HYPERTHYROIDISM WITH ORAL SEPSIS 127 



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. 



