the number of bacilli, lepra ceils, and globi being proportionately fewer. In old , maculæ, as in very old lepromata, the bacilli may be hard to find or entirely absent. In the anæsthetic maculæ the terminal nerve fibres are degenerated.
As the fusiform thickening of the larger nerve trunks in nerve leprosy is a secondary inflammation, bacilli may not always be found in it, although at the very commencement of the nerve disease bacilli, both in cells and, according to Leloir, free between the nerve tubules, are present and may even lie in the nerve tubules themselves. In time the affected nerves become mere fibrous cords destitute of nerve tubules.
The anatomy and histology of the various trophic lesions are such as are found in other examples of destructive neuritis, and are in no way peculiar to leprosy; they do not, therefore, call for description here.
In nodular leprosy the liver and spleen are the seat, in many instances, of a peculiar infiltration which, in well-marked examples, may be visible to the naked eye. Fine yellowish-white dots and streaks are seen to occur in the acini of the former. These dots and streaks consist of new growth in which bacilli abound. According to Leloir, the parasites are never found in the hepatic cells themselves.
In all cases of nodular leprosy the testes atrophy and undergo fibrotic changes, bacilli and globi being found both in and around the tubules, free and in cells.
In all forms of leprosy the lymphatic glands appertaining to parts in which leprous deposit is present are characteristically affected. They are swollen and hard, and on section the gland tissue is seen to have a yellowish tinge from an infiltration which contains numerous bacilli and globi.
Albuminoid disease of the alimentary canal, liver, and spleen, and nephritis occur in a large proportion of the cases of nodular leprosy.
Diagnosis.— The touchstone in all doubtful cases is the presence or absence of anæsthesia in some skin lesion, or in some skin area. Anæsthesia is rarely
