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MEDICAL JURISPRUDENCE.

BY W. P. STRICKLAND, M. D., LL. D.,

Professor of Medical Literature and Forensic Medicine in the Eclectic Medical College, of the City of New York.

(Continued from page 156, April, 1880.)

FEIGNED, FACTITIOUS AND LATENT DISEASES-THE MEANS OF THEIR DETECTION.

It is well known that there are persons who find it for their interest to assume the appearance of illness, or to aggravate existing ailments, or even to bring about diseases in themselves. These impostures have been classified as follows: 1. Feigned diseases. 2. Factitious diseases. 3. Exaggerated diseases. 4. Aggravated diseases. Feigned diseases are those which are altogether fictitious. A feigned disease may be converted into a factitious disease.

Diseases may be simulated from a variety of motives: To avoid being compelled to engage in the military or naval service, or to obtain a discharge from the same, or in order to enable the person to obtain a pension. Persons may simulate disease to escape imprisonment or punishment. To these may be added, all those who seek to live on public bounty or charity by exciting compassion. Mendicants have been known to cover themselves with sores and to feign lameness or mutilation. Again, persons not at all in poverty, nor living in a condition of restraint, or liable to be impressed or drafted into service, have been known to assume the semblance of disease from inexplicable motives. Such chiefly belong to the female class, though the number of such cases is small. The wonderful extent of railroad travelling, and the consequent frequency of collisions and other accidents, have been the cause of bringing out an additional class of simulators.

The diseases which are best adapted for the purpose of simulation are those of a chronic kind. The symptoms of these are purely subjective, and produce no sensible disturbance of the system; consequently, the evidence of their existence rests mainly on the veracity of the patient. Other and more obvious diseases may be imitated by swallowing certain drugs, or by the employment of certain applications externally, or by the continued indul gence of certain deleterious habits.

The numerous simulators in the army, not only among the men, but the officers, who, to obtain an extension of sick leave, or to avoid a malarious district, are known to army surgeons, as well as to medical practitioners in civil life. The same will apply to the navy, and are often encountered in hospital, dispensary, medicolegal and private practice. Of the purely feigned diseases, the most common are deafness, dumbness and some of the more occult forms of neuroses, such as neuralgia, spinal irritation, muscular debility, spasm, paralysis, contraction of joints and rheumatism. All of these complaints demand but little cunning in the simulator, and no great self denial on his part. In dumbness, impostors seldom attempt more than ceasing to speak, and in paralysis ceasing to move about. In both cases, suspicion should be aroused from the alleged suddenness and the fully formed or confirmed state of the disease at the outset. In neuralgia and chronic rheumatism, impostors do not admit having any intermission or alleviation of their sufferings like patients thus afflicted, while they are apt to enumerate incompatible symptoms; the same, also, in the case of assumed palsy, so easily affected and so difficult to be detected.

Contraction and rigidity of the large and small joints are often affected by soldiers and mendicants, and some color is occasionally given to the imposture by keeping the limb at rest by bandages, which stop the circulation, until some stiffness and wasting of the muscles ensue; and thus a feigned disease may be converted into a factitious one. This feigned contraction may be converted into a permanent rigidity of the joints by burning a portion of the skin over the flexor tendons. Hæmoptysis has frequently been simulated by first swallowing the blood of animals and ejecting it in the presence of witnesses. Scurvy has also been imitated by picking and irritating the gums. Amaurosis has been imitated by applying belladonna, hyoscyamus or atropine to the eye, to secure the dilatation and immobility of the pupils. A little watchfulness, or a few simple tests, will usually suffice to detect such impostures. To give color to a feigned attack of epilepsy, a ligature has been applied around the neck to induce redness of the face, and soap has been placed in the mouth to imitate froth about the lips, and pricking of the gums to present the appearance of having been

bitten by the teeth. The impostor, in this case, would find it impossible to simulate the fixing or twitching of the eyeballs, the insensibility of the pupils, the perturbation of the heart, rigidity of the muscles, and the insensibility of the skin and the mucous inlets.

