THE ABDOMINAL AND PELVIC BRAIN WITH AUTOMATIC
 VISCERAL GANGLIA WITH REFERENCE TO SEXUAL ORGANS.

"Instinct is a propensity prior to experience and independent of instruction."
- Paley.

"Probability is the rule of life." - Butler.
 

    At this point I desire to call attention to the following points:

    1.  The intimate and profound connection of the genito-urinary organs with the sympathetic (and cerebro-spinal) nervous system.
    2.  Its connection with the rectum and relation to coition.
    3.  The relation of the pelvic organs to the larynx (voice); the fifth (ganglionic) cranial nerve, stomach and eyes.
    4.  Automatic menstrual ganglia.
    5.  The menopause.

    Every observing physician sees a close connection between the genital organs and the nervous system.  This is not strange when one considers existing conditions and the long-continued effect of evolutionary forces.  Of all the instincts in the animal race, the sexual instinct is dominant.  This instinct has an all-pervading influence in every species of animal.  It governs their actions.  It forms habits in their lives.  It induces new phases of existence.  All through the stages of animal evolution, every other instinct must bend to the sexual.  Physical and mental forces wonderfully combine to make this instinct the most effectual in its consummation.  The sexual instinct dominates most powerfully the males, and hence the physical and mental vigor of the best animals in the race survive.  The cow in rut is served, from sheer physical and mental vigor, by the most powerful bull.  In herds of animals the sexual instinct dominates most vigorously in the finest males, and the weak males are cast aside that the strong ones may become the parents.
    The main study of zoology is reproduction.  The weapons of offense and defense possessed by males are primarily to cultivate and defend the sexual instinct.  The horns of bulls, the powerful heels of stallions, the eagle's talons, and the claws of powerful feet are the weapons to defend and to carefully cultivate this dominant instinct of animal life.  When we pass to man, the sexual instinct is rather heightened than diminished.  But in man it is more subtle; secretly in the depths of man's mental forces lies his sexual instinct.  As he has gained the ascendancy in animal life by his mental activities, in this light alone can be studied his sexual instincts.  Thus in the lowest form of physical existence sexual instincts dominate, yet in the higher forms of mental existence these instincts are still more powerful.
    From such premises, patent to all observers, it is quite obvious that evolutionary forces have through long ages established a very close connection between the nervous system and the genitals - the organs which gratify the sexual instinct.  Forces (mental or physical) acting through eons of ages establish definite results.  The increase of man's intelligence is not in proportion to the increase of ganglion cells, but by the increase of conducting cords.  Chicago and New York may each represent a ganglion cell, and a single railroad may represent the conducting cord.  Now, when there was but one railroad between New York and Chicago, little business could be done on account of the limited amount of commerce which the single road would accommodate.  Chicago and New York, as the ganglia cells, could dispose of far more business than the single road would transmit.  But when the railroads multiplied between the two centers, the business increased just in proportion to the number of roads or conducting lines.  Now, ages of natural forces have established numerous lines, and vigorous lines, of connection between the genitals and the nervous system.  The facts which dissection show are positive in demonstrating the widespread and intimate connection of the genitals with the cerebro-spinal and sympathetic system.
    The ganglion cells can receive and dispose of far more mental work than a few conducting cords can transmit; so that the progress and advance toward a higher nervous system and a higher intelligence is an increase in the conducting cords or lines to transmit intelligence or ideas.  Also a well developed periphery is an absolute necessity for the purpose of collecting ideas for transmission.  An increasing sensitive periphery is required to perceive the forces and comprehend ideas so that they can be sent to the central ganglion.  Now, the number of conducting cords which attach the genitals to the nervous centers is simply enormous.  Besides, the nerve periphery, situated in the external genitals, is highly sensitive and highly developed, so that it quickly perceives and quickly transmits the slightest sensation, and evolutionary forces through the ages seem to increase the sexual instinct with the progress of intelligence and mental growth.
