The Vegetative Nervous System from the Clinical Viewpoint

Malcolm S. Woodbury
1917 Boston Medical and Surgical Journal  
While the territory indicated by our title is very great, our knowledge of it is not, and the portion of our knowledge having sufficiently practical bearing to warrant presentation at the present time is still less. However, when the practical available material is reduced to lowest terms, there yet remains enough to furnish ample for many papers of the length which this can reasonably assume. I shall, accordingly, utilize the scope of the title merely to permit the observation of a few of the
more » ... ore important points now discernible as a result of the studies of numerous physiologists and neurologists. Langley, Jacobsohn, Müller, Sherrington, Hess, Eppinger, and Timme, among others, should be accredited at the outset with having furnished and collected much of the information which has opened the way to us for more intelligent clinical observation. The papers of Hess and Eppinger and of Timme discuss most of the clinical essentials available up to the present. When one's interest in the significance of the vegetative nervous system is fully aroused, certain obscure symptomatic manifestations take on new aspects and-if one may in a general way anticipate conclusions-help to clarify the mechanism of symptomatology and point out certain medical and surgical leads in therapy. Confusion in nomenclature, coupled with seemingly contradictory experimental evidence, has rendered obscure the arrangement and function of the various elements of the vegetative nervous system; but there cannot be the least doubt that this system plays a far-reaching rôle in every conceivable pathological process, as well as being a factor of inestimable importance under normal conditions. Through its activities and the degree of its sensitization to various stimuli, it is essential in determining the functional type of the normal individual. While it would be out of place here to enter too minutely into a discussion of anatomy, certain outstanding anatomical and physiological essentials must be borne in mind in order to furnish a basis for our discussion. It is better, as Langley has pointed out, to abandon the term "sympathetic system" in its too general meaning, and to recognize that the true sympathetic is but a subdivision of what is known as the vegetative nervous system which furnishes fibers to smooth muscles throughout the body as, for example, to the intestines, blood vessels, gland ducts, and skin; also to certain cross-striated muscles, such as the heart, the terminal parts of the alimentary canal and the genital apparatus, and also furnishes secretory fibers to glands, in contrast to the sensori-motor nervous system, which supplies voluntary muscles and the special senses. The vegetative nervous system, according to Langley and others, is divided into: (a) The autonomie system, and, (6) The sympathetic system proper (also called the thoracic autonomie), which arises from the sympathetic cells in the lateral horns of the spinal cord from the first thoracic to the fourth lumbar segment, and whose fibers pass out by the white rami to the gangliated cord on each side of the anterior aspect of the bodies of the vertebrae. By its peripherally connecting fibers it supplies the skin, blood vessels, glands, viscera and internal generative organs. The autonomie is further subdivided into: (oe) The mid-brain autonomie which originates beneath the anterior corpora gemina and supplies (contractor) fibers to the iris and ciliary muscles. (b) The bulbar autonomie, which arises in the region of the fourth ventricle and which, by way of the facial, the nervus intermedius, the vagus and the glossopharyngeus, supplies the vessels and glands of the mouth, pharynx, nose, esophagus, stomach, small intestine, part of the large intestine, the trachea and lungs. It is important to note at this point that the vagus is an important member of the autonomie group, and to remember its wide distribution, as well as the fact that its influence on the gastro-intestinal musculature is contractile. (c) The sacral autonomie which, leaving the spinal cord from the first to the third sacral segments as the pelvic nerves, supplies the descending colon, rectum, anus, bladder, urethra and external genitals. Omitting a description of the course, and finer arrangement of the fibers of
doi:10.1056/nejm191711151772004 fatcat:j5das775wrhbnnc6w6n63uaavu