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BRADFORD MEDICO-CHIRURGICAL SOCIETY.
BRADFORD MEDICO-CHIRURGICAL SOCIETY.
1652
1 the excellence of anaesthesia in America. The Mayo blood. Such a discussion was futile, because it depended to I Clinic was not typical of all American practice, for that on both. The discussion was postponed until the next meeting ofsurgical centre stood high above everything else in the the section. and from what he had seen in the other places that ! States, he had visited in America the anaesthesia was not up to the standard obtained in the hospitals of London. He thought SECTION OF ANSTHETICS. that the surgeon interfered with the anaesthetist far more in The Administration of Anaesthetios in Anaericcz. America than in London. Open ether was given (and given A MEETING of this section was held on Dec. 6th, Dr. J. well) at the Mayo Clinic for everything. He did not know whether the freedom from ether bronchitis was due to the BLUMFELD, the President, being in the chair. Dr. MAY DICKINSON BERRY read a paper entitled Notesdry climate of America, but with regard to this point it must be remembered that the class of case dealt with at the Mayo on the Administration of Anaesthetics in America," the Clinic was different from the hospital cases on this side, for of which referred to observations made a greater part during recent visit to the Mayo Clinic at Rochester, Minnesota. She frequently patients had to travel hundreds of miles to get said : There are four anaesthetists at the Rochester Hospital there, and so they did not get the horrible pulmonary cases who are all nurses specially trained in anaesthetics. Operations that London hospitals got. Dr. J. F. W. SILK laid stress on the fact that the type of go on every morning in four theatres simultaneously. The method of anasthesia used is exclusively open ether. The patient at the Mayo Clinic was not that of the usual face-piece employed is.a modified Esmarch covered with two hospital patient. Dr. LLEWELYN POWELL spoke of the benefit of studying layers of stockingette, which after the first minute or two of induction is loosely surrounded by folds of gauze bandage. the methods of other countries, and pointed out that Ether is dropped on, slowly at first, then more rapidly, from although we might be able to learn a lot from the Americans the pound or quarter-pound tins in which it is supplied, by about open ether, they could learn a lot from us about other The anaesthetics, and said that the American surgeons would means of a pledget of cotton-wool fitted into a cork. to minutes is in about five after probably be very glad to have such a body of skilled eight operation begun The patient anaesthetists at their disposal as the London surgeons had. the commencement of the anaesthetic. Dr. C. CARTER BRAINE discussed the responsibilities of is rarely so deeply under as to show no reaction when the first cut is made, and throughout the opera- nurse-ansesthetists, seeing that they were not medically tion, especially if this is abdominal, it is usual to qualified. Mr. PATERSON considered that we had learnt more from see a lighter anaesthesia maintained than is generally .clemanded over here. Large abdominal retractors are used the Americans than they had learnt from us, and he did which probably render deep anaesthesia unnecessary. The not think that open ether was given as well in this country - anaesthetists, however, always have their patients well under as it was in America, where they practised a drop method ,control j there is never vomiting or actual struggling. The of administration. From a fortnight’s inquiry amongst patient’s condition is generally excellent. There has never practitioners and patients in America he had become con.been a death due to the anaesthetic at the hospital ; after- verted to the open method of giving ether, and now thought sickness is usually slight, and ether bronchitis is stated to be that it was not right to give chloroform except in rare Ether is given for all operations, including instances. unknown. Mrs. BERRY replied, amplifying the experiences and .goitre, simple or exophthalmic, cleft palate, tonsils and .adenoids, and even for small operative proceedings where impressions dealt with in her paper. Mr. W. DE COURCY PRIDEAUX, dental surgeon of Weynitrous oxide would have seemed sufficient. The amount of ,ether used is small ; for operations lasting from 30 to 50 mouth, sent for inspection a Face-piece designed for patients ,minutes 4 oz. are the usual quantity. In one goitre operation bereft of many teeth. lasting 43 minutes only 2 oz. of ether were used. Commenting on points of difference in the administration of anaesBRADFORD MEDICO-CHIRURGICAL thetics in America compared with our own methods, Mrs. Berry the small use is that in made of chloroform ; emphasised very SOCIETY. some hospitals it is almost prohibited. Another noteworthy point was the little use that is made of the eye-reflexes. The President’s 8 inaugural Address. eyes are almost everywhere left