124 DIABETES INSIPIDUS 



cases the remedy has been ineffectual, and of course it will always be futile in 

 persons who readily perspire. 



Finally, that method of ti'eatment must be considered which^ perhaps 

 appears to be the rdost obvious, the limitation of the intake of fluid. This 

 has often been tried by the patients themselves, but, as regards the propriety 

 and success of such attempts at cure, the views of different authors are dia- 

 metrically opposed. 



In some cases withdrawal of water, strictly adhered to, acts with great 

 rapidity; the patients are better almost from the first day, and after a few 

 days may be looked upon as permanently cured. These are the cases which we 

 have designated, upon the basis of this sort of improvement, as primary poly- 

 dipsia. Very characteristic is a case described by Westphal : primarily for the 

 purpose of studying her condition, the intake of fluid was limited, and at the. 

 conclusion of the experiment the disease was cured. In other cases the same 

 result has been attained by a gradual diminution of drink. 



However, it is only with a small number of diabetics that we so readily 

 reach the goal. Most patients cannot endure the tormenting thirst, and with 

 or without the knowledge of the physician they vsdll drink water. In such 

 patients, this method of treatment can be carried out, and with it sometimes 

 an actual cure attained, by isolation and ohservation. Geigel reports such a 

 case of diabetes insipidus in which during the first few days of treatment 

 severe disturbances appeared, but the withdrawal of water was persisted in, 

 and after a short time the case could be looked upon as almost cured. 



For the cases of diabetes insipidus, sensu strictiori, in which the polyuria 

 actually depends upon increased renal secretion, such attempts at cure by the 

 withdrawal of water are rarely successful. Indeed there is reason to fear that 

 we do harm by a dangerous inspissation of the blood. Unfortunately it is 

 often difficult in practice to decide between the two forms, and this is true 

 of the majority of cases, i. e., of those that are symptomatic of hysteria or at 

 least have some connection with it. Despite this difficulty, and in order to 

 achieve success wherever possible, it is advisable to attempt with all patients 

 of this type a methodical and cautious withdrawal of water. Of course this 

 can hardly be carried out except in thoroughly organized hospitals. 



