food: it requires repose be- fore it is again called into action. Hunger itself does not depend upon the vacuity of the stomach solely; it is an unpleasant sen- sation, which most frequently returns at a certain and definite period. As the organs of the senses, are capable of being edu- cated and rendered more or less perfect; so the stomach by well directed diet and regimen, is invigorated, and has its di- gestive powers enhanced. The vital properties of the gastric organs, seem moreover de- bilitated at certain periods, as they appear different at one period from what they do at another. Thus the great mass of mankind are not able to eat the same articles of food in the evening, which they take without inconvenience at mid-day. On the other hand, a perfect intermission of the nutritive func- tions may be observed for a notable period in the different stages of life. The digestive viscera and the kidneys are quiescent in the foetus; and the organs of generation receive neither increase nor evolution. The spermatic and uterine nerves which are given off from the sympathetic, seem to have acquired no power during the course of many years. The venereal passion returns periodically in quadrupeds, al- 104 STRUCTURE OF THE though the uterus, ovaries, testes, etc, of these animals, receive their branches from the nervous system of the ganglia. If to these it be added, that respiration and the circulation of the blood are suppressed for many months in hybernating animals, it will certainly be admitted that the actions which depend upon the sympathetic nerve, are in some measure periodical. III. It yet remains for me to attempt to explain the mechan- ism by which the functions of the sympathetic nerve are per- formed. But it is not to be expected that I can clearly and completely elucidate a subject which is involved in the greatest obscurity. For the question, in respect to the manner in which the nervous apparatus of the ganglia acts, should belong rather to a comprehensive dissertation upon the action of the whole nervous system, which, it is agreed by all, is one of the most difficult of subjects, and affords nothing but conjectures and hypo- thesis. The theory of the dependence of the nervous fluid upon the vibrations and oscillations of the nerves, etc. is completely overthrown; nor does there exist any, entirely capable of ex- plaining the action of the nervous system. It is true, nevertheless, that the nerves are merely conductors of some very mobile, though material principle, which is secreted in their funicles from the arterial blood, during the act of nutri- tion, or chemico-vital process; not, however, that it emanates from a particular source, like blood from the ventricles of the heart, although in the encephalon, medulla spinalis, and ganglia, it is produced in greater quantity, proportionate to their greater supply of vessels.^ The same principle in a kind of halitus or vapour, I suspect, pervades the nervous filaments, and constitutes * Though as most physiologists admit, the nervous centres constitute the great source of nervous influence, yet as the nervous cords themselves are, propor- tionally to their size, as well supplied with blood, the material from which it is produced, the latter are said to be also capable of its production, though to such a limited extent, as to make them in general the mere agent of the central masses. For if a nerve is irritaled, it will by its own influence at once excite its peculiar functions in the part to which it runs, in cases, where the irritation of the nervous centre, fiom its disease or injury would 1:0 longer produce that result. M. Broussais has even gone so far as to asseit that the nerves are every where provided with their peculiar properties which they do not borrow from the brain, and that they only communicate with this centre, in order to form a correspondence between the organs.—Translator. SYMPATHETIC NERVE. 105 a peculiar imponderable nervous gas, which cannot be assimi- lated to any fluid, either electric or magnetic, but forms a ner- vous atmosphere about the nerves and muscles, as was proved from experiments by the celebrated Humboldt.* This gas, I believe, is conducted into the intimate structure of the organs, is mixed with the deepest seated of the fluids, and, although the filaments which are placed upon the branches of the vessels, ter- minate or disappear from the view, yet this vapour, in my own opinion at least, is effused into the cellular texture, penetrates to every point of the organs, and, if I be allowed the expression, fills them with its own atmosphere. This vital nervous halitus or va- pour is likewise introduced into the bodies of the vertebrae by ner- vous filaments, which I have myself, traced into those parts. The reasons which induce me to admit a peculiar gas in the nerves, arise from the multifarious phenomena that occur in the sound and diseased states of the body. A. 1st. In regard to the former, (the sound state) I think that all vital turgescence may be considered as arising chiefly from a psychological cause. The sudden redness of the face, arising from mental excitement, does not certainly depend upon a gene- ral affection of the nervous and sanguineous systems, but upon a topical action of the nerves. The capillary vessels of the skin are here suddenly dilated; the blood is expanded to a volume and extent greater in proportion to the nervous principle mixed with it, and which produces the same effect upon it as caloric in boiling water. The same phenomenon occurs in the turgescence or erection of the genital organs, which is rapidly and often solely by the power of the imagination produced, as it cannot be ex- plained either by spasm, or by the additional arrival of blood from an increased action of the heart. Hence it is manifest why the remarkable nervous branches accompany the deep seated cavernous arteries of the penis; a fact which may readily be ob- served, not in man only, but likewise in quadrupeds, and espe- cially in the horse, t * L.C.p,82,83,84,87; fig. 36,37. „,.,.„ « , t Tiedeman, in Meckel'sdeutschem Archiv. fur die Physiologic, 2 ter Band p. 200. O 106 STRUCTURE OF THE 2d. The gross and brawny states of body, peculiar to certain men, are not always produced by the adipose matter which fills the cellular texture, nor by sanguineous plethora, but by some subtle matter which pervades and distends the parenchyma of the organs. Hence it may happen that these men, speedily, and even in the space of twenty-four hours, assume an emaciated appearance, without the loss of either fluids or adeps. This likewise is the reason why infants and adolescents are more brawny than the old, because in them the impelling power which is produced from the energy of the nervous system is more vigorous. 3d. When experiments are performed upon living animals, we find very frequently that their parts sustain a notable tur- gescence, and a distinct crepitation is heard under the edge of the scalpel. This phenomenon, which is not found to exist in the cadaver, cannot certainly be derived from the atmospheric air; it depends upon an aerial fluid, which is evolved from the nervous parts disordered by the excruciating suffering. In the bodies of animals nearly dead from canine madness, the same phenomenon may be observed, the fluids and fleshy parts of which abound with gas before the action of putrefaction commences.* B. But the chief part of the perceptible phenomena, which ap- pear to manifest the power and importance of the nervous ha- litus, are to be found in the state of disease. In inflammatory diseases arising from a phlogistic diathesis, the pulse is full and hard; the veins grow turgid; the heat of the body increases: can any one believe that the mass of fluids, and the store of blood is suddenly increased ? Certainly not: But the blood, which receives no additional supply from the focus of nutri- tion, is dilated, expanded, acquires a greater capacity from the nervous principle interposed between its globules, intestinal and livelier motions are excited in it, which are sustained as it were by a latent fire, and which may be compared to the movements that * Andry. mem.de la Societe royale de medecine ann. 1776. p. 113. SYMPATHETIC NERVE. 107 occur in boiling water. All Physiologists know that the blood in inflammatory diseases, is endowed with greater vitality, and is fitter for the preparation of new organic parts (which is mani- fested by the pseudo-membranes, formed of the fibrous part of the blood, and exhibiting new sanguineous vessels in the space of twenty-nine hours.) And why? Because no doubt, that most important principle which is elaborated by the nerves, and there- fore emanates from the highest fount of vitality, is intermingled with it. I have no doubt but that the nerves when excited to increased action, evolve a greater quantity of nervous gas; that they are pregnant as it were with this principle, and which they effuse afterwards into the parts over which they preside. This opinion I think will enable us better to understand why the nervous ramifications constantly run to the arteries, and em- brace and accompany them in every direction. It is by no means equally clear, that they transmit the mandates of the will to the arteries, or that they convey the impressions which arise in the network of capillary vessels to the sensorium: but they no doubt serve to impart tone, strength and energy to the parietes of the vessels, and the nervous principle to the blood. The ob- servations of Harvey, Bohn, Glisson, Albinus, and Wilson,* upon the molecular mqvement of the blood, confirm my opinion; as well as the experiments of G. R. Treviranus,! in relation to the influence of the nerves in this motion of the blood, and the microscopical observations of Rosa,j upon the aerial fluid in which the sanguineous globules swim. I have therefore framed for myself the following theory, not only of inflammation, but also of acute febrile diseases generally. No pernicious influences can in any other way reach the or- ganism, than by the medium of the nerves. These when sub- jected to morbid impressions, are so instantaneously affected that they give rise to spasms, which are manifested by shivering. * An enquiry intojthe moving power employed in the circulation of the blood. London 1774. t Biologic 4 ter. band. p. 646. Vermischte Schnften anatomischen und phy- siologischen inhalts 1 ster. Band. p. 99. t Lettere Sopra alcune curiosita fisiologiche. Lapoli, 1788. 103 STRUCTURE OF THE Hence a chill is the first and a constant symptom of fever. But this affection or derangement of the nerves prepares a reaction, Which speedily ensues, and increases, not only the volume, but also the irritating property of the blood. Then the heart and ar- terial system are excited to quicker actions; the chemico-vital processes become more rapid: a burning heat invades the body; the organic forces are raised to a greater degree of activity; the functions are disturbed; and all the actions of the organism are per- formed with the greatest impetus. The whole of this state in my opinion depends upon a nervous plethora, that is, a nervous gas, Collected and accumulated in the nervous filaments, and from thence making an irruption into the parenchyma of the organs, and into the fluids themselves, until it is discharged by the emunctories to the great relief of the sick. When for in- stance we open a vein in inflammatory diseases, drowsy symptoms are frequently found to occur, and the anomalous actions are sud- denly restored to a more natural condition, in consequence chiefly, that with the loss of blood, the principle is withdrawn that forced the vital fluid, as it were into effervescence, and because a two- fold detraction is effected by this operation; to wit, of the nervous and sanguineous fluids. In other cases, the nervous influence extends to the capillary vessels, of the natural excernents: hence it is that the organs for cutaneous transpiration and pulmonary exhalation, are set exuberantly into action by the nervous principle. The mode is here evident, by which diseases may become contagious: name- ly, the organism elaborates, and through the medium of nervous action, evolves the noxious miasm. This consists of an impon- derable matter, analagous to the nervous gas itself, from which it probably emanates. This being admitted, w*e shall no longer- marvel, that any animal miasm immediately affects the nervous system, as by that only it can be perceived, and upon which alone it can make an impression. It was indeed formed from, and has an affinity with the same nervous principle: it has a ten- dency to return to the place from whence it was produced. I believe therefore that in all contagious fevers, the nervous system SYMPATHETIC nerve. 109 is always the first affected, the perverted action of which is con- spicuous over that of the rest, and imparts to the fluid with which it escapes, a depraved imponderable character, which takes place in the following manner in these diseases: 1st. It escapes with, and is thus mingled with the cutaneous and pulmonary exhalations in ataxic or adynamic fevers: 2d. It is united with the blood in malignant fevers, which it expands and sometimes forces into the cellular texture, forming petechiae and ecchymosis; and sometimes the blood is eliminated by the exhalent vessels, pro- ducing hemorrhages which no skill can stop. 3d. It occasionally is retained in the rete mucosum of Malpighi, destined for the protection of the nervous papillae, and elevates the epidermis into chrystalline vesicles called miliary, which are more often filled with gaseous than serous fluid. On the other hand, there are various idiopathic affections of the nerves, of the spasmodic kind, in which this gaseous fluid is evolved in abundance. This class consists of the hypochondriac and hysteric affections, angina pectoris, nervous apoplexy, etc. I receive it as fixed, that in the paroxysms of these diseases, the nervous pulp is saturated with the peculiar principle it bears, the mode of action of which is such, that when it is rapidly added to the secreted humours, it escapes from the body as the patient recovers, or with his destruction if the nervous fluid is mingled with the blood. Every one knows that the paroxysms of hypo- chondriasis and hysteria, angina pectoris, etc. are dissolved by a copious eructation of flatus, whilst in the species of apoplexy re- ferred to, aerial bubbles have been found enclosed in the vessels of the brain.