    I base these remarks on years of careful dissection of cadavers and of animals.  If one carefully dissects a male body he will note the extensive cerebro-spinal nerves supplying the genitals, especially the penis.  Of the spinal nerves supplying the genitals, the main one is the pudic.  But the pudic nerve is composed of nearly all the third sacral, and branches from the second and fourth sacral.  As one examines this nerve he is forced to the conclusion that it is an enormous supply for a small organ.
    The periphery of the pudic nerve spreads itself like a fan over the genitals.  The branches of this fan-like nerve-apparatus supply also the bladder and rectum - organs which must act and work in harmony.  Hence the great disturbance which arises in the pelvis (bladder, rectum or genitals) when any one organ is damaged-e. g., a rectal fissure, a urethritis, or penile irritation quickly disturbs the whole system.  The connection of the pudic nerve with the external genitals (where sensation is experienced) is vast.  Not less remarkable is the wonderfully harmonious action of the bladder, rectum and genitals through large branches of the same pudic.
    Another peculiar spinal-nerve connection of the external genitals is the supply of the pudendal nerve to the lateral walls of the penis.  I have time and again called the attention of medical men to the peculiar connection between the gluteus maximus muscle and the external genitals by means of the pudendal nerve or branch of the lesser sciatic.  The gluteus maximus is the real muscle that holds man upright (physically), but it is also the main muscle of coition.  The lesser sciatic nerve supplies only one muscle, and that is the gluteus maximus, and then sends off the large pudendal branch to the sides of the penis, and hence the friction of coition induces active contractions of the gluteus maximus.  The spinal-nerve supply to the external genitals is mainly the large pudic and pudendal nerves.  In woman the pudic nerve is equally large; but the pudendal nerve is much smaller in woman than in man, according to my dissections.  The lesser size of the pudendal nerve in woman is in direct accord with the methods of cohabitation.  The vigorous and aggressive activity of man in coition, and the quiet passive receptivity of woman, explains the larger pudendal nerve in man.  But the reverse nerve supply arises in regard to the glans elitoridis and the glans penis.  I have dissected many a clitoris, and its nerve supply is three or four times as large as that of the penis in proportion to its size.  The clitoris is a veritable electrical bell, which, when irritated, rings up the whole nervous system.  There is no doubt that adhesions of the prepuce to the clitoris have led to masturbation in girls.  Every gynecologist should examine the clitoris, and, if preputial adhesions exist, simply break them up, for the vast nerve supply of the clitoris gives great chances for profound irritation.  The poor girl, neglected by the mother and possibly by the doctor, is soon induced to become a masturbator.
    But the extensive spinal-nerve supply to the external genitals, though vast and intimate, is but a small matter relative to the supply to the internal genitals.  The spinal-nerve supply to the external genitals is mainly sensitive, so that the sexual instinct may be gratified by the organs.  What I wish mainly is to call attention to the profound connection of the internal genitals with the nervous system by means of the sympathetic system.  It is in this field that the gynecologist and the genito-urinary surgeon find full play for lucrative operations - for so-called aggressive surgery.  In manipulations and instrumental examinations of the genitals one sees the nerve storms flash over the system.  These nerve storms radiate over distant nerve plexuses like electricity over a system of wires.  Take, for example, the uterus.  Its sympathetic nerve supply is enormous.  The cervix only, so far as I can see, has spinal nerves, while the body and fundus are supplied by the sympathetic.  One can count some twenty or thirty strands of nerves in the hypogastric plexus which originate in the abdominal brain and terminate in the uterus, and the nerves are very large.  The ovarian plexus - a very large plexus - goes from the abdominal brain, and many of the nerves of this plexus terminate on the oviducts and fundus of the uterus so that the sympathetic nerve supply of the uterus is enormous.  A large nerve supply to any organ subjects it to the danger of sad complications and stubborn pathology.  I have seen a patient in the gynecological chair make active efforts to vomit in less than fifteen seconds after careful introduction of the sound.  In those few seconds a complicated nervous phenomenon had occurred.  The irritation of the endometrium had been flashed up the hypogastric plexus to the abdominal brain, and there it was reorganized and dashed over the various plexuses to other viscera.
