OBSERVATIONS ON THE GANGLIA AND NERVES OF THE UTERUS.

DECEMBER 9, 1854. Molesworth-street, Dublin, April 22nd, 1842. " My DEAR SIR,-I received the paperOn the Nerves of the Uterus’ which you so kindly sent me, and beg to congratulate you on the triumphant success of your researches; and I rejoice exceedingly that what was begun in our own country by W. Hunter has been brought to perfection in our own country by your talent and perseverance; and as such I shall speak of it. " Yours very sincerely, "W. F. MONTGOMERY, M.D." "

OBSERVATIONS ON THE

GANGLIA AND NERVES OF THE UTERUS. BY ROBERT LEE, M.D., F.R.S., THE ROYAL COLLEGE OF PHYSICIANS, LONDON; PHYSICIAN TO THE BRITISH LYING-IN HOSPITAL, AND OBSTETRIC PHYSICIAN TO ST. GEORGE’S HOSPITAL.

FELLOW OF

(Continued from p. 415.)

" 14, Savile-row, December 29th, 1843.

SiR,-I have carefully inspected your preparations, exhibiting the nerves of the gravid uterus, and I can find " MY

SINCE the publication of these papers " On the Nervous System of the Uterus," in the " Philosophical Transactions," many of the most distinguished British and foreign anatomists, and medical practitioners have carefully exaphysiologists, dissections described and delineated in them, and mined all the have borne testimony to the correctness of my statements: Sir B. Brodie, Mr. Lawrence, Mr. Paget, Dr. Knox, Dr. J. Davy, Mr. Stanley, Mr. Skey, Mr. Gulliver, Dr. Montgomery, Dr. Evory Kennedy, Dr. Collins, Mr. Edward Grainger, Mr. Liston, Mr. Hilton, Mr. Prescott Hewett, Dr. Herschfeld, M. Velpeau, M. Dubois, the Professors Retzius, Elliot, and Boech, of Stockholm; Professor Meigs, of Philadelphia; Mr. Fergusson, Mr. Erasmus Wilson, Mr. Gray, Mr. Simon, Dr. Chambers, Dr. Bright, Dr. Mantell, Sir Charles Clarke, Dr. Melville, Dr. Arnott, Dr. Baly, and many others. Some recorded their opinion in writing. A few of these are subjoined:-

DEAR

no reason

have

to doubt the correctness of the statements which you

published in thePhilosophical " Yours

Transactions.’

truly,

"B. C.

" Brook-street, January 8th, 1843. to SIR,-In reply your question, with what im. pression I came from the examination of your dissections of the gravid uterus? I can have no hesitation in stating my opinion to be, that your dissections do satisfactorily display the uterine nerves and their ganglia. Looking to the arrangement, con. nexions, and relations with the bloodvessels which the filaments and intumescences present, I cannot think otherwise of them than that they are the uterine nerves and ganglia. " Believe me to be, my dear Sir, yours sincerely,

"My

DEAR

Dr. R. Lee."

"EDWARD

FIG. 2.

FIG,

2

Represents

entering the hypogastric ganglion, and the bloodleft hypogastric cr;r 1 a portion of the neurilemma being retnocecl, and uterus, of the gunglio and irerrez thereby greatly reduced belowthe natunal aize. the

vessels, gaaglin, and nerves of the virgin

the siz

No. 1632.

BRODiE, F. R S."

STANLEY, F.R.S.

474 Fict.3.

FiG. 3 Represents the right hypog.astric nerve and ganglion, and the ganglia and nerves of the same virgin uterus, with a great part of the rzeurileanuza dissected off. The ganglia and nerves, in the watulrat state, are aboittfour times the size here represented.

