℞ Ext. belladonnæ gr. 1/8 ad 1/2. Cocain. hydrochloratis gr. 1/4 ad 1/2. Ol. theobromæ gr. x. Misce, et fiat suppositoria j. Or an ointment of extract of conium may be used, as recommended by Harrison Cripps:[25] ℞ Ext. conii ℨ ij. Olei ricini ℨ iij. Ung. lanolini            ad ℥ ij. A small quantity of this ointment should be smeared on the part five minutes before expecting a motion, and again after the motion has passed. All ointments used in the treatment of rectal disease may be applied by means of a hard-rubber pipe (Fig. 7). [Illustration: Fig. 7—Hard-rubber Ointment-Applicator.] The various methods of treating anal fissure may be divided, for the sake of convenience, into the _palliative_ and the _operative_. PALLIATIVE MEASURES.—Palliative treatment will meet with success in a considerable proportion of cases, especially when there is no great hypertrophy of the sphincter muscles. Allingham[26] states that the curability of this lesion does not depend upon the length of time during which it has existed, but rather upon the pathological changes it has wrought. He asserts that he has cured fissures of months' standing by means of local applications, where the ulcers were uncomplicated with polypi or hemorrhoids, and where there was not very marked spasm or thickening of the sphincters. It is essential to the success of the treatment of fissure, especially by local applications, that rigid cleanliness of the parts be maintained; for this purpose the anus and the adjacent portions of the body should be carefully sponged night and morning and after each stool with hot or cold water, the temperature being regulated to suit the patient's comfort. An excellent instrument for irrigating the rectum is the one devised by Dr. Edward Martin, of Philadelphia (Fig. 8). I have also employed Bodenhamer's instrument for this purpose (Fig. 9). In applying the various local remedies it is necessary first to expose the ulcer to view, and to anæsthetize its surface with a four-per-cent. solution of hydrochlorate of cocaine, well brushed in with a camel's-hair pencil. The application of the cocaine may have to be repeated once or twice, at intervals of three or four minutes, in order to obtain the desired anæsthetic effect. [Illustration: Fig. 8—Martin's Rectal Irrigator.] [Illustration: Fig. 9—Bodenhamer's Irrigator.] If any ointment has been used about the fissure, the anus should be subjected to a hot-water douche before using the cocaine, as cocaine will not exert its anæsthetic influence on a greasy surface.[27] For this purpose Martin's irrigator (Fig. 8) answers admirably. The parts should subsequently be dried thoroughly with cotton or a sponge. A convenient sponge or cotton mop holder is shown in Fig. 10.