112 DIABETES INSIPIDUS 



To gain a comprehensive grasp of the manifold clinical phenomena of the 

 disease, it is still most convenient to group the cases according to their appar- 

 ent etiology. Thus the following forms may be described : 



1. Diabetes insipidus in cerebral diseases, 



2. Diabetes insipidus in functional neuroses, 



3. Diabetes insipidus, idiopathic form. 



Further description will show that under each of these divisions several 

 very different clinical pictures are grouped together. 



SYMPTOMS AND CLINICAL COURSE 



The essential symptom is the large quantity of urine. The daily excre- 

 tion is increased to 5, 10, even 20 liters, and in the severest cases it amounts 

 to even more than this; cases have been reported in which the weight of the 

 daily quantity of urine was as great as the body-weight. These cases occurred 

 in children weighing 20^ and 27-| pounds; a patient of Trousseau voided 43 

 liters daily. 



Of course the urine is greatly diluted, almost colorless, and feebly acid; 

 its specific gravity is low, usually under 1.010, and it may even fall nearly 

 to that of water. 



As a rule the normal solids of the urine show no deviation from their ordi- 

 nary amounts. It is true that the daily amounts of urea and sodium cJilorid 

 have been found abnormally large or abnormally small in a number of cases, 

 but it is extremely probable that this was in consequence of a profuse or scanty 

 ingestion of albumin and sodium chlorid in the food; diabetes insipidus in 

 itself does not influence these values. Uric acid and hreatinin are found in 

 the usual amounts; special importance has been attached to the occurrence 

 of inosite in urine free from sugar; but according to the investigations of 

 Strauss and Kiilz it is only the result of profuse excretion of urine such as 

 may occur in the healthy after abundant ingestion of water. 



The manner in which the urine is discharged varies in individual patients ; 

 in most, the number, in others, only the quantity, of the individual evacua- 

 tions is increased. Many patients excrete more urine during the night than 

 during the day, as in cases of contracted kidney; others do not show this 

 peculiarity. The "morning flood of urine" (Quincke), that is, the produc- 

 tion of a large amount of urine as soon as the patient wakens in the morning 

 even when he stays in bed and takes no fluid, is quite similar to what occurs 

 in the case of healthy persons. Further, as regards the influence of increased 

 body warmth, the excretion of urine in diabetes insipidus appears to conform 

 to the condition of health, i. e., in fever whether produced naturally or arti- 

 ficially (by injections of albumoses) it is decreased. 



In the main the kidney functions more independently of the ingestion of 

 water than in the healthy individual; after the ingestion of a large amount 

 of fiuid the amount of urine does not increase so rapidly as in health (though 

 even to this peculiarity there are many exceptions). After a decreased inges- 

 tion of water it is true the urine decreases, but not so rapidly nor so markedly 

 as in health. 