covered by protective tissue and are never referred to. With regard to the position of anaesA MEETING of this society was held on Nov. 14th, Dr. thetists in America, it was stated that medical practitioners F. W. EURICH, the President, being in the chair. After thanking the society for having elected him President, who practise anaesthetics as a specialty are comparatively in in the EURICH said that he wished that the only surviving but eastern Dr. are few, number, especially increasing cities. Many hospitals employ nurses who not infre- original member of the society, Dr. D. Goyder, could quently have been trained at Rochester, preferring a specially reoccupy the chair and do full justice to the history and traditions of the society during its 50 years existtrained nurse to a comparatively untrained house surgeon. Mr. H. J. PATERSON showed some photographs of the ence. He referred next to the late Mr. R. H. Meade, the late Dr. A. Bronner, sen., and the late Dr. J. H. Bell, administration of open ether as done in America. The PRESIDENTcommented on the "light"anaesthesia men whose pioneer work had placed the society on its mentioned by Mrs. Berry, and pointed out that such present firm basis. Much of the work done in the society anaesthesia would not be satisfactory for surgeons in this was bound to have but an ephemeral interest, but the value country. He did not think that much skill was required to of the clinical cases cited, and of the facts then newly discovered and recorded, remained undiminished. Two produce the light anaesthesia that had been described. Mr. H. BELTJA1BIY GARDNER asked if there was any increased influences had been, and still were, inimical to the progress haemorrhage with open ether in aclenoid and cleft palate of medicine-armchair speculation and dogma. The former operations, as this fact seemed to militate against open ether was disappearing ; the latter remained, more perhaps amongZ) in this country. He thought that the London surgeons were the laity than in the profession. In primitive times belief allowed to have their way much too far with regard to the in a Godhead was almost universal, and disease was Relaxation of the believed to be a punishment for sin, and penance to the relaxation of the abdominal muscles. abdominal muscles should never be attempted, and was presiding deity was necessary before the disease could be unnecessary if proper abdominal retractors were used. In stayed. Hence the healing art fell into the hands of the this country there was still need for a consensus of opinion priesthood ; and the dogma of the supernatural causation of as to the best form of anaesthesia in particular classes of disease prevented any serious advance in medical knowcases. ledge. Hippocrates was the great liberator of the art of Dr. A. L. FLEIIIIING thought that the opinion long held medicine from priestly dogma. He believed in the natural in this country, but now dying out, that deep anaesthesia causation of disease and upon that his fame rested. For pievented shock, had been a handicap, and answerable for 2000 years no progress of note occurred, though observations many of the accidents which had happened. It would be a made for the 500 years following his death were collected by great gain if there eventuated out of this discussion some Galen. Galen had a less profound belief in the natural causation of disease. In the Middle Ages the priests annexed ,opinion as to the safety of light anaesthesia. Mr. GEORGE E. GAS1B: differed from Mrs. Berry with regard the beliefs of Galen, and medicine again became shackled ____
EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
1653
by dogma. Not until dissection became allowed could from the effects of disease. Such cases were rare however. Galen’s infallibility be attacked. Morgagni, an Italian, a 2. Cases in which, after an accident, a disease which had clinician as well as a morbid anatomist, laid the foundation existed prior to the accident was said to have been due to of pathology. Morgagni’s methods embraced a wider field the accident. This was more common than the former, and than mere morbid anatomy, and were still applicable, even in many cases these were difficult to diagnose. He had met to the few remaining diseases of which the pathology was with cases as club-foot, old-standing facial paralysis, oldyet unknown. Certain mental diseases could be analysed standing ear disease, old scar in cornea, epilepsy, &c. correctly only by the correlation of clinical material by the The patient might know that he had the condition which he physician, and yet they still came under the sway of dogma. attributed to the accident or he might not know this until For insanity and criminal responsibility were still decided the time of the accident. These cases afforded great scope Only the medical mind could realise for difference of opinion. 