    The irritation, no doubt, went to every viscus similarly, but the stomach manifested itself in motion (vomiting).  The heart, lungs, liver, spleen and digestive organs no doubt suffered similarly, but they were better able to resist the irritation.  A study of the hypogastric plexus and its action on the uterus convinces me that pressure on the aorta for postpartum hemorrhage is generally explained wrongly.  It is said the pressure obstructs the blood, but in reality the pressure on the hypogastric plexus irritates the peripheral ends in the uterus, and induces it to contract.
    This is more reasonable.  The dominating influence of uterine disease is due to the vast and intimate connection of the uterus (oviducts and ovary) with the sympathetic nervous system.  Besides, a great and complicated network of nerves is easily deranged.  The importance of the uterus demands a vast and complicated nerve supply.  It may be laid down as a general proposition that the viscera have their normal function in rhythm, and the disturbance of the rhythm induces disease.  The main pathology of the sympathetic is reflex action from some distant viscus.
    The ganglia controlling the viscera are entirely out of the control of the will.  If the visceral movement was not involuntary or out of the mental sphere men would speculate and experiment on their viscera.  This fact no doubt explains the curious action of neurotic women.  The nerve storms which emanate from a pathological uterus flash over the whole system by distinct nerve plexuses, and, as the will does not control any of such reflexes, the patient acts on the induced feelings.  The close nervous connection of the uterus with the nervous system is at once seen in the great changes which uterine disease induces in both the mental and physical life of a woman.  But anatomical facts, physiological experiment, and clinical study all show that the genitals and nervous system are more highly and intimately connected than any other system.  No organ influences a woman mentally or physically to such a degree as the uterus - the autocrat of menstrual life even in its normal physiological and anatomical condition, while its pathological condition is still more manifest.  It is owing to the very distinct connection of the genitals with the cerebro-spinal and sympathetic system.  Let a woman's genitals become pathological and she acquires liver disease and indigestion and becomes anemic and neurotic.  Uterine disease also induces eye disease and heart trouble, and the joints and muscles do not escape.  Pelvic diseases are often accompanied with hip, knee or ankle trouble.  This is no doubt due to the intimate connection of the uterus with these joints through the sacral plexus; e. g., the sacroiliac joint, the hip joint, and the knee joint are all supplied by three distinct nerves - the great sciatic, the anterior crural, and the obturator.  Now, these three nerves are really the sacral plexus.  A cold contracted at the monthly period from wet feet is explained no doubt by close connection of the uterus with the sacral plexus, for the lower end of the sacral (the sciatic nerve) supplies the feet.  The disturbed circulation in women afflicted with uterine disease is owing to the powerful reflexes sent over the great hypogastric plexus, and the normal rhythmical contractions of the heart and its blood-vessels are broken by reflex due to uterine disease.
    But it is not the woman only who is afflicted with reflexes from the genitals.  The genito-urinary surgeon who deals with men afflicted with urethral disease knows the effect often of the mere introduction of a sound into the bladder.  A healthy man will frequently faint from the introduction of a sound, and if the urethra or genitals are long diseased he will be profoundly shocked.  This means that the urethra is extraordinarily supplied with nerves.  I do not see, so far, any better explanation of so-called urinary fever after the introduction of a catheter than that it is "reflex." The urethral irritation may travel in two ways and act in two ways: (1) It may travel up the spinal cord, to the heat center either by the sacral plexus through the cord or by the splanchnics through the cord and thus disturb the heat center. (2) But more probably the urethral irritation is transmitted up the hypogastric plexus to the abdominal brain and is reorganized and emitted on the various plexuses.
    It travels on the renal plexus more vigorously, owing to the more intimate connection existing between the kidney and the genitals - e. g., the ureter has a plexus, the testicle has a plexus, and, also, a part of the hypogastric plexus forms part of the renal plexus; furthermore the kidney and genitals originally arose from the same body - the Wolffian.