In the category of factitious diseases, some of which are also partly fictitious, we find scrofulous and other sores, stiffening and contraction of the joints, diseases of the anus, ophthalmia and cutaneous eruptions. By the help of caustics and other escharotics, sores have been produced, especially on the neck, in imitation of scrofulous ulcers, and also by the application of the juice of euphorbium, to promote the swelling and redness of the eyelids, nose and lips. Ulcers of the legs are frequently produced by mendicants, recruits and old soldiers, by the application to the parts of corrosives or irritants, or by purely mechanical means. Fistula in ano has been artificially produced by first making an incision near the anus, and then irritating it. Ophthalmia has been artificially caused by the application of various irritant substances to the eye. Cutaneous affections have been successfully imitated. Herpetic eruptions have been produced by the use of rotten cheese, mussels, oysters, etc.; and tinea capitis, by nitric acid, applied to the scalp, previously guarded by fatty substances.

The above are a few of the frauds which have been practiced, and the list might be greatly increased; but, instead of completing the catalogue, it will be more important to place the medico-legal jurist in a position to meet and counteract all such impostures by whomsoever attempted. To meet this demand, it is important that he be well acquainted with the different classes of diseases most commonly simulated, as well as with the means resorted to for producing the morbid appearances. The history of the person, by showing whether or not he has an interest in assuming disease, may assist him in coming to a correct decision. He ought also to inquire whether or not the patient has been exposed to the usually exciting cause of the apparent disease. The suspected im

postor ought to be drawn into a full description of his illness, and its origin and progress. In a great majority of cases, it will require more knowledge than is possessed by non-medical persons to give such a narrative as shall be consistent in all its

parts, as there will be either discrepancies or exaggerations, or the symptoms will be such as are incompatible with the assumed

disorder.

Serious diseases are known occasionally to exist in a latent form, with little or no outward manifestation during life, and which can only be detected after death. It is obvious, that a person laboring under disease in this form might readily be treated as an impostor. In the practice of medical jurisprudence, nothing is more common than for the expert to find his opinion and conduct embarrassed by sudden death, by the discovery of appearances in the dead body adequate to accouut for death, yet unconnected with any traces of the existence of corresponding disease during life.

In the list of latent diseases, the following have been enumerated: Apoplexy, cerebral meningitis, cerebral inflammation, pleuritis, pneumonia, pneumothorax, pulmonary tubercle, diseases of the great vessels within the chest, and affections of the abdomen and spine. To some of these the term latent must be applied with considerable latitude; such, for instance, as cerebral meningitis, softening of the cerebral lobes of the brain. The nearest approach to cases that may be assumed as strictly latent are: Fatal disease of the heart, aneurisms of large vessels, and apoplexy. In some cases of sudden death of persons apparently in ordinary health up to the time, it may have been too much to assume that the morbid changes first disclosed at the post mortem examination had been entirely unconnected with any traces of the existence of disease during life. The disease was there, and led to a fatal termination, though its existence was not known. But had the previous physical condition of the persons been intimately known, it might have been found that some warning, however obscure, had been given of the impending event. The medical jurist is warned against the mistake of trusting merely to the discovery in the dead body of appearances sufficient to account for death. Evidence should be taken from a variety of sources, such as derangements of structure incompatible with the continuance of respiration and circulation; the presence of morbid appearances seldom encountered except where death immediately follows; the detecting of symptoms before death corresponding with the appearances discovered at the inspection; the improbability in the case of pre

vious violence, and from the collateral conditions under which latent diseases usually prove fatal. By attending to one or other of these several criteria, an opinion strongly presumptive, if not positive, may be formed on the cause of death in cases coming under the head of latent disease.

(To be continued.)

LETTER FROM THE COMMISSIONER OF EDUCATION.

SALE OF DIPLOMAS.

DEPARTMENT OF THE INTERIOR,

BUREAU OF EDUCATION,

WASHINGTON, D. C., March 26, 1880.

DEAR SIR: I have the honor to invite your attention to the following important letter from the United States minister at Berlin, of the 2d ultimo, and to the communication from the honorable the secretary of state, transmitting the same to the honorable the secretary of the interior, by whom the paper was referred

to me.

The issue of fraudulent diplomas by so called institutions of learning in our country has been brought in many ways, and often, to the attention of this office; the institution named in Mr. White's letter is not the only one of this kind known here.

The accompanying data bring out the character of these disgraceful transactions quite unmistakably. After reading them, I trust that you will co-operate in the detection of the offenders, and the prevention of a practice so injurious to the credit of learning in the United States, and so opposed to the laws and practices of other nations.

Very respectfully, your obedient servant,

To the President of the

JOHN EATON,

Commissioner.

Eclectic Medical College, of the City of New York,

New York, N. Y.

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