the late stages, and is proportionately rare. When the mucous membrane ulcerates the cords grow together, both anteriorly and posteriorly, and when the infiltration disappears there remains a scar tissue, which, by its contraction, reduces the rima to a small slit, a few millimètres wide. In such cases a very little mucus is sufficient almost or completely to close the opening, and the patient may perish from suffocation. Usually an emetic suffices to open up the hole at once; but tracheotomy is often necessary to supply air to the patient, the attacks of suffocation are so frequent, and since he is already voiceless, he loses nothing by the operation. [Illustration: PLATE III.] The lymphatic glands (cervical, axillary and inguinal) in relation to the affected skin and mucous membrane are always swollen: this leprous swelling is always indolent, and never goes on to suppuration. Sometimes the glandular swelling may aid in the diagnosis, if the skin affection is not absolutely characteristic, though this is most rarely the case. The nodules are almost always seated in the cutis, but they may, though rarely, be placed deeper in the subcutaneous connective tissue; they form then no projections, but the skin over them is almost always somewhat hyperæmic and bluish-red, and, if the finger is passed over the place, the thickening or the nodule may be felt in the deeper parts. It is in our experience that a patient who had only this form of nodules was regarded by a colleague, well acquainted with the disease, as free from Leprosy, probably because he did not use his fingers. From the symptoms described above, the diagnosis is almost always very easy, and we ourselves know of no disease of the skin which can be confounded with nodular leprosy. If necessary a piece of skin may be removed and examined for the presence of bacilli, which, at least in the nodular form of the disease, are never absent. This, we have once had occasion to do.