ACNE. 



493 



ment and of soft soap, and vapor baths, are preferable to the tepid 

 baths of bran-water, milk, or mucilage. A very sure remedy for pru- 

 rigo although merely a palliative one consists in friction of the skin 

 for half an hour at a time with a piece of flannel dipped in the solu- 

 tion of sulphuret of lime mentioned above (see p. 488), and known as 

 Vlemincky?s solution. After being rubbed down, the patient is to be 

 put in a bath, in which he must spend at least an hour. It is a good 

 plan to follow the bath by a shower-bath, and then to rub the body 

 with oil. Even the first bath always affords great relief, and the itch- 

 ing generally subsides completely after continuing the bathing for a 

 week. Unfortunately there is always a relapse, rendering a repetition 

 of the treatment necessary. Any complication which may exist must 

 be combated by internal medication and by suitable diet ; and, when 

 the nutritive state of the body is deranged, that also must be regu- 

 lated, if possible. Veiel regards arsenic as a real specific in prurigo, 

 and claims never to have used it without effect. 



CHAPTER XV. 



ACNE, ACNE VULGARIS, ACNE DISSEMINATA INFLAMMATION AND SUP- 

 PURATION OF OBSTRUCTED SEBACEOUS FOLLICLES. 



ETIOLOGY. Bareneprung very properly classes inflammation and 

 suppuration of the sebaceous follicles with similar derangement of the 

 mucous follicles ; and in truth the acne pustule of the skin and the 

 follicular ulcer of the mucous membrane both originate by the same 

 process obstruction of the outlet of a follicle, inflammation of its walls, 

 and bursting of its covering externally. By and by we shall consider 

 the effects of obstruction of the follicles by inspissated sebaceous matter 

 upon which the development of the so-called comedones (Mitesser) 

 depends. A comedo is not an acne at first, and does not become one 

 until the obstructed follicle inflames. In most cases such inflammation 

 terminates in suppuration, producing acne pustules. But it sometimes 

 happens that the inflammation is resolved, and then only leads to 

 chronic infiltration and thickening of the wall of the follicle, or, in other 

 words, to the formation of acne nodules or tubercles. Very few per- 

 sons ever remain perfectly exempt from acne vulgaris. The majority, 

 however, merely suffer from it during the period of puberty, and the 

 form of the disease is mild, and, even in individuals w T ho have been 

 afflicted by acne vulgaris in its worst form for years, the affection has 

 never commenced in childhood, but only appears at the time of ado- 

 lescence, although it may considerably outlast that period. It is, how- 

 ever, extremely rare for acne to last until the age of advanced man- 



