The COURSE AND TERMINATION naturally vary greatly with its etiology and the diseases with which it is associated. In some cases where nutrition is but little affected, and no attempt is made to check the natural appetite for water, the disease may go on for years with no essential change or impairment of the general health, as in the remarkable one quoted by Dickenson, where a French infant had at the age of three impoverished her family by her demand for water, which seems to have been an expensive luxury, and at a later period kept her husband—to whom, however, she bore eleven children—in a constant state of impecuniosity by the same depraved appetite. At the age of forty she drank in the presence of a scientific commission within ten hours fourteen quarts of water, of which she returned through her kidneys ten to their astonished gaze.
When polyuria is merely a symptom of cerebral inflammation, of central tumor, of syphilis, or of phthisis, the course and prognosis will of course be that of the primary disease. It occasionally comes on during pregnancy, and in one such case it is stated to have ceased two days after delivery, and in another the secretion, uninfluenced by parturition, resumed its normal quantity when lactation was fully established.
It is very rare, if indeed it ever happens, for life to be terminated by diabetes insipidus unaccompanied by any other disease, although from its association with many and severe affections, both of the nervous system and of the kidneys, it must of course not unfrequently happen that a patient dies in, though not on account of, the polyuric state. It is strange to observe, however, as has been often before remarked, how thin a shell of renal structure will suffice to carry on not only the usual, but an excessive, flow of water.
The ORIGIN of diabetes insipidus has been found in several conditions. Greater disposition toward it exists in early life, although it is by no means confined to youth. After middle life polyuria is likely to awaken the suspicion either of chronic interstitial nephritis or of prostatic disease, or other affection of the urinary passages setting up a sympathetic irritation of the kidney. It has been found to originate during convalescence from acute diseases, with perhaps preference for meningitis. Syphilis has its share of cases, as in most other organic nervous diseases. Shocks of various kinds, including fright, sudden or prolonged immersion in cold water, the rapid ingestion of large quantities either of water or of alcoholic fluids, are undoubted potent factors. In this respect, again, we may see the resemblance between diabetes without sugar and true or saccharine diabetes. It is favored by the hysterical diathesis. A very interesting case of severe hysteria with hemianæsthesia and hemiplegia and other marked symptoms varied for a time between almost complete anuria and the most profuse discharge of over two hundred ounces per diem.
A most interesting group of cases has been recorded by Weil,10 where out of a family of 91, 28 were polyuric. The head of the family, a polyuric, lived to the age of eighty-three, while his descendants were robust, many of them attaining a good old age. There were no anomalies of the circulation, and the persons affected were not alcoholics. Their only complaint was of a troublesome thirst, and they declined treatment.
10 Cbl. für die Med. Wiss., 1884, p. 263, from Virch. Arch., xcv.
The PATHOLOGY of diabetes insipidus, so far as is positively known, may be gathered from the previous account of its etiology and symptoms. It is evidently of nervous origin in the great majority if not all cases. It is often connected with distinct lesions of the nervous system, and attended with other nervous symptoms. In some cases it occurs in connection with a well-marked hysterical diathesis. The copious flow of pale urine as a sequel to the hysterical paroxysm is well known, and the same thing often attends a severe nervous headache in either sex. It is probable that the polyuria attending lesions of the urinary passages is a reflex nervous phenomenon, since it may be present when there is no suspicion of organic renal disease.
Guyon11 states that surgical polyuria occurs under three conditions—painful excitation of the sensibility of the deeper portion of the urethra or the vesical mucous membrane; repeated attempts to urinate during the night; retention of urine more or less complete, but especially when there is distension of the bladder. Of the first cause he gives an instance in the case of a young man who had a polyuria whenever a bougie was passed beyond a urethral stricture.
11 Leçons cliniques sur les Maladies des Voies urinaires, Paris, 1881.