Ulcerations: Nasal 2 Laryngeal 1 Pharyngeal 1 Central Nervous System: Mental deficiency 23 Cerebrospinal syphilis 14 Hemiplegia 6 Epilepsy 5 Spastic paraplegia 4 Chorea 2 Hydrocephalus 2 Miscellaneous Conditions: Ozena 1 Enlarged spleen (only symptom) 1 Torticollis 1 Aortitis 1 Obscure abdominal pain 1 Obscure pain in legs 2 Endarteritis obliterans 1 Paroxysmal hemoglobinuria 1 Raynaud’s disease 1 Hutchinson’s teeth 4 =Juvenile paretic neurosyphilis. Quadriplegia.= =Case 78.= Gridley Ringer, 15 years of age, had the facies of a congenital syphilitic, including Hutchinsonian teeth, rhagades of the face, and the so-called Olympic brow. No secondary sexual characteristics had developed. There was a marked speech defect. =Mentally=, Ringer was a low-grade imbecile. He had been born at full term, and delivery had been normal. There had never been other pregnancies. He had never developed normally. The father admitted syphilis 23 years before, namely, 8 years before the birth of his son, but the father had been treated for several years and had been declared cured. 1. What would be expected in the spinal fluid of this case? Without the history, it would perhaps be impossible to say whether the case was one of a quiescent imbecility or one of juvenile paresis. The spinal fluid of the juvenile paretic gives a picture identical with that in the adult. The spinal fluid in this case showed a positive W. R. (as did also the serum), a marked increase of albumin and globulin, 115 cells per cmm., and a “paretic” gold sol reaction. Accordingly, the diagnosis of GENERAL PARESIS was made. 2. What is the prognosis? The prognosis of juvenile paresis is currently regarded as entirely grave. There is probably less hope for improvement in juvenile paresis than in the acquired paresis of adult life, since it seems to be a general principle that congenital syphilis is always more difficult to cure than acquired syphilis.