Where the bacilli come from, in these, so to speak, later eruptions, when there is no skin affection, it is difficult to say with certainty. In a case of maculo-anæsthetic leprosy we found the inguinal glands leprous, although no skin eruption was present. Possibly, then, fresh eruptions develop from the glands when the original skin eruption has disappeared. Thus the specific leprous affections gradually disappear, and only their results remain--in other words, _the leprosy is healed_. Most maculo-anæsthetic patients become in time purely anæsthetic; they no longer suffer from leprosy, _but only from its results_. The late eruptions show, however, how difficult it is to define the fact of recovery, for when all externally diagnosable signs of actual leprosy are gone, bacilli may still remain somewhere in the body, in the lymphatics, or possibly in the liver and spleen. CHAPTER V. PATHOLOGICAL ANATOMY OF THE MACULO-ANÆSTHETIC FORM. The maculæ exhibit generally the same anatomical characters as do the nodular lepromata, viz., infiltrations with round cells, epithelioid and spindle cells. The difference between them is quantitative; in the macular infiltration the number of bacilli are less. We will describe the microscopical appearance of macules of different duration. In a _recent_ (three weeks old) macule, microscopical examination showed cord-like and rounded infiltrations of the cutis, with round and epithelioid cells, mostly arranged around the vessels. There were _pretty numerous_ bacilli lying between and also definitely in, the cells; here and there were found little collections of bacilli or bacillary granules, with one or more nuclei--small globi--in their neighbourhood, which in size could not be compared with those found in the tuberous form. Specimens hardened in perosmic acid showed unaffected nerve fibres, which the leprous infiltrations did not implicate. Gold preparations showed a marked increase in the number of Langerhans’ cells in the epidermis, which, indeed, we expected, since we agree with Ranvier in considering them as wandering cells, and not as nervous elements. Definite changes in the cutaneous nerves were not evident. Microscopical sections from an older spot (perhaps two years old) show here and there infiltrations in the cutis--especially around the vessels, consisting of epithelioid, round and spindle cells. Bacilli were found here and there--one or two in each infiltration. In the lumen of one small vessel we found a collection of round cells, with a bacillus among them; and on the inner side of the wall of another vessel we saw a similar appearance. Gold preparations of this macule, which was definitely anæsthetic, showed slight changes in the small nerve twigs in the cutis, less marked precipitation of the gold salt in the nerve fibres, and a number of Langerhans’ cells.