In July of 1866, a short story called “The Case of George Dedlow” appeared in the Atlantic Monthly. It’s remembered today as a vivid early description of “phantom limb” pain: Dedlow, the narrator, has lost both arms and both legs in the Civil War, yet he experiences clenching and burning in those vanished limbs that cannot be soothed.

“I had begun to suffer the most acute pain in my left hand, especially the little finger; and so perfect was the idea which was thus kept up of the real presence of these missing parts, that I found it hard at times to believe them absent,” Dedlow recounts. “Often, at night, I would try with one lost hand to grope for the other.”

Though Americans had read plenty of war stories since the first volleys at Fort Sumter in 1861, “George Dedlow” drew public attention to the altered bodies and minds that veterans bore home. Many readers mistook it for a real memoir, and donations poured into the U.S. Army Hospital for Injuries and Diseases of the Nervous System (known as “Stump Hospital”), where the story was set. Some people visited the hospital hoping to meet Dedlow in person and were disappointed when the superintendent informed them that no such man existed. The author of the piece would remain anonymous for decades.

By the numbers, the Civil War was a medical catastrophe, with hundreds of thousands dying from wounds, infections and contagious diseases that physicians had no power to stop. New front-loading rifles and bullets known as “minnie balls” allowed more accurate firing at longer ranges—a boon to generals, but a curse for soldiers and surgeons. Conical and hollow, minnie balls rotated in flight, then flattened on impact, shattering bone and tearing up body tissue. In most cases, it was hopeless to try stitching someone back together, especially with a battle still raging all around.

Surgeons adapted the only way they could, by perfecting the art of rapid amputation. Today removing a limb in less than three minutes sounds barbaric, but speed was their only weapon against blood loss and infection, as well as pain. Historians estimate that surgeons had removed about 30,000 limbs by the time the fighting ceased.

One of these surgeons, Silas Weir Mitchell, was drawn to cases of nerve injury that his colleagues rejected as impossible to treat. When his specialty ward in Philadelphia filled up, the Army Medical Department created a dedicated hospital for nervous disease. Soldiers flocked to the Turner’s Lane Hospital, seeking relief from pain that persisted after their wounds had healed. Mitchell described one man so “nervous and hysterical” from nerve damage that his family “supposed him to be partially insane.”

“The Case of George Dedlow” was based on Mitchell’s experience at Turner’s Lane. It reflected the testimony of countless amputee soldiers who all described the same sensation, the feeling that a missing arm or leg was still there, sometimes innocuous but sometimes agonizing. After publishing the Dedlow story anonymously, Mitchell turned his clinical material into articles for medical journals and books, including the influential Injuries of Nerves and Their Consequences in 1872. He built his career as “the father of modern American neurology” on the ghostly pain that lingered in the aftermath of the Civil War.

Mitchell did not discover the phenomenon that he named “phantom limb”—in previous centuries, surgeons regarded it as “worthy of wonder… almost incredible.” Then, as now, doctors would often ignore patients whose complaints had no apparent physical cause. How could there be violent cramping in a leg that did not exist? They were trained to look for objective evidence, and when no evidence turned up, they began to suspect duplicity. “Malingering,” the feigning of illness to avoid military service, was a bugaboo of Mitchell’s, but he believed that most patients at Turner’s Lane were not faking. Yet the possibility of “pain without lesion” challenged the basic premises of scientific medicine at the time.

Civil War veterans, of course, were well aware of phantom limb syndrome before Mitchell coined the term in 1871. It was ubiquitous among amputees, although they were sometimes reluctant to talk about it because of skepticism from doctors. Historian Daniel Goldberg has unearthed these veterans’ sentiments in Mitchell’s records. “Of course,” Henry S. Huidekoper explained, “as with everybody else who has lost a limb, the fingers are distinctly felt, and pains occur oftentimes to various parts of them.”

Henry A. Kircher of Belleville, Illinois, also took for granted the pain in his phantom limb: “Of course it hurts,” he said. Mitchell followed up with these patients in the early 1890s, seeking detailed information about their ongoing symptoms. One man living in Kentucky described a continuous burning sensation in his amputated feet. He dared not waste money on seeing the local doctor, though, unless the renowned S. Weir Mitchell could furnish him with a letter confirming that his pain was real.

Mitchell’s patient Henry S. Huidekoper lost his right hand in the Battle of Gettysburg, and his pain there often started while he dreamt. “I write often in my dreams,” he said in 1906, more than four decades after the hand was amputated. “I attempt to use the tendons which would hold and guide the pen.” The writing hand, seemingly restored, refuses to cooperate. Instead, malevolently, the tendons cramp, “wakening me up from the most profound sleep because of pain.”

On top of the struggle to find treatment for their pain, veterans had to adjust to disabilities that undermined their sense of self. The fictional Dedlow, missing all four limbs, feels “less conscious of myself, of my own existence… I felt like asking some one constantly if I were really George Dedlow or not.” This is where his story takes an unexpected turn. A friend convinces him to attend a Spiritualist séance where the medium summons the ghosts of his amputated legs—literal phantom limbs. He briefly walks on the materialized legs, before sinking back to the ground. This strange encounter gives Dedlow hope that, in death, he’ll become whole again, reunited with his scattered parts.

Mitchell might have meant this over-the-top ending as a satire of Spiritualism, a movement that skeptics accused of exploiting grief-stricken families after the Civil War. But it’s also a subtle admission of the doctor’s helplessness. Dedlow’s resort to Spiritualism hints at an emotional need that Mitchell and his medical colleagues couldn’t address: the need to feel whole after a traumatic loss.

Across the war-ravaged country, missing limbs reappeared in literature. In Louisa May Alcott’s 1863 Hospital Sketches, a wounded soldier supposes that “my leg will have to tramp from Fredericksburg, my arm from here… and meet my body, wherever it may be” at the Resurrection. These imagined reunions were also a metaphor for repairing the divided nation.

Though Mitchell aided many patients at Turner’s Lane and in his subsequent career, his attempts to treat phantom limb pain, which included electrical stimulation and re-amputation, were rarely effective. As a doctor, he staked his hope on eventually finding a physical lesion, a material cause for phantom limb that he could treat, while his patients had to find a way to live meaningful lives with haunted bodies and minds.