* Hence it is unusual to meet with a neuralgic af- fection of the nervous system, and especially of the sympathetic or pneumogastrict nerves, in which there is not an extrication of aerial fluid or true pneumatosis. * JIorgagni,TL\pisi. anat. 3, No. 17; Epist. 59, No. 18. Fabricius,acta na- tura3 curiosorum, vol. x. p. 117. jP. Zuliana, de apoplex. prassert. nervea. comment.} 26. Portal, obs. sur la nat. et le traite de Fapopl. p. 288. f The exact limits of the office which the par vagum performs in the human system has not yet been satisfactorily decided. It sends branches to many or- gans so entirely different in their functions, as the muscles of the larynx, lungs, 110 STRUCTURE OF THE Now to return to my subject, I consider there is residing in the nervous filaments, a- subtle, imponderable, cogent matter, analagous to the magnetic or electro-galvanic fluid, and which is secreted and transmitted by the nervous pulp, constituting the sole active principle that resides in the nerves. I admit that this very mobile substance, which possesses the highest degree of importance, forms a nervous atmosphere about the trunks and branches of the nerves as well as the muscular structure, as was first announced by the sagacious genius of Reil, prior to the ex- periments of Humboldt* and ALDixi,t which were made with the greatest care, and completely established its existence, and also that it was endowed with the property of sensibility; that is, with the faculty of perceiving a stimulus, and by the aid of the or- gans from which it emanated, of reacting against it. I consider that this nervous atmosphere, which an ingenious physiologist has denominated organic ether,! by sweeping through the or- gans, draws them under the dominion of the nerves; and I assert upon anatomical grounds, that it is eft'used into the humours of the body, and even into the blood itself, to which it gives a cha- racter of vitality. To the action of this organic ether, I attri- heart, and stomach, that it is difficult to believe they are endowed with no other properties than those of the other encephalo-spinal nerves, that of com- municating, sensation and motion; neither of which in their more ordinary de- velopment, can be said to exist in the heart and stomach. It is likewise diffi- cult to believe in opposition to many of the most distinguished physiologists, that it is a dispenser of the organic nervous influence, an office which by Bichat, Gall, Reil, and Broussais, is said to belong solely to the great sympathetic nervous system. M. Brachet has asserted (an opinion in which he seems to be borne out by the result of many experiments by different persons) that the par vagum in these organs, merely presides over the sensations which are located in tne interior organs, such as the want of respiration, hunger, thirst, etc., as the nerves of the lower part of the spinal marrow, over the organs of urination, and defecation; the sympathetic maintaining the organic actions of the parts. M. Gall asserts, that many of the nerves usually considered as sent from the par vagum to these organs, belong properly to the sympathetic. The intimate connection between these nerves in the neck and thorax, has already been de- scribed, and their direct communication in the epigastrium so emphatically depicted by M. Lobstein, seems in further corroboration of these opinions. It seems, therefore, that we are obliged to admit, either that part of the structure of the par vagum, is composed of filaments from the sympathetic, or that UVt nerve holds a middle station in function between the two grand divisions of the nervous system.—Translator. * Place last cited. Essais theoriifu.es etpractique sur legalvanisme; torn. I,p. 13,15,86, Eschenmayer, Professor at Tubingen. SYMPATHETIC NERVE. Ill bute the phenomena perceived in the healthy and diseased states, the chief of which I have already indicated. This terminates what I have to say in regard to the mode or mechanism, in which the sympathetic nerve displays its peculiar properties, and performs its functions. If any one is disposed to deny the existence of the nervous ether, because a ligature placed upon the nerves induces a para- lysis in the parts below where it is tied, let him consider, that this operation effects an alteration in the nervous pulp, and ex- cites a commotion in the nervous funicle, by which its power is lost Here the same phenomenon takes place in the nerves, as we see occur in experiments in physics, in regard to the motion of the magnetic fluid. A simple blow, applied in a particular way upon the iron conductor, annihilates at once the magnetic influence which it had before possessed. SECTION THIRD. PATHOLOGICAL. §111. Having described the healthy condition of the sympa- thetic nerve, it is but a natural transition to proceed to the study of its diseases. For in the morbid affections of the body, the vital energy is generally deranged, and the organic structure like- wise more or less impaired: hence, as is proved by numerous ex- amples, physiology is closely allied to pathology, or rather, these two branches of medical science are closely linked together. § 112. It was long suspected by physicians, that the ganglionic system of nerves was affected, in the nervous diseases of the ab- domen, and that especially in hypochondriasis and hysteria the nerves of the abdomen were subjected to some alteration. This suspicion is now confirmed, and it is established as a pathological dogma, that these diseases are to be referred to a pure and sim- ple neuralgia of the abdominal nerves. This certainly is not the place, to furnish a graphic description of the diseases which are produced by the affection of the system of abdominal nerves; it will be well, however, to advert to their leading symptoms, in order better to illustrate the perverted ac- tion of the nerves. § 113. I will commence with hypochondriasis which is gradu- ally established under a continued and hidden depression of mind, with sadness and the corroding effects of silent grief, until it finally bursts out in spasmodic symptoms, with deceptive ve- hemence. All the symptoms of this disease, certainly demonstrate that it is of a spasmodic character, and evince a morbid condition of the ganglionic system of nerves. The remarkable sensation of pressure in the praecordia, after taking food; the difficult digestion of food accompanied by a development of flatus, anxiety without any disorder of respiration, palpitations of the heart, vertigo, tremors of the joints &c., are phenomena which can only have ■ their seat in the diseased nerves of the abdominal viscera. The SYMPATHETIC NERVE. 113 vital actions of the gastric organs, which give rise to no dis- agreeable sensation, and of which we have even no perception in the state of health, now make an unusual impression on the brain, from which the mind necessarily forms a mistaken opinion in relation to the vital processes going on in the abdomen. Hence it is, that impressions transmitted to the brain by the nervous ramifications from the interior of the abdomen, excite sudden alarm, the fear of apoplexy or other serious diseases, when the individual is not exposed to the least danger. The derangements of the abdominal nervous system, and its irruption into the cerebral sphere, sometimes produce such changes in the constitution of the mind, that the chain of reflec- tions become so much impaired from the multitude of phantasies which arise, as to give rise to symptomatic loss of mind and gen- uine delirium, which disappear as the mind regains its energy. The mind is very frequently forced into various emotions, bursting out on every slight occasion into scornful laughter, and as quickly from a like simple cause, again relapsing into sadness and tears. § 114. Hysteria, which I believe to be an utterly different dis- ease from hypochondriasis, consists in an affection of the uterine nervous system, with which the nerves of the epigastric organs, and especially the lungs are drawn into consent, so that dyspnea and constant constriction of the tracheae, form a part of the mor- bid symptoms. This affection is extended likewise, with much activity into the dominion of the brain; when the exaggerated power of the sympathetic nerve, begets strange mental aberra- tions, and produces actions that appear to be spontaneous, but which in fact are perfectly involuntary. Spasms of a lighter kind are frequently felt to commence in the abdominal region, and to spread by degrees upwards through the chest, where they produce a sensation of vibration, and os- cillation in the integuments and muscles of the head and face; and to excite intolerable pains, which occupy by turns the sinciput and occiput, in some instances a half only and in other cases the whole of the head; sometimes they arc limited to a small space, which 114 STRUCTURE OF THE may be covered with the ball of the thumb, attended with an in- cessant sensation of cold, and yield to no remedies but those that remove the derangement in the abdomen, and obtund the exces- sive sensibility of the viscera. Hence those which were before the most excruciating, are found to be mitigated immediately by a single eructation of flatus, and to have the pains quickly re- lieved by a few drops of laudanum or a few grains of castor. In the clinical institute of this city, we watched the case of a a young girl during many months with great attention, in whom we could daily trace with admiration, the course which this dis- ease (hysteria,) pursued in the various branches of the nervous system. At first there was only spasms in the inferior part of the abdomen; then pain and distention of the epigastrium, with a sen- sation of anxiety and inclination to vomit; afterwards constriction of the lungs, dry cough, palpitation of the heart, followed by at- tempts at deglutition, as if pellets of food which the patient wished to swallow had stuck in the pharynx, and finally, perfect aphonia. More than twenty times, this train of symptoms as- sailed the patient in such a manner as to develop every day a new phenomenon; and as often the disease appeared to us to have migrated into another plexus of the nerves. For it origi- nated in the hypogastric plexus, from whence it proceeded into the gastric and solar plexuses, from thence into the pulmonary and cardiac plexuses, from these into the nerves of the pharynx, and ultimately into the laryngeal and recurrent nerves. - The morbid < symptoms subsequently disappeared gradually from above downwards to the pelvic organs, in a mode, the re- verse of that in which they arose, to be quickly again repeated as before.* * "Within a few years past the infallible existence of either acute or chronic inflammation, in nearly all derangements of the system, has become more pro- blematic, and the attention of physicians, has been much turned towards the {>art which the nerves play in the production of diseases. The respective pub- ications of Messrs. Teale, and Tate, with which the public has lately been fa' voured, have produced much good, by exemplifying in the strongest manner, the visceral disorders which may be maintained by focal irritation or inflamma- tion in the different masses of the nervous system, and especially in the spinal marrow; these disorders had previously been considered under a variety of appellations, and when remedies were applied, they were directed frequently SYMPATHETIC NERVE. 115 § 115. The seat of melancholy and many forms of mania, in the general opinion of physicians, exists originally in the deep- seated viscera of the abdomen. What was formerly ascribed to obstructions of the viscera, and principally of the spleen, and to to the apparent seat of the evil in the extremities of the nerves, and not to the real cause which existed in the centres from which these nerves proceeded. The ganglia of the sympathetic nerve, when diseased, not only in tins way pro- duce derangement in the parts to which their nerves are sent, but likewise give evidence of their own disorder, by causing irritation and tenderness upon pressure over the spinal marrow, between which and the ganglia nerves of com- munication run. In this way the medulla spinalis serves as a sort of index to the visceral disease,_and which it may also complicate with other symptoms, (such as deranged action of the heart and lungs,) through the medium of the branches which this portion of the nervous system gives oft to the pulmonary and cardiac plexuses. In addition to the effect of pain, there is also very excellent testi- mony in favour of the belief however difficult it may be to account for, that all severe lesions of the nervous structure are apt finally to excite inflammatory action in the parts to which the nerves are distributed. In the experiments of Dupuy, referred to in \ 100, of this work, it is shown that the excision of the su- perior cervical ganglia of the sympathetic nerve in the horse, was productive of emaciation, oedema, general cutaneous inflamation, and finally of death. In- tense inflammation, with ulceration and sloughing, has frequently taken place in the eye ball, and in some cases in the membrane of the nose and in the gums, as was first ascertained by MAGE.\niE,"both from an artificial section, and from disease of the fifth pair of nerves which supplies these parts. Inflammation with an increase of secretion in the mucous membrane of the bladder have been known to follow injuries of the spine, in many cases of paraplegia. Ad- mitting the importance and usefulness of the views, particularly inculcated by the writers above mentioned, it would seem that the tenor of their doctrines were inclined to give so undue a prepondency to the affection of the spinal marrow, as to throw into obscurity, the primitivedisorder of the abdominal vis- cera, the common cause of all the catenated nervous symptoms. It does no doubt often occur, that after the internal affection has subsided, the secondary affection of the spinal marrow still exists, and maintains a train of symptoms which maybe relieved as if by magic, by the effect of local bleeding and revul- sives at the spine. But in the far greater number of cases, it is most important to keep in view during the treatment and remove the original source of the evil, while we combat at the same time its sympathetic effects on other parts. It is less likely that the spinal marrow should be primitively affected by disease encased as it is in its canal, without the application of direct violence, than the abdominal viscera; which are exposed in a thousand ways to every species of derangement, from the ingestion of improper articles into the alimentary canal, or in disorders of their functions of external relation such as urination, mens- truation &c. In the chronic diseases of some of these organs, as the uterus for in- stance which receives few or no nerves of sensation, what way exists, through which the intellectual organs may be apprised of the circumstance, but by the sympathetic extension of the disorder, through the ganglia and plexuses of the abdomen, and from thence to the brain by the par vagum, or through the spinal nerves which mingle in the hypogastric plexus, to the spinal marrow. In either instance, it is equally important, that the view of the practitioner should extend through the train of effects, up to the first cause of the disease in the viscera. The amount of influence which the spinal marrow really exercises over the visceral nerves, has not only been thus exaggerated by practitioners, but by several experiineniers in physiology. The puncturing, burning, and crushing of the spinal marrow, so frequently resorted to, for direct evidence of its control .ever the functions of the pectoral and abdominal organs, has given it in this 116 STRUCTURE OF THE infarctions of the vessels, is referred at this day with more reason to an altered condition of the nerves. Vapors do not ascend into the head, nor does atra bilis form a part in the production of these diseases; but the solar plexus, or abdominal brain, reacts in such a manner upon the cephalic brain as to produce a manifest change in the character of the mind. The existence of this won- derful connexion, or rather antagonism of the brain with the abdominal nervous system, is explained in the physiological section of this treatise, where the subject was discussed. The clearest demonstration of this fact is found in the cure of the above mentioned diseases, by medicaments which irritate and derange the nerves of the abdomen. The wonderful power of emeties when productive of nausea only, the beneficial use of which is proved by experience in dis- eases of the mind, substantiates this fact. This class of medicines never act in these cases as the solvents or evacuants of the sordes and saburral matter; but as efficacious irritants to the gastric nerves, through which the effect is subsequently extended to the solar plexus, and thus changes the mode of action in its nerves: or at least through the intimate connection of the plexus with the brain, the disorder of the latter is counteracted and drawn to the abdomen. § 116. The seat of saturnine colic is without doubt, to be found in the abdominal nerves. What other system exists, to the affection of which could be attributed the excruciating pain of the intestines, the retraction of the abdomen towards the spine, the alvine constriction, tenesmus, suppression of urine, respect an undue physiological importance; all the results which occurred. (partly from the sympathetic action of the injury upon the brain, and the mutual derangement excited between that organ and the sympathetic nerve,) having been attributed to the direct effects of the operation through the branches which the medulla sends to the ganglionic system. All the visceral organs in the foetal Btate, as was expressed in a former part of this treatise, were endowed with the visceral nerve prior to the existence of the brain and spinal marrow, and con- sequenUy can only relatively depend upon the latter in the maintenance of their functions, so far as they form a part of the circulus of Hippocrates; the sympathetic nerve maintaining the actions of the nutritive vessels of the brain and spinal marrow, and the latter furnishing part of the power with which the sympathetic nerve performs its functions; while both systems coincide in the support of the intermediate function of respiration, the sympathetic moving the venous blood into the lungs, where it is arterialised through the influence of the cerebro-spinal.—Translator. SYMPATHETIC NERVE. 117 palpitations of the heart, asthmatic paroxysms, inclination to vomit, cardialgia, vertigo, cold sweat, palsy, etc., which charac- terise this disease, but the ganglionic system of nerves, and the muscular fibres of the intestines under its control? There is cer- tainly no symptom observable in this disease, which cannot be explained by the affection of the nerves. § 117. The various spasmodic paroxysms with which patients are differently tortured, should likewise be considered as arising from irritation of the nerves. Thus, although tussis ferina, or convulsiva, (hooping cough) is chiefly located in the pulmonary apparatus, it seems, notwithstanding, to extend its pernicious in- fluence in the caeliac plexuses: for whence comes the titillation at the scrobiculus cordis, which patients experience in this dis- ease, until the occurrence of the violent and suffocative convul- sion which ensues? Why do children run about with such anxiety previous to the eruption of a paroxysm? Why does vomiting so frequently take place? How does it happen that clonic convulsions, which endanger existence, almost always accompany or succeed the cough? Can it after these observations be denied, that some dy- namic or vital influence of the par vagum and epigastric plexuses invades the cerebral sphere, and effects a change in its condition? § 118. The praecordial spasm, known under the name of an- gina pectoris, inconstant arthritic asthma, sterno-cardia or syncopes anginosse, seems to me to consist essentially in an af- fection of the cardiac, and perhaps also of the pulmonary nerves. It attacks the organs of the chest: a constriction of the thorax takes place producing excessive pains, runs transversely out- wards, terminates in the arms, and afflicts the patient with an inexpressible sense of anxiety. These paroxysms, which are suddenly excited by excessive bodily exertion, by the excessive indulgence in food and alcoholic drinks, and especially by de- pressing mental emotions, are dissipated by an eructation of flatus. Here we find a confirmation of the theory which I laid down above,* that neuralgias constantly produce pneumatosis. But the * See page 109. 118 STRUCTTTRE OF THE occasional causes of this disease, as well as the sudden occurrence of its paroxysms, most clearly evince a dynamic affection of the nerves.' I know very well that in the bodies of those who have died with this disease, osseous incrustations are often discovered at the oiigin of the aorta and pulmonary arteries, in the semilunar valves, in the callous ring which separates the cavities of the ventricles and auricles, and frequently in the tunics of the coro- nary artery. But in my opinion, these phenomena are the ef- fects onlyy and in no wise the causes of this disease, since they have been found in many individuals who did not die under any form of angina pectoris, and were never subjected to its attacks. When, however, such ossifications are met with in this disease, we may clearly comprehend their mode of production, if we re- call to mind the jurisdiction which the nerves exercise,over the vessels to which belong the functions of nutrition: for the ner- vous filaments act upon the capillary vessels, the functions of which they elevate, when the latter, thus forced into an unusual manner of action, gives origin to a peculiar substance, in the texture of the above named portions of the heart. It is well known by every cultivator of pathological anatomy, that the fibrous texture of whicl the arteries are composed, is very easily penetrated by the phosphate of lime. As to the remote cause of angina pectoris, I do not imagine that it is always to be found in the arthritic diathesis; and I know not why we should refuse to believe in the existence of any other pernicious powers, capable of producing injury in the cardiac nerves. The celebrated Winchman* moreover asserts, that there were no perceptible symptoms of arthritis in the cases of angina pectoris which he had noticed, t * Ideen zur Diagnostic; 2 te. Auflage, 2 ter Band, p. 163. f It has long been the habit of the Professor of the Practice of Medicine in the University of Pennsylvania, to impress upon his class the intimate connec- tion, if not identity between angina pectoris and some forms of gout. He also describes cases occurring in his own professional sphere, where the subjects of the latter were affected with the former disease, and in whom life was termina- ted with much the same awful rapidity, as takes place in those affections called gout of the heart and stomach. It may be asked with much advantage to the enquirer, what is gout?—A question once thought not difficult to answer, when the ontologicaf notions of medicine were received as infallible dogmas. At the present time, it has become the prevailing system not to study with devotional zeal, the doctrines of the schools, or trust to the defective lights of mere exter- SYMPATHETIC NERVE. H9 & 119. We adjoin to the aforesaid disease another kind of asthma, called incubus or ephialtis, which attacks individuals only in the night. For the sensation of a load at the praecordia, with short laborious sighing, and suffocative respiration, when individuals go to sleep upon their back with their head depend- ing; suspension of voice and speech; hallucinations of the mind and senses, to which females chiefly are obnoxious; brief, but often reiterated attacks; palpitation of the heart, with terror and profuse sweats; great lassitude after the paroxysm is over, and the occurrence of yellowish spots, which are sometimes seen scattered over the body, etc., all constitute phenomena indicating the exist- ence of a dynamic affection of the soltr plexus, which transmits the most injurious impressions through the par vagum to the brain, produces disagreeable sensations in the joints by means of its anastomosis with nearly all the rest of the nerves, and finally governs the capillary vessels through its nervous ramifications, or perhaps excites some intestinal action in the blood itself. Perhaps there is in this affection some development of the electro- nal experience, but to learn from the unerring school of nature, the functional and diseased actions of each organ of the human frame; to learn the part first invaded by the disease, and the mode and the direction in which, by the natural route of the sympathies of the body it involves the rest. This method needs no other recommendation than that of its very general adoption. Hence it cannot be of any disadvantage to ask, whether gout does not simply consist in some derangement of the functions of the alimentary canal, in which the central masses of the nerves of organic life are greatly irritated, and perhaps in the more inveterate cases inflamed, which may be temporarily relieved by metas- tasis to the extremities, by the same sympathy that causes that weakness felt in the limbs, from accumulation of bile, or constipation;—or whether this dis- order of the nerves, may not, in other cases, extend up the sympathetic nerve and par vagum to the heart and lungs, and produce cases of derangement, or arrest of the functions of these organs, identical with angina pectoris. It is cer- tainly much more important to know the nature, than the names of disease; and its entire limits than its separate phases. I have in several instances, seen females about the middle period of life, who had from puberty been continually subject to paroxysms of sick headache, from which relief was generally sought by vomiting, and sometimes by catharsis, fol- lowed by subsequent doses of opium. As these sufferers advanced in life, the paroxysms were much less frequent, and in one case diminished entirely; but when the functional derangement of the chylopoietic viscera, which formerly had produced headache took place, the sympathetic irradiation upwards, through the sympathetic and par vagum nerves, produced such excessive func- tional distress in the heart and lungs, as to necessitate a resort to the usual medi- cines for relief, before the head was affected. Here there were great palpita- tion of the heart, and embarrassment of the circulation, and most suffocative asthmatic respiration, with pain along the spine, (on pressure) and sometimes in the arm and shoulder,—in short, a case analogous to angina pectoris.—Tr. 120 STRUCTURE OF THE galvanic influence, which, when artificially applied, produces succussions in the nerves and muscles, with which all physiolo- gists and physicians are well acquainted. ^ 120. Whenever in different diseases nervous phenomena are discovered in the region of the epigastrium and praecordia, there is some disorder always to be found in the branches of the sym- pathetic nerve. Idiopathic miliary disease is always preceded by symptoms of the gravest character; to wit, oppression of the chest, short- ness of breath, stricture of the praecordia, and especially a sensa- tion of anxiety; a series of symptoms which seem to threaten the wretched sufferer with instantaneous death. There is no system certainly, but that of the nerves of the abdomen to which we can possibly attribute this array of afflictions. For no one will admit that the causes of these phenomena exist either in the diaphragm, liver, stomach, spleen, blood-vessels, cellular texture, or mem- branes, but all must agree that they are only to be found in the great organ of sensation, which reacts upon and controls the other viscera, and which though overwhelmed as it were for a time by the violence of disease, subsequently recovers itself, and gives rise to a variety of anomalous paroxysms, until it (nervous sys- tem) is freed from the destructive miasm, by the production of a cutaneous eruption. * * The term idiopathic miliary disease is here meant to embrace the severe train of internal diseases which are sometimes succeeded by the millet seed form of eruption. All the various eruptive phlegmasia?, as scarlatina, small pox, etc. commence their career only as functional or organic lesions of the interior organs of the body, for which they must be treated, and for more than which they cannot be known, until they have developed their peculiar effects upon the surface of the body. Idiopathic miliary fever, or miliary disease, is precisely analogous in its operation, where the term is used to signify the abdominal dis- ease, which is sometimes of the severest character, that has preceded the erup- tion of minute vesicles, called miliary, upon the skin. But unlike the proper exanthemata, this eruption does not possess a peculiar appanage of visceral de- rangements which invariably precede it. It sometimes supervenes upon trivial occasions, when the functions of the skin only have been impaired, by that organ being retained for some time in an unusual degree of excitement, by a burthen of clothes, or the protracted action of diaphoretics, aggravated by a retention of its excrementitious discharges: therefore, though the peculiarity of this disease (the eruption) can only be considered as an Incidental phenomenon, supervening occasionally upon the severest abdominal disorders, it by no means diminishes the vast importance of the part which the sympathetic system of nerves plays in the latter affections, and of the great attention which it is necessary to pay, when the principal functions of life are embarrassed by an impaired condition of the sympathetic system of nerves.