The first point to be considered is the probable cause of the eruption, and the means best adapted to its removal. A detailed consideration of these will take us too much out of our way. The next point to be looked into is the general hygienic condition of the patient. If there is room for improvement in this respect it should certainly not be neglected. Fresh air, exercise, diet, etc., should be duly regulated, and any habits that are prejudicial to health should be corrected. Atteution to the foregoing may involve the employment of tonics, neurotics, emmenagogues, etc. Among the first, cinchona and its derivatives are, I believe, rarely indicated, except when the condition calling for the tonic treatment is the result of excessive menstrual or seminal losses, or is dependent on malarial poisoning. Iron, if prescribed, should be given sparingly and for short periods only, for if given in excess and for too long a time is capable of producing anaemia, and is even credited with the power of exciting an acneform eruption (vide, p. 53). Nux vomica and strychnia are tonics, peptics, and neurotics, and may often be usefully employed; so also the bromide of potassium may prove useful as an anaphrodisiac and sexual sedative, but its special influence on the sebaceous glands should not be overlooked, and care should be taken that it does not do more harm than good. If menstruation be deficient, any of the well-known emmenagogues may be employed, the blue cohosh (Catdophyllum thalic-troiden) having given me great satisfaction in this connection. Functional dysmenorrhoea is sometimes promptly relieved by pulsatilla or viburnum opulus, and menorrhagia by ergot. The regulation of the bowels by laxatives, etc., when necessary, should be borne in mind. All this should be regarded as preliminary, and brings us to the direct treatment of the eruption, which treatment will be either internal or external - or, better, a combination of both.

The remedies specially interesting in connection with the direct into nal treatment of acne vulgaris are arsenious acid, bromide of arsenic, sulphide of calcium, and sulphur. The action of these drugs is by no means the same, and the indications for their employment are far from being identical. While making this statement, it must be understood that the iter is not prepared to present their several indications with the precision that might be desired. Literature is almost silent on the subject, and personal experience (too often deceptive) is the writer's main guide to the differential selection of the drugs mentioned. Arsenious acid has appeared best adapted to those eases in which the papular element was the most prominent, the papules being indolent, not very painful, and slowly pursuing their course to resolution without changing to pustules. Sulphide of calcium, on the other hand, is best adapted to eases characterized by a plentiful development of sensitive and painful papules, rapidly becoming pustules, which pursue a somewhat acute course. The greater the tendency to pustulatiou, the more strongly the sulphide is indicated. The bromide of arsenic occupies a middle ground between arsenious acid and sulphide of calcium, and is probably adapted to a greater number of cases than the drags just mentioned. Sulphur has always enjoyed a certain measure of repute in the treatment of acne, but I have rarely found it of service except in a few extremely indolent cases, in which doses of from five to fifteen grains, alone, or mixed with bitar-trate of potassium, have appeared to excite a beneficial influence.

The external treatment of acne vulgaris should go hand in hand with the internal. Recollecting that the lesion of acne runs a definite course, the progress of lesion should be hastened as much as possible. An inflamed papule having appeared, it, on the one hand, remains a papule for a week or two, and then gradually undergoes resolution without suppuration, and gradually disappears - or it may change into a pustule, the pus appearing at its summit, - sometimes more deeply. After the pus is discharged, the lesion gradually disappears, leaving a slight macule which in turn fades away. In either case the duration of the lesion may be materially shortened. This may be accomplished by freely incising, or rather puncturing, each advancing lesion with a lancet point. The slight bleeding that follows should be encouraged by fomentations of warm water. This to be followed by applications of water as hot as it can be borne, and which should be repeated two or three times a day, each application lasting five or ten minutes. The patient is then directed to procure a proper lancet, one with a guarded point is preferable (Fig. 4), and to puncture every new lesion as it appears. As comedones frequently coexist with acne vulgaris, they should be next disposed of (see Comedo). This accomplished, various ointments and lotions are of service, the most useful of which, in my experience, are Ungt. Hydrarg. Ammon., Ungt. Sulphuris, Ungt. Sidphuris Iodidi diluted, and lotions containing a little Hydrarg. Chlor. Corros. (gr. j. - ij. to the ounce), or sulphur. An admirable application is precipitated sulphur, intimately mixed with three or four times its weight of any simple toilet powder. All that is really needed is a mildly stimulating application, and one not strong enough to produce much irritation. The ointments, lotions, etc., should be applied at night and washed off the next morning with soap or quillaya.

Fig. 4. - Acne lance.

The faradic current has been found by myself and by my friend, Dr. Satterlee (110, 2: 164), an excellent adjuvant in the treatment of Acne vulgaris. The positive pole is applied to the nape of the neck, and the negative to the affected parts. The applications to be continued for ten or fifteen minutes, and to be repeated every two or three days.