Postvaccinal Encephalitis Associated With Diabetes Insipidus

Abstract

The word "polyuria" as used in this article means excessive urination following or accompanying excessive intake of water by mouth, a "urina potus" in which the constituents of the urine remain in normal proportion to each other, but in which the urine is extremely dilute. REPORT OF A CASEHistory.\p=m-\JamesG., aged 7\m=1/2\years, had been under my supervision from the age of 18 months to 5 years, at which time the family moved east. There was nothing unusual in his early history, except a mild facial eczema. I next saw him on May 8, 1931, when he was brought back for examination because of the following complaint: On Sept. 9, 1930, he was vaccinated on the arm with a glycerinated vaccine virus1 by the multiple puncture method. He had never previously been vaccinated. The third day after vaccination he had a temperature of 102 F., and a pustule developed at the site of the vaccination. The temperature returned to normal in twenty-four hours, and the child appeared well. His brother was vaccinated at the same time, but no "take" occurred. On the seventh day after vaccination the patient complained of headache and had a fever. The temperature was not taken. He had severe chills which shook the bed that night and every night for the following month, and an enormous thirst immediately developed, the child rising as many as twelve times a night to drink and urinate, drinking as much as 12 ounces (354.8 cc.) and urinating up to 18 ounces (432.3 cc.) at a time. A marked change in behavior took place; the boy, who formerly was an even-tempered, agreeable child, became difficult to manage, and showed pronounced emotional instability.The temperature subsided in twenty-four hours, but the thirst, frequency of urination, chills and irritability continued unabated for a month, when the chills diminished in frequency ; they have continued to do so up to the time of writing, though he still wakes occasionally and complains of being cold. His average twenty-four hour intake of water during the first month of illness was 220 ounces (6,505.4 cc), and the urinary output was 185 ounces (5,470.5 cc.) (figures given by the family).One cubic centimeter of solution of pituitary was given hypodermically three times a day in September, 1930, with no perceptible change in the intake of fluid or the output of urine.Examination.-When brought to me on May 6, 1931, the boy weighed 51 pounds (23.1 Kg.) and was A7l/2 inches (120.65 cm.) tall. Physical examination 1. Manufactured