The ratio of pre- to postganglionic neurons and related issues in the autonomic nervous system.

The motor outflow of the autonomic nervous system (ANS) is differentiated into two major divisions, parasympathetic (PSNS) and sympathetic (SNS). Both are organized hierarchically into pre- and postganglionic levels, but classically the two divisions have been assumed to differ in their ratios of pre- to postganglionic neurons. The PSNS been characterized as having lower ('one-to-few') ratios, whereas the SNS has been described as possessing higher ('one-to-many') ratios. These patterns have been assumed to measure differing divergences of the outflows. In this review, a ratio of pre- to postganglionic neurons is called a ratio index, and the idea that the PSNS and SNS have characteristically different ratio indexes and divergences is called the ratio rule. The putative differences in the ratio indexes of the two divisions - as well as Fulton's influential proposal that they form one of the bases of contrasting functional capacities of the PSNS and SNS - have been widely accepted for nearly for nearly three quarters of a century. A survey of the original observations yielding the concept of the ratio rule as well as the more recent estimates of pre- and postganglionic numbers, however, challenges both the generality and the adequacy of the ratio rule and indexes. The originally formulated differences between the PSNS and SNS represent an overgeneralization since they were based on observations of only two ganglia, the ciliary ganglion in the PSNS and the superior cervical ganglion in the SNS. Furthermore, these original estimates were based on limited samples and were subject to a number of counting artifacts. A survey of the literature suggests that ratio indexes vary much more within each ANS division than they do between the two divisions. When ganglia other than the ciliary and superior cervical are examined, the two divisions of the ANS have broad, largely overlapping ranges of ratio indexes. Additionally, other PSNS-SNS pairs can be found in which the relative sizes of their respective indexes are completely contrary to the ratio rule. For a given ganglion, there are substantial differences in the ratio index between species, between individuals of the same species, and between stages of development in the same species. Furthermore, both divisions of the ANS have wide and largely overlapping ranges of physiological effects varying from specific to diffuse, from local to widespread. Finally, the ratio index measure ignores the degree of convergence found in different ganglia, and it is insensitive to the fact that many ganglia have multiple functionally distinct motor neuron pools, each with separate inputs varying in their degrees of divergence and/or convergence. Thus ratio indexes do not differentiate the PSNS from the SNS, and conclusions based on such putative distinctions are questionable.