nection with the chloral, will be found of service. If hypodermically administered, not less than gr. should be given. Small doses only excite the patient, and do more harm than good. Hydrobromate of hyoscine has some advocates. The milder hypnotics, such as sulfonal, chloralamid, etc., are not to be thought of in these cases; they are practically inert, and do no good.—Lancet-Clinic, June 22, 1895.

IN diarrheal affections of adults and children the observation is frequently made that after due attention has been paid to the regulation of diet and to intestinal antisepsis, the profuse discharges, nevertheless, continue. In these cases an astringent is indicated, and among the numerous remedies of mineral and vegetable character suggested for this purpose, tannic acid and the vegetable tinctures of which it forms the essential ingredient occupy a prominent place. It has often been objected to the use of tannic acid that it induces nausea and gastric disturbance, or increases these if, as often happens, they already be present. This objection is certainly well founded, since it has been shown by experiments that it exerts an irritant and even mildly caustic effect upon mucous membranes. Another objection that applies with even greater force to the employment of tannic acid as an intestinal astringent, is that being soluble in the stomach juices, the larger portion is absorbed before it reaches the affected portion of the intestinal canal. Professor Meyer of Marburg, therefore, deserves much credit for his discovery of a tannic acid derivative known as Tannigen, which passes unaltered through the stomach and is gradually and slowly decomposed in the intestinal canal, exerting its astringent effect just where it is most wanted, in the lower portion of the small intestines and in the colon. According to the careful clinical observations of Professor Muller and Drs. Kunkler and Drews, Tannigen is an ideal remedy in the acute and subacute gastro-enteritis of children and adults in acute and chronic dysentery, and in the chronic diarrhea of phthisical patients. At this time of the year when diarrheal affections are most prevalent and are attended with a high mortality, this perfectly harmless, yet effective, remedy is therefore deserving of a careful trial.

AMERICAN ACADEMY OF RAILWAY SURGEONS.

Rail

THE following titles for papers have already been received for the Second Annual Session of American Academy of Railway Surgeons, to be held in Chicago, Ill., September 25, 26 and 27, 1895: A Practical Way of Testing Railway Employes for Color Blindness, Dr. D. C. Bryant, Omaha, Neb. way Sanitation, Dr. W. M. Bullard, Wickes, Montana. Transportation of Injured Employes, Dr. F. H. Caldwell, Sanford, Fla. Traumatic Neurosis, Dr. Henry W. Coe, Portland, Ore. Concussion of the Brain, Dr. W. H. Elliott, Savannah, Ga. The Use of Gold Foil in Fractures of the Cranium and Resulting Hernia Cerebri, Dr. W. L. Estes, S. Bethlehem, Pa. Wounds that Open the KneeJoint, Treatment, Dr. C. D. Evans, Columbus, Neb. Treatment of Wounds of the Face and Scalp, Dr. Chas. B. Fry, Mattoon, Ill. Sanitary Regulations Governing Railways, Dr. L. E. Lemen, Denver, Col. Injuries of the Hands and Fingers, Dr. John McLean, Pullman, Ill. How to Differentiate Between the Use of Heat and Cold in Railway Injuries, Dr. Wm. Mackie, Milwaukee, Wis. IntraVenous Injection of Neutral Salt Solution in the Treatment of Desperate Injuries; Exhibition of Apparatus, Dr. C. B. Parker, Cleveland, Ohio.

The Baltimore & Ohio Railroad maintains a complete service of vestibuled express trains between New York, Cincinnati, St. Louis and Chicago. Equipped with Pullman Palace Sleeping Cars, running through without change. All B. & O. trains between the East and West run via Washington. R. B. Campbell, General Manager; Chas. O. Scull, General Passenger Agent, Baltimore, Md. Principal Offices: 211 Washington Street, Boston, Mass. 415 Broadway, New York. N. E. Cor. 9th and Chestnut Sts., Philadelphia, Pa. Cor. Baltimore and Calvert Sts., Baltimore, Md. 1351 Pennsylvania Avenue, Washington, D. C. Cor. Wood St., and Fifth Ave., Pittsburg, Pa. Cor. Fourth and Vine Streets, Cincinnati, O. 193 Clark Street, Chicago, Ill. 105 North Broadway, St. Louis, Mo.

