The secondary eruption which follows the phagedenic form is pustular, though differing from that which has been already noticed. The pustules soon give way, and ulcers remain, covered with thick scales or crusts, which sometimes increase, layer by layer, so as to become prominent, dense, and of a conical form,—the rupia prominens. After the separation of the crusts the ulcers are found, superficial, rather unhealthy, and showing a disposition to extend, chiefly towards the circumference. When healing, the process of cicatrisation frequently proceeds from the centre of the sore, which is still enlarging at its circumference. The reason for this unusual mode seems to be that ulceration does not commence in the secondary sores till the crusts which cover them have been removed: they then are very superficial, not extending through the thickness of the true skin; and the ulceration does not go on in the centre of the original sore, but towards its margins, so that a portion of true skin remains in the centre of the sore, whilst it is gradually destroyed towards the margins. Then, whilst the surrounding skin, which usually forms the new cutaneous texture necessary for reparation, is gradually and progressively destroyed, the remaining old skin in the sore assumes an excited action, as in ordinary cases, and from it the requisite new texture is formed, and gradually extends over the surface, until it meet with a similar substance, which has been produced by the surrounding skin after the ulceration in that quarter has ceased. Thus the general principle that skin is formed by skin is, even in such instances, found to be correct; the healing from the centre not following, as some have supposed, the complete destruction of the cutaneous tissues, but from its having remained unaffected, or nearly so. The appearance of the eruption is preceded by general indisposition, and occasionally by smart fever. It is sometimes extensive, but is in general confined to the upper parts of the body.