As we have already mentioned, the eyelids can no longer be closed on account of the paralysis of the orbicularis palpebrarum, and consequently the under part of the cornea remains uncovered during sleep. This leads to a punctiform drying of the epithelium of the cornea, and further, to an injection of the conjunctivæ at the under margin of the cornea; then the vessels gradually attack the cornea, which becomes opaque, at first around the xerotic spots, and later in its whole under part. It may go on to ulceration with rupture of the cornea and prolapse of the iris, and finally to complete atrophy of the globe. As a result of the paralysis, the lower lid is always ectropic, at first at its inner end, and later, completely. As the lower punctum is thus drawn away from the bulb, the tears run down over the cheeks, and the paralysed countenance looks still more woe-begone. In the later stages, when the facial paralysis is very pronounced, the senses of smell and taste may be very much diminished, or completely lost. We often see symptoms which are not proper to the disease itself developing during its course, such as obstinate cardialgia, acid pyrosis, and vomiting of a slimy nature indicating gastric catarrh. Diarrhœa or chronic obstruction is by no means rare, nor is albuminuria dependant on parenchymatous, interstitial or amyloid nephritis. The course of maculo-anæsthetic leprosy is essentially chronic. Cases usually last between ten and twenty years; some may even exceed forty. The patients often die cachectic, without one being able to find on the post mortem table any definite cause of death, or they may--though in our aseptic and antiseptic times more and more rarely--perish from septicæmia or pyæmia. Pulmonary or general tuberculosis was formerly a frequent cause of death, which, however, usually takes place from some intercurrent disease. In the ordinary course of the disease the macular eruptions disappear, and the neuritic symptoms--anæsthesia, muscular paralysis and atrophy, and necrosis of bone--appear. Sometimes, though rarely, there are several macular eruptions after the disappearance of the earlier maculæ, or there may be an eruption of nodules. If, then, these eruptions are auto-infections, they are evidence in favour of the unity of the disease, in spite of the difference in form.