A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
Among the concomitant symptoms the most necessarily and closely
connected with the increased discharge of fluid is its increased
ingestion, so that the disease has been called polydipsia instead of
polyuria, it being assumed that the thirst is the initial and important
symptom upon which the diuresis naturally depends. It has been observed
in many cases, however, that the quantity of water drunk is very much
below that which is passed. In the case last spoken of the water
ingested in the form of drink was but a small fraction of the quantity
of the urine, so that the patient drank but two or three pints while
passing many gallons. In cases where the beginning of the disease has
been carefully observed patients have distinctly stated that the
increased discharge began before they felt increased thirst. This of
course takes no account of the quantity of water contained in solid or
semi-solid food. Polyphagia is occasionally seen, as in the oft-quoted
case of Trousseau, the terror of restaurant-keepers. So intense is the
craving for water that in several instances where attempts have been
made to limit its amount the unfortunate patient has drained the
chamber-pot. Emaciation is probably connected with increased
metamorphosis, as indicated by the increased secretion of urea and
phosphates. Dryness of the skin has been frequently noted, and has been
said to mark the distinction between polyuria and polydipsia, in the
former the skin being dry, and in the latter moist. In one case,
however, where copious perspirations were noted, the patient stated
positively that the polyuria began a number of days before increased
thirst was experienced. In another very extreme case, attended,
however, with no wasting, night-sweats occurred. Pruritus has been
mentioned as affording another point in the resemblance which
undoubtedly exists between the severer cases of this disease and
diabetes mellitus. Dyspeptic symptoms have been noted in some cases,
and oedema may take place, as in many wasting diseases.
The nervous symptoms are perhaps the most important in the severer {30}
cases. In some which have been examined post-mortem distinct nervous
lesions have been found, such as the remains of tubercular meningitis,
tumors involving the cerebellum, and softening of the floor of the
fourth ventricle; in others the patients are known to have been
syphilitic.
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