Delegates and visitors to the Chicago meeting will find the equipment of the Baltimore and Ohio trains complete in every detail, affording speed, safety and comfort.

I HAVE selected for my subject today Malingering, or Feigning Disease. In studying this subject, we will consider it under three heads: What, How and Why?

First, What diseases are feigned? We find that nearly every disease that flesh is heir to can be, and often is, simulated with more or less success. In view of this fact, then, the list being so long, we will not consume valuable time by naming them over, but will be content with calling your attention to, and briefly treating of a few of the most common. Among the diseases most frequently feigned are: heart disease, consumption, hematuria, incontinence of urine, epilepsy, paralysis, catalepsy, deafness, dumbness, blindness, tumors, wounds, etc. Mental diseases are often feigned, especially by criminals, in the hope of escaping punishment.

In the second place, Why are diseases feigned? There are various and numerous motives. Prisoners will often simulate a disease in order to obtain a pardon, or to be removed to a hospital, where conveniences are greater. For the latter reason, tramps and street arabs may often pretend illness. In the case of some nervous individuals, feigning is practiced in order to obtain sympathy, in others for notoriety, etc. In a great

many instances diseases and injuries are feigned in order to defraud railroad or street car companies, and accident insurance companies. These would doubtless come under the head of feigning for a money consideration. Actresses have been known to feign illness for the purpose of advertising themselves. Dr. Latimer mentions the case of an actress who declared that her throat was in such a serious condition that she would be unable to sing upon her regular engagement. The management secured the services of Dr. Latimer to examine her and ascertain if her throat were really affected. In doing so, he made use of a clinical thermometer. "What is that for?" asked the patient. Observing that she was not acquainted with the uses of the thermometer, the Doctor replied, "This is a little instrument which, when introduced into the mouth, registers the exact condition of the throat and tells us if there is anything wrong." Fearing the deception would be exposed, she said it was not her throat at all that troubled her, but her limbs. She said she would not be able to go through with a dance which was in her part. She was finally convinced, however, that there was nothing whatever the matter with her, which was indeed the true state of affairs, so

Among other motives in feigning are, to obtain a pension; to avoid army service; to avoid serving in court as a witness or juror.

In the third place, How are diseases feigned? To answer this question fully and state the manner in which each and every disease is simulated would occupy too much time, so we will just treat of it in a general sense. We find that ulcers and wounds are sometimes produced and kept open by application of caustics. Malingerers will sometimes resort to the most disgusting practices, in order to accomplish their purpose; such as swallowing feces, urine and blood; also by mutilating themselves in various ways. "Disease is sometimes simulated by simply lying, or by mimicry, or cunning; at other times by the aid of trusses, splints, bandages, crutches, spectacles or such means.' Abroad, where military service is compulsory, it is not uncommon for such as are liable to cut off a finger, break a tooth or put out an eye, to avoid conscription.

It is evidently very necessary that, if a person is feigning, he should be found out. It will not only prove a great saving in patience, medicine and perhaps money, to some one, but since "feigning is a species of fraud and the exposure of fraud is a public good," it should be done in justice to the physician himself, to the profession, to the public and to the patient.

In the detection of feigning, there are certain general rules, according to Dr. Fairbrother, which greatly aid in the investigation.

1. Moral Character. In a case under observation, where feigning is suspected, if upon investigation the person is found to be of bad moral character, if he is untruthful and a schemer and associates with people of this sort, that may be set down as supporting the theory of feigning.

2. Motive. If, from the disorder complained of, any considerable gain is to accrue, such as pecuniary damages, excuse from prison work, or the sojourn

considered as a part of the evidence of feigning.

3. Physical Condition.- If the person under investigation complains of some serious illness or injury that would naturally make its impression upon the physical condition, and if, at the same time there is no appearance of this impression, but on the contrary the expression of countenance, the color of skin and general appearance indicate perfect health, this also should be considered as strong evidence of feigning.

4. Expression of Countenance.- Very few people are experts in deception. The heart of man is naturally honest and attempts to deceive are often betrayed by the expression of countenance. It is the desire of the eye to look up, but it is forced to look down by a guilty conscience.

