Maja's physical decline, and the impossibility of her immediate return to Europe.
Einstein writes that his sister cannot return as early as planned to rejoin her husband in Europe: 'I am writing to you now, as it is necessary that you should have a clear idea about Maja's physical condition. I am doing it, unwillingly, without her knowledge'. Maja is suffering from an 'arteriosclerosis which is unusually advanced for her age', coupled with a kidney disease which she first contracted as a child. 'Her condition shows itself in the first place through disturbances in the instinctive nervous processes': her balance, gait and physical coordination are all affected, and she is often discouraged and depressed by her physical uncertainty; her memory for recent experiences has also suffered.
Taking all this into consideration, her planned return to her husband in Switzerland must be postponed: 'In these circumstances it cannot come into question for her to travel to Switzerland alone. It is therefore necessary for her to make the journey with [Hans] Albert and his family, though he does not yet know for certain when he can travel, although undoubtedly it will be in the first half of the year ... Maja has already greatly suffered from the fact that she has had to postpone her journey for so long. She probably also suffers from the anxiety that she somehow does not feel completely equal to the obligations that now await her'. She does not however express this explicitly; her intelligence, her judgement and her sensitivity remain substantially intact.
He urges Paul not to be too alarmed by this: 'We are of course all at an age when such signs of decay are inevitable'. If ever it became too difficult for Maja to carry on living with Paul, she would be welcome to come back to live with Einstein himself, 'where she would have a quiet life and the care of Margot and Frl. Dukas and no responsibilities to fulfil'. Ultimately it would be better if she and Paul could go back to their house in Italy, although the practicalities of this appear complicated. Paul's 'Musssolini picture' [presumably a satirical depiction] gives Einstein great pleasure – he received a framed photographic reproduction for his birthday. Maja often reads him extracts from Paul's letters, and he thanks him for the pleasure these have brought her: 'Through them you have very much alleviated the time of this long "banishment"'.
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