Feigned diseases, their detection and management / by George Wilson.

  • Wilson, George
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: Feigned diseases, their detection and management / by George Wilson. Source: Wellcome Collection.

    38/48 (page 36)
    them, therefore, makes the case look very suspicious. But some¬ times a malingerer will show a quantity of blood which he asserts has been passed in this way, when it is found that it has been derived from the nostrils. The following is an instance of this form of scheming :—One morning I was roused out of bed to visit a prisoner, whose cell-floor was said to be covered with blood. I found him groaning in bed, and there was certainly a considerable quantity of blood on the cell-floor, in his pot, and on the sheets of the bed. He said that he had passed the blood from his bowels, and that he was in great pain ; but as he was an old malingerer, I was very doubtful about the truth of his statements. Accordingly, I pushed my finger up his rectum, and, on withdrawing it, could discover no signs of bleeding from that quarter; but on examining his nostrils I found abundant evidence as to how the bleeding had been produced. Internal haemorrhoids are often pleaded as a disqualification for being put to the more severe kinds of prison labour. As they sometimes do not exist at all, and, when they do exist, are often made the most of, an examination with the anal speculum is essen¬ tial to a correct diagnosis in each particular case. IV. Feigned and factitious diseases of the urinary system chiefly affect, the following pathological conditions, viz., incontinence, retention, diabetes insipidus, and hsematuria. When a prisoner complains that his urine is constantly dribbling away from him, it is a matter of importance that he should be examined at once, because it very often happens that he has not reckoned upon such examination, and his linen, therefore, will be found dry. But sometimes, having prepared for this contingency, he presents him¬ self with his linen properly soaked, and it then becomes a ques¬ tion whether or not this is owing to incontinence. If he be malin¬ gering, there will be an absence of the disagreeable urinous odour which is always more or less perceptible in the real affection, and the penis and neighbouring parts will not present the characteristic moist and chafed appearance. To clear up any doubts, the mat¬ tress on which he has slept should be examined. Persistent cases should be admitted into hospital for observation, and a catheter passed at an hour when a visit is least expected. If a considerable quantity of urine be drawn off, and if it issue in a tolerably strong jet, there need be little doubt as to the feigned nature of the case, because when incontinence is due to a paralyzed condition of the bladder and consequent over-distention, the urine, unless in recent cases arising from accident, is ammoniacal, and, moreover, it is always associated with some serious form of disease, as paraplegia, apoplexy, fever, etc. As another diagnostic test, a good dose of opium might be administered at bed-time, and the sheets examined towards morning before the patient awakes. In all feigned cases, and when the bed is u wetted” every night, I know of no more