C.

Sir William GULL’s account of his illness.

I have availed myself of the permission implied in the subjoined letter of Sir William Gull to make large extracts from his account of Mr. Motley’s condition while under his medical care.  In his earlier years he had often complained to me of those “nervous feelings connected with the respiration” referred to by this very distinguished physician.  I do not remember any other habitual trouble to which he was subject.

                              74 Brook Street, Grosvenor Square, W.
                                             February 13, 1878. 
My dear sir,—­I send the notes of Mr. Motley’s last illness, as I promised.  They are too technical for general readers, but you will make such exception as you require.  The medical details may interest your professional friends.  Mr. Motley’s case was a striking illustration that the renal disease of so-called Bright’s disease may supervene as part and parcel of a larger and antecedent change in the blood-vessels in other parts than the kidney. . . .  I am, my dear sir,

                              Yours very truly,
                                        William W. Gull.

To Oliver Wendell Holmes, ESQ.

I first saw Mr. Motley, I believe, about the year 1870, on account of some nervous feelings connected with the respiration.  At that time his general health was good, and all he complained of was occasionally a feeling of oppression about the chest.  There were no physical signs of anything abnormal, and the symptoms quite passed away in the course of time, and with the use of simple antispasmodic remedies, such as camphor and the like.  This was my first interview with Mr. Motley, and I was naturally glad to have the opportunity of making his acquaintance.  I remember that in our conversation I jokingly said that my wife could hardly forgive him for not making her hero, Henri IV., a perfect character, and the earnestness with which he replied ‘au serieux,’ I assure you I have fairly recorded the facts.  After this date I did not see Mr. Motley for some time.  He had three slight attacks of haemoptysis in the autumn of 1872, but no physical signs of change in the lung tissue resulted.  So early as this I noticed that there were signs of commencing thickening in the heart, as shown by the degree and extent of its impulse.  The condition of his health, though at that time not very obviously failing, a good deal arrested my attention, as I thought I could perceive in the occurrence of the haemoptysis, and in the cardiac hypertrophy, the early beginnings of vascular degeneration.

In August, 1873, occurred the remarkable seizure, from the effects of which Mr. Motley