124 THE INTERNAL SECRETIONS—1920 
Oct. 20, 1915—Transferred to London. 
Oct. 21—A skiagram showed a comminuted fracture 
of the left ischial tuberosity. 
Nov. 19—As they were still discharging, the two 
wounds were opened up, and much dead bone removed. 
Temp., 103° F. shortly afterwards. 
Dec. 12.—Temperature normal, wounds healthy, gen- 
eral condition very unsatisfactory. 
Dec. 28—The dentist was asked to see the patient. 
He did nothing but advised extraction when the general 
condition was better. (He did not suggest that the 
pyorrhea and oral sepsis were primary to the heart con- 
dition, and, therefore, must be dealt with first if the 
patient were not to die.) 
Dec. 30—Very ill, indeed, no albumen, no signs in 
chest. Left foot swollen for two days. 
Dec. 31—On the danger list; he turned blue and faint 
even if moved in bed; put on digitalin and brandy. The 
surgeon of his ward came to the X-ray Department, of 
which I was in charge, and asked me to see him and 
“do anything I could for him, as he was going to die, 
and there was nothing further to be done surgically.” 
I found the patient very weak, emaciated and highly 
excitable. The wounded hip was kept flexed, the 
wounds looked healthy. The left leg and foot were 
edematous, with tenderness of the popliteal vein and 
evident thrombosis. 
The heart was slightly dilated, sounds feeble and 
toneless, no murmurs, pulse 138 (in the ward), 158 in 
the X-ray room. No goitre, no exophthalmos; tremor, 
perspiration and general nervousness all marked. Ab- 
domen doughy, and constipation marked. Teeth much 
decayed and very septic, the mouth condition being 
about as bad as possible. 
I diagnosed his general condition as being really due 
to hyperthyroidism, much aggravated, if not actually 
caused by the extreme oral sepsis. I may say that I 
