Volume 1

Internal medicine : a work for the practicing physician on diagnosis and treatment with a complete desk index / by Nathaniel B. Potter, James C. Wilson.

  • Nathaniel Bowditch Potter
Date:
[1919]
Catalogue details

Licence: Public Domain Mark

Credit: Internal medicine : a work for the practicing physician on diagnosis and treatment with a complete desk index / by Nathaniel B. Potter, James C. Wilson. Source: Wellcome Collection.

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    unconscious, or may have lost the power of speech. The history com¬ municated by his friends is often uncertain and misleading. Persons of the lower classes are very commonly indifferent to symptoms which are not painful or disabling and lack the ability to describe their sensations. Many persons, on the other hand, often intentionally, sometimes uncon¬ sciously, make false statements in regard tq their past life and present symptoms. Some parts of the narrative are exaggerated, others suppressed. Symptoms may be imitated and superficial lesions artificially produced. Hence a group of feigned diseases, against which the physician must be upon his guard. Malingering.—The term malingerer is used to describe one who in¬ tentionally simulates a disease. Malingering occurs in every grade of life and under various circumstances. It is to be suspected when a simulated disease lacks essential symptoms or its picture is overdrawn, and when there is lack of correspondence between the alleged symptoms and the actual signs or the obvious general health; it is to be detected by close study of the case under various conditions, by the use of instruments of precision, and in some cases by the application of powerful faradic currents or an examination under anaesthesia. The over-indulged child, to avoid his lessons or escape punishment, may feign an illness; an older person, to excite compassion or from mere love of deception. It is common among beggars, sailors and soldiers, those improperly seeking pensions, and claim¬ ants against corporations for accidental damages. The simulation of disease is, however, not always intentional. Hysterical and neurasthenic individuals sometimes exaggerate symptoms or imitate the manifestations of disease without purpose or intention—the unconscious mimicry of disease. There are those, on the other hand, who from motives of delicacy or shame, or in consequence of natural reserve, or from fear of having their apprehensions confirmed, refuse to consult the physician, or when forced to do so give a garbled and incomplete history of their sickness. This may occur among those suffering from venereal diseases or chronic diseases popularly regarded as incurable, as tuberculosis and cancer. The diagnosis of an obscure case occasionally demands an investiga¬ tion of the surroundings of the patient at the time of the development of the illness. Time may be required to ascertain etiological conditions relating to his food, drink, occupation, endemic influences, or exposure to transmissible diseases locally epidemic. Questions' of this kind frequently arise at a period like the present, when facilities for commercial intercourse are increasing and when military operations and the exigencies of trade have greatly extended travel to all parts of the world. Repeated examinations may be necessary in order to obtain accurate impressions when the physical signs are obscure or ill defined. Excessive subcutaneous fat, local oedema, or general anasarca may interfere with the physical exploration; or local tenderness, intense pain, great restlessness, or an unwillingness on the part of the patient to submit to an examination may give rise to delay. In other cases the unusual character of the symp¬ toms or an association of clinical phenomena not previously encountered may render repeated examinations necessary. During the stage of invasion in the acute febrile infections a positive diagnosis is often impossible.
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