CONTENTS

• EXPLANATION
• THE HEPATIC SYSTEM AND ITS CIRCULATION
• THERAPEUTIC OPTIONS
• DOCUMENTATION
• TRADITIONAL OSTEOPATHIC PERSPECTIVES ON KIDNEY DYSFUNCTION

    The Cayce readings regard the kidneys as the negative pole of the body's battery which maintains an intimate relation to the liver (positive pole) in maintaining balance in the body and eliminating wastes.  Problems with the liver are often reflected in the kidneys and vice versa.  The other organs of the hepatic system (pancreas, spleen, and gallbladder) are also closely linked to kidney functioning.
Thus the kidney can be regarded as the focus of the lower hepatic circulation while the liver regulates the upper hepatic circulation.

    When the liver is torpid or sluggish, the kidneys are called upon to work harder to eliminate wastes.  If the kidneys are unable to compensate, systemic toxicity can manifest in varied symptoms such as eye problems and rheumatism as well as local problems with the urinary tract.

   Kidney dysfunction can sometimes be traced to pressure on nerves which provide impulse to the kidneys.  Spinal manipulations to improve nerve functioning is a common treatment for kidney dysfunction in the Cayce readings.

    The kidneys are also responsible to a significant degree for maintaining proper acid-alkaline balance in the body.  Thus systemic acidity is often reflected in kidney functioning.  The kidneys may attempt to throw off excess acidity producing bladder and urinary symptoms.

    To better understand problems with the hepatic circulation, it may be helpful to consider a brief overview of the "hepatic system" and its patterns of circulation.  The organs of the hepatic system are:

• Liver
• Positive pole of body's battery,
• Excretory functioning - emunctory/cleansing through hepatic circulation,
• Secretive functioning - through gallbladder/bile/intestines,
• Gallbladder,
• Kidneys,
• Negative pole of body's battery,
• Secretive  functioning (although the readings mention both excretion and secretion from this organ),
• Pancreas,
• Spleen.

• The hepatic circulation is the "deep circulation" and corresponds to cerebrospinal nervous system as distinguished from superficial circulation (surface of body - sympathetic nervous system).
• The hepatic circulation can also be more narrowly defined as circulation between liver and kidneys.
• The upper hepatic circulation refers to the circulation between liver, heart and lungs - the upper body.
• The lower hepatic circulation refers to the circulation between the kidneys and urinary system - the lower body.
• The hepatic portal system refers to the circulation from the intestinal tract to the liver.
• Edgar Cayce also sometimes spoke of a day/night cycles in which the patterns of circulation alternated between the lower and upper hepatic circulation and the deep an superficial circulation.

    The Cayce readings recognize several pathophysiological patters associated with hepatic dysfunction, including:

• Torpid (sluggish) liver,
• Cold (low) hepatic circulation,
• High (hot) hepatic circulation,
• Incoordination between deep and superficial circulation,

Day/night or upper/lower circulation (e.g., nightsweats).

DIETARY SUPPLEMENTS

    Several natural remedies were commonly recommended for kidney dysfunction.  The following substances were recommended in the readings to assist with cleansing the kidneys:

• watermelon seed tea
• Coca Cola syrup (uncarbonated)
• lithia water
• Jerusalem artichoke
• sweet spirits of nitre

    Drinking adequate fresh water will assist in cleansing the kidneys.  The readings typically recommended 6 - 8 glasses for most individuals.  For symptomatic relief of back pain associated with kidney problems, the readings often advised one of the following hot packs:

• turpentine,
• mullein,
• castor oil,
• Glyco-thymoline,
• Epsom salts.

    Maintaining a balanced diet tending toward alkaline-producing foods is likely to improve kidney functioning.
 

MANUAL THERAPY

    Spinal manipulation to improve nerve impulse to the kidneys is also likely to improve kidney functioning.  Particular attention should be given to the lower thoracic and lumbar nerve centers which are associated with kidney functioning.  Massaging the back at the location of the kidneys was also recommended in numerous readings.  A massage compound containing mutton tallow, spirits of camphor, and spirits of turpentine was a common recommendation in such cases.

