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Acne is situated in the sebaceous follicles of the skin; it depends upon the quality of the sebaceous secretion, and is not, or at least very seldom, determined by the narrowness or closure of the excretory duct. If the sebum secreted by the follicle is too thick, it naturally reaches the surface with more difficulty, solidifies near the external opening, and closes the follicle by means of a plug which has generally a black color. These blackish points are called comedones, or acne punctata. In certain circumstances the disease may not progress any further; on some portions of the skin, as for instance on the nose, this condition becomes habitual. Under other circumstances that will be stated below, the glands thus closed show a disposition to become inflamed. That this is not alone owing to the pressure of the sebum upon the follicular walls, is shown by the circumstance that in persons of a more advanced age the comedones scarcely ever inflame, or that they enlarge to the size of small bursae without any symptom of inflammation whatsoever. The inflamed follicle either changes to a small pustule, discharges and sometimes forms small scurfs, or else the inflammation does not terminate in suppuration, the follicle retains for a time the shape of an indurated, somewhat painful and red papule, and gradually the exudation is reabsorbed. If the inflammation is severe, if the irritation is increased by the pressure and friction of the clothes, the subcutaneous cellular tissue becomes involved, giving rise to a furuncle of a larger or smaller size. These different changes or processes come under the designation of acne simplex. This form of acne appears principally in the face and on the neck, on the back, buttocks, thighs, less frequently on the chest, sometimes on the skin of the penis and scrotum. No other consequences are involved in this affection, except that the places of the acne-pustules remain red for some time. Considering that a number of follicles sometimes become diseased while others are at the same time in full bloom, the face must become considerably disfigured. Acne scarcely ever makes its appearance except between the age of pubescence and the twenty-fifth or thirtieth year. After this period, a few single follicles may become inflamed, but not a whole number together. Males are more subject to acne than females. All the circumstances connected with this eruption show that acne has its essential origin in the sexual sphere. In corroboration of this statement we will allude to the circumstance that on many ladies a few acne-pustules break out during the menses, and that almost every individual who is addicted to onanism, is afflicted with an excessive breaking out of acne. We do not mean to say that acne only breaks out in the faces of onanists. Among the young people of the city acne seems to be general, whereas among country-youths it is comparatively a rare disease. If a predisposition exists, acne may be developed under the operation of a variety of causes, such as overheating, washing a heated skin with cold water, partaking of boiled and roasted or fried fat, more particularly the fat of geese; indigestion, the excessive use of wine or spirits. Among us, for instance, acne prevails in the winter-season, because so much pork or gooseflesh is eaten in winter; jews are likewise troubled with acne, for the reason that they replace the fat of swine by goose-fat, and for the additional reason that they are generally fond of very fat eating. It follows from these remarks that the first thing to be done when treating a case of acne is to prescribe a careful and appropriate diet. This task, however, is very difficult of accomplishment, for the reason that acne-patients generally enjoy the sensation of perfect health, and that a rigid diet, if only persisted in for a short time, effects very little improvement in the disease. The next point is to see to a proper management of the skin generally. Cold bathing and washing is of no use; on the contrary, the trouble seems to get worse in consequence. For acne on the trunk, frictions with soap and the use of the flesh-brush in a vapor-bath are the best remedy; for acne in the face the following proceeding is better than all cosmetics: every morning, or, if the patient has to leave his home early in the morning, then every evening, the face should be gently rubbed for a few minutes with a soft piece of flannel moistened with warm water and greased over with soap, after which it is washed with warm water, and subsequently again with water that is almost cold. The best soap for such a purpose is the so-called venetian soap made of vegetable fats. By means of these washings the disorder is reduced to its minimum proportions. The formation of pustules is, moreover, best prevented by the comedones being squeezed out. The nails must not be used for such an operation, but a small watch-key, the opening of which must neither be too narrow nor angular, is placed upon the spot so that the black point of the comedo is exactly encompassed by the opening of the key which is firmly and vertically pressed upon the skin. This had better be done previous to washing. By resorting to such simple proceedings, the face can be kept tolerably clean.
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