—Translator. SYMPATHETIC NERVE. 121 N § 121. Latent Arthritis, of an inferior grade of intensity, or which is not yet fairly developed, often lies concealed under the form of spasmodic affections of the hypochondria; and it appears to merit our particular attention, that the genuine hypochondriac affections when long protracted, are finally removed by an attack of gout; whilst on the other hand, arthritis itself is capable of producing the miliary disease: hence it becomes evident, that there is some affinity between the merely nervous diseases of the abdomen and arthritis and miliary fever. § 122. In reflecting upon the nature of intermittent fevers, I have thought that it might perhaps be found in the disorder and perverted action of the abdominal nervous system, and there appear indeed to be sufficient grounds to render this opinion pro- bable; 1st. The cases of this disease are very rare, in which the functions of the abdominal organs continue vigorous, and entire- ly unaffected: 2d. The commencement of the paroxysms is often marked with vomiting: 3d. We experience daily, that this dis- ease is mitigated, and very often entirely removed by the use of cathartics: 4th. A single emetic, when given previously, some- times suppresses the paroxysm, and not unusually'removes the whole disease; from which it appears that tnis remedy makes an impression upon the solar plexus, of an opposite nature to that which had produced the fever. 5th. When the disea-se is either left to itself or maltreated, congestions are produced in the abdo- minal viscera, induration of the liver, intumescence of the spleen, etc., and the general morbid state is changed into a topical affec- tion. This metaptosis appears to me to prove that the morbid action, prevails at first in all the plexuses, and afterwards mi- grates from one to another. For it is first apparently dissemi- nated in the whole territory of the ganglionic system, before it runs with much impetus "into a single plexus, which is com- monly the splenic; and as the vessels are under the influence of the nerves, it Cannot be otherwise than that congestions should thus be produced in the vessels: 6th. The paroxysms of inter- mittent fever, are tied down to a regular rythmus, in conse- quence of their being radicated in the nervous system upon 122 STRUCTURE OF THE which nature has impressed a law, according to which they must perform their functions periodically, (p. 97, No. 6, and 98.) § 123. Each nervous system therefore is obnoxious to its own diseases. But the mode in which the cerebral and spinal nerves, and the nerves of the abdominal plexuses and ganglia are affected by disease, is the same. As in the various kinds of convul- sions, epilepsy, tetanus, etc., there is disorder in the voluntary nerves, even when no organic lesion can be discovered in them; so the nerves of the thoracic and abdominal viscera, may be af- fected without any alteration perceptible to the senses. As the perverted action of the cephalic brain, is reflected with great force upon the abdominal brain, so in turn does the latter react upon, and overwhelm the former; and finally as the cerebral system when it is stupified as it were by the violence of disease destroys life, in like manner I believe, an analogous effect takes place in certain diseases in the solar plexus. It has been long taught, that sudden deaths take place in the human body, in three different ways, by the cerebrum, heart and lungs; and I would add to this a fourth, the solar plexus, the source and centre of the abdominal nerves, which when subjected to a sudden con- cussion or any serious derangement whatever, is affected with a paralysis, which is speedily followed by death. There are many instances in which injuries inflicted externally upon the epigas- trium, have produced death by their mechanical effects. 1st The dropping of water from any height upon the scrobiculous cordis, cannot be long borne. 2d. A boy was killed from being struck by a playmate on the epigastrium with a snow-ball, which left no visible marks on the organs within.* 3d. Ruysch, who du- ring fifty years, taught anatomy at Amsterdam, states that sudden death may occur from a concussion of the mesenteric nerves (solar plexus) without the existence of any lesion in them which can be detected. 4th. An electrical discharge through the ab- domen, may cause instantaneous death. This is confirmed! by * Metzger, system der gerichtlichen Arzney-wissenschaft; 3te, Ausgabe. Koenigsberg, 1805.$142, not. 2. f Observat. sur l'anguille electrique, Recueil d'observations de zoologie et d'anatomie compar. torn. 1. p. 56. SYMPATHETIC NERVE. 123 Humboldt, who saw himself, the electrical eels, (Gymnotus Electricus,) when placed under the bellies of horses and mules, destroy the lives of these animals, by the sudden emission of their electric fluid. 5th. In the recession of the miliary ex- anthemata, by which patients are suddenly destroyed with a de- velopment of the severest symptoms, inexpressible anxiety, suf- focative asthma, &c, whilst the function of the brain is unim- paired, there is proof that an impression is thrown upon the solar plexus and the par vagum which are closely connected together, and produces the partial death of those nerves, called with much justice abdominal paralysis or apoplexy. % 124. Let us now turn to the sympathetic diseases, the source and seat of which exist in the abdomen. The symptoms are innumerable which are openly manifested between the head and the viscera of the abdomen, however great may be the harmony existing between these organs: for a thou- sand observations teach us, that there is no affection of these viscera, either dynamic or organic, which does not sometimes sympathetically affect the head. § 125. Hypochondria and hysteria, of which I have just treat- ed, very often excite hemicrania : this affection frequently passes off in vehement pains, and spasms of the occiput, extend- ing to the neck and scapulae, or the eye of the affected side be- comes swoln and sparkling, is depressed within, or projected be- yond the orbit, and suffers greatly by exposure to light; the pupils are contracted, the tears flow in streams, the palpebrae become of a shining redness, and serum is discharged in considerable quanti- ty from the nostrils. It is easily understood how these symptoms are produced in the various diseases of the abdomen: for we find, as is displayed in the anatomical section of this treatise, that there is a very intimate communication of the sympathetic nerves, with the fifth pair, par vagum and cervical nerves. The intercostal nerve therefore, or the par vagum, being affected in the abdomen, the irritation accruing from this cause, readily rises into the nerves of the head, where it excites pains and spasms, which take place the more readily, as there gene- 124 STRUCTUKE OF THE rally occurs at the same time, in consequence of the abdominal spasms, a greater congestion of blood in the vessels of the head. § 126. We learn from daily experience that sympathetic cepha- lalgia, arises very frequently from obstruction of the bowels. F. Hoffman, Van Swieten, and a host of others, have cured the severest cases of this affection, by cathartics. In whatever man- ner, the affections of the head are produced, it is certain that the abnormal state of the intestines, is reflected by the nerves to the brain, although by the application of an irritant to the intes- tines, viz. purging, it may again be attracted downwards, § 127. The congestion and induration of the chylopoietic viscera, effect such a change in the sensibility and tone of the abdominal nerves, as to give rise to injurious sensations, and in consequence of this, disagreeable impressions are carried to the head, the effects of which are manifested either by headache or vertigo. It is likewise deserving of remark, that affections thus produced, sometimes attack the head»upon the side of the dis- eased viscera, so that from a lesion of the liver, beside the ce- phalalgia of the right side, there is especially, a tinnitus of the right ear; and occasionally the same phenomenon is observed in the disease of the spleen: this may now be very readily explain- ed, since Jacobson has detected the anastomosis in the tympan- um (§ 48.) § 128. Every one is aware, that intestinal worms, occasionally produce a variety of diseases. There are many examples of the occurrence of spasmodic affections from this cause, especially, headache, spasms of the neck and torpor of the principal senses, which after venesection, scarification, etc. had been practised in vain, were cured by mercurial cathartics. What physician is ignorant of the fact, that verminose fever is often attended with the severest symptoms, so as to induce an incurable form of dropsy in the ventricles of the brain? § 129. There are many cases of sympathetic soporose disease bordering on apoplexy and belonging to the same class of affec- tions which seem to ascend from the interior of the abdomen to the brain, and that may be removed by the evacuating plan with SYMPATHETIC NERVE. 125 such invariable and complete success, that scarcely one good phy- sician can be found, to object to the use of cathartics. The same thing occurs in sympathetic delirium, the origin of which is so frequently, found in the praecordia, that every day's experience confirms the saying of Tissot,* " that in twenty cases of either acute or chronic delirium, eighteen arise from the hypochrondria." That all these affections of the brain, de- pend solely upon the morbid condition of the abdominal nerves is manifest from this fact; that in the same class of diseases when arising from known causes, as for instance, poisonous in- gesta in the stomach, no organic disorder can be detected in the cavity of the cranium. I admit however that a cure may be' produced by the same mode in idiopathic diseases of the brain, when we act upon the* intestinal canal, and excite revulsion towards the abdomen. But this fact itself and the success of its application, furnishes another argument in behalf of the intimate connection, that is believed to exist between the head and the nervous system of the abdo- men. § 130. No one will doubt the propriety of enumerating sym- pathetic agrypnia among the affections of the abdominal nerves, who considers with me the numerous causes of irritation pro- ceeding from the abdomen, that augment nervous action, deter- mine the movement of the blood towards the head, and obstruct the supervention of the principal causes of sleep. Hence we find that those who have gorged themselves at supper, are wakeful after the first period of sleep has passed, and are scarcely able to fall into repose again. We hear very often, when there are no strong sensations, or severe symptoms to excite suspicion of incipient cerebral disease, that patients labouring under acute fevers, have passed many sleepless-nights, or that when sleep did supervene, it was interrupted or dis- turbed! with frightful dreams. If we open the bowels in these cases, which before were constipated, if we loosen and evacuate * Dissert, de feb. bilios. opusc. 1.1. p. 77. 126 STRUCTl'RE OF THE the humours collected in the primae vise, which are corrupted by their detention, and irritate the nerves; if we excite the languid and almost suppressed vital movement of the intestinal canal, by the aid of purgatives; we find that sleep of a more natural kind, will be speedily regained by the patient. § 131. I have often observed a species of insomnia, which I believe arose from an irritation of the nervous system of the ab- domen. It occurred in cases of the miliary disease; for after this affection had been chiefly subdued and the remaining symp- toms were fast disappearing, an inveterate state of vigilance nevertheless existed for many weeks, which exhausted the pa- tient's strength. I convinced myself, that this symptom was owing neither to the existence of fever nor to the congestion of blood in the head; but that it arose from a disagreeable sensa- tion, diffused over the whole abdomen, and from obscure and irregular movements perceptible within that cavity. I have noticed in general, that there exist diseases, and certain states of life in which the ganglionic system, when it has become unusually excited, and, if I be allowed the expression, morbidly vigilant, overwhelms and oppresses the cerebral system, acts upon the encephalon like the external senses, and prevents it, although fatigued, from obtaining repose. I have seen some un- fortunate patients who, though they had but just fallen asleep, would be suddenly awakened, in dismay, by a powerful and ap- parently electrical shock, from the epigastrium; an afflicting phe- nomenon, to which they were subjected for many months. § 132. The sympathetic affections of the eyes and nostrils, depending upon causes within the abdomen, were known to phy- sicians from the earliest ages. The physicians of Vratislaw,* describe a severe epidemic opthalmia, complicated with vehement headache, and a liabi- lity to blindness, arising from some disorder in the hypo- chondria, in which nothing proved of greater utility, than free catharsis of the bowels, occurring either spontaneously, or * Hist. morb. Vratislaw. Laus. et. Genev. 1746, p. 237. sympathetic nerve. 127 provoked by medicines. We are told by Fothergill,* that he cured chronic opthalmia by the aid of tonic medicines, which restored the power of the stomach and intestines. Corrupt matter, adhering to the intestines, and infesting their nerves, is very often the only cause of dilatation of the pupil, am- blyopia, nyctalopia, hemeralopia, and amaurosis. The most fre- quent complaint of hypochondriacs, also, is that the eyelids oscil- late and tremble, as at the approach of sleep, attended with some sensation of roughness and weight; and that they feel a pressure over the supercilia and forehead like the constriction of a band. As to the shedding of tears, the livid circles surrounding the palpebrae, the inflation of the lower eyelid, every one knows, that they indicate some nervous affection of the abdominal viscera; hence they are habitual to those who are afflicted with worms or chlorosis, or during the period of menstruation. In regard to the sympathetic affections of the nares, the false perception of odours, and the troublesome pruritus with which the verminose are vexed, the hemorrhagies from the obstruct- ed viscera of the hypochrondia, etc. all furnish very evident proofs that the action of the abdominal nerves is of a perverted character and is directed towards the head. § 133. If I am not greatly mistaken, I have observed a pecu- liar sympathy between the teeth and a disordered state of the abdominal nerves. I have found that the cause of obstinate tooth-ache oftener exists in disorder of the chylopoietic viscera than in any defect, depending upon the crasis or constitution of the fluids. Women who are especially liable to hypochon- driacal attacks, have their teeth frequently in a state of caries, atrophy, or necrosis, although they may make use of the best articles of provision, and exhibit no symptoms of depraved di- gestion. The hysteric passion, on the contrary, I am convinced produces this phenomenon much more rarely; which is of so constant occurrence in the preceding case, at least in our section of country, that one would be justified in immediately conjec- * Of the use of the Cort. peruv. in scroph. disord. Med. observ. and inquir. vol. I. p. 303. 128 STRUCTURE OF THE turing the existence of abdominal irritation from the diseases of the teeth. § 134. The action of the abdominal nervous apparatus is not limited to a few fixed parts alone, but extends in such a manner , likewise mto the other nervous system, (which is formed of the encephalon and medulla spinalis,) that it is capable of altering com- pletely, and very frequently of depressing the tone and energies of the latter. Hence arise lassitude of the joints, hebetude of the external senses, and the purely sympathetic asthenic.— There exists sometimes, as Van Swteten* thought, in diseases in the region of the praecordia, something that prostrates as with a poisonous blast, all the energies of the system in a moment, and whilst it continues to act, is productive of the greatest debi- lity; although there is no wasting of the fluids, nor any observa- ble change in the solids or liquids. Hence arose the surprise expressed by Sydenham,! that in continued epidemic fevers, there should be, beside other symptoms, such as anxiety, jactita- tion, and laborious respiration, great and sudden prostration of the forces, all of which were susceptible of being removed by the exhibition of a single emetic. Thus, as the result of his experience, BalloniusJ has also most judiciously observed, that, even in the most depraved condition of the fluids, there was not so much depression of the bodily and mental energies, and that the physician need not fear the production of debility in such cases by the use of evacuants; a precept which the authors above have strenuously enforced, and the correctness of which has been proved a thousand times over by its successful application. I admit, however, that these observers have ascribed the diseases arising from the abdomen, to corrupted, pituitous, bilious, sa- burral humours, etc.; but whatever may be the opinion we enter- tain in regard to the true existence of these humours, it is nevertheless positively determined, that the abdominal sensitive s}Tstem, when either primarily or secondarily affected, may trans- * Comment, in Boejh. Aphor. t. 2. p. 271,272. f Oper. t. i. p. 32. t Oper. 1.1, p. 1. 153. 157; t. IV. p. 130. SYMPATHETIC NERVE. 129 pose the affections of the abdomen from place to place in the organism: whence it is that those who are not in the least tinc- tured with humoral pathology, are compelled to fly to nervous action for the explanation of the phenomena of disease. § 135. But the physiological condition of the system itself, as well as experiments upon healthy individuals, fully prove the influence of the nutritive nervous, over the animal nervous sphere. For how powerful is the sympathy, we daily observe between the strength of the joints and senses, and the viscera of digestion? A certain geometrician, who, before dinner was able to solve the most difficult problem, became totally stupid after eating very largely of a repast. Hence with the greatest pro- priety Eoerhaave* says, " When I see the writings and listen to the conversations of the wise, who consider that the nature of their thoughts depends solely upon themselves, I am astonished that food alone can be capable of overwhelming that particle of divine flame, the human mind." Let a healthy individual, take a good sized dose of opium, or of any other poisonous medicine, as for instance, hydrocyanic acid; he will speedily feel intoxication, heaviness of the head, languor of the joints, inertia, will stagger, etc., though the medi- cine may have not yet passed beyond the limits of the stomach. (j) 136. When this antagonism which exists between the abdo- minal nervous system and the cerebral, is well understood, we shall no longer be astonished at the sudden diseases which carry off the sick, by paralysis or apoplexy of the brain. For what- ever may be said in relation to those cases of apoplexy, of which the cause exists in the abdominal organs, should be attributed originally to the irritation, derangement, and disease of the nerves of the interior of the abdomen. In intermittent apoplectic fevers, therefore, (pernicious intermittents of Alibert) the'morbid cause is generally found to exist in the abdomen. We find no mention made of any remarkable disorder of the cerebrum, as being the idiopathic cause of this disease, t * Praelect. academ. vol. iv. p. 488. t Werlhoff, obs. de feb., p. 21. Medicus. Beobacht. 1. p. 379. R 130 STRUCTURE OF THE It is proved from experience in a similar manner, that the essential cause of arthritis, (§121) may be either retained in the nerves of the viscera, and not obtruded upon the joints, or, when incautiously thrown back from the joints upon the nerves, pro- duce cerebral apoplexy, which may be properly considered of the spasmodic species, since by the concurrent testimony of anato- mists, it is very frequently impossible to discover any material cause of this affection after death, either in the encephalon or nerves. There are many other examples of sudden death, arising from affections of the mind; to wit, from joy, fright, fear, rage, which appear to assail the nervous centre of the abdomen, and to de- stroy the individual by producing a paralysis or apoplexy of the latter, (^ 123) and not by the paralysis, or apoplexy of the brain. ^ 137. In all the diseases to which we have hitherto alluded, the.affection of the abdominal nervous system, is only of a dyna- mic character, consisting solely in a derangement of its forces, and vital properties; its vitality is either exalted or diminished, or varies from its usual condition, without any organic change ca- pable of being detected in it by the senses. But this disorder, morbid tone, or ataxia* of the nerves,' exercises, by degrees, more and more influence over the organs, brings them into its own morbid sphere of action, if I may be allowed the expression, and finally generates diseases, in which genuine alteration Of structure is visible. Examples will furnish a better illustration of this subject. § 13S. Grief, melancholy, and all mental afflictions which de- press the vital power, and are for that reason called sedative, produce a change in the tone of action of the abdominal nerves. Spasms are then produced, which disturb the action of the vessels, from which necessarily follows a stasis of the fluids in the capil- laries, from the retarded motion of the blood; and lastly, infarc- * Those diseases are said to be dOa^Iox, which attack in a vague, irregular « disorderly manner. A.Fffisn oeconomia Hippocratis. Hence the term ataxia has passed through the ancient, as well as most recent medical writings. SYMPATHETIC NERVE. 131 tion of the vessels, obstruction of the viscera, and genuine or- ganic diseases. Protracted mental depression arising from the sufferings produced by disease at the praecordia, have been known to give rise to aneurisms of the heart, and very frequently of the larger vessels. Many unfortunate individuals who have been pursued by adversity, and loaded with an insuperable crowd of afflictions, have in the course of time become affected with indu- rations of the epigastric viscera, particularly of the pylorus, and finally of the pancreas, liver, and spleen. In a love sick girl, who had sunk under the blighting of her matrimonial prospects, I discovered a peculiar organic disease of the ovaries; which it is my intention to describe in another place. All the changes of these organs depended primarily upon the altered state of the nerves, and were undoubtedly dynamic dis- eases before they degenerated into organic. § 139. I have been fully convinced by the most attentive ob- servation of disease, that spasmodic (spasticus) symptoms always for a considerable time, precede organic alteration. 1st. In affections of the head, every one knows that convulsive movements of the facial muscles, gritting of the teeth, strabis- mus, etc., indicate a serious lesion of the brain. These symptoms should, I think, be enumerated merely as the prodromi of dropsy of the ventricles, because they are some- times treated with the happiest success; which, in my opinion, can scarcely ever occur, if a collection of water has already taken place in those cavities. The perverted action of the brain, is by no means circumscribed to the cavity of the cranium; it is extend- ed to distant regions of the body, whence organic diseases are pro- duced. After lesions of the brain, there is undoubtedly a dyna- mic disorder of the nervous apparatus of the liver, antecedent to the inflammation and suppuration of that organ. Various hypothe- ses have been invented to explain the connection between the brain and hepatic system, none of which have yet been at all satis- factory. I may with better reason refer it to a communication of nerves, and chiefly to the communion of the right par va- gum with the solar plexus, by which the cerebrum is connected to 132 STRUCTURE OF THE the right semilunar ganglion, from whence emanate directly the posterior hepatic nerves. 2nd. Aneurisms of the heart exhibit preparatory symptoms depending upon irritation of the nerves, especially when they originate from gouty affections, and are slowly formed. The heart is often, for a long time, subjected to palpitation and tremors, or nervous oscillations, before it is affected with the genuine form of dilatation. 3rd. The morbid affections are very diversified which precede the alteration of the lungs. The patient is often, for many years, obnoxious to spasmodic attacks, to which at length super- vene ossifications of the trunks of the arteries where they emerge from the heart, as occurs, for instance, in many cases of angina pectoris. I have likewise seen some forms of phthisis, that in their incipient stage, presented no symptoms but those of abdo- minal neuralgia; viz. paroxysms of hypochondriasis, dyspepsia and swelling of the hypochondria. The lungs, in these indivi- duals, seemed a long time absolutely unaffected; so that, from all appearances, it might have been said, that the general and nerv- ous affection was suddenly changed into an organic lesion. I saw a young girl, who finally fell a victim to pulmonary phthi- sis, in whom the disease had begun with a pain in the knees, which was followed from metastasis, with gastric oppression, and anorexia. I have attended patients, during many months, who laboured under a slow fever, and in whom there appeared to be no symp- toms of disease of the lungs, until their organic lesion was sud- denly developed. 4th. In abdominal diseases, the nerves are sympathetically affected before they produce organic lesions in the viscera to which they run. I am acquainted with many instances of indu- ration of the pylorus, which have arisen after a long continu- ance of hypochondriasis. The symptoms of a more or less severe character, which constitute in the first place, a lesion of the stomach, intestines, liver, spleen, etc. are, in general, nothing but dynamic spasms (insultus) of the nerves, and which clearly SYMPATHETIC NERVE. i^J demonstrate, that there is in these cases some peculiarly preter- natural degree or violence of action, (if the expression be allow- ed,) by the intervention of which the organic disease is pro- duced. Of all the other symptoms, however, the extrication of flatus, or pneumatosis, is the most conspicuous, (p. 109,) which arises from the perverted action of the nerves. There is no disease of the abdomen, the lesions of the peritoneum not ex- cepted, but in which there is observed a troublesome and fre- quent evolution of gas. This is always ascribed, and erroneous- ly, to dyspepsia, to the retrocession of miliary eruption, to hysteria, etc.; but the evolution of flatus is most generally symp- tomatic of some disorder of the nervous system, and of the incu- bation of some future organic disease. The strange sensations of the sick, which it is vain to attempt to describe in words, such as inquietude, wandering pains, sighs and groans which they unconsciously utter when asleep, all attest the existence of the same affection of the nerves. In nearly all diseases, both dynamic and organic, jactitation, anxiety, tension of the praecor- dia, dread of death, etc., in the sick, give me the greatest alarm; because these phenomena (when they do not depend upon hypo- chondriasis or hysteria) indicate the most serious affection of the sympathetic nerve. § 140. Although it has been said, that there is nothing in the affections of the sympathetic nerve to be detected by the senses, yet I am convinced, by attentive autopsic researches, that phleg- masia? positively do occur in that nerve, corresponding to vari- ous diseases. Hence I am fully convinced, that other organic changes might be found in the intercostal nerve, if the cultiva- tors of anatomy would sedulously investigate the subject. I will narrate, in the mean 'time, what I have myself verified by the most careful observation. § 141. A female of excellent