The conditions of occurrence of phantom limbs

Abstract

ALMOST ninety years ago Weir Mitchell (9) coined the term phantom, limb to describe the amputee's experience of the continued presence of a limb which has been lost. Immediately after amputation, as he awakes from the anesthesia, the patient may not believe that the arm or leg has been removed until he can convince himself by looking under the covers. But even once he knows beyond doubt that the extremity is gone, he typically continues to feel it as if it were still present. In the days-and years-to come, the foot of the amputated leg may itch and, as the patient reaches down to scratch it, he reaches for an empty space. He may feel the bedsheets on the arm or leg, he may feel a mild, perhaps pleasant tingling-a phenomenon which Henderson and Smyth (5) regard as basic-or, much more rarely, he may feel pain. He may feel that he can wiggle his finger or toes, flex or extend the wrist or ankle, and that he can perform these movements more or less at will. Despite his knowledge that the amputation has been performed the patient may forget and reach out with the missing hand to grasp something, or to steady himself, or he may step on the phantom foot and fall. At least initially a good many amputees report that they are more aware of the phantom extremity-even though painless-than of the contralateral intact limb, an observation already recorded by Weir Mitchell (9). When the phantom first appears the experience is usually-though not always-that of the limb as if it were still present, i.e. the phantom has normal size, shape, etc. In time, however, certain changes take place. The less articulated parts, such as the calf or the forearm, may fade and eventually drop out altogether, leaving only the foot, and eventually perhaps only the toes, or, correspondingly, leaving only the hand and finally only the fingers. Furthermore, the remaining parts may gradually move towards the stump-