    Click here for a extensive discussion of traditional osteopathic perspectives on kidney dysfunction.

• DISEASES OF THE KIDNEYS (E. D. Barber, D.O.)
• DISEASES OF THE URINARY SYSTEM (C. Hazzard, D.O.)

THE KIDNEYS

    The kidneys are two in number, situated in the back part of the abdomen, and are for the purpose of separating from the blood materials which, when dissolved in a quantity of water, also separated by the kidneys from the blood, constitute the urine.
    They are situated one on each side of the vertebral column, behind the peritoneum, surrounded by a mass of fat and loose areolar tissue.
    Their upper extremity is on a level with the upper border of the last dorsal vertebra, and their lower extremity is on a level with the third lumbar.  The right kidney is usually a little lower than the left, probably on account of the vicinity of the liver.
    The kidney is flattened, and presents, at one part of its circumference, a hollow.  It is larger at its upper than at its lower extremity.
    Each kidney is about four inches in length, two to two and a half in breadth, and a little more than one inch in thickness.  The right is somewhat shorter, though some what broader, than the left.
    The weight of the kidney in the adult male varies from four and a half to six ounces.  In the adult female, from four to five and a half ounces.
    Relations. - Their posterior surface is in relation with the crus of the diaphragm, the eleventh and twelfth ribs, and the quadratus lumborum and psoas magnus muscles.  The right is covered in front by the right lobe of the liver, the descending portion of the duodenum, and the beginning of the transverse colon.  The left lies behind the fundus of the stomach, the tail of the pancreas, and the upper part of the descending colon.
    At the hilium of the kidney the relative position of the main structures passing into and out of the organ is as follows: The vein is in front, the artery in the middle, and the duct or urethra behind and toward the lower part. (By a knowledge of these relations a student may distinguish between the right and left kidneys.)
    Blood Vessels. - Considering the size of the kidney, it is most abundantly supplied with blood.  The renal artery, arising from the abdominal aorta, divides into four or five branches, which pass into the kidney at the hilum.  These branches, surrounded by connective tissue continuous with that of the capsule, continue to divide, and pass between the papillae to reach the bases of the pyramid on the limit between the cortical and boundary zones, where they form incomplete arches.  From these horizontal trunks, the interlobular or radiate arteries run vertically and singly into the cortex, between each two medullary rays, and in their course they give off on all sides the short undivided vasa afferentia, each of which enters a Malpighian capsule at the opposite pole from which the urinary tubule is given off.
    Nerves. - The nerves of the kidney, although small, are about 15 in number.  They have small ganglia developed upon them and are derived from the renal plexus, which is formed by branches from the solar plexus, and lower and outer part of the semilunar ganglion, and aortic plexus, and from the lesser and smaller splanchnic nerves.  They communicate with the spermatic plexus, a circumstance which may explain the occurrence of pain in the testicle in diseases of the kidneys.  They accompany the renal artery and its branches, but their exact mode of termination is not known.
    Nerve Influence on the Kidneys. - With regard to the influence exerted by the nervous system on the renal secretion, there can be little doubt that here, as in other glands, the process is under the control of the nerves.  Many of the conditions which cause increased secretion have no effect upon the general blood-pressure, so that if the increased flow be brought about by the vaso-motor mechanism, it must be by means of nervous channels altering the blood-flow in the special arteries of the glands.  In some emotional conditions, such as hysteria, an unaccountably great amount of urine of very low specific gravity is evacuated.
    The principal renal vaso-motor fibers leave the spinal cord by the anterior roots of the tenth, eleventh, and twelfth dorsal nerves.
    In regard to the effects of the vaso-motor nerves, we know that section of all the nervous twigs going to the kidneys causes great congestion and an immense increase in the secretion.  This undoubtedly depends upon the sudden rise in pressure in the glomeruli owing to the dilatation of the arteries.
    If the great splanchnics, in which also are renal vasomotor fibers, be cut, in addition to the lesser and smallest splanchnics, a great quantity of urine is produced from the vaso-motor paralysis, but, on account of the large area of vessels injured, the general blood-pressure falls; and the effect, therefore, is not so marked.  If, on the contrary, the lesser and smallest splanchnic nerves be stimulated, the secretion is diminished, Owing to the contraction of the renal arteries.  Section also of the spinal cord at the seventh cervical vertebra stops the flow, because it reduces the general blood-pressure below that necessary for the secretion of urine.
 

