120 DIABETES INSIPIDUS 



Hence, even if we do not consider this type of diabetes as belonging to hys- 

 teria, we must look upon it as closely related. 



In this category we also include the cases in which diabetes insipidus occurs 

 in pregnancy. A typical example of this kind is reported by Janzen from 

 V. Mering's clinic, in which a woman in three successive pregnancies was 

 attacked by a severe form of diabetes insipidus (passing 15 liters of urine, 

 whereas she ordinarily voided but 2 to 3 liters). 



The belief that such cases are closely related to the hysterical group is 

 not simply a matter of theoretic classification but has an important influence 

 9n the choice of treatment to be employed and the energy with which it is to 

 be carried out. 



A number of cases remain in which none of the previously mentioned fac- 

 tors comes into question, and in which the malady progresses slowly, frequently 

 becomes very severe, and comparatively often leads to decided loss of strength 

 and to emaciation. These forms have mostly been looked upon as typical cases 

 of diabetes insipidus. In the majority of these, observations regarding metab- 

 olism and the influence of varying quantities of fluid ingested have been made. 

 For the most part such cases are serious; as a rule, attempts at cure are 

 unavailing or have only a transitory effect. ISTevertheless, life is preserved 

 and the nutrition, which at first suffers severely, improves again without, how- 

 ever, reaching the normal. 



Occasionally, decided permanent impairment of health has been observed, 

 but marasmus increasing in severity until the disease terminates in death is 

 rare. Earlier literature contains more frequent reports of an unfavorable out- 

 come. Indeed, Trousseau believed diabetes insipidus to be almost invariably 

 fatal. During the last decades, however, it seems that no instances "of the 

 kind have been published; perhaps a case reported by Strubell belongs to this 

 group. 



As a rule, in these severe eases of diabetes insipidus the constitutional con- 

 dition appears to go hand in hand with the psychical. Permanent psychical 

 depression, hypochondriacal and melancholic conditions, are frequent and 

 almost constantly accompanying phenomena. We may even be impelled to 

 ask whether a psychical anomaly is not the fundamental condition, and the 

 diabetes insipidus only a symptom. 



Nevertheless, such severe eases are rare; the majority of idiopathic eases 

 lead a fairly comfortable life for years. 



The cases of diabetes insipidus developing from sypMlis appear to occupy 

 a position quite apart. A number of instances of this kind are known in 

 which, besides the diabetes, there were various symptoms pointing to organic 

 disease of the brain, and in some of these the necropsy showed the presence of 

 gummata or of meningitis. In addition to these, there are cases in which 

 diabetes insipidus develops during the course of syphilis, sometimes many years 

 after infection has taken place and without any other cerebral symptoms. 

 By antisyphilitic treatment this form of the affection has several times been 

 made to disappear promptly. It is therefore scarcely questionable that it was 