3. The patient after an accident, upon by laymen. that the exercise of the will could and must under injury, or illness exaggerated his condition and did not all circumstances find expression through the medium of the recover as one would have expected. These were the common brain alone, and that the manifestations of the personality cases which gave rise to so much difficulty. If it paid a could move within the limits of what we call the normal, patient to be oft work or if he wanted a holiday there was only if that medium, the brain, were normal also. We were little inducement to get well. Such were cases of The patient was partly deceived. It what we were by virtue of the sum total of the sensory valetudinarianism. the that had reached brain. Freud’s methods of was most to get the litigation settled as soon as impressions important psycho-analysis had shown that even forgotten events of possible, because in many perfectly genuine cases recovery did childhood could exert influences in later life alII.ost not take place until the case was settled. It was of the impossible to estimate. How were these difficult matters to greatest importance to distinguish partial malingering from And yet the legal valetudinarianism, and yet it was very difficult. be decided if not by medical men ?‘! It was profession was still inclined to hold to the dogma of the impossible to say when a patient was able to return to work. absolute responsibility of many persons whom physicians If there was no question of compensation the man might go knew to be insane. In criminal trials two decisions had to back to work too soon. The diagnosis and detection of be arrived at, first the guilt of the prisoner, properly decided malingering must be based on (1) medical examination and by the jury, and secondly the degree of his guilt, the proper opinion; and (2) on collateral non-medical evidence. The function of the judge. This latter function should be shared success of a malingerer depended on his competence to simuby the alienist and the student of criminal anthropology. late the real disease, and fortunately, as a rule, malingerers Dr. Eurich believed that the whole punitive system was were not skilled in this art. A careful medical examinabased upon principles fundamentally unsound. The tion must be made in order to exclude organic disease, and educational possibilities in punishment were its only this was often a very difficult question, especially in nervous justification, and any system of punishment which was the cases, and even in non-compensatior. cases. Many real expression of the vengeance of society was doomed to failure. diseases existed, as aneurysm or angina pectoris, where He prophesied the time when the only sentences of courts it was impossible to detect them by examination. Dr. would be indeterminate segregation, during which time the Bramwell referred to the value of electrical tests, use of prisoner would work out his own salvation, and his educa- chloroform, X ray, ophthalmoscopic examination, &e. tion, guidance, and occupation would be left in the hands of As regarded collateral evidence one had to lay traps for the educationists and of medical men of special training and malingerer, but often great difficulty was met with in experience. The connexion of science as a whole with man certifying certainly that a patient was a malingerer, and as a whole made both the difficulty and the glory of medical if so, one also incurred a great and grave responsibility. work. The development of social medicine had been one As regarded the procedure advisable, in order to detect and of the great advances witnessed during the lifetime of the prevent malingering under the National Insurance Actsociety, but even now, while medical help was invoked for 1. Exhaustive examination by the ordinary medical attendant the physical care of school children, doctors were not often (panel doctor). In giving a certificate great care must be permitted to have any say in the hygiene of their minds. exercised in making the statement, and one must avoid the Since suffering was the punishment of imperfection, suffering use of the term malingerer. 2. The panel doctor must be there must always be ; but it was a medical man’s privilege protected, and this could be done in doubtful cases by an to minister to it, and by doing so to increase not a little the examination and report by a specialist who was not on the sum of that happiness to which mankind was called. panel and whose opinion should be unbiased and independent of the result. 3. If necessary, prolonged observation in hospital. In Germany the patient may be obliged to EDINBURGH MEDICO-CHIRURGICAL go into hospital. 4. There should be a time limit for money SOCIETY. compensation in cases of neurasthenia and other conditions in which there was no evidence of organic disease. Dr. GEORGE MACKAY said that true malingering was not Malingering. A MEETING of this society was held on Dec. 14th, Dr. so common in eye diseases, as the organ was so delicate that the malingerer did not dare to interfere with it much. BYROM BRAMWELL, the President, being in the chair. A discussion on Malingering was introduced by the Excessive blinking in children, sailors, or soldiers was PRESIDENT. He said that a malingerer might be de- generally overacted. In compensation cases the assumption fined as one who feigned sickness or who knowingly often was of partial or total blindness ; it might be that one and wilfully exaggerated his condition. He said that the eye had been lost and that subsequently the vision of the "unconscious malingerer"could not exist, for there was remaining eye had become poor. A careful examination of the eye could be easily made. - The reaction of the pupH no such condition. As regarded those who were malingerers, the largest number came from sailors, soldiers, prisoners, might reveal the fact that the case was one of true schoolboys, conscripts, hospital patients, hysterical young malingering. The employment of prisms, coloured spectacles Since the intro- to read complementary coloured types, &c., women, club patients, and criminals. might often duction of the Workmen’s Compensation Act cases of reveal the malingerer. In neurotic individuals the vision malingering had become much more common. In his might even be suppressed. work on’’ Diseases of the Spinal Cord"" (1$95 edition), he Sir THOMAS S. CLOUSTON said that from the psychological had said regarding concussion of the cord that injuries to the point of view malingering was most interesting. Itwas back in pitmen which had led to concussion of the cord were almost a primary instinct to malinger ; many insects feigned rarely followed by that train of symptoms which was so death to escape observation ; wild ducks played lame to often seen after railway accidents. Now his experience protect their eggs or young. Amongst nervous patients in the medical wards had showed him that the most frequent especially did we meet with malingering. As a lunacy form of malingerer occurred in colliers who had been expert, he had found it often not easy to determine whether injured in this way and they now suffered from traumatic prisoners were malingering or not. Melancholic patients neurasthenia. He thought that when the National Insurance exaggerated their symptoms in order to appear more iusane. Act came into force ordinary cases of illness would form a Nervous patients might honestly simulate disease or large proportion of malingerers. As regarded variety and z, exaggerate their symptoms, and, indeed, might really prodegree of malingering we had : 1. Perfectly healthy persons duce real nervous disease, and thus we might find them who feigned disease or who affirmed that they suffered I suffering from true organic disease. Aq ,.
I’
A
1652
1 the excellence of anaesthesia in America. The Mayo blood. Such a discussion was futile, because it depended to I Clinic was not typical of all American practice, for that on both. The discussion was postponed until the next meeting ofsurgical centre stood high above everything else in the the section. and from what he had seen in the other places that ! States, he had visited in America the anaesthesia was not up to the standard obtained in the hospitals of London. He thought SECTION OF ANSTHETICS. that the surgeon interfered with the anaesthetist far more in The Administration of Anaesthetios in Anaericcz. America than in London. Open ether was given (and given A MEETING of this section was held on Dec. 6th, Dr. J. well) at the Mayo Clinic for everything. He did not know whether the freedom from ether bronchitis was due to the BLUMFELD, the President, being in the chair. Dr. MAY DICKINSON BERRY read a paper entitled Notesdry climate of America, but with regard to this point it must be remembered that the class of case dealt with at the Mayo on the Administration of Anaesthetics in America," the Clinic was different from the hospital cases on this side, for of which referred to observations made a greater part during recent visit to the Mayo Clinic at Rochester, Minnesota. She frequently patients had to travel hundreds of miles to get said : There are four anaesthetists at the Rochester Hospital there, and so they did not get the horrible pulmonary cases who are all nurses specially trained in anaesthetics. Operations that London hospitals got. Dr. J. F. W. SILK laid stress on the fact that the type of go on every morning in four theatres simultaneously. The method of anasthesia used is exclusively open ether. The patient at the Mayo Clinic was not that of the usual face-piece employed is.a modified Esmarch covered with two hospital patient. Dr. LLEWELYN POWELL spoke of the benefit of studying layers of stockingette, which after the first minute or two of induction is loosely surrounded by folds of gauze bandage. the methods of other countries, and pointed out that Ether is dropped on, slowly at first, then more rapidly, from although we might be able to learn a lot from the Americans the pound or quarter-pound tins in which it is supplied, by about open ether, they could learn a lot from us about other The anaesthetics, and said that the American surgeons would means of a pledget of cotton-wool fitted into a cork. to