The out standing advantages of nupercaine, “Ciba base with phenol and benzyl alcohol consist in (a) the unusually of pain following the injection, and, (b) the unusually prolonged duration of the anesthesia which it produces. Being a concentrated solution, the preparation should be used only in strict accordance with directions. Injections should not be made into an infected region, and the solution should be introduced well beneath, and the solution should be introduced well beneath the skin; never intradermally. Ten cubic centimeters of nupercaine, Ciba base with phenol and benzyl alcohol at the first treatment four different punctures in the posterior half of the rectal circle.
A week later, five cubic centimeters are injected in the right anterior and the left anterior quadrants. Cracks or fissures are swabbed with silver nitrate, balsam of Peru, or a simple lead lotion applied to the irritated peri-anal skin. A feeling of numbness develops which lasts several weeks, so that sufficient timed is afforded for the treatment of any allied pathology. An average cases requires three doses (ten, five, five cubic centimeters) to effect cure. It is important to make these injections subcutaneous and not intradermal, otherwise a slough is liable to result, but if such were to occur it would be painless and heal without any discomfort to the patient”.
I have omitted from this discussion the standard anti pruritic solutions and ointments, formulas for which are readily procured from any textbook. The effort has been to cover, in a practical way, the etiologic factors which must be entirely eliminated before instituting treatment; then to present as applicable and worthy of consideration, the alcohol treatment, stressing the dangers of sloughing; also, to present the technic of the use of he Gabriel solution as eminently satisfactory in overcoming the condition in that group of cases which are not cured by the elimination of definite systemic causes or evident pathology in the rectum and the adjacent tissues.
