It seems that Bridget had had stomach trouble and headaches at the top of her head or sometimes in her temples. =Physical examination= showed the left pupil to be larger than the right, a slight tremor of the lips, a slight systolic murmur at the apex, slightly irregular pulse, and moderate edema of ankles. The blood serum was negative to the W. R., but lumbar puncture was executed and the fluid showed a positive W. R. The patient was tested by the Binet and other methods, and although 35 years of age, seemed to be by the mental tests hardly over 11 years old. She was inclined to be feverish, somewhat restive, and pugnacious; rather slow of speech, sometimes refusing to answer and grimacing. Her pugnacity was, however, easily controllable, and the excitement was largely at night. This excitement subsided rapidly in the course of a few days. 1. What is the diagnosis in this case? The following diagnoses and suggestions for diagnosis were made at the staff meetings: Unclassified mania. Manic-depressive psychosis, manic phase. Toxic delirium. Dementia praecox. Bacterial infection of the brain. Unclassified delirium. Acute delirium. Infectious psychosis. Acute confusional psychosis. Psychopathic personality by use of alcohol. Mental deficiency with atypical mental state. Syphilitic paranoia. 2. Is this a case of syphilitic paranoia? The so-called syphilitic paranoia of Kraepelin is a rare and uncertain type of syphilitic mental disease. Delusions and hallucinations are prominent. As a rule, the onset is stated to be slow and insidious, or at any rate there are a variety of indefinite prodromata. Jealousy is a prominent feature, sometimes attended with marked sexual excitement. Auditory hallucinations and ideas of persecution are particularly in evidence. The most striking feature in Kraepelin’s group was a sudden occurrence and equally sudden disappearance of violent excitement, with or without external cause. Thus, an excitement would be produced by a few words spoken, and immediately after, the phase of excitement would pass and the patient would become entirely friendly and accessible once more, as if nothing had happened. About half of Kraepelin’s cases showed a positive serum W. R. He does not report lumbar puncture findings, and grounds the existence of disease upon certain autopsied cases. The speech and writing disorder of paresis as well as the characteristic disorientation for time and muscular weakness of general paresis were absent in the group. It appears that most cases of the group have hitherto been placed in dementia praecox. =The clinical symptoms of CHRONIC ALCOHOLISM are sometimes largely identical with those of PARETIC NEUROSYPHILIS (“general paresis”): differentiation by means of the laboratory findings.=