minutes is in about five after probably be very glad to have such a body of skilled eight operation begun The patient anaesthetists at their disposal as the London surgeons had. the commencement of the anaesthetic. Dr. C. CARTER BRAINE discussed the responsibilities of is rarely so deeply under as to show no reaction when the first cut is made, and throughout the opera- nurse-ansesthetists, seeing that they were not medically tion, especially if this is abdominal, it is usual to qualified. Mr. PATERSON considered that we had learnt more from see a lighter anaesthesia maintained than is generally .clemanded over here. Large abdominal retractors are used the Americans than they had learnt from us, and he did which probably render deep anaesthesia unnecessary. The not think that open ether was given as well in this country - anaesthetists, however, always have their patients well under as it was in America, where they practised a drop method ,control j there is never vomiting or actual struggling. The of administration. From a fortnight’s inquiry amongst patient’s condition is generally excellent. There has never practitioners and patients in America he had become con.been a death due to the anaesthetic at the hospital ; after- verted to the open method of giving ether, and now thought sickness is usually slight, and ether bronchitis is stated to be that it was not right to give chloroform except in rare Ether is given for all operations, including instances. unknown. Mrs. BERRY replied, amplifying the experiences and .goitre, simple or exophthalmic, cleft palate, tonsils and .adenoids, and even for small operative proceedings where impressions dealt with in her paper. Mr. W. DE COURCY PRIDEAUX, dental surgeon of Weynitrous oxide would have seemed sufficient. The amount of ,ether used is small ; for operations lasting from 30 to 50 mouth, sent for inspection a Face-piece designed for patients ,minutes 4 oz. are the usual quantity. In one goitre operation bereft of many teeth. lasting 43 minutes only 2 oz. of ether were used. Commenting on points of difference in the administration of anaesBRADFORD MEDICO-CHIRURGICAL thetics in America compared with our own methods, Mrs. Berry the small use is that in made of chloroform ; emphasised very SOCIETY. some hospitals it is almost prohibited. Another noteworthy point was the little use that is made of the eye-reflexes. The President’s 8 inaugural Address. eyes are almost everywhere left covered by protective tissue and are never referred to. With regard to the position of anaesA MEETING of this society was held on Nov. 14th, Dr. thetists in America, it was stated that medical practitioners F. W. EURICH, the President, being in the chair. After thanking the society for having elected him President, who practise anaesthetics as a specialty are comparatively in in the EURICH said that he wished that the only surviving but eastern Dr. are few, number, especially increasing cities. Many hospitals employ nurses who not infre- original member of the society, Dr. D. Goyder, could quently have been trained at Rochester, preferring a specially reoccupy the chair and do full justice to the history and traditions of the society during its 50 years existtrained nurse to a comparatively untrained house surgeon. Mr. H. J. PATERSON showed some photographs of the ence. He referred next to the late Mr. R. H. Meade, the late Dr. A. Bronner, sen., and the late Dr. J. H. Bell, administration of open ether as done in America. The PRESIDENTcommented on the "light"anaesthesia men whose pioneer work had placed the society on its mentioned by Mrs. Berry, and pointed out that such present firm basis. Much of the work done in the society anaesthesia would not be satisfactory for surgeons in this was bound to have but an ephemeral interest, but the value country. He did not think that much skill was required to of the clinical cases cited, and of the facts then newly discovered and recorded, remained undiminished. Two produce the light anaesthesia that had been described. Mr. H. BELTJA1BIY GARDNER asked if there was any increased influences had been, and still were, inimical to the progress haemorrhage with open ether in aclenoid and cleft palate of medicine-armchair speculation and dogma. The former operations, as this fact seemed to militate against open ether was disappearing ; the latter remained, more perhaps amongZ) in this country. He thought that the London surgeons were the laity than in the profession. In primitive times belief allowed to have their way much too far with regard to the in a Godhead was almost universal, and disease was Relaxation of the believed to be a punishment for sin, and penance to the relaxation of the abdominal muscles. abdominal muscles should never be attempted, and was presiding deity was necessary before the disease could be unnecessary if proper abdominal retractors were used. In stayed. Hence the healing art fell into the hands of the this country there was still need for a consensus of opinion priesthood ; and the