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For Mr Fullerton Greenock

Puzzled to form any clear opinion. Pain without swelling
hardness or Inflamation either from the symptoms of the part or from
the state of the Pulse are circumstances certainly puzzling. Your
former hemorrhoidal state leads me to think your late ailments
belong to that disease but without either swelling or evacuation
the conclusion must be doubtfull. In short I cannot in this letter
give you every speculation or discussion which have passed in my mind
but shall give you my Conclusion. – The Ailment I consider as
an affection & a spasmodic affection of the Sphincter without any
Inflamition. the pain was not excited by any thing passing
the anus to show that there was any topical affection in those
parts to be irritated but the pain was excited only upon the
action of the sphincter & your feelings after your stool show
the seat of the disease. How such an ailment should arise I cant
tell but could say something about referring it to a former
hemorrhoidal habit for some time interrupted. However it
might arise it is easy to account for the continuance while the
repetition of the irritation could not be avoided. While the
disease may be a little mysterious I am glad you are
so far recovered as to render any dispute the [cure?] not

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necessary. Had I been advised sooner I should have depended
upon opiates & especially applied as well as possible to the part
affected & the same I would still advise. As you take a dose
of Rhubarb the night before you will know pretty nearly
the time when you are to have a stool & about an hour
before I would throw in but a little way only to the anus
100 drops of Laudanum in a few ounces of solution of
Gum arabic. – According to the effect you will proceed
& I shall advise no further till I shall have another re¬
port.