" 3. The occurrence of small ganglia and gangliform enlarge" Winchester House, St. James’s-square. Friday. "MON TRÈS HONORÈ CONFRÈRE,-Vous m’avez fait un cadeau ments, on the newly-discovered nerves, are very characteristic, bien précieux, en me croyant digne de posseder le resultat and corroborativeof their real nature. admirable de vos longs et difficiles travaux. Je vous en ‘° 4. The nerves are accompanied by injected bloodvessels, a manner that is not seen in elastic tissue, although usual remercie bien sincèrement. Mes collogues de Genève, auxquels cette stupendous decouverte du developpement I with the ganglionic nerves. je "5. The ganglia discovered by Dr. Lee present, in their des nerfs d& l’uterus, partageront 1’estime et l’admiration que son auteur m’a inspirè.-Agrèez, dear disposition, and in the openings which they possess, Sir, 1’expression de ma a and and entire correspondence with the larger ganglia of reconnaissacnce et de mon sincère devotiement, perfect " " the sympathetic. MAUNOIR, Prof." "After the examination which I have made, it certainly Ihave derived great pleasure from examining the dissecto be impossible for any one to arrive at a just conappears tions of the uterine, vaginal, and vesical nerves made by Dr. clusion the true character of Dr. Lee’s description, respecting Lee. The trunk and branches of the sympathetic nerve being without a careful It is proper of his inspection left, as well as the trunks of some of the sacral nerves, a satis- toadd, that I have not yet had anpreparations. of making a opportunity factory clue is afforded in the examination. The injection of examination. the bloodvessels renders a further and valuable aid in testing microscopical " R. D. GRAINGER, F. R. S. "Nov. 13th, 1843." what are, and what are not, nervous fibrils. "After carefully inspecting and examining these beautiful "Merrion-squaoo, Dublin, Jan. 17th, 1844. "MT DEAR SIR,-I have a perfect recollection of the dissections, I have no hesitation in expressing my conviction that they bear out, fully and entirely, the delineations and gratification I experienced at examining, along with you, your descriptions published by Dr. Lee. preparations of the nerves of the uterus. Most schoolmen " 1. The preparations show an unequivocal continuity of admit the simplest of all sensible proofs to be demonstration, fibres proceeding from undisputed nervous structures-the and where, as in your case, the fact at issue is capable of being sympathetic and sacral nerves, to the newly-discovered ganglia tested by such proof, I am at a loss to know how a question of the uterus, vagina, and ureter. For myself, I can only say that I can arise on the matter. " 2. The nervous branches of the newly-discoverecl gangliawas as satisfied what I saw was nerves and ganglionic structure, join, in various directions, with acknowledged nerves, such asI as I am of the existence of nervous structure in any other organ those of the inferior mesenteric plexus, furnishing the haemor- of the human bodv with which I am familiar. rhoidal nerves, and with the spermatic nerves, descending onL ’’ Believe me, yours very faithfully, " ETORY KENNEDY, M,D. the uterus from the folds of the broad ligaments. ’

feraiconnattre ’

in

IBform

475 FiG. 4.

FIG. 4 Exhibits

an

anterior and lateral zzem

of the gravid uterus

in the faccrflc month, and

of the vagina and bladder.

A. The right hypogastric nerve. B. The sacral nerve. C. The right hypogastric ganglion. D. Nerves from the hypogastric nerve to the ganglia on the bloodvessels of the uterus E. Ganglia surrounding the uterine artery and veins. F. Ganglionic plexus, under the peritonæum on the fore-part of the uterus. G. Filaments from this plexus passing out with the round ligament. H. The round ligament. I. The right ureter and trunk of the vaginal and vesical veins surrounded with nerves. J. Ganglia and nerves of the vagina. K. Nerves passing between the vagina and rectum. L. Ganglia and nerves of the bladder. M. Vaginal nerves passing into the bladder around the ureter. N. Bloodvessels and nerves of upper part of the bladder. 0. Plexus of nerves under the peritonæum on the left side of the uterus, the bloodvessels of which have not been injected. P. Filaments from this plexus passing out with the round ligaments. Q. The peritoneum of the anterior nart of the body and cervix of the uterus reflected upwards, to expose the ganglionic plexuses situated below.

476 FIG. 5.

[For description see next page.]

477 "Grosvenor-street, Jan. 6th, 1814. DEAR SIR,-I have much pleasure in complying with your request that I would state the result of my impressions on viewing your dissections of the impregnated uterus. " I see no reason to doubt the correctness of your viewsviz., that the immense network which you have so industriously investigated on the surface of the uterus is composed of true To my judgment, they present nerves and nervous ganglia. all the visible characters of nerves, and appear to be in direct communication with the pelvic branches of the sympathetic. " I am, my dear Sir, very truly yours, "MY

"F. C.

"To Dr. Robert Lee."

SKEY, F.R.S.