dogma of the supernatural causation of as to the best form of anaesthesia in particular classes of disease prevented any serious advance in medical knowcases. ledge. Hippocrates was the great liberator of the art of Dr. A. L. FLEIIIIING thought that the opinion long held medicine from priestly dogma. He believed in the natural in this country, but now dying out, that deep anaesthesia causation of disease and upon that his fame rested. For pievented shock, had been a handicap, and answerable for 2000 years no progress of note occurred, though observations many of the accidents which had happened. It would be a made for the 500 years following his death were collected by great gain if there eventuated out of this discussion some Galen. Galen had a less profound belief in the natural causation of disease. In the Middle Ages the priests annexed ,opinion as to the safety of light anaesthesia. Mr. GEORGE E. GAS1B: differed from Mrs. Berry with regard the beliefs of Galen, and medicine again became shackled ____
EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
1653
by dogma. Not until dissection became allowed could from the effects of disease. Such cases were rare however. Galen’s infallibility be attacked. Morgagni, an Italian, a 2. Cases in which, after an accident, a disease which had clinician as well as a morbid anatomist, laid the foundation existed prior to the accident was said to have been due to of pathology. Morgagni’s methods embraced a wider field the accident. This was more common than the former, and than mere morbid anatomy, and were still applicable, even in many cases these were difficult to diagnose. He had met to the few remaining diseases of which the pathology was with cases as club-foot, old-standing facial paralysis, oldyet unknown. Certain mental diseases could be analysed standing ear disease, old scar in cornea, epilepsy, &c. correctly only by the correlation of clinical material by the The patient might know that he had the condition which he physician, and yet they still came under the sway of dogma. attributed to the accident or he might not know this until For insanity and criminal responsibility were still decided the time of the accident. These cases afforded great scope Only the medical mind could realise for difference of opinion. 3. The patient after an accident, upon by laymen. that the exercise of the will could and must under injury, or illness exaggerated his condition and did not all circumstances find expression through the medium of the recover as one would have expected. These were the common brain alone, and that the manifestations of the personality cases which gave rise to so much difficulty. If it paid a could move within the limits of what we call the normal, patient to be oft work or if he wanted a holiday there was only if that medium, the brain, were normal also. We were little inducement to get well. Such were cases of The patient was partly deceived. It what we were by virtue of the sum total of the sensory valetudinarianism. the that had reached brain. Freud’s methods of was most to get the litigation settled as soon as impressions important psycho-analysis had shown that even forgotten events of possible, because in many perfectly genuine cases recovery did childhood could exert influences in later life alII.ost not take place until the case was settled. It was of the impossible to estimate. How were these difficult matters to greatest importance to distinguish partial malingering from And yet the legal valetudinarianism, and yet it was very difficult. be decided if not by medical men ?‘! It was profession was still inclined to hold to the dogma of the impossible to say when a patient was able to return to work. absolute responsibility of many persons whom physicians If there was no question of compensation the man might go knew to be insane. In criminal trials two decisions had to back to work too soon. The diagnosis and detection of be arrived at, first the guilt of the prisoner, properly decided malingering must be based on (1) medical examination and by the jury, and secondly the degree of his guilt, the proper opinion; and (2) on collateral non-medical evidence. The function of the judge. This latter function should be shared success of a malingerer depended on his competence to simuby the alienist and the student of criminal anthropology. late the real disease, and fortunately, as a rule, malingerers Dr. Eurich believed that the whole punitive system was were not skilled in this art. A careful medical examinabased upon principles fundamentally unsound. The tion must be made in order to exclude organic disease, and educational possibilities in punishment were its only this was often a very difficult question, especially in nervous justification, and any system of punishment which was the cases, and even in non-compensatior. cases. Many real expression of the vengeance of society was doomed to failure. diseases existed, as aneurysm or angina pectoris, where He prophesied the time when the only sentences of courts