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 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.
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.