"Hyde-park Barracks, January 12th, 1844. "My DEAR SIR,-I have read your papers in thePhilosophical Transactions’I On the Ganglia, and on the other Nervous Structures of the Uterus,’ and carefully examined the preparations which you exhibit as vouchers for the facts you have

" 4. That many of the minutest, as well as of the nerves, are evidently associated with bloodvessels.

larger

" 5. That the nervous system displayed is such the pregnant uterus, from its known structure and functions, be expected to possess. might " I think that your statements are proved by all the evidence to which it is possible, in the present condition of science, to attain ; and I beg to add my congratulations to those which you have already received, on your having, by a truly admirable perseverance and dexterity, made one of the most important anatomical discoveries of the century. " Believe me, my dear Sir, very truly yours, " JAMES PAGET." an one as

"Whitehall-place, December 28th, 1843. "MY DEAR SIR,-I have carefully examined your dissections of the nerves of the gravid uterus on various occasions, and I continue to believe, as I did in the first instance, that the structures you have succeeded in displaying are ganglia announced. and nerves; while I am satisfied that your figures and descrip" Your descriptions and plates appear to me to be executed tions are perfectly correct. The extraordinary and interesting with remarkable fidelity. spectacle you haveset before us is so entirely novel, that some "I cannot doubt but that the structures which you have hesitation might very probably be felt in arriving at a decided shown by dissection are really nerves, and nervous ganglia, opinion on the subject. Yet this augmented size of nerves and because their fibres are clearly shown to be continuous with ganglia is only analogous to the increased development of the sympathetic, and with the sacral nerves, and because I do bloodvessels in the gravid uterus, with which we havebeen not believethat any ingenuity in the art of dissection could long familiar : probably a corresponding clange might be found show such a regular continuity between the nerves and fibres in the absorbing system, if it were submitted to the same kind of elastic tissue, or that this tissue could be made to imitate of patient investigation which you have bestowed on the the nerves and nervous ganglia displayed in your preparations. nerves. " "I am, my dear Sir, very sincerely yours, The considerations which have led me to form the conclu"GEORGE GULLIVEP., F.R.S. sions above-mentioned, are exactly the same as those so clearly "Dr. Robert Lee." stated by my colleague, Mr. Paget. I have therefore only to "The Oaks, Ambleside, March 25th, 1844. i add, that I entirely agree with what he has written to you on "MY DEAR SIR,-Now that I am at home, and have the subject. " leisure, let me thank you for the gratification I had, when in Sir, yours very faithfully, Remaining, my dear " WILLIAM LAWRENCE, F.R.S. "Dr. Robert Lee." town, in seeing your preparations, displaying the nerves of the uterus in its unimpregnated and pregnant states. I never All the dissections here referred to havebeen preserved, witnessed any anatomical demonstration more satisfactory; and are now in the museum of St. George’s Hospital, where indeed, I cannot but consider your dissections of these nerves they may be examined. These are the only dissections of the as a perfect demonstration, &c. -1remain, my dear Sir, ganglia and nerves of the unimpregnated and gravid uterus with much esteem, faithfully yours, now existing in Great Britain, except two mutilated specimens "J. DAVY, M.D., F.R.S." in which the neurilemma was intentionally removed, as stated in the following communication published by Dr. L. HerschJune 1844. "Edinburgh, Newington, 29th, feld. "DEAR SIR,-Since my return to Scotland I have turned "Dr. Snow Beck has two specimens," says Dr. Herschfeld, over in my mind the opinion I offered you in Savile-row whilst "in the preparation of which he employed eight months, examining the very beautiful preparations you showed me of removing from day to day, with forceps and needles, (as he the nerves of the ’unimpregnated and of the gravid uterus.’ told me himself,) not merely the cellular tissue, but the The opinion amounted to this : that what you showed me as neurilemma even, so that he has left only the fasciculi of the nerves, ganglia, and nervous filaments of communication, are nervous tubes. It seems to me that the work of this anatomist really such, and can be nothing else ; that the increase in size or ought not to be appealed to when the subject of the volume of bulk, to which so much importance has been attached, has been, the Nerves of the Uterus is agitated, for they only present upon the whole, somewhat exaggerated by those who have the nerves deprived of one of their constituent tissues-the adopted a different view from that I now propose; that the neurilemma." preparations you showed me are, without exception, the most In the preparation of these two mutilated specimens here beautiful I have ever seen of any part of the nervous system; referred to, Dr. Thomas Snow Beck employed eight months to as dissections of structures viewed aifficult that, simply from day to day, with forceps and needles, not unravel, they merit the highest praise ; but, taken in con- "removing the cellular tissue, but the neurilemma even, so that merely nexion with the physiology of the organs, they place the he has left only the fasciculi of the nervous tubes." This dissector in the foremost place of observers. " unprecedented process was carried on under the auspices of Very faithfully yours, several eminent microscopical anatomists, especially Professor " " R. KNOX, M. D., F. R. S. E. William Sharpey, of University College, and now secretary at the Royal Society. This proceeding is now commonly called "St. Bartholomew’s Hospital, December 19th, 1843. "My DEAR SIR,-After the minute examination of your " skinning the nerves of the uterus." This" skinning,"so long from men of science throughout the world, was hailed preparations of the nervous system of the gravid uterus which concealed in 1845, by the Committee of Physiology and Council of the you permitted me to make, I examined your descriptions, and Mr. Perry’s delineations of them. Both appear to me remark- Royal Society, as one of the most original and sublime discoveries ever made in human anatomy, for which the immorable for their accuracy. " With regard to any doubt whether the structures which tality of Martin Horky has been his reward. The proceedings of the Royal Society relative to the disyou have dissected be, as you have described them, nerves and nervous ganglia, it is chiefly by these following facts that covery of the nervous system of the uterus will form the subject of my next communication. I feel convinced of the truth of your account :" 1. That there is a visible and orderly continuity between FiG.5 Exhibits the ganglia and nerves on the posterior and left side of the the well-known hypogastric and sacral nerves, and the most gravid uterus at the end of the ninth month ofpregnaney. minute and remote of the nervous cords which you have A. The fundus and body of the uterus, having the peritonaeum dissected off displayed. from the left side. ’’ 2. That these cords, like those of larger size, have such an B. The vagina covered with nerves proceeding from the inferior border of of nerves as I am be could imitated the left hypogastric ganglion. appearance not, sure, being C. The rectum. by"dissections of any other known structure. D. The left ovarium and Fallopian tube. 3. That the ganglia which you have found are like those of other parts of the sympathetic system, and have distinct * Note upon the Nerves of the Uterus, by Dr. L. Herschfeld, in the nervous cords passing to and from them. Medical Times and Gazette, July 23rd, 1853,p. 8. ,

