The =diagnosis= of some form of organic brain disease was clear with the picture of convulsions followed by slight aphasia with headaches and limb pains. With onset at 28, the most frequent cause for such epileptiform seizures is certainly syphilis. Examination of the blood and spinal fluid showed a positive W. R., in both. The albumin was also somewhat increased. The clinical picture suggested a fairly generalized meningitic involvement. The =prognosis= in such cases of generalized meningitic involvement is in general good, and this principle was illustrated in the O’Neil case, in which the symptoms soon disappeared under intensive antisyphilitic treatment. In fact the spinal fluid W. R. became negative in the course of four weeks. The blood serum W. R., however, has remained positive despite eight months of active treatment. =CONDITIONS IN WHICH CONVULSIONS OCCUR= NEUROSYPHILIS HYSTERIA EPILEPSY MAJOR (GRAND MAL) EPILEPSY MINOR (PETIT MAL) DEMENTIA PRAECOX TOXIC CONDITIONS: Asphyxia, Uremia, Alcohol, Absinthe, Lead, Mercury, etc. ORGANIC BRAIN LESIONS Apoplexy, Meningitis, Intracranial Growths STOKES-ADAMS DISEASE MALINGERING DISSEMINATED SCLEROSIS CHART 15 1. Are certain cases of syphilitic epilepsy really cases of Jacksonian epilepsy? As a matter of nomenclature, Jacksonian cortical epilepsy is usually the result of a focal and circumscribed irritative lesion in the cortex. Gumma, local syphilitic meningitis, and syphilitic vascular lesions, as well as scars consequent upon the latter, are among the causes of Jacksonian epilepsy, along with such other focal lesions as trauma, tumor abscess, tubercle, and the like. Even non-syphilitic Jacksonian epilepsy has been observed from time to time in cases of diffuse intracranial pressure. Jacksonian attacks also have been found in so-called genuine epilepsy. Accordingly, we must not conclude from the occurrence of Jacksonian convulsions, even though in a proved syphilitic case, that the convulsions in question are surely due to a focal lesion, for they may be due to diffuse syphilitic lesions. 2. What is the significance of aphasia in Agnes O’Neil? Aphasia is not a characteristic symptom in ordinary Jacksonian epilepsy, but the aphasia is another sign of focal lesion and forms an added argument against the diagnosis of genuine or idiopathic epilepsy. See also discussion of aphasia in paretic neurosyphilis under Case Levenson (22).