pring, and I
have promised him to give you some account of his case. To me it is
one of special interest, and personally, as respects the subject of
it, of painful interest. I have known Mr. Motley for some time, but
he consulted me for the present condition about midsummer.

. . . If I have formed a correct opinion of the pathology of the
case, I believe the smaller vessels are degenerating in several
parts of the vascular area, lung, brain, and kidneys. With this
view I have suggested a change of climate, a nourishing diet, etc.;
and it is to be hoped, and I trust expected, that by great attention
to the conditions of hygiene, internal and external, the progress of
degeneration may be retarded. I have no doubt you will find, as
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:--

CALVERLY PARK HOTEL, TUNBRIDGE WELLS,
June 4, 1875.

MY DEAR SIR WILLIAM,--I have been absent from town for a long time,
but am to be there on the 9th and 10th. Could