GRAVES' DISEASE 81 



history of some great nerve shock, but it is doubt- 

 ful if this is the causa causans ; careful inquiry 

 will nearly always elicit some pre-existing defect, 

 gastro-intestinal chiefly, but often dental, ton- 

 silar, or nasal ; in women there is often evidence 

 of ovarian or uterine disorder. If we hope to 

 cure we must go deeply into all these errors and 

 call in surgical help if necessary. A chronic 

 appendix, pyorrhoea, a focus of disease in the 

 tonsils, chronic disease of the antrum or of the 

 posterior nares may need help or removal. In 

 women ovarian disease or uterine may need 

 medical or surgical treatment. Above all the 

 intestinal tract needs watching : often there is 

 colitis or intestinal stasis, or both. During the 

 war Graves' disease occurred rather frequently 

 among men in the trenches. Here we had the 

 double causes of nerve strain or shock and the 

 intestinal irritation set up by exposure and by 

 food that was often irregularly supplied and of 

 doubtful quality. To dwell minutely on these 

 causes is outside the scope of an article that 

 deals with endocrine treatment only, but as a 

 preliminary to success they cannot be ignored, 

 but must be regarded as the very foundation of 

 therapeusis. We all know that in the early stages 

 of Graves' disease thyroid feeding is distinctly bad ; 

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