COURSE AND PROGNOSIS.—Anal fissure is not an immediately dangerous disease; nor can it be said that it has any tendency toward recovery if let alone. An indefinite time may elapse without any other change than the gradual wearing down of the patient's vitality from continued suffering and nervous strain. With proper treatment, however, this disease can be promptly cured, and practically without risk, the operation usually practiced being one of the simplest of surgical procedures. ----- Footnote 15: _Op. cit._, p. 132. Footnote 16: Bodenhamer, _op. cit._, p. 81. Footnote 17: _Op. cit._, p. 92. Footnote 18: _Op. cit._, p. 187. Footnote 19: "Diseases of the Rectum and Anus," third edition, New York, 1890, p. 294. Footnote 20: Medical and Surgical Reporter, August 14, 1880. Footnote 21: In some cases of fissure the irritable condition of the sphincter will cause such contraction of the anus when an examination is attempted that it will be impossible for the surgeon to pass his finger into the rectum without etherization of the patient. In these instances it is best to advise the patient to submit to such operative measures as may be deemed necessary at the same time that the examination is made under ether. Footnote 22: Allingham, _op. cit._, p. 212. Footnote 23: _Op. cit._, p. 212. Footnote 24: Bodenhamer, _op. cit._, p. 100. CHAPTER III. TREATMENT, PALLIATIVE AND OPERATIVE. It is highly important to the success of any plan of treatment directed toward the cure of anal fissure, that attention be paid to the condition of the bowels. Regularity of habit should be established, and the evacuations rendered semi-fluid—as figured or hard stools generally aggravate the symptoms. To accomplish these purposes, enemata or mild aperients should be employed, and the diet must be regulated, the use of bland and unirritating food being enjoined. All drastic purges should be avoided, as they are more or less irritating to the extremity of the rectum. In order to establish a daily evacuation of the bowels and to render the movement as painless as possible, I am in the habit of ordering an enema of warm water, or one of rich flaxseed tea, say from half a pint to a pint, to be administered every evening; preference being given to the night-time, as then the patient can assume the recumbent posture, which, combined with the rest, affords the most relief from subsequent pain. If the first enema should prove ineffective, it should be repeated in half an hour. In order to relieve the pain and spasm of the sphincters attending the evacuation, it is well to use a suppository about half an hour before the enema is employed, consisting of: