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.

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    become very rare. In prison, I have only seen one case of feigned skin disease, which was, however, limited to the forehead and both cheeks. The cuticle had evidently been rubbed off with a rough towel, and the bleeding, ichorous surface had been well soaped to keep up the irritation. Being satisfied as to the nature of the case, I had the parts carefully washed and dried, and afterwards brushed over with collodion, thereby preventing the patient from tampering without my knowledge. In three days the thin crusts had all cleared away, and the healthy skin appeared beneath. As I have already said, such abrasions as these are sometimes met with in cases of feigned epilepsy, and are produced in order to give the impression that the patient must have fallen daring one of his a fits.” But more frequently they are made on the shin, and attributed to an accident, the patient in this instance stating that he shows the ab¬ rasion thus early lest he should be suspected of tampering witli it in the event of its festering—a result, by the way, which is not at all unlikely if he be not cautioned at the time ; for, generally speaking, the convict who assumes this air of injured innocence is the very fellow who does tamper when he thinks he can do so with impunity. In the vast majority of cases of ulcer that occur in prison, I believe the ulceration is commenced in the first place by producing an abra¬ sion, and afterwards keeping up the irritation by applying soap, lime, whiting, etc. This variety of malingering goes by the name of “fak¬ ing,” and is often resorted to in wounds of all descriptions to prevent them from healing. The factitious ulcer is almost invariably found on the leg, or, less frequently, on the forearm. Its edges are gene¬ rally circular and well defined, without being callous ; its surface healthy-looking when cleaned* while the surrounding skin is natural in appearance, except where ulceration has formerly existed. In short, its distinguishing characteristic is an entire absence of a raison d'etre, so to speak ; its existence being altogether inexplicable,except on the ground of artificial production. Sometimes with the aid of a magnifying glass minute particles of whiting, glass, etc., can be de¬ tected, but usually examination can only decide that both ulcer and dressings are dirtier than they ought to be. The most effectual plan of treatment is to dress the ulcer in such a way that it cannot be tam¬ pered with without discovery, and this mode of dressing should, as far as possible, be adopted with regard to all wounds. Various methods have been proposed, such as sealing the bandages after they have been applied, or painting lines on them, or by enclosing the limb in a wooden box, as first carried out by the late Mr Hutchison. All these have proved more or less serviceable in the detection or prevention of interference, but the plan which I have found to be most efficacious, in a curative as well as preventive sense, is an adaptation of the antiseptic system of treatment, varying it according to circumstances. The first desideratum is to have the wound or ulcer thoroughly cleaned, washed with a carbolic acid lotion, and dried ; then, if it be small and superficial, a coating of
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