The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
DISEASES OF THE URINARY SYSTEM
CASES: (1) Lithuria in a young girl after typho-malaria.
Lesion, a faulty condition of the lower dorsal and lumbar regions.
Such quantities of uric acid "sand" appeared as to be easily seen by the
naked eye. Dr. A. T. Still found a "hotspot" at the 4th lumbar which
was slipped. Also, found the 10th right rib off its articulation
at its head, interfering with the function of the adrenal bodies.
In less than two-hours after his treatment normal urine was passed.
The previous passage, one-half hour before the treatment, had been cloudy,
dark, and contained a heavy precipitate.
(2) Abscess of the kidney and catarrh of the bladder,
(chronic cystitis) of three years standing, in a man. He was obliged
to urinate every five or ten minutes, always with great pain. The
urine was about one-half sediment and blood, and only about one-half the
normal amount. After six weeks treatment the case was almost well,
no pain upon urination; retains urine one hour; practically no sediment;
normal amount of urine.
(3) Bright's disease in a man twenty-nine years
of age; diagnosis confirmed by several physicians; great dropsical swelling
of feet, limbs and body up to the 12th dorsal vertebra. After five weeks
treatment be was able to go to work at an occupation that kept him constantly
upon his feet. After the fourth treatment there had been rapid improvement;
in six weeks the urine was almost normal, and the dropsy had disappeared.
(4) Acute nephritis in a married woman of 65, of
4 weeks standing. She had suffered from previous attacks. The
inflammation had extended to ureters and bladder (cystitis). 10th, 11th,
and 12th dorsal were posterior and lateral. The case was cured in
3 weeks. It was free of pain after the second day.
(5) Acute Nephritis in a man of forty. Lesion
was found irritating the renal splanchnics. The treatment was at
the 11th and 12th dorsal, and raising of the 11th and 12th ribs.
(6) Acute Bright’s disease. Large quantities
of albumen appeared in the urine. The 12th dorsal vertebra was found
anterior. One treatment relieved the pain and the patient slept.
Good progress was reported.
(7) Acute Bright's disease. Spinal lesion
was found. After seven weeks treatment no further symptoms remained.
For five weeks a physician examined the urine daily finding no further
evidence of the trouble at the end of that time. He said he had never
seen a case do so well.
(8) Bright’s disease and paraplegia; lesion was
found as a separation between the 11th and 12th dorsal. There was
a history of the patient’s having jumped from moving trains for years.
(9) Chronic Nephritis (probably) diagnosed as floating
kidney. The patient, a lady of twenty-five, was in a very bad condition;
heavy sediment in the urine; painful micturition. Lesions: Upper cervical
lateral; posterior curvature from 5th dorsal to 5th lumbar; marked lesion
at 10th, 11th, and 12th dorsal, and 2nd lumbar. The 11th and 12th
ribs were subluxated, giving the appearance of tumor, diagnosed as floating
kidney. The case began to improve upon the first treatment, and was
practically cured in two months.
(10) Enuresis in a boy of seventeen, of seven years
standing. Occipital pains present. Tissues about 2nd cervical
tense; about 3rd and 4th cervical sore; 7th and 8th dorsal vertebrae anterior
and sore. The boy had been thrown from a horse at ten years of age,
and the trouble had persisted ever since.
(11) Enuresis. The 5th lumbar vertebra was
lateral. The disease was entirely cured in six weeks by the removal
of this lesion.
(12) Enuresis in a boy of five. The lumbar
region was very weak, and had a posterior tendency. Treatment here
relieved the case.
(13) Enuresis in a boy of five, had been present
all his life. For four years he had been constantly under medical
care. He had no warning of the passage of urine, even in the day
time. After eleven treatments but two involuntary passages occurred
in eight months. After a recurrence due to an attack of the mumps, two
weeks treatment cured the case. The treatment was given over the
sacral and lumbar regions.
(14) Enuresis in a boy of nine. He had been
troubled for eight years during sleep. The usual methods of treatment
had been without avail. Great tenderness and a slight lesion
occurred at the 2nd lumbar, removal of which cured the case.
(15) Enuresis in a boy of twelve who had always
had poor health. For eight years nocturnal urination had been constantly
present. In the day time the urine passed involuntarily. Lesions
were found in the cervical region; pronounced posterior position of the
lower dorsal spine; lesions from the 2nd to 5th lumbar. Steady improvement
took place under treatment, and the case was cured in three months.
(16) In a man of 21, enuresis and chronic cystitis
of five years standing. Voiding of urine was usually followed by
the passage of pus and blood. There were accompanying pains through
penis and bladder. The 8th dorsal to 2nd lumbar vertebrae, were posterior,
the left innominate was forward and downward, the prostate gland was enlarged.
The case was improving under treatment.
(17) Renal Calculus. Lesion was found in the
11th dorsal. Inhibiting treatment upon the renal splanchnic lessened
pain. The calculus was worked along the course of the ureter into
the bladder and passed later.
(18) Renal Calculi in which operation had been advised.
The patient was kept in bed by the great pain of the colic. After
two treatments the patient was able to go to the office for treatment,
and after a third treatment had no further trouble.
(19) Renal Calculi. There was great pain due
to the colic, which was lessened by inhibition of the renal splanchnics.
Lesion was found at the 11th dorsal. The tone was manipulated down
along the ureter, the pain moving downward with it. Twelve hours
later the calculus passed from the bladder.
(20) Uremic Poisoning; the case was sleepless, vomiting,
and near convulsions. Treatment, relieved the case at once.
(21) Uremic poisoning (kidney and bladder disease)
in which the patient was in a critical condition; had not slept for two
days on account of severe pain. The pain was relieved by the treatment.
Spinal lesion was found at the centers for bladder and kidneys. Great
improvement attended one months treatment.
(22) Retention of urine from enlarged prostate,
and uric acid poisoning, in a man of seventy-nine years of age. He
was about to be operated upon for "abdominal tumor." The Osteopath used
a catheter once, and drew about a gallon of decomposing urine.
The next morning about one quart of urine was drawn, containing much blood
and stringy mucous. In three months treatment the prostate was reduced,
and the urination was about normal.
(23) Inflammation of the urinary meatus. Constipation
was present. There had been congestion of the kidneys one year before.
The vertebrae from the 2nd to the 5th dorsal were approximated and to the
right; those from the 8th dorsal to 3rd lumbar were separated. The
right innominate was displaced upward and backward, shortening the limb.
