Physical changes are always found associated with the disturbed mental status. If it arises during the active stage of an infectious process there is of course the high temperature and all other physical signs of fever. In a certain number of cases with temperature no definite signs can be found indicative of any of the well known fevers, hence has been called by various names, such as “Bell’s Delirium,” “Acute Mania Gravis,” or “Acute Febrile Delirium.” This ordinarily runs an acute rapid course with very high temperature, very marked delirium, followed by stupor and usually death from exhaustion. Even though no temperature be present the physical condition reminds one very much of that found in fever diseases. There is the lost appetite, resulting emaciation and malnutrition, insomnia, exhaustion, etc. =Osteopathic Theory.=—While it may be admitted that the various factors mentioned above may take part as exciting or predisposing causes, it is obvious that in numerous instances mental disorders do not arise whatsoever, even when the patient is subjected to these factors. There must necessarily be other elements essential to produce the psychosis. The osteopathic theory comes in at this point to fill in and complete the chain of causes and to initiate the onset by the introduction of the idea of nutritional and circulatory disturbances resulting from the spinal lesions. The records of the Still-Hildreth Institution show 18 of the toxic type, in which the poison is derived from without, who were treated, with 17 recoveries. There were 25 cases connected with the infection and exhaustion group, with 20 recoveries. Remarks by Dr. Hildreth In this group we have to do with blood disorders, resulting from the infections, conditions producing exhaustion, and the various toxins, or poisons, whether originating within the body or derived from without. These disorders are largely functional in character, resulting from brain irritation due to the toxemia or disturbance to the centers of nutrition. The main object of the osteopathic treatment, therefore, is to aid elimination and regulate and build up the nutrition. In most of the patients the physical lesions are found in the mid-dorsal area, chiefly from the 4th to the 7th, and in the cervical region, the 1st to the 3d. In aiding the kidneys in elimination the 10th and 11th dorsal vertebræ must be looked after. These conditions commonly respond very rapidly to the treatment and represent one of our most successful groups so far as results are concerned. Manic Depressive Psychoses