CLINICAL CASES 
—op— 
Hyd roadipsia, 
—BY— 
Z. COLLINS McELRO\ , M. D., Zanesville, O. 
Reprint from the Cincinnati Lancet & Observer, January, 1877. CLINICAL CASES 
—OF— 
HYD ROAD I PS I A, 
With some Facts concerning the Water Supply 
of Living Bodies. 
By Z. COLLINS, McELROY, M. D., Zanesville, O. Physician to the 
Muskingum County Infirmary, Fellow of Zanesville Academy of Medicine, 
and of the Meigs and Mason’s Academy of Medicine, Member of the Perry 
County, Muskingum County, and Licking County Medical Societies, etc., etc. 
Reported at session of the Muskingum County Medical Society, Sept. 14th, 1876. 
In the prosecution of my inquiries in regard to the quanity of 
water drank in a given time by single individuals, I visited the 
Zanesville Glass Factories. In the window-glass department I 
learned that the blowers work between two furnaces, a melting 
and heating furnace; that in the warmest weather the principal 
blowers drank from fifty to sixty pints of ice water, each, in nine 
hours, the time usually occupied in blowing out a “melt. ” That 
the weight of glass blown averages four hundred pounds per hour, 
duringseven hours, the remaining two hours being occupied in “split- 
ting cylinders,” etc. Some of the men will drink during the same 
time from one to three pints of beer, or an equivalent of spirits, in 
addition to their fifty to sixty pints of ice water, per nine hours. 
In the winter the consumption of water, per man, falls down to 
from twenty to twenty-five pints. The amount drank, per man, 
follows the external temperature very closely. I ascertained that 
the amount excreted bv the kidneys was not perceptibly increased, 
nor was the color perceptibly changed by their increased consumption 
of water during working hours. Nor do the excreta from the 
bowels increase during their working hours when using such large 
quantities of water. When off work they do not drink more than 
three or four pints of water each in the whole twenty-four hours. 
And they do not eat more food at work than when lying idle. 
The water drank at work is mostly eliminated at the cutaneous 
surfaces by sweating; perhaps some at the lungs, but certainly no 
considerable portion finds exit at the kidneys. 
The foreman, from whom I mainly gathered these facts, is a 2 
man weighing not far from a hundred and fifty pounds, looks pale 
after quitting work and getting on his clothing, for they work 
nearly naked in hot weather. They do not wear anything hut 
pants, or drawers, and shoes, while at work; the shoes to protect 
their feet. 
Perhaps the men, blowers and helpers, will hardly average in 
weight one hundred and fifty pounds per man. But take it at 
that, and it will be seen that they drink inside of three days, water 
equal in weight to that of their bodies. 
Occasionally a man gets what they call “blown up with water;” 
that is, ceases sweating, and quickly becomes utterly helpless, and 
has to be carried out. They restore the sweating process by 
rubbing him briskly. As soon as the sweating process is restored 
he can go right to work again. 
The men occasionally lose the sense of thirst— Hvdroadipsia— 
in which condition they cannot continue work. To recall the 
sense of thirst they throw salt in their mouths, and chew and 
swallow it. When the sense of thirst returns, they resume work. 
