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638 which leprosy is endemic, the possibility of their being attributable to this disease must be borne in mind. If doubt exist, and it be found feasible, search for the bacillus should be made in eruptions, or in thickened nerves, or in any nasal or other morbid discharge that may be present. If this be found the diagnosis of leprosy will be infallibly established.

Prognosis.— Complete recovery is an event so rare in leprosy that, though it may be hoped for, it must not be expected. Recovery from the actual disease itself— that is, in the sense that fresh leprous infiltration may cease to occur, and old infiltration may be absorbed, and that the bacilli may die out— is perhaps the rule in nerve leprosy; but the effects of the leprous process are generally permanent, the trophic lesions resulting from nerve destruction being irremediable. Such cases may live, however, for many years— thirty or forty— and die of some other disease. Nodular leprosy is usually a much more acute disease than nerve leprosy, sapping the strength and general health much more effectually and more quickly. It rarely runs its full course, death being brought about by some intercurrent disease, such as, and especially, phthisis, nephritis, albuminoid degeneration of the alimentary tract, dysentery, stenosis of the larynx, or pneumonia. It may even prove fatal as a sort of "galloping" leprosy within a year of its first declaring itself.

Etiology. Age.— It is open to question if leprosy has ever been seen in the foetus. It has once or twice been reported in the newly born. Cases are also on record of its occurrence as early as the first and second years of life; such cases, however, are quite exceptional. Leprosy is extremely rare before the fifth or sixth year. In the great majority of instances the disease begins between the tenth and thirtieth year. It rarely commences after 40, although it has been known to begin up to and even after 70.

Sex; occupation; social and hygienic conditions. —Apart from social conditions as affording opportunity for contagion, sex seems to have little bearing on the liability to leprosy. The same