DIAGNOSIS.--In view of the description which we have given of the two forms of the disease, the diagnosis is usually accompanied by little difficulty. We have, however, noted above how a case of tubercular Leprosy, with subcutaneous nodules only, was overlooked by a doctor well acquainted with the disease; and we have occasionally seen, in the country, people described by the doctors as leprous who were not so. And, on the other hand, we ourselves were once in doubt as to the diagnosis in a tuberous case, since all the nodules were exceptionally small, and presented no characteristic appearance. But the doubt was readily dispelled by the excision of a nodule and the recognition of the bacillus. In the diagnosis of the maculo-anæsthetic cases, one is more frequently in doubt, since the maculæ have not always a characteristic appearance; sometimes they closely resemble psoriasis, and in such cases the excision and microscopical examination of a portion might clear away doubt. This we have never needed to do, since the swelling of the lymphatic glands, or a thorough investigation of the sense of touch, have always been sufficient to establish a diagnosis. Even in comparatively, recent cases there may almost always be detected some loss of sensation in the fingers and toes; sometimes it is first evident on the wrists or back of the feet. For this investigation one must either use callipers, or very slight stroking, since deeper _pressure_ can be at once perceived. As a rule, the maculæ themselves are somewhat anæsthetic. We recollect once seeing a syphilitic eruption exactly resembling the leprous maculæ, but here the history cleared up the diagnosis.