Thursday, February 04, 2010

S. W. Mitchell and Phantom Limbs

Posted by Darin Hayton on 02/04 at 10:11 PM

In the winter of 1906 an aging Civil War veteran wrote to Dr. S. Weir Mitchell to update him on his condition. The two had, apparently, spoken some years earlier regarding the veteran’s experiences having lost his right arm. The man describes the pain he continues to feel in his amputated hand and his recurring dreams of using both hands.

Letter to S. Weir Mitchell, dated Feb. 10, 1906(Source: College of Physicians of Philadelphia)

“Dr. S. Weir Mitchell,
Referring to a talk we had some years ago, about the loss of a limb, I thought it would be interesting to you to have some of my experiences in the case.
I do not care to have my name go out with any use you may make of what I say, but the facts are for print, if you ever so desire.

I was wounded on July 1st 1863, about four oclock [sic] in the afternoon by a minie ball going through my right elbow joint. A cord with a noose at the end of it, which I carried for the purpose, was used as a ligature, and I returned to my command for further duty. I had soon, however, to abandon the field, and, walking a mile and a quarter, had my arm amputated, about six oclock [sic], never quite loosing [sic] consciousness. On JULY 10th, Dr Hunt did the first dressing to my arm, at the Continental Hotel, and my arm healed up directly. Never was I unable to walk about from the time of wounding to the time of healing.

Unfortunately, after healing the first time, an opening appeared on the side of the stump, and it was not until eight months and four days after wounding, that suppuration stopped and the opening commenced to close. I understand that Lord Nelson’s arm troubled him in the same way, although the ligature came away in six months, in his case.

At home, I drove every day while regaining strength. When a gust of wind would make it possible that my straw hat would blow off, an attempt was involuntarily made to catch my hat with my right hand. This feeling of the possibility of using the right hand gradually grew less, until it entirely disappeared, and now I never think of my right hand with any though of using it. The fingers however, remain in a half closed condition, and never have I been able to feel them extended or fully closed, no matter what force I apply to the imagined tendons. Of course, as with everybody else who has lost a limb, the fingers are distinctly felt, and pains occur oftentimes to various parts of them, lasting, in my case, from one or ten seconds.

Now for the curious part. I was 24 years old when I lost my arm, and am now 67. Almost two-thirds of my life has passed without thought of the possible use of my right arm, and yet never have I dreamed once, that I was not without two arms, and only last night I dreamt that I was holding a paper up with my two hands. When I ride or drive, or cling to limb on the trees, or write, in my dreams, I always have the use of both my hands.

I am now fond of writing with a pen, fond of the mechanical skill which writing requires, and I write often in my dreams, but always with the right hand I used over forty years ago. To do this, I attempt to use the tendons which would hold and guide the pen, and this is done with so much fatigue in attempting to control the hand and move the pen, that I suffer great pain in my finger tendons, even to wakening me up from the most profound sleep, because of the pain in the lost hand.

Thus, in my dreams, I remain a man with a perfect frame, but while awake, I never think of myself otherwise than a one-handed being. And this after two-thirds, (and that of course the last two-thirds), of my life had fully accustomed me to being with one hand only.

Yours sincerely,

By the turn of the century, Mitchell had been studying nerve injuries for nearly 40 years. The son of a physician, he had studied medicine at Jefferson Medical College, where he received his MD in 1850. He spent a year in Paris studying with the French physiologist Claude Bernard. Upon returning he worked with his father in the family practice. The outbreak of the Civil War marked the beginning of Mitchell’s focus on neurological injuries.

Initially Mitchell served as a surgeon at the Filbert Street Hospital in Philadelphia, but he soon transferred to Turner’s Lane Hospital. There he and his colleagues George Read Morehouse and W. W. Keen realized that they had a rare opportunity to study neurological injuries. Turner’s Lane Hospital was the first hospital in the United States devoted exclusively to neurological injuries, especially those related to amputations. The hospital was located on a country estate between Girard College and Eastern State Penitentiary, overlooking Philadelphia.1 Because so many of the patients lost limbs, Turner’s Lane was dubbed “Stump Hospital.” In 1864 Mitchell, Morehouse, and Keen produced their seminal work on nerve injuries, Gunshot Wounds and Other Injuries of Nerves (Philadelphia, 1864). Mitchell continued to study nerve injuries through the rest of the century. A decade later he extended his war-time work in a new book, Injuries of Nerves and Their Consequences (Philadelphia, 1872) and then later his Clinical Lessons on Nervous Diseases (Philadelphia, 1897).

