i
DE. KING
• 341 PEBKINS LIBRARY
CAMPUS MAIL
Duke University
Medical Center
Intercom
VOL. 24, NO. 48
DEC. 9, 1977
DURHAM, N.C.
Hospital hoboes ^cry wolF to get medical care
By David Williamson
If your doctor has ever treated a patient
with Munchausen's syndrome, one of the
quickest ways to make him angry may be
to remind him of the fact.
Odds are that it wasn't a very satisfying
experience. These patients go from
hospital to hospital, dreaming up reasons
to be admitted.
The syndrome is one of the most
bizarre conditions medical personnel
have to deal with, according to Dr. Allan
A. Maltble, assistant professor of
psychiatry. It's also one of the most
frustrating.
Complete with symptoms
In a typical case, a patient will arrive at a
hospital with an apparently acute illness
complete with a plausible medical history
and symptoms, Maltbie said.
After a series of examinations, tests
and sometimes surgery, doctors will
discover that the patient has been leading
them on and there is nothing physically
wrong with him. When psychiatric
evaluation is suggested, the patient
quickly leaves the hospital.
"This same pattern may then be
Holiday check early
Christmas is coming, but paychecks
are coming earlier.
The payroll office has announced
that the faculty and staff paydate for
this month will be Dec. 16.
Biweekly employees, who would
normally be paid Dec. 24, will receive
those checks a day early.
repeated with other doctors and other
hospitals in an attempt to secure
adnnission," the psychiatrist said. "The
patient may wander around the country
presenting his false story often enough
that he literally lives from hospital to
hospital."
32 hospitals in two years
Don Woodin, public information
director for the North Carolina Hospital
Association, said that one patient has
been admitted to at least 32 hospitals
within the past two years, including 14 in
North Carolina.
"We have consequently estimated that
this person has cost the hospitals more
than $35,000 over the 24 months," he
said.
Another patient successfully
impersonates doctors on the telephone to
HOSPITAL
order his own admission. He has even
generated large florist bills by sending
flowers to himself.
Woodin said his organization maintains
files on known Munchausen patients and
tracks their movement to warn hospitals
when they are likely to turn up.
"We're interested in sparing hospitals
the expense of these people, but that's not
our sole concern," he said. "It is
conceivable that someone who is
genuinely ill could be affected if the last
critical care bed in a hospital is occupied
unnecessarily."
Peregrines
Maltbie, who has seen a number of
patients with the syndrome in his
capacity as head of the Psychiatry Liason
Service at the VA Hospital, said the
condition was named after an 18th
century cavalry officer who travelled
from town to town telling of his v«ld but
highly unlikely adventures in Russia.
Other names that have been suggested
in medical literature include "hospital
hoboes" and "peregrinating problem
patients."
Patients sometimes complain of
headaches, seizures, bleeding from
various body orifices, stomach pains or
heart problems. Others may swallow any
of a variety of objects, including razor
blades, coins, lightbulbs and nails.
"TTie particular illnesses these people
may feign are many and varied," Maltbie
(Continued on page 4)
Dog's best friend not necessarily his master
DR. JOSEPH L. WAGNER
By David Williamson
A man's best friend may be his dog, but a dog's best friend isn't
necessarily his master, especially with cold weather coming on.
That's the opinion of Dr. Joseph L. Wagner, a veterinarian
who oversees the daily care and well-being of some 40,000
animals as director of Duke's Division of Laboratory Animal
Resources, the vivarium on Research Drive.
It's not that canines can't stand low temperatures, Wagner
says. On the contrary, most healthy, mature dogs adapt well to
winter weather because nature provides them with an
insulating layer of fat and a heavier hair coat.
But when man manipulates an animal's environment
artificially, potential problems can arise, Wagner said.
"If you happen to be an irresponsible dog owner and permit
your dog to roam free, as long as he can find food and water, he's
smart enough to find shelter and a place that he can sleep,"
Wagner said. "A dog that's tied up outside in wind and sleet or
put in a pen without shelter, however, can get frostbitten or
freeze to death."
Not all dogs are huskies
How well dogs can withstand harsh winters depend upon
their age, health, breed and acclimation to the environment,
Wagner said.
A dog that has been kept inside much of its life, a puppy or a
Chihuahua, for example, will be in greater danger from the cold
than a husky that was originally bred to live outside in
temperatures well below zero, he explained.
Wagner recommends that all animals, including livestock,
have clean, dry shelters insulated against the weather and
containing water supplies that are not frozen. Such shelters are
essential for maintaining the health of animals kept out-of-
doors, he said. ,. . -v
(ConUnued on page 2)