The phantom from the battle field

The Lancet recently published a fantastic article on one of the earliest cases of phantom limb. It was written by American Civil War surgeon Silas Weir Mitchell but not as a study in a medical journal, but as a short story in a popular magazine.

The story was titled The Case of George Dedlow in which Mitchell gives a careful medical description of sensations coming from a recently amputated limb, a portrait of how the amputation affected the soldier, and some musings on what it means about our relation to reality.

At this stage in the story, Mitchell uses his fictional character to muse on the neurological phenomenon of phantom limbs. Phantom limbs had been described in the mid-16th century by French military surgeon Ambroise Paré, but very little was known about what caused stump neuralgia (in the 1860s, the only treatments were electrotherapy, leeching, irritation of the surface of the stump, and re-amputation, none of which were very successful).

In The Case of George Dedlow, Mitchell speculates freely about what caused absent limbs to itch and feel pain. According to him, sensory impressions were transmitted through nerves to spinal nerve-cells and then to the brain. When a limb was removed, and until the stump healed, nerves continued to accept sensory impressions and to convey these impressions to the brain. If the stump never fully recovered, the result was constant irritation or a burning neuralgia. As Mitchell later explained in his famous textbook, Injuries of the Nerves and Their Consequences (1872), phantom limbs made “the strongest man…scarcely less nervous than the most hysterical girl”.

Somewhat poignantly, it seems Mitchell was haunted by his own phantoms from the war. In his later years he was troubled by ‘ghosts’ and intrusive memories from his gruesome years as a military surgeon.

It’s a fantastic short article that really conjures up the feel of the time as well as giving an insight into this important point in medical history.

Link to Lancet article.
Link to PubMed entry for same.
Link to text of short story The Case of George Dedlow.

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