IMAGE EVALUATION TEST TARGET (MT-3) & 1.0 I.I 1^12^8 |2.5 |50 '■^" ■■■ i^ 12.2 UUL. 1.8 1.25 1.4 1.6 ^ 6" — ► V] / /A Photographic Sdences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 972-4503 ^^ & Ua CIHM/ICMH Microfiche Series. CIHIVI/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / lns*titut Canadian de microreproductions historiques Technical and Bibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. □ Coloured covers/ Couverture de couleur I 1 Covers damaged/ Couverture endommag^e □ Covers restored and/or laminated/ Couvertuz-e restaurde et/ou pelliculie □ Cover title missing/ Let! D D D n D tre de couverture manque I I Coloured maps/ Cartes giographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) I I Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Reli6 avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La re liure serrie peut causer de I'ombre ou de la distorsion le long lie la marge intdrieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajout4es lors d'une restauration apparaissent dans le texte. mais, lorsque cela 6tait possible, ces pager n'ont pas M filmdes. Additional comments:/ Commentaires supplimentaires; L'Instltut a microfilm^ le meilleur exemplaire qu'il lui a M possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mithode normale de filmage sont indiquAs ci-dessous. I I Coloured pages/ n Pages de couleur Pages damaged/ Pages endommagies Pages restored and/oi Pages restaur^es et/ou pelliculdes r~~l Pages damaged/ r~l Pages restored and/or laminated/ ~7| Pages discoloured, stained or foxed/ i—J Pages dicolor^es, tacheties ou piqudes I I Pages detached/ Pages ddtach^es Showthrough/ Transparence Quality of prir Qualiti indgale de {'impression Includes supplementary materit Comprend du matdriel supplementaire Only edition available/ Seule Mition disponible I I Showthrough/ I I Quality of print varies/ I I Includes supplementary material/ r~~~| Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont M filmies i nouveau de faqon d obtenir la meilleure image possible. This item is filmed at the reduction ratio checked below/ Ce document est filmd au taux de reduction indiqu6 ci-dessous. 18X 22X 10X 14X 26X 30X J 12X 16X 20X 24X 28X J 32X The copy filmed here hee been reproduced thenke to the generosity of: Medical Library IMcGili University IVIontreal The imeges sppeering here ere the beet quelity possible considering the condition end legibility of the originsi copy end in keeping with the filming contrsct specifications. L'exempiaire film* f ut reproduit grice A la g^nArositi de: IVIedical Library McGill University IVIantreal Lee images suivantes ont iti reproduites avec le plus grsnd soin, compte tenu de la condition et de la netteti de I'exempleire filmi, et en conformity avec lee conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the beck cover when appropriate. All other originel copies are filmed beginning on the first psge with a printed or illustrsted impree- sion, end ending on the laet pege with e printed or illustreted impression. Lee exemplelree orlglneux dont ia couverture en pepier eet imprim^e sont filnite en commenpant par le premier plet et en terminent soit per ia derniAre pege qui comporte une empreinte d'Impression ou d'iilustration, soit par le second plat, salon le caa. Tous lee autres exempieires orlginaux sont film6s en commenpant par ia pramlAre page qui comporte une empreinte d'Impression ou d'iilustration et en terminent par la derniAre pege qui comporte une telle empreinte. The last recorded frame on eech microfiche shell contein the symbol — ^(meening "CON- TINUED"), or the symbol y (meeninti "END"), whichever epplies. Un dee symbolee suivsnts spperettra sur la dernlAre imege de cheque microfiche, selon le cee: le symbols — ► signifie "A SUIVRE", le symbols y signifie "FIN". IMeps, pletee, charts, etc.. mey be filmed at different reduction retioe. Those too lerge to be entirely included in one exposure ere filmed beginning in the upper left hend corner, left to right and top to bottom, aa many framee ae required. The following diagrame llluatrate the method: Lee cartes, plenches, tableaux, etc.. peuvent Atre filmte it dee taux de rMuction diff Arents. Lorsque ie document est trop grand pour dtre reproduit en un seul cllchA. 11 est film* A psrtir de Tangle supArieur gauche, de geuche d droite. et de heut en bee, en prenent ie nombre d'imeges nteesseire. Les diagrammes suivants illustrent ie mithode. 32X 1 2 3 1 2 3 4 5 6 ^^r ■ Sat/.-. *i'-- If? SOajE CASES OF EEIGNED ERUPTIONS. FRANCIS J. SHEPHERD, M.D., CM., SursMh to tka Mamr«il Gcnwral Hoapital; Lecturer on DiieaMs ol the Skin, McGill Univeraiiy. RlFRIMTBD raOM THK JOURNAL OP CVTANBOUS ANP GBNtTO-UmNAaV DlSBASBS^ For Dicrmbrr, 1897. •ii! «fij_ -J f MEDICAL FACULTY, McGILL ■k .c \ iH [Reprinted from Journal op Cutaneous and Genito-Urinary Diseases, December, 1897.] SOME CASES OF FEIGNED ERUPTIONS.* By FRANCIS J. SHEPHERD, M.D., CM., Surg:eon to the Montreal General Hospital ; Lecturer on Diseases of the Skin, McGill University. THE simulation of various diseases has been resorted to in every age, and by all classes of society. When the pur- pose is to avoid conscription, work, or duty, the simulator is usually a male ; when to excite sympathy and interest, or to obtain notoriety, a female. In some cases the malingering or simulation is apparently motiveless. Of course, mendicants from time immemo- rial have simulated diseases which are peculiarly abhorrent to the pass€ir-bv, such as sloughing ulcers, running sores, scabs, contract- ures, etc, but this is for the purpose of provoking pity and charity. In some cases, since the introduction of railways and modern machinery, persons simulate nervous symptoms and spinal injuries for the sake of obtaining compensation, and this, when obtained, results in a permanent cure. A remarkable case of simulation of disease has lately been exposed in France. A man simulated loco- motor ataxia so perfectly that the great Charcot and many other prominent Parisian physicians were deceived. He