habits, who had suffered from the age of puberty with spasmodic and hypochondriacal symp- toms, and had twice been attacked with incomplete apoplexy which left an imperfect paralysis of the right side of her face, 134 STTIT'CTURE OF THE was married, after she had passed her forty-second year, and be- come pregnant fifteen months afterwards. She was subjected, after the eighth week of gestation, to a series of afflictions, under the excruciating torments cf which she ultimately died; to wit, spells of vomiting, the commonest symptom of pregnancy, which occurred more than thirty times a day, and produced such dis- tress, that for three months every thing that was taken into the stomach was immediately rejected: and although every measure was tried likely to arrest vomiting both internally and external- ly, during the last seven days of her existence, not even a single drop of the water she swallowed was retained in the stomach. From these repeated attacks of vomiting, the fauces and interior of the mouth, became first inflamed and subsequently mortified, emitting a most fetid odour; the fingers themselves, which the patient sometimes put into her mouth, were ulcerated from the effects of the putrid sanious discharges. But the most distress- ing symptom of all, was a burning pain in the course of the vertebral column, and in the lower portion of the right hypo- chondrium, which produced several twists in the body and ex- hausted the strength of the patient by incessant jactitation, day and night The only way in which this pain could be alleviated for any length of time was, by dry friction; at first with the hand, and afterwards with the towel; which at last were so fre- quently repeated, as to excoriate the whole surface. Her wretch- ed existence was finally terminated under the worst form of marasmus. I carefully examined the body of this female forty- eight hours after death. The cranium appeared to me unu- sually small, although the individual was not at all deficient in intellect. I removed the cranium, but could detect nothing praeternatural in the cerebrum, which, however, I most studious- ly examined, because this woman had been tortured during nearly the whole period of her life, with paroxysms of occipital headache, the severe pain of wliich could only be removed by continued pressure with the hands upon the head, assisted by large doses of opium. SYMPATHETIC NERVE. 135 I was likewise unable to detect in the encephalon any organic cause of the chronic delirium to which she had been subject, and which for a very long period had disordered her sleep. The neck showed a scrofulous enlargement of the glands, a complaint very usual with us, but which in no way had caused injury by pressing upon the blood-vessels. The thoracic viscera were perfectly sound. The stomach, which the discharges of black vomit that had occurred in the disease had induced me to believe gangrenous, exhibited no organic affection: neither in the intestines nor uri- nary organs could any change of structure be detected. The liver was the only abdominal viscus that appeared diseased; it was of a livid colour. In the uterus, which was then in the fifth month of pregnancy, there was no appearance of disease, except a few fibrous tumours in its substance of the size of walnuts. The neck of the uterus was hard, and perfectly closed at its external orifice, which had prevented me from succeeding in the efforts I had to make to produce abortion, in order to get rid of the continual vomiting in this way, by removing the cause. The foetus was healthy and in its natural situation. Having removed all the viscera, I sought out the semilunar ganglia, which I likewise separated from the body, and most carefully examined in our anatomical amphitheatre. These bodies were not, indeed, found converted into any foreign sub- stance, but were of an intensely red colour, which, by some ex- perienced men and distinguished anatomists, to whom I com- mnnicated the case, was admitted to be the product of true and genuine inflammation. This inflammation was so obstinate, that the ganglia, after three days maceration in cold water, were but little altered in colour: I then had a drawing made of the right ganglion, of which a representation will be found in Plate IV. of this treatise. Its superior part was of a lively red; but the inferior from which the me^ateric branches are sent off, was of a livid co- lour. The splanc3fc nerve just before fts entry into the gan- glion, appeared tl^e much broader than usual. I am strongly led to believe that this singular inflammation of 136 STRUCTURE OF THE the ganglia, which I then only, distinctly and satisfactorily ob- served for the first time, formed, in the case of this female, a chronic affection, which had been gradually increasing in inten- sity during a long period of time. Should not the numerous nervous and hypochondriacal affections, the excruciating, but merely symptomatic headaches, and the delirium she early ex- perienced in her sleep, all which were so conspicuous in this case, be attributed to this morbid alteration? All these symp- toms which had existed nearly the whole period of her life, (from the age of puberty) were undoubtedly raised to the highest degree of severity, by the unhappy circumstance of her preg- nancy, by which the nervous disease of the abdomen was in- creased, and finally gave rise to the emesis, which proved fatal. I am at least, myself, convinced that the burning pain at the ver- tebral column (except the cause of the disease, should possibly have been concealed in the medulla spinalis, which I was not al- lowed to examine) depended upon the inflammation of the gan- glia. § 142. This observation has induced me to be very attentive to the condition and character of the semilunar ganglia and solar plexus in diseases in which I suspected an affection of the abdo- minal nerves, and where spasmodic symptoms had existed either in the viscera of the thorax or epigastrium. I dissected the body of a girl, six years of age, who had been seized with epidemic pertussis, which was first converted by metastasis into a spasmodic vomiting of three days continuance, and finally degenerated into an incurable form of clonic convul- sions, from which she died. I found the whole left part of the solar plexus in this case inflam- ed, whilst the right appeared to be in a natural condition.* In order that I might more satisfactorily ascertain whether in this place there existed genuine inflammation, which possibly might have been only accidentally red, I immerse^he plexus for a few days in pure water. ^\.t the end of this pei^^although the red- * See plate V., fig. 1. SYMPATHETIC NERVE. 137 ness of the inflammation was removed, there still existed a yel- lowness in the part affected, not discoverable in the other healthy portion; this proves that some alteration had taken place in the former.* I sought in vain for the causes of these convulsions, in the en- cephalon of this subject, since they were, no doubt, entirely symptomatic, and produced by the morbid reaction of the solar plexus upon the brain. AutenriethI the celebrated professor at Tubingen, on ex- amining lately, the body of a girl who had died from pertussis, found the par vagum inflamed in the whole of its course through the thorax. The neurilema of this nerve was elegantly displayed in consequence of the vessels being filled with blood, and the nervous pulp was also of an imperfect red colour. The cardiac nerves, and the thoracic portion of the sympathetic nerve had likewise suffered some alteration. The same author asserts that he has seen the abdominal nerves themselves a little changed, in subjects who had died from typhus fever. This observation I am not able to confirm by any expe- rience of my own. § 143. I have received the detailed history of two cases of disease, which plainly denotes the existence of inflammation in the semilunar ganglia. J The first occurred in a man forty seven years of age, in whom a fibrocartilaginous tumor, which was loosely attached to the dorsal spine, had been removed by the knife. Two years after- wards he returned to the Hospital for relief, requesting that another tumor, which had been developed upon the site of the former, and over which the skin was highly inflamed and ulcerat- ed, might also be cut out. He had been previously affected with a diarrhea, and exposed at the same time to the cold, in the rainy * See plate V., fig. 2. + Tubinger Bloetter fur Naturwissenchaft und Arzneykunde; erster Band, 1815. X These observations were communicated to me by Dr. Aronssohn, a very able Surgeon of the Strasburg Hospital. S 138 STRUCTURE OK THE month of October; he was immediately seized upon entrance, with trismus and opisthotonos, in consequence of which he died in about three days, in despite of all the medical aid we could afford him. In the examination of the body, there was nothing unusual discovered, except, 1st a vascular network well filled with blood, upon the surface of the spinal marrow, and a quanti- ty of effused serum within the sac formed by the dura mater; and 2d. a very distinct inflammation of the semilunar ganglia. The other history was that of the disease of a woman, thirty- six years old, who in her second pregnancy, was subjected to vomiting throughout the whole period of gestation. It con- tinued after parturition had taken place, but was rendered at least milder, by the appearance of a furfuraceous eruption upon the breast and arms. To these morbid symptoms were afterwards added inflamma- tion and swelling of the left knee, and diarrhea; but after the supervention of the latter, the vomiting which had been so obsti- nate and continual for almost three years, was brought to a close. Finally, hectic fever was developed, which by exhausting the strength, gradually terminated the existence of this suffering fe- male. On examination after death, the villous coat of the stomach appeared to be inflamed, and thicker than usual, especially to- wards the pylorus, and the semilunar ganglia were found in a state of genuine inflammation. In the body of a boy ten years of age, who had died from the retrocession of a miliary eruption, attended with symptoms of great anxiety, oppression of the chest, and distention of the epi- gastrium, I found a place in the left trunk of the intercostal nerve, highly inflamed between >the eighth and tenth ribs, with a phlo- gosis of the ninth and tenth thoracic ganglia, and their two anas- tomotic branches from the costal nerves. * These marks of disease in the sympathetic nerve, should not assuredly be despised, nor the inflammation be lightly thought of in which the vital forces are undoubtedly raised to the highest * See plate VI. fig. 11. let. e. SYMPATHETIC NERVE. 139 grade of intensity, and produce phenomena of a more or less serious character. § 144. On examining into the condition of the nerves in dis- eases of the lungs, I discovered another alteration which is pe- culiar to these organs; to wit, in that species of peripneumony, in which the lungs become red and slightly indurated, and which from its similarity in appearance to the spleen, should I think be called splenification or red broncho-puriform congestion ; the nervous filaments attending the ramifications of the bronchia were found equally red, a little more tumid, but much more tender than usual; so as to be broken by the slightest degree of force. This however is the only state of the lungs in which I have been able to discover any organic change in the branches of the nerves: they presented nothing unusual in the ulcers or vomicae, in the hepatiform induration, or in any of the tubercles of the lungs. I examined the lungs of a female filled with numberless tubercles, of which the largest was the size of an orange, and the smallest that of a cherry stone: The whole weighed nine pounds after the heart had been separated. All the tubercles were form- ed of a matter resembling the foetal brain, not enclosed in cysts, but in contact with the parenchyma which was perfectly healthy. The whole of the superior lobe of the right lung, was converted into avast sac, filled with this pultaceous substance, with which a mass of coagulated blood was mixed. The pulmonary nerves, when examined with the greatest care, were not found to differ in the least from their healthy condition. They ran into, and perforated the tubercles; but without undergoing there any al- teration, or as was believed, leaving in them any of their filaments. § 145. I have very frequently seen the nervous branches com- posing the anterior and posterior pulmonary plexuses, compress- ed, displaced and forced apart by lymphatic glands, that were so congested as to form a tubercular mass—but still more frequently by calcareous tubercles which were firmly attached to the bron- chia. When these glands, abounded with black fluid, I have seen the incumbent, nerves died with the same colour; they like- 140 STRUCTURE OF THE wise appeared to me in these cases more tender than usual, as they were very easily ruptured. But in regard to the stony concretions, I have many times found them so closely attached to the nerves, that they could only be separated from them by considerable force. Besides in the lungs, I have found the nerves in a similar condition in the solar plexus, at the margin nearest the capsula renalis. I have likewise found a small concretion of the size of a cherry stone in the trunk of the par vagum, separating its filaments from each other, whilst the functions of the lung and stomach were in these cases unimpaired. § 146. The observations I have made in reference to the car- diac nerves, have principally been in cases of aneurism of the aorta: for these nervous cords rarely suffer any organic change in diseases of the heart. I have discovered in cases where the arch of the aorta was very much dilated, that the nerves were apparently received into grooves in the thickened tunics of the artery, whilst in their ordi- nary state, they appear like reddish bands simply agglutinated to the vessel. They seemed to me also, more elongated and redder than usual in these cases; in every instance the patient had com- plained of a burning pain in the breast, which I could ascribe to no other cause than the inflammation and deranged condition of the nerves; for there was nothing unusual to be found in the other organs or in the nerves contained in the cavity of the thorax. § 147. An unmarried female, sixty-four years old, who was subject to a great many morbid affections, remained under my care during a long period of time. She had formerly suffered from gout in the hand, which left behind it some deformity of the metacarpal bones: She was again attacked in 1819, with ar- thritis, to which was added a miliary eruption, covering the whole of the left arm. Symptoms analogous to hydrothorax, speedily made their appearance, but which was removed by venesection—a measure strongly indicated in consequence of the imminent danger of suffocation. Her health then became considerably improved, and continued SYMPATHETIC NERVE. 