A system of practical medicine. By American authors. Vol. 4

by Unknown

Rx.	Aloin,	gr. iij;
	Ext. belladonnæ,	gr. ij;
	Strychniæ sulphatis,	gr. ¼.

M. Ft. pilul. No. xv.—S. One or two at night. If there is torpor of the liver, an occasional dose of blue mass or calomel may be prescribed. When there is flatulence or other symptoms of fermentative indigestion, a mixture such as the following will be found useful:

Rx.	Sodii hyposulphitis,	drachm ijss-ounce j;
	Ext. nucis vomicæ fl.	fluidrachm ij;
	Aquæ menthæ piperitæ,	fluidounce iv.

M.—S. Teaspoonful in a large wineglassful of water a half hour before meals. The hyposulphite of sodium contained in the mixture may have a laxative effect in addition to its antifermentative action.

If there is anæmia or chlorosis, a preparation of iron, combined with aloes if there is tendency to constipation, is to be prescribed, the wine of iron being one of the most eligible ferruginous preparations. Ergot in the dose of a half drachm of the fluid extract has been recommended in the acne of females, especially where it seems probable that uterine disturbance is the exciting cause. Possibly its effect is, as has been suggested, due to its action on the unstriped muscular fibres of the skin. After one or two weeks' administration it is apt to cause gastric disturbance and, directly or indirectly, vertiginous symptoms. Calx sulphurata in the dose of one-tenth to one-half grain every three or four hours is of value in some cases, usually proving of most service in the pustular type. In strumous individuals, and in those whose nutrition is below the average, cod-liver oil is a valuable remedy. In like cases glycerin in similar doses may be prescribed, although its action is not so certain.

Arsenic is of decided value in some cases, but proves powerless in others. The sluggish papular forms are often influenced favorably by its continued administration. The alterative effect of mercury is sometimes beneficial, corrosive sublimate in small doses being the most available preparation. Where the inflammation is of a high grade, potassium acetate and other alkalies may be prescribed, as in the following formula:

Rx.	Potassii acetatis,	drachm v gr. xx;
	Liq. potassæ,	fluidrachm ijss;
	Liq. ammonii acetatis,	fluidounce iij drachm v.

M.—Sig. Teaspoonful in a large wineglassful of water one hour before meals.

Local Treatment.—This is of great importance and is demanded in every case. In acute acne, rarely encountered, mildly astringent applications are to be advised. The disease, as generally met with, however, is of a subacute or chronic character, requiring stimulating measures. External treatment in these cases has for its object the production of hyperæmia and the removal of the superficial layers of the epidermis, thus stimulating the glands and circulation and assisting in the excretion of the sebaceous matter. For this purpose washing the parts energetically with sapo viridis and hot water every night, using a sponge or preferably a piece of flannel, may be advised. After the soap-washing the parts are to be sponged with hot water for several minutes, or the face held over a basin containing steaming hot water. Subsequently, the comedones are to be pressed out by means of pressure with the fingers, or, better, by a watch-key with rounded edges so as not to injure the skin. An application of a simple emollient, such as cold cream or vaseline, may then be made and allowed to remain on over night. This plan of treatment is to be repeated nightly or every other night.

In many simple cases of acne the above method of external treatment, combined with appropriate constitutional medication, will bring about marked improvement and sometimes permanent relief. In the majority of cases, however, a more stimulating plan of treatment is called for. In almost all cases the soap-washing, either with the sapo viridis or a milder soap, and the sponging with hot water, are to precede the nightly remedial applications. Among the external remedies for acne sulphur preparations stand first. Properly managed, they rarely fail to benefit, and often prove curative. Precipitated sulphur is the preparation generally employed, and in many cases the most suitable. It may be prescribed as a powder, in ointment, or in lotion. As a powder it may be applied pure or mixed with starch, and as an ointment the following formula can be recommended: