HYPERTHYROIDISM WITH ORAL SEPSIS PAY 
May 27, 1916—Well in himself, putting on flesh. P., 
80, both standing and lying down, no tremor, no per- 
spiration, no nervousness—he has but few teeth, but he 
eats well. 
He left the hospital and was discharged from the 
army. 
Oct., 1917, or 18 months later, he wrote that he was 
perfectly well and had resumed work as a pitman in a 
mine in Scotland. 
Events would seem to show that the combination of 
stopping the source of the poison by radical daily 
cleansing of the mouth and gums, and treating the over- 
stimulated thyroid by X-rays to cause partial atrophy, 
in this case turned the balance between life and death, 
the myocardium gradually recovering its tone and func- 
tioning correctly when no longer poisoned. 
The tonelessness of the cardiac first sound is mark- 
edly characteristic of hyperthyroidism. Cases such as 
this might be recognized and diagnosed earlier as to the 
true source of the symptoms; in which case treatment 
might be started at a much earlier stage. It is only 
fair to add that without excellent nursing this man 
would have inevitably succumbed. 
