The =physical examination= showed a variety of increased reflexes, including ankle clonus on the left side. The question might arise whether this case was one of hemorrhage or thrombosis, and the facts about the onset of the hemiplegia are inadequate for a decision. However, at so early an age, the probability of syphilis is large and the history of labial chancre was quite suggestive. If we may conclude neurosyphilis, the diagnosis of thrombosis rather than rupture of blood vessel is likely. The laboratory tests bore out the diagnosis since the W. R. of serum and fluid both proved positive; the gold sol reaction was syphilitic; there were 176 cells per cmm.; there was excess albumin, and a positive globulin reaction. =NON-PARETIC NEUROSYPHILIS= =DIFFUSE NEUROSYPHILIS, MENINGOVASCULAR PARENCHYMATOUS, CEREBROSPINAL SYPHILIS= CASES SYSTEMATICALLY TREATED 13 CLINICAL RECOVERY, C.S.F. NEGATIVE 11 UNIMPROVED 1 UNIMPROVED, BUT C.S.F. NEGATIVE 1 MASSACHUSETTS COMMISSION ON MENTAL DISEASES, _November, 1916_ CHART 23 The outcome in such a case is dubious. If death does not occur soon, recovery is not impossible under treatment. At all events, a considerable improvement is likely. Edwards was given bi-weekly injections of salvarsan, intramuscular injections of mercury salicylate, and doses of potassium iodid, averaging 100 grains, three times a day. Under this treatment, he slowly recovered and became mentally clear after a few weeks. The paralysis seemed complete and permanent. Even after three or four months, there was absolutely no change in the condition, and Edwards was quite unable to move either arm or leg. Meanwhile, the spinal fluid had become practically negative to all tests. _Treatment_ was somewhat optimistically continued and was _rewarded at the end of ten months_ with marked improvement such that the patient was able to stand on the paralyzed leg and move the arm to a certain degree. This improvement is still continuing. The spinal fluid and the serum have remained negative to laboratory tests. Note: A period of six months is commonly regarded as that period in which improvement in paralysis is to occur if there is to be any improvement. There was certainly not the slightest improvement in the paralysis of this case before eight or nine months of treatment had elapsed, and it took ten months to secure the marked improvement mentioned. 1. What is the significance of the prodromal symptoms? The headache and dizziness should have been viewed with great gravity. They are characteristic in MENINGOVASCULAR NEUROSYPHILIS.