Pain : its causation and diagnostic significance in internal diseases / by Rudolph Schmidt ; translated and edited by Karl M. Vogel and Hans Zinsser.

  • Rudolf Schmidt
Date:
1908
Catalogue details

Licence: In copyright

Credit: Pain : its causation and diagnostic significance in internal diseases / by Rudolph Schmidt ; translated and edited by Karl M. Vogel and Hans Zinsser. Source: Wellcome Collection.

    22/354 (page 18)
    Simulation.—Experience shows that intense and persistent pain in the course of time nearly always leads to more or less serious disturbances in the con- dition of the body as a whole, so that disorders of nutrition are produced and loss of weight results. In some cases, therefore, systematic observations of the patient’s weight may serve as a means of control in this regard. When paroxysmal pain is complained of, the determination of the blood pres- sure by means of the tonometer [or, preferably, the sphygmomanometer] is to be recommended in sus- pected cases. This should be done both in the in- terval when the pain has subsided and at the height of the paroxysm. From analogy with the labora- tory experiment of stimulating the sciatic nerve an elevation of the vascular tension during the paroxysm is to be expected, and in fact this phe- nomenon may often actually be observed. In deal- ing with patients suspected of malingering I would suggest that if pain is complained of on pressure, the size of the pupils be observed in order to detect any possible increase in dilatation that may follow the painful stimulus (sympathetic reflex). If this reflex is present there is no doubt of the veracity of the patient in stating that he is experiencing pain. It is advisable, however, to obtain some insight into the patient’s susceptibility to reflexes of this sort by the production of an artificial pain, e.gby pinch- ing. Theoretically, this procedure even offers the possibility of obtaining an insight into the intensity of the original pain by observing the degree of