DIABETES INSIPIDUS 



By D. GERHARDT, Strassburg 



Diabetes insipidus belongs to those diseases which are of great interest 

 to physicians, less because of the frequency of their occurrence than on account 

 of the peculiarities of the pathological disturbances, and their definite analogy 

 to physiological experiment. 



Strictly speaking the disease has but one symptom: decided increase in 

 the excretion of urine. Everything else that is mentioned among the symp- 

 toms is either a consequence of this disturbance or is only an inconstant accom- 

 panying symptom. 



Increase of the excretion of urine occurs in quite a number of pathological 

 conditions as a more or less regular symptom ; thus, particularly in contracted 

 kidney, in the convalescence of febrile diseases, and during the absorption of 

 fluids from the cellular tissues or serous cavities. But we speak of diabetes 

 insipidus only when none of these conditions is present. 



This rare disease occurs at all ages, most frequently between the tenth 

 and fortieth years of life. The male sex is about twice as frequently affected 

 as the female. 



There are great variations in the severity of the clinical picture in differ- 

 ent cases. In many persons the disease lasts for decades, and even for a life- 

 time; and beyond the inconvenience of frequent urination and the corre- 

 sponding thirst, there are no disturbances of- the general health. In others 

 nutrition suffers greatly, and there is a lessening in the capacity for work 

 yet without any influence on the duration of life. In still other cases it is a 

 severe disease which soon terminates in death. 



This great difference in the severity of the symptoms makes it likely that 

 there is no single disease corresponding to the name " diabetes insipidus," 

 but that a number of different diseases in which the most conspicuous symp- 

 tom is the profuse production of urine, are grouped under this name. 



We know that an increase of urinary excretion may be artificially pro- 

 duced by increasing the intake of fluid, by raising blood-pressure, by irritation 

 of certain areas of the central nervous system, by direct irritation of the kid- 

 neys with certain pharmacological remedies, and finally, by the introduction 

 of so-called diuretics, which in their excretion through the kidneys carry with 

 them profuse quantities of water. 



It is probable that in the genesis of the clinical pictures which have been 

 included under the name of diabetes insipidus, several of these factors and 



no 



