Early in December, 1915, he came under Collie’s observation. He then showed right wrist bent at right angles to the forearm; hand tightly clenched, so firmly that it seemed as if the wrist were ankylosed. The case was obviously a functional one. The man refused to enter hospital at Collie’s suggestion. He was sent to the Maida Vale Hospital. Previously he tried to persuade the medical officer that further hospital treatment was unnecessary, stating that he was now able to straighten his arm and that he was applying a splint to keep it straight. He progressed slowly in the institution. Told, if he would recover within fourteen days, he would be classified “for home service only”—before the fourteen days were up, he had suspended his weight on a trapeze and pulled himself up to his chin on it; had also lifted a 28-lb. weight with his paralyzed hand. In short, he wholly recovered. He is now doing duty with his unit.
Collie says this is not deliberate malingering but a mixture of functional disease and an obvious desire to avoid active service. When he appeared before the board for a final decision, there was a tendency to assume the old paralyzed position until he was sharply called to order, when his arm assumed normal position.
Conclusion: The direct personal treatment of his mental condition and an appeal to his lower instincts were immediately curative and of much more value than the radiant heat or high frequency treatment.
Re Collie’s case, Russel finds surprisingly large numbers of malingerers; he found many at the time of the battles at Loos. It was particularly easy in cases of epilepsy to demonstrate a close relation between hysteria and malingering. In the psychogenesis of these conditions, Russel emphasizes the initial element of deception, which soon enormously increases either through the patient’s convictions of his ability to deceive or through a process of autosuggestion. Cases of semi-malingering are not uncommon. In England, Russel found more cases of a clearly psychogenic nature; yet in these, also, there was always primarily an element of deception.
Yes-No test of value re anesthesia.
Case 459. (Mills, January, 1917.)
The “Yes-No” test proved of special value in the case of an Australian private. Shortly after landing at Gallipoli this man had a bullet graze his ankle and fell some thirty feet over the bow of a ridge. He was picked up unable to move his legs and insensitive therein.
The paraplegia and anesthesia lasted three months. “Fracture dislocation of the dorsal spine” was the diagnosis made, and laminectomy was even contemplated. The sphincter reflex was normal and there was no atrophy, no rigidity and no reflex disorder. Asked to say “no” when he could not feel a pin-prick and “yes” when he did feel it, he replied “no” to each prick to the anesthetic area and changed his reply to “yes” when the sensitive parts of the body were examined. At another time the answers were found not to correspond with those given before.
The soldier was assured that he would get well and that as soon as he could walk he would be boarded and returned to Australia.