EXPLANATORY

    We desire to call the attention of the reader particularly to the large blood-supply of the kidneys, and the important duty which these organs are called upon to perform in separating the urine from the blood.  With poor circulation, and the blood in a stagnant, diseased condition, it is obvious that the kidneys are laboring under a disadvantage, and must in time feel the effects of this extra effort; hence, in all kidney diseases, the first duty of the osteopath is to free the entire circulation; neither can we hope to have healthy kidneys for any length of time if the liver is in an abnormal condition; it is, therefore, advisable to look well to that organ, giving such treatment, if it is found diseased, as conditions would indicate.  The nerves, also, play an important part, and we have no reason to hope for healthy kidneys if certain regions in the spinal column are in a sensitive or a congested condition.
    So many complications are liable to arise in diseases of the kidneys that the results obtained from osteopathic treatment will depend largely upon the good judgment of the operator in making a correct diagnosis, and applying, in all cases, such accessory treatments for complications arising in individual cases as the conditions indicate.

ANURY, ANURIA, ANURESIS, OR RENAL INADEQUACY
(Deficiency of the urine; of low specific gravity, containing but little urea, and neither
albumin nor casts.)

TREATMENT
    1.  Place the patient upon the face; beginning at the eighth dorsal vertebra, with one thumb on each side of the spine, between the eighth and ninth vertebra, press strongly a few seconds; with the thumbs between the ninth and tenth, repeat the operation; work in this manner between each successive vertebra, until the first lumbar is reached.
    2.  Place the patient on the back, with the knees slightly flexed, thus lessening the tension on the abdominal muscles; place the hands over the kidneys, the patient being required to make several strong expirations; with each succeeding expiration we come closer to the kidneys, until at last they art, easily felt.  The patient will now make thoracic respiration, that the manipulation of the kidneys may not be interfered with.  Knead the kidneys gently but thoroughly, from without inward and slightly from above downward, that the pressure may be applied in the direction of the venous circulation and large number of renal canals.  This treatment should be given in a very thorough manner, as it assists largely in exciting the kidneys to renewed action.
    3.  Place the hand over the kidney, and vibrate gently for two minutes over each kidney.
While the above treatment is very beneficial in stimulating the kidneys to greater activity, it is very often necessary to give General Treatment or such part thereof as may, in the judgment of the operator, be deemed essential.
    Treatment should occupy about fifteen or twenty minutes, and be given every other day.

ALBUMINURIA
(Albumin in the urine, generally from defective action of the secretary tubes of the kidneys;
detected by heating.)

TREATMENT
    Acute and Productive Nephritis.

CHYLURIA
(A discharge of milky urine, without apparent derangement of the kidneys or bladder, there being chyle in the urine, from communication between the lymphatic system and the genito-urinary tract; detected by microscope.)

TREATMEINT
    Not treated successfully by Osteopathy.

HEMATURIA
(Hemorrhages from the mucous membrane of the urinary passages.  Blood in the urine.  Small quantity and uniform admixture with the urine points to renal hemorrhages.  Pure blood or clots mixed with the urine at the beginning or close of urination points to bladder or urethral hemorrhage.)

