This is an old revision of this page, as edited by DrFlo1 (talk | contribs) at 01:35, 11 May 2005. The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.
Revision as of 01:35, 11 May 2005 by DrFlo1 (talk | contribs)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)Phineas P. Gage (1823 - May 21, 1860) was a railroad construction worker who suffered an unusual kind of traumatic brain injury which inflicted severe damage to parts of his frontal brain during a work accident. While early studies (Damasio et al, 1995) postulated a bilateral damage to the frontal lobes, a recent study (Ratiu, Talos et al., 2004), corroborating findings of a high-resolution CT scan of Phineas' skull with state-of-the art computerized image reconstruction techniques and Dr. Harlow's thoroughly recorded clinical findings, concluded that the extent of Gage's brain injury must have been much more limited than previously thought. In light of modern medical science, a bilateral damage of the frontal brain by a projectile measuring 3.1 cm in diameter and weighing ca. 6 kg, appears to be incompatible with survival, since this would imply an extensive damage to vital vascular structures, such as the superior sagittal sinus. Nevertheless, the patient survived the traumatic event and developed personality changes of an yet to be determined extent. Interestingly, recent measurements have shown that the diameter of the projectile is twice as large as the diameter of the entry hole on the left side of the skull base. This case fueled speculations that specific parts of the brain, particularly the frontal lobes, might be involved in specific psychological processes dealing with emotion, personality and problem solving.
Gage's injury
On September 13, 1848, Phineas Gage was working outside the small town of Cavendish, Vermont on the construction of a railroad track where he was employed as a foreman. One of his duties was to set explosive charges in holes drilled into large pieces of rock so they could be broken up and removed. This involved filling the hole with gunpowder, adding a fuse, and then packing in sand with the aid of a large tamping iron. When Gage was momentarily distracted, the tamping iron sparked against the rock and ignited the gunpowder, causing the iron to be blown through Gage's head with such force that it landed almost thirty meters behind him.
The 1.09 m (3.75 feet) long tamping iron, with a diameter of 3.17 cm and weighing 6 kg, entered his skull below his left cheek bone and exited after passing through the frontal brain (presumably, the fronto-orbital and dorsal prefrontal areas of the left frontal lobe). Remarkably after such a dramatic accident, Gage regained consciousness within a few minutes, was able to speak and survived a 45 minutes long ride back to his boarding house sitting in a cart. As the doctor arrived, he was conscious, and he had a regular pulse of about 60 beats per minute, signalling that he only suffered minimal blood loss. His left pupil was still reacting to direct light (and sayed that way for the following 10 days), which indicates that the left optic and occulomotor nerves were still functioning to some extent. This fact supports the hypothesis that the tamping iron must have passed laterally to the left optic nerve. After a seemingly complete recovery from such a serious injury, Gage was soon back at work.
However, whereas previously he had been hard-working, responsible, and popular with the men in his charge, his personality seemed to have been radically altered after the accident. Dr Harlow reported that:
- fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was 'no longer Gage'.
J. M. Harlow, 1868 (Publications of the Massachusetts Medical Society 2: pp. 339-340)
After his injury, Gage lost his job with the railroad construction company. Subsequently, he had was in and out of jobs. He worked for a while as a coach driver in Chile and at one time he was part of P. T. Barnum's travelling circus, putting his his injury, and the tamping iron which caused it on display, to anybody willing to pay for the show.
Significance for Neuroscience
Gage's case was among the first evidence that damage to the frontal lobes could alter aspects of personality and affect socially appropriate interaction. Before this time the frontal lobes were largely thought to have little role in behaviour.
Neurologist Antonio Damasio has written extensively on Gage, as well as on various patients he has studied which, in his personal view, had similar brain injuries. In a theory he calls the 'somatic marker hypothesis', Damasio suggests a link between the frontal lobes, emotion and practical decision making. He sees Gage's case as playing a crucial role in the history of neuroscience, arguing that Gage's story "was the historical beginnings of the study of the biological basis of behavior".
It is occasionally suggested that Gage's case inspired the development of frontal lobotomy, a now-obsolete psychosurgical procedure that lead to a blunted emotional response and personality changes. However, historical analysis does not seem to support this claim. It seems that consideration of Gage's injury had little influence on the development of this practice.
There is no doubt that Gage suffered the accident, and that it had a dramatic impactt on his life. However, in his book "An Odd Kind of Fame: Stories of Phineas Gage", Australian psychologist Malcolm Macmillan casts serious doubts on the accuracy of the account that entered both scientific and popular discourse. First, very little is known about Gage's personality and habits before the accident; second, the post-traumatic pshychological changes reported while Gage was still alive were much less dramatic than later reports assert.
Within twenty-four hours of the accident, a first report was (anonymously) printed in the Ludlow, Vermont Free Soil Union. Having described the accident, the paper reports that "the most singular circumstance connected with this melancholy affair is, that he was alive at two o'clock this afternoon, and in full possession of his reason, and free from pain."
Harlow mentioned very few psychological changes in his initial report of 1848. Henry Bigelow, Professor of Surgery at Harvard, wrote in 1850 that Gage was "quite recovered in faculties of body and mind." It was Harlow's account from 1868 that introduced the now-textbook changes. Later writers began to embellish even more, adding drunkenness, braggadocio, a vainglorious tendency to show off his wound as part of Barnum's Traveling Exhibition and an utter lack of foresight - all unmentioned by Harlow.
Gage's skull is currently part of the permanent exhibition at Harvard Medical School's Warren Anatomical Museum in Boston, Massachusetts.
See also
Further Reading
- Damasio, A.R. (1995) Descartes' Error : Emotion, Reason, and the Human Brain. ISBN 0380726475.
- Fleischman, J. (2002) Phineas Gage: A Gruesome but True Story About Brain Science. ISBN 0618052526
- Damasio H., Grabowski T,. Frank R., Galaburda AM., Damasio AR. (1994) The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264 (5162), 1102-5.
- Macmillan, M. (2002) An odd kind of fame: Stories of Phineas Gage. ISBN 0262632594.
- Ratiu P, Talos IF, Haker S, Lieberman S, Everett P, The tale of Phineas Gage, digitally remastered, J Neurotrauma, 21(5): 637-43, 2004
- Ratiu P and Talos IF, Images in Clinical Medicine: The Tale of Phineas Gage, Digitally Remastered, New England Journal of Medicine 2004 Dec 2;351(23):e21
- More on Phineas Gage Lymphangitis after Self-Administration of ... from the New England Journal of Medicine. Login required.