(24) A kidney trouble of five years standing, complicated
with heart disease, due to lesions as follows: A luxated atlas, causing
the heart difficulty, which was cured by righting the atlas; 9th dorsal
vertebrae posterior; 2nd lumbar lateral; 5th lumbar anterior. The
case was cured in three months.
(25) Kidney disease due to double scoliosis, 6th
to 10th dorsal left; 1st to 5th lumbar posterior. Treatment of the
curvature improved the kidneys.
(26) Frequent micturition, vericocele and weak eyes
being present. The lesions were at the 3rd cervical, lateral spinal
curvature, and lesion at the 2nd and 4th lumbar.
(27) Pyuria. See case (16).
(28) Hematuria. See case (16)
(29) A case of kidney disease is reported in which
insufficiency of urine was overcome solely by stimulation of the superior
cervical ganglion. A renal center exists in the medulla, and was
thus affected. The quantity of urine was trebled by the treatment.
No other treatment was given. Probably the
general vaso-motor center in the medulla, through the treatment of the
superior cervical ganglion, supplied the increased blood pressure, and
the arterial tension in the kidneys necessary, under the circumstances,
to activity of the organ.
LESIONS: The centers of importance, osteopathically,
in urinary diseases are generally stated as follows: 6th dorsal for kidneys;
12th dorsal for renal splanchnics; 2nd lumbar for micturition; 3rd and
4th sacral for neck of bladder; medulla (sup. cervical, atlas) renal center;
2nd to 5th lumbar (American Textbook Physiology) urino-genital (or genito-spinal)
center for peritoneal sympathetic centers, each side of the umbilicus for
the renal plexus; the umbilicus as a landmark for the renal vessels and
their sympathetic supply, (two inches above.)
The lesions usually found in renal diseases are
as follows: (1) At the atlas or upper cervical, affecting the superior
cervical ganglion and the renal center in the medulla. (2) At the 10th,
11th and 12th dorsal, and the 1st lumbar, the main lesion affecting the
kidneys directly. (3) From the 2nd lumbar to the 4th sacral for disease
in the bladder and urethra. (4) In the female patient it may occur that
uterine prolapsus, wrinkling the anterior vaginal walls, may twist and
obstruct the urethra. (5) In the male patient an enlargement of the prostate
gland, especially of its middle lobe, is with considerable frequency found
to be the cause, easily overlooked, of stricture of the urethra.
A careful analysis of the lesions in the cases presented
above brings out facts representative of the class of cases, (urinary diseases).
These facts well illustrate what is usually found in such cases.
The lesions are mostly spinal, few being rib lesions. As a matter
of fact, spinal lesions are the important causes of urinary troubles.
The vast nerve supply of the kidneys and bladder is delicately balanced.
Most of the lesions in renal diseases being spinal, the conclusion is that
spinal derangement of this nerve supply is the most potent and frequent
cause of such disease. The kidneys are, at bottom, generally deranged by
lesions affecting tile nerve supply, including vaso-motor, i. e., blood
Of these lesions, practically all are low down in
the spine, including also the sacral region. Dr. Still points out
sacral lesion in kidney diseases.
A great number of cases show lesion about the 10th
11th and 12th dorsal. Many show lesion in the lumbar and sacral region.
These latter occur chiefly in bladder and urethral diseases. This
is seen in the fact that of the cases of enuresis reported, most of them
presented lumbar and sacral lesions. The fact that many of the above
cases showed lesion below the 10th dorsal, especially about the 10th, 11th
and 12th dorsal, must be remarked in considering distinctively kidney diseases.
In the cases of Bright's Disease mentioned, all in which the lesion was
described showed lesion in the lower dorsal and lumbar regions, practically
all of these concentrating about the 10th and 11th dorsal. In most
of these cases the micturition center at the 2nd lumbar was affected, participating
in both kidney and bladder affections. Its anatomical relations make
it most important in the latter class, and experience shows that it is
more likely to affect bladder than kidneys.
Neck lesions are not important. Few of the
cases show them, but they occurred at the 2nd to 4th vertebrae, where they
could all affect the superior cervical ganglion, and through it the medulla.
This location of the lesion is mainly important as a secondary or adjuvant
lesion in renal diseases
Without exception, the lesions in these cases fall
within areas in which they may affect the sympathetic innervation of the
urinary apparatus. It is noticeable, therefore that only through
this nerve supply could they become the causes of renal disease, even though
they should affect mainly the blood supply. The vaso-motor function
in relation to disease thus has its importance emphasized.
ANATOMICAL RELATIONS: Sensory nerves are distributed
through the sympathetic, from the spinal nerves, as follows: To the kidneys
from the 10th, 11th and 12th dorsal; to the upper part of the ureter, from
the 10th dorsal; at the lower end of the ureter, supply from the 1st lumbar
tends to appear; to the mucous membrane and neck of the bladder, from the
1st, 2nd, 3rd and 4th sacral; for sensation of over-distention and ineffectual
contraction, from the 11th and 12th dorsal and 1st lumbar (Quain).
This sensory distribution is made use of in relieving spinal pain in kidney
and bladder disease.
Disturbed sensation in these parts is usually found
associated with lesion in the spinal areas named, generally in connection
with more serious trouble.
Vaso-motor fibres for the renal vessel are found
in the splanchnics and somewhat below, occurring from the 6th dorsal to
the 2nd lumbar nerve. As shown by the American Textbook of Physiology,
stimulation of the central endings, not only of the splanchnics, but also
of the sciatic, causes constriction of the renal vessels. Thus work
upon the spine over the origin of the great sciatic nerve, at the 4th and
5th lumbar, and 1st and 3rd sacral, is useful in controlling the circulation
of the kidneys. Actual cases of kidney diseases show spinal lesion
as high as the 5th or 6th dorsal, and as low as the 3rd or 4th sacral.
The continual action of lesion in these situations upon the vaso-motors
of the kidneys has most important pathological results through modification
of the renal blood supply. As a rule these lesions are concentrated
about the 10th dorsal to 2nd lumbar. The main vaso-motor supply,
originating as above described, passes from the aortico-renal ganglion,
solar and aortic plexuses to the renal plexus. Important branches
come from the renal splanchnics, sometimes also from the lesser splanchnic
and from the first lumbar ganglion. The branches of this plexus lie
upon the, renal vessels, and accompany them in their ramifications in the
kidneys. Osteopathic work upon this important vaso-motor supply of
the kidneys via the splanchnic area of the spine (by removal of lesion)
and the renal plexus, which is reached by abdominal work at the level of
the umbilicus, gains marked results upon the circulation, and through it
upon the whole metabolism of the kidneys.
The blood vessels and the muscular coat of the bladder
are supplied by the vesical plexus. It consists of numerous nerves
from the lower end of the pelvic plexus to the side and lower part of the
bladder. The supply to the fundus of the bladder is from the hypogastric
plexus. The American Textbook points out that stimulation of the
2nd, 3rd and 4th sacral nerves causes reflex contraction of the bladder.
The chief motor fibres of the bladder, probably supplying the longitudinal
muscle fibres, pass to the bladder from the sacral. At the same time
some of the motor fibres passing to the in the vesical plexus rise in the
lumbar nerves and reach their destination via the aortic plexus, inferior
mesenteric ganglion and hypogastric and pelvic plexuses. They supply
the circular muscle of the bladder and its sphincter.
These facts explain why lower spinal lesion is so
often found by the Osteopath to be the cause of motor derangement of the
bladder. A good illustration of this is seen in the lack of motor
control in enuresis, due as a rule to low lesions. Reference to the
case reports above will show that six of the seven cases of enuresis presented
lumbar and sacral lesion.
These anatomical facts underlie osteopathic theory
of renal diseases. They form a foundation of truth for osteopathic
procedure. Lesion to these various important nerve supplies at their
origin along the spine must produce renal disturbance in kind, and this
disturbance can be righted only by correction of the anatomical derangement
responsible for them.
(Acute Bright’s Disease)
DEFINITION: An acute inflammation of the kidneys,
mild or severe, attended by structural changes in the organ.
The LESIONS AND ANATOMICAL RELATIONS have been discussed.
Lesions occur preferably from the 10th dorsal to the upper lumbar, but
may be either higher or lower. Cervical lesions, as low as the 3rd
or 4th vertebra, may occur.
The PROGNOSIS is, on the whole, good, still bearing
in mind the necessity of guarded prognosis in all renal diseases as above
indicated. Considering the seriousness of the disease, it is a matter
of remark how many cases of acute Bright’s Disease have been entirely cured.
Good results are quickly evident under the treatment. The ordinary
course of a few days to six weeks is generally shortened.
According to Anders, the restoration of the destroyed
epithelium and of the glomerular function may occur. The chances
of accomplishing the result by the natural method of restored and corrected
circulation as brought about by osteopathic treatment would seem of the
best. The same author states that in cases due to exposure to cold
and wet, irrespective of alcoholic indulgence, it may be presumed with
reason that there is some inheritance or acquired weakness or a susceptibility
of the kidneys, rendering them the weak links in the visceral or systemic
chain. It is the osteopathic idea that these cases, as a rule, present
lesions of the spine of such a nature as to interfere with the vital forces
distributed to the kidneys. This, we reason, is the "inherent or
acquired weakness or susceptibility of the kidneys that renders them weak
links in the visceral chain," and that is the real cause why they fall
victims to the various causes ascribed as the active agents in producing
the disease. This explains why the poison of acute infectious diseases,
as in scarlet fever, producing nephritis in certain cases, has been able
to unbalance the already weakened urinary mechanism. The same explanation
holds good for all the ordinary active causes of the disease. It
seems to be the sufficient reason why one person (presumably with spinal
lesion) suffers from the disease while similar circumstances have failed
to cause it in another.
TREATMENT. The general treatment for nephritis,
acute and chronic, is given with that for congestion of the kidneys, q.
v. Its object, as stated, is primarily to gain vaso-motor control,
and thus allay inflammation, relieve vascular tension, and through restored
and corrected circulation, to clear away the debris from the tubules, absorb
the exudates check degenerative or new growths, and rebuild as far as possible
the destroyed or compromised renal epithelium.
Repeated and careful analysis of the urine must
be made in all cases of nephritis for signs of the processes in the kidneys,
as directed in standard medical texts.
In Acute Nephritis, aside from the main treatment
already discussed, the practitioner must direct his work to the alleviation
of many of the manifestations of the disease. The general treatment
will allay many of the symptoms at once, others may call for special attention.
Uremic symptoms such as nausea, vomiting, headache, and pain in the back
are treated as before directed. For the latter, relaxation of the
spinal muscles and inhibition of the sensory nerves, (10th to 12th dorsal).
Convulsions are quieted by inhibitive spinal treatment and by inhibition
of the centers or local nerve supply for the affected part. The dropsy
is relieved by the stimulation of the general circulation brought about
by the general treatment. It is aided by local treatment of the venous
flow from the part affected, e. g., treatment of the long and short saphenous
veins, relaxation of the tissues about the saphenous opening, and raising
the intestines from femoral veins, in edema of the lower extremities.
Suppression, if it occur, yields at once, generally, to thorough stimulation
of the kidney. The lungs must be stimulated against the occurrence
of bronchitis or pneumonia. Perspiration may be excited by thorough
stimulation of the spinal system, heart, and lungs. It is a necessary
measure for the relief of the system from the accumulated poisons.
As a rule, it is readily accomplished by this treatment. Failing
of this, recourse should be had to the hot baths, applications, packs,
and the use of vapor. The vapor should be generated at the bedside, and
be conducted under the cradled-up bed clothes.
A hot pack is applied as follows: The patient is
stripped and wrapped in a blanket well wrung out of hot water. Over
this is wrapped a dry blanket, and over this a rubber cloth or oil-cloth
cover. These are kept on until the patient has sweat copiously for
one or two hours.
Children with post-scarlatinal nephritis may be
placed in a hot bath for twenty, thirty, or forty minutes.
The patient should live upon a bland liquid diet.
The skimmed milk diet is best. Milk taken hot is very good.
Buttermilk is also advised, and the thin broth of meat. The patient
should drink plenty of water and lemonade,
"Diuretics, other than simple diluent drinks, have
little use in acute nephritis" (Anders).
The patient must carefully avoid exposure during
convalescence, and must afterward use great care in the matters of dress,
diet, and exercise.
During the attack he should be in a warm bed, in
a warm room, and be dressed in woolen underwear and covered with blankets.
Upon convalescence he must not return too suddenly
to solids, especially meat. He may have vegetables, fruits, cereals
The hygiene and diet of nephritis patients is a
most important matter. These should be carefully looked after according,
to directions laid down in standard works.
