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I have no doubt of your forgiving
and therefore will make no Apology for giving you the
trouble of this. it is to have your Opinion and Advise for
myself. My friend Mr Hamilton of Glasgow, who I had
the pleasure of seeing here last Saturday, told me that he
was to be in Edinburgh next Thursday, and would certainly
see you on Friday when he would take the Opportunity of
conversing with you about my case – and we agreed that
I should write you the history of it before that time, as
some of the circumstances might escape his Memory ––

In the Month of August last, I was seized one day after
stool with a pain & disagreeable burning heat in my
fundament especially on the left side which lasted for some
hours. I had been rather costive for some days before, and
had strained a good deal at stools, so I did not think much
of it, but concluded, that as soon as the Costiveness could be
removed, I should have no more trouble from it. But I
was grievously deceived, Every succeeding stool was followed
by the same sort of pain, which was greatly augmented by

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walking, or standing any time on my legs –– I went on in this
way, or rather, grew gradually worse for about a month; the
fits of pain became both severer & longer, and walking was
become quite insufferable – It was absolutely necessary to
keep the house & take rest. I was bled at the Arm, had
Leeches repeatedly applied to the verge of the Anus, restricted
myself to a low Diet, and kept an easy Belly by the use of
the gentlest Laxatives. Notwithstanding all this, the painful
symptoms were nothing relieved, but increased to a very
high Degree. Every stool, however cautiously procured,
or assisted by Oiley Injections, was followed by burning
pain in the fundament (especially on the left side). Tenesmus,
strangury, sharp shooting pains up along the Gut; a dis¬
agreeable flatulency & commotion in the Abdominal viscera,
sickness at stomach; and, an Anxiety & inquietude and
Impatience which I can hardly communicate ↑the idea of↑ by words,
but, which I never experienced any Degree of, with any pain
or Ailment I ever had before. The largest Dose of Opium
(such as 140 or 150 Drops in the course of ten or twelve hours)
taken by the Mouth; besides Laudanum in starch Injections,
and cataplasms, to which a strong Solution ↑of↑ Opium was added
had sometimes all enough to do, to give any relief or rest.
They intoxicated me indeed, & gave a sort of fortitude to bear
with more patience, but, this was often, all the good from
them, I was sensible of –––– During a period of eight or nine

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weeks as certainly as I had a stool (which for most part
was every ↑other↑ Day; and though that was always carefully
assisted by some Laxative taken by the mouth or by
Injections, or both) as surely, had I the above described
disagreeable scene to pass through – The extreme violence
of the fits of pain seldom abated any thing, in less time
than ten or twelve hours, so that the Intervals of Ease
were both short & imperfect – I was quite worn out, and
you will easily believe, became very nervous & hysterical.
Indeed, I must have been demolished. I do not think I could
have stood much more – Happily however the Disease be¬
gan to abate a little of its severity – The fits of pain grew
a little more moderate and did not last quite so long – Less
Opium was needed, and I gradually recovered a little
Appetite for food and of course, mended a little in strength
& spirits – I was advised by Dr Stevenson to a gentle mer¬
curial Course by friction, and at the same time to take
Bark as my stomach would bear – This prescription I
followed faithfully – My mouth was ↑very↑ slightly but sensibly
touched with the mercury, many weeks – There was scarcely
a day for more than two months that I did not rub in a
little. It is but within this fortnight that I left it of altogether
& till that time too, I have taken thirty grains of Bark

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twice a Day – I have been gradually mending under this
Course, but whether in consequence of it, I cannot tell –
I have made a shift without any Opium these five or
6 weeks past – My appetite & sleep considering so long
& close a confinement (for I have not been on the street
these six months) are both tolerably good, and I have
gathered flesh again, nearly as much as I lost. Yet,
the Disease still remains in a very considerable degree –
enough to disable me from walking abroad, or even much
through my Room –– These days I have a stool, which
is almost regularly every other Day (and which is happily
made as easy as possible by taking the night before eight
or ten Grains of Rhubarb) I never fail to suffer for five or
six hours in the same Part, but by no means, in the degree
that I have formerly – The other Days, I pass very tolerably
& comfortably, especially if I sit still & stir little about ––
Walking or standing any time together, never fails to raise
some uneasiness –

Is it not surprizing that after all I have suffered, no exter¬
nal swelling or Inflammation have ever appeared – no
hardness or Swelling or any thing wrong can be perceived
internally, within reach of the finger. Both Sandy Dunlop
& Mr Hamilton have examined and assure me so There
is one part on the left side at the verge of the Anus, which,

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when I press on it gives considerable pain, & in certain
postures, I think I feel a little hard Knob, but I can
make nobody to feel it so distinctly as I do myself
It is nearly in a standing posture that I feel it best –
Neither Blood, nor any thing that could be suspected
for Pus, have been ever observed to come from the Gut;
& you may be sure that my Anxiety & Suspicions
would lead me to be pretty inquisitive about that –
It may be proper to tell you, that I have been formerly,
(but not so much for a few years past) subject to piles
which swell'd sometimes to a great size & were very
painful – that at other times I have voided very
considerable quantities of Blood from the Hæmorrhoid¬
al Vessells, without either Swelling or pain – four or
five Ounces of ↑pure↑ Blood sometimes at a time – but I have
had no Evacuation of that sort these five or 6 years –
I have been much subject too, to a wandering chronic
Rheumatism, but have had little of it these two years
past, and none at all this Winter – Perhaps I should
have mentioned that during this whole illness, my pulse
has never been quickened – It has seldom exceeded sixty
four beats in the minute, and is seldom above fifty six.

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If I have omitted any thing in this long Account, which
might tend to throw any light ↑on the case↑ Mr Hamilton, with whom
I had so lately, a very particular Conversation on it,
will be able to supply the Deficiency – I will look
impatiently my Dear Sir for your Observations on it,
It is a mysterious, as well as very troublesome
affair to me –– I am most respectfully and
with entire Esteem Dear Sir

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Dr William Cullen
Physician in
Edinburgh

✍
Mr Gavin Fullerton
March. 1781.
XI. page 173.