quent practice, such skill in feigning this disease, as almost to deceive Foderé; and this, indeed, would have been the case, had he been also able to resist the application of fire. This always recovered him, though he lay apparently without sense, his eyes starting from their orbits, and his mouth foaming. He afterwards confessed that he never counterfeited a paroxysm without feeling for several days a violent pain in the head.* De Haen was consulted by a mother, whose daughter, after being cured of deafness, became epileptic. He directed her to be brought to the hospital at Vienna, where he attended. The fit, which at first did not occur more than once or twice a day, now recurred every hour. It resembled a real one, as the hands were violently clenched, and the eyes disordered; but he suspected deception, for the following reasons: She did not open her eyes, during the paroxysm, with a wink, but in the natural manner; her pulse was natural; when the curtains were drawn, the pupil of the eye was dilated, and when opened, it was contracted, and this last occurred very violently when a candle was presented. Convinced that the disorder was pretended, he ordered her to be taken out of bed, and directed the attendants to keep her in an erect posture. If she fell, they were to chastise her severely. A cure was thus effected; and she confessed that both the deafness and epilepsy were feigned, to avoid going to service. In another case, a female, aged twenty, confined in prison for a murder, had on her the marks of three successive burnings, which she resisted without confessing the deceit. De Haen, and many others, saw her imitate a paroxysm of epilepsy with such horrible accuracy, * Foderé, vol. ii. p. 464. "A case is related of a country boy, who feigned epilepsy, to avoid work. A surgeon was called, who suspected the deceit, and observed to one of the by-standers, that if it was a true fit, as he thought it was, the patient would turn round on his face and bite the grass: this he did, and so betrayed himself. On occasions of this kind, it is proper to examine the mouth for soap, which is easily done by pressing the cheeks against the grinder teeth. I once saw a pseudo-epileptic in Edinburgh, recovered by the simple expedient of calling a police officer." (DUNLOP.) The soap is put into the mouth to produce frothing. that the feigned was supposed to be real, until in the midst of it, being ordered to rise, she got up and walked away. In such an instance, our author recommends the remedy used at Paris. A beggar there, often fell into fits in the street. A bed of straw, through compassion, was prepared, on which he might be laid, to prevent injury to himself. When next attacked, he was laid on it, and the four corners set on fire. He sprang up and fled.* Various substances have been successively applied to detect the imposition, as snuff blown into the nostrils, (and Dr. Hutchison remarks that he had tried this on the real without any effect;) flannel dipped into hot water, and applied to the side; a drop of alcohol poured into the eye, and pouring a small stream of water on the face. Aloes and salt insinuated into the mouth, have broken up a feigned paroxysm.† A few drops of hot water suddenly thrown on the legs, may also recover the individual. It is denied that the peculiar appearance of the eye is always present in epileptics: it has been said to contract. At all events, it is frequently difficult to ascertain its state correctly, and we must attend to other circumstances. If the hands of the real epileptic be forced open, they remain expanded; but the feigned will immediately close them again.§ The contractions also of various parts of the body always come on simultaneously in the real; nor is there any regular period in the return of the fits. Thus, Vaidy, a French surgeon, detected a case by stating to the individual that the real disease always came on in the morning. He swallowed the bait, and the attack always occurred before noon.|| * De Haen's Ratio Medendi, vol. ii. p. 56, etc. Mr. Marshall mentions that a few drops of croton oil were introduced through an opening left by the loss of two teeth, and in a few minutes the pretended epileptic started on his feet, and ran to the water-closet. Medico-Chirurgical Review, vol. iv. p. 598. The impost or cannot, however, render his eyes altogether insensible to light, and if narrowly watched, he will be found to open them occasionally, so as to observe the effect produced on those around him. (MARSHALL.) Marc.; Orfila's Leçons, vol. i. p. 414. || Marshall, p. 178. One fact should be kept in mind respecting this disease: The real epileptic is desirous of concealing his situation, and attaches to it a kind of false shame; while the feigned talks about the disease, and takes no precaution to avoid publicity.