The Practice and Applied Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
  
 
CHAPTER XIX
 
CONSTITUTIONAL DISEASES
 
 
RHEUMATISM

    CASES: (1) Inflammatory rheumatism, off and on, for sixteen years.  The effect was general, but the body below the waist was worse, hip and lower limbs being very bad.  Lesion occurred at the 4th lumbar vertebra.  The inflammation began to subside with the first treatment.  The patient, confined to the bed, was able to sit up in one week, and was cured.
    (2) Muscular rheumatism, in the form of torticollis, following malarial fever.  The condition was of one months standing.  It improved from the first treatment, and was cured in three weeks.
    (3) Muscular rheumatism in the shoulder, the patient having been unable to raise her hand to her head for seven months.  The first rib was found partly dislocated at its head.  The arm could be raised to the head after one treatment, and the case was cured in one month.
    (4) Acute articular rheumatism in a lady of eighty-three, of three months standing.  Lesions occurred in the upper dorsal and lumbar regions of the spine.  The hips and knees were affected.  One months treatment had greatly improved the case.
    (5) Articular rheumatism affecting the foot, of six years standing, and due to an upward dislocation of the tarsal end of the first metatarsal bone.  The case was cured by reducing the dislocation.
    (6) Chronic rheumatism of eight months standing.  The patient was unable to raise his hand to his head or to dress himself.  After one treatment he could do both, and the case was practically cured by four treatments.  Lesions were found at the third cervical vertebra, 1st to 4th dorsal, and 4th lumbar.
    (7) Lumbago, in occasional attacks, one of which had been brought on by bicycling.  Lesion was found in a lateral luxation of the 4th lumbar vertebra.  The case was relieved by one treatment, and was cured in three treatments.
    (8) Lumbago, brought on by muscular strain, showed lesions at the lumbo-sacral and sacro-iliac articulations.  The case was cured in a few treatments.
    LESIONS: In the three forms, Acute Articular Rheumatism, or Rheumatic Fever, or      Inflammatory Rheumatism; Chronic, or Chronic Articular Rheumatism; and Muscular Rheumatism, various bony and muscular lesions are found.  In rheumatic fever special bony lesions may be lacking.  Often spinal lesions affecting liver and kidneys are found, and muscular contractures may be present as lesion.  Bony lesions are apt to occur at the origin of the nerves supplying the affected points.  Contractured tissues due to climatic effects are common.
    In practically all forms of rheumatism, lithaemia, uric acid gout, and the allied conditions, the real foundation of the trouble lies in lesions which interfere with metabolism.  The commonest of these are found in the splanchnic area of the spine, interfering chiefly with the functions of the digestive tract and of the liver.  Probably the great majority of these cases originate in this way.  Often some other particular lesion determines the point at which the disease makes its chief attack.
    In Muscular and Chronic Rheumatism specific, lesion is much more definite than in Rheumatic Fever.  Local bony lesions play an important part in the production of muscular rheumatism, as do also muscular contractures.  Both may be due to physical strains.  Contractures may likewise be due to exposure to inclement weather, etc.
    It is common in muscular rheumatism of shoulders and arms to find luxation of the lower cervical and upper dorsal vertebrae, one or several together with contractures in the fibers of the trapezius muscles in these regions.  So in rheumatism of special muscle groups, bony lesion is quite generally found at the origin of the nerves supplying them.  This is equally true for chronic articular rheumatism.  For example, in those very numerous cases in which the joints of the lower limbs are affected, it is almost the rule to find lumbar or innominate lesions obstructing the nerve supply to the limbs.
    In rheumatic affections of special locations as, for example, the wrist, ankle, etc., it is common to find a local bony part out of place, as carpal, tarsal, or metatarsal bone.  In lumbago there is almost invariably luxation of lumbar vertebrae, irritating the nerve fibres supplying the muscles bundles of the erectors spine.
    The contracturing of tissues as the result of chronic rheumatism is often sufficient to draw a joint out of place, as in case of the hip joint.
    Lesions in rheumatism act by deranging blood and nerve supply, locally or generally.  In inflammatory rheumatism the effect is a constitutional one, acting upon the system through lesions which derange the functions of liver and kidneys: also of the central nervous system.  Yet this condition is often a good deal like "catching cold," and presents, therefore, no constant lesion.
In the other forms of rheumatism, such as Rheumatic Torticollis, affecting the sterno-mastoid and other muscles; Lumbago, affecting the lumbo-dorsal fascia, erectors spinae and smaller lumbar muscles; Cephalodynia, attacking the occipito-frontalis and temporal muscles, and the galea capitis; Dorsodyma, of the muscles of the upper part of the back and shoulders; and Pleurodynia, of the fibro-muscular structures of the chest, local derangement of nerve and blood supply is the result of the lesion.  This lesion may be present at the exact locality of the effect, or in the course or at the origin of the nerves supplying the part.  In the case of muscular rheumatism particularly, the fact that the pathology in indefinite, that no structural changes occur in the muscles, and that many authors regard it as neuralgia, well supports the osteopathic theory that it is due to bony or muscular lesions irritating the nerve supply of the muscles affected.  This effect is especially well shown in that form of muscular rheumatism known as Lumbago, in which vertebral lesion, irritating the local nerve fibres, is regarded as the cause, osteopathically, As a matter of fact, one meets numerous cases diagnosed as either rheumatism or neuralgia, or to which these terms are applied interchangeably.  From an osteopathic point of view it makes but little difference which view of the case is taken.  The essential fact is lesion irritating nerve supply, its removal being the necessary therapeutic measure.
