IV. In this fourth class of sores, or the irritable from over-action, the sore and its edges are of a jagged, irregular appearance, the discharge is thin and bloody, and considerable pain is experienced. This ulcer is very superficial, involving only the surface of the corium and the more sensible part of the integument, the papillæ, and extremities of the nervous filaments. They often succeed to scaly eruptions, and present a remarkable character and appearance, cicatrising in the centre, whilst they extend towards the circumference. The sore is often covered by an ash-coloured slough; on the removal of which, granulations arise, but these either again slough, or are removed rapidly by the ulcerative process. In the treatment of such sores, complete rest and soothing applications are the means on which most reliance is to be placed. Warm and soft poultices, such as those of arrow-root, fomentations, tepid water dressing, solutions of opium, or of extract of poppy, and the occasional use of a local vapour bath to the part, may be enumerated amongst the means best fitted to allay the irritable condition of the ulcer. When the surrounding integuments are swollen, red, painful, in short, evince marks of inflammatory action going on in them, the feelings of the patient will be rendered grateful, and the cure advanced, by abstraction of blood from the parts by punctures. When the nature of the sore is changed, and when cicatrisation has commenced, the treatment is similar to that of a simple granulating surface—light dressings, due support of the parts, and repression of exuberant granulations by the sulphate of copper. The nitrate of silver, applied in substance round and about the ragged edges, is of great service at an earlier period. This practice must be sparingly and seldom resorted to, but it does wonders when judiciously employed. Ulcers are occasionally prevented from healing by the presence of dead portions of tendon, fascia, or cellular tissue, and are accompanied in general with a bad state of constitution; in such it is necessary to clean the surface by a powerful escharotic, and the best is potass. Otherwise, granulations will be produced quickly, it is true, and in abundance, to supply the original substance; but then they are flabby and exuberant, new skin is formed slowly, if at all, and the sore does not contract; but by removing the dead or half-dead surface, a healthy and firm foundation is prepared, on which is securely and gradually raised the new matter for cicatrisation. But caustics are applied injudiciously to firm and healthy granulations which have not yet reached the level of the surrounding parts; they are only useful in repressing exuberant granulations, or in destroying half-dead parts, which interrupt or deteriorate the cure: and when employed, it should be effectually, and once for all.