vn THE CLIMATE OF LONDON 67 



of England, Fothergill sends his patients, he tells us, in the 

 spring to the south or west country or to the sea coast ; and in 

 summer to the north, or to Wales, Buxton, Matlock, etc. 



Of continental resorts for phthisis he says with regret that 

 but little is known ; they should have a short mild equable 

 winter, and be of easy access. The south of France (Nice 

 and near Marseilles), Italy (near Naples), and Portugal (near 

 Lisbon and Cintra) are most resorted to. Madeira is more 

 equable than these, but the voyage is a hindrance. Above all, 

 let not the journey be undertaken when the disease is advanced 

 or the season unfit. 



Fothergill's treatment of consumption shows his clinical 

 instincts at their best. His proposition to diminish the 

 blood-flow through the lungs would now find little favour, yet 

 in some plethoric cases it might promote a cure by fibrosis. 

 He makes no contribution to the pathology of the disease, 

 evidently following himself the views of Richard Morton ; for 

 he makes some allusion to heredity, and speaks of the disorder 

 as for the most part taking its rise from an accidental cold. 

 It is to the French school, commencing with Desault, that we 

 chiefly owe the doctrine of tubercle. 1 



THE MANAGEMENT OF THE CLIMACTERIC 



A paper which continued to be read long after Fothergill's 

 time, and was translated into French, dealt with the manage- 

 ment proper at the climacteric period. Rejecting the old 

 theories on which this management had been based, and yet 

 knowing little of the mechanism of ovulation, Fothergill lays 

 down a plan of treatment which is essentially symptomatic 

 and based on experience. He defines clearly, amongst other 

 conditions, the plethoric state, and the irritable or nervous 

 habit, and adjusts his remedies according to the needs of each ; 

 here eliminants and cathartics, there astringents or anodynes ; 

 and above all, such regulation of diet, drink and general 

 regimen as he had found useful in the differing conditions. 

 His clinical pictures of some of the various disorders, real or 



1 Med. Obs. & Inq. iv. 231 (1769) ; v. 345 ; Works, ii. 115, 127 ; iii. 154, 

 179 ; Proc. Roy. Soc. Med. iv. Epidem. Sect. pp. 153, 154. Lettsom (writing 

 in 1812) states that about 1770 the faculty of Paris enquired of the College of 

 Physicians in London whether the frequency of consumption in this city was 

 due to the use of coal-fires ; and that Fothergill told him the question was 

 answered in the negative, since it was just as frequent where peat or wood 

 was used as fuel. Since that time, he adds, the disease has spread over the 

 continent and still more in America. Mem. Lettsom, iii. 211, 348. 



