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 