,

478 not possess the above properties; and if they promote, I do I what is favourable heat and do, they sloughing, fear artery, !

E. The trunk of the left spermatic vein and artery surrounded by the left

spermatic ganglion. F. The aorta divided a little

as

to

most

above the origin of the right spermatic and about three inches above its division into the two common iliac arteries. G. The vena cava. H. Trunk of the right spermatic vein entering the vena cava. I. Right ureter. K. The two cords of the great sympathetic nerve passing down along the front of the aorta. L. Trunk of the inferior mesenteric artery, passing off from the aorta, and covered with a great plexus of nerves sent off from the left and right cords of the great sympathetic. M. M. The two cords of the great sympathetic passing down below the bifurcation of the aorta to the point where they separate into the right and left hypogastric nerves. N. The right hypogastric nerve, with its artery injected, proceeding to the neck of the nterus, to terminate in the right hypogastric ganglion. 0. The left hypogastric nerve where it is entering the left hypogastrie ganglion, and giving off branches to the left sub-peritcneal ganglion. P. Hæmorrhoidal nerves accompanying the hasmorrhoidal artery, and proceeding from the great plexus which surrounded the inferior mesenteric

moisture, and the confinement of the noxious gases and discharges to the parts, they must in these respects have a tendency to do harm. I trust that this suggestion may be the means of materially adding to the comfort of the wounded in the East, and. effectually preventing those loathsome scenes amongst them painfully recorded in many papers.

Bromsgrove, Nov.

1854.

REPORT OF A CASE OF TRANSPOSITION OF THE VISCERA. BY THOMAS

CHAPLIN, ESQ., M.R.C.S. and L.S.A.

RESIDENT MEDICAL OFFICER TO THE BLOOMSBURY DISPENSARY.