went from hos- pital to hospital, and, finally, was sent to Notre Dame de Lourdes, where he was miraculously cured, and was kept as an example of what our Lady of Lourdes could do, to the mortification of many member.? of the medical profession. However, he was detected committing a theft of money from his spiritual doctors and they > Read before the Twenty-first Annual Meeting of the American Dermato- logical Association. a Some Cases of I'eigned Eruptions. had him arrested. He then confessed everything-, including the fact that he had been shamming, and that the miracle of cure was performed by himself. Mania is another form of disease which is often simulated, and is sometimes most difficult to detect. The fact that skin diseases are often feigned is well recognized, and in some cases the deception is so clever that the fraud may for a long time go undiscovered, especially if the patient falls into the hands of medical men who have no sense of humor, for such are easily imposed upon. The common forms of eruption which are simulated are the erythematous, bullous, and vesicular, for these are easily produced by irritants, such as Spanish fly, mustard, acids, etc., and repeated applications of such unguents, as pointed out by the late Dr. Hilton F^gge, give rise to appearances which differ from those we are ac- customed to see as the result of the use of the same substance as a local remedial agent. Heat and friction with the fingers are often made use of to pro- duce lesions of the skin. According to the late Mr. Startin, tartar- emetic ointment has been used successfully to simulate lupus. Local gangrene, which has been called erythema gangrenosum, spontaneous circumscribed gangrene, etc., according to the late Dr. Tilbury Fox, is always the result of artificial production. He says repeated applications of nitric acid or Spanish fly will cause gan- grene, or, first, the application of Spanish fly, and on top of this nitric acid. It is well known to surgeons that the heat produced by a rubber bottle filled with hot water will produce gangrene of the skin in patients whilst unconscious from ether. One of the cases reported below is an example of the spontaneous gangrene, and, taking all things into consideration, although no absolute proof was forthcoming, the case is doubtless one of feigned eruption. It goes without saying, that it is most important to have a knowl- edge of real disease in order to detect a simulated one. The fact that most of these feigned eruptions differ from any known skin disease, both as to their situation, symmetry, and common appear- ance, together with the looks, history, and general conduct of the patient, must lead any intelligent and observing practitioner to suspect the fraud. That there is no known cause for the deception, or that no benefit can accrue to the simulator, goes for nothing. To excite interest and draw attention to herself is a sufficient induce- ment to a hysterical woman, I am inclined to believe that, on Some Cases of Feigned Eruptions. 3 account of the large audience, cases are seen more frequently in the public clinics than in private practice. In the two cases of large bullous eruptions of the cheeks, I omitted to test the acidity of the fluid, and so lost the opportunity of deciding whether or no the lesions were produced by an acid. Mr. Startin {Brit. Med. Jour., January 8th, 1870) relates a case where he detected a fraud by getting an acid reaction of the bullous contents with litmus paper. Case I. Gangrenous Patches of Skin on the Arms. — Amelia B., aet. 30, a servant employed in the Montreal General Hospital, was brought to me by the lady superintendent in July, 1890, and was said to be suffering from a peculiar eruption of the skin, which had been coming out for the previous week or ten days. The erup- tion was on the back of both hands and forearms, and consisted of a number of circular patches about the size of a lo-cent piece. Some of the patches were quite dry, hard, and gangrenous, and of an al- most black color; others were shiny, and of a dead yellowish color, and quite insensitive; and some, again, were merely red and in- flamed. Around the edges of each patch was an inflammatory areola, and a slight line of demarcation was already beginning to form. In some of the patches a number of concentric rings could be made out very distinctly, looking as if they were produced by a metal disk. I at once said that the eruption had been produced artificially, but the patient indignantly denied it, and the people in authority over her scouted the idea. I said no more patches would appear if she were carefully watched and a bandage put over her hands and arms. She was admitted into one of the wards, and the hands and arms covered, first with absorbent cotton, then with a dextrine bandage. At the end of a week the bandages were re- moved and no fresh spots were seen ; some of the old ones had dis- appeared, and in others the sloughy skin had come away, leaving superficial ulcers, which soon healed. The lesion was evidently pro- duced by the bottom or cover of some metal box, or other similar article, heated to a high temperature. The object of the trick I could never discover, unless it was to get off her work. Apparently she was not in any way hysterical. Case II. — Elizabeth B., aet. 44, a sturdy, thick-set woman, with a stolid appearance, was employed as cook on a large dairy farm near the city of Montreal. Came to my skin clinic July 4, 1894, complaining of troublesome blisters on the cheeks. She said that, it being the haying season, she was pressed against her will into the field work, and all the previous day was loading 4 So file Cases of /■'ci^iKu/ Uruptions. hay. The weather being very hot, she sweated a good deal, and frecjuently wiped her face with her apron. vShe said there was milk- weed and poison-ivy in the hay, ond to this she attributed the con- dition of her face. Her face was (piite well when she went to bed, but on awaking in the morning it was all red and swollen, her eyes Fi