actually present, but where the symptoms are falsely aggravated, and greater sickness is pretended than really exists. This may be more difficult of detection in some respects; and it requires, like the cases above noticed, the skill of the physician experienced in the history of disease, to guide aright.

Several classifications of feigned diseases have been suggested. Thus Marc proposes to arrange them under the heads of imitated and produced diseases; (par imitation et par provocation.) The authors of the article on this subject in the Cyclopedia of Practical Medicine, say that they are referable to four groups: feigned, or altogether fictitious; exaggerated; factitious, being wholly produced by the patient, or with his concurrence; and lastly, aggravated, or real possibly at first, but intentionally increased by artificial means.

It is not necessary to notice them under either of these divisions at the present time. I propose to mention the principal diseases that have been feigned, somewhat in the usual nosological order, and to state under each the most approved mode of detection.

FEVER may be induced by the use of various stimulants, such as wine, brandy, cantharides, etc. It is often assumed when a disease is suddenly necessary, to avoid military requisitions, or the performance of work in prisons. Foderé states that he has observed a feverish state of the system induced intentionally by violent exercise; and then calling for the physician, has noticed the patient imitating the cold fit to admiration. Dr. Cheyne was sent for to a soldier, who was said to be in the chill of an intermittent. He found him shaking violently; but on throwing off the bedclothes, he was seen, not in the cold, but in the sweating stage, produced by his exertions. Of all cases of feigned fever, it may be remarked that they are ephemeral. A day or two's examination generally develops the deceit, as a frequent repetition of the use of stimulants is too hazardous, and real disease might then be the consequence. In doubtful cases, the remarks of Dr. Hennen should be remembered: "Neither the quickness of

the pulse, nor the heat of the skin, are infallibly indicative of the presence of fever; and therefore it is, that the state of the tongue, stomach, and stools, and of the senses, should be most particularly attended to."* And even these require close examination. In a soldier under Dr. Cheyne, where great complaint was made of pain in the chest, etc., the tongue was of a dry, white appearance, made so by rubbing it with whiting from the wall. When washed with tepid water, it was clean and moist. Dr. Hutchison saw a French prisoner with an extremely small and rapid pulse; his tongue was covered with a brown coating, the eighth of an inch thick, and withal he was vomiting. The smell alone of the ejections proved that he had swallowed tobacco; and on removing the matter from the tongue, it was found to be common brown soap. After this, he recovered in a few hours. Chalk, pipe-clay, brick-dust, flour, have all been used for coating the tongue. I may also add, that those feigning intermittents, often pretend that the chill comes on during the night. This is a very uncommon circumstance in ordinary practice.†

[When fever is simulated, the intermittent type is usually selected. The rigors may be well imitated, but the other stages of the paroxysm do not follow in due order and proportion. Gingerbread and extract of liquorice have been used to change the appearance of the tongue. As an exception to the rule, that factitious fevers are ephemeral, the case of a woman under my care at Bellevue Hospital, N. Y., in 1839, may be cited. In order to secure the comforts of that institution, this woman drank, from time to time, portions of her urine, and asserted that there was none secreted or voided. The symptoms thus produced, were those of advanced typhus, though her body and breath exhaled an urinous odor. Her bedding was dry and clean, and the catheter failed to detect any accumulation of urine. At times her condition seemed

*Hennen, p. 198. "Scrubbing the skin with a hard brush, gives a flush difficult to distinguish from the color caused by fever, and only to be detected by waiting patiently by the bedside until it subsides." (DUNLOP.) † Marshall, p. 110.

critical, at others, her health was nearly restored; but it was not till after repeated relapses, that her imposture, early suspected, was fully demonstrated.-R. H. C.]

DISEASES OF THE HEART. The pulse is sometimes found extremely weak, and occasionally none is perceived at the wrist. Should deceit be suspected, the physician may examine whether ligatures have not been applied to interrupt the. pulsation, and he should also ascertain whether the arteries beat at the corresponding extremity. I am indebted to my late worthy preceptor, Dr. M'Clelland, of Albany, for a case illustrating this point. During the period of his attendance at the Royal Infirmary in Edinburgh, a person applied for and obtained admission, on the score of ill health, who had formerly been a patient there. The attending physician examined the pulse at the right wrist, but found none; he then tried the left, but with similar success. The trick was carried on for several days; at the end of which time it was discovered that the patient was in sound health, but that whenever the pulse was to be examined, he pressed his finger on the artery under the armpit.*

Ligatures have sometimes been applied, to produce the appearance of aneurism of the heart, or great vessels. In two cases in France, they were found tightly bound round the

"I have seen a gentleman, who, by the exertion of the muscles of the arm and thorax, could stop the action of the pulse at the wrist; but in so doing, he required to call into action all the muscles of the arm: so that, should a malingerer attempt this, the cheat would be easily discovered by feeling the arm above the elbow. There was a preparation in the museum of Mr. Allan Burns, and which I believe is at present in the possession of my friend Mr. G. S. Pattison, of Baltimore, U. S., where a slip of muscle passed across the humeral artery, and impeded its action. On inquiry being made, it was found that the subject had been a servant-girl; and though strong and healthy in other respects, she could never, for any length of time, pump a well or switch a carpet.

