864 JOHN K. WILLIAMS 



reviewed between the years 1888 and 1916, the proportion was 28 males 

 to 8 females. 



Earlier writers observed a familial tendency in the occurrence of 

 diabetes insipidus which does not appear in recent literature. The most 

 complete discussion of the subject from the standpoint of heredity is by 

 Bulloch. He reviewed quite fully all the important cases which had been 

 published up to 1909. A remarkable example of heredity was studied by 

 Weil. He describes an individual born in 1772 who died in 1855 at 

 the age of 83 years. His descendants were 5 children, 29 grandchildren, 

 66 great-grandchildren, 119 great-great-grandchildren, altogether 220 per- 

 sons. Of these 220 individuals, 35 had diabetes insipidus: the founder 

 of the family, 3 children, 7 grandchildren, 13 great-grandchildren and 

 11 great-great-grandchildren. There were besides, 16 doubtful cases, 

 namely 9 grandchildren and 2 great-grandchildren who died young, and 

 5 great-great-grandchildren. The disease preponderated in the males but 

 was transmitted by both sexes. One is impressed by the number of il- 

 legitimate children, 19 having been born out of wedlock. In addition there 

 were 4 stillbirths and 2 idiots. In the absence of post mortem data, one 

 can only speculate as to the probable disease which was transmitted and 

 in this connection syphilis must be kept in mind, although Weil mentions 

 only one of the total number as being thus infected. 



Other studies are cited in Bulloch's article where in two or more 

 generations of a family several cases of diabetes insipidus were said to 

 have occurred. Ehrmann (a) describes an instance of the syndrome in a 

 family of 5 children, 3 boys and 2 girls. The boys, aged respectively 

 8, 9, and 10 years, Were all backward, one being an imbecile, whereas the 

 girls were all bright. 



There can be no doubt but that new growths of one kind or another 

 involving the hypophysis or contiguous brain areas are responsible for 

 many cases of diabetes insipidus. Frank (c) collected evidence on the etio- 

 logic relationship of tumor to the syndrome and cites five cases in which 

 new growths involved the hypophysis or the infundibular region. As 

 an illustration of metastases, Simmond's case occurred in a woman of 37 

 years, who a few months after operation for cancer of the breast developed 

 an intense polyuria and thirst. At autopsy a small nodule was found in- 

 volving the dorsum sell a, the posterior lobe and the infundibulum. The 

 pars intermedia and anterior lobes were apparently not involved. Barach 

 states that cases have occurred after carcinomatous disease of the liver 

 and suprarenals. In Finkelnberg's case at autopsy a cystic tumor was 

 found at the bottom of the third ventricle between the chiasm and the 

 hypophysis which was not enlarged. In Rosenhaupt's ase, a sarcoma 

 was found in the anterior lobe of the hypophysis and a similar growth in 

 the thyroid. Newmark reports a case in a boy fourteen years of age 

 who suffered for years with symptoms of diabetes insipidus. Two weeks 



