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 sincerely yours,
My dear Sir William,
J. L. Motley.

On Mr. Motley’s return from America I saw him, and found him, I
thought, rather better in general health than when he left England.