THE MUNCHAUSEN SYNDROME WILLIAM B. BEAN, M.D.* The patient who shops around from doctor to doctor, the dowager alert for some new handsome young physician to hear her flatulent and oleaginous outpourings, the bewildered neurotic who has had a dozen operations for a thousand misunderstood complaints—these we recognize as interesting patients or as nuisances we have to deal with as charitably as we may. They live at the lower end of the human spectrum, with all its infinitely various people. Nearby reside the malingerer and the deadbeat, the shoplifters ofmedical aid, who escapejust ahead ofthe policeman. At the frayed end ofthis spectrum is the fascinating derelict, human flotsam detached from his moorings, the peripatetic medical vagrant, the itinerant fabricator of a nearly perfect facsimile of serious illness—the victim of Munchausen's syndrome. This is the tale of such a patient. He had our medicaldepartment in an uproar offand on for forty days and fortynights. His Odyssey I outline here in verse. I find to my anguish that much of theverse doesnot scan, some does not rhyme, and all is obscure. Iproceed: The Munchausen Saga In the summer ofnineteen and fifty-four At Iowa City, to our hospital door— Mecca for hundreds every day— A merchant seaman found his way: A part-time wrestler, in denim jacket, He crashed through the door with a horrible racket, Two hundred and sixty pounds at least, And covered with blood like a wounded beast. With gestures, he told us his chest was stricken— The coughed-up blood made the residents quicken To bring him assistance and ease his anguish. * Department ofMedicine, State University ofIowa, Iowa City, Iowa. Perpetrated at the seventyfirst meeting of the American Clinical and Climatological Association, Cooperstown, New York, October io, 1958. 347 Residents don't let "an emergency" languish. Examined, his legs were red and swollen, The large blue veins were easily rollen: "Thrombophlebitis, then clot to the lung"— The residents knew this, although they were young. Anticoagulants were ordered pronto, And morphine prepared, but he said, "I want no M.S. Only Demerol works the best, Eases my pain and brings me rest." This man knew more than he'd learned from fiction; Could he be harried by drug addiction? His medical words were far from shoddy; He knew where to find every vein in his body. When surgeons suggested a quick ligation Ofhis vena cava, with prompt oration Ofvehement words, he put the stopper. More and more Demerol he thought proper. Were it delayed, he would demonstrate, Sulking and fussing, he could not wait. A resident he had small use for Called him "obstinate, obscene, obtuse, or Obese, obstreperous—not obedient"— He was deprived ofthis ingredient. He threatened the staffand frightened the nurses, Cajoled, or deployed a corps ofcurses. He gave us a history, in elegant diction, Which later we found was all-out fiction. Carpenter, wrestler, bosun's mate, And stevedore. He could exaggerate! His body was covered with many a scar, He said from surgeons near and far. The appendix went in County Cork, A navel hernia in New York. Once, he declared, in Portland, Maine, A surgeon stripped out his saphenous vein. Surgical scars above one kidney Came from an ectomy done in Sidney. Another injury he wouldn't reveal us Messed up his left internal malleolus. From time to time, as he wove this story. He boasted ofprowess and wealth and glory. Slight fever, anemia, spitting up blood, A negative chest, and the X-ray good All made us ponder and waggle a finger, Suspecting something had made him malinger. „ William B. Bean · The Munchausen Syndrome " Perspectives in Biology and Medicine · Spring 1959 We searched his nose and mouth and pharynx, His gums, teeth, tongue, his gullet and larynx. His windpipe was scanned with a bronchoscope—¦ No bleeding point, though we had high hope. Once from the bathroom he, bleeding, strode, And we found some needles in the commode, We accused him ofneedling blood from his veins But found no holes, despite infinite pains. Because he was not a native born, Our mental hospitals looked with scorn On all our efforts to let them get him. He understood, and it did...