The sun. [volume] (New York [N.Y.]) 1833-1916, 1905-01-22

denly regaining Consciousness on removal
of the depressed bone. There can be no
doubt that the man was "A rnalin gerer and
adopted this arduous method Of leaving
"A service into which he had been forced
The amount Of pain and discomfort which
malIngerers are willing TO endure to obtain
their discharge is almost incredible but the
facts are well attested. 4 limb has been
held In a fixed position for many months,
and not even the application of the actual
cautery has suifced To move It. Many
men have chopped off some fingers and have
claimed that il was an accident. Mental
arrangement of one sort or another Is
favorite form Of malngery, but the results
usually resemble the popular or stage idea
Of insanity rather than the true products Of
mental alienation. 1t il not uncommon
for the mallugerer to combine two forms
Of insanity and this may he of value in
detection Still it is often very difficult
to be certain that patient II shammlng.
There are however some phenomena which
cannot be simulated. II is impossible for
a sane man to initiate successfully the per
sistent insomnia which often occurs in the
insane; the impostJr cannot put of sleep
beyond the second or third day
Another frequent motive for malnRer-
ing is 10 attract attention not for the pur-
pose of obtaining money but merely 10
gam notice. simulated joint affections
arc not rare and there are many other forms
These cases merge Imperce ptibly into hys-
terra. and indeed IN many hysteria is com
bined with the wish 10 deceive. II ~ not I'M
probable that III some OF these patients there
IL certain degfre of cltaneous anH.sthesia,
which renders the self mutilation more
easy OF accomplishment There are other
causes for Stimulating disease or injury.
Sometimes 1t Is done TO avoid punishment,
sometimes to wreak vengeance on another
person who is accused Of having inflicted
the injury. To obtain compensation for
injury m "A railway accident several LESSONS
may be simulated, and especially those OBJ
scure and ill-dettned conditions which have
been attributed to spinal conclusion.
These latter form "A large and very import =
ant class the detection Of the fraud Of
which l. often most difficult.
Sad 70 relate, many of the attempts TO
initiate disease have he'd to serious and
irreparahle results and even TO death itself.
man excited AN ulcer in his leg by means
Of a copper coin, and later gangrene APP
yeared, ueces-itating amputation below
the knee. In endeaVOring toeNClte hRmOp-
ty-s a man swallowed q cork into which
pins has been inserted. He spat up blood
and became very cmaCiated and then sud
denly died from homorrhage. At the ne
CT0psy It was found that the cork and pins
had lodged at the junction OF the pharynN
and d-ophagus and that the pins had III
cerated through the psophageal walls
and had opened into the common carotid
artery on both sides. Children are great
adopts at feigning maladies and they fire.
uuenty display surprising acquunt ance
with the symptoms Of disease
The detect ion Of malingerlng IL often
no easy matter, and no general rule can he
laid down which viii be applicable 20 all
cases The mere theatening Of severe
methods Of treatment Is sometimes sue
ce--ful but frequently fails The threat
Of the application Of the actual cauteTy
has cured paralysis but cases have been
recorded where malin gerers have endured
the Cautery ON several occasions A mar
who simulated blindness was placed on the
edge Of jetty and told 10 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, however. a mar
who seemed TO have paralysis Of an arm
allowed the amput3tlng knife to he placed
close TO II without nching but when thrown
into he river he struck out with both arms
and swan.
4 very useful method 81 detection i,
! the suggest ing of new signs and symphonic
Of the pate The surgeon remarks
saw in he case of a paralyNed arm in tbs
hearing ~ the mnlingerer that 1t - strangs
that he little fingeris heNed 1t ought 20 N
straight. In all probability mt the next visit
the little finger will have assumed the sug
gested position. The more outre and irreg
/ ular the fresh symptoms suggested by the
1 surgeon the more definite Is the detect ion
/ In general nnesthesia we POSSESS valuable
means Of discriminating in certain case'
I tctwcen true and false paralysis or con
fractures. While the patient " just gonl
under or recovering from annsthia the
I "paraly2ed- limb may be seen TO move
freely.