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 I make an appointment
with you for either of those days? I am anxious to have a full
consultation with you before leaving for America. Our departure is
fixed for the 19th of this month. I have not been worse than usual
of late. I think myself, on the contrary, rather stronger, and it
is almost impossible for me not to make my visit to America this
summer, unless you should absolutely prohibit it. If neither of
those days should suit you, could you kindly suggest another day?
I hope, however, you can spare me half an hour on one of those days,
as I like to get as much of this bracing air as I can. Will you
kindly name the hour when I may call on you, and address me at this
hotel. Excuse this slovenly note in pencil, but it fatigues my head
and arm much more to sit at a writing-table with pen and ink.

Always most