Hans Förstl

Richard Asher:

Munchausen's Syndrome

abbr. from
The Lancet, Feb. 10, 1951, pp. 339-241.

As to the name of the syndrome Asher wrote, 'Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him are both dramatic and untruthful.' Asher gave three illustrative cases:

Case 1 (of 3):

    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.