Phantoms in Patients with Leprosy and in Elderly Digital Amputees

Abstract

When a person has lost an arm or leg in an accident, or as the result of surgery, he typically continues to experience the lost extremity for some time. It was Mitchell who first coined the term phantom limb for this enduring experience of the limb which is no longer present.1 On first awakening from the anesthesia such a patient may not believe that the leg actually has been removed until he can convince himself by looking under the covers. Even when he knows beyond doubt that it is gone, the foot of the amputated leg may itch and he may reach down to scratch it. He may perceive the bed sheets on it; experience a mild, perhaps pleasant tingling within it (a phenomenon which Henderson and Smyth regard as basic),2 and even, though rarely, sense pain. He may 'feel' that he can wiggle his fingers or toes, flex or extend his wrist or ankle, and that he can perform these movements more or less at will. Despite his knowledge of the amputation which has been performed, the patient may 'forget' and reach out with his missing hand to grasp something, or to steady himself, or(he may step on the phantom foot and fall. Phantoms are not limited to limbs. Removal of other body partssuch as fingers, toes, the nose, eyes, nipples, and genitals-results in similar experiences. Nor is amputation proper a necessary condition for the appearance of phantoms. They appear typically after complete denervation by plexus-lesion or spinal-cord transection and, more rarely, in certain types of peripheral nerve section as well as occasionally after cerebral lesions. Under these conditions, thd affected 'body part is of course still present, but the neural pathways which ordinarily mediate the sensations reported have been eliminated. Thus, a paraplegic patient may experience sensations of tingling in his legs; he may 'feel' that he can move the toes of the