The patient with acute nephritis should be treated
once or twice daily, more treatment, or less, may be given as the practitioner's
In CHRONIC EXUDATIVE NEPHRITIS, (CHRONIC PARENCHYMATOUS
NEPHRITIS) AND CHRONIC NON-EXUDATIVE NEPHRITIS, (CHRONIC INTERSTITIAL NEPHRITIS),
the practitioner must be constantly upon his guard. A fair number
of cases of chronic nephritis have been cured or greatly benefited.
In the former, the prognosis, while guarded, is fair. The patient
may be cured, or be helped to enjoy a prolonged and comfortable life.
In these cases the practitioner may be thrown off his guard by the fact
that the disease may have arisen insidiously without having presented marked
In the non-exudative form the prognosis must be
unfavorable, owing to the very serious pathological changes that have taken
place in the organ. Perhaps much can be done for the comfort of the
patient. The slow progress of the case renders thorough treatment,
useful. The patient may be helped to a long and comfortable life.
Concerning lesions and treatment, little need be
added to what has already been said. Special manifestations of either form
may call for special treatment. One must sustain the entire system,
and be continually upon his guard against a sudden bad turn in the case,
or intercurrent maladies or complications. The retinitis may call
for some treatment of the eye locally and through the cervical sympathetic
and blood supply.
Concerning hygiene and diet, the same remark applies
as for acute nephritis.
In all chronic cases very much depends upon the
way in which the patient lives, and he must be directed accordingly.
Thorough general treatment along the lines indicated for acute nephritis
tends to correct the chronic changes, congestions, fatty degenerations,
destruction of epithelium, exudations, etc., characteristic of these conditions.
The growth of new connective tissue may be limited.
The general circulation and excretions should be
kept stimulated, and the condition of all the organs must be looked to.
The diet should be much as in the acute case.
Skimmed milk and buttermilk are useful. Dried bread and crackers
should be used during dropsy. When the dropsy is light the diet may
be more solid. Light meats, vegetables, rice and fruits may be had.
The patient should live in a warm dry climate, wear
woolens, and lead an out of doors life, but should avoid over-exercise.
"Hygienic and dietetic treatment are more important
than medicines." (Thompson).
One must not forget that in these cases, death may
occur, at any time, from dropsy, heart-failure, or edema of the larynx.
Chronic cases should be treated daily or three times
per week, according to the needs of the individual.
AMYLOID DISEASE OF THE
This condition is commonly associated with chronic
paryenchymatous or interstitial nephritis, and with cachetic conditions
of the system, consequently it is quite as important to treat the nephritis
or the other disease present as to treat for the amyloid degeneration.
It is especially necessary to be on one's guard against suppurative processes
in the system, as they particularly dispose to this condition. It
is quite likely to be associated with amyloid changes in spleen, liver,
The lesions are those described for kidney diseases, especially those
of nephritis. The treatment would be practically that for nephritis,
in so far as direct treatment to the kidney is concerned. See also
the remarks concerning the treatment of amyloid disease of the liver.
A general course of treatment must be directed to upbuilding the health
and to overcoming the weakness. Dyspnea must be treated as before
directed. The liver and spleen must be looked after, as they are
enlarged and tender. Correction of the kidney circulation tends to
regulate the quantity of urine, which is usually in excess, and to free
it of albumen and casts. This treatment, together with treatment
to the heart and general circulation, reaches the dropsical condition.
The diet should be carefully regulated, and the
patient should take plenty of light, outdoor exercise, as directed for
other kidney diseases.
FATTY DEGENERATION of the kidney is very frequent
in chronic parenchymatous nephritis. The epithelium of the glomeruli
and tubules is effected. The treatment of the nephritis, correcting
the circulation in the organ, must be relied upon to prevent this change,
and to renew the epithelial cell if thus destroyed. Thorough general
treatment, including bowels, liver, spleen, etc., prevents fatty degeneration
by preventing the anemia to which it is often due. Fatty degeneration
is less likely to take place under osteopathic treatment, as it is often
cured by the administration of certain drugs, such as phosphorous, arsenic,
cantharides, chloroform, iodoform, etc.
PERINEPHRITIC ABSCESS must be treated practically
as are pyelitis and pyelonephritis, q. v. Careful search should be
made for suppurative disease in surrounding tissues, as of the spine, bowel,
veriform appendix, liver, etc. Marked cases require surgical treatment,
as it is not probable that large quantities of pus could be safely absorbed
into the circulation. The fever, lumbar pain, etc., should be treated
as before directed.
CONGESTION OF THE KIDNEYS
In both acute or arterial hyperemia and chronic or
venous hyperemia a good PROGNOSIS can, generally speaking, be expected.
This must, however, be guarded in all cases, especially in the chronic
venous congestion, secondary to heart and lung diseases. As both
of these conditions of congestion of the kidney are secondary to other
diseases, and as each may precede inflammation (acute or chronic) of the
kidney, much care must be taken in prognosis and treatment. When
the condition is secondary the prognosis must depend upon that for the
primary disease. Yet, even though a favorable prognosis is limited
by such circumstances, good results are generally gotten upon the kidneys.
They are very responsive to treatment; it is usually readily effective
in producing good effects. While keeping in mind the difficulties
presented by renal cases as a class, we can yet expect improvement under
the treatment. Yet, the prognosis for cure is always to be guarded.
The LESIONS for kidney diseases have been discussed
above. In cases of congestion specific lesion is expected in the
vaso-motor area, 6th dorsal to 2nd lumbar. In cases secondary to
other disease the lesion is that producing such disease, though auxiliary
lesion to the kidney is often present and has weakened the organ preliminarily
to its being thus affected. Though cold and exposure, the toxic products
of various acute diseases, and other causes may produce congestion directly,
it is still necessary in most cases to account for such agents especially
attacking the kidneys; to account for the disease settling upon them.
There can be no doubt that in very many cases it is the presence of spinal
lesion which determines the disease to the kidneys. This hypothesis
not only accounts for the frequency with which spinal lesions are found
in such cases, but also explains why one person may become the victim of
kidney disease, while another under a similar set of circumstances escapes.
These general remarks apply with equal force to the subject of nephritis
before considered, as do those upon treatment.
The TREATMENT has for its object the correction
of the vaso-motor disturbance evident as congestion of the kidneys.
It gains vaso-motor control both directly, by treatment to the kidneys,
and indirectly, if necessary, by the treatment of the disease to which
the congestion is secondary. In the latter case the main treatment
must be directed to the primary disease. The spinal lesion to the
kidneys must always be removed.
