Patient.
—W. M., aged 54, American of Scotch parentage; occupation, foreman of public works. Family history negative.
History.
—Patient is over six feet in height, is of unusual intelligence and displays evidence of having possessed great muscular development when in his prime. He declares that his use of alcohol and tobacco has always been extremely moderate and there is no history of venereal infection. He confesses that he has always been a very nervous man and that, despite his efforts at control, his temper has been a quick and unruly one. Mumps, measles and "grippe" are the only illnesses in his personal history, with the exception of an ephemeral attack occurring a year ago designated by his medical attendant "muscular rheumatism."
Present Illness.
—Five years ago the patient first observed a swelling of the neck, which has persisted in the form of a moderate sized goiter ever since that time.