I have had the opportunity, during the last five years, of observing an interesting case of exophthalmic goiter in a woman, aged 24, in whom there can be no doubt that it is a late clinical manifestation of hereditary syphilis. The patient began about five years ago to suffer from palpitation and tachycardia, accompanied by violent attacks of nervousness, while her mother also called attention to a swelling of the neck. There was very little protrusion of the eyes.
Four years ago when I was first consulted (shortly before leaving on a journey to Europe, during which I was kept informed of the progress of the case), the clinical symptoms had become decisive and the syndrome grew steadily worse until the patient fell into a drowsy, almost comatose condition, with pulse over 200 beats, the sphincters quite paralyzed, with continuous vomiting lasting a fortnight. Dr. Sylvio Moniz, a well-known Brazilian