Case 467. (Briand and Haury, January, 1916.)

A soldier, 19½, entered the central psychiatric service at Val-de-Grâce, having been evacuated from a hospital in Paris, suspect of having brought about a picric acid jaundice. He had been undergoing treatment in this hospital, when the physician who had isolated him found that he was getting picric acid in packages secreted in his képi.

It seems that the soldier lived with his mother, and enlisted when he was not yet 18. He proved to be as good a soldier as he was workman, and came through the campaign without wound or disease. Accordingly, in December, 1915, he got a six-day leave. His mother, who loved him well, and of whom he was the sole support, had much regretted his enlisting. She was sick with some stomach disease and, after he enlisted, she told everybody that she was going to die and that it was his fault. So, when he came on leave the next day, she asked him to take a powder so he might stay a fortnight. She did not tell him the name of the drug; only told him how to take it in a small paper, swallowing it with a little water. She said he would become yellow and that he would get a supplementary leave. Three days after his return to the front, the boy took three of the ten powders; took the same number three or four days later; and the others five or six days later. He soon had jaundice with colic and diarrhea, and apparently was exempted from service for a few days. He had returned to the front hardly a month when his mother died and the boy got another six-day leave for the funeral. He took ten fresh doses of picric acid while at Paris, and was put into hospital by a physician without suspicion. His relatives thought he was suffering from a recurrent jaundice. When the story was told, the boy confessed to the family, and said that he had taken the drug in the first place only to please his mother. It is harder to explain the second trial, since he talked about the compassion and sense of obedience he felt to his dead mother. It is probable that he simply wanted a prolonged leave at Paris.

Re malingering, Blum speaks of fictitious jaundice as having received the name of La Carotte (the carrot) from the soldiers. Blum gives a partial list of instances of simulation as follows:

SIMULATION

(Blum, December, 1916)

False angina, from irritating solution.

Gastric disorder. Oil and tobacco (with tachycardia or jaundice) (use ipecac).

Diarrhea. (Isolate.)

Diarrheal stools imitated by a mixture of urine and water.

Dysenteric stools imitated by the addition of fat pork and bits of raw meat.

Appendicitis. Complaint of pain at the well-known McBurney point.

Tape worm. Carriers supply others.

Jaundice. (Smoke mixture of antipyrin and tobacco; drink tobacco juice. Ingest picric acid.)

Hemoptysis. Irritation of throat surfaces with a needle.

Albuminuria. Eat kitchen salt to excess in a bowl of milk. Edema and albumin disappear on surveillance. Albumin injected into bladder.

Diabetes. Phloridzin, or oxalate of ammonia. Glucose added to urine.

Incontinence. (Difficult to prove fraudulent. True incontinence in middle of night. Simulated, just before waking.)

Skin diseases:

Impetigo. With cantharides plaster and pomade stibiée.

Intertrigo. (In the infantry.)

Hyperidrosis of feet. Prolonged hot baths. Hot foot baths with excoriation, followed by scratching and covering with linen soaked in urine.

Edema of legs. Constriction.

(In Lombardy, cases due to introduction of equisetum arvense, an astringent herb, by fingers and toes, followed by energetic rubbing.)

Recurrent wounds. (Cover with wax sealed bandages.)

Abscesses. Introduction of septic material. A thread soiled with tartar from teeth is drawn through the skin. Characteristic odor of resulting abscess.

Phlegmons. Subcutaneous introduction of turpentine or petrol.

Paraffine tumors. (Apply heat.)

Sprain. A stopper is put under the heel; or compress the leg with bandages to stop circulation and knock below repeatedly and forcibly. Edema and ecchymosis follow.

Conjunctivitis. Ipecac, pepper, septic or fecal materials. Pupillary dilatation has been produced by introduction of a belladonna grain under the eyelid daily.

Ears. Running at the ears produced by placing urine or chemical product in the ear.

Emaciation and pallor. Ingestion of a large amount of vinegar. Abuse of strong tobacco.

Muscular weakness. Arsenious acid in eggs. Voluntary lead and mercurial intoxications.

Epilepsy. Absence of pupillary reflex to light and pupillary dilatation, insensibility of nasal mucosa and modifications of pulse persistent after the attack is over cannot be imitated.

Fever. Striking elbows against walls to elevate the mercury in the thermometer. Take temperature by rectum.

Bites. One simulator had a fork with twisted teeth to produce the effect.

Intra-abdominal projectiles. Bullet swallowed.