llg DIABETES INSIPIDUS 



Hysterical polyuria occurs most frequently in adults between the third and 

 fourth decades of life. It is rare in adolescents and children, but, neverthe- 

 less. Terrier reports two undoubted instances in children aged one and a half 

 and two and a half years respectively. 



In this hysterical polyuria, as in the other forms, the patient is much more 

 inconvenienced by constant thirst and the frequent desire to urinate than by 

 actual pathologic symptoms ; but there are exceptions to this rule. Some per- 

 sons in whom the further course of the disease Justifies the diagnosis " hys- 

 terical polyuria " emaciate decidedly as long as the diabetes exists. This is, 

 however, unusual. As a rule, nutrition and the general well-being are not 

 disturbed. Variations in the degree of polyuria are frequent; often the course 

 of the polyuria is parallel with the severity of the other hysterical phenomena. 



Hysterical polyuria may be cured, and sometimes with surprising rapid- 

 ity. Occasionally this occurs spontaneously, more frequently after the employ- 

 ment of various drugs (valerian, antipyrin, etc.), by suggestion, under true 

 hypnosis, or by means of powders of sodium chlorid and similar placebos. 

 Indeed, it is often this rapid cessation of the malady after such slight external 

 causes that stamps the condition with certainty as hysteria. 



But by no means all cases of hysterical diabetes terminate so promptly. 

 Many cases are protracted over long periods of time. In quite a number the 

 history states only that at the time of the patient's discharge the diabetes con- 

 tinued unimproved. In such cases the disease appears to last for decades. 

 In another series it disappears gradually in the course of a few weeks under 

 appropriate antihysteric treatment, or more rarely it ceases spontaneously. 



Diabetes insipidus in hysterical subjects shows very varying behavior. In 

 some, the symptoms point decidedly to a primary increase of renal activity. 

 This is especially shown by the dryness of the skin and the slight tendency to - 

 sweating. In other patients, on the contrary, perspiration is profuse, occa- 

 sionally so free that they complain of it. If we are still in doubt, in such 

 instances, whether the decided excretion of water through the skin can be 

 explained by a primary renal insufficiency or whether the increased excretion 

 of water is a phenomenon coordinate with the increased activity of the kid- 

 nej^s, the study of a further group of cases distinctly proves that this hj'sterical 

 polyuria is really the consequence of an increased ingestion of water, i. e., a 

 condition of primary polydipsia. A number of such cases are susceptible of 

 cure by a more or less compulsory limitation of the intake of water, without the 

 patients undergoing any great hardship. Sometimes we have only to quiet 

 the thirst with simple remedies, such as stewed prunes or small quantities of 

 lemonade, in order to control the polyuria. Such cases appear to represent 

 scarcely more than a bad habit, and the number of these cases may in reality 

 be much greater than can be determined from the clinical histories in litera- 

 ture because proof (i. e., the therapeutic test) cannot be obtained. 



As the third main group the idiopathic form of diabetes insipidus will 

 next be considered, i. e., that form in which no other organic or functional dis- 

 turbance can be found as a cause for the polyuria. According to its mode of 

 origin we may subdivide this group into; 



