James Le Fanu

‘For every problem there is a solution: neat, plausible and wrong’. H.L.Mencken

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The ghosts that haunt amputees

What lurks behind the phenomenon of phantom limbs?

Of the many requests for advice generated by this column, one of the more unusual came from a North Yorkshire farmer who lost a leg following an accident while driving his tractor.

Like virtually all amputees, his missing leg was replaced by a “phantom”, which was so real he often forgot his leg was missing. When he retired to bed, however, his phantom foot became intensely itchy and he had found that this was best relieved by scratching the anatomical site the foot would have occupied had it been there.

He wrote to me to ask whether I might have any other suggestions on how to alleviate this problem, but regrettably I could not be of much help. Phantom sensations are not limited to loss of a limb. A phantom breast, which seems to fill out the padded bra, is often described by women following a mastectomy from breast cancer. The internal organs such as the uterus and stomach may also develop phantom symptoms after their removal—so period pains may persist following a hysterectomy.

Most curious, perhaps, are patients with spinal cord injuries who can feel nothing below the waist, but can still wake after an erotic dream having experienced a phantom orgasm.

But phantom limbs are much the best-described of this type of phenomenon—thanks to a remarkable paper written by two British neurosurgeons, W. R. Henderson and T. E. Smythe, who were captured by the Germans in 1940 and spent the war studying the effects of amputation on 300 of their fellow soldiers held in prisoner-of-war camps.

Patients are aware of the phantom immediately they recover from the anaesthetic; indeed, it feels so natural that “at first the impression is that the expected amputation has not been done until it is discovered that the limb, though still felt so vividly, is in fact absent”.

The phantom limb can also be moved voluntarily, the ankle can be flexed and extended and the toes, especially the big toe, moved up and down. Over time, the phantom limb appears to shorten or telescope, and the foot or hand, which is always the most readily perceived part, appears to move closer to the stump. Similarly, the facility with which the phantom can be moved declines with time, and it seems to become much stiffer.

The phantom limb has a ghostlike quality, being able to move through solid objects like a wall or table, and is famously sensitive to changes in the weather, being most noticeable in cold and wet conditions, while “involuntary movements of the absent digits are unfailing precursors of an East Wind”.

There are two possible explanations for the phantom limb. The first is that they arise from nervous impulses in the parts of the brain concerned with the missing limb. This would seem plausible enough, but it is actually rather difficult to imagine how our bodies could have two separate existences—the physical reality of the bone and flesh of a limb and a parallel, equally realistic reality, albeit a metaphysical one, in the brain.

Doctors Henderson and Smythe described several very curious cases in which phantom limbs seemed to “remember” their previous life. In one instance, a soldier jumping from a truck sprained his ankle and so fell behind his companion. A few minutes later he was wounded in the same leg, was taken prisoner, and required an amputation a few days later. He described how he could still feel the pain of his sprained ankle in his phantom limb, but not the much more severe pain of the bullet that had necessitated the amputation.

An alternative theory for phantoms put forward by the biologist Dr Rupert Sheldrake is that the limb severed at amputation still “exists” as a field of energy. In his book Seven Experiments That Could Change the World, published last month, Dr Sheldrake examines how extra-sensory powers, inexplicable by standard science, might be verified experimentally.

Perhaps phantom limbs fall into this category. He cites the experience of Dr Barbara Joyce, head of the Nursing Programme at New Rochelle College in New York, who claims to be able to “feel” phantom limbs and reduce sensations of pain and itchiness by massaging them. This is essentially the experience of my North Yorkshire farmer who could only obtain relief from the itching of his phantom foot by scratching.

Dr Sheldrake described an experiment which seems to confirm this hypothesis. There were two participants, Mr Casimir Bernard of New York, who lost his right leg below the knee while in action in France in 1940, and a Mr Inigo Swann. Mr Bernard moved his phantom limb up and down while Mr Swann, with a hood covering his head, “guessed” its position.

Initially, Mr Swann’s guesses were no better than would have been expected by chance but, dramatically, after 100 attempts, “the results started to show something”. Mr Swann had “learned” to feel Mr Bernard’s phantom limb as it passed through his hands, which he perceived as an unpleasant sensation.

Personally, I find it difficult to accept Dr Sheldrake’s hypothesis, but it is necessary to keep an open mind. How else, for example, can one explain, other than by postulating an energy field, that when a prosthesis is fitted to the amputated limb, the phantom functions to control its movements. “The lifeless appendage seems to be animated by the living phantom.”

Copyright: Telegraph Group Ltd