For years Garfield had been totally deaf in the right ear (following explosion of a gun?). Now, however, the left ear also showed a sensory impairment. Slight slurring of speech had been noticed first in the sixty-sixth year. =Physically= there was a slightly enlarged heart with accentuated second aortic sound and irregular rhythm. =Neurologically=, inability to stand or walk; marked ataxia in his leg movements; upper extremities quite well controlled; the pupils were small and unequal, the left being larger than the right; although the reactions were difficult to test, the pupils seemed to react slightly to direct light stimuli; the knee-jerks were absent; tests for sensibility so far as could be determined did not show any abnormalities; there was much complaint of sharp pains in the legs. There is no doubt that we are here dealing with a case of TABES DORSALIS plus certain complications due to VASCULAR LESIONS. The case went on to death from rupture of =aortic aneurysm= (also doubtless a syphilitic complication). The death occurred at 71, four years after admission to Danvers Hospital. =MAIN FORMS OF NEUROSYPHILIS= =(CLASSIFICATION OF THIS BOOK)= DIFFUSE NEUROSYPHILIS (non-vascular forms of “cerebral,” “spinal” and “cerebrospinal syphilis”) VASCULAR NEUROSYPHILIS (“cerebral arteriosclerosis,” “cerebral thrombosis”) PARETIC NEUROSYPHILIS (“general paresis”) TABETIC NEUROSYPHILIS (“tabes dorsalis”) GUMMATOUS NEUROSYPHILIS (“gumma of membranes, of brain”) JUVENILE NEUROSYPHILIS (paretic, tabetic, diffuse) CHART 5 =POSSIBLE INVOLVEMENT= =BRAIN AND CORD SYPHILIS= [M]embranes, [V]essels, [P]arenchyma [MVP] EARLY, LATENT?, SYMBIOSIS?, ATTENUATION?.... MVP CEREBRAL, CEREBROSPINAL SYPHILIS, PARESIS MVP [M]VP PARESIS; SYPHILITIC ARTERIOSCLEROSIS VP M[V]P ?SYPHILOTOXIN FROM MENINGITIS MP MV[P] SYPHILITIC MENINGITIS; CEREBRAL OR CEREBROSPINAL SYPHILIS MV [MV]P SYPHILOTOXIC ATROPHY OR SCLEROSIS P M[VP] SYPHILITIC MENINGITIS M [M]V[P] SYPHILITIC ARTERIOSCLEROSIS V M, V or P in brackets [] means not involved. CHART 6 =NEUROSYPHILIS= =SIX TESTS= BLOOD WASSERMANN SPINAL FLUID WASSERMANN SPINAL FLUID CYTOLOGY SPINAL FLUID GLOBULIN SPINAL FLUID ALBUMIN SPINAL FLUID GOLD SOL CHART 7