Maculo-anæsthetic Leprosy may in its later stages be confounded with syringo-myelia, as Charcot has already noted in giving the points of distinction between the two conditions. If the maculæ are no longer present, careful investigation will often enable one to recognise their previous presence by finding areas of skin, especially on the upper arms, the back, the thighs and calves, which are somewhat paler than the surrounding skin, and in which sensation is somewhat blunted. We have thus frequently recognised the previous presence of maculæ in patients who themselves knew nothing of them. Zambaco Pasha has stated that certainly many of the cases described in France as syringo-myelia and Morvan’s disease are cases of Leprosy; that Leprosy in this form still exists in Brittany; and further, that he has there found some cases of nodular Leprosy. It is remarkable that in these last cases, where the proof would have been so easy, he has not demonstrated the Lepra bacillus. From the drawings which he gives in the _Annales de Dermatol. et de Syphil._ (T. III., Nr. 12), some of the cases can scarcely be regarded as Leprosy, since on the hands with mutilated fingers, no muscular atrophy can be noted; but in others there is distinct atrophy, and these may very well be leprous, the more as Pitres has published in the _Gaz. des hôp._ 1892, a case diagnosed as syringo-myelia in which Lepra bacilli were demonstrated in an excised portion of the ulnar nerve. It is unfortunate that Zambaco Pasha did not demonstrate the remains of previous maculæ, which would probably have been possible in some cases, were they really cases of Leprosy. According to the rich experience of Dr. Danielssen and our own, it must be admitted that a skin eruption is never absent in true cases of Leprosy. With multiple neuritis from some other cause, it is, with a good history and careful examination, not possible to confuse Leprosy; and the same is true of progressive spinal muscular atrophy, where there is no disturbance of sensation.