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Phineas Gage

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   Death mask of Phineas Gage
   Enlarge
   Death mask of Phineas Gage

   Phineas P. Gage ( 1823 – May 21, 1860) was a railroad construction
   foreman, who suffered a traumatic brain injury, caused when a tamping
   iron accidentally passed through his skull, damaging the frontal lobes
   of his brain, causing the supposed inversing of his emotional, social
   and personal traits—leaving him in a temperamental and unsociable
   state.

   At the time of discovery, Gage's condition led to changes in the
   perception of the function and compartmentalisation of the brain with
   regards to emotion and personality, and to the inception of methods
   such as pre-frontal lobotomies as methods of treating anti-social
   conditions.

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. Gage was momentarily distracted and forgot to pour the sand into
   one hole. Thus, when he went to tamp the sand down, 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 yards (27 meters) behind him.

   The three foot (1 m) long tamping iron with a diameter of 1.25 inches
   (3.2 cm) weighing thirteen and a half pounds (6.12 kg) entered his
   skull below his left cheek bone and exited after passing through the
   anterior frontal cortex and white matter. Whether the lesion involved
   both frontal lobes, or was limited only to the left side, remains a
   matter of controversy. Remarkably, after such a dramatic accident, Gage
   regained consciousness within a few minutes, was able to speak, and
   survived a 45-minute ride back to his boarding house sitting in a cart.

   As the doctor arrived, he was reportedly conscious, and had a regular
   pulse of about 60 beats per minute, suggesting that he only suffered
   minimal blood loss. His left pupil was still reacting to direct light
   (and stayed that way for the following 10 days), which indicates that
   the left optic and oculomotor nerves were still functioning, supporting
   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.

   While early studies by Antonio Damasio and colleagues suggested a
   bilateral damage to the medial frontal lobes, a recent study by Ratiu
   and colleagues, based on a CT scan of Gage's skull suggests that the
   extent of Gage's brain injury must have been more limited than
   previously thought.

   In light of modern medical science, a bilateral damage of the frontal
   brain by a projectile measuring 1.25 inches in diameter and weighing
   thirteen pounds, appears to be incompatible with survival, since this
   would imply an extensive damage to vital vascular structures, such as
   the superior sagittal sinus. Nevertheless, Gage survived the traumatic
   event and reportedly developed personality changes.

Effect on Gage

   According to Gage's physician, Dr J.M. Harlow, 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. His physician reported that :


   Phineas Gage

       Gage was 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.'


   Phineas Gage

   After his injury, Gage lost his job with the railroad construction
   company. When he was well enough again in or around 1850, he spent
   about a year as a sideshow attraction and at P. T. Barnum's New York
   museum, putting his injury, and the tamping iron which caused it, on
   display to anybody willing to pay for the show. He then worked as an
   assistant in New Hampshire and, for nearly seven years, as a coach
   driver in Chile. When his health started to fail in 1859, he returned
   to San Francisco, where he lived with his mother and, for some months
   before his death, was employed as a farm worker.

Significance for neuroscience

   This computer generated graphic, based on data from a "standard human
   skull", shows how the tamping rod may have penetrated Phineas Gage's
   skull, crossing the midline and damaging both frontal lobes, according
   to Damasio et al.
   Enlarge
   This computer generated graphic, based on data from a "standard human
   skull", shows how the tamping rod may have penetrated Phineas Gage's
   skull, crossing the midline and damaging both frontal lobes, according
   to Damasio et al.

   Gage's case is cited as among the first evidence suggesting 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
   behaviour".

   It is occasionally suggested that Gage's case inspired the development
   of frontal lobotomy, a now-obsolete psychosurgical procedure that leads
   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.

Criticism of popular story

   There is no doubt that Gage suffered the accident, and that it had a
   dramatic impact 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 psychological 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 University,
   wrote in 1850 that Gage was "quite recovered in faculties of body and
   mind." It was Harlow's account from 1868, years after Gage's death,
   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.

Physical remains and legacy

   Gage kept the rod which damaged him throughout his life as a souvenir,
   and it was buried with him in death. In 1867, when his skeleton was
   exhumed, the original rod was thus available with it. There is an
   inscription on the rod that reads, "[t]his is the bar that was shot
   through the head of M. Phineas P. Gage at Cavendish, Vermont on
   September 14, 1848. He fully recovered from the injuries and deposited
   this bar in the Museum of the Medical College of Harvard University."
   Gage's skull, as well as the rod that pierced it, is currently part of
   the permanent exhibition at Harvard Medical School's Warren Anatomical
   Museum in Boston, Massachusetts.

Related texts

     * Antonio R. Damasio (1995) Descartes' Error: Emotion, Reason, and
       the Human Brain. ISBN 0-380-72647-5.
     * J. Fleischman (2002) Phineas Gage: A Gruesome but True Story About
       Brain Science. ISBN 0-618-05252-6
     * M. Macmillan (2000), " Restoring Phineas Gage: A 150th
       retrospective," Journal of the History of the Neurosciences, 9(1):
       42-62. DOI 10.1076/0964-704X(200004)9:1;1-2;FT046
     * M. Macmillan (2002) An odd kind of fame: Stories of Phineas Gage.
       ISBN 0-262-63259-4.

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