64 FOTHERGILL'S MEDICAL PAPERS CHAP 



in the mutual interests of England and of its plantations ; 

 smuggling would be discouraged, the consumption would be 

 greater, and the revenue in consequence would not suffer. 



Tea, coffee and chocolate compete, he says, for our prefer- 

 ence ; tea at present taking the lead. Fothergill personally 

 inclines to coffee. Letters from the West Indies tell him how 

 much coffee is used by the French, contributing to their 

 vivacity. " Coffee and scalded milk with a crust of bread," 

 would surely, in Governor Scott's humble opinion, " be one 

 of the best breakfasts in the world for the honest brave people 

 of the foggy island of Great Britain, where such a multitude 

 of melancholy accidents happen from a lowness of spirits." 1 



ON TAPPING IN DROPSIES 



Another paper relates to the early use of tapping in dropsies. 

 Fothergill begins by remarking on the folly of applying 

 remedies when too late to be of service, and goes on to show 

 that the operation of tapping has fallen into disrepute on 

 this account ; few patients, he says, survive its employment 

 because it is not used early enough. His own practice is to 

 use diuretics, such as squills, purgatives (salts), and corrobor- 

 ants (balsams) for a time. But if no benefit accrues, if also 

 the viscera appear to be sound, if there is no history of in- 

 temperance and if strength is adequate, he makes a pause, 

 until the signs of ascites become so evident that tapping can 

 be safely performed. After this has been done the diuretics, 

 chalybeates, and bitters have again a fair chance, for the 

 vessels have recovered their absorbent power. He does not 

 make incisions in anasarca, preferring the use of the scarificator, 

 by which small transverse cuts are made in the skin. 2 



PAINFUL CONSTIPATION 



Elsewhere Fothergill deals with cases of Painful Constipa- 

 tion, masked by apparent diarrhoea, due to rectal impactions ; 



1 Extracts from The History of Coffee by J. Ellis, with a botanical descrip- 

 tion by Dr. Solander, and a figure of the plant : also extracts from La Roque's 

 Voyage; a Letter (dated 1773, from Dr. Fothergill) on the Culture and Use of 

 Coffee ; and Observations on Coffee communicated by Governor Melville, and 

 by Governor Scott of Dominica, 1765 ; also notes by Lettsom ; all in Works, 

 ii. 280. See also Ellis's Letter to Franklin, 1773, Amer. Philosoph. Soc. 

 Calendar, iii. 181 ; and Dr. T. Percival, Essays, ii. 122. Fothergill had some 

 coffee-trees growing in his garden at Upton. The largest, about 15 feet high, 

 fruited in full berry in 1783, being then in Lettsom's garden at Grove HilJ. 



* Med. Obs. & Inq. iv. 114 ; Works, ii. 85. 