At the Ohio Iron Works, Rolling Mill department, the mana- 
ger informed me that at the puddling furnaces, the men worked 
in front of the fires, the other side being open to the weather, in 
summer and winter; and, like the glass men, wore only pants and 
shoes. Those at the rolls, cutting and piling muck bar, shearing, 
etc. work differently, generally wore flannel shirts, pants, and shoes, 
and were not exposed to the same degree of heat as those at the 
boiling furnaces. That a “set” of men and boys, numbering one 
hundred and fifty, drink in hot weather from ten to twelve barrels, 
of from forty to fifty gallons each, of well, or spring water, in ten 
hours. Some years, when ice can be had, the men are supplied 
with ice water; and he thinks they do better on ice water, than 
when using that drawn from the well. Thinks there is less sick- 
ness among the men when they use ice water. Certainly less bowel 
complaint, and cramps, etc. In the winter, or cold weather, as at 
the glass factories, the consumption of water falls off one half at 
least. The consumption of water at the Iron Works, per man and 
boy, per ten hours, averages something over twenty pints. Those 
at the boiling furnaces running up as high as thirty pints per 
man. • 
Men who do not drink these quantities of water, at both Glass 
and Iron Works, soon fail in their work. It seems that this quan- 3 
tity in about what is required, per man, to enable them to do their 
work in the time allotted by the managers. At the Blast Furnace, 
the manager could give me no exact information, as the men drank 
from a pump; but knew the quantity was large, as it seemed to 
him they were at the pump every few minutes. Per contra. The 
manager of a Rolling Mill at Columbus, O., who was in the office 
of the Blast Furnace at the time of my visit, informed me that he 
had two men in his mill—boiler and helper—exposed to high heat, 
who drank very little water, not more than a quart in twelve hours. 
They were exceptionally good hands, and very moderate in 
everything. They were both religious enthusiasts, and drank by 
rule at stated intervals. Other men in the mill drank about as 
they did in the Iron Company’s work. 
These are certainly surprising results. Even the foremen and 
managers at the works were astonished at the quantity drank when 
attention was called to it. It is an every day affair with them, and 
they never had had attention drawn to it particularly before my 
visit. In my own person I kept as accurate an account as I could 
of the amount of fluid I drank on the twenty-eighth day of June, 
1876. Counting from morning to morning, of water, milk, tea, 
and coffee, ten pints were consumed. Like the men at the Glass 
and Iron Works, I found mv thirst for water followed the external 
temperature very closely. But I never pass a day, warm or cold, 
without drinking more or less water. Never drink spirits of any 
kind whatever. 
Inquiries of individuals in health nearly always elicits the fact 
that they drink more or less water. Amongst a certain number 
there is a prevalent belief that it is injurious to drink water at meals, 
founded on statements to that effect they have read in newspapers, 
copied generally from some quasi medical journal of health. 
Among invalids I rarely find a water drinker. Here are two 
clinical cases, the first a typical case of simple hydroadjpsia; the 
second a complicated case, with hydroadipsia as its central defect. 
Both these parties have been heard from not three days since (Nov. 
28, 1876.) Both are in fair health, and attending to ordinary 
duties daily. 
J. D. aged 68, German, 85 years in Muskingum County. Is a 
blacksmith by trade, at which he worked steadily the first twenty 
years of his residence here. For the last fifteen years has resided 
on a farm in Wayne township. 4 
Is rather slight in build, and never has been robust. Is perhaps, 
what would be called dull, that is, intellection is a slow process, 
never responds to a question promptly. Has, during a portion of his 
residence in the city, been a moderate beer drinker. Seldom tastes 
it now. In fact, seldom comes to the city. His health failed him 
very much about his OOtli year; seemed to recover under the use 
the use of hard cider, with iron in it. Did not like the looks of it, 
thought it looked too much like ink, but was convinced that it did 
him good, and so continued to use it and recovered a fair measure 
of health. Has for several years lost entirely the sensation of thirst 
for water, and has very rarely drank it. 
Monday May 15th, 1875. Mr. D. is in extremely poor health, 
and has been for several months. Is dull, stupid, listless, eats very 
little, and what he does hurts him. Has not tasted water, as water, 
tor many months, drinks a little tea and coffee at meals, but never 
anything between meals. Does not rise till about ten o’clock A. M. 
Has no pain, except such as he attributes to food, in the region of the 
stomach. Sleeps tolerably well, does not get up at night oftener than 
once to void water. It is always scanty, high colored, and deposits a 
dense sediment when he passes it in a night vessel. Is sallow, shrunk- 
en, cadaverous, thin in flesh, and complains of great weakness. Is 
giddy when he attempts to walk. Bowels fairly regular, excreta 
small in quantity, and the feces dry and hard. Pulse very small and 
corded, flesh chilly and almost lifeless, tempeiature not taken, has no 
cough, cannot use tobacco, though accustomed to do so from early 
life, mainly smoking. 