    Now, the reflex irritation induced by the catheter on the urethra then flashes up the hypogastric plexus, and the reorganized forces are sent to the kidney and the irritation acts on the kidney to change its circulation; it is congested and urinary fever follows. The fainting of patients on the introduction of a catheter is explained on the same principle.  The high nerve supply to the urethra being disturbed, the irritation is transmitted to the abdominal brain, where it is reorganized.  The reorganized forces are then radiated on the various sympathetic splanchnics to the three cervical ganglia and are then transmitted by their three nerves to the heart, which is induced to move in a riotous manner.  The heart is weakened and the patient faints.  The irritation of the genitals being sent to the abdominal brain, it induces dilatation of the abdominal visceral circulation, and this probably explains the rise of temperature.  Occasionally the introduction of a sound kills a patient, but that may be due to the weakness of the patient after a long-continned exhausting disease.  Thus the nerve storms arising from the genitals are entirely due to the abundant and exhausting nerve supply.  The irregular nerve storms arising in . genitals highly supplied by nerves are profound in their invasion of the whole system.  They pervade all active organs and disturb rhythm and induce further reflexes.  Reflex action from the sympathetic explains much - e. g., when a man begins the "catheter life" he rings his own death knell; by the use of the catheter he induces reflexes which will remorselessly follow him until death.  Besides, he introduces infection into the urethra and kidneys by the dirty catheter.
    Thus the man goes through three stages on his road to the grave: (1) He has acquired some form of obstruction to the outflow of urine from kidney to penis; (2) he introduces the catheter, which calls up the wide domain of reflexes; (3) he introduces infection, and death follows.  If the genitals were not so highly supplied by nerves, the terrible reflexes would not arise.  As an application of the extensive supply of sympathetic nerves to the genitals and its wonderful reflexes, examine for a moment the result of coition.
    The role played by the vaso-motor centers should not be lost sight of.  I have found, time after time, that the ganglia of the lateral chain of the sympathetic, situated at the root of the pudic (third sacral), were very large, and this will aid in transmission of irritation.

Conclusions.

    1.  The sexual instinct is the most dominant instinct of animals.
    2.  Evolutionary forces have linked the abdominal sympathetic nervous system and the genitals by numerous and intimate bands which increase with the progress of higher development - i. e., sexual instincts dominate and influence man, as well as the monkey and the ape, far more than the lower grades of animals.
    3.  By reason of the growing and increasing intimate relations between the genitals and the nervous system, mental forces play a greater role in the production of disease.
    4.  I have observed that the monkey is an inveterate masturbator in confinement, and his persistent attention to the genitals shows that the sexual instincts keep pace with mental progress.
    5.  The severe shock arising from hysterocotomy shows that the uterus has an extensive nervous connection with the abdominal brain.  In this operation one severs the great hypogastric plexus, and I have seen an alarming rise of temperature (103 degrees F.), disturbed respiration and circulation, all from cutting the hypogastric plexus.  The disturbance was not due to infection, as almost all of it arose a few hours after the operations.  Occasionally removing the appendages shocks, but, as the ovarian plexus is small, the shock is limited.
    6.  The genital and the urinary organs both arise from the Wolffian body, so they are anatomically and physiologically connected, and both have an enormous nerve supply, so that damage to one often injures the other by reflex - e. g., hysterectomy has caused death by inducing nephritis a few days succeeding the operation, the test-tube revealing three-quarters albumin under the heat test.
    7.  The close connection between the genitals and nerve system is clearly seen from the terrible nerve storms which flash over the system from irritation (manual, instrumental or pathological) of the genital e. g., irritation of the clitoris quickly disturbs the whole nerve balance.
    8.  The great nerve connection of genitals and centers indicates that all irritation should be at once removed.  All preputial adhesions on the clitoris should be broken up, and the same with those of the prepuce.  In short, all pathological conditions of the genitals should be at once righted, so that the nerve balance may be maintained.

    The reports of fainting and vomiting and even death during coition have a scientific interest in view of the present subject.  The celebrated Russian general, Skobeleff, died while cohabiting with a woman of ill-fame.  Attila, king of the Huns, died while holding sexual relations with his young wife.  In a small town in Ohio, a man nearly 70 years of age was reported to have died during coition.  Stock men have made interesting reports in regard to animals.  A mare put to a stallion fell dead at the end of coition.  Young male animals have often fainted when first allowed to serve the female. The dog coition is prolonged, which limits shock.  A dog has no semen sacs.  The boar has an intensely violent coition, with consequent effect on his viscera, as in respiration and circulation.  Young stallions are the most liable to faint of any of the domestic animals.  Young bulls become weak, exhausted and tremble at first coition.  A medical acquaintance related to me a death in a middle-aged man about an hour after coition.
