Mark Corson

By H. Rakus. Columbia International University. 2018.

I saw a disease pattern which was completely different from that which I had seen in England 5 mg elocon otc. The people came from more or less the same genetic stock as the people I had seen in practice in England order 5mg elocon overnight delivery, so it was more than probable that their different medical condition had been affected environmentally cheap elocon 5 mg. In the extremes of poverty, in areas where industrial food production, in this case fish canning, has laid waste natural communities and their cultures, medical lessons are sometimes easier to learn. The illnesses I saw were those associated with very poor communities, for example, a six year old child, having to have a complete upper and lower dental extraction because all the teeth were brown and eroded. There was a great deal of depression and a lot of high blood pressure amongst young men and young women. A lot of cardiovascular disease, a lot of young deaths, miscarriages and stillbirths. In 2,500 people, I saw an enormous amount of congenital malformations, the kind of cases that I would just not see in general practice in England. Davies concluded that diet was of major importance in shaping the pattern of illness which he saw. His observation of this community gave him a foundation upon which to build his future medical practice. There was a vast amount of drinking, Newfoundland has a very high intake of alcohol. They were also eating a lot of salted fish, which had very few vitamins left in it. Solutions offered by the doctor who worked in the town before Davies arrived had mainly been dependent upon the prescription of drugs. In his first six months, using vitamin B complex, he took more than 300 dependent people off psychotropic drugs prescribed by the previous doctor. He had only one treatment failure, and none of those who came off drugs went back on during the eighteen months he was there. Arriving back in England in 1977, Davies set about his quest through books and discussions with other doctors for an eclectic medical model. In the beginning, working from home, learning as it were from his patients, he charged £2 an hour. I use it in relation to pathological diagnosis, biochemical diagnosis and patient examination. The fundamental difference in the way I practise is that I do not have a blind adherence to drug therapy. Like many pioneers Stephen Davies wanted to set up some kind of institutional network which would support and further the ideas, research and clinical work which he was doing. The only real forum available at the time for nutritional practitioners was the British Society for Allergy and Environmental Medicine, which allowed Davies only 15 minutes a year at its conference and, at that time, had no interest in placing nutritional medicine on its agenda. In 1984, together with other doctors, he set up the British Society of Nutritional Medicine. In 1984, following a bequest from his recently deceased dentist father, Stephen Davies set up Biolab Medical Unit, with the help of a biochemist. Having a clinic and laboratory was to enable him to have control over testing and measuring the samples taken from his patients. Setting up the laboratory was a costly exercise, although it enabled him to work more cheaply and efficiently than if he were still having the tests done outside the practice. I looked high and low for someone who was willing to measure vitamins and minerals in my patients. Biolab looks for trace element deficiencies and toxic element excesses, using atomic absorption spectrophotometry. One of the main research thrusts is the development of biochemical tests which can be performed in a routine biochemistry lab, without any specific expertise or high technology equipment. These are low tech, low expertise tests which give very similar results to the high tech tests. These enable any interested biochemists at the local district hospital to tee up the facilities for the tests without requirement for any new equipment or expertise. It was not until the early eighties that Stephen Davies became aware that there were people who were opposed to his medical practice. In 1982, he responded forcefully to an article by Dr Vincent Marks, a biochemist, in Doctor? Some might think that such vested interests might preclude any doctor from passing medical opinions on sugar and illness. Although mere were general and consistent rumblings against nutritional medicine and the setting up of the British Society of Nutritional Medicine, it was not until 1988 that the first public shots were fired at Stephen Davies. At the time this article was published, it did not occur to Davies or his colleagues that it represented the view of an organised opposition. Observer journalists sent an unsolicited sample of hair for analysis to Larkhall Laboratories, a firm which sub-contracts its hair-mineral analysisf to Biolab. The Observer took the results to Dr Stephen Davies, Medical Director of Biolab and a specialist in nutritional medicine, who practises in luxurious premises above his laboratories close to 5 Harley Street. Hair analysis is a valid measure for toxic elements such as lead and cadmium; in certain circumstances, it is considered the test. It is good for looking at the overall picture of mineral nutriture, whether or not diet is adequate or absorption is adequate or inadequate. It is exceptionally good for assessing levels of lead, mercury, arsenic, aluminium and cadmium. A whole half of the article deals with the apparent discrepancy between the two results. However, the article does not explain that there had been considerable dialogue between Stephen Davies and the Observer prior to publication. When Stephen Davies was asked for his opinion on the discrepancies in the hair-mineral analysis, he asked the journalists to explain how they had taken the sample.

