A man, injured by shell fragments in the head and sustaining fracture of both arms and a thigh, got well of his wounds, but fell into a nervous state with headache and dizziness. He was given prolonged observation psychiatrically and then sent back to the front as fit for service, but was shortly returned to hospital and sent to Cologne under the suspicion of simulation.
The picture was of unilateral increase of tendon reflexes, accelerated pulse, disorder in the intake of ideas, difficulty in finding words and delayed associations. His gait suggested a psychogenic disorder. X-ray showed two shell fragments in the vault of the skull.
According to Voss, it is a sad fact that victims of skull injuries are frequently charged with simulation or exaggeration. In the above instance, moreover, this charge was undoubtedly inaccurate.
Re simulation, see remarks under [Case 453]. Re neurological cases, the Neurological Society of Paris sent to the War Ministry a special note pointing out how tardy was the reference of sundry neurological cases to the special neurological service. They pointed out how important it was to send to these special services all cases of bullet and shrapnel lesions.
Re the malingering question, there is a wide divergence of opinion, even amongst experienced workers in the same city. The late Professor Dejerine said he had not seen a single case of malingering. In fact, he thought that malingering amongst soldiers and amongst injured industrial workers had been much exaggerated. Marie, however, working in the examination of many surgical cases, found malingering relatively common. Amongst forty of his cases, he regarded at least nine as malingerers or exaggerators.
“Sciatica,” torticollis, stiff arm: The desire to avoid active service plus functional disease.
Case 458. (Collie, January, 1916.)
A man enlisted September, 1914, went to France after six months’ training, immediately put himself on sick list, and was admitted to a base hospital: Diagnosis, sciatica. Later, he ceased complaining of sciatica and developed spastic torticollis. He was sent back to England, was treated with radiant heat and so on, and was eventually sent to the Royal Bath Hospital at Harrowgate.
He recovered from torticollis after six weeks’ treatment; but then developed a spasmodic contracture of the right shoulder and forearm. He was massaged for this and also given high frequency treatment. Then came two transfers (massage).