    Dr. Miller related two instances which interested him very much because he did not understand the explanation.  A man about 60 years of age, while walking to the door a few minutes after cohabiting with a strange woman, fell and died immediately.  In another case, at the first coition the young husband fainted, and the sphincters relaxed, defecation and urination resulting.  One can easily observe in domestic animals that, especially in the male, the respiratory rhythm is disturbed - slowed for a while and then quickened.  The heart will also be disturbed in its rhythm - slowed for a time and then quickened.  The explanation of these phenomena lies in the sympathetic ganglionic system.  The vesicular seminales are very highly supplied by the hypogastric plexus of nerves.  As soon as the irritation is produced on the nerves of the semen sacs, it is carried to the abdominal brain.  Then the irregular, stormy irritation accumulated in the abdominal brain is radiated on the various plexuses of nerves, especially in the direction of least resistance.  The disturbance of rhythm will be most manifest in that organ which is weakened or most sensitive.
    We will consider first the sudden deaths which are due to rupture of blood-vessels in the brain.  Such sudden deaths are apt to occur in elderly men who have weak arteries, and also death is more liable to occur when the man is cohabiting with a strange woman for the first time, when he will be the most excited.  Such deaths seldom occur with men who repeatedly cohabit with the same woman, when excitement is but ordinary.  The explanation is, that the irritation goes from the semen sacs, during the spasm of expulsion, to the abdominal brain.  Here the irritation is reorganized and radiated to the vaso-motor center.  The irritation may also go up the spinal cord to this center.  The disturbance in the vaso-motor center produces narrowing of the caliber of the peripheral blood-vessels and thus the blood-pressure is suddenly raised.  At the same time the heart is slowed and hence the force is increased.  It pumps the blood vigorously into the arteries and the weak wall gives way under the sudden pressure.  The weak cerebral artery yields to the excessive blood-pressure, and death follows immediately from blood extravasation.  It will be noted that all such deaths have occurred with elderly men who generally have weak, atheromatous arteries, with degenerated walls.
    In cases of vomiting and fainting, the law is just the same.  The irritation due to the emptying of the semen sacs is conveyed to the abdominal brain or up to the spinal cord.  The disturbed energies are reflected to the heart and stomach, and fainting and vomiting are apt to arise.  It comes under the same law as vomiting in pregnancy.  In domestic animals, fainting, vomiting or death is liable to occur in those animals which have a short, intense orgasm, as the horse or pig.  The orgasm is much more intense in males, and hence they are nearly always the subjects of disturbances during cohabitation.  Females suffer very rarely.  All this profound impression in the coition of animals is due to the irritation being sent to the abdominal brain, where it is reorganized and radiated out on the plexuses of the various viscera.  The sudden, short irritation deranges the normal rhythm, and hence the pathology of fainting and vomiting.  The disturbance of rhythm will be the most manifest in that organ most sensitive or most essential to normal life.  The same rules apply precisely to man.
    Men during coition occasionally faint, vomit, defecate, urinate, or die.  I know of a noted judge who died shortly after connection with a girl in a brothel.  In Chicago, a short time ago, at one of the principal hotels, a man of probably forty-eight was found dying after cohabiting with a strange woman.  All such deaths that I know or have read of have occurred in elderly men.  The smaller manifestations, such as fainting, vomiting, urination, and defecation, have all occurred in quite young men - mainly at the first coition.  The elderly men scarcely ever die while cohabiting with their wives, as they are familiar with them, and the excitement of the orgasm is not so violent or intense.  It generally occurs with old men (in age, if not in years) in first coition with a strange woman.  Death may occur with an old man who has not had connection with his wife for a long period, especially if the orgasm is intense.  I do not include in such a subject rupture of some pelvic tumor, due to coition.  The explanation of the matter lies in the sympathetic nerve and its reflexes.  The irritation of the penis is due to friction, and of the semen sacs to spasm and evacuation, which is transmitted to the abdominal brain and there reorganized.
