Diabetes Insipidus 



JOHN R. WILLIAMS 



ROCHESTER 



In the light of modern investigation, diabetes insipidus must be 

 looked upon as a symptom complex or syndrome caused by some irritation 

 Or injury to certain areas of the brain as a result of which there is excited 

 in the patient an excessive secretion of urine of low specific gravity and a 

 profound degree of thirst. Numerous other symptoms and signs more 

 or less inconstant are associated with the syndrome as weakness, slow 

 pulse, low blood pressure, dry skin with absence of perspiration, regres- 

 sive changes in sexual characteristics, and visual disturbances. 



Clinicians have heretofore classified diabetes insipidus cases into two 

 groups : the idiopathic group in which there are placed cases of unknown 

 origin thought by some workers to be due to a disturbance in kidney func- 

 tion; and the symptomatic group which includes all cases associated with 

 brain injury, whether due to trauma, infection, tumor or disturbed func- 

 tion. With our present understanding of the phenomena, it would seem as 

 though this classification should now be abandoned. 



Historical 



A number of complete historical accounts of diabetes insipidus have 

 appeared recently in the literature. Among the most interesting of these 

 reviews is that of Fitz(rf), to whose writings the author is indebted for 

 many references. Thomas Willis (1621-1675), one of the great pioneers 

 of the seventeenth century whose studies in brain anatomy are still remem- 

 bered, was a keen clinical observer. He saw cases of diabetes which im- 

 pressed him as being unusual and noted that the urine of these was quite 

 different from that of true diabetes in that it lacked the characteristic 

 sweet taste. He suggested this as a basis of differentiation. 



About one hundred years later, Simmons in 1792 described two cases 

 which are quoted at length in Fitz's article. These are the first to be 

 published in English. The next reference to the disease was made by 

 Jojiann Peter Frank (1745-1821) who in 1794 defined the malady as 



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