In critically studying his case I could not see that he 
had any organic changes of structure not incident to his 
time of life. The giddiness when walking, to be sure, pointed 
to considerable changes of structure in the brain and cord. But 
he had fair sight, and could read common print with 18 in. focus 
glasses, though he reads but little; takes no interest in newspapers, 
and confines his reading mainly to his catholic prayer book. He 
has not been to the city for six months, though living only seven 
miles from town. 
A most earful scrutiny of his case convinced me he was a true 
hydroadipsiac, aud that his physical condition was mainly to be 
attributed to defective water supply of his b :dy, on his part. I 
based my prescription on that pathology, and asked him to take 5 
milk, mainly, one and a half to two pints at a meal, to he placed be- 
fore him boiling. To make it palatable, he was to add halt a tea- 
spoonful of common salt to each pint, with black pepper, and bread, 
plain or toasted. When he felt like it he could take boiling water, 
made palatable with salt, and sipped from a tablespoon, blowing 
each spoonful with his mouth so that it would not scald him. After 
this was taken he might have almost anything else he desired at 
meals. He was to drink cold water with hi. carb. potass, in it, if he 
had pain, or wind in the stomach, after his meals. In addition to 
this, I prescribed a weak s >lution of Per Chloride of Iron, with Tinct. 
of Capsicum and Chlorate of Potassa, after meals. 
May 22nd, Mr. D. is up, and is very much better, skin has lost 
its sallow hue to a large extent; is full, and soft, and not in wrinkles, 
as a week since. Passes water in much larger volume, takes his 
milk regularly, thinks it very good, has no pain after meals now; 
pulse full, soft, and regular, though slow. Talks promptly, sleeps 
well, and lias less giddiness, though still some. Is in fact a new 
man. 
He got into my carriage and rode with me to a neighbors, some- 
thing over two miles. Enjoyed his ride, and as it was dinner time, 
we had dinner at his neighbors, he sipping nearly three pints of 
boiling milk with pepper and salt in it. After that he had some 
ham, and eat an egg. After dinner he put on his hat, walked out, 
and lit his pipe, and had a smoke, and said it seemed just like it 
used to, years ago, when he enjoyed it so much. 
He was to continue his milk diet, or broth, and water medi- 
cine occasionally. 
I think this a typical (ase of hydroadipsia—loss of the sensation 
of water thirst. In his recovery, I give the medicine very little 
credit, but think the saturation of his body with fluids the real agency 
which in a week, worked such a change in his physical condition. 
If he keeps up a proper water supply for his body long enough to 
change his structures, and give exit to the bulk of the"dead matter 
in it, he will be as well as he has been at any time for twenty 
years past. 
I had requested him, in case he failed to sleep any night, or was 
restless, or “nervous” as it is sometimes called, he should sip a pint 
of boiling water. This happened the very first night after my first 
visit. He sipped the water, and as he expressed it, felt well, and 
soon went to sleep, and had a good nights rest 6 
May 25tl), 1876. Mrs. D. aged 50, “widow; earns her liv- 
ing by working for ready-made clothiers. Has been sick for a 
month past, attended by two physicians of her own choice. She 
comes under mv professional care as an out patient of the City 
Infirmary. 
