APPENDIX TO BOOK V.
As no better opportunity is likely to occur, we shall in this place give a short notice of two subjects connected with medical practice, which are entirely omitted by our author.
ON FEIGNED DISEASES, AND THE DETECTION OF THEM.
Galen, we believe, is the only ancient author who has treated professedly of the detection of simulated diseases. He begins his short treatise on this head with remarking, that persons feign diseases from various motives, and that it is expected the physicians should detect such impostures. That, for example, inflammation, erysipelas, and œdema, when produced artificially, ought to be distinguished from the same diseases when they originate in constitutional causes. He adds, that hæmoptysis, hæmatemesis, and bloody discharges from the bowels, are often simulated. Hæmoptysis is simulated by opening a vein in the gums, and sucking blood from it while one affects to cough. Others, he says, affect dementia, fatuity, and insanity, all which cases the vulgar expect that the physician should detect. Inward pain, such as that of colic, he had often known to be simulated, and relates briefly an interesting case in point. He remarks, that experience and natural sagacity will enable a man to expose all impositions of this nature. He gives a very interesting account of the manner in which he detected the nature of a swelling at the knee, that had been produced intentionally by the juice of thapsia (thapsia garganica, deadly carrot?) Feigned inward pains, he remarks, may often be distinguished from the real by the aversion which the malingerer discovers to swallow medicines, which he would be anxious to have given him if he were actually in acute pain; and adds, that the state of the pulse, and the other symptoms of intestinal diseases, will assist in making the detection. (Quomodo coarg. sint qui fing. se Ægrot. t. iii, 388, ed. Basil.)
ON PROFESSIONAL IMPOSTORS.
Rhases has an interesting chapter on this head. The frauds of impostors, he says, are more numerous than could be contained in his whole work. Some of them, he adds, pretend to be able to cure epilepsy, and having made a crucial incision in the back part of the head, they extract from the wound something which they hold in their hands, and thus impose upon people. Others, in like manner, cause it to be believed that they extract a small lizard by the nostrils. Some of these characters, he says, make it be believed that they remove films from the eye, by secretly introducing a small membrane into the eye, and taking it out again. Others manage to create a belief that they suck water from the ear with a reed. Others also make it be believed that they extract worms from the ears or teeth. Others practice a trick by which they obtain the credit of extracting the ranula below the tongue. Why should I mention those, he adds, who introduce pieces of bone into wounds and ulcers, and afterwards extract them? He says, it is not uncommon for these impostors to sound a man for the stone, pretend to find one, perform the operation, and exhibit a calculus which they themselves had introduced secretly into the incision. Others pretend to cure piles, make incisions about the anus, and form ulcers there which did not exist before. Certain of them affect by scarifications and other means to suck the vitreous humour from the hip-joint, while they exhibit something of the kind which they themselves have introduced. There are some who undertake to collect all the infirmities of the body into one spot, and then extract them; for this pretended object they raise an itching and violent heat in some place by means of alkekengi (winter cherry); and having accomplished this they exact a fee for removing the uneasiness from the spot, which they do by anointing it with oil. There are others who will make a man believe that he has swallowed hairs, glass, or the like; and then tickling his throat with a feather, and making him vomit, they exhibit the substance in question as if it had been brought up. Thus, he adds, they often do much mischief, and sometimes are guilty of culpable homicide. He concludes by warning sensible people to be upon their guard against such wretches. (Ad Mansor. vii. 27.)