846 GENERAL DISORDERS OF NUTRITION. 



Strauss justly regards this as another proof that polydipsia is not 

 the cause oi polyuria, but the reverse. He writes as follows : 



" What reasonable and satisfactory grounds are there for assuming 

 that the cutaneous and pulmonary exhalations of a polydiptic person 

 should differ from those of a healthy person who voluntarily drinks 

 copiously of water ? " 



But if we suppose a polyuria with consequent concentration of the 

 blood, and decrease of water in the tissue, there would be nothing 

 strange in a diminished gaseous excretion of water by the skin and 

 lungs. In our cases, as in most others, among the symptoms referring 

 to the skin, we find mentioned dryness, harshness, and frequent itch- 

 ing, while profuse perspiration is not mentioned in a single case. 



The quantity of liquid imbibed daily, including that contained in 

 the food, is said to have amounted sometimes to sixty or eighty pints. 

 Of course, such a quantity could never permanently be less than that 

 of the urine secreted, without the occurrence of a corresponding de- 

 crease of the weight of the body. All cases, wherein it is claimed 

 that the quantity of urine secreted exceeded that of the liquid imbibed, 

 must have been inaccurately observed. 



In my case, the sense of hunger was considerably augmented. 

 Trousseau also tells of a patient who ate such enormous quantities 

 that, at a certain restaurant where bread was furnished d discrelio?i, 

 they paid him to stay away. In this disease (unlike diabetes mellitus, 

 in which a part of the food consumed, instead of going to repair the 

 used-up constituents of the body, is voided unused), this unnatural 

 hunger which, moreover, is not a constant occurrence can only be 

 accounted for by supposing that the exaggerated consumption and dis- 

 charge of water accelerate the waste of the nitrogenous elements of 

 the body. It may be accepted as a law that, during an accelerated 

 flow of the juices of the parenchyma through the organs, a larger 

 quantity of albuminous material is consumed. 



In some patients the general health and vigor long remain undis- 

 turbed. A girl twenty years of age, with insipid diabetes, who 

 remained under observation at my clinic for a considerable time, 

 retained her blooming aspect, and could even do hard work without 

 special effort. In other patients, signs of digestive derangement, 

 cardialgia, vomiting, irregularity of the bowels, emaciation, and an un- 

 accountable sense of debility, set in early. In the instance reported by 

 Neuffer, the patient died with these symptoms, no appreciable cause 

 of death being discoverable upon autopsy. The course and duration 

 of the disease vary. In some cases it develops gradually, in others 

 it sets in suddenly. Not unfrequently a transient improvement in the 

 symptoms is observed. It may also happen that, during the attack 