    The PROGNOSIS in all forms of rheumatism, is good.  Even the so-called incurable chronic rheumatism is often cured.  The prognosis is especially good in inflammatory and muscular rheumatism.  In such cases one expects to give relief at one treatment.  Quick cures are often made in them.  In chronic cases the progress is slow because of the deformity, the deposit in the joint, and the thickening of the local tissues.  Many of these cases are incurable but may be benefited.  Up to a certain point the deposits may be absorbed, the deformity overcome, and the joint be put in good condition.  It is the rule, however, that the enlargement or deformity of the joint cannot be much relieved, though the progress of the disease may be stayed.
    The TREATMENT of these cases must be persistent, but not severe.  In Inflammatory rheumatism the extreme pain, which cannot tolerate the slightest jarring of the floor, or movement of the bedclothes, must be considered.  Yet it does not prevent treatment of the case.  Delicacy of manipulation enables one to soon overcome the patientís fear and to manipulate the joints at will.  The beneficial effect of this treatment becomes at once apparent in reduction of the pain and inflammation.  Cases should not be treated too often or too long at a time.
    In these cases, especially in rheumatic fever, special attention must be given to stimulating the activities of kidneys, liver, digestive system, and  skin to remove poisons from the system and to improve the condition of the blood.  Often the treatment is at first confined to these part, so important is it to gain control of their functions.
    A general spinal treatment is necessary in rheumatic fever, for constitutional effects.  A close watch must be kept upon the general health, and lungs and heart must be kept well stimulated.      Careful stimulation of the heart will prevent the disease reaching that part.  It is particularly necessary to provide against the heart being affected.
    The circulation to the joint, muscle, or part affected must be kept free.  This is accomplished by work along its vessels, by removal of bony lesion and muscular contracture, but especially by springing the bones of the joint so as to separate them and allow of free circulation of the blood to the membranes.  It is in this way that the deposits are removed and the membranes restored to normal condition.
    In acute inflammation of a joint, also, its blood supply must be kept free and itself be lightly manipulated to take down the inflammation.
    In muscular rheumatism the muscles should be stretched and manipulated gently to stimulate the metabolism of the local tissues, aiding them to throw off the poisonous substances supposed to correct in them.
    In any case the nerve supply of the part must be treated from its origin, and the lesion be removed.
    In lumbago the affected muscles must be relaxed, and the lesion be reduced.  It is readily affected.  The patient may sit upon a stool, while the practitioner stands in front and passes the arm about the body, clasping either side of the spine well down toward the sacrum.  He now raises and slightly rotates the trunk, first to one side, then to the other, relaxing the muscles, separating the vertebra, and releasing the nerve fibers from impingement.  By these means, in most cases, a subluxated lower dorsal or lumbar vertebra, the most usual cause of the trouble, is set back into place, and the cause is removed.
    In inflammatory rheumatism one should look after the hygiene of the sick chamber.  Cold baths and sponging with tepid water are allowable for the fever, but are not usually necessary under the osteopathic treatment.  The patient should be between blankets, which absorb the perspiration and prevent chill.  The joint should be well protected by being wrapped in some soft, warm material such as cotton.  The diet should be light and nutritious.  Chronic cases should be protected from toil, exposure, etc.
    The treatment for the special forms of rheumatism mentioned is upon the same lines.
    GONORRHEAL ARTHRITIS, while not properly regarded as a rheumatism, may yet be considered in the same category of treatment.  Specific bony lesion is commonly found at the affected joint or at the origin of its nerve supply, weakening the joint, and laying it liable to invasion by the poison of the disease.  Knee and ankle joints are most frequently affected.
    The PROGNOSIS, while guarded, is favorable for a cure.  There is not the destruction of the joint as in chronic articular rheumatism, and to a certain extent the condition is more sure of entire recovery.  Yet the progress of the case is apt to be slow, and one must be upon his guard against relapse.
    The TREATMENT of the joint is practically the same as that described for articular rheumatism, combining with it treatment for the primary disease, looking particularly to the excretion of the poison from the system via bowels, liver, kidneys, and skin.
 



 
ARTHRITIS DEFORMANS (Rheumatoid Arthritis)

    DEFINITION: A chronic disease of the joints, in which destructive and proliferative changes occur in the tissues of the joint.  While not a rheumatism, it is regarded osteopathically from much the same point of view as are the various forms of this disease. The lesions found are of the same style as these for articular rheumatism, occurring at the spinal origin, or in the course of the nerves supplying the affected joints.  The small joints of the hands or feet, sometimes the large joints, are affected.  Every joint in the body may finally become involved.
    The PROGNOSIS is fair, but the case will require a long course of treatment.  The progress of the disease can be entirely stopped, the function of the joints can be almost entirely restored, and they can be much reduced in size, pain can be stopped, and the general health can be kept good.  The deformities that have taken place in the joints cannot be removed.
    Most satisfactory results have been attained under osteopathic treatment.
    The TREATMENT is practically that outlined for articular rheumatism.  It must be persistent in order to repair the marked changes that have taken place in the tissues of the joint.  It is of prime importance to increase the suffering nutrition of the joint, and to this end lesion must be removed from blood and nerve supply, and they must be kept actively stimulated.  The bones of the joint should be spread apart, as in rheumatism, to enable the blood to circulate freely throughout the joint.  A certain amount of local treatment, about the joint is necessary to aid this process, as well as to affect the muscles and other appendages of the joint, which are suffering atrophy.  Treatment should begin at the spinal origin of the nerves of the part affected.  A thorough course of muscular treatment for the limb involved should be carried out.
    Hygiene and diet should be considered.  Plenty of meat and vegetables are allowed.  Exposure to wet arid cold must be avoided, and bathing is recommended.
 



GOUT (Podagra)