TREATMENT
    1.  Place the patient on the face; with the thumbs of the operator upon each side of the spine, beginning at the eighth dorsal, pressing hard with the thumbs, move the muscles upward and outward; move the thumbs down to the next dorsal, and repeat until the second sacral vertebra is reached.
    2.  Place the patient upon a stool; the thumbs of the operator upon the angles of the second ribs, an assistant standing in front, raising, the arms slowly, strongly, high above the head; press hard with the thumbs while the arms are lowered with a backward motion.  Treat in this manner until the eighth ribs are reached.
    3.  Place the patient upon the back; one operator grasping the shoulders, another the feet, give thorough extension of spine.
    4.  Place the hand lightly over the kidney, and give thorough vibration three or four minutes.  Treat the opposite kidney in a similar manner.
    In case of other complications, see General Treatment, applying such portions thereof as will meet the conditions.

HEMOGLOBINURIA
(Hemoglobin in the urine.  Urine dark-red or chocolate brown, high specific gravity, contains albumin, and few or no blood-cells.)

TREATMENT
    See Hematuria.

LIPURIA
(Fat in the urine.  May occur in health after excessive ingestion of fatty food; detected by adding potassium hydrate and shaking with ether.)

TREATMENT
    1.  Place the patient on the side; beginning at the upper cervicals, move the muscles upward and outward very deeply the entire length of the spinal column, being very thorough over the splanchnic nerves, as it is here we will find conditions which are causing an obstruction to the nerve wave, thereby interfering with their control of the digestive mechanism of the stomach. pancreas, and liver.   Thorough treatment of these nerves stimulates them to greater activity.
    2.  Place the patient on the back; with one hand under the chin, draw the head backward and to the side; with the disengaged hand manipulate the muscles thoroughly and deeply over the pneumogastric, thus freeing and stimulating this nerve to great activity.
    3.  Place the hands over the stomach, vibrating gently two minutes.  Vibrate the pancreas, liver, and kidneys in a similar manner.
    This treatment will occupy about fifteen or twenty minutes, and should be given every other day.
    During the course of this treatment, the patient should be confined strictly to a fruit and vegetable diet.

PYURIA
(Pus in the urine.  From suppuration in any portion of the genito-urinary tract; detected by microscope.)

TREATMENT
    1.  Place the patient on the face; beginning at the last dorsal vertebra, with the thumbs on each side and close to the spinal column, move the muscles upward and outward gently but very deep, being particular to treat thoroughly between the last lumbar and first sacral vertebra.
    2.  Place the patient upon the back, with one hip and limb off the edge of the table; place one hand upon the knee, the other under the great trochanter, pressing downward strongly upon the knee, at the same instant lifting upon the great trochanter.  This treatment stretches the muscles through which passes a large portion of the urinary tract, thereby freeing the circulation in this immediate region.  Treat the opposite side in a similar manner.
    3.  The kidneys and the entire urinary tract should be manipulated in a very thorough and careful manner.
    Treatment will occupy about fifteen minutes, and should be given every other day.

OXALURIA
(Calcium oxalate in the urine.  From insufficient activity of the stage which should change
oxalic acid into carbonic.)

SYMPTOMS
    Dull pain in the loins; boils or carbuncles; specific gravity of urine increased, and contains an excess of urea and oxalates.

TREATMENT
    1.  Place the patient upon the back; grasping both knees, flex the limbs slowly but very strongly against the abdomen; with the knees in this position, press as hard as the patient can stand without too much pain, at the same time moving the limbs gently from side to side.
    2.  Flex one limb strongly upon the chest, giving it strong abduction, and extending with a light jerk.  Treat the opposite limb in a similar manner.
    3.  Knead the kidneys carefully and thoroughly.
    4.  Place the hand over the liver, vibrating gently three or four minutes; also vibrate over the kidneys.
    Treatment should occupy about ten or fifteen minutes, and be given every other day.

UREMIA
(Toxic condition of the blood from accumulation of urea.  Due to retention of poisonous materials
which should be eliminated by the kidneys.)

SYMPTOMS
    Headache; nausea; vertigo; vomiting; dilatation of the pupils; delirium; convulsions; and coma.

