Doubtful accounts by patient concerning arm palsy: Incorrect diagnosis of simulation.
Case 455. (Voss, November, 1916.)
A volunteer, 18, just before the war had a fall in which apparently he injured his skull. In December, 1914, he hurt his left forearm. About this injury he sometimes said he fell in a storming attack in a trench and broke his arm, and again he said his arm had been smashed by stones from a falling house. From that time forward there was paralysis of the left forearm with flexor contracture. May, 1915, slight hypesthesia could be demonstrated on the ulnar side of the arm, suggesting ulnaris injury. There were, however, no considerable electrical changes.
Six months later the man was sent up with a suspicion of simulation. In the meantime the contracture had resolved and there was a typical hysterical paralysis with all signs of neurosis. Six months later he was well enough to be examined for military service.
Here was a case in which the incorrect data offered by the patient himself as to the origin of his paralysis gave rise to the suspicion of simulation, whereas, as a matter of fact, the man was clearly hysterical.
Re incorrect data supplied by the patient to his own disadvantage, Lumsden remarks on the great difficulty of diagnosis in cases where hysteria and malingering have been combined, and Morselli states that, if the doctor has really made up his mind that the man is shamming, he should send him back to the fighting line at once.