    The accumulated irritation in the abdominal brain is radiated rapidly and on the various directions of least resistance.  It rapidly ascends the splanchnics and is reorganized in the cervical ganglia and sent to the heart.  The irritation sent so suddenly to the heart at first violently stimulates it to a vigorous action, so that the blood-pressure is raised to a high tension in the brain, especially in the left cerebral artery.  Old men often have friable, degenerated arteries, and this sudden rise of blood-pressure induces the middle left cerebral artery to rupture, and thus arises the death from coition.  The primary cause is the reflexes arising from the semen sacs and genitals.  During the dissection of quite a number of. cadavers, I have noticed that the connections of the lateral chain of sympathetic ganglia are very large at the root of the third sacral nerve.  It must be remembered that the third sacral makes up nearly all of the pudic nerve; also that all the external genitals are supplied by the pudic nerve.
    Hence, we find that the pudic nerve connects itself with one of the largest ganglia in the lateral chain of the pelvic sympathetic.  Irritation of the external genitals is quickly carried to the vaso-motor center by the close and extensive connection of the cerebrospinal sympathetic.
    The rectum and anus have a close connection with the sympathetic nerve.
    The anus is guarded by two kinds of sphincters: (a) One, the internal sphincter, ruled by the sympathetic, and this accounts for the fact that rectal disease (fissure, ulcer) creates such intense disorder and neuroses among the viscera through violent reflexes. (b) The other anal sphincter, the external, is dominated by the spinal nerves and does not create such wild disorder among the viscera by reflexes.
    I have often noticed that in dilating the rectum under an anesthetic, the patient would utter a kind of hoarse bray or expiratory moan, similar to the braying of an ass or mule.
    The reason for this violent braying or expiratory moan in rectal dilatation is, that there is a distinct nerve strand arising from the inferior cervical ganglion and passing directly to the phrenic, which controls the diaphragm, e. g., rectal dilatation induces the irritation to pass to the abdominal brain over the hypogastric plexus, whence it is reorganized and emitted to the inferior cervical ganglion to the phrenic, which transmits it to the diaphragm, which rapidly forces the air over the vocal cords.
The mare in heat will often utter a similar sound.  If the mare is watched, she will be seen to be disturbed occasionally, every five to eight minutes.  When a "spell" or disturbance arrives, she will first raise the tail, and then begin to straddle and utter a kind of bray, then the pudenda is spasmodically everted, followed by the emission of fluids from the pudendo-vaginal gland.  The explanation of this phenomenon must be made through the pudic and sympathetic nerves of the rectum and genitals on the one hand, and the recurrent laryngeal and sympathetic on the other.  In short, there is a distinct relation between the voice and the rectum.  This connection must lie in the sympathetic nerve.  If one dilates the rectum suddenly the patient's skin capillaries become flushed with blood and sweating is induced.
    One of the most prominent features of patients suffering from rectal disease is their manifest nervousness.  Rectal patients become irritable and neurotic.  The profoundly rich supply of the hypogastric to the rectum explains why disease of the rectum makes neurotic subjects.
    There is also an evident connection between pelvic disease and the voice.  Menstruating women are likely to have tonsillitis congestion, more than non-menstruating women.  Chronic irritation in the pelvic organs will induce chronic disease in the tonsils and throat.  In some women the voice changes at menstruation or during aggravation of pelvic disease.  Not uncommonly young women have difficulty in swallowing at menstrual times, and their hearing may be a little disturbed, because of the congestion, times, and the chronic inflammation travels up the Eustachian  tube.  The distant relation and connection between the ovary and the parotid gland is well known, and in mumps and operations on the ovary.  Few writers have called attention to the relation of pelvic disease to pharyngeal disturbances,  which exist by means of the connection with the sympathetic.  The relation of the tripod in exophthalmic goiter - heart, thyroid gland and eyeball - will be more readily understood through the study of the sympathetic nerve.  The enlargement of the thyroid in the menstrual life of women rests on the sympathetic nerve.  The sexual life of woman is her chief life, from a physical standpoint, and as she has a larger ganglionic system than man, she demands special study; for form this chief function of her life will arise new structures and diseases.