141 so during several years; emaciation and debility subsequently occurred, and finally, another attack of asthma was developed which harassed the patient by day and night. For many months she was unable to breathe, save in the erect posture, had a small and very irregular pulse, a pallid face, speech checked through , fear of suffocation, oedema of the'feet, obscure and pulsatile move- ments in the upper part of the left side of the thorax, and pain in the humerus of the same side, all which indicated the existence of organic disease in the lungs and praecordia, which was con- sidered at one time to consist in hydrothorax, at another in con- • gestion of the lungs, and subsequently in a disease of the heart or larger vessels. The use of antispasmodics aggravated all these symptoms. Venesection alone afforded relief, which was however but of a few hours duration. This woman finally died in the clinical institute of this city, with all her mental functions unimpaired. Upon opening the body, a large quantity of serum was found in the right cavity of the thorax; the lung of the same side had suffered the broncho-puriform induration, the left lung was shrunken, there was also dcopsy of the pericardium, and the cavi- ties of the heart were dilated so as to form what is called passive aneurism: the «parietes of the anterior ventricle, were extremely thin, scarcely two lines thick. The pulmonary artery which was very much dilated, was an inch and nine lines in diameter: its. orifice was an inch broad. The diameter of the aorta at its ori- fice was very little above seven lines; but immediately after its origin, it was dilated into a vast sac, two inches and seven lines in diameter. The adscititious tunic of this artery formed of the reflected pericardium, was thickened, whitish and changed to a cartilaginous consistence; between the other tunics there existed numerous osseous scales; but there were no ossifications or stony incrustations discovered in the semilunar valves of either the aortic or pulmonary arteries, in the fleshy rings which separate the ventricles from the auricles, nor even in the valves of the ventricles. But the principal disease we met with in these places, was an aneurism arising from the concavity of the arch • 142 STRUCTURE OF THE of the aorta, three inches and three lines broad, and two inches and eight lines in height, furnished with dense parictes which were formed of pseudo-membranes, placed one upon another. The aneurismal sac, was intimately connected with the pulmo- nary artery by very short and dense cellular texture: and the par vagum and phrenic nerves, which rested exteriorally upon it, were enclosed between the pseudo-membranes of its walls. But which more particularly merits attention, there were no nervous branches to be found between the aorta and pulmonary • artery, proceeding as is usually the case towards the heart for the formation of the coronary plexuses. But the aneurismal sac itself, was filled with polypous blood, denser and more lamel- lated at the exterior than within. This autopsis furnishes a satisfactory explanation of the phe- nomena which were perceptible during the life of the patient. Orthopnea was certainly to be expected to have occurred in the latter period of the disease from the hydrothorax and hydrops pericardii. The congestion of the right lung in its inferior portion, and the shrivelled condition of the left, served to render the orthopnea more severe. The aneurism of the aorta produced the obscure pulsatile motion in the left cavity of the breast, and perhaps the pain in the left humerus. But is it not probable that the diseas- ed condition of the nerves bore a part in the production of these .phenomena ? Would not the compression of the phrenic nerve and par vagum by the dense false membranes of the aneurismal sac, prevent the nervous influx into the organs, to which those nerves belong? Was not also the shrivelled state of the left lung produced to all appearance by the constriction of the par vagum? And is it likely that the absence of the principal cardiac nerves was of no importance, or that this did not constitute one of the -causes of derangement in the action of the heart? § 148. In a case of aneurism of the heart, where an active dilatation of the left, and a passive dilatation of the right ventricle, were produced by bony concretions, I observed at the commence- ment of the arch of the aorta, and in the callous ring of the SYMPATHETIC NERVE. 143 aortic ventricle, an osseous scale, an inch in length, with spin- ous processes projecting toward the base of the heart, and situat- ed in the sulcus which separates the right ventricle from the auricle. In dissecting out the anterior coronary plexus, I found its branches completely surrounded this scale, and by which I have no doubt, they were much irritated in extraordinary move- ments of the heart. § 149. In the heart of a female thirty-one years old, who had died from hectic fever after congestion of the lungs, I found the principal cardiac nerve of the right side, tumid, reddish, and gangliform, near the base of the heart, for a space of eighteen lines, and two and a half broad, exhibiting a blackish point in the middle; this enlargement differed from the true ganglion in this respect, that it was softer, and when pressed with the finger appeared to be hollow; which, however, was not found to be the case on dissection of the nerve. § 150. The inflammation peculiar to the nerves of which we treated (§ 140—143) differs from that, which seems only to be communicated to them by the phlogosis of neighbouring parts: for in this case the redness of the nerves is less intense, and dis- appears by macerating them in water. In a very violent case of pleurisy which I dissected, the first thoracic ganglion was neither increased in size, or density; but upon its surface there was a red vascular network, elegantly de- veloped. The redness did not in this case extend into the cen- tral structure of the ganglion, which when cut in two, appeared of the same colour as the other ganglia that were perfectly healthy. The same fact, with little variation, was noticed in the nerves of the intestines. Part of the jejunum, contained in a hernial sac where it was incarcerated, exhibited the deepest inflammation in all its tunics, as well as in the mesentery. I eagerly embraced this opportu- nity to examine into the nature of the nerves, and determine whether they were in such cases, in a state of inflammation or not. I found the intestinal nerves more red and pulpy than usual, and even somewhat pellucid: whilst on the contrary, their 141 STRUCTURE OF THE trunks near the place of incarceration, were of their usual cha- racter and colour. Will it then not be correct to infer from this autopsis, that the medulla of the nerves may be locally nourish- ed, increased and modified without the other portion of the nerves being affected by the alteration? § 151. The branches of the sympathetic nerves have appeared to have been enlarged in various diseases. A. Duncan* has noticed a case of diabetes, in which the urinary bladder was very much dilated, and the sympathetic nerve three or four times larger than usual, from its ingress into the abdomen to its termi- nation in the pelvis. I have myself observed the nerves forming the suprarenal plexus, much thicker in disease, where the capsulae rcnales (renes succenturiati) which were more than twice as large as usual, had degenerated into tuberculous substance. There were eight branches sent off from the right semilunar ganglion, to the suprarenal capsule of the right side, and thirteen from the left semilunar ganglion, to the capsule of the left side. All these branches were terminated at the surface of the cap- sules. I detected this organic disease in an unmarried woman of twenty-five, who had been affected with chronic miliary dis- ease. The eruption, from the effect of a fright she experienced, had been repelled from the surface, after which there arose con- vulsive spasms, analogous to the epileptic, under which she finally sunk. Nothing unusual was discovered in the body of this woman, but the aforesaid change in the suprarenal glands, and the enlargement of the nerves. § 152. It has been proved by observations undertaken for that purpose, that the nerves may not only be increased in thickness, but likewise in number. 1st. I dissected a case of hydrosarcocele, in the spermatic cord of which I detected many nervous filaments, though evi- dently belonging to the sanguineous vessels, of which one ex- * Reports of the practice of the clinical wards of the royal infirmary of Edinburgh, during the months of November and December 1807, and January, i\Iay, June and July 1818.—Edinb. 1818. SYMPATHETIC NERVE. 145 tended to the vas deferens. I convinced myself in each case, with the microscope, that I had not mistaken the lymphatic ves- sels for nervous filaments. 2nd. A peculiar organic disease, in which the epididymus alone was changed into a cyst, containing a serous liquor, and which, for this reason, might properly be called epididymico- cystid, presented to me in a similar way, a body of nervous branchlets, passing to the testicle itself. 3rd. In a thyroid gland of remarkable size, weighing four pounds, which had been converted into innumerable cysts, abounding with limpid, gelatinous humour, I discovered a great many nerves. Three nervous trunks which proceeded from the laryngeal nerve, and upper cervical ganglion, entered the gland on each side, in company with the superior thyroid arteries___ Each arterial branch had an attendant nervous filament, not con- nected immediately to the tunics of the vessels, but adhering to them by the aid of cellular membrane. But all these nervous branches which were linked together by anastomotic filaments, formed a beautiful plexus; they were united with the nerves of the opposite side, and thus formed a kind of crown around the superior part of the gland. From this crown branchlets descended upon the external face of the gland, one of which was joined by anastomosis with an ascending filament from the recurrent branch of the par vagum. Nevertheless, all these thyroideal nerves, which formed a net- work about the arteries at the upper margin of the gland that ex- cited my admiration, presented nothing unusual in their struc- ture or appearance. {$ 153. But the contrary of this phenomenon is observed in other instances; to wit, where the number of nerves is greatly diminished. I found a kidney entirely destroyed by suppuration with the exception of a coriaceo-lardaceous capsule, which still existed and was full of pus. The pelvis was distended with matter, as well as the ureter, the parietes of which were very thick and hard. There were also observed some indurated and apparently T 146 STRUCTURE OF THE scirrhous adeps, upon the surface of the same kidney, which is frequently found in other organic diseases, and especially in those produced by chronic inflammation. The renal plexus was composed of only five branches, (§ 36) which were little con- nected together, but exhibited a ganglion half a line broad. When the kidney with its nerves were dried, an oily fluid was exuded from the nervous branches; but the nerves of the other kidney, which was healthy, when dried in a similar way, did not exhibit this phenomenon. § 154. In reflecting upon this difference of the nerves, it ap- pears to me that we ought to acknowledge two peculiar states of the parts affected by organic diseases. Thus in one case, the organs may be converted into another kind of structure, but not corrupted in character; on the con- trary the parts that constitute it may be more fully developed. The arteries, for instance, may be more numerous, the veins more dilated, the cellular texture contain a greater abundance of fluid, the cryptae and follicles increased in size, and the lymphatic ves- sels more conspicuous, etc. There is some peculiar physiological modification undoubtedly corresponding with this change of structure; the vital forces are perhaps increased or altered in their natural properties and direction. Thus, the unusual secre- tion of gelatinous fluid which 1 described in the thyroid gland, and the extraordinary condition of the vaginal tunic, which was the source of serous fluid in the diseased testicle, imply an aug- mentation of the organic forces. What is there then to surprise us, in discovering as we do in these cases a greater interlacing and abundance of nervous struc- ture than is usually met with ? But in the other or opposite condition, this state of things does not exist. The organs have likewise undergone a change; but it is that of wasting, corruption, and evident destruction. Their natural structure has disappeared; but although another condi- tion has been substituted in its place, there is no development of new vital forces, new uses, or new functions. There cannot be, therefore, in these cases, the least necessity for a fuller de- SYMPATHETIC NERVE. 147 velopment of the nervous apparatus,—it appears on the con- trary, diminished in amount, and of less importance. § 155. I am very well acquainted with the fact that the nerves resist for a long period, the causes which finally effect their de- struction. Chambon de Montaux* noticed a gangrenous ulcer which, though it had destroyed the cheek and parotid gland, left the pes anserinus entirely uninjured. I have myself observed lumbar abscesses, in the foci of which, the nerves forming the lumbar plexus remained unimpaired, although they were con- stantly steeped in a sanious fluid. But in cold, steatomatous, encysted tumours, etc., I have found the nerves apparently shrunken, dryer and flatter than usual, and applied upon, or agglutinated to the tumours; and in abscesses upon the dorsal spine, produced by caries of the vertebrae, I have seen the nerves entirely destroyed. A girl of ten years of age, who had been affected with para- lysis of the lower extremities for a very considerable period, la- boured for three months under diarrhea, with incurable tormina and tenesmus. On dissecting the body, I found nothing unusual in the tract of the intestines; but there existed a remarkable abscess on the left side, which extended from the sixth to the tenth dorsal ver- tebra. The larger splanchnic nerve which was unchanged in its structure, was in contact with it. The semilunar ganglia were in a healthy state, and there was no apparent derangement in any of the nervous branches proceeding from the solar plexus. When the abscess was opened, I discovered a caries by which the bodies of the sixth and seventh dorsal vertebrae had been de- stroyed, though the intervertebral cartilages, and investments of the spinal marrow were uninjured. The left trunk of the sym- pathetic nerve, was entirely destroyed from the sixth to the twelfth vertebra; the lumbar portion of the same nerve was in a state of inflammation. The medulla spinalis, corresponding to * Voightel, Handbuch der pathol. Anat.; 1 ster Band, $ 663. 