it was impossible to detect them by examination. Dr. would be indeterminate segregation, during which time the Bramwell referred to the value of electrical tests, use of prisoner would work out his own salvation, and his educa- chloroform, X ray, ophthalmoscopic examination, &e. tion, guidance, and occupation would be left in the hands of As regarded collateral evidence one had to lay traps for the educationists and of medical men of special training and malingerer, but often great difficulty was met with in experience. The connexion of science as a whole with man certifying certainly that a patient was a malingerer, and as a whole made both the difficulty and the glory of medical if so, one also incurred a great and grave responsibility. work. The development of social medicine had been one As regarded the procedure advisable, in order to detect and of the great advances witnessed during the lifetime of the prevent malingering under the National Insurance Actsociety, but even now, while medical help was invoked for 1. Exhaustive examination by the ordinary medical attendant the physical care of school children, doctors were not often (panel doctor). In giving a certificate great care must be permitted to have any say in the hygiene of their minds. exercised in making the statement, and one must avoid the Since suffering was the punishment of imperfection, suffering use of the term malingerer. 2. The panel doctor must be there must always be ; but it was a medical man’s privilege protected, and this could be done in doubtful cases by an to minister to it, and by doing so to increase not a little the examination and report by a specialist who was not on the sum of that happiness to which mankind was called. panel and whose opinion should be unbiased and independent of the result. 3. If necessary, prolonged observation in hospital. In Germany the patient may be obliged to EDINBURGH MEDICO-CHIRURGICAL go into hospital. 4. There should be a time limit for money SOCIETY. compensation in cases of neurasthenia and other conditions in which there was no evidence of organic disease. Dr. GEORGE MACKAY said that true malingering was not Malingering. A MEETING of this society was held on Dec. 14th, Dr. so common in eye diseases, as the organ was so delicate that the malingerer did not dare to interfere with it much. BYROM BRAMWELL, the President, being in the chair. A discussion on Malingering was introduced by the Excessive blinking in children, sailors, or soldiers was PRESIDENT. He said that a malingerer might be de- generally overacted. In compensation cases the assumption fined as one who feigned sickness or who knowingly often was of partial or total blindness ; it might be that one and wilfully exaggerated his condition. He said that the eye had been lost and that subsequently the vision of the "unconscious malingerer"could not exist, for there was remaining eye had become poor. A careful examination of the eye could be easily made. - The reaction of the pupH no such condition. As regarded those who were malingerers, the largest number came from sailors, soldiers, prisoners, might reveal the fact that the case was one of true schoolboys, conscripts, hospital patients, hysterical young malingering. The employment of prisms, coloured spectacles Since the intro- to read complementary coloured types, &c., women, club patients, and criminals. might often duction of the Workmen’s Compensation Act cases of reveal the malingerer. In neurotic individuals the vision malingering had become much more common. In his might even be suppressed. work on’’ Diseases of the Spinal Cord"" (1$95 edition), he Sir THOMAS S. CLOUSTON said that from the psychological had said regarding concussion of the cord that injuries to the point of view malingering was most interesting. Itwas back in pitmen which had led to concussion of the cord were almost a primary instinct to malinger ; many insects feigned rarely followed by that train of symptoms which was so death to escape observation ; wild ducks played lame to often seen after railway accidents. Now his experience protect their eggs or young. Amongst nervous patients in the medical wards had showed him that the most frequent especially did we meet with malingering. As a lunacy form of malingerer occurred in colliers who had been expert, he had found it often not easy to determine whether injured in this way and they now suffered from traumatic prisoners were malingering or not. Melancholic patients neurasthenia. He thought that when the National Insurance exaggerated their symptoms in order to appear more iusane. Act came into force ordinary cases of illness would form a Nervous patients might honestly simulate disease or large proportion of malingerers. As regarded variety and z, exaggerate their symptoms, and, indeed, might really prodegree of malingering we had : 1. Perfectly healthy persons duce real nervous disease, and thus we might find them who feigned disease or who affirmed that they suffered I suffering from true organic disease. Aq ,.
I’
A