"In the army hospital, where I have been accustomed to skulkers of all kinds, whenever I suspected a man of deceiving me as to his pulse, I felt it at the temporal or carotid artery, under the pretext of saving him from the trouble of taking his arm from under the bedclothes." (DUNLOP.)

neck; one was so fine that it was almost hidden by the folds of the skin. The countenance was terribly swollen and livid; but on removing the ligatures from the neck, and in one instance also from the top of each arm, this purple and swollen state of the face disappeared, and the irregular action of the heart ceased.*

[Many persons can diminish the force of, or even stop the pulse at the wrist, by taking a full inspiration and dropping the shoulder with the arm and elbow close to the side. A tight coat will aid in this imposture. In examining the pulse of persons dressed, my habit is, to support the elbow and carry it from the body. Some persons have in health an intermittent pulse. PALPITATION may be excited by strong compression of the abdomen with a bandage or waistbands of skirts or trowsers; and it is said that hypertrophy may be thus induced. Hennen relates a case of violent palpitation produced by the man's own efforts, (Mil. Surg. ;) and it may also be caused by tea or coffee in excess. The circulation may be excited by various stimulants, or depressed by arterial or nervous sedatives, such as digitalis and American hellebore. The former are easily detected; the latter have distinctive characteristics, and frequently endanger life. Artificial means so violent as to simulate aneurism, hypertrophy, or pericarditis, will, if continued, produce those diseases. (Gavin.) In this class of cases, examine the heart and chest by percussion and auscultation.-R. H. C.]

Internal remedies have also been used to produce palpitation and derangement of the functions of the heart. The powder of white hellebore was thus applied, at first, by a man who had lived with a veterinary surgeon. He not only produced the disorder in himself, but sold his secret and his drugs to others, so that many in the same corps (the marine artillery) were affected with it, and in consequence invalided, before the deception was discovered.† Garlic, tobacco, and other irritating

Scott, Cyclop. Prac. Med., vol. ii. p. 138.

"At the General Hospital at Chatham, this was lately practiced to a great extent. The mode employed was, to take fifteen grains of hellebore,

substances, introduced into the rectum, have been known to cause violent palpitations and fever.*

CONSUMPTION. This is sometimes feigned by men desirous of obtaining a discharge. They complain of pain in the chest, and cough, produce emaciation by abstinence and drinking vinegar; and mix up the expectoration, it may be of catarrh, with puriform matter obtained from others, and tinge it with blood from the gums.† It requires, however, only a proper acquaintance with the phenomena of the real disease, and a sufficiently prolonged examination of the case, to detect it. Patients recovering from catarrh or bronchitis, may simulate the symptoms of consumption. The history and the physical signs will suffice for a correct diagnosis.

HEPATITIS, in its chronic form, is very frequently simulated by those who have been long in the East or West Indies. They are often able to enumerate most of the symptoms correctly. Marshall relates the case of a recruit who referred the pain to the left side. He was cured by the mistura diabolica. These cases, however, require close examination as to the pulse, local enlargement, secretions, and excretions; and, above all, mercury (says Dr. Cheyne) should never be given in any doubtful case. The course of salivation is what is most desired by the malingerer.‡

PAIN, whether simulating neuralgia, rheumatism, lumbago, or affections of the hip and knee joints, is the symptom of dis

which produced great excitement, and which was maintained by taking four grains daily. The practice was introduced by a man who had been servant to a veterinary surgeon. One man took an overdose, and died in consequence."-DUNLOP. [Others would have died but for the employment of remedies, and the frequency with which the drug is adulterated.”—R. H. C.]

* Dr. Cheyne expresses his conviction that many soldiers have the power of quickening their pulse, when they expect a visit. Thus he has found the beats as frequent as 120 or 130 in a minute; and on returning unexpectedly in a quarter of an hour, they were reduced 30 or 40. Seamen sometimes produce this temporary quickness, by knocking their elbows against a beam. † Marshall, p. 120. Cheyne, p. 173.