Treatment to gain vaso-motor control is made directly
upon the vaso-motor innervation of the kidneys. This consists (in
addition to the removal of the lesion obstructing them) of spinal stimulation
from the 6th dorsal to the 2nd lumbar, for the vaso-motor fibres to the
kidneys originating in this spinal area. This includes the whole
splanchnic area. As stimulation over the central ends of the splanchnics
and of the great sciatic is known to cause renal constriction, it is well
to carry this spinal stimulation down over the origin of the sciatic nerve,
including the 4th and 5th lumbar and the upper three sacral.
This treatment for the circulation is aided by direct
work over the region of the kidney. Deep pressure, with a spreading motion,
applied at the umbilicus and about two inches above it, stimulates the
peritoneal nerve centers said to exist at each side of the umbilicus, it
also reaches the renal and supra-renal plexuses and aortico-renal ganglion,
lying upon the aorta and renal vessels, the plexus ramifying the kidney
upon the blood-vessels. This treatment further affects the renal
vessels mechanically, and relieves them of tension in the surrounding tissues.
The spinal treatment should be applied especially
to the region of the lesser and renal splanchnic. In these various
ways the kidney circulation is equalized and the inflammation or congestion
To aid in calling the blood from the kidneys and
in equalizing the general body circulation, general deep inhibitive work
is made over the abdomen to call the blood to its vessels; a general spinal
and neck treatment, particularly directed to stimulation of heart and lungs
and to the inhibition of the superior cervical ganglion, tones the general
circulation and relieves blood-tension (through the superior cervical).
A valuable spinal treatment for stimulation of the
kidneys is performed with the patient lying on his back. The practitioner’s
hands are slipped, palm tip, beneath the back, one on each side, in the
region of the innervation of the kidneys. Now as the fingers are
bent at the metacarpo-phalangeal knuckles, making a fulcrum of the latter
upon the table, the cushions of the fingers are pressed deeply into the
spinal tissues, the weight of the patient is raised by the fingers thus
applied, and the tissues are drawn laterally away from the spine.
Quick repetition of this movement a number of times thoroughly manipulates
the tissues and stimulates the nerve-connections of the kidneys.
The bowels and skin should be kept free and active
by treatment as before described.
The treatment thus described applies not only to
congestion of the kidneys, but to nephritis.
In both forms of congestion of the kidneys the case
must be carefully looked after to obviate the danger of its passing into
inflammation; acute hyperemia tending to acute nephritis, the passive congestion
tending to become chronic nephritis.
The patient should be kept quiet, resting in bed,
and upon a liquid diet, in active hyperemia. In venous congestion
a light diet must be followed. The patient should drink plenty of
pure water. Hot baths and hot applications over the kidneys, may,
if necessary, be used with advantage. In the acute form the patient
should be seen daily; more than one treatment per diem may be necessary.
In the venous form daily treatment should be given.
DEFINITION: A condition in which obstruction to ureters,
bladder, or urethra causes accumulation of urine in the pelvis and calyces
of the kidney.
LESION may or may not be concerned. in the causation.
It is said that about 20 to 35 per cent of the cases are due to congenital
obstruction. Prostatitis, causing urethral stricture may be the cause,
itself dependent upon a bony lesion. The same is true of displaced
uterus pressing upon the ureter; of a tumor or growth in the contiguous
tissues pressing upon the ureter; of an inflammation of the urethra, leading
to obstruction; disease of the bladder involving the urethral orifice;
of a floating or movable kidney, causing a twist in the ureter. Parasites,
or calculi may obstruct the tube.
The TREATMENT must be directed to the relief of
the patient, but chiefly to the removal of the obstructing cause.
This may not always be feasible, but is often possible. A careful
study must be made of the history of the case to determine the probable
nature of the obstruction. A movable kidney must be carefully raised,
straightening out the ureter, manipulation being directed particularly
to this end. All manual operations in such cases must be conducted
with extreme care to avoid rupture. A movable kidney may be held
in place by strengthening its omental supports and the abdominal walls
(see movable kidney). Reducing an enlarged prostate, replacing a
prolapsed uterus, or dilating the ureter and working the calculus or parasites
down out of it, may be all the treatment necessary. (See Chap. IX
D, Renal Calculi, Uterine Diseases).
The bony lesion must be removed. A continued
course of treatment should be carried on to overcome the atrophy of the
renal epithelium and the growth of connective tissue that has likely taken
TUMORS OF THE KIDNEY of the benign variety, such
as fibroma, lymphadenoma, angiomia, lipoma, may he amenable to the treatment.
The malignant tumors, sarcoma and carcinoma, probably would not be.
The latter is almost invariably fatal and removal by surgery seems to be
only resort. The treatment and lesions in these conditions are as
described in the chapter on tumors, q. v. An obstructed venous or
lymphatic current is probably most potent in causing them.
CYSTIC KIDNEY, OR RENAL CYST, is a condition that
is usually remediable only by surgery. The treatment would be palliative,
and of the kind described for nephritis, to the chronic interstitial variety
of which the cysts are, often due. The kidney excretions should be
kept free by plenty of stimulative treatment to the organs, to guard against
the sudden occurrence of uremia in the patient. The heart is often
hypertrophied and should be treated as directed for that condition.
In retention cysts due to chronic interstitial nephritis, much might be
accomplished in the measure that the nephritis is benefited, which is often
considerable. The patient's life may he rendered safe and be much
prolonged by the treatment. Just what would be accomplished in these
cases is still an open question.
RENAL CALCULI, (Nephrolithiasis)
DEFINITION: Fine or coarse concretions in the substance
of the kidney or in the renal pelvis, resulting from precipitation of the
solid constituents of the urine. It is due to spinal lesion which
disturbs the normal secretory activities of the kidney and leads to the
deposition of certain substances.
The LESIONS AND ANATOMICAL RELATIONS have been discussed
under the general consideration of renal diseases. Lesions from the
10th dorsal to the 1st lumbar, including those of the lower two ribs, are
the most frequent in these cases. No pathognomonic lesion has been
located for this condition. From the nature of the case, any lesion
interfering with the proper innervation and circulation of the kidney might
so interfere with normal secretions as to render them disproportionate
or excessive as to certain constituents. Whether the stone be of
uric acid or urates of calcium oxalate, phosphates, or some other substance,
it is clear that some cause is operating which prevents the natural proportions
of the renal constituents from being maintained. While, as Anders
states, the causes are not well known, the osteopathic view is that the
real cause is found in spinal lesion which deranges the vital forces underlying
kidney activity. It is as reasonable that spinal lesion should unbalance
the delicate sympathetic nerve mechanism controlling these organs, leading
to disproportionate or excessive secretion of the urinary constituents
and the precipitation of the stone, as that spinal lesion should in a similar
way disturb intestinal secretion and lead to diarrhea. Dr. Still
points to the fact that the supra-renal bodies have a rich arterial supply,
and believes that the secretions have to do with preventing renal calculi.
They should be stimulated at the level of the 10th rib in such cases.
Lesion to them may be one of the causes of renal calculi.
The PROGNOSIS is good, both for the removal of the
stone and for the prevention of its further formation. Immediate
relief is usually given in the case of renal colic, and the case is entirely
under the treatment. The treatment of these cases is almost uniformly
The TREATMENT has as its object the removal of the
stone and the correction of the metabolism of the kidney to prevent stones
being formed again. The stone may be removed in one of two ways.
Correction of the activities of the organ will lead to disintegration of
the stone. Renal secretions dissolve kidney stones. (A. T.
Still). Stones too large to pass, formed by the precipitation of
insoluble substances necessitate operation. This corrective work
embraces the removal of lesion, and general stimulation of controlling
nerves and circulation. This is accomplished by both spinal and local
abdominal treatment as before described in the treatment of the kidney.
Under this restorative process normal urine is secreted and the stone is
This same procedure would prevent the formation
of more calculi. It would he efficient in all cases, and should be
administered to cases passing renal sand or gravel without pain as a prophylactic
against worse conditions, and to cure the case. It corrects those
conditions favoring precipitation; lessens the acidity of the urine, dispels
the uric acid, increases the salines, etc.
The stone may also be removed by manipulation of
it along the ureter and into the bladder. The practitioner is generally
called to these cases during an attack of renal colic. Under these
conditions the first step is to allay the usually extreme pain. First,
spinal inhibition is to be made. As the sensory innervation is through
the sympathetic, from the 10th dorsal for the upper part of the ureter,
while at the lower end the 1st lumbar probably supplies the structure,
strong inhibition (as in diarrhea) must be made. This inhibitive
treatment for the pain probably also aids in dilating the ureter for the
passing of the stone. Quieting the colic must itself be in the nature of
a relaxation of the tissues of the ureter. This treatment is a step
preliminary to the abdominal treatment along the course of the ureter,
which has for its object the inhibition of pain, relaxation of the ureter,
and the manipulation of the stone downward along the duct. As the
pain spreads, and is very likely to extend down the spine to the testicle
or inner side of the thigh, it is well to carry the inhibition from the
middle dorsal down over the sacrum. After this treatment abdominal
work is better borne. This is a very deep, firm, but not rough, treatment,
over the coarse of the ureters. It is slow, inhibitive and relaxing,
thus helping to quiet the pain, and relaxing the ureter for the passage
of the stone. This relaxation may be aided by inhibition of the inferior
mesenteric, spermatic, and pelvic (lower hypogastric)) plexuses. This treatment
aides the ureter to pass the stone by mechanically working it along.
It should be begun at a point two inches above and two inches externally
from the umbilicus and progress diagonally downward and inward to the promontory
of the sacrum and as far below it as possible. This treatment reaches
the ureter by deep pressure of the overlying tissues down upon it.
It must be very deep, but slow and with the careful avoidance of any violence.
Usually the stone is readily passed under the treatment, but some cases
require nearly continuous treatment for a considerable time, three quarters
of an hour or more. If possible, treatment should not be stopped
until the stone is passed. Treatment afterwards over the sore parts may
be necessary. The patient's system should be stimulated against syncope
or collapse by treatment of the heart, lungs, and cervical region.
The patient should be directed to avoid red meats,
and those articles of drink and diet favoring uric acid. He should
lead a temperate life, taking moderate exercise. The drinking of
lemonade, soda water, and plenty of pure water is a valuable aid in keeping
the kidneys flushed and free. Hot baths, and the application of hot
fomentations or poultices to the loins, afford relief in the acute attack.
PYELITIS, if present, must be treated (aside from
the removal of the stone from the pelvis) as the inflammatory condition
of the kidneys before discussed.
PYELONEPHRITIS results from an extension of the
inflammation inward to involve the substance of the kidney. Both
of these conditions are to be regarded in the light in which nephritis
is looked at, and call for practically the same treatment (See nephritis.)
Careful attention must be given the conditions causing the disease.
Irritant calculi may sometimes be absorbed from the pelvis of the kidney,
or may have to be removed by surgical operation. A cystitis, the
inflammation from which extends upward to involve the pelvis and kidney,
must be carefully looked after. (See cystitis).
In a similar way infectious diseases, irritant drugs,
cold and exposures. etc., acting as the cause of the pyelitis and pylonephritis,
must be attended to. Bony lesion must be removed.
The inflammation is sometimes simply catarrhal in
nature and is easily overcome by the corrected circulation. Ulceration
may occur in the pelvis from the continued irritation of calculi, and tissue
changes occur. In such cases a longer course of treatment will be
necessary to overcome these conditions.
From severe irritation, and in the course of infectious
diseases, a purulent process may be set up. This exudate and
strictures, may obstruct the kidney, and ABSCESS OF THE KIDNEY, or PYONEPHROSIS
occurs. In such cases the treatment is upon the same plan, but the
prognosis is not so favorable. The process may be limited and the
case be cured by the treatment. Surgical treatment may become necessary.
In all of these cases, especially in those with purulent features, constitutional
treatment must be given.
MOVABLE KIDNEY (Nephroptosis, Displaced Kidney)
may be successfully treated by osteopathic means if it has not that extreme
degree of mobility known as "floating kidney." Movable kidney is
the term designating the condition in which the upper end of the organ
may be pushed down to the level of the umbilicus. The lesions, so
far as this condition may be traced to them, are of the sort producing
enteroptosis, q. v. There is usually present a slight curvature of
the dorsal and lumbar spine (McConnell). A bad spinal condition,
or a definite single lesion, compromises blood and nerve supply of the
organ and its related tissues, weakens the tissues and vessels supporting
it in place, and allows of a prolapsus of the organ directly or by allowing
other causes to operate. Thus it occurs as a part of enteroptosis,
or from falls, heavy lifting, straining at stool,, etc. Spinal lesions
causing relaxed abdominal walls also repeated pregnancies producing the
same result, favor mobility of the kidneys. Lesions and diseases
leading to extreme emaciation and consequent wasting of the fatty tissues
of the capsule of the kidney may cause this condition, as may also tight
TREATMENT: From the nature of these causes it may
be seen that one's chances of curing a moderate degree of movable kidney
are good, the causes being removable. Much the same treatment would
be given as for enteroptosis. q. v. The removal of spinal lesion,
spinal treatment to restoring tone to the supporting tissues, local treatment
at the kidney to mechanically replace it and to remove the tenderness and
swelling in it due to twisting of the renal vessels, and abdominal treatment
to restore tone in the surrounding and supporting tissues would all be
useful. In cases suffering from extreme emaciation attention should
be given to the general health and to increasing the nutrition of the body.
Abdominal supporters and pads should be gradually laid aside, the abdominal
muscles being toned to act in their stead. The neurasthenia, nervous symptoms,
indigestion, palpitation, irritable bladder, etc., call for general treatment
of the nervous system coupled with special treatment for any particular
The patient should have plenty of rest lying down,
and should avoid over-exertion, over-eating, straining at stool, etc.
SPECIAL PATHOLOGICAL STATES OF THE URINE, Such as
Hematuria, Albuminuria, Lithuria, Oxaluria, and various other conditions,
hardly call for special discussion. They depend upon pathological
states of the kidney, and are adequately treated along with the various
kidney diseases with which they occur, as symptoms or complications.
DEFINITION: An acute or chronic condition due to
acute or chronic kidney disease, and resulting from toxemia caused by the
retention in the blood of renal poisons.
Uremia is symptomatic, therefore no separate lesions
are expected for it. They are those causing the primary disease from
which the patient is suffering, most frequently Bright's disease, but quite
often also such diseases as gout, scarlet fever, typhoid fever, cholera,
etc.; conditions in which the blood and kidneys are affected.
The PROGNOSIS, while guarded, is fair. In
the acute form rapid work must be done to obviate the danger of a fatal
termination. The treatment quickly relieves, however, and usually
the kidneys can soon be gotten to acting freely.
In the chronic case one must be continually upon
his guard against a bad turn. The chances in these cases are better
than in the acute, to overcome the condition.
The prognosis must always depend upon that for the
The TREATMENT, especially in the acute case must
be promptly efficient. The first object is to arouse the kidneys
to activity, and to excrete from the system the poison that is causing
Thorough stimulation at the renal region of the
spine fortunately soon accomplishes this object. Cases that have
not urinated in many hours will often respond promptly to this treatment.
Reference to cases reported above will give an indication of what may be
done. The accomplishment of this object is furthered by the local
treatment to the kidneys, renal vessels, and associated nerve plexuses,
given upon the abdomen and above the umbilicus. For this abdominal
treatment, and a special treatment for these cases, see the treatment of
congestion of the kidneys. Catheterization should be employed when
Sweating should be induced in order to help free
the blood of the poisons. Thorough spinal treatment, and stimulation
of heart and lungs will cause perspiration. A hot pack may be used
for this purpose if necessary. The stimulation of the heart overcomes
the feeble and labored beating of the heart, while the stimulation of the
lungs, raising of the ribs, etc., relieves the dyspnea. (Cheyne-Stokes
breathing is often present).
For the convulsions general relaxation of the spinal
and cervical tissues should first be done, followed by strong inhibition
in the superior cervical region, affecting the vaso-motor center in the
medulla. This treatment, together with the stimulation of the heart,
corrects the circulation to the brain. The spasms are supposed to
be due to localized or general anemia of the brain and cerebral anemia.
The eye and ear symptoms, such its dimness of vision,
blindness, tinnitus aurium, deafness, etc., are of central origin, and
are remedied by restoring the circulation to the brain. They do not
commonly last more than a few days in the course of the disease.
Fever may be present and should be treated as before
directed. Bowels and skin should be kept active. The bowels
may be made to respond to treatment, or may be emptied by an enema.
Subnormal temperature may be normalized by the heart and lung treatment.
The coma is reached by the spinal and cervical, and heart and lung treatment
The vomiting, nausea, diarrhea, and stomatitis,
etc., should be treated as before directed for those conditions.
They depend upon the irritation of the mucosa.
DEFINITION: An acute or chronic inflammation of the
mucous membrane of the bladder.
LESIONS AND ANATOMICAL RELATIONS: Lumbar and sacral
lesions predominate in bladder troubles. The urino-genital center
occurs in the spine from the 2nd to 5th lumbar, while the sensory nerve
supply to the mucous membrane and neck of the bladder is derived from the
1st, 2nd, 3rd and 4th sacral. The vesical plexus is derived from
the lower end of the pelvic plexus and supplies vasomotor fibres to the
blood vessels of the bladder. Through the pelvic plexus it is in
connection with both lumbar sympathetic and sacral nerves, hence may be
subject to the effect of lumbar or sacral lesion, acting to derange the
blood supply of the bladder. Such lesion weakens this circulation
renders the bladder liable to the action of various causes to produce the
cystitis. In this way cold or exposure could cause the condition.
Through lesion to the motor nerves of the bladder (See Enuresis), a paresis
of the bladder walls may be caused, leading to cystitis. An enlarged
prostate may cause pressure inflammation of the upon the bladder and retention
of urine, leading to the disease. Traumatism, such as the careless
use of catheter or sound, irritation of fecal matter, or of a stone in
the bladder, or from a pregnant uterus, may be a sufficient cause.
This is also true of septic causes of cystitis; the introduction of an
unclean catheter, the poisonous products of febrile diseases, of gonorrhea
etc., becoming direct causes of the condition. Yet, in many of such
cases, the weakness of parts due to spinal lesion precedes and predisposes
to the trouble. Also lesion is often the direct cause of the condition
leading to cystitis, as in inflammation of the surrounding organs; vaginitis,
The TREATMENT is to restore normal circulation.
It is upon that part of the spine pointed out above as related directly
to the vaso-motor innervation of the bladder. Lesion in these areas
must be removed. Such treatment is often followed by great relief
at once. Local abdominal treatment over the course of the internal iliac
veins aids in reducing the inflammation. The abdominal treatment
must be carefully applied. It may be made over the hypogastric plexus
to aid in controlling the circulation. It should be inhibitive.
Inhibitive and relaxing treatment aids in quieting the pain and vescical
irritability. It also calls the blood to the abdominal vessels away
from the bladder. An enlarged prostate must be reduced, (Chap.
IX. D.) and mechanical irritants must be removed if possible.
For the pain and irritation of the bladder,, strong
inhibition should be made from the 1st lumbar down, especially over the
2nd, 3rd and 4th sacral nerves. For the vescical and rectal tenesmus,
stimulation of the lumbar, and especially of the sacral region should be
made after the pain is allayed. For all of these pains a good treatment
is to have the patient lie upon his back, and strong pressure is made upon
the pubic arch; or better, have him lie upon his chest, and the practitioner
brings the heavy pressure upon the sacrum.
The patient should remain lying down, as it is said
that then the intra-vesicle pressure is but one-third as great as in the
erect position. The diet should be simple, avoiding highly seasoned
foods and alcohol. In the early stages a milk diet is recommended.
The patient should drink freely of water for internal irrigation of the
bladder. Treatment should be given to keep active the cutaneous circulation
(2nd dorsal, 5th lumbar, superior cervical). This is aided by general spinal
treatment, by friction of the skin, and by bathing. The bowels must
be kept open and the kidneys free. The usual treatments should be
given for this purpose. Hot sitz baths and hot applications may be
employed to relieve the pain in the intervals between treatments, if necessary.
The patient should be treated once or twice daily.
In the chronic case the prognosis is fair but guarded.
Treatment should proceed along the lines laid down above. In this
form, and in septic cystitis, washing out the bladder is a valuable aid
to the treatment. For the chronic case boiled water, sterile normal
salt solution (40-60 gr. to a pint), or a weak solution of mercuric chlorid
(1:50,000 or 100,000) are recommended. For septic cases, a saturated
solution of boric acid may be used.
DEFINITION: Inability to retain the urine.
A neurosis due to sacral or lumbar lesion which so affects the motor nerve
mechanism of the bladder as to result in lack of control.
LESION AND ANATOMICAL RELATIONS: The lesions usually
occur in the lower lumbar and sacral regions. They have been discussed
in the beginning of the chapter on renal diseases (see ante). Frequently
some single lesion, as of the 2nd or 5th lumbar, is found, the removal
of which cures the case at once. A common lesion is weakness and
posterior position of the whole lumbar spine. Quite often lower dorsal
lesion is found. Anterior lesion of the 5th lumbar is a frequent
As the vesical plexus supplies the muscular coats of the bladder, and
as it is in connection, through the pelvic plexuses, with both the lumbar
and sacral nerves, lesions of these portions of the spine may readily affect
the motor activities of the bladder. This becomes more evident in
the light of the fact that the motor fibres of the circular muscles and
sphincter of the bladder are derived from the lumbar portion of the sympathetic
namely, from the 11th and 12th dorsal and the 1st and 2nd lumbar spinal
nerves connecting with the sympathetic by way of the aortic plexus, the
inferior mesenteric ganglion, the hypogastric and pelvic plexuses.
On the other hand, the 2nd, 3rd, and 4th sacral nerves furnish the chief
motor supply to the longitudinal muscle fibres of the bladder. (Quain).
The American Textbook of Physiology states that stimulation of the sacral
nerves (1st, 2nd, 3rd and 4th) causes a reflex contraction of the bladder.
It is evident that lumbar and spinal lesion may directly affect this nerve
supply. The lesion involving the sphincteric center of the bladder;
the paralytic incontinence; the imperfect vesical innervation and paresis
of the walls from over distention; the spasmodic incontinence due to over
action of the compressor muscle of the bladder, may all arise from spinal
lesion as described occurring at certain or various points in the lumbar
and sacral regions. This lesion may cause a stoppage of nerve supply,
resulting in a paralytic condition, or in an irritation of the bladder.
The anatomical relation between lesion and disease is clear in this case.
The PROGNOSIS is good. Very many cases have
been successfully treated. Generally quick results are attained.
Treatment causes immediate lessening of the trouble. Cure is the
TREATMENT: The relation of lesion to disease is so close in this disease
that the first step is to remove the lesion. This may be all the
treatment necessary. A thorough stimulation of the lumbar and sacral
region affects the nerve connections explained above and tones the motor
mechanism of the bladder. Spasmodic conditions call for thorough
inhibition of these regions. Corrective spinal work restores normal
conditions and allows Nature to attend to the result. Abdominal treatment
over the hypogastric plexus and over the internal iliac vessels aids the
case. When the condition is due to a prostrating disease the treatment
must be directed as well to the upbuilding of the system. A prolapsed
uterus must be replaced, and other irritating causes removed. Among
the latter may be intestinal worms, an elongated prepuce, etc. Circumcision
is advisable in the latter case. In neurotic children treatment must
be given to the general nervous system. Enjoin regularity of habits
in children, and regulate diet and drink, especially for the latter part
of the day. Avoid late play; all worry, and excitement. The
child should sleep in a cool room, under light covers. The hips may
be elevated a little. Keep the rectum empty.
DEFINITION: This is "an abnormal accumulation of watery
fluid transuded from the blood vessels into the cellular tissues and lymph spaces."
"A toxemic edema" (Butler). It is a common occurrence in acute and chronic
nephritis and in other form of kidney disease.
The lesions are those causing the primary disease of the
The prognosis is good, the condition yielding quickly to
treatment. The kidneys become very active under treatment and throw off
the accumulated fluid from the system. In case 3, under "Diseases of the Urinary
System," great dropsical swelling of the body from feet to middle of the back
was quickly overcome by treatment. Under the subject "Ascites" is reported
a case in which enormous quantities of the fluid were passed from the system
by the kidneys which were kept well stimulated.
The TREATMENT is for the removal of lesion and the cure of
the primary disease of the kidneys. The organs must, themselves, be kept
thoroughly stimulated by treatments described in "Congestion of the Kidneys,"
q. v. The heart should be kept thoroughly stimulated to overcome its weakness,
a feature quite important in these cases. This treatment aids in overcoming
the venous stasis present in the whole system. Any special disease of
the heart present should be given due attention. It is apt to be dilated
as well as weak. Any lesion affecting the heart should be removed.
An important effect is gotten upon the heart by the thorough treatment to the
kidneys, thus lessening the vascular tension in the system due to the kidney
disease. (See Dilatation of the Heart, for treatment).
It is thought that the accumulation of fluid in the tissues
is due to the relaxation and loss of elasticity in them. This prevents
the forcing of the lymph into circulation, and allows the fluid to infiltrate
the tissues. For this condition a thorough general spinal and muscular treatment
is necessary to increase the activity of the circulation, and to add tone to
vessels and tissues.