he
lower eyelids in young women often owes its origin to a box of paints.
Factitious skin diseases are seen most commonly on the face and
extremities, especially on the left side--in other words, on the most
accessible parts of the body.

Feigned menstruation, pregnancy, abortion, and recent delivery are
common, and should give rise to no difficulty. The same may be said of
feigned insanity, aphonia, deaf-mutism, and loss of memory.

The following hints may be useful to a medical man when called to a
supposed case of malingering: Do not be satisfied with one visit, but go
again and unexpectedly; see that the patient is watched between the
visits; make an objective examination, compare the indications with the
statements of the patient, noting especially any discrepancies between
his account of his symptoms and the real symptoms of disease; ask
questions the reverse of the patient's statements, or take them for
granted, and he will often be found to contradict himself; have all
dressings and bandages removed; suggest, in the hearing of the patient,
some heroic methods of treatment--the actual cautery, or severe surgical
operation, for example; finally, chloroform will be found of great use
in the detection of many sham diseases.

XL.--MENTAL UNSOUNDNESS

The presumption in law is in favour of a person's sanity, even though he
may be deaf, dumb, or blind.

The terms 'insanity,' 'lunacy,' 'unsoundness of mind,' 'mental
derangement,' 'madness,' and 'mental alienation or aberration,' are
indifferently applied to those states of disordered mind in which the
person loses the power of regulating his actions and conduct according
to the ordinary rules of society. The reasoning power is lost or
perverted, and he is no longer fitted to discharge those duties which
his social position demands. In some cases of insanity, as in confirmed
idiocy, there is no evidence of the exercise of the intellectual
faculties. It is probable that no standard of sanity as fixed by nature
can be said to exist. The medical witness should decline to commit
himself to any definition of insanity. There is no practical advantage
in attempting to classify the different forms of insanity.

According to English law, madness absolves from all guilt, but in order
to excuse from punishment on this ground it must be proved that the
individual was not capable of distinguishing right from wrong in
relation to the particular act of which he is accuse