Longitudinally the effects of bony spinal development were that there arranged musculature would also allow for some was now a new movement option buy generic elocon 5mg. Rather than degree of flexion-extension (as seen in the caterpillar); sequential peristaltic contraction buy elocon 5mg cheap, there was now the however discount elocon 5mg visa, without a bony spine the flexion-extension option to contract the musculature down the entire would be little more than a transient ‘ripple’ down the length of the body on one side, then, using the stretch body segments. This would provide an How this pertains to human development efficient cyclical means of moving forward through and movement rehabilitation water and made use of the viscoelastic properties of In terms of motor control, this movement is exploit- mesodermal (muscle) tissue. In humans, of course, the appen- bony strut would be required to prevent ‘telescoping’ dicular extensions (arms and legs) are also employed of the body under the load of unilateral longitudinal to facilitate movement. This has been demonstrated in work by roundworm bauplans, digestion became less depen- Hodges et al (2001) in which they confirm Lewit’s dent on movement and, in fact, with a decreased utili- (1999) assertion that the diaphragm is a respiratory zation of the peristaltic action of the body wall, would muscle with postural functions, while the transversus require a further functional separation of the digestive is a postural muscle with respiratory function. Therefore, any creature that by Hodges and colleagues (2001) showed that human has mastery of a movement pattern beyond a peristal- subjects, when under perturbation loads, would tic forward creep, must have evolved a celomic cavity recruit both transversus and diaphragm to optimize to allow gross movement without compromising Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 325 digestive efficiency. Indeed this is what the fossil movement skill with them to swamps to clamber over record and morphological studies suggest. On The earliest animals to truly master motion in the land, however, this mastery brought with it some frontal plane (above and beyond the primal dimen- serious limitations. It is at this juncture in evolution (and Gracovetsky (1988) describes how any ground-lying in every vertebrate development after fish) that we objects, such as rocks, stones, fallen trees, would need find development of a celomic cavity. This solution would result initially in axial same layer of embryological tissue (the lateral plate rotation which, when coupled with lateral flexion, mesoderm) as the abdominal wall musculature (see would culminate in motion in the sagittal plane. The structure sequence of events is corroborated by Kent & Carr therefore is interrelated with the function. Gracovetsky (1988) believes that this provided a solution to both the ground-lying How this pertains to human development objects and the fact that, until this juncture, the mass and movement rehabilitation of muscle responsible for moving the organism forward on land was intra-abdominal and therefore • In the infant human, and in many apes, lateral was competing for space with the vital viscera in the flexion is utilized as a primary trunk pattern in abdominal cavity. This seriously limited the potential both gait and other gross movements – such as for significant hypertrophy. One of the characteristics An alternative solution, Gracovetsky (1988) argues, of early gait is a laterally directed arm swing (to was to develop effective flexion-extension of the trunk compensate for frontal plane motion of the trunk), and limb which brought with it a number of benefits as opposed to the drive forward and backward in over lateral flexion: more accomplished sprinters (Haywood & Getchell 2005). In a competitive and found in the gym environment, train the user hostile environment, this would have been primarily in the sagittal plane; hence frontal plane highly desirable. Of course, the story is far more lateral flexion/direction specific/ complex than this, but it does provide a general over- coupled rotation view of our understanding of the evolution of verte- From this point in the evolution of vertebrate design, brate biomechanics – including our own – based on we can turn to the work of Gracovetsky (1988) to the fossil record. This then provides a greater insight provide a concise, insightful description of upcoming to how human biomechanics have evolved and are events. This understanding is fundamental Having mastered motion in the frontal plane in the to helping solve problems when the biomechanics water, the first amphibious pioneers brought this break down. From this, Ahlberg (personal communication, Lateral flexion → Axial rotation → Flexion-extension 2000) agrees it can be inferred that, consistent with How this pertains to human development Gracovetsky’s interpretation, axial rotation may be and movement rehabilitation allowed (as a mechanical necessity) during evolution from lateral flexion to sagittal flexion-extension. Mastery (active) axial rotation When compensation patterns are present, injury may occur either centrally at the spine or Indeed, even in a human infant, it takes many years peripherally in a limb. The end result is an It is interesting to note that the only two true bipeds attempt to increase the power from the arm, alive today are birds and humans, and that both of increasing the tension locally through the arm and them have significant spinal rotation, and both are the grip required on the racket, club or other able to sing and generate rhythm. Across a period of time, cumulative is believed to be intrinsic in the spinal cord circuitry stress to the tendons of the extensor and/or flexor of bipeds – to effectively generate rhythmic gait. Mammals (2nd dimensional mastery) – The astute observer may, at first, consider that a cat’s reflexes, its ability to right itself, might be considered flexion-extension/direction specific/ more advanced than human reflexes, and