Vaccine treatment gives excellent results in cases which have resisted all local measures; the best method is to prepare a culture of the acne bacillus extracted from a pustule on the patient's face. In a few days this will be found to flourish on Fleming's oleic acid agar medium, and a weekly dose of so million killed bacilli may be injected. When pustula tion and induration are very prominent features in the case 250 million of staphylococci (also originally obtained from the patient's own lesion) may he injected along with the acne bacilli. In most inveterate cases complete disappearance of comedones and pustules has been observed after from twelve to twenty inoculations, hut relapses are not uncommon.
Gilchrist affirms that a stock vaccine is quite as valuable as one pre pared from the patient's pustules when given in doses of so to zo million every week, and when much pustulation is present he injects a stock vaccine of S. aThus.
Towle has modified the vaccine treatment by using a fluid ointment with a liquid cold cream basis, each coo mils (about 4 oz.) of which is made to contain coo million acne and 400 million staphylococci applied with gentle friction every second or every clay for short periods.
The internal drug treatment of acne is unsatisfactory, but many observers believe that suppuration can he checked by i-gr. doses of Cal cium Sulphide in pilules, whilst some put their faith in teaspoonful doses of Yeast or io grs. Yeast Nuclein. Precipitated Sulphur in .1-dr. doses may be tried, but Arsenic is of very doubtful value. Iclithyol (-dr. capsules) seems to act beneficially where there is much err thematous redness surrounding the sebaceous glands, and Calcium salts often modify or correct this condition.
Menstrual or gastric derangements should receive close attention; plethoric patients are decidedly benefited by Saline Purgatives, and debili tated subjects improve as regards the severity of the eruption under large doses of Cod-Liver Oil. Fermented liquors almost invariably incveasu the malady, and every article of diet liable to induce dyspeptic symptoms, as pastry, pork, and re-cooked dishes, should be avoided.