    DEFINITION: A constitutional disease, in which there is arthritis of the small joints, and deposits of urates of soda about them.
    LESIONS, as commonly found, affect the joint locally, its innervation, or the kidneys. One or more such lesions may be present in any case.  It is common to find a slight derangement of one of the joints of the great toe, or of the part affected.  McConnell notes lesion of the astragalus.  These cases generally present the characteristic lesions of the kidney areas, weakening the organs, and laying the system liable to an accumulation of urates by means of sedentary habit, overeating, abuse of alcohol, etc.
    The PROGNOSIS is good.  Immediate relief is given during the attack.  The pain is quieted.  Recovery, will be complete if the treatment is followed long enough.
    The TREATMENT looks at once to the removal of bony lesion above described.  It is quite necessary to adjust the bones of the joint involved.  This may be carefully undertaken even during an acute attack.  The intense pain may be relieved by careful manipulation of the joint itself and by opening the circulation about it.  This takes down the inflammation.  In this stage, treatment should begin at the spinal origin of the nerves of the part involved and be carried down the limb to the joint.  The limb should receive a general muscular treatment.  The joint should be carefully stretched.  In case of the great toe, it may be submitted to tension and to slight motion from side to side.  In urgent cases hot applications to the affected joint may be made.  It may be wrapped in cotton woop and be kept elevated during the intervals of treatment.  During the acute stage the patient should be kept upon a diet of milk, farinaceous food, and plenty of water.  Fever if present, should be treated as described for fevers.  The bowels should be kept well opened.
    It is necessary to give most thorough treatment to the kidneys to eliminate the urates from the system.  The blood supply to the joint should be kept under treatment to cause absorption of the deposits of urates in and about it.
    The joint should be well protected from the cold, and the patient should be guarded against exposure, while at the same time the heart, stomach, brain, etc., and the general spinal system should be kept well stimulated in order to avoid the grave complication known as retrocedent gout, in which the arthritic symptoms are transferred to an internal organ.
    The diet of the gouty patient is a matter of considerable importance.  It should be restricted in quantity, and should be taken at regular hours.  Succulent vegetables (cabbage, salads, stringbeans); farinacea (rice, hominy, etc.); fruits, except bananas, tomatoes and strawberries; fats, in the form of butter; and stale bread may be used.  Meats are to be restricted; oysters, fish, and fowl may be taken.  All alcoholic beverages must be refused.  Plenty of water and alkaline mineral waters are good.  Bathing and exercise should be regularly employed.
    LITHEMIA (Irregular gout; American gout) is a condition the pathology of which is much like that of gout, but the joints are not very much involved.  There is an excess of urates in the blood.  The kidneys are involved, suffering from lesion, and are unable to keep the blood free of these poisons
    The PROGNOSIS is good.  The condition yields readily to treatment.  Cases may be entirely cured.
    The TREATMENT is a most thorough and corrective one for the kidneys.  They must be kept active in order to free the system of the urates.  A general spinal treatment, with attention to bowels, liver, stomach, etc., is necessary to increase the nutrition of the body, and to cause it to take up more of the excess of nutriment.  On the other hand, the diet must be strictly  limited.  A diet of cereals and fruit is particularly good, meat being entirely omitted.  Alcohol, tea, coffee, and tobacco are best not taken.  Sweets, fats, butter and cheese are not to be taken.  The patient should drink plenty of water.
    The liver should be kept well treated to avoid hemorrhoids and biliousness.  The general spinal and special treatment for nervous and digestive systems aid in keeping the patient free from many annoying symptoms.  Further symptomatic treatment may be given as necessary.
 



OBESITY (Polysarcia, Lipomatosis Universalis)

    DEFINITION: A condition due to an increase of fat in the tissue of the body, sufficiently great to impair functions, and showing lesion to the lymphatic system, liver, pancreas, etc.
    CASES: (1) A case of obesity in which there was marked pathological condition of liver and kidneys.  Treatment was directed particularly to these organs, and a strict diet was enforced.  In ten days the patient began to improve, and at the end of two weeks found that he had lost ten pounds.  After one month the treatment was discontinued, as the patient left the city temporarily.  Returning later he reported a loss of twenty-five, pounds and the enjoyment of better health than for a long time.
    (2) A second case, treated upon the same plan, lost 37 pounds in two months, and the health improved.
    (3) A case of obesity reduced 23 pounds in five months treatment.
    Numerous cases have been successfully treated.
    The LESIONS in these cases are largely spinal vertebral ones affecting the innervation of the lymphatic system, of the liver, and of the pancreas.  Dr. Still points out spinal lesion to the full length of the thoracic duct, acting through the various spinal sympathetic connections, splanchnics, etc.  He mentions especially lesion at the 4th dorsal, which he calls a center for nutrition, and at the 7th cervical, opposite which the duct ends.  He has called attention to lesion in the upper dorsal region, just below the cervical, giving rise to the growth of a fleshy cushion, a condition of affairs that seems to influence the lymphatic system and cause a deposition of fat.  He also works high in the cervical region, opposite the transverse processes of the vertebra, for nerves controlling the calibre of the duct.
    Lesion at the 1st and 2nd ribs, and at the clavicle, are found in some cases.  They may cause pressure upon, and obstruction of, the thoracic and right lymphatic ducts where they empty into the innominate veins.
    Obstructive lesions to the nerves controlling the lymphatics, or to the lymphatics directly, prevent the proper flow of the lymphatic fluid containing the saponified and emulsified fat absorbed by the lacteals.  Thus the fat is not freely enough poured into the circulation and passed to the lungs to be oxidized, there and in the arterial blood, and as a result the fat is deposited in the tissue of the body.   Lack of oxidization of the fats is a well known cause of obesity.
    Splanchnic spinal lesion is also a factor in such conditions.  It acts probably in more than one way.  In the first place it may aid in disturbing the nerve control of the thoracic duct, and receptaculum.  But it probably also affects the activities of pancreas and liver.  Lower rib lesion could do the same thing.
    The pancreatic fluid and the bile, chiefly the former, emulsify and saponify the fats, preparing them for absorption into the lymph capillary of the lacteal, whence they are carried into the thoracic duct, and to the circulation to the lungs for oxidization.  Deficiency of these secretions would thus present the proper preparation of the fats for absorption and further elaboration.  The American Textbook of Physiology states that the bile acids stimulate the epithelial cells to a greater activity in the absorption of fats.  As the fats are not properly prepared by the action of the pancreatic and liver secretions, it seems probable that they are absorbed into the circulation directly from the intestine, and, not being in a state for oxidization, are carried through the portal circulation and deposited in the tissues.  Of course much of the fat is passed  from the intestine with the fecal matter.
    Thus excess of fats and starches in the diet is deposited as adipose tissue.
    The PROGNOSIS is fair in cases of obesity.  If the fat is solid and healthy, and the general health good it is difficult to reduce the fat except by careful dieting and exercise.  But if the fat is soft and flabby, it may be greatly reduced by proper treatment.  Many cases have been treated successfully osteopathically.
    The TREATMENT must be directed to the correction of the lesions described.  It is essential to keep normal the functions of liver and pancreas.  They should be treated by local abdominal work, and by the removal of lesion.  If the cushion of flesh appears in the upper dorsal region it should be treated by direct manipulation, causing it to be gradually absorbed.  All sources of obstruction to the lymphatics and to their innervation must be removed.
    The heart should be kept stimulated, on account of its tendency to weakness and fatty degeneration.  The breathlessness often present should be treated by raising the ribs as in asthma.  Kidneys must be kept active, and be stimulated against nephritis, which is apt to come on late in the disease.
    A thorough general spinal and muscular treatment, including limbs, abdomen, chest, etc., aids in the oxidization of the fat in the tissues.  A course of exercise may be prescribed with the same object.  It should not be too severe in patients with weak hearts and vascular systems.
Lungs and stomach should be kept treated.  The latter is apt to be dilated, and to suffer from gastritis.  The lungs are likely to suffer enlargement and fatty infiltration.
    A strict diet should be enforced in these cases.  This is an essential part of the treatment of them.   The amount of food should be small.  Starches, fats, and sweets are to be excluded.  The amount of water allowed is small, and alcoholic drinks are forbidden.  It is well to follow some prescribed dietary such as Oertel's, Ebstein's, or Banting's.
    Severe exercises must not be prescribed in cases in which heart and vessels are not perfectly sound.
 



 
RICKETS (Rachitis)

    DEFINITION: A constitutional disease of children, in which there is marked nutritive change in bones and cartilages, resulting in deformities.
    It is a general nutritive disturbance, and there are no constant bony lesions.  Improper hygiene and nutrition are the causal factors.
    Osteopathic treatment has been successful in the handling of these cases.  The progress of the disease may be limited, further deformity is prevented, but deformities once confirmed cannot be corrected.  Beginning deformities may be corrected.
    The TREATMENT is mainly such a change in the diet as to supply the elements lacking in the nutrition of the body.  In case the babe cannot be properly nourished by the mother's milk, cow's milk diluted is found to be the most satisfactory substitute.  Barley water is also recommended.  The feeding should not be too frequent nor excessive in amount.  Older children are allowed light meats, vegetables and fruit.
    The hygienic treatment is quite as important.  Plenty of fresh air and sunshine, and daily bathing are very helpful.  The child should not be allowed to lie much in one position.  This should be frequently changed.  It should be kept from walking until danger of deformity is past.
    With this treatment the value proper osteopathic treatment cannot be overestimated.  Its effects in increasing general nutrition of the body are well demonstrated.  A thorough, but careful, general spinal treatment should be given.  This reaches the general nervous system and affects function throughout the body.  It also aids in overcoming the nervous symptoms manifest in the case.  The liver, spleen, and kidneys should be treated, as they may be involved.  The bowels should be kept free.
    A general muscular, abdominal and special treatment should be added to the general spinal treatment.  Impaired nutrition of certain muscles may lead to a semblance of paralysis.  These muscles should be well treated to build them up.
    If the bony parts are yet soft much may be done to restore shape of the parts.  A curvature of the spine may be entirely cured.  Treatment should be directed to shaping of the parts undergoing deformity.
 



 
DIABETES MELLITUS AND DIABETES INSIPIDUS

    CASES: (1) Diabetes Mellitus in a man of thirty-four.  The disease was well established by urinalysis and the characteristic symptoms.  The patient was a great sufferer from pain in the lower dorsal and lumbar regions, and showed bony lesions at the 12th dorsal, second and fifth lumbar vertebrae.  He was discharged cured after months treatment, and has since passed the medical examination for life insurance, being pronounced a good risk.
    (2) Diabetes Mellitus in a young man of nineteen, who had been given up to die.  He was passing nine pints per day of urine of a sp. gr. of 1054.  In one week it was reduced to 1043, and four pints per day.  He gained strength daily, and was practically cured at the time of report.
    (3) Diabetes Mellitus in a lady of fifty-six.  The patient had lost eighty pounds in six months, and her symptoms were very marked.  The case was expected to die.  Lesions were found in the upper cervical vertebrae, also of the 2nd and 3rd dorsal, and lower dorsal and upper lumbar vertebrae.  The sp. gr. of the urine was 1043, sugar 4 per cent, and quantity from 10 to 18 pints per diem.  Improvement was continuous from the first, and in five months the case was cured.
    (4) Diabetes Mellitus in a lady of fifty-six.  She passed about 200 ounces of urine each day, containing a large percentage of sugar.  Lesion: A depression of the right ribs over the region of the liver.  The case showed marked improvement under the treatment.  In four months the general symptoms were much improved, and the quantity of sugar was less than half as much as at first.
    (5) Diabetes Mellitus, in which lesions were found in the lower dorsal and lumbar region.  Also in the cervical region and at the atlas.  Marked improvement took place under treatment, but the treatment was discontinued before a cure was affected.
    (6) Diabetes Mellitus showing lesion in the lower dorsal and lumbar regions.  The treatment was continued for four months, and the case was completely cured, the patient passing a medical examination for life insurance.
    (7) Diabetes Mellitus in a man fifteen years of age.  Lesions was a posterior condition of the spine from the sixth dorsal to the second lumbar vertebra.  At the time of report one months treatment had been taken, and improvement was made.
    (8) Diabetes Mellitus showing lesion in the cervical and lower dorsal regions.  The urine contained two per cent of sugar.  Complete cure was made.
    LESIONS causing diabetes are usually bony lesions along the spine from the middle dorsal to the lower lumbar region.  McConnell notes the fact that in a number of cases there was a posterior swerve of the spine form the middle dorsal, to the upper lumbar region.
Sacral lesion has been noted in these cases, some showing a slip of the ilium, some lesion of the fifth lumbar.  Cervical lesion, chiefly in the upper cervical region is sometimes found in diabetes mellitus.  Sometimes a rib lesion, as in case 4, occurs in the region of the liver or of the splanchnics.
    Lesions of the dorsal and upper lumbar region involve the innervation of these organs, degeneration of which is thought to be most, associated with diabetes.  Through their effects upon the splanchnics and solar plexus, they derange the functions of the liver, pancreas, and intestines, all thought to be implicated in this condition.  It is established that pancreatic disease is usually closely associated with diabetes; that a glycolytic ferment secreted by this gland is necessary to normal metabolism.  This being disturbed results in sugar in the urine.  Such a result is doubtless affected by such legions as above, interfering with the innervation of the organ by way of the solar and splenic plexuses.
    It has already been shown how closely are such legions associated with derangement of the liver innervation, the glycogenic function of the organ being disturbed in diabetes.
    It may be that these lesions likewise aid the condition by deranging the activities of the intestinal villi.  According to Pavy's view of diabetes, a disturbance in the functions of the cells of the intestinal villi is the essential feature in the causation of diabetes.  Lesion to the vaso-motor innervation of the portal vessels, arising from the 5th to 9th dorsal may have something to do with such a disturbance.  Lesion to the upper region may aid this effect.
    The influence of the general nervous system in diabetes is well known, but not well understood.  It is shown that lesions to the medulla, cord and sympathetic system cause diabetes.  The various spinal and cervical bony lesions doubtless could do the mischief resulting in diabetes, as it has been shown frequently that these lesions may injure cord, medulla, or sympathetic system, as in paralysis, etc.  In this connection one sees the importance of upper cervical lesions, which affect the medulla.  Here, in the floor of the fourth ventricle, lies the so-called diabetic center.  It is a point, puncture at which results in diabetes.  The effect is doubtless gotten through the vagi nerves, whose origin is from this point.  With regard to this fact, also to the well known participation of the vagi in liver functions, it seems that cervical and spinal lesion, affecting the vagi through their sympathetic cervical connections, or through their connections with the solar plexus, may in this way produce a part of the effect of lesion in diabetes.
    PROGNOSIS: Although diabetes mellitus is a grave, and by ordinary methods, an incurable disease, the outcome under osteopathic treatment is usually more encouraging.  A fair percentage of cures has been shown, there being no room for doubting the facts in such cases.  In accounts of twenty-six cases gathered by Dr. C. W. Proctor, thirteen improved continually under the treatment; seven were entirely cured; others were yet under treatment.
    It may be well said that in such cases our prognosis for recovery is fair, and for benefit is good.
    The TREATMENT is mainly, as far as the specific treatment is concerned, upon that portion of the spine most affected with lesion, namely along the splanchnic and lumbar regions.  It is of course necessary to remove the lesion as soon as possible.  Treatment at the above mentioned regions is particularly for restoring the normal functions of pancreas, liver and small intestine.
    As the heart, kidneys, lungs and spleen undergo pathological changes, it is necessary to give special attention to their condition, according to methods before given.  The skin and general excretory system must be stimulated to aid in excreting the sugar from the blood. The bowels must be treated for the constipation which is usually present.
    A thorough general systemic treatment is given for the purpose of affecting the various organs involved in the disease stimulating and increasing the general nutrition of the body; which is much affected, and upbuilding the general nervous system.
    It is necessary to give close attention to the diet and regimen of the patient.  Carbohydrates must be excluded from the diet as thoroughly as possible, no sugars nor starches being allowed in any form.  Meats, fish, poultry, eggs, and green vegetables,  which do not contain starch (string-beans, lettuce, watercress, spinach, young onions, tomatoes, olives, celery) are allowed.  So, likewise, are milk, cream, butter and cheese.  The patient should drink plenty of water, especially such alkaline mineral water as Vichy, Carlsbad, etc.
    He should take light exercise, but should avoid fatigue, particularly inimical to his weakened condition.  For the same reason, while warm and steam baths are recommended, they should not be prolonged for fear of a weakening effect.
    In DIABETES INSIPIDUS the lesions are usually found in the lower splanchnic area, affecting the kidneys.   Some cases show lesion of the superior cervical vertebrae.  In the latter case the effect may be upon the medulla, or upon the sympathetic system.  There is a point in the floor of the fourth ventricle, puncture at which causes diabetes mellitus.
    These various bony lesions may cause it by affecting the cord, since it is known that injuries to the cerebrospinal axis result in the disease.  Anders regards the condition as a vaso-motor neurosis, usually of central, sometimes of reflex origin.  It is also thought to be due to a vaso-motor relaxation of the kidneys.  It is readily seen that spinal lesion to the renal splanchnic could result in this vaso-motor neurosis and; give rise to the disease.
    The PROGNOSIS is good under osteopathic treatment, although the condition is regarded as incurable.  A fair number of cases are cured.
    The TREATMENT is mainly local for the kidneys, by removal of lesion at the splanchnic areas arid by the various special ways of affecting the kidneys as pointed out in considering diseases of the kidneys.
    Some general treatment for the nervous system may be necessary.