Munchausen Syndrome

   Deliberately simulating medical or surgical illness in order to be admitted to hospital for an operation is a form of malingering, unlike involuntary addiction to surgery. (See HYSTERIA: Karl Menninger describes "polysurgical addiction" [1934].) The faking of illness is called Munchausen syndrome, after an anonymous pamphlet that appeared in 1785 in London, The Adventures of Baron Munchausen, which was partly based on the adventures of the real Hieronymus, Count von Münchhausen, who in the service of the Russian army before 1760 achieved fantastic military and athletic feats. In 1951, Richard A. J. Asher (1912–1969),* a London internist affiliated with the Central Middlesex Hospital who had a special interest in mental disorder, suggested the term "Munchausen syndrome" in the Lancet for * Asher is also remembered for a 1947 paper in the British Medical Journal on "the dangers of going to bed," a warning to physicians against overprescribing bed rest. patients with fantastical medical stories who simulated illness in order to gain an operation: "The patient . . . is admitted to hospital with apparent acute illness supported by a plausible and dramatic history. Usually his story is largely made up of falsehoods; he is found to have attended, and deceived, an astounding number of other hospitals; and he nearly always discharges himself against advice, after quarrelling violently with both doctors and nurses. A large number of abdominal scars is particularly characteristic of this condition" (p. 339).

   In 1977 in the Lancet, (Samuel) Roy Meadow (1933–), a pediatrician at a child hospital in Leeds, proposed "Munchausen syndrome by proxy" for parents who falsely reported that their children had a variety of fantastical illnesses. He assigned it to "the hinterland of child abuse." Sir Roy, as he later was knighted in 1997, achieved national prominence for the observation that, "one sudden infant death is a tragedy, two is suspicious and three is murder, unless proven otherwise." This gained him a reputation for being particularly severe in assessing multiple crib deaths in one family.