148 STRUCTURE of the the carious place, was found for the space of sixteen lines whiter than usual, and in a state of atrophy. § 156. Glandular tumours are sometimes developed in the cavities of the body, (particularly in those affected with a scrofu- lous taint) in which the nervous filaments are compressed or dis- placed, though very rarely altered in their structure, with the exception of the development of adipocire, which is formed and deposited during life between the nervous filaments. § 157. I have in some other instances found small tubercles seated upon the semilunar ganglia, to which they were connected by short cellular texture. They were of a peculiar character; of softer consistence than the conglobate glands, and of a yellow violaceous colour. I was not able even with the microscope to detect any lymphatic vessels proceeding from them. These tu- bercles were discovered in the solar plexus of an individual, who had died of colica pictonum. I cannot say whether or not their presence had produced any derangement in this case, or been connected with the above disease; but their existence certainly proves that some abnormal action had existed in the nerves, and in which it had caused the deposit of some unusual matter by a vice of nutrition. I discovered tubercles of the same kind likewise in an indivi- dual, who had died from scirrhus of the stomach. But they were larger than in the former case, and more analogous to the sub- stance, of which the capsulae renales are composed. § 158. The nervous funicles sometimes undergo a peculiar alteration in certain tumours of the abdomen. These tumours, which may be called heterogeneous, in con- sequence of the dissimilar lobes of which they are composed, frequently rest upon the sacrum and lumbar vertebrae, surround the aorta, enclose within them the crura of the diaphragm, reach into the epigastric region, push the transverse colon from its usual position, elevate the gastro-hepatic omentum by which they are covered, and constitute in one case a dense lobu- lated and lardaceous, and at another, a pultaceous and hydatid mass; these tumours are more or less vascular, and gradually sympathetic nerve. 149 extinguish life by the production of hectic fever. I concluded, at first, that the nervous branches might be traced through these tumours, but on making an examination, discovered that they were most generally ruptured in these cases. In a tumor si- tuated upon the lumbar vertebrae behind the peritoneum, I found the origin of the hypogastric plexus which is there form- ed by two roots, entirely divided so as to consist of two parts, a superior and inferior. The former terminated in a gangliform tumor, similar to those which the nerves exhibit, after the for- mation of a cicatrix, from the amputation of a limb: the other, although separated from the former about the space of a finger's breadth, did not appear either attenuated or shrunken. I exam- ined another tumor of the same kind, which extended up to- wards the epigastric region, and firmly adhered to the lesser curvature of the stomach. Both the pneumogastric nerves were ruptured in this case, of which the right formed a slightly elongated ganglion, from which three tender filaments proceeded formed of a substance, which was of nearly the same character as the tumor in which they run. The patient, a man forty-seven years of age, in whom this tumor was found, was suddenly seized with cardialgia, and tortured with severe pain in the spine of the back, and between the scapulae. Obsti- nate constipation and violent tormina succeeded to these symp- toms, under which the sufferer finally sunk in the lapse of seven weeks. This truly inveterate organic disease was not manifest- ed during its production by a single symptom, until the pneu- mogastric nerves were forced apart, and finally lacerated by the daily increasing size of the tumor; when the most violent pheno- mena were developed. It was, no doubt, the vellication of these nerves, transmitted to the right semilunar ganglion, and to the trunk of the right sympathetic nerve, which produced the in- tense pains of the abdomen and dorsal spine. § 159. It is not only in individuals of advanced age that the sympathetic nerve exhibits organic changes; it is likewise affect- ed with singular alteration in the embryo; from which it appears, that it is obnoxious to diseases at the most tender period of life. 150 STRUCTURE OF THE SYMPATHETIC NERVE. A tumour of a yellow colour was found upon the thora- cic portion of the trunk of the sympathetic nerve. This co- lour, which was a golden yellow, did not appear to exist upon the surface of the nerve, but was peculiar to the nervous pulp; it could not be removed either by water or alcohol, or destroyed by the action of the solar rays. The medulla spinalis exhibited the same affection: for the whole of its substance was of a citrine colour, and when surveyed with a microscope, presented innu- merable brown points to view, as if a fine red powder had been sprinkled upon and mixed with the nervous pulp. This disease, which I think should be called kirronosos,* I have detected in three embryos of four months, in which the serous membranes, to wit; the arachnoid, pleurae, and perito- neum with its reflections, were likewise tinged with a yellow colour. The other organs, common cellular texture, skin, etc. were not in the least affected; and wThich is remarkable, neither the brain or its nerves, nor the spinal nerves themselves, were altered from their natural condition. The causes of this disease, and the effects which it may pro- duce in the economy of the embryo, are not, as I believe, en- tirely hidden from us. From all that has hitherto been said, it follows, that the nerve, of which we have undertaken to illustrate, the structure and func- tion, constitutes firstly, a peculiar system in the animal economy, which is not derived from the brain and spinal marrow, though it communicates with them in a multiplicity of ways; secondly, that it is designed for certain definite functions; thirdly, that it is not only capable of being affected in its powers and properties so as to produce dynamic diseases, but that it also exhibits alte- rations in its structure, perceptible to the senses. And if the attention of anatomists become directed towards these altera- tions, it cannot fail, but that we shall hereafter be supplied with ampler knowledge of the pathology of the human sympathetic nerve. From X'gg'-c, golden yellow, and voiroc, disease. ADDENDA. I. To .- ^ a-------i. J'^.XCL.fU: cUlt. XC»*vixeAy VfJCncaSs IjUlx PLATE I. Vessels of the Ganglia. Fig. 1. Superior cervical ganglion of the natural size; the arteries filled with a yel- low wax injection. o. Ganglion enveloped by its tunic. bbbb. Small arterial vessels arising from the neighboring branches of the ca- rotid artery, and forming a network in the second cellular tunic of the gan- glion. Fig. II. Superior cervical ganglion, rendered very red by the injection of the vessels contained in its tunic. a. The naked substance of the ganglion. 6 &. The tunic of the ganglion separated and spread out. ccc. Small nerves in this reflected tunic. In the substance of the ganglia very minute vessels are seen running between the nervous filaments. Fig. IV. A microscopical view of a transverse section of the ganglion, with the vessels injected. aaaaa. Trunks of the vessels. 6 6 6 6. Small flexuous vascular branches running out laterally, broken off per- haps, in removing the involucra of the gangha. c. Two corpuscles, which appear to be formed by the orbiculo-tomentose, or glo- bular substance. The remaining congeries of the vessels may be readily de- tected without the aid of references. All these vessels run in the direction of the ganglion, and compose the principal part of its structure. Fig. V. View of the veins in the superior cervical ganglion. a. The ganglion itself. 6. A branch called mollis, given off by the ganglion. c. The trunk of a small vein. d. Venous plexus, arising from the same trunk. e. Branches emanating from this plexus, and running in the direction of the ganglion. All these vessels are found in the second tunic of the ganglion. PLATE II. A representation of the right semilunar ganglion; in Fig. 1, of the size of nature; and in Fig. 2, magnified to twice its usual dimen- sions. Fig. I. a. Greater splanchnic nerve divided into six or eight fasciculi. 6. Branches anastomosing with the dorsal nerves. c. Semilunar ganglion. ddd. Branches given off by the ganglion, to form the superior mesenteric plexus. c e. Two foramina, with which the ganglion is perforated. Fig. II. a. Fasciculi of the splanchnic nerve entering the ganglion. 6 6. Small nervous bands running through the ganglion and collected below into, cccccc. Branches that emerge from or are given off by the ganglion. ddddd. The orbiculo-tomentose or globular substance interposed between the bands, and in which the latter are applied and interwoven. e e. Two foramina, with which the ganglion is perforated. PlaJ, 11 F^ll £'-\.nrorr„. cZtt. kZ,^,ly fy L».ca.*;,.L lH:.: Piatt m K-'^eAylf Luna :.: Llt\, PLATE 111. In this plate the nervous branches are represented as if they were fastened upon a black board. In this way the character, division, and course of the minutest filaments are betler seen. Fig. 1. a a. Two branches of the hepatic plexus, which, after uniting into a single trunk, (6) are quickly divided again into three parts, (c c c.) Fig. II. The same nerve magnified to twice its natural size, and unfolded into a plexus. This figure is thus represented under the microscope in order to furnish the best view possible of the direction and interlacing of the minutest filaments. ' 1 wish to exhibit the preparation, contrary to the opinion entertained by Bichat, that the branches of the nerves of the ganglia, are similarly situated, and form plexuses in the same manner as the branches of the cerebral and spinal nerves. d. Represents the branch (e) unfolded into a plexus. The other references indicate the same as in Fig. 1. Fig. III. A representation of the anastomosis of the right par vagum with the solar plexus, in the body of an infant, increased to twice its natural size by the microscope. a. Right paf vagum. b. Branch given off to the stomach. - c. Branch to the posterior part of the stomach. d. Fascia communicans of Wrisberg, unrolled into a plexus. e e e. Ganglionic branches of the solar plexus. In examining this preparation with the microscope, the very delicate filaments of which these branches are composed, could be readily seen running from the par vagum to the ganglia, and vice versa, arising from the ganglia and running to the par vagum without any interruption in their course. There was also exhibited an interweaving of the filaments, deserving of attention, in several places, and especially in that indicated by the letter/. X PLATE IV. Ji representation of the inflamed semilunar ganglion, described (§ 141.) in the pathological portion of the work. a. Trunk of the splanchnic nerve in the thorax. 6 6 6 6. Origin of the same from the thoracic ganglia. c. Portion of the trunk, near the ganglion, greatly increased in size. d. The ganglion itself, of a vivid red at its upper portion, and of a livid hue at its inferior. e e ee. Branches given off by the ganglion. /. Branches to the renal plexus. g. A portion of the right emulgent artery. Pit,/, IV JPy-nooi-a- deli K>1X11 r.rSy k./jUA II r j. hilh. PlafzeV. F. vln,-orrt.. ilell. X, >, „ ,_ djr tjl,ucu,s-s. Li'tl,,: PLATE V. rig. i. The solar plexus of an infant, the disease of which is described ({142.) The nerves were drawn and painted immediately after the dissection. a. Aorta. o. Right splanchnic nerve, terminating in the solar plexus of the same side. This part was found in its natural condition. c. Left splanchnic nerve, terminated in the ganglien, and red from in- flammation. Fig. II. The same parts after a maceration of four days in water. The left part of the solar plexus exhibiting a different colour from the right. PLATE VI. Fig. I. A representation of the carotid artery, removed from its canal in the petrous portion of the temporal bone, with the branches of the sym- pathetic nerve. a a. Internal carotid artery. 6. The reddish plexiform carotid ganglion of the sympathetic nerve. c. Three branches proceeding from the ganglion upwards to the sixth pair of nerves (abductor oculi.) d d. The nerve itself (6th pair) divided into two fasciculi. e. Superior fasciculus. f. Inferior fasciculus, separated from the former by a sulcus. The three branches of the ganglion unite with this fasciculus. g. Branch running to the ganglion from the deep-seated Vidian nerve. h. A twig from this branch to the tunics of the artery. i i. Two branches sent from the ganglion to the artery. k. A branch proceeding from the ganglion behind the artery, to the trunk of the intercostal nerve. I. A principal branch descending from the ganglion on the upper surface of the artery, divided at the letter (m) into two portions. Note. All these branches were carefully drawn out a little from the artery, and depicted in that position, in order that their disposition might be more clearly exhibited. Fig. II. Intercostal nerve of an infant, described ({143.) a a. Trunk of the intercostal nerve of the left side. 6 6 6 6. Branches anastomosing with the spinal nerves. c. Splanchnic nerve. d. Semilunar ganglion, much redder than usual. c. An inflamed portion of the trunk of the intercostal nerve, including the ninth and tenth thoracic ganglia. TPlaU VZ. d I'izl. ---a \ \ lAoll T.A:nsc»'Cis dr.lt: fC,:r