Phantoms in cases of congenital absence of limbs

ALTHOUGH THE PHANTOM LIMB has been described for some four centuries as the subjective awareness of a nonexistent or deafferented appendage, to the authors’ knowledge there have been no reports of phantoms in cases of congenital absence of limb. In fact, most authors, starting with Pick,’ deny the possibility of phantoms in cases of congenital absence of limb or where the amputation occurs during the first five years of life. The usual explanation of such absence of phantom is derived from the theoretic positions of Pick,’ Head,* and Bonnier.3 Thus, for example, in describing a case of congenital absence of the forearm with no experience of phantom limb, Bailey and Moersch4 state: “This would be expected since sensory impression for this part had never been recorded by the cerebral cortex.” Browder and Gallaghe+ say of congenital absence of limb that I ‘ . . . there would not be a phantom of the missing part since it was never included in the normal body pattern.” In discussing the case of congenital absence of limbs, Kolbe maintains: “In such cases, the continuing barrage of sensory impressions either has not existed or has been of too short duration to allow the development of this body concept.” During the course of an investigation to determine somatosensory changes in loss or absence of limbs, 30 patients with cases of congenital absence of limb were examined. Since the routine procedure in the examination of all patients requires the administration of a questionnaire concerning the presence and type of phantom, this series of questions was also administered to the patients with congenital absences. The authors were quite surprised to discover the presence of phantom limbs in 5 of the 30 patients. This report describes the patients with such phantoms, discusses the reasons it is believed phantoms have never been reported in such cases before, and the implications of these findings.