Inquiry elicits that she has been suffering with pain in the head 
nearly all the time she has been sick; at times she has paroxysms 
of terrible severity, with remissions of uncertain duration; but is 
almost never entirely free from it; goes to sleep, when she does 
sleep, with it, and wakes up with it, She is, and has been, sick at 
stomach, most of the time. Has no appetite, but cats, from a 
sense of duty a little bread and butter, which hurts her every time 
after eating it. Never drinks any water, either at, or between 
meals. Drinks some tea, perhaps a pint in 24 hours, which is all 
the fluid she takes. Has no thirst for water, and has not had for 
several years. Passes very little water from the bladder, and not 
oftener than twice in 24 hours. It is very high colored, and (piick- 
ly smells bad. Is very pale and pasty in her complexion. Has 
not slept any that she is aware of for several nights. Does not sit 
up any. Pulse about 108, very small, thready, and weak. Tem- 
perature 100°. 
Has taken medicine all the time she has been sick; has been 
blistered at nape of neck; does not know what medicine she has 
been taking. Says the physicians who have been attending her 
tell her she has softening of the brain. She does not ex{>ect to get 
well, but desires to have some relief from her suffering while she 
does live. Her tongue is heavily laden with fur. 
With the condition of things in this woman’s body, partly dis- 
closed by her own statements, what is my duty as a physician ? 
Am I to try to merge the phenomena into some “Disease” by name, 
and then, like my predecessors, prescribe for, or treat it? It may 
be, but that is not what I shall do. She is dry, shrivelled, and 
pinched up on the exterior. No process of her body is being per- 
formed as it would be in health. No appetite, no thirst for fluids, 
no sleep. My first duty, it seems to me, is to get her to sleep, and 
for that purpose she is to take chloral hydrat. and bromide of potash, 
one drachm chloral, one and one half bromide of potash to an ounce 
of vehicle, teaspoonful every half hour till asleep, and after, only as 
needed for that purpose. She is to drink a tea cup full of water, 
hot as she can take it, made palatable with salt, after each dose of 7 
chloral. In the morning she is to take ten drops Fowler’s solution, 
and repeat every six hours. To have milk, hot or cold, or both, 
for food, and to take three or four pints the next 24 hours. I leave 
her with the expectation that she will sleep the greater part of the 
night, and be better tomorrow morning. 
May 26th, morning. Patient has not slept any, she says. A 
two ounce mixture of chloral more than three-fourths gone; has 
vomited her every time she took it, or swallowed water. Head aching 
severely, pulse 96. Temperature Looks haggard and care 
worn. 
My expectations have not been realized in regard to her condi- 
tion. She is certainly no better. Inquiry brings to light the fatq 
that she has not passed any water from her bladder during the 
night, has not, so far as she can remember, passed any for two days 
and nights. Has no desire to pass any now. Function the ex- 
pression of the condition of structure behind it. The total suj>- 
pression of urine is not present without adequate cause. What is 
it? Does it depend on structural changes in the kidneys? This is 
not probable. Much more likely it is due to the utterly inadequate 
water supply of her body lately. There is probably no softening 
of the brain, so called; nor any other permanent changes of struc- 
ture in her body, other than these incident to her age. But physi- 
ological decay of the structure is almost suspended. My duty with 
this understanding of the real condition of things in her body, is to 
hurry up the rate of waste, and the elimination of effete matter 
from her body — matter no longer available for the purposes of 
life. 
Therefore, omit, Fowler’s solution perscribed last evening; and 
take a half grain of calomel granule every hour till stomach settles, 
bowels move, and she passes water. To aid these purposes—waste 
of existing tissue, which does not now perform physiological duty, 
and the exit of effected products from her body — she is to drink 
water as hot as it can be swallowed, sipped from a tablespoon, and 
made palatable with salt, all she can. May drink in addition cold 
water, with bi. carb potassa, teaspoonful to a pint, made palat- 
able with lemon; and if she wants it, plain water sometimes. This 
she is requested to do, no matter whether it comes back by vomit- 
ing or not. She is to try to pass water every hour, and take no 
food, but may drink some milk. 8 
Evening. Patient no better. Has taken medicine as requested, 
vomited very frequently, and drinks fluids as prescribed in the 
morning. Has intense headache. Has passed no water; nor have 
bowels moved. Is thoroughly disheartened ; and friends have ar- 
rived from abroad to see her before death. 
