SYMPTOMS AND CLINICAL COURSE 117 



on an organic cerebral affection) has not been determined by any reliable 

 evidence up to date. 



The cases associated with epilepsy are not very frequent. In contrast to 

 this, those combined with hysteria form a very large group. It is true that 

 there are great differences of opinion in regard to our right to associate many 

 of these cases with hysteria. The earlier writings on this subject were based 

 on a careful collection of cases from literature, and a few cases were described 

 in detail as a proof of the possibility of a combination of hysteria and diabetes 

 insipidus ; lately, with a number of authors, there is rather a tendency to class 

 the bulk of such cases under hysteria, and we even read that practically all 

 cases not due to organic cerebral lesions are of a hysterical nature. The latter 

 view seems too extreme; but it is really difficult to draw the line correctly. 

 We know that " normal " diabetes insipidus leads invariably to various psy- 

 chical anomalies, slight in themselves (nervous irritation, hypochondriacal 

 conditions and melancholia). Hence it may be difficult subsequently to deter- 

 mine how far symptoms of this kind should be referred to diabetes insipidus, 

 and how far they should be ascribed to an hysteria which has existed for 

 some time. 



Diabetes insipidus develops in the course of hysteria either gradually or 

 quite suddenly after nervous irritation, fright, or worry, or sometimes directly 

 after a severe hysterical attack. In the latter cases it must be remembered that 

 the hysterical attack is always followed by the profuse discharge of clear 

 urine, typical urina spastica, that, therefore, a certain tendency to polyuria 

 accompanies any such attack and is included in the conception of hysteria. 



Some cases of diabetes insipidus occur in profoundly hysterical individuals 

 whose disease has existed for years, and who exhibit severe spasms, paralyses, 

 and similar symptoms. Examples of this form have been particularly de- 

 scribed by French authors; curiously it is more often seen in men than in 

 women. 



More frequently, at least in Germany, polyuria appears in persons in whose 

 previous history slight signs of hysteria are found, or in those in whom exami- 

 nation reveals hysterical stigmata, such as anesthesia, hyperalgesia of the skin, 

 mucous membranes, or ovaries, limitation of the fields of vision, and increased 

 reflexes. 



That we are not dealing in such cases with a mere coincidence of two dis- 

 eases entirely independent of one another, and that the diabetes insipidus may 

 be a real symptom of the hysteria, has been demonstrated several times very 

 clearly by the influence of hypnosis. By this means polyuria has been made to 

 disappear suddenly, and later to reappear as before. Matthieu mentions a 

 very significant case which was cured by the administration of powders con- 

 taining, nothing but sodium chlorid, but which later relapsed when the patient 

 discovered the deception. 



In most of the hysterical cases, we are dealing apparently with pure poly- 

 dipsia, as has already been mentioned, and in fact the majority of cases of 

 polydipsia appear to belong to this group, viz. : to hysterical diabetes. But thp 

 reverse of this statement is not correct; cases of pure primary polyuria may 

 also be caused by hysteria. 