artery. Q.The sacral nerves entering the whole outer surface of the hypogastric SOPHIA H- died on the 8th of July, 1854, aged one year ganglion. R. The left hypogastric ganglion, with its arteries injected. and ten months. The body was examined forty-eight hours S. The nerves of the vagina. after death. On opening the abdomen, the liver was found to T. Nerves with an injected artery proceeding from the upper part of the left hypogastric ganglion along the body of the uterus, and terminating in be placed upon the left side, and, from being enormously enthe left spermatic ganglion. larged, extended downwards as far as the crest of the ilium, U. Continuation of these nerves and the branches which they give off to the whilst the small lobe crossed the abdomen and occupied nearly sub-peritoneal plexuses. the whole of the right hypochondriac region. The large end V. The same nerves passing upward beneath the sub-peritoneal plexuses, and of the stomach was on the right side, the pylorus and duodeanastomosing freely with them. W. The left spermatic ganglion, in which the nerves and artery from the num being on the left. The pancreas was placed to the right hypogastrie ganglion, and the branches of the left sub-peritoneal plexuses of the duodenum. The spleen, which was very large, was terminate, and from which the nerves of the fundus uteri are supplied. situated in the right hypochondriac region, and reached as low X. The left sub-peritoneal plexuses covering the body of the uterus. The left kidney was lower than the right. Y. The left sub-peritoneal ganglion, with numerous branches of nerves as the iliac fossa. extending between it and the left hypogastric nerve and ganglion. The cæcum was in the left iliac region; the sigmoid flexure in Z. The left common iliac artery cut across and turned aside, that the left the right. On examining the chest, the heart was found with hypogastric nerve and ganglion might be traced and exposed. its apex pointing to the right side, and the aorta, which proceeded from the right ventricle, arching downwards towards (To be continued.) the right side of the spine. The left lung had three lobes, the two. The child had been delicate from its birth, and some time before its death had fallen into a very cachectic condition. The autopsy showed evidences of recent general peritonitis. Both lungs were partially emphysematous, and there were signs of rather severe bronchitis. The heart was large, and the pericardium roughened in several spots by an old deposition of

right lung only TREATMENT OF SLOUGHING SORES BY CHLORINE. BY THOMAS S. FLETCHER, ESQ., M.R.C.S. AT the suggestion of the professor of surgery at the Queen’s College, Birmingham, I beg to call the attention of the readers of THE LANCET to a simple and at the same time highly efficacious mode of treating sloughing wounds by means of

lymph. .

The first

chlorine. curative agent fully these properties.

in which I used this article as a illustrates how powerfully it possesses

Great

Russell-street,

Dec. 1854.

case

A man, aged eighty-four, was in August last shot through the palm of the hand, and, in a few days, the wound becoming very offensive, each orifice was covered with large pads of tow, dipped in a weak solution of chloiide of lime (two drachms of the powder to a pint of cold water,) and the dressing renewed The offensive odour was immediately about twice a day. destroyed, the wound became clean and healthy, the granulations sprung up with great rapidity, soon covering the ends of the fractured bones, and healing up the wound, and this without the use of any other remedy. I havetrusted to the sole use of chlorine in other cases with equal success, applying it not only where the wounds aree become offensive, but in the earlier stages, where there was reason to apprehend there would be sloughing or offensive discharges. Various preparations of chlorine have long been used to remove the odour from wounds, and for this purpose they are applied over other dressings; but what I here wish to recommend is that it should be used alone, and as a curative remedy. The 1’ationale of its action may perhaps be explained in the following manner :-Portions of the wounded parts are preserved from sloughing by means of the antiseptic properties possessed by chlorine; granulations are to a very remarkable extent promoted-first, by the stimulating power of chlorine, from its increasing the activity of the small vessels on the surface of the wound, and secondly, by the peculiar property it has of keeping the wound clean, and thus enabling the plastic cells formed from the liquor sanguinis to have immediate contact with, and adhere to, active living substance, and so form new healthy tissue, instead of their being thrown off in the form of pus. If chlorine has the power of increasing the process of granulation, it must, as a natural consequence, have in an equal ratio the property of suppressing the suppuration. Lastly, the formation of those noxious gases and larvae so detrimental to the parts themselves and injurious to the general health, is prevented by the chemical action of chlorine. Poultices, ointments, and hot and cold water applications,

A Mirror OF THE PRACTICE OF

MEDICINE AND

SURGERY

IN THE

HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum et dissectionum historias, tam aliorum proprias, collectas habere et inter se comparare.—MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

ST. THOMAS’S AND UNIVERSITY COLLEGE HOSPITALS. TWO CASES OF STRANGULATED INGUINAL HERNIA; OPENING OF THE SAC; RECOVERY.

(Under the care of Mr. LE GROS CLARK

OPERATION;

and Mr.

QUAIN.)

ALTHOUGH there is some difference of opinion amongst surgeons as to the propriety of opening the sacin the operation for strangulated hernia, we are confident that the peritoneal investment is never laid open, except the surgeon conscientiously thinks the measure necessary. But even when this necessity is most manifest, there may be some apprehension in the mind of the operator, who is apt to ask himself whether he is not, by laying bare the intestine, jeopardizing his patient’s life? Now, it must be evident to those who see a great many of these operations, that the opening of the sac, and even the decidedly dark colour of the bowel, are, to say the least of it, pretty often followed by favourable results. Of course, we are only here stating a general impression, and know full well that