Phantom Limbs

The various phenomena which may appear in a 88 phantom limb are so puzzling and their elucidation 89 so beset with difficulty that it is with some hesitancy 90 that we approach the problem.The difficulty is 90 not lessened by the fact that several penetrating 92 studies have appeared recently, notably by Lhermitte 92 (1939) and Riddoch (1941).Close contact, however, 93 with many amputation cases over a long period 96 provided an opportunity to study limb phantoms, and the excuse for this paper must be that our 96 conclusions are in some important respects at 96 variance with those currently held.This study is 96 not a comprehensive review but is limited to those 96 aspects which seem to us to be the more important 97 in illuminating what may be called the physiology 97 of the phantom. 9797Material.-Theobservations were made in pris- 98 oner-of-war hospitals and camps in Germany in 98 the years 1940-45.The patients were all men of 98 military age, and amputation was nearly always a 98 sequel to gun-shot wounds.The series was, there- 98 fore, fairly uniform and the circumstances of a 98 prisoner-of-war life alike for al}. 100 Some three hundred major and many minor 100 amputations were seen.Amputation had been done 100 usually within the first week or two after wounding, but sometimes not for several months and occasion- 101 ally as late as twelve to eighteen months.The first 101 ninety-eight cases came under our care six months after wounding in 1940.Thereafter, new cases 102 arrived periodically from other campaigns, and in 102 most of them amputation had already been done 103 weeks or months earlier.The majority of observa- tions began, therefore, when stump and phantom 103 had reached a relatively stable stage.Other cases 104 were seen in the early days, and a few studies were 105 made both before and after amputation.Most of the men remained under observation until repatri- 106 ated one to three years later, thus allowing study 106 of the phantom at intervals through the more 111 important changes in its evolution.88