ANUS, Fissure of If the ulcer or fissure is deep and of long standing, the surgeon, under local anaesthesia, should proceed at once, after the bowels have been cleared out, to make an incision across its entire length and deep enough to divide about one-third of the fibres of the external sphincter. The small sentinel pile, which is nearly always present at its distal end, should be removed at the same time. Ball finds that removal of the latter alone is sufficient to induce healing in the ulcer. The after-treatment consists in keeping the lips of the incision apart with a strand of gauze inserted daily so as to procure healing from the bottom. Some surgeons treat the affection by forcible dilatation of the sphincter under Chloroform. Touching of the ulcer with the thermo- or galvano-cautery is often quite sufficient to effect rapid healing, and Donner finds that a few insertions of one electrode within the sphincter and the other placed over the fissure while a mild continuous current is turned on act equally satisfactorily. In more recent cases the application of a mild caustic like strong Carbolic Acid suffices and causes little pain if cocaine be previously used. If by any means the reflex spasm of the sphincter can be controlled, the fissure heals spontaneously, and by regulating the bowels this may be sometimes easily accomplished. Purgatives arc injurious, and their action usually
causes as much pain in defecation as if constipation were present; the physician should administer a laxative like Olive Oil, Sulphur, or Tamar lndien, which will produce a copious softened motion, often voided without pain. The distress and pruritus accompanying the affection cannot satisfactorily be relieved with cocaine or morphia, and the writer finds nothing so successful as the old B.P. Ungt. Conii made of double strength combined with Ichthyol. This must be inserted well within the sphincter. lie believes that the conium paralyses the ends of the motor nerves dis tributed to the fine muscular layer under the surface of the mucous membrane, and prevents the reflex twitching which keeps up the incessant pain and uneasiness alter the patient retires to rest, and after the act of defecation. The conium ointment alone, or with ichthyol, can be made into a suppository and used with advantage. If eczema is also present, Tar can be added to the ointment, and where an astringent is required to arrest bleeding, Cripps adds so grs. Persulphate of Iron to each ounce.