Army Doctor's Dilemma

All the advances of science have not yet conquered the ancient occupational disease of soldiers: malingering. In a new book, War Medicine (Philosophical Library; $7.50), Lieut. Colonel Albert G. Hulett, U.S.A., takes up not only feigned sickness but the equal problem of feigned good health.

To get in the army, candidates have worked out a rogue's repertory for concealing disabilities. Concealment becomes especially ingenious, says Dr. Hulett, among candidates for West Point, Annapolis, the Air Force and Submarine Service, where physical standards are unusually high. "Even if the examiner discovers a defect, despite the effort to conceal it, a candidate will often argue its insignificance to the point where you will almost be persuaded to delete such from your report. Beware. . . ." Epidemics of concealed ill-health break out whenever army groups prepare to travel. Reason: seasoned soldiers fear nothing more than separation from their comrades.

Men trying to get into the army often conceal bad eyesight by memorizing the letters on test charts (famed Flyer Quentin Roosevelt did so in World War I). Doctors must also be prepared for men who take opiates to stop diarrhea, barbiturates to reduce blood pressure, digitalis to correct an abnormal heart, etc. Concealment may succeed for years. An epileptic stayed in the regular army for years and became a technical sergeant, because his fits always came at night and his barrack-mates helped him conceal them. Eventually he had an attack during night field exercises, and army doctors retired him.

To keep out of the army, conscripts have been known to chop off fingers, toes, hands, feet, have all their teeth pulled (suspicious examiners always check with the malingerer's dentist), puncture their eardrums, blind an eye with acids or alkalis, slash tendons, break bones in their arms and legs. Detection is often simple: a deliberate eardrum puncture, for example, will never occupy quite the same spot as one acquired from blast concussion.

A few days' observation usually uncovers high blood pressure induced by benzedrine sulfate, low blood pressure induced by thyroid extract and other drug-induced disorders. In 1918 an A.E.F. hospital had an entire ward full of sufferers from a mysterious, persistent diarrhea. An observer camouflaged as another patient discovered that all the diarrhetics were bribing a night orderly to steal purgatives for them.

Jaundice can be simulated by taking large doses of picric acid, but the yellowness thus produced is not quite that of true jaundice, and the picric acid can be detected in the malingerer's urine.

Hardest class of malingerers to detect are those who pretend to have nervous derangements such as headaches, neuralgic pains, vertigo, fits. Worst problem of all is distinguishing the malingerer from the psychopath. Hysterical vomiting, for example, has no more physical basis than self-induced vomiting, yet morally and medically it requires different treatment.

Army doctors find that simple tricks often catch malingerers off guard. One draftee claimed he could read only the biggest type on an eye chart. His sympathetic examiner gave him a certificate to sign, told him it would release him from service. The impostor promptly returned the form, complaining that it did not refer to his deficiency. It was printed in type only one-fifth as large as he claimed he could read.

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