evidence in the law courts, to apply to their doctor for a
certificate, assigning as a cause of exemption neuralgia, or some
similar complaint unattended with objective symptoms. In such cases it
is well to remind the patient that in most courts such certificates are
received with suspicion, and are often rejected, and that the personal
attendance of the medical man is required to endorse his certificate on
oath.

Malingering has become much more common since the National Health
Insurance Act has been passed. The possibility of obtaining a fair sum
each week without the necessity of working for it induces many persons
either to feign disease or to make recovery from actual disease or
accident much more tedious than it ought really to be.

The feasibility of successfully malingering is greatly enhanced by the
possession of some chronic organic disease. An old mitral regurgitant
murmur is useful for this purpose.

It is not flattering to one's vanity to overlook a case of malingering,
but should this occur little harm is done. It is a much more serious
matter to accuse a person of malingering when in reality he may be
suffering from an organic disease.

Here are some of the diseases which are most frequently feigned:

=Nervous Diseases=, as headache, vertigo, paralysis of limbs, vomiting,
sciatica, or incontinence or suppression of urine, spitting of blood;
others, again, simulate hysteria, epilepsy, or insanity.

On the other hand, the malingerer may actually produce injuries on his
person either to excite commiseration or to escape from work. Thus, the
beggar produces ulcers on his legs by binding a penny-piece tightly on
for some days; the hospital patient, in order to escape discharge,
produces factitious skin diseases by the application of irritants or
caustics.

It is much more difficult to decide whether certain symptoms are due to
a real disease which is present, or whether they are merely
exaggerations of slight symptoms or simulations of past ones. The miner,
after an injury to his back, recovers very slowly, if at all. He is
suffering from 'traumatic neurasthenia'--a condition only too often
simulated, and a disease very difficult to diagnose accurately. The
miner takes advantage of our ignorance, and continues to draw his
compensation. A workman during his work receives a fracture; instead of
being able to resume work in six weeks, he asserts that the pain and
stiffness prevent him, and this disabilit