The preliminary treatment will be the same as in the other form. That is to say, the causes of the affection must be inquired into as minutely as possible. Hygiene and the general health of the patient should receive careful consideration, and all obstacles to a cure should be removed so far as practicable. The direct internal treatment is in the main the same as in the preceding: variety. Arsenic and sulphide of calcium are to be used on the same indications as already laid down, but in addition valuable service is sometimes rendered by mercury, phosphorus, and the iodides of potassium and sulphur. This is especially the case when the eruption is subacute with large tubercles and much surrounding infiltration. The external treatment involves the employment of scarification and hot water, if the lesions exhibit an acute character. If subacute, actively irritant applications are more useful. Of these the Sapo Viridis is one of the most important. This should be applied every night to the affected parts until a considerable degree of irritation is produced - as much, in fact, as the patient can conveniently bear without too much suffering. When this limit is reached, the applications of the soap are discontinued, and emollients used until the artificial inflammation shall have subsided. When this has taken place it will be generally found that the original infiltration and induration is lessened. Another series of green-soap applications are then to be made in the same manner, and after subsidence of the irritation to be followed by another course, if necessary. When the whole or greater part of the infiltration disappears and the tubercles levelled down, as it were, lotions of sulphur, etc., will prove serviceable in combating the remaining hyperaemia. Instead of Sapo Viridis, ointments containing Hydrarg. Bi-chlor., Hydrarg. Biniod., Potassii Iodid., Sulphuris Iodid., etc., may be employed. The object sought in these applications is the substitution of an artificial inflammation which tends to a spontaneous subsidence, and usually results in a beneficial modification of the pre-existing lesions.

Hebra places little reliance on internal treatment, relying almost exclusively on external remedies. He says: "In the first place, everybody, and most of all a person affected with acne, should be careful to keen his skin scrupulously clean, and not only (as is usual) to wash the hands alone, but also the face, and when possible the back and chest as well, at least once a day, and that with soap. The operation is best undertaken before going to bed at night, and in the following manner: A piece of flannel should be dipped in lukewarm water and then rubbed with fluid glycerine soap or Spiritus Saponatus Kalinus, or any solid soap preferred, after dipping it also in water. The flannel thus impregnated with soap should be rubbed over the skin, and that briskly, since the mechanical pressure is of considerable service in removing the plugs of sebum which obstruct the follicles. The soap should then be washed off with water, and, to prevent the tension of the skin which may follow, either a little glycerine, cold cream, or any simple ointment should be applied, or, if this is not well borne, some earthy powder, such as pumice-stone, Venice talc, or asbestos. It is best to wash at night, because the redness of the skin, which is produced by the rubbing with flannel, takes some little time to disappear; and many patients dislike this in the earlier hours of the day. The application of oily preparations is also recommended as being agreeable to the patient's feelings.

"In cases which need something beyond mere washing with soap, this should be followed by the application of a sulphur paste by means of a camel's-hair brush.

This should be left all night upon the skin, and washed off next morning; not with soap but with a glutinous lotion, obtained by pouring hot water over bruised almonds and used lukewarm. After this paste has been applied a few days in succession, slight reaction follows in the form of mild Pityriasis rubra; it must thru be intermitted till this has disappeared. and meanwhile Wilson's sine ointment may be used.*

While this treatment is going on, the aone-nodulcs should be scanfied in good time, before their contents become yellow and purulent. As soon as a red tubercle appears, it should be incised to the depth of one or two lines and allowed to bleed.

Ungt. Zinci Oxidi Benzoati., Alcoholis............. M

"The use of ordinary baths or, when the disorder attacks the face, of vapor- and shower-baths, will be of important service in assisting these measures.

"Another method of treatment is by sulphuretted sand-soap, or iodized sulphur-soap: a piece of one of these is moistened and rubbed into the skin until a lather is formed, which is allowed to remain all night, and only washed off next morning with bran-water.

"In using corrosive sublimate, one of its solutions should be applied once or twice a day with a camel's-hair brush or a piece of sponge, until -either an eruption of vesicles follows, or simple desquamation. Then all treatment should be suspended, or Wilson's zinc ointment may be used. Mercurial plaster may be also applied during the night, followed by washing with soap in the morning" (97, Syd. Soc., ed. 2: 298).

Wilson (T7, 596) says: "The treatment of acne must be adapted to the cause of the affection; in those cases in which a torpid action of the cutaneous system is evident, stimulating remedies must be employed, whereas in those which are dependent on congestion, stimulants would be injurious, and prolong the morbid action. In both cases the regimen should be regulated; it should be moderate and nutritious, all stimulants avoided. To this hygienic management, laxatives and acids, and tonics may be added, with a view to order the secretions and regulate the digestive functions. Whenever other general indications present themselves, they must be especially attended to; thus, in young women at the time of puberty, the state of the uterine functions must be ascertained, and at the critical period of life derivative measures may be employed with advantage. Whenever the indication is obviously congestive, bleeding may be had recourse to locally.

"In applying the local treatment, due regard should be had to the ordinary principles of surgery. When the pimple is congested and painful, it may be punctured, and the bleeding encouraged by water-dressing or poultice; and when pus or sebaceous substance is suspected to exist, embedded in the tubercle, a fine puncture, succeeded by a poultice, is especially indicated. When the local determination has somewhat subsided, stimulants may be employed; for this purpose a lotion containing sulphur sublimatum, two drachms; camphor, one drachm; and distilled water, four ounces, is often of service; or the hypochloride of sulphur ointment, or an ointment of ioduret of sulphur, in the proportion of ten grains to the ounce of elderflower ointment or simple cerate."

"In the simple, as well as in the other varieties of acne, when they present a chronic character, a solution of bichloride of mercury in emulsion of bitter almonds, or of the same salt in eau de cologne, in the proportion of a grain to the ounce, will be found of service. A solution of sulphur, in spirits of wine or brandy, has been recommended as a local application; but this merely acts upon the general principle of stimulation, and is inferior in every respect to the solution of the bichloride."

The following drugs may also be considered in connection with the treatment of acne:

For Internal Use

Acid. Nit., 9; Belladonna, 32; Cich. Intyb., 42; Glycerine, 56; O1. Morrhuoe, 78; and Taraxacum, 110.

For External Use

Acid. Carbol., 6; Aconite, 12; Antim. Chlor., 18; Citr. Limon., 45; Collodium, 46; Ferri Chlor., 55; Ferri. Perox., 55;

Hydrarg. Cyan., 65; Hydrarg. Nit., 65; Mais Guasto, 75; Potassa, 90; Potas. Chlor., 92; and Sodii Boras, 106.

Certain purely mechanical processes have also been recommended in the treatment of acne, more particularly rubbing down the affected patches with fine sand, proposed by Ellinger (1T7, '76, No. 45), and scraping away the lesions with the dermal curette, by Hans Hebra (177, '75, No. 51), and Wigglesworth (115, '76).