Toward the end of the century, Mitchell decided to try to contact surviving veterans who had been patients at Turner’s Lane Hospital and had endured amputations. He wanted to learn as much as he could about their subsequent life and their physical and mental condition. He composed a survey that he sent out to as many veterans as he could locate. Many of the veterans completed and returned these surveys. The letter above is one of the many responses Mitchell received as part of the study.2

What is perhaps most fascinating about Mitchell’s survey, and this letter in particular, is how it confirms Mitchell’s early speculation about how patients suffered after losing a limb. In 1866, just two years after Mitchell, Keen and Morehouse had published their work on nerve injuries, Mitchell published, anonymously, a fictional story in The Atlantic Monthly: “The Case of George Dedlow.”3 Mitchell’s story described for the first time in print the condition now known as phantom limb syndrome.

Mitchell’s anonymous “The Case of George Dedlow”(Source: The Atlantic Monthly 18(1866): 1–11)

Mitchell’s story followed the misfortunes of George Dedlow, a fictitious Civil War physician who, like Mitchell, had studied medicine at Jefferson Medical College. In the first few pages of the story, Dedlow loses one arm to a gunshot wound, both his legs, and finally his second arm had to be amputated because it was infected with gangrene. Dedlow is finally transferred to the Stump Hospital in Philadelphia. Mitchell’s story is explicitly a philosophical reflection on what happens to the human psyche when a person’s limbs are amputated. Reduced to nothing more than a torso, Dedlow is convinced to attend a séance, where the medium contacts Dedlow’s severed legs. Now housed in the United States Army Medical Museum, nos. 3486 and 3487, Dedlow’s phantom legs carry him across the room:

“Suddenly I felt a strange return of my self-consciousness. I was re-individualized, so to speak. A strange wonder filled me, and, to the amazement of everyone, I arose, and, staggering a little, walked across the room on limbs invisible to them or me. It was no wonder I staggered, for, as I briefly reflected, my legs had been nine months in the strongest alcohol” (11).

While this closing scene offers a graphic description of Dedlow’s phantom legs, throughout story Dedlow recounted various symptoms he felt in his now amputated limbs. Dedlow describes the sensations in terms remarkably similar to those expressed in the letter above:

“I amused myself, at this time, by noting in my mind all that I could learn from other limbless folk, and from myself, as to the peculiar feelings which were noticed in regard to lost members. I found that the great mass of men who had undergone amputations, for many months felt the usual consciousness that they still had the lost limb. It itched or pained, or was cramped, but never felt hot or cold. If they had painful sensations referred to it, the conviction of its existence continued unaltered for long periods; but where no pain was felt in it, then by degrees, the sense of having that limb faded away entirely” (6).

Further, Dedlow notes that “every person who has lost an arm above the elbow feels as though the lost member were bent at the elbow, and at time is vividly impressed with the notion that his fingers are strongly flexed” (6). Dedlow describes other sensations, some peculiar to the arms, other to the legs, and some common to both.

Mitchell’s interest in nerve injuries and his close study of amputees enabled him to understand their experiences, especially the recurring sensations of still having all their limbs. His work on nerve injuries was unparalleled, and his follow-up survey of amputee patients, a longitudinal study, was likewise groundbreaking. While the basic contours of Mitchell’s work have been retold, most commonly in vaguely historical articles in medical journals, there is much still to do. His use of fiction to explore the medical condition of innumerable Civil War veterans raises a number of questions about the broader acceptance in the medical community of phantom limb experiences. Perhaps more interesting is the collection of surveys, which lies largely unexamined in the archives at the College of Physicians of Philadelphia, waiting for somebody with the time and interest to explore them.

1There is an interesting contemporary account of Turner’s Lane Hospital by the Chaplain. See Hermann Bokum, Wanderings North and South (Philadelphia, 1864), esp. pp. 59–73.
2Mitchell’s surveys recently entered the College of Physicians of Philadelphia’s archive. They seem to be cataloged under: “Turner’s Lane Hospital; case and follow-up studies, 1863-1892,” Call number [CAGE]Z 10/40.
3Mitchell claims in the Introduction to his Autobiography of a Quack that he never intended to publish the Dedlow story. He had merely sent it to a friend, who in turn sent it to another friend who sent it to The Atlantic Monthly.

Tags: civil war, college of physicians of philadelphia, medicine, phantom limb syndrome, s. weir mitchell, stump hospital