The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).

Date:: 1849-59

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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$been intentionally produced. The proof will rest eometiines on the nature of the wound, sometimes on the circumstances under which it is stated to have occurred, and sometimes on other collateral circumstances. In the case of a soldier or sailor it will often be a matter of grreat importance to the individual, that the decision come to is the true one; as it will frequently have the effect of ob- taining for him his discharge from the service, and perhaps a pension, or of depriving him of both advantages, and perhaps entailing punishment also. In forming his opinion of the probability of the wound being self-inflicted, the surgeon will be guided by the consideration of the nature and extent of the wound, its situation, the nature of the alleged cause, &c. For instance, if the wound be of such a kind as renders it improbable that the patient either could or would have in- flicted it; if it be of great extent and more than sufficient to effect the object the perpetrator may be supposed to have had in view,—if it be in a part of the body to which the patient's hands, or an instrument wielded by him, could not have reached, —the probability certainly is that it is accidental. On the other hand, if these circumstances are re- versed, and if the mode in which it is stated to have occurred is improbable or impossible,—if the alleged cause or instrument is ill calculated or not at all calculated to produce the effect,—the sur- geon will be more disposed to regard it as volun- tarily inflicted. The examination of collateral circumstances will often atlbrd more positive evi- dence than grounds of a merely medical kind. The following case affords an example of both kinds of evidence. A seaman on board one of His Majesty's ships lopped off two of his fingers with an axe upon a post, in the fore part of the ship termed the manger, and in the confusion of the moment left them there. He then ran down into the hold, and uttering a piercing cry rushed on deck, exhibiting his mutilated hand, and assert- ing that he lost his lingers by the accidental col- lision of two water-casks. Here the character of the wound sufficed to disprove the truth of the al- leged cause;—no collision of casks could produce so clear a wound, or so complete an amputation ; still more certain evidence, however, the man's own stupidity afforded ; for shortly after his two fingers were found on the manger, and lying near them the axe which had divided them. The improbability or even impossibility of a ivound being inflicted by the patient himself, is, however, no certain proo' that it has not been in- flicted intentionally ; snice the unhappy men have been known, like the ancient Romans, to assist each other in the perpetration of this partial sui- cide. Instances of this kind have been mentioned to us both in the army and navy; the wounds be- ing produced both by fire-arms and cutting instru- ments. During the late war we remember an in- stance of a father cutting off one of his son's fingers to prevent him serving in the militia. There was a young convict on board the hulk for boys at Chatham, not long since, who placed his right arm over a space between two beds, and got a companion to strike the forearm with a long piece of wood. Both the bones were thus frac- tured ; and ever, after the arm had been put up in splints, he found means to displace the bones, and thereby prevented a perfect union. [See a table of feigned, pretended, simulated or excited diseases or disqualifications in the writer's Dictionary of Medical Science, 4th edit. p. 303, Philad. 1844.] In concluding this article, we cannot dismiss from our minds the possible impression it may leave on the minds of junior medical officers in the public service ; whom we would guard, on the one hand, if possible, from suffering a spurious humanity to be detrimental to the interests of the army or navy, and, on the other, with even more anxiety, from the vain desire of acquiring tempo- rary consideration by a stubborn and cruel incre- dulity, or by an affected shrewdness in detecting imposture where no imposture may exist. There are cases mentioned in the preceding part of this article, which show, indubitably, that the simulation of disease has frequently been prac- tised without the existence of any interested mo- tive, indeed without motive of any kind; that there is, in short, a species of monomania of which this simulation is the characteristic. Such cases may occasionally be remembered with ad- vantage. But there is another consideration equally wor- thy of being entertained by all who do not wish the common feelings of a man to be lost in those of a mere disciplinarian. For notorious malin- gerers we are in no degree disposed to plead; but when instances of deception become frequent, in any countr}^, in any garrison or station, in any regiment, or in any ship of war, the question may very reasonably present itself—is there not some- thing wrong in the arrangement of the place, in the government or administration of the particular portion of the community in which such frequent deceptions are resorted to; — something which, acting injuriously on the bodies or the minds of the men, is therefore not beneath the c!onsidcra- tion of the medical officers of the establishment, who alone can appreciate the mischief, and by whose mediation alone it is likely to be remedied ' The privilege conferred by their profession, of be- ing the fric;ids of mankind, is one which ought not to be willingly resigned. The negro-slave, and the conscript of an impe- rial conqueror, may be equally placed beyond the pale of such considerations; but the British sol- dier or sailor ought never to be so ; even the con- vict is not shut out from mercy. The condition of both soldiers and sailors has, during late years, been much ameliorated ; and deceptions are less frequent both in the army and navy than of old. These amendments in their condition have often arisen out of the representations of enlightened and humane medical superintendents. Wherever, therefore, we repeat, the instances of imposture are numerous,—wherever these manifestations of discontent are frequent among men whose gene- ral characters afford an assurance that in ordinary circumstances they would not jm-for pain and pri- vation to duty ; the circumstances in which such opposite and desperate resolutions are taken, should undergo the most scrupulous and fearles'i investigation. Such a duty is enjoined by ar,$