conse- coupled lateral flexion-axial rotation quently may question the idea that human mastery of What Gracovetsky (1988) only touches on within his the transverse plane is greater than feline mastery. True mastery of the transverse plane – or the invested, a cat could simply not be taught to ride a 3rd dimension – requires significant nervous system bike, let alone jump a bike, somersault a bike, nor development, which is why it has only really been jump out of a helicopter with skateboard in hand to mastered by the primates – although some cats and land in a 30-foot high half pipe performing all kinds birds may also merit the award of transverse plane of mind-bending tricks. As has been pointed out (P Ahlberg, Profes- leopard standing on its hind legs and flicking a sor of Evolutionary Organismal Biology, Uppsala football up with one paw and juggling it on the other University, Sweden, personal communication, 2000), paw is unthinkable – if amusing! The point is that, rotation in the transverse plane does occur in certain no matter how it is viewed, the human nervous lower vertebrates, including dinosaurs, lizards, snakes system can be developed far above and beyond that and birds. However, significant rotation would only of the average cat and it is this development, these appear to be limited to birds in the cervical portion kinds of abilities which the average person might and mammals, particularly cats, in the lumbar region. Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 327 How this pertains to human development this day – are not man-eaters, since they have an and movement rehabilitation abundance of other easier prey to satiate them. Atten- borough (2002, 2003), De Waal & Lanting (1997) and • True mastery of the transverse plane requires Morris (1982) support the Homo aquaticus theory significant computational demands, and this may with observation of wading behavior in chimpanzees, be why learning difficulties (e. This provides a possible explanation for how Gra- top-down voluntary axial rotation/ covetsky’s (1988) model of gait – the spinal engine – direction specific could have developed, and the subsequent realization To brachiate is to move by using the arms to swing that movement emanates from the core (Cresswell from branch to branch (Anderson 2000). Overcoming such aquatic resistance to chiate is a rare feature even within primates, though forward propulsion of the lower limbs would neces- by and large all primates are able to rotate their upper sitate development of spinal strength in the transverse (cranial) limbs through nearly 360° of motion – some- plane during gait, which most primates lack. Indeed any actor trying to mimic an greater number of hunting and/or escape possibilities ape-like gait will always incorporate more of side-to- in an arboreal environment, than having claws and side gait sway, which is instantly recognizable as ‘ape- limited range of forelimb motion. Experiments where chimpanzees have been allows for movement via vines and under branches, trained to walk bipedally have sadly resulted in heart as well as on them. How this pertains to human development Nevertheless, predation from many of the big cats and movement rehabilitation was presumably a problem for our ancestors – as it still is for our primate cousins today (Anderson 2000, • Efficient human bipedal gait requires strength in Morgan 2001). To help to gested, the migration from the shrinking canopy to a retrain dysfunctional gait patterns, exercises which more land-dwelling existence would have brought teach integration, while building strength in upper with it an increased risk of predation from our alto- and lower limbs, may be useful (see ‘Standing cable gether larger, stronger and ‘toothier’ feline counter- pull’ below). As Morgan (2001) points out, although critics of the Humans (3rd dimensional mastery) – axial aquatic ape theory might suggest that the aquatic environment is altogether as dangerous as the savan- rotation/direction specific/bottom-up nah, many of the hominid fossils have been found Certainly, it would seem that controlled long-axis around lakes whose crocodilian inhabitants – even to rotation of the spine from the finely controlled, high- 328 Naturopathic Physical Medicine amplitude axial rotation is a specialization that has Lovejoy et al (2003) go on to describe that within any only evolved in animals that have already mastered given embryological field of development (limb, bone, sagittal flexion-extension (P Ahlberg, personal com- muscle, tendon) each is controlled by a structured munication, 2000). To bring about change in an This brought with it some significant advancements, adult structure – such as those we might anticipate if including: we could watch hominid evolution unfold – must therefore involve altering the positional information • increased efficiency in gait over long distances of the developmental field. Lovejoy et al (2003) • decreased surface area for the sun to strike, suggest, then, that it is this ‘field’ – not the bone or the resulting in less energy wasted on muscle – that is the selective force driving the adapta- thermoregulation tion. Expression, therefore, of new anatomies is not • greater hunting opportunities (the big cats – the result of the genes so much as the regulatory field. Such struc- The rapid expansion of the human brain didn’t begin tural adaptations to use are discussed further in until less than 2 million years ago – millions of years Chapter 2. Bipedalism there- This is in line with Ingber’s (1999) evidence that gene fore was the forerunner of neocortical development – expression alters when structural features are modi- rather than the result of it. Because human gait fied as in the weightlessness affecting astronauts pre- demands alternating contraction of the anterior venting normal metabolism in cells whose cytoskeleton oblique slings for forward propulsion (see sling tensegrity structures have warped in zero-gravity systems below), across time this would have remolded conditions.

