“Just rub my left calf,” said I, “if you please.”

“Calf?” said he, “you ain’t none, pardner. It’s took off.”

“I know better,” said I. “I have pain in both legs.”

“Wall, I never!” said he. “You ain’t got nary leg.”

As I did not believe him, he threw off the covers, and, to my horror, showed me that I had suffered amputation of both thighs, very high up.

“That will do,” said I, faintly.

(Excerpt from “The Strange Case of George Dedlow,” Atlantic Monthly.)

During and after the American Civil War, stories about soldiers who could still feel pain in their amputated limbs were widely circulated. One can only try to imagine the anguish and confusion a soldier felt when hospital attendants brought to their bedsides their amputated limbs to look upon. They saw their hand or leg clear as day, and yet, felt the raw continuous pain of an appendage that was no longer attached. Although instances of these experiences were reported on for centuries, the term, “phantom limb phenomenon,” or PLP, did not come about until 1871 (Puglionesi). 

The Favored Amputation:

The aftermath of the Civil War, unfortunately, set the scene for the medical community everywhere to gain a better understanding of the mysterious pain that injured soldiers were coming forward about. After all, roughly 3 out of every 4 surgical procedures during the war were amputations (Wegner). First off, minie balls were hollow and flattened out upon impact, thus causing severe damage to surrounding tissue structures and bones. Soldiers were also injured from cannons, bayonets, and shrapnel. If the actual injury did not call for amputation, infection often did. In a time before germ theory was understood, patients were unknowingly exposed to bacteria which caused life threatening infections. Wounds would weep, soldiers would run high fevers, and osteonecrosis (necrosis of bone) was also known to have occurred. Also, bear in mind the fact that surgeons were overwhelmed with wounded men that they needed to attend to. They lacked the precious time necessary to perform complex operations, oftentimes lacked experience, staff, and supplies (Wegner). All of these factors combined led to the vast number of amputations that took place during the war.

Eben E Smith posing 16 month after his right leg as amputated at the hip joint, 1866. Image Credit: EllsworthAmerican.

“Stump Hospital”:

Silas Weir Mitchell was a surgeon who focused on nerve injuries. He met with many soldiers who struggled with PLP at Turner’s Lane Hospital, also known as Stump Hospital, in Philadelphia, Pennsylvania. Silas observed that most men experience PLP within 3 weeks of waking up from surgery. The most common of their sensory hallucinations was burning, itching, stabbing, and cramping pain (Green). When a limb is removed, nerve endings can continue sending pain signals to the brain, thus making the individual feel as though the limb still exists (“Phantom Limb Pain”). 

“…this hand, which is dead except to pain.” 

Silas attempted to treat these patients, typically unsuccessfully, with electrical stimulation, massage, and re-amputation (Puglionesi). In 1872 he published, “Injuries of Nerves and Their Consequences,” which goes into detail about patient cases and their experiences with the effects both physically and psychologically after undergoing amputations. Many soldiers kept their experiences to themselves, feeling fearful that physicians would not believe them. Phantom limb phenomenon still exists today, and treatments are not perfected. Some of the most common treatments include massage, heat pads, acupuncture, surgical intervention, and electrical stimulation of the spinal column (“Phantom Limb Pain”). 

S. Weir Mitchell. Image Credit: Civil War Profiles.

In Conclusion:

An estimated 60,000+ amputations occurred over the course of the Civil War, leaving men maimed and forever physically altered. Due to the high levels of amputations that took place in field hospitals across the country, it was during this time that medical professionals began really documenting instances of PLP. Most people that suffered from the phenomenon simply had to learn to live with the pain and psychological stress that came along with it. 

If that doesn’t make you thankful for modern medicine then I don’t know what will!

Until Next Time

N.F.

Sources:

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