    The anus is the last to become insensible under chloroform.  One can arouse a patient who is supposed to be dying from chloroform anesthesia, by suddenly dilating the rectum; the peripheral capillaries will also dilate and the cardiac and respiratory action will again resume.  It is possible that the same safety arises in dilating the cervix and vagina in labor, as then we may give chloroform with impunity.  The heart center lies in the medulla, and one often observes how dilating the rectal sphincter makes the capillaries flush and the skin sweat.  Now, the very opposite often happens, for very often when a sphincter is dilated, as in labor, urinating or rectal dilation, the subject has a distinct chill.  This is due to the disturbance carried to the heat center in the medulla. The kind of irritation which produces chill and the kind which produces heat are not yet determined, but both arise by means of the sympathetic nerve.
    Reflexes from the rectum, e. g., fissure, produce just the same disturbance upon the system as do reflexes from the vagina or uterus.  Both arise by means of the sympathetic, and both result, if persistent, in malnutrition.  The reflexes seem to alter (stimulate, depress or produce irregularity) the circulation in adjacent or remote organs.
    It is well known that young girls who have a uterus badly developed and anteflexed, suffer from constipation and rectal troubles.  It is likely that the constipation and rectal trouble is mainly due to reflex action by means of the abdominal brain.  It is known that long continued irritation of a voluntary degeneration and finally cicatricial contraction.  Now it is also well known that women possessed of rectal trouble soon acquire uterine trouble.  It is due to reflex action, the rectal irritation is sent up the abdominal brain and reorganized and then transmitted to the uterus, inducing circulatory and nutritive disturbance.
    The sympathetic nerve, as its name implies, is liable to be brought in unison with surroundings.  For example, when the young pregnant wife begins to vomit, the young husband may vomit also, a purely mental impression through the sympathetic nerve.  The effect of the sympathetic on the glands of woman is important.  The main glands are (a) mammary; (b) the sebaceous on the face and (c) those of the pudendum.  As soon as menstruation begins (or a little later) the girl begins to have facial acne.  The sebaceous glands of the face inflame, enlarge and have a severe exacerbation at each monthly.  Some women look almost as if they were chronic drinkers at the time of menstruation.  A monthly rhythm excites and exacerbates the facial sebaceous glands into a chronic inflamed condition. (These glands may be trying to imitate the glands in the boy in enlarging a growing beard.) The trouble is due to the sympathetic and is especially active in the face by reason of the presence of the ophthalmic ganglia, Meckel's ganglia, otic ganglia and sub-maxillary ganglia - all sympathetic ganglia situated on the fifth cranial nerve.  This facial acne, highest at the maximum of the rhythm of the automatic menstrual ganglia, is very annoying to many women.  At the climax of the menstrual rhythm, there may be noticed on some women, dark discolorations, or pigmentation, just below the eyes.  This pigmentation of the eyelids is what is so frequently mentioned as the dark rings about the eyes.  It is due to deposit of pigment induced by venous congestion.  The congestion is brought about by the rhythmic irritation of the ophthalmic ganglia (sympathetic) on the supraorbital branch of the trigeminus.  The congestion and pigmentation of the eyelids in menstruation must also be connected with the presence of large glands known as the Meibomian glands. The sympathetic nerve has a predilection and a dominating influence over glands; so that the eyelid congestion and consequent pigment deposit during menstruation must be associated with the ciliary ganglia of the Meibomian glands.
    In the pelvic diseases of young girls, I have found quite frequently an association of weak eyes.  This is especially the case with endometritis, deficiently developed uterus and dysmenorrhea.  They can use their eyes to read but a few minutes at a time, without pain or the letters blurring.  I could find no reference to the subject in gynecological text-books.  Since writing the above I have learned from Dr. B. Bettman that Dr. Fritsch and others have investigated the connection between pelvic and eye diseases.  It must be that there is some prominent connection between certain cases of female generative disease and eye trouble.  I have noted so many cases that I cannot consider it an accident and believe there must be some physiological connection.  The eyes are worse at the maximum of the menstrual rhythm.  The explanation of this association must lie in the sympathetic nerve.
