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 never recovered. I did not see him in the attack, but was informed, as far as I can remember, that he was on a casual visit at a friend's house at luncheon (or it might have been dinner), when he suddenly became strangely excited, but not quite unconscious. . . . I believed at the time, and do so still, that there was some capillary apoplexy of the convolutions. The attack was attended with some hemiplegic weakness on the right side, and altered sensation, and ever after there was a want of freedom and ease both in the gait and in the use of the arm of that side. To my inquiries from time to time how the arm was, the patient would always flex and extend it freely, but nearly always used the expression, "There is a bedevilment in it;" though the handwriting was not much, if at all, altered.
In December, 1873, Mr. Motley went by my advice to Cannes. I wrote the following letter at the time to my friend Dr. Frank, who was practising there:—
[This letter, every word of which was of value to the practitioner who was to have charge of the patient, relates many of the facts given above, and I shall therefore only give extracts from it.]
December 29, 1873.
MY DEAR DR. FRANK,—My friend Mr. Motley, the historian and late American Minister, whose name and fame no doubt you know very well, has by my advice come to Cannes for the winter and spring, 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.