A person feigning will never look his examiner in the face and answer his questions clearly and squarely but his countenance will be bent upon the floor and his answers will be guarded and evasive.

5. Want of Consistency. The malingerer is not a medical man. He does not know all the symptoms that belong to a certain disorder. His ardor to learn all the symptoms connected with the disorder of which he complains often leads him into embarassing situations. Thus a man who had received a slight injury in a railroad wreck maintained that he was suffering from concussion of the spine, or railway spine, as it is sometimes called. He was, of course, anxious to do his part in presenting all the symptoms of that hydraheaded ailment. The attending surgeon, observing this ambitious disposition, remarked to a nurse, in the hearing of a relative of this man, that he would think it this disease, but for the absence of one symptom, that the man could lie upon his back while those suffering from this complaint are unable to do so. As was intended, this remark was duly conveyed to the patient, and upon his visit the next morning the surgeon found him lying upon his face and declaring that he could not turn upon his back without the greatest pain.

In this connection I desire to call attention to a report by Dr. Bevan of Chicago, of twenty-four alleged cases of railroad spine. In the settlement of these cases many frauds were detected in the effort to palm off an old injury or lesion as recent and produced by the accident, such as hernia, bunion, curvature of the spine, blindness in one eye the result of thrombus of the central artery of the retina, displacement of the uterus, gray hair which was dyed at the time of the accident and got suddenly white after it, etc. These cases were produced in a wreck in which one hundred and twenty-three were injured. The interest of this wreck centers on the twenty-four alleged cases of railroad spine backed up by medical testimony. Some of them were clearly cases of malingering, some were examples of traumatic psychosis. These cases have all been settled, and the patients have all recovered. The more interesting cases are here analyzed in detail.

CASE I. A woman, injury to the back. No evidence of external injury. Claimed paralysis of right upper extremity and that her hair turned white within a few weeks after the injury. Also claimed severe nervous exhaustion and that she was permanently disabled. Settled, $5000. Recovery.

No question but that this case was a mixture of nerve shock and malingering. Her hair had been dyed a reddish brown before the accident and she had allowed it to resume its natural color.

CASE II. A man. No evidence of external injury. Claim of railroad spine. He remained in his room, used crutches, said one lower limb was paralyzed, that he had great pain in his back and whenever any agent of the company was about he used the crutches and dragged his limb. A detective took him out in a buggy two miles from town to look at some farm land, and left him so that he had to walk home, which he did naturally without the aid of the crutches until he came to the outskirts of the town. Settled, $1000. Within a short time he was teaching school and entirely recovered.

CASE III. A woman. Rib broken.

Claimed damages for railroad spine. Remained an invalid until the claim was settled for $1000, then recovered entirely.

CASE IV.A man. Bruised leg. Claimed to have railroad spine with paralysis and permanent injury. Remained an invalid until settlement, $1000, then recovered rapidly and returned to work.

CASE V.-A man, ribs broken; claimed to have railroad spine and permanent injury; remained an invalid and sued the company for $20,000. On the morn ing before the trial the case was settled for $10,000. He recovered and returned at once to business.

CASE VI.-A man. No evidence of injury; claimed spinal concussion and permanent injury. He was suffering from rheumatism at the time of the accident and was in search of a favorable climate to live in. Used crutches. The case was settled for $5000, and the claimant recovered the day he received the check, and traded his crutches at the drug store for toilet articles and left town perfectly well. Settlement was made in this case largely to get rid of the man, as he was putting up all the injured to claim railroad spine.

CASES VIII and IX.-A man and his wife. No evidence of external injury. Both claimed the night of the wreck that they were permanently injured in the spine and would make the railroad company suffer. They went home, pretended to be in bed and invalids for seven weeks with the most exaggerated symptoms of spinal trouble. Settled for $1250 each, and the same week they left for a short trip and returned entirely recovered.

These cases are reported in order to show to how great an extent this form of malingering is carried on for the purpose of defrauding railway companies. The cases all recovered entirely; none of them, however, until settlement had been made.

An instance is noted in which a workingman in a factory sued his employer for damages for an injury alleged to have been sustained while in his employ, which caused him to lose entirely the sight of his left eye. On the day of