    I suggested the subject to Dr. Frances Dickinson, Professor of Ophthalmology in the Chicago Post-Graduate School, who has carefully followed some of the cases.  So far, the doctor has reported that the eye trouble seems to be in the general circulation of the eye, the visual apparatus (the cornea, lens and retina) being normal.  The endurance of the eye for work is lessened, and it appears to me that the chronic defect in the blood canals is accounted for by the disturbance in the rhythm of the diliary ganglia, and the sympathetic nerve supply of the Meibomian glands accounts for the pigmentation of the lids.  What role the lachrymal glands play in the matter of eye trouble through the sympathetic, I am unprepared to state.
    The associated disturbances of the mammary glands in menstruation and gestation, have attracted the attention of many thinkers.  The problem must be solved through the sympathetic nerve.  The spinal nerves supplying the mammary glands come from the cervical plexus and the six upper dorsal nerves.  The arteries which supply the gland are the long thoracic, internal mammary, the intercostal arteries under the gland, and a few branches from the axillary arteries.  Now, on these arteries, the sympathetic nerve goes to the gland.  The first stage of milk secretion is a silent process reflected through the cord.  The second stage is a gross reflection through the splanchnic from fetal irritation in the uterus; the cerebrospinal nerves elaborate milk, but the sympathetic hastens its secretion.
    The original irritation nearly always arises in the pelvic organs.  It travels to the mammary gland in three ways: First, by the way of the spinal cord; second, by way of the lateral chain of the sympathetic; third, the main way is through the hypogastric plexus to the abdominal brain and then through the great sensory nerves of the viscera, viz.: the three splanchnics.  But we must again consider that the mammary gland has a peripheral nerve apparatus which not only shares in the genital rhythm, but also has the capacity to form milk.  The mammary gland must be looked on as simply a modified sebaceous gland and we have noticed above how the sebaceous glands of the face are affected by menstruation and gestation.  The spinal nerves do not induce any rhythm in the glands as is shown in girls up to puberty.  But the impetus to rhythm must suddenly arise at the peculiar condition known as puberty, or the period of tubal motion.
    The sebaceous glands on the pudendum are large and the odor at menstruation is chiefly due to their increased secretion.  The pudendal glands are remnants of ancient life when the female, in heat, attracted the male by the increased odor emitted from the active glands.  The odor during menstruation is often due to the activity of the Pudendale sebaceous glands and decomposition of their products, not merely to decomposition of menstrual blood.  Here, as in other glandular apparatus, the sympathetic nerves play an important part.
    The sympathetic nerve seems to play a significant role on the heat centers of the medulla.  I have noticed this especially in laparotomy and vaginal hysterectomy.  In short, when certain bundles of sympathetic nerves are cut, especially the hypogastric plexus, the temperature will rapidly rise above or fall below normal.
    Surgeons are alarmed at these manifestations until experience teaches their real meaning.
    The practical application of the sympathetic nerve in gynecological work lies in its control over nutrition.  Reflex irritation from a pelvic viscus will remotely, or through several years, impair the whole visceral economy.  Remote effects of pelvic disease must be traced through the nervous system (sympathetic) due to circulatory modifications.
    The connection of the cerebral cortex (the seat of epilepsy), with ovarian diseases, resulting in so-called hystero-epilepsy, is far from being proven.
    The different sizes of the peripheral ganglia in the various viscera is an important element in studying the sympathetic.  Some viscus may have abnormally small ganglia and hence its rhythm and nutrition will be defective.  Small automatic cardiac or menstrual or gastrointestinal peripheral ganglia will be unable to do normal, vigorous, nutritive and rhythmic work, thus making the visceral system defective.
    Menstruation and the menopause I shall place in the realm of the sympathetic nerve.  The peculiar cycles and rhythms throughout the life of woman demands attention.  We may call attention to the wide domain of the sympathetic nerve not only in health, but also in disease.  Having made considerable investigation in this subject, some of the resulting views may be of interest and may stimulate the study of the sympathetic nerve.