Consequently cheap elocon 5mg on-line, trials of its use have been limited to patients without a history of previous Intravenous thrombolysis is a standard therapy for ischemic events generic elocon 5mg with visa. For routine use of alteplase after thromboembolic events were significantly increased stroke there is an upper limit of 3 hours after the in the highest-dose group (160 µg/kg) cheap 5 mg elocon visa. A further trial onset of stroke, but an extension of this time limit to involving more than 800 patients also found reduced 4. Ten effectively achieved by using a combination of intra- percent of the total dose is administered as an intra- venous vitamin K and prothrombin complex concen- venous bolus with the remaining 90% delivered trate, or fresh frozen plasma. Aspirin and other antiplatelets or anti- coagulants should be avoided for 24 hours following With intracerebral hemorrhage, thrombolysis is thrombolysis. Hypertension should be gradually Transcranial Doppler ‘sonothrombolysis’, micro- lowered. Raised intracranial pressure can be bubble and intra-arterial thrombolysis administration lowered if necessary. In order that patients obtain the full potential benefit of The efficacy of either dipyridamole, clopidogrel, acute stroke therapies, significant changes in the way or a combination of antiplatelet agents has not been stroke services are configured have been required. It is, however, good practice and an appreciation that patients with suspected stroke 239 to commence appropriate secondary prevention should be transported to an appropriate medical Section 4: Therapeutic strategies and neurorehabilitation antiplatelet therapy at the earliest opportunity in Intracranial pressure should be maintained at appropriate patients. A ‘U-shaped’ association between intracranial pressure can be lowered if necessary. Cerebrovasc Dis 2008; acute post-stroke period, the reduction should be 25:457–507. Recommendations for the Management of Measurement of blood glucose is mandatory for Intracranial Haemorrhage – Part 1: Spontaneous all patients with suspected stroke. Intravenous thrombolysis with between elevated admission plasma glucose and poor recombinant tissue plasminogen activator for acute post-stroke outcome, with increasing stroke severity, hemispheric stroke. The National Institute of Neurological Disorders and lowering of hyperglycemia following acute stroke. Tissue plasminogen routine use of insulin infusion regimens to control activator for acute ischaemic stroke. Randomised double-blind placebo Raised body temperature following stroke is controlled trial of thrombolytic therapy with commonly treated with antipyretic medication. Aspirin and clopidogrel compared years with acute ischaemic stroke: Canadian Alteplase with clopidogrel alone after recent ischaemic stroke or for Stroke Effectiveness Study. J Neurol Neurosurg transient ischaemic attack in high-risk patients Psychiatry 2006; 77(7):826–9. Anticoagulants ultrasound monitoring in stroke patients treated with for acute ischaemic stroke. Thrombolysis with Alteplase treatment in acute cardioembolic stroke: a meta- for acute ischaemic stroke in the Safe Implementation analysis of randomized controlled trials. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke 17. Glucose-potassium-insulin infusions in recanalization in the first hours after ischemic stroke. Treatment of post-stroke antithrombolytic therapy for ischaemic stroke: the hypertension. N Engl J Med 2005; Groups: The American Academy of Neurology affirms 352(8):777–85. Glucose and insulin therapy in acute acute ischaemic stroke in the Safe Implementation stroke; why delay further? Alteplase infusion followed by subcutaneous insulin treatment in compared with placebo within 3 to 4. Both high and temperature in acute stroke patients is an often blood pressure and low blood pressure were inde- neglected matter although it may have an important pendent prognostic factors for poor outcome. This chapter will summarize consideration that prolongation of the elevated blood the current knowledge regarding the management of pressure may be caused by more severe stroke as the above. However, in most of these studies The association between elevated blood pressure and antihypertensive agents were administrated several recanalization was evaluated in 149 patients after weeks after stroke onset. The authors concluded that namic and metabolic impact of pharmacologically when there is need for or no contraindication against increased systemic blood pressure on the ischemic early antihypertensive therapy, candesartan is a safe core and penumbra was evaluated in rats. Three months after treatment tions including 319 subjects, the small size of the trials began, the active treatment group had a significantly and the inconclusive results limit conclusion as