HYPERTHYROIDISM AS A CAUSE OF THE IRRITABLE HEART OF SOLDIERS
78 diseases. The first impression obtained, however, is a promising one. It seems probable that the light will be of distinct value in the treatment of superficial ulcerations, especially those which are of a purulent character. Investigations should be made to determine how this light compares with other arc lamps. The exposure required with it is a short one which is an obvious advantage. It seems possible that in some diseases cures will be obtained more quickly than with other treatments.
... yond a slight reaction, which is quite definite when a long exposure has been given, no bad results have been seen. CAPTAIN (TEMP.), R.A.M.C.; CONSULTING RADIOLOGIST, ALDERSHOT COMMAND. THE following cases seem to us worth recording as they may explain many of the so-called "irritable hearts " which are now so common in men home from the front. CASE 1.-The patient, aged 28, admitted into the Herbert Samuelson Hospital for Officers, and first seen by one of us (C. P. W.) on April 13th, 1915, had been at the front for eight months, and had there been subjected to great strain. As all his work had to be done at night he had been very short of sleep. He complained of palpitation, the pulse even in bed varying between 90 and 100 per minute, though quite regular. There was no cardiac murmur ; the apex was in the nipple line. The temperature was slightly raised ; he suffered much from sleeplessness. He improved to a certain extent while in hospital and left on May 6th to go home and to lie in the open air. He did fairly well until the middle of August, when he became very breathless and was hardly able to walk a hundred yards. He came under observation again on Sept. 30th. I had seen him only once since he left London, and I was much struck with the change. The thyroid gland was enlarged, he had well-marked Stellwag's sign, fine tremor of the hands, a pulse-rate of 120, apex in nipple line, and no murmur. He was breathless on the slightest exertion. All the typical signs of Graves's disease were present; he came into hospital again. The pulse-rate after a few days' complete rest varied from 98 to 84, and the respirations were 28 to 34 per minute. After three weeks' rest in bed one of us (F. H. -J.) gave him some X ray treatment. Sittings were three times weekly, and it was only possible to give seven in all. The patient then said that he felt so much improved that he considered himself equal to travelling north to attend to urgent business affairs. It is difficult to say how much of this alleged improvement was imagined as the result of the patient's wish to escape. All that can be said on the physical side is that during the last few days while he was up the pulse was no worse than when he had been confined to bed. In civil practice a few cases certainly do show definite benefit from X rays in a fortnight, but a month is generally necessary for any effect to be seen. CASE 2.-The patient had been wounded at the base of the neck and the left shoulder (June 28th) after two months' compaigning in Gallipoli, during which time he was under fire the whole time. He was confined to bed between two and three weeks. As soon as he was allowed to get up he began to be troubled with profuse sweats. He slept badly and felt restless and unsettled. His legs " seemed scarcely to belong to him," and any exertion made him breathless. He was first seen by one of us (F. H.-J.) early in September, when he still c'mplained of all the above symptoms, though, of course, in somewhat less degree than when he first got up. He thought, however, that there had )een no improvement for a month or more. He complained nuch of aching in the wound, which, though healed, )resented an angry-looking scar. To look beyond the natural affects of exposure, shock, and continued pain to furnish an ixplanation of the symptoms had not been thought of. Con.sequently treatment by high-frequency vacuum electrode was. jrescribed for the neck and shoulder, together with the 3inusoidal bath as a general tonic. Under this treatment thepain lessened, but the general condition remained un-,mproved. He complained of night sweats which left him limp in the morning. Belladonna was prescribed for these, and it produced some improvement. So matters stood at thebeginning of October, when it was thought desirable to. re-examine the patient carefully in the light of Case 1. There was slight exophthalmos, definite enough when looked for ; also the pulse was 120. The hands showed tremors when held out. The thyroid gland was definitely enlarged, and pulsation was distinctly visible. The clinical picture was thus illuminated as by a flash, and the whole oj the symptoms fell into their proper place. It was, in fact, a typical, and-rightly looked at-obvious case of Graves'a disease. Exophthalmos, enlarged and pulsating gland, tremors, sweatings, tachycardia, breathlessness, irritability -nothing was lacking. The patient was doing light duty, which he was very anxious not to relinquish. He was unwillingly allowed to continue this for a time while X rays were being tried. He. has had treatment for two months. The pulse is 100.