DIABETES INSIPIDUS. 845 



patient with diabetes insipidus is as great as, or even greater than, 

 that passed in diabetes mellitus. In twenty-four hours it often 

 amounts to from 10,000 to 15,000 ccm. (ten to fifteen quarts), and 

 sometimes even more. 



A little girl, ten years old, with diabetes insipidus, who was 

 very undeveloped, and only weighed twenty-three pounds, during her 

 stay in the Tubingen clinic, passed daily an amount of urine that 

 weighed about one-third as much as her body. The urine is very 

 limpid, and, in contradistinction to diabetic urine, of low specific 

 gravity. It rarely rises above 1.005, and often sinks to 1.001 or 

 1.0005. The relative amount of urea and salts in the urine is low, 

 but the absolute amount of urea excreted in twenty-four hours is 

 usually normal or somewhat increased. In one case that I observed, 

 where the patient consumed a moderate quantity of nitrogenous 

 material, he passed 9,000 ccm. of urine, containing 38 grm. of urea, 

 in twenty-four hours. Barely the amount of urea passed in the twenty- 

 four hours is diminished. Thus, in one of the cases in my clinic, 

 published by Strauss, where the patient weighed about 114 pounds 

 and had good diet, he passed only 23.42 grm. of urea in the 

 twenty-four hours.* 



The excretion through the skin and lungs seemed to be consider- 

 ably reduced, judging by the relative quantities of the liquid drank 

 and urine voided. Doctors Schmidtlein and Spaeth, who for some time 

 ate and drank exactly the same quantities of food and drink taken 

 by a patient with diabetes insipidus at my clinic, in twenty-four hours 

 excreted from two thousand to twenty-six hundred grammes through 

 their lungs and skin, while the patient only lost from five hundred and 

 forty fa six hundred and forty grammes by the same way and in the 

 same time. 



Straws^ observations^also led to the result that, taking the same 

 amount of fluid, the patients passed from five hundred to two 

 thousand centimetres more urine than healthy persons, while, in the 

 latter, the loss of weight by insensible perspiration was considerably 

 more than in the former. 



* In some cases of diabetes insipidus the urine is said to have a very high specific 

 gravity, and to contain an abnormal amount of urea. In this form of disease, 

 about which the observations are very scanty, the original disease would consist 

 of an increased destruction of tissue ; the great thirst, as well- as the increased 

 secretion of urine, would be very insignificant as compared with the severe con- 

 stitutional disturbance, and would be explained as in diabetes mellitus. The serum 

 of the blood is abnormally concentrated, and, on endosmotic principles, draws water 

 from the tissues. We shall not further consider this obscure and problematical form 

 of diabetes insipidus. 



