The perpetual patient

Malingering extraordinaryIn 1872 a case reported in The Lancet made quite a stir in the international journals.  For once, it concerned a patient who was perfectly healthy – although he had spent four years persuading London’s leading doctors that he was gravely ill.  He was regarded as a fraudster and condemned as a malingerer – but this looks a clear-cut case of Munchausen syndrome (also known as factitious disorder), in which an individual feigns illness.  It seems fair to say that this patient would have been treated with rather greater sympathy if he turned up at a hospital today.

The subject was a well-educated and intelligent man of 43. He usually assumed the role of a physician, and generally gave a straightforward history of his case for the time being and of his social antecedents…. He successfully duped eleven of the hospital surgeons and physicians in London, some of them men of eminence. His object in carrying out the deception was never discovered. He passed successively from one hospital to another, remaining sometimes till he was pronounced convalescent, at other times taking sudden leave when suspicion appeared to be aroused to a degree too unpleasant.

He was treated for tetanus, for hemiplegia, and for ingravescent apoplexy, and his imitations of symptoms were so perfect as to entirely blind his medical attendants. He learned at one hospital points in his disease to be improved upon at the next; his tongue was at one time protruded too straight to conform to the paralytic condition he otherwise presented so well; at the next stopping place the lingual deviation was correctly assumed. At one time he suffered from traumatic tetanus, but the surgeons could find no cicatrix about the scalp to recall the alleged fall of forty feet some years before; the next time he has tetanus there is a distinct scar. His temperature arose once to 102° Fah., as it should; it was some time subsequently discovered that he had slyly placed the thermometer bulb near the candle flame when it should have been in his axilla.

At one hospital, doctors pointed out that his abdominal muscles were not as rigid as one would expect to find in a case of tetanus, from which he was supposedly suffering:

He profited by the suggestion, and at the next hospital his tetanus was attended with spasms which made his abdominal muscles “as hard as boards.” Night or day, he never forgot to carry out the simulated symptoms. In one hospital he had tetanus for ten days, and although a carbuncle, which he did not feign, came on the hack of the neck and was freely opened without an anaesthetic, the tetanic opisthotonos was not meantime neglected. Treatment did not discourage him, and the variety of therapeutics to which he was subjected was heroic and was heroically endured. Opium and morphia were administered by the stomach and the rectum and under the skin. Oalabar bean, belladonna, bromide and iodide of potassium, chloroform and hydrate of chloral were given in enormous doses to control his paroxysms. Ice-bags and ether spray to the spine were also duly tried. He was watched with at night by diligent students enthusiastic to study the natural progress of tetanus ; he was made the subject of a clinical lecture on “arachnoid hemorrhage” before a medical class; and the notes of his case in the hospital case-books were always voluminous as the urgency of his disease appeared to demand.

The writer notes that he was particularly cunning to pose as a doctor; this played well.

A medical man, attacked with such grave disease, generally without warning and in the street, and brought to the hospital in a helpless state, called forth special commiseration ; he was given good quarters, usually a private ward, and good food and stimulants were not withheld. On one occasion, he was believed to be incurable; a solicitor was sent for, and the pseudo-doctor made his will, bequeathing a handsome sum to the assistant-physician and to the hospital ; this thoughtfulness on his part resulted in special comforts from the hospital authorities, including the best of wines and of food.

The period of this arch impostor’s performances extended over nearly four years, and under his successive aliases comprised such Hospitals as St. Bartholomew’s, Middlesex and St George’s.

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