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MALINGERING OR FEIGNED DISEASES                                   421

tioner should not, however, approach every case of accident with a suspicious
mind, as owing to financial anxiety from insecurity of compensation the
injured workman may develop anxiety neurosis which is likely to prejudice
his recovery to a great extent.


Malingering or shamming a disease or injury or exaggerating its effects
is very common in India and is usually practised by soldiers or policemen to
evade their duties, by prisoners to avoid hard work, by persons to evade
legal responsibility for their criminal conduct, by workmen to claim com-
pensation under the Workmen's Compensation Act, or by beggars to excite
the sympathy of charitable people. Similarly, an assaulted person tries to
aggravate the effects of injuries or simulates them when he has none, so as
to mislead the medical jurist. A medical practitioner who has any experi-
ence of medico-legal or police work in India must have come across such
cases of feigned diseases and injuries.

The number of diseases shammed by a malingerer is legion. Ophthal-
mia, dyspepsia, intestinal colic, diabetes, spitting of blood, ulcers, burns,
feigned abortion, rheumatism, lumbago, neurasthenia, nervous diseases, such
as aphasia, sciatica, vertigo, headache, epilepsy, insanity and paralysis of the
limbs, and feigned bruises and injuries of the internal organs, are very com-
mon. In some cases it is quite easy to find out the deception, but in others it
is difficult to find out whether an individual is shamming or not. In such
cases the medical practitioner should bear in. mind the following hints before
he decides the question of malingering : 

1.    Keep the patient under observation and have him carefully watched
without his knowledge.

2.    Pay him several unexpected visits before you decide on the case.

3.    Hear patiently the history of the case and compare the symptoms, if
they refer to a particular disease or a group of diseases, and find out if there
are any discrepancies in his description of the symptoms of the disease which
he simulates.

4.    Have all the bandages and dressings removed.   An injured person
often goes to a medical man with the application of turmeric (haldi) on the
body.   It should be thoroughly washed and wiped out to ascertain if there
are any abrasions or bruises on the body.

5.    Try to find out the motive of deception in each case.

6.   Be  chary in giving credence to the story of the bystanders  or
relatives of the malingerer.

7.    Examine each and every organ carefully and thoroughly,

8.    Suggest in the presence of the patient some heroic method of treat-
ment, such as the application of an actual cautery or some severe operation.
In one case, where an assaulted man pretended aphasia, he started speaking
when he was laid down on the operating table and a big amputation knife
was shown to him to open his skull to find out the injury on his brain.   I
have often succeeded in making the malingerers admit their deception by
applying strong currents of electricity or Liston's long splint, or by adminis-
tering some nasty drug, such as castor oil, etc.

9.    Administer an anaesthetic, if necessary.