PUPILLARY DISORDER HEADACHE VERTIGO INSOMNIA DROWSINESS CHANGE IN DISPOSITION Irritability Slow thinking SEIZURES PARALYSES Permanent Transient APHASIA HEMIANOPSIA SENSORY DISTURBANCES GASTRIC CRISES SPHINCTER DISTURBANCES INTRACRANIAL PRESSURE SYMPTOMS POLYURIA, POLYDIPSIA, GLYCOSURIA MÉNIÈRE’S SYNDROME NYSTAGMUS CHART 14 See Appendix B for technical details. 2. What is the relation of the tibial exostosis to neurosyphilis? The syphilographers have always stressed the tibial lesions in the diagnosis of syphilis. Although not so much attention has been paid to these and kindred osseous lesions in neurosyphilis, yet we have frequently found such lesions and they afford an important auxiliary means of diagnosis. =A POSITIVE SERUM Wassermann reaction with a NEGATIVE FLUID Wassermann Reaction may be found in NEUROSYPHILIS, particularly in VASCULAR NEUROSYPHILIS: the remaining signs in the fluid, although frequently positive, may even be negative.= =Case 18.= Frederick Wescott was a promoter, an elderly looking man of 60 years. His health had been failing for 18 months. There had been shortness of breath, dizziness, a tired feeling, inability to “get the words he wanted,” and forgetfulness of names. About eight weeks before examination, Wescott had had a convulsion, following which he had been unable to express himself at all well. This convulsion was not accompanied by loss of consciousness. Besides a marked motor aphasia, there was agraphia. =Physically=, Wescott showed arteriosclerosis and a blood pressure of 135 systolic, but, except very lively knee-jerks, no other reflex disorders or anomalies were discovered. In particular, the pupils reacted fairly well. There was, perhaps, no special reason to implicate syphilis in the case, yet Wescott gave a history of syphilis at 35 years. The W. R. of the blood serum proved positive; that of the spinal fluid was negative, and the albumin was but slightly increased; there was a very slight amount of globulin, and there were 16 cells per cmm. in the fluid. The gold sol reaction suggested syphilis. We felt entitled to make a diagnosis of SYPHILITIC CEREBRAL ARTERIOSCLEROSIS, regarding the convulsion or seizure eight weeks before as due to a vascular insult. The laboratory picture in the spinal fluid in Wescott’s case seems to be rather characteristic of this group of syphilitic arteriosclerotics.