TREATMENT
    1.  Place the patient upon the side; beginning at the eighth dorsal, move the muscles upward and outward to the last lumbar vertebra, being very particular over the lesser splanchnic nerves to manipulate deeply, as it is here we are very apt to discover conditions which are the real cause of the failure of the kidneys to properly perform their duties.
    2.  Place the patient on the back; and knead the kidneys careful] and thoroughly; also give vibrations.
    It is often advisable in this disease, in addition to the above treatment, to give a thorough Treatment to Equalize the Circulation.
    Treatment will occupy about twenty or twenty-five minutes, and should be given each day.

RENAL CONGESTION
(Excess of blood in the kidneys.)

SYMPTOMS
    Amount of urine diminished, and of high specific gravity, 1020 to 1030, dark, and only small amounts passed at frequent intervals; uric acid increased, small amount of albumin, hyaline casts, and few red blood-cells.

TREATMENT
    1.  Place the patient on the side; beginning at the eighth dorsal, move the muscles upward and outward, very deep, to the end of the sacrum, thus freeing and stimulating the nerves which assist in controlling the kidneys.  Treat the opposite side in a similar manner.
    2.  Place the patient face downward; the operator pressing very hard upon the sacrum, as an assistant raises the limbs, slowly, as high as the patient can bear without great inconvenience, holding them in this position a moment, also moving them gently from side to side; lower the limbs; and repeat, this time, if possible, raising the limbs a little higher.
    3.  Place the hand lightly over the kidney, and vibrate gently two or three minutes.  Treat the opposite side in a similar manner.
    Treatment will occupy about fifteen minutes, and should be given each day, until recovery.

ACUTE EXUDATIVE AND PRODUCTIVE NEPHRITIS, OR ACUTE BRIGHT'S DISEASE
(Inflammation of the kidneys, with exudation of plasma, red and white blood-cells; excessive growth of capsule-cells in the glomeruli; and overgrowth of connective tissue.)

SYMPTOMS
    May commence with a chill, followed by fever; pain in the loins; headache; eyelids puffy; extremities dropsical; diminished excretion; micturition frequent; urine smoky and reddish, specific gravity high, deficient in urea, contains albumin, hyaline, and blood-casts.

TREATMENT
    1.  Patient lying face downward; beginning at the tipper cervicals, with the thumbs on each side of and close to the spinous processes, pressing rather hard, move the muscles upward and outward the entire length of the spinal column, being very thorough in the lower dorsal and lumbar regions.
    2.  Place the patient on the back; the operator grasping the patient's shoulders, while an assistant, grasping the ankles, assists in giving thorough and strong extension, which should be continued one minute.
    3.  Place the patient close to the edge of the table, the limb and hip lying over the side; place one hand upon the knee, the other under the trochanter; while lifting strongly upon the trochanter with one hand, with the other press the limb as far downward as possible, holding it a few seconds in this position.  Treat the opposite limb in a similar manner.
    4.  Place the hand lightly over the kidney, and vibrate gently two minutes.  Treat the opposite
kidney in a similar manner.
    5.  Flex the limb strongly against the chest, while in this position moving it slowly from side to side; give the knee strong abduction, extending with a light jerk.  Treat the opposite limb in a similar manner.
    6.  Place one hand on each side of the thigh, and move all the flesh gently but very deep from side to side the entire length of the limb.  This and the above treatment frees the circulation to the limb, and will immediately relieve its dropsical condition.
    7.  Knead and manipulate the bowels carefully but deeply.
    Treat twenty minutes each day, till a cure is effected.

CHRONIC EXUDATIVE AND PRODUCTIVE NEPHRITIS, OR CHRONIC BRIGHT'S DISEASE
(May follow acute attacks.  And develop in the course of syphilis, endorcarditis, tuberculosis,
or bone diseases.)

SYMPT0MS
    Development slow.  Dropsy; skin pasty in color; sclerotics very white; headache; insomnia; dyspnea; nausea; vomiting; urine deficient in urea and specific gravity; excess of albumin; casts abundant, both epithelial, fatty, and granular; few red blood-cells.
    More common in males.

