The prison physician who examined the patient at the penitentiary
before his second admission to this hospital made the following
notation in the case: "The mental examination of T. W. reveals
inconsistencies that are strongly suggestive of simulation, and I
believe there is in this case a degree of malingering, frequently
associated with prison psychoses, yet that there is a psychosis, in my
opinion, there is no doubt."

Upon his return to this hospital he became involved in fistic
encounters, on the way to his ward, for which there was very little
provocation. For several weeks following this he was very surly,
dissatisfied, moody, and inaccessible, but showed no other psychotic
symptoms. Four days after admission he subscribed to a local newspaper,
which he read regularly and kept himself well informed on ordinary
topics. He was clear mentally, well oriented in all respects, and
adapted himself readily to his new environment, except that he
absolutely refused to eat the regular food furnished the patients. For
about three weeks he lived practically on fruit and candies which he
purchased, persisting in his determination to starve himself unless he
were given a special diet. This was furnished him, and he had no
further dietetic troubles. No delusions or hallucinations were
manifested, intellectual examination revealed no intelligence defect
(gross), and, aside from his surly mood and his tendency for rather
frequent endogenous depressed periods, he showed no abnormal
manifestations.

In this state he required no special hospital treatment, and, as he
promised to conduct himself properly if he were returned to the
penitentiary, he was transferred back on February 20, 1912.

Upon his return he continued, however, to manifest periodic
excitements, with destructiveness, always, however, in reaction to some
environmental irritation. He nevertheless managed to remain in the
penitentiary until the termination of his sentence.

It is highly doubtful whether proper means will ever be evolved to
enable one to differentiate accurately between that which is genuine and
that which is malingered in cases like, for instance, the foregoing.

This man unquestionably suffered from a psychosis, and yet there is
likewise no doubt that he malingered. The question of the accurate
differentiation between the genuine and the shammed seems to me,
however, to be strictly an