FEIGNED DISEASES—MALINGERING
Human ingenuity is not wanting among those who, for private ends, pretend to be suffering from disease. The soldier or sailor, anxious to escape the dangers of active service, finds a ready means of evading his duties by shamming; the prisoner, in order to lighten the burden of his punishment, does the same. A man declares himself impotent to save the expense of keeping an alleged bastard child, or to avoid punishment for rape. Beggars appeal to the public by feigning some painful disease, and incautious benevolence becomes the dupe of the clever impostor.
Any attempt at classification is here out of the question, nor does it appear necessary to give a long list of diseases which have been feigned, or the means that have been employed by artists in deception. To give some general hints for guidance is all that will be attempted here, leaving matters of detail to the acumen of the medical examiner, who, if in active practice, will have many opportunities of testing his powers of discernment:
1. Never be satisfied with one visit, but pay a second at a short interval, and unannounced.
2. Have the patient carefully watched in the interval of your visits.
3. Examine each organ of the body separately, carefully comparing the state of each with the symptoms described by the patient.
4. Note the discrepancies in the statements of the patient as to his symptoms and their known occurrence in real disease.
5. Sometimes ask questions the reverse of his statements, or take his statements for granted, when in all probability he will contradict himself.
6. Remove all bandages and other dressings.
7. The administration of sham physic, or the suggestion of some heroic mode of treatment; the application of the actual cautery may have a beneficial effect.
8. Pay little attention to the reports of bystanders, or of the culprit‘s fellow-prisoners.
9. Anæsthetics may be employed, if necessary, for the purpose of detection.
10. The motives of deception should be inquired into, and borne in mind, in the examination of all cases.