The Camden chronicle. (Camden, Tenn.) 1890-current, 1905-04-07
HOW MEN SHAM DISEASES
NOTABLE INSTANCES AMONG
SOLDIERS AND SAILORS.
Efforts of Beggars Appeal to the
Rest and Treatment in HOspit Pa tai Self Imposed
Injuries-a-Not Easy to Detect Maingering.

In detection. Still it is often very diff
cult to be certain that a patient is
shamming. There are, however, some
phenomena which cannot be simulat-
ed. 1t is impossible for a sane man
to initiate successfully the persistent
insomnia which often occurs in the
insane; the imposter cannot put off
sleep beyond the second or third day.
Another frequent motive for malin-
gering is to attract attention not for
the purpose of obtaining money but
merely to gain notice. Simulated Joint
affections are not rare and there are
many other forms. These cases merge
1mperceptibly into hysteria, and in
deed in many hysteria is combined
with the wish to deceive. 1t is not i'm
probable that in some of these patients
tnere is certain degree of cutaneous
anaesthesia, which renders the self
mutilation more easy of ACCOMPLISH
ment There are other causes for
Stimulating disease or injury. Some
times it is done to avoid punishment,
sometimes to wreak vengeance on an
other person who is accused of having
inflicted the injury. To obtain com
pensat1on for injury in a railway ac-
cident several LESSONS may be simulat
ed, and especially those obscure and
1ll-defined conditions which have been
attributed to spinal concussion."
These latter form large and very i'm
portant class, the detection of the
fraud of which is often most difficult.
Sad to relate, many of the attempts
to initiate disease have led to serious
and irreparable results, and even to
death itself. A man excited an ulcer
in his leg by means of a copper coin.
and later gangrene appeared necessi-
tatlng amputation below the knee. In
endeavoring to excite haemoptysis a
man swallowed a cork into which pins
has been inserted. He spat up blood
and became very emaciated and then
suddenly died from hemorrhage. At
the necropsy it was found that the
cork and pins had lodged at the juno
ton of the pharynx and osophagus
and that the pins had liberated
through the oesophageal walls and had
opened into the common carotid ar
terry on both sides. Children are great
adopts at feigning maladies, and they
frequently display a surprising ac-
quaintance with the symptoms of dis
ease.
The detection of malingering is often
no easy matter, and no general rule
can be laid down which will be APP
plicable to all cases. The mere threat
ening of severe methods of treatment
is sometimes successful but frequently
fails. The threat of the application of
the actual cautery has cured paralysis
but cases have been recorded where
malingerers have endured the cautery
on several occasions. A man who
simulated blindness was placed on
the edge Of a jetty and told to walk
straight forward. He stepped out and
fell into the water, for he knew that
those who were testing him dared not
let him drown. In another case. how
ever, man who seemed to have par
alysis of an arm allowed the ampu-
tating knife to be placed close to it
without finching, but when thrown
into the river he struck out with both
arms and swan.
A very useful method of detection is
the suggesting of new signs and symp-
toms of the patient. The surgeon re-
marks, say in the case of a paralyzed
arm-in the hearing of the malingerer
that it is strange that the little finger
is fexed, it ought to be straight. In
all probability at the next visit the
little finger will have assumed the sug-
gested position. The more outre and
irregular the fresh symptoms suggest
ed by the surgeon the more definite is
the detection. In general anaesthesia
we possess a valuable means of dis
in certain cases between
true and false paralysis or contract
ures. While the patient is just going
under or recovering from anaesthia
the "paralyzed" limb may be seen to
move freely.