After each application the part should be well smeared with an ointment of iodoform (thirty grains to the ounce). The odor of the iodoform may be disguised by the addition of a few drops of otto of roses. Iodol may be used instead of iodoform, and in the same way.
After the ulcer has been touched once or twice with the silver solution, the effect will be, in those cases which are benefited by this treatment, a considerable mitigation of the severe pain which has troubled the patient when at the closet and afterwards; and the sore will present a healthy granulating appearance, and slowly contract in size.
In children and in young persons, unless the fissure be complicated with some other affection, this lesion is almost always curable by adopting the foregoing mode of treatment.
Some authorities speak highly of the use of the acid nitrate of mercury, fuming nitric acid, carbolic acid, the actual cautery, etc., but in my experience their employment is attended with more suffering than follows the employment of the nitrate of silver or the simple operative treatment which will presently be described. Furthermore, the application of these remedies is not so certain to effect a cure as either of the two procedures just mentioned, so that I rarely resort to their use.
The daily introduction of a full-sized bougie, made of wax or tallow, will sometimes act beneficially in cases of fissure, by distending the sphincter and producing such an amount of irritation as will set up a healing process in the ulcer. An application of cocaine or of belladonna ointment should be made to the part prior to the employment of the bougie.
Allingham[[29]] strongly advocates the local use of the following ointment:
| ℞ | Hydrarg. subchlor | gr. iv. |
| Pulv. opii | gr. ij. | |
| Ext. belladonnæ | gr. ij. | |
| Ung. sambuci | ℨ j. | |
| M. | Sig.: To be applied frequently. |
This authority states that he has cured many cases with this ointment alone.
Another excellent ointment recommended by Mr. Allingham[[30]] is the following:
| ℞ | Plumbi acetatis } __ | |
| Zinci oxidi } aa | gr. x. | |
| Pulv. calaminæ | gr. xx. | |
| Adipis benzoatis | ℥ ss. | |
| M. |