F feel confident that I am on the right track in regard to her 
treatment, and so recommended the same through the night that 
she has had during the day. 
May 2 7 th, morning. Patient is better this morning in mam- 
respects. Has began to pass water in small quantities from her 
bladder; and her bowels have moved though not freely. Is still 
somewhat sick at stomach, but vomits much less frequently. Head 
aches still, but much less severe than yesterday. Temperature 
Pulse .9(5, still small and thready. 
To continue calomel granules every two hours; to drink hot and 
cold water, and cold water with bi-carb. potassa. May have milk 
today. 
27th evening. Bowels have moved very freely, and what passes 
from them is extremely offensive. A large volume of water has 
passed from her bladder. Stomach still sick, but much less so. Is 
a good deal warmer to the touch. Pulse slow-er, not counted ; nor 
temperature taken, because she is so evidently better. No medi- 
cine to night, but is to continue drinking water, hot or cold, or 
both ; and drink milk. 
28th morning. Bowels continued to move at intervals through 
the night, and has parsed urine largely. Has some headache, and 
is still more or less sick at stomach. Her pulse fuller and slower, 
but very soft, and easily obliterated by tlie pressure of the fingers. 
She says she is ever so much better. Her most urgent complaint 
is weakness. 
The wasting processes are now as fully active as I could 
desire. 
The condition of debility, as evidenced by the circulation, and 
her own complaint of weakness, made now for the first time, de- 
mands my attention. The indications are now to steady tin; pro- 
cess of waste, and advance the processes of repair. If I am not 
mistaken in my judgement, the “stored up force” in opium will re- 
lieve the remaining head ache, sick stomach, and give her rest, 
and restore to her a demand for food—new material. Therefore, 
of pills of opium and camphor, grs. j and ij., take one every three 9 
hours. To take all the food she can, preferably in fluid form of 
broth, milk, etc., and continue to drink water as water. 
28th evening. Much better [ less headache and less sick stom- 
ach. Kidneys fairly active and bowels quiet. She is to continue 
pills, if awake, through the night. 
29th morning. Has had an uninterrupted night’s sleep, and 
feels better in every way. Pulse fuller and stronger. No head 
ache, no sick stomach, and begins to relish food. Asks to have 
solid food, and there being no objection, she may do so. 
She is to take pills every 4 hours, and commences with Fowler’s 
solution, 10 drops, 3 times a (lay. 
29th morning. Mrs. D. is again better in every respect this 
morning. No head ache or sick stomach, and is sitting up in an 
easy chair. She has a clear complexion, but is very pale. Relishes 
her food, and she thinks she eats enough. 
Pills every 0 hours. Fowler’s solution. 
30th. Patient sitting up, and gaining strength. Feels well. 1 
explained to her that her sickness was largely due to her not tak- 
ing water, or fluids, enough to carry on the work of life properly. 
That if she desired to remain well, she must drink water every 
day, never less than three pints every 24 hours. She commences 
work today. 
June 12. Mrs. D. called to say that though she was still im- 
proving, her feet would swell towards night and hurt her. Her 
pulse had hardly regained the necessary strength. Tinct. digitalis, 
30 drops, three times a day. 
T see her through a window almost every day working at her 
sewing machine. I regard this as a complicated case of hydroadip- 
sia. At my first examination I did not comprehend the extensive 
damage to structure, mainly owing to the deficiency of water supply. 
At my second visit I comprehended the whole of the case, having to 
suspend the accomplishment of my original purpose with chloral 
and arsenic. After having got up the requisite pace of waste, and 
eliminated some of the accumulated dead matter in her body, her 
appetite returned, which means the resumption of repair, and 
speedily regained more than her usual health for several years past. 
I certainly succeeded better than my predecessors, both of whom 
are regarded as good physicians. But they evidently treated her 
“diseases,” while I treated the woman herself; supplied the defects 
of her body, due mainly to insufficient water supply.