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The incredible story of Phineas Gage and the prefrontal cortex.

Discussion in 'General Discussion' started by J.P.C. Peper, Jun 4, 2012.

  1. J.P.C. Peper

    J.P.C. Peper Bronze Member

    Apr 8, 2012
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    Medical student (since 2009)
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    It’s quite possible some of you know this story already, but for the ones who don’t I’ll tell it anyway.

    The first clue of the role of the prefrontal cortex in controlling our personality and ”˜social behaviour’ (also referred to as the formation of ”˜structured event knowledge’) was derived from the near-fatal accident of the American railroad worker Phineas Gage (1823 ”“ 1860).

    On September 13, 1848, 25-year-old Gage was foreman of a work gangblasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. After a hole was bored into a body of rock, one of Gage's duties was to add blasting powder, a fuse and sand, then compact the charge into the hole using a tamping iron ”“ a large iron rod. Possibly because the sand was omitted, around 4:30 PM “the powder exploded, carrying an instrument through his head an inch and a fourth in diameter, and three feet and seven inches in length, which he was using at the time. The iron entered on the side of his face... passing back of the left eye, and out at the top of the head.” From that day forth, Gage was known as “the American Crowbar Case”, although I should point out that back then a crowbar did not have the bend or claw like it has today. Gage's tamping iron was simply a cylinder, “round and rendered comparatively smooth by use.” The drawing shows how the rod penetrated Gage’s head.

    Schedel Phineas Gage.jpg

    Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3⁄4-mile (1.2 km) ride to his lodgings in town. The first physician to arrive was Dr. Edward H. Williams:

    “I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage's statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head.... Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.”

    Dr. John Martyn Harlow took charge of the case about an hour later:

    “You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. His person, and the bed on which he was laid, were literally one gore of blood.”

    But already two months later, on October 7, Gage “succeeded in raising himself up, and took one step to his chair.” One month later he was walking “up and down stairs, and about the house, into the piazza,” and while Harlow was absent for a week, Gage was “in the street every day except Sunday,” his desire to return to his family in New Hampshire being “uncontrollable by his friends... got wet feet and a chill.” He soon developed a fever, but by mid-November he was “feeling better in every respect... walking about the house again; says he feels no pain in the head.”

    Unfortunately however, despite the lack of pain and his relatively well being, he was ”˜no longer Gage’. In contrary to his previous calm, responsible en socially well-adapted personality, Gage had become a rude, non-social character, seemingly caring nothing about the opinions or feelings of others. This is disputed by some researches however, claiming the personality had only changed for a short period of time and that in the end he’d become decent and vain. The second portrait would demonstrate this, Gage being well-dressed ”“ like he would always be ”“ and proudly holding his so called ”˜constant companion’.

    Portret Gage.jpg

    Whatever is true, the fact remains that the dreadful accident in September 1848 has led to an idea that is still recognised by scientists today, and that many similar circumstances (like soldiers having their prefrontal cortexes pierced by grenade splinters) have resulted in comparable, remarkable changes in personality.

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