TREATMENT
    1.  See Exudative and Productive Nephritis.
    2.  Manipulate and vibrate (see Acute Lithemia, 7, 8, and 9) the liver in a very thorough manner.
    3.  Place the patient upon a stool; the knee of the operator between the scapula of the patient, grasp the wrists and draw the arms slowly but strongly above the head as the patient inhales (cut 5), pressing hard with the knee as the arms are lowered with a backward motion.
    Treatment should be given every other day, and occupy about twenty or twenty-five minutes.
    Patients suffering with this disease are very often benefited and occasionally cured by the above treatment.

DIABETES INSIPIDUS, OR POLYURIA
(Excessive quantity of urine of low specific gravity.)

SYMPTOMS
    Urine pale and of low specific gravity, 1001 to 1005.  Patient usually well nourished.  Generally secondary to some disease of the brain or abdomen.  More common in young males.

TREATMENT
    1.  Place the patient upon the side; beginning at the first cervical, move the muscles upward and outward, carefully but very deep, the entire length of the spinal column.  Be very thorough from the ninth dorsal vertebra to the second lumbar.  Treat the opposite side in a similar manner.
    2.  Place the left hand upon the sacrum, just below the last lumbar; with the right beneath the knees of the patient, the limbs should now be drawn toward the operator, upon a level with the table, after which they should be raised as far as the patient can stand without too much inconvenience, the operator pressing, at the same instant, very hard upon the sacrum; move the limbs until they are on a line with the body, and lower to the table (cut 31).  Repeat this operation two or three times, raising the limbs a little higher with each succeeding operation.
    3.  Place the hand over the kidney, and vibrate for two minutes.
    The above treatment acts directly upon the nerves and, if given correctly, will immediately check the excessive flow of urine.
    In case the disease is secondary to brain or abdominal troubles, it, of course, will be necessary to give such accessory treatment as the conditions indicate.

DIABETES MELLITUS, OR GLYCOSURIA
(Excessive quantity of urine containing sugar.)

SYMPTOMS
    Urine pale, of high specific gravity, 1025 to 1045, acid reaction, and contains sugar; hunger; emaciation; muscular weakness; and loss of sexual power.

TREATMENT
    See Diabetes Insipidus.
    This disease is very often benefited by the above treatment, using such other accessory treatment as the condition of the patient and judgment of the operator would indicate.

PAROXYMAL HEMOGLOBINURIA
(Hemoglobin in the urine, accompanied by paroxysms.)

SYMPTOMS
    Languor; fatigue; feeling of chilliness; fingers, toes, and ears become numb, cold, and cyanotic.      More common in young adult males.

TREATMENT
    In the treatment of this disease it is necessary to stimulate the nerves controlling the entire digestive tract) particularly the nerves of nutrition, which can be stimulated by thorough treatment in the upper dorsal region.  It is also essential to expand the chest, thus stimulating the lungs to greater activity, and also freeing the circulation to these organs.  The liver, pancreas, and kidneys must also be treated, with a view of equalizing and stimulating their action.
    1.  Place the patient upon the side; beginning at the upper cervicals) move the muscles upward and outward very deeply the entire length of the spinal column, being very thorough in all regions which appear at all sensitive to the touch, or in which the temperature is abnormal.  Treat the opposite side in a similar manner.
    2.  Place the hand under the chin, drawing the head backward and to the side; with the disengaged hand manipulate the muscles immediately over the pneumogastric nerve.  Treat the opposite side of the neck in a similar manner.
    3.  Vibrate one minute over each of the following organs: the lungs, stomach, liver, pancreas, and kidneys.
    4.  Place the patient upon a stool; the knee of the operator between the scapula at about the second dorsal, draw the patient's arms strongly above the head, as the lungs are filled to their fullest capacity (cut 5); press hard with the knee as the arms are lowered with a backward motion.
    This treatment will occupy about fifteen or twenty minutes, and should be given every other day.

PYELITIS
(Inflammation of the pelvis of the kidney.)

SYMPTOMS
    Pain in the lumbar region; urine acid reaction; sediment, principally pus, but may contain blood.

TREATMENT
    1.  Place the patient on his side; beginning at the last dorsal, move the muscles upward and outward, gently but very deep, the entire length of the lumbar and upper sacral region.  Treat the opposite side in a similar manner.  This treatment, if correctly applied, will remove almost immediately the pain in the lumbar region.
    2.  Manipulate the kidneys and entire urinary tract gently, but as thoroughly as possible.
    3.  With the patient lying upon the side, place one hand against the sacrum, with the other grasping the knee; draw the limb strongly backward, pressing hard at the same instant upon the sacrum.
    4.  Place the hand lightly over the kidney, vibrating one minute.  Treat the opposite kidney in a similar manner.
    Treatment should be given each day, and occupy about ten minutes.

RENAL CALCULUS, OR NEPHROLITHIASIS
(Stone in the pelvis of the kidney.)

SYMPTOMS
    Constant dull pain in the lumbar region; following paroxysms, urine may contain blood; if calculus enters ureter, there is excruciating pain in its course; numbness of the thigh; nausea and vomiting.

TREATMENT
    1.  Place the patient on the back, the operator's hands immediately over the kidneys; the patient will now be required to exhale several times very deeply; with each exhalation the hands are brought nearer the kidneys, until at last they can be felt very distinctly; patient will now make thoracic respiration, that the process of kneading the kidneys may not be interfered with.
    In manipulating the kidney, great care must be exercised in endeavoring to move the stone towards its natural point of exit.
    2.  Place the hand over the kidney, and vibrate gently two or three minutes.
    3.  Place the patient on the face; the operator's thumbs upon each side and close to the spine, beginning at the ninth dorsal vertebra, move the muscles upward and outward, gently but very deeply, to the first sacral, being very thorough the entire length of the lumbar region.
    Treatment should be given at short intervals, until the desired results are obtained.

HYDRONEPHROSIS
(Dropsy of the kidneys, due to obstruction.)

SYMPTOMS
    Dull pain, with sense of fullness; periodical discharges of large quantities of urine, as the obstruction is temporarily removed; rigor; sweat; and emaciation.

TREATMENT
    1.  Place the patient on the side; beginning at the upper dorsal vertebra, move the muscles upward and outward the entire length of the spinal column, being very thorough in the splanchnic and lumbar region.
    Treat the opposite side in a similar manner.
    2.  Place the patient on the face; operator placing one hand upon the sacrum, the other beneath the knees, raise the limbs strongly, pressing at the same instant very hard upon the sacrum.
    3.  Place the hand lightly over the kidneys, vibrating each kidney two minutes.
    4.  Place the patient upon a stool; the operator places his thumbs upon the angles of the second ribs, an assistant raising the arms strongly above the head as the patient inhales; press hard with the thumbs as the arms are lowered with a backward motion; place the thumbs on the angles of the third ribs; raise the arms as before, and repeat until the lower borders of the scapulae are reached.
    This treatment will occupy about fifteen minutes, and should be given each day.

CHRONIC INTERSTITIAL NEPHRITIS
(Overgrowth of connective tissue, with atrophy of the epithelium and tubules.  Due to lead poison, gout, or alcoholism.)

SYMPTOMS
    Urine increased and of low specific gravity; frequent micturition; diarrhea; shortness of breath; arterial tension high; and hypertrophy of the heart.
    No care in Osteopathy.

RENAL AMYLOID DEGENERATION
(Starch-like degeneration of the renal capillaries.)

SYMPTOMS
    Albuminuria; edema; diarrhea; waxy complexion; urine pale, and specific gravity 1008 to 1014, containing hyaline casts and white blood-cells.
    No cure in Osteopathy.

RENAL TUBERCULOSIS
(Consumption of the kidney, with specific bacillus.)

SYMPTOMS
    As a rule, other organs of the body are involved.  Urine generally contains pus and waste matter and tubercle bacilli; emaciation; and exhaustive perspiration.
    No cure in Osteopathy.

RENAL CARCINOMA
(Cancer of the kidney.)

