CHAPTER V 



FOTHERGILL'S MEDICAL PRACTICE. A CASE IN 

 CONSULTATION 



If your work is first with you, and your fee second, work is your 

 master, and the Lord of work, who is God. But if your fee is first 

 with you, and your work second, fee is your master, and the lord of 

 fee, who is the Devil. RUSKIN. 



So will we in our work, whether here and now, or everywhere and 

 always, have one end and one design the promotion of the whole 

 science and art of healing. Sir JAMES PAGET, 1881. 



FOTHERGILL'S practical instinct is illustrated by a special 

 study, undertaken early in his career, of the diagnostic 

 signs and approved treatment of those disorders whose 

 attacks are sudden in their onset. Of tropical diseases, 

 again, he was not without experience. He directed 

 Smeathman to treat fevers in West Africa with an emetic, 

 followed by cinchona in large quantities, given between 

 the fits, and Epsom salts if necessary. In fluxes fowl- 

 broth was to be taken largely, and after the bile had been 

 freely discharged, anodynes. 



Emulsions of insoluble drugs had generally been made by 

 means of yolk of egg, an unsatisfactory excipient, for it often 

 disagreed in digestion, sometimes became rancid, and it was 

 besides expensive. Oils were often mixed with a volatile 

 alkali or with spirit of wine. Mucilage of gum arabic was 

 slowly coming into use for emulsifying. FothergilTs attention 

 was drawn to it by his friend Rutty of Dublin, and finding 

 the method good, he induced J. Bogle French, a London 

 apothecary, to carry out a series of experiments with various 

 excipients, in order to ascertain which were the best emulsifiers, 

 and in what proportions they should be used. Fothergill 

 brought the results in detail before the Medical Society (of 

 Physicians) in 1757. It was shown that gum arabic was the 



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