to the lower mortality compared to the placebo group. According to region, but raises the risks of hemorrhagic trans- the American guidelines [21] it is generally agreed formation, cerebral edema, recurrence of stroke and hypertensive encephalopathy. There is an indication to treat blood pressure blood pressure in the acute phase of ischemic stroke only if it is above 220 mmHg systolic or if the mean 244 was found and more research is needed to identify the blood pressure is higher than 120 mmHg. No data are effective strategies for blood pressure management in available to guide selection of medication for the Chapter 17: Management of acute ischemic stroke and its complications lowering of blood pressure in the setting of acute hyperglycemia) or could not be fully classified due ischemic stroke. The recommended medication and to missing data in the oral glucose tolerance test. Several ongoing clinical trials such as pendent of age, stroke type and stroke size. How- these conditions, including impaired vascular tone ever, it is not clear whether hyperglycemia itself and flow, disruption to endothelial function, changes affects stroke outcome or reflects, as a marker, the at the cellular level, intracellular acidosis and severity of the event due to the activation of stress increased aggregation and coagulability. Pretreatment with insulin was found to limit the Among the factors found to contribute to the ischemia. Glucose level is an important risk factor for morbid- In one systematic study [24b] it was shown that ity and mortality after stroke, but it is unclear glucose pathology is seen in up to 80% of acute whether hyperglycemia itself affects stroke out- patients, many of them showing a high probability comes or reflects the severity of the event as a of previously unrecognized diabetes. The study was conducted among 933 hyper- pre-thrombolysis patients, an even more aggres- glycemic acute stroke patients who received glucose- sive approach may be advisable. In the treatment group significantly lowered glucose and blood pressure values were documented; however, Hyperthermia no clinical benefit was found among the treated Several animal studies [35, 36] demonstrated the cor- patients.

As men- mechanisms particularly relevant to circulatory distri- tioned above elocon 5 mg for sale, Dr Carroll was trained by Dr Ledoux of bution and metabolic function cheap 5mg elocon with amex. Dr developed during the 1920s elocon 5 mg free shipping, which was a particularly Carroll was encouraged to move to the American fruitful period for the profession. While he the whole-body constitutional approach that utilized was unable to do that, he did operate a very busy and physical medicine for a wide variety of complaints well-known clinic until his death in 1962. It was during The standard constitutional hydrotherapy treatment this period that the general naturopathic tonic treat- combines a modified Kneipp torso pack with the ment was originally developed, as well as the basic spondylotherapy methods of Dr Abrams (see Chapter spinal and abdominal treatments of neuromuscular 12). Chapter 11 • Naturopathic Hydrotherapy 531 Constitutional hydrotherapy treatments are still replaces the two Turkish towels previously widely taught, applied and researched because of applied. Slide two 4-inch electrode pads tional hydrotherapy represents the clinical evolution underneath the patient, one from each side, so of an eclectic, flexible, constitutional and uniquely that each is on one side of the spine with the naturopathic approach to comprehensive physiother- upper edge of the electrode approximately apy treatment for a general clinical setting. Replace the hot towel with one Turkish towel well wrung from cold water from the Standard constitutional hydrotherapy faucet (40–55°F/4–12°C; note this does not include iced or especially cold water) and As previously discussed in the naturopathic applica- folded in half. Again cover the patient with the dard treatment’, the representative treatment and cor- blanket. Place the low volt alternating current sine Indications wave unit within reach of the patient and instruct the patient to adjust the intensity. The The standard constitutional treatment is designed to current output should be on the surge tonify digestion, enhance appropriate immune func- (massage) setting with a low duty cycle of tion, improve intestinal flora balance and gently 6–10 cycles each minute. Modifications of the physiotherapy adjusted by the patient, and the following modalities allow for a flexible application to a large levels are noted in this order: variety of clinical conditions such as inflammatory bowel disease, asthma, upper respiratory infection, a. The patient will feel a gentle contraction dysfunction, cancer, musculoskeletal injury and/or somewhere in the