v A CASE IN CONSULTATION 45 



Horace Walpole, to his taking an extra dose contrary to 

 his doctor's orders. 1 



It may be of interest to illustrate Dr. Fothergill's 

 practice and the medical methods of the time by relating 

 a case, the particulars of which have come down to us. 



In the year 1764 he was consulted by his friend Dr. 

 Cuming on behalf of a young lady of 27 years of age. She 

 was plump, sanguine and of a lively disposition. Her 

 physician stated that she had formerly suffered from a " pleu- 

 retic fever," and that she was subject for several years after 

 this to acute pains in the affected side, which were always 

 removed by bleeding. There followed in succession amenor- 

 rhoea, threatening of phthisis, fiuor albus, and a violent hemi- 

 crania. The latter disorder withstood, wrote her doctor, " the 

 united force of the most efficacious medicines that I know, 

 for almost a twelvemonth. It were endless to tell you the 

 efforts I made. What expedient," he continued, " did I 

 leave untried, what method unattempted ? At last I suc- 

 ceeded." The hemicrania cured, the patient took a course 

 of Bath waters, and continued well until about eight months 

 prior to the date of consulting Fothergill, when she began to 

 suffer from large alvine haemorrhages. Forthwith ten ounces 

 of blood were taken from her arm, and astringents, balsams 

 and laxatives administered, with anodyne injections, and 

 dossils dipped in ointments. The cethiops mineral, a prepara- 

 tion of crude mercury condemned by Boerhaave, was also 

 prescribed, with testaceous powders, made from oyster shells. 

 Her next symptom was a general miliary eruption, attended 

 with a great itching, which required the exhibition of a purge 

 and of more cethiops, followed by a course of Plummer's pill 

 and a decoction of the woods, and later calomel. The local 

 use of a lixivium (ley) of salt of tartar, white precipitate, and 

 finally sulphur ointment resulted in the cure of the eruption. 

 Violent alvine pains, with slight haemorrhages, had in the 

 meantime occurred, and these dictated further venaesection 

 and more injections, with laudanum and a decoction of 

 comfrey. A small excrescence close to the sphincter, appearing 

 to be the seat of acute pain, was removed. It would be 

 tedious to enumerate all the many remedies employed, which 

 included Locatelli's balsam, eryngo (sea holly), white poppy, 

 copaiva and linseed, but in spite of all these means the 

 paroxysms of local pain continued to afflict the patient. 



1 H. Walpole, Letters, ix. 97, Nov. 23, 1774 ; Sir J. Malcolm, Life of Clive, 

 iii. 371-373. 