* [As epilepsy is often successfully feigned; as it is not always possible to determine satisfactorily the condition of the pupil during the paroxysm; and as the value of the tests for insensibility depends partly upon the period of the fit in which they are applied, a few additional diagnostic signs may not be superfluous. In the feigned, the glottis is not closed, and respiration though impeded is not interrupted, nor does the face become so swollen and livid as in the real, symptoms which cannot be simulated unless with the aid of a ligature round the neck. Simulators cannot feign the general paleness which suddenly occurs at the end of the fit. (Aide Mémoire.) Marshall says, "the liability to epilepsy is not characterized by any external marks;" and Henderson expresses the same opinion. Most authorities, however, agree that the frequent repetition of the attacks gives a peculiar physiognomy, tersely described as "composed of sadness, shame, stupidity and timidity," (Dict. des Sci. Med.) Epilepsy rarely occurs for the first time, after puberty, unless it be the result of injury of the head.-R. H. C.] CONVULSIONS, when feigned, do not present that stiffness of the muscles, or that resistance and rapidity of action, which appear in the real. The treatment must be similar to that of epilepsy. Twenty years ago, says Foderé, I proved, by the aid of fire and force applied to the antagonist muscles, that a woman, who had imposed on a good curate in the Alps, was an impostor. She was supposed to be possessed-fell down apparently without sense, and made frightful contortions. * Dumas of Montpelier, in his work on the Physiognomy peculiar to some chronic diseases, mentions, that in constitutional epileptics, the facial angle is always under 80°, and recedes from that to 70°. He found this to be the case in many instances, at the hospital in Toulouse. (London Medical and Physical Journal, vol. xxvii. p. 38.) She could not, however, withstand the above tests, and rose up, to her great confusion, and the astonishment of the spectators.* In feigned cases, the muscles do not stiffen and contract as in real ones. Hence, continued action of the antagonist ones will develope the fraud. Feigned convulsive action, confined to a particular part, may be exposed by protracted watching. A seaman pretended to have a convulsive motion of the muscles about the neck and upper part of the trunk, so as to produce an involuntary and incessant shrugging of the shoulders. The surgeon set a watch upon him; a mark being made for each shrug. He held out nearly twenty-four hours, and then succumbed.† The following case is reported by Dr. Marshall Hall.‡ A young person of hysteric disposition was bled and soon afterwards became affected with contraction of the fingers into the palm of the hand. Under the idea that the nerve had been wounded, the cicatrix left by the venesection was removed; the spasmodic action of the fingers immediately became relaxed, and their use was restored. By degrees, the spasm returned, and the operation was repeated with the same good effect, less prompt but not less perfect than before. The spasm returned a third time. Dr. Hall now began to suspect that even this strange degree of spasm, during which the nails actually grew into the palm of the hand, was not altogether real. A mock operation was therefore performed; painful incisions were made, the division of a nerve pretended, and it was loudly said, "Now the spasm will cease, and she will open her hand;" and she did open her hand; and when informed of the truth, took care to remain. well. CHOREA is sometimes attempted by mendicants. It would tend to discover the reality of the disease, if we applied the *Foderé, vol. ii. p. 468. Edinburgh Medical and Surgical Journal, vol. xxx. p. 179. A somewhat similar case occurred to Dr. Elliotson; Lancet, N. S. vol. vii. p. 273. See Med.-Chir. Review, N. S. vol. i. p. 385, for a report in detail of this case. suggestion of Darwin-forcing them to make continued and repeated efforts to move the limb in the designed direction. They should be secretly watched. CATALEPSY would most probably seem to be a form of hysteria: at least, this will best explain most of the cases now occurring. Its peculiar characteristics are, that the patient becomes suddenly motionless, while the joints remain flexible, and yet external objects make no impression. In so mysterious a disease, if there be any cause for suspicion, the remedies already indicated should be applied. Dr. Gooch quotes the following feigned case from Mr. Abernethy's Hunterian Ora tion: "A patient in the hospital feigned to be afflicted with catalepsy;—in which disorder it is said a person loses all consciousness and volition, yet remains in the very attitude in which he was suddenly seized with this temporary suspension of the intellectual faculties;-Mr. John Hunter began to comment before the surrounding students on the strangeness of the latter circumstance: and as the man stood with his hand a little elevated and extended, he said, 'You see, gentlemen, that the * The following references to some cases may assist in forming an opinion: Memoirs of Literature, vol. iii. pp. 100, 194. Cases by Deidier. Medical Commentaries, vol. x. p. 242. American Medical and Philosophical Register, vol. i. p. 47. Cyclopedia of Practical Medicine, Art. Catalepsy, by Dr. Joy. Case by Lancet, N. S. vol. vi. p. 277. A case treated by Dr. Duncan, junior, in the Edinburgh Royal Infirmary. Copland's Dictionary of Medicine, Art. Catalepsy. Lancet, N. S. vol. xi. p. 532; vol. xvi. pp. 129, 443; vol. xvii. p. 23cases by Mr. G. Burnett, Mr. Ellis, Dr. Hannay, and Dr. Kelso. Vol. xxii. p. 725, by Dr. Imray; vol. xxxii. p. 633, by Dr. Chowne. American Journal Med. Sciences, vol. xxvi. p. 387. Case by Dr. Isaac Parrish. Encyclographie des Sciences, Medicales, June 1842, (from Gazette Medicale.) Case by Dr. Duvard. |