A MODERN OUTLOOK ON
diameter.” Simply on the basis of vocabulary, we can understand that there was comprehension of the parts of the brain, the surface had been mapped out, but the actual responsibilities of these parts and the effect of any damage on general human functioning, was extremely limited.
THE REVOLUTIONARY AMERICAN CROWBAR CASE Lizzy Brown (WHS), Ella Loizou (WHS), Prashanti Sen (OHS)
With William’s assistance Harlow proceeded to remove Gage’s hair, coagulated blood, small bone fragments and ‘an ounce or more’ of protruding brain from the exit wound. Surgery was performed to replace two large pieces of dislodged bone and the wound was held together with adhesive straps to allow fluids to drain, as the brain swelling reduced gradually. From a modern medical standpoint, this procedure was outstanding, as the fundamental principles that were used then, are still carried out today, but with improved safety, use of higher surgically graded equipment and advanced technology. The discovery of antibiotics in 1928 for example, was eighty years too late for Gage, whose death from an epileptic seizure was caused by a severe wound infection.
Often medical afflictions experienced in the past play a vital role in opening the eyes of the modern day thus helping to advance our current understanding of human physiology. For hundreds of years doctors have been fascinated by the brain, the centre of our existence which controls all that we do. However, that awe of the three pound, soft mass inside our cranium was not at all understood until Phineas Gage was rendered ‘one gore of blood.’ an accidents with repercussions that inspired and gave doctors clues to solving the enigma of the brain. On September 13th 1848, near Cavendish, Vermont, Phineas Gage was paving the way for the construction of a new railroad when a distraction caused a tamping iron rod, measuring over 1 metre in length, to pierce through his upper jaw, underneath his left eye, then through the frontal, temporal lobe before landing 25 metres away. Given the extent of the trauma, one might have expected Gage to have suffered more severe repercussions than he did, especially with regard to his motor skills and mobility. He did suffer severe loss of blood and blindness in the left eye, but, for the most part, his physical capacity remained intact, hence the most severe consequence was the subsequent immense shift in his personality.
Given the lack of physical change to the body, many neuroscientists, psychologists and behavioural analysts have since remained fascinated by the switch in his personality. Very little is known about Gage’s behaviour prior to the explosion, but accounts from his peers and doctors indicate an acute shift. Gage was described by those around after the accident as lacking in inhibitions, with later embellished claims saying that he became “beset by drinking habits” (Wilson, 1879), “intemperate” (Hughes, 1897), and finally a “braggart”, ‘the decisions he made did not take into account his best interest”, and that “there was no evