time goes on, increasing evidence of renal change, but this is
rather a coincidence and consequence than a cause, though no doubt
when the renal change has reached a certain point, it becomes in its
own way a factor of other lesions. I have troubled you at this
length because my mind is much occupied with the pathology of these
cases, and because no case can, on personal grounds, more strongly
challenge our attention.

Yours very truly,
WILLIAM W. GULL.

During the spring of 1874, whilst at Cannes, Mr. Motley had a sharp
attack of nephritis, attended with fever; but on returning to
England in July there was no important change in the health. The
weakness of the side continued, and the inability to undertake any
mental work. The signs of cardiac hypertrophy were more distinct.
In the beginning of the year 1875 I wrote as follows:--

February 20, 1875.

MY DEAR Mr. MOTLEY,--. . . The examination I have just made
appears to indicate that the main conditions of your health are more
stable than they were some months ago, and would therefore be so far
in favor of your going to America in the summer, as we talked of.
The ground of my doubt has lain in the possibility of such a trip
further disordering the circulation. Of this, I hope, there is now
less risk.


On the 4th of June, 1875, I received the following letter:--