Case 1
A man of 47, giving the name Thomas Beeches, was
transfered to the Central Middlesex Mental Observation Ward on May 16 from
Harrow Hospital. He had been admitted there on May 13 with suspected intestinal
obstruction; laparotomy had shown nothing abnormal. After the operation
he had accused the ward sister of tampering with his wallet while he was
under the anaesthetic, he had become truculent and demanded his discharge,
and because of his violence, and his foolhardiness in wanting to walk out
with a day-old laparotomy, he was sent for mental observation.
On examination he was rational and convincing. His
abdomen was a mass of scars of various vintage. He explained that while
in the Merchant Navy in 1942 he had been torpedoed, suffering multiple
abdominal injuries. He was then takin prisoner by the Japanese and kept
in Singapore til 1945. Throughout this time he had multiple discharging
faecal fistulae. In 1945, after the liberation of Singapore, he had been
takin to Freemantle where he had eleven operations in 7 months (to close
the multiple fistulae), since when he had been continuously at sea till
4 days previously.
The characteristic Munchausen flavour of this history
led to further inquiries which revealed that only 8 days previously, while
supposed to be at sea, he had been in St. James' Hospital Balham, complaining
of acute abdominal pain; and that a year before he had been in the same
hospital and again beheved in the same way. It was further found that in
1943, when he should have been in Singapore, he had been admitted to the
Central Middlesex Hospital complaining of 'bursting open of an old torpedo
wound' with a discharging sinus in the right iliac fossa. He had then told
such a bewildering series of different stories that he had been transferred
to Shenley Hospital as a chronic delinquent psychopath, where he was observed
for 2 months and then discharged. At Shenly it was discovered that he had
a long history of delinquency and had three past convictions for crime,
as well as having been twice in West Park Mental Hospital. (He had escaped
both times.) On this present occasion no certifiable abnormality could
be found and he was discharged on May 19, 3 days after admission. No doubt
he is still going from one hospital to another.
A fortnight later, a surgical registrar, knowing
my interest in Munchausen's syndrome, produced the notes of a case he had
encountered at the Norfolk and Norwich Hospital. It was interesting but
not surprising to find that it was the same patient. The notes showed
that a Thomas Beeches had been admitted on June 23, 1949, as a case
of acute intestinal obstruction. He told a story of having been 33 years
in the R.A. F. and of having been shot down over Mannheim in 1942, after
which he needed 'eitht abdominal operations and three short-circuits.'
After treatment with morphine, intravenous drip, and gastric suction, he
refused a laparatomy and discharged himself against advice on June 26.
Contrast this case presentation with another from July 1995: Munchausen
Syndrome - Presenting as Immunodeficiency: A Case Report and Review of
Literature ; Aamer Aleem, MBBS, MRCP(UK); Dahish S. Ajarim, MD, FRCP(C)
Chris Amirault, 'Pseudologica
Fantastica and Other Tall Tales: The Contagious Literature of Munchausen
Syndrome,' Literature and Medicine 14.2 (1995) 169-190
Dr. Marc Feldman's Munchausen Syndrome,
Factitious Disorder, & Munchausen by Proxy Page
Raspe, R. E., et al (1785) Singular Travels, Campaigns and Adventures of Baron Munchausen London: Crosset Press. 1948.