DIABETES INSIPIDUS 877 



diabetic type, in which the blood sugar is normal or subnormal and in 

 which there is no direct relation between carbohydrate food intake and 

 urine sugar outgo. 



The polyurias observed in individuals who overeat or who from habit 

 drink large quantities of fluid are much less severe and easily controlled 

 by restriction of food and fluid intake. 



Treatment 



Obscure diseases and disease syndromes are -characterized by the va- 

 riety and multiplicity of methods of treatment proposed. To this diabetes 

 insipidus is no exception. Previous to the discovery of the value of 

 pituitary extract as a helpful therapeutic measure, the most commonly 

 used remedial agents were such sedative drugs as the bromids, valerian, 

 opium derivatives, and asafetida. Hydrotherapy and electrical treatment 

 are of no benefit.' In cases known to be due to syphilis, antiluetic treat- 

 ment is indicated. Psychic treatment or the forced restriction of water 

 has not proven efficacious. Thyroid extract has no effect upon the 

 polyuria. In cases associated with brain injury, the endeavor has been 

 made to give relief by spinal puncture and by cerebral operation. 



Lumbar puncture has been tried by a number of workers in cases due 

 to other causes than injury but without benefit. Herrick first suggested it 

 as a therapeutic measure. In his case, occasional doses of pituitrin were 

 also given hypodermatically, thus vitiating the value of the test. Fur- 

 thermore, the symptoms of thirst and polyuria returned very soon there- 

 after. Fitz's case was not relieved by this measure. In Williams' 

 case, after lumbar puncture, the average daily output of urine 

 dropped from 6,000 c.c. to 3,600 c.c. for one day only. Marafion 

 observed similar transitory effects from its use in two cases. It may be 

 said therefore that the procedure gives only temporary relief due possibly 

 to the lowering of intracranial pressure. The benefit afforded is too fleet- 

 ing to make the method worth while. 



The most useful remedial agent thus far discovered is the extract 

 prepared from the posterior lobe of the hypophysis, familiarly known as 

 pituitrin. To be effective, the extract must be given hypodermatically. 

 The dose recommended by most writers is one cubic centimeter daily. 

 Intravenous injection is inadvisable and not without danger. Within a 

 few minutes after its subcutaneous administration, patients sometimes 

 complain of ringing in the ears, dizziness, or headache. These symptoms, 

 however, soon pass away, as does also the intense craving for water. For 

 the following eighteen to twenty-four hours, the patient will have a feeling 

 of well being and comfort due to the cessation of the extreme thirst and 

 excessive urination. Toward the end of the twenty-four hour period, the 



