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In the course of the illness other diseases may spring up, and the one under
which the patient was admitted is, possibly, not the one of which he ultimately
dies.
The case of ulceration of the œsophagus caused by a foreign body lodging
in the tube is of interest and is quoted as follows.
Thomas Wright, a Native Christian, had for several days a difficulty in swal-
lowing his food, but it was not discovered that he had a foreign body in the œso-
phagus until the day of his admission into hospital. On that day he was weighed,
and the loss in weight registered against him first drew my attention to his con-
dition. On examination nothing could be detected externally, and when the
throat was examined no foreign body could be seen, but some immovable hard
substance could be felt very low down in the œsophagus, which nothing but such
force as would produce dangerous results would release, and it was too low down
for operative measures. When he swallowed solid food it was forced back again.
In consequence of this difficulty of deglutition all the solid food he took was
divided into very small portions. During the latter days of his ailment, whenever
he happened to eat a morsel exceeding a certain size (and that very minute) it
lodged in the œsophagus, and for several days he would take neither food nor
drink; he used to wash down small particles of solid food with liquids. He in
time became exhausted and lay in a semi-lethargic state, speaking very little and
taking only small quantities of fluid; he was, however, able to swallow fluids to the
last. He brought up blood occasionally, and large quantities of pus, pointing to
the occurrence of ulceration in the affected part; his pulse was feeble, and latterly
scarcely perceptible, so that his death was expected from one day to another for
a fortnight before it occurred.
On post-mortem examination it was found that the body was by no means
emaciated; there was some fat over the abdominal muscles. In the œsophagus,
at its cardiac extremity, a piece of bone about three inches in length, sharp at
each end, penetrating through both walls of the tube, was discovered, the œsopha.
gus above and below was extensively ulcerated, and the structures in the imme-
diate neighbourhood diseased, as evidenced by a large collection of matter in
them ; above both ends of the bone the walls of the œsophagus presented a large
irregular opening, the result of ulceration.
The next case which should be noticed presents in its details extraordinary
features and at the time was particularly interesting to me.
Steers, an engine-driver employed in the State Railways, was twice in the
asylum, at first under observation and eventually as a patient. When first ad-
mitted it was said that he had enjoyed tolerably good health until about two
years before, when he complained of giddiness and a peculiar sensation (as ex-
pressed by himself) as "if my mind was a blank," which lasted for a minute or
two and then passed off. In the letter accompanying him it was said that he
drove his engine through a station at full speed when the signals were against
him, and asking why he did this he said, that he then had one of those parox-
ysms. During this period of his detention in the asylum he showed no signs of
insanity, but he complained of giddiness, confusion of ideas, sudden loss of memory
accompanied, occasionally only, with a staggering gait, and after being under ob-
servation from the 30th April to the 19th May 1883, he not having shown signs
of insanity, was reported capable of making his defence and discharged.
After his trial he was re-admitted on the 25th July 1883 under a warrant from
the Chief Commissioner. At this period the disease was observed to be making
rapid progress; he took some time to think when he was questioned, and his
answers were often contradictory, but he was sane withal, and he was perfectly
aware that he was not saying what he wished to say, and by his facial expression
it could be seen that he painfully felt his position, cried, and was annoyed at the
mistakes he was committing ; he did what he was told ; there was confusion of
memory; sensibility appeared to be present in all parts of the body except in the
legs, and numbness was felt in the extremities generally but not to any marked
degree.
After 14 days he lost flesh rapidly, became emaciated, and unable to stand
without support, though with the assistance of one of the attendants he was able
to walk short distances, but with a stumbling gait, at times jerky and hurried