Malingering and feigned sickness / by Sir John Collie... assisted by Arthur H. Spicer.

  • Collie, John, Sir, 1860-1935.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Malingering and feigned sickness / by Sir John Collie... assisted by Arthur H. Spicer. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    morning, that his appetite was bad, that he had sleepless nights, and that he passed matter from his bowels. He gave his age as forty-seven, but looked older, and apparently had a large family, ranging in age from twenty-six to three and a half years. Examination.—He was well nourished, his eye was bright, his skin clear, and circulation good. He held his back stiffly. In the course of the examination he allowed considerable movement of the lumbar spine; but when picking up his boots at the close of the examination, he did so by kneeling on the ground and going through contortions which were quite unnecessary, considering his own statements with regard to his back. The stiffness in the cervical region was, however, a definite symptom, and an X-ray photograph of that region of the spine, taken at my instigation, showed definite ankylosis between the fourth and fifth cervical vertebrae. This was due to a definite organic lesion known as spondylitis deformans—a disease of slow progress, which chiefly affects manual labourers past middle age. It is generally associated with similar changes in other joints. In this case there was a certain amount of osteo-arthritis, a similar con- dition, in one of the claimant's shoulders. The relationship of this condition to injury is always an extremely difficult one to determine ; it often occurs in patients in whom there is no suggestion of injury, but occasionally it appears to follow a defiiiite injury. In this par- ticular instance it appeared to have reached its highest development in an area of the spine (cervical) remote from the part injured, which, according to the history of the case, was the lower part of the spine. The claimant's account of himself and his condition was full of inconsistencies, and we believed his account of many of his symptoms to be distinctly exaggerated. Whether he suffered from traumatic neurasthenia, as alleged, immediately after the accident, three years and eight months previously, it was difficult to say, having regard to the lapse of time; but it appeared extremely improbable that any patient, after suffering so long from severe traumatic neurasthenia, should look so well as this man did at his examination. It appeared to be a case where spondylitis deformans had gradually developed during a long period of rest, and commenced about the same time as the injury occurred. There was no real evidence to connect the condition of the back with the injury, beyond the fact that the one was observed after the beginning of the other; but it would be almost impossible to say that the injury had no influence whatever upon the condition of the back. It would also be impossible to say whether, had he resumed work when he was first asked to undertake light work, the oncoming of the present condition of the back might not have been very considerably delayed. He was not now capable of doing a good day's work at his former occupation, partly on account of his back, and also because of the irregular and loafing habits acquired during the last three years. He probably realized this, and, in order to retain his compensation, exaggerated such symptoms as did exist, and introduced others for which no physical foundation could be discovered.