abdomen, usually under disease, metabolic diseases as well as cardiac condi- the costal margin on the right, but not tions (Blake 2006b, Boyle & Saine 1988e, Scott 1992). The patient will feel strong contractions of Methodology the muscles of the upper back. This is Patient supine, undressed from the waist up, covered unnecessary and counterproductive. Two Turkish towels, each folded in half, well minutes of total treatment time have elapsed), wrung from hot water (130–140°F/54–60°C; check the center of the towel over the solar note the relatively high temperature of the plexus to see if the patient has warmed the compress) are applied covering chest and towel to at least body temperature. If the patient has not, the towel as needed so that they do not lie then cover the patient again with the blanket, beyond the anterior axillary line. Ask the patient to arch the back or lift the is used to separate the patient and the shoulder in order to move the sine wave pads blanket, as is common for sanitation reasons, from the upper back to the abdomen. One an impermeable barrier (such as a thin rubber pad is placed on the back and will be centered mat) should be placed over wet towels so as over the spine at the thoracolumbar junction, to avoid wetting the cotton sheet and thus the top edge at approximately the 11th fundamentally changing the treatment thoracic vertebra. At the 5-minute mark one Turkish towel, the epigastric region (directly superior to the folded in half, well wrung from hot water, umbilicus on adults). Instruct the patient to adjust the sine wave have been described in the literature (Blake 2006b, intensity until a gentle contraction at one or Watrous 1996). The sine wave output remains on the surge (massage) cycle at the Alternatives same low duty cycle. At the 10-minute mark (approx 25 minutes Standard constitutional hydrotherapy is a broadly total), remove the sine wave pads. Ask the applicable modality for a wide variety of clinical com- patient to turn over onto the abdomen. Internal medi- the back: cations do not supply the same physiological responses 10. Place two Turkish towels (the same as though, and application of constitutional hydrother- previously used), freshly well wrung from apy in combination with internal medications will hot water, each folded in half, on the patient’s have additive effect. The lateral towel edges are folded up so as not to lie beyond There have been a number of preliminary investiga- the posterior axillary line. At the 5-minute mark (approx 30 minutes has been conducted at the National College of Natu- total), replace the two towels with one fresh ropathic Medicine to investigate the blood count towel wrung from hot water. Quickly replace parameters and to identify if heat shock proteins are this towel with a towel well wrung from cold involved in any changes observed. The tigation has identified that post-treatment core tem- lateral towel edges are folded up so as not to perature is more likely to show a net increase than a lie beyond the posterior axillary line. At the 10-minute mark (approximately 40 peripheral temperatures likewise are more likely to minutes), check the center of the towel to see show a net increase (91% of patients) (Wickenheizer if the patient has warmed the towel to at least et al 1995). If the patient has warmed Unpublished research conducted at the Southwest the towel, then remove the towel and College of Naturopathic Medicine by Mark Carney proceed. Use a fresh dry towel to give a 5–20 second (triglycerides, high-density and low-density lipopro- dry friction rub to the patient’s back. Regardless of the a post-treatment increase in leukocyte circulation relatively high temperature of the constitutional towel that remained elevated for 2 hours (longest point application, the temperatures are usually well toler- of observation), particularly the monocyte levels. Appropriate knowledge of physio- Drs Carroll and Scott regularly observed a decreased therapy modality application is necessary. These two observational trends sug- Chapter 11 • Naturopathic Hydrotherapy 533 gest improved intestinal flora balance and improved • The Water Cure in America: Over 300 Cases of kidney function. It should be understood that during Various Diseases Treated with Water by a serial course of treatments, variations from the ‘stan- Wesselhoeft et al, published in 1856 by Fowlers dard’ are commonly employed on an as-indicated & Wells, New York, contains numerous cases basis. The cases include pneumonia, tuberculosis and Naturopathic perspectives various other acute and chronic diseases, including appendicitis, peritonitis and The constitutional hydrotherapy system is a uniquely salpingitis. The cases document the potential naturopathic approach to clinical physiotherapy usefulness of a simple yet effective treatments.