SYMPTOMS
    Hematuria and development of tumor; dull exacerbating pain in the lumbar region; anorexia; emaciation; anorexia; and edema of the lower extremities.
    No cure in Osteopathy.

RENAL  HYDATID CYST
(Tumor of the kidney.)

SYMPTOMS
    Fluctuating tumor in the loin or lateral region.  Peculiar thrill on percussion.

TREATMENT
    1.  Place patient on the back; flexing the limb corresponding to the diseased kidney slowly, gently, gradually increasing the force used, as far as possible upon the abdomen; abduct the knee strongly as the limb is extended.
    2.  Place the patient in such position that the limb will hang over the edge of the table; placing one hand under the trochanter, with the other press the limb gently downward, being very careful not to cause much pain; raise the limb carefully, and again press it downward, this time a little further, if possible, than before.
    Place the hand over the tumor, and vibrate two minutes.
    Treatment will occupy about ten minutes, and should be given every other day.

RENAL ABSCESS
(Abscess of the kidney.  May be due to general pyemia, or to traumatism.)

SYMPTOMS
    Rigors; sweat; emaciation; urine may contain pus, albumin, tube casts, and blood-corpuscles; pain and tenderness in the renal region.

TREATMENT
    1.  Place patient on the back; manipulate very carefully over the abscess, working gradually deeper, until the kidney has been manipulated as thoroughly as possible.
    2.  Place the hand over the abscess, and vibrate two minutes.
    3.  Place the patient on the face; while pressing hard upon the sacrum with one hand, draw the limb corresponding to the diseased kidney backward slowly, but as far as possible.  This operation should be repeated, the second time drawing the leg a little further backward.
    Great care must be exercised in giving this treatment to cause no unnecessary pain.  If given very gently, patient relaxing all muscles, quite a thorough treatment can be given even the first time.
    Treatment will occupy, about fifteen minutes, and should be given every day.

PERIRENAL ABSCESS
(Suppuration in the perirenal connective tissue.)

SYMPTOMS
    Fluctuating tumor in the lumbar region; chills; fever; sweat; emaciation.

TREATMENT
    See Renal Abscess.

FLOATING KIDNEY
(Mobility of the organ.  Generally the right.)

SYMPTOMS
    A void in its usual position; sense of weight and dragging in the abdomen, with dull pain; sometimes nausea and vomiting.  More common in females.

TREATMENT
    In treating this disease it is necessary to free the circulation and nerve-wave to the muscles and ligaments holding these organs in position.
    1.  Place the patient on the face; with the thumbs on each side of and close to the spine, move the muscles upward and outward the entire length of the spinal column, being very thorough in the lumbar region, which will be found in a very sensitive condition.
    2.  Place the patient on the back; one operator grasping the shoulders, the other the feet, give very thorough extension, using as much strength as the patient can stand without too much inconvenience.
    3.  The operator should now endeavor, by any manipulation which seems most applicable to the case, to work the kidney back to its normal position.
    Treatment will occupy about fifteen minutes, and should be given every other day.

ADDISON'S DISEASE
(Disease of the suprarenal capsule.)

SYMPTOMS
    Skin discolored; appetite impaired; heart action feeble; pulse soft and slow; nausea and vomiting. Supposed to be tuberculous.
    No cure in Osteopathy.

    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 supply, also.
    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 NEPHRITIS (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 and milk.
    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 judgment dictates.
    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 symptoms.
    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 KIDNEY

    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, intestines, etc.
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 is reduced.
    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.

HYDRONEPHROSIS

    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 place.
    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 successful.
    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 dissolved.
    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 lacing.
    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 troublesome manifestation.
    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.

UREMIA

    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 primary disease.
    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 the trouble.
    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 necessary.
    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 as described.
    The vomiting, nausea, diarrhea, and stomatitis, etc., should be treated as before directed for those conditions.  They depend upon the irritation of the mucosa.

CYSTITIS

    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, urethritis, etc.
    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.

ENURESIS, (Incontinence of Urine)

    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 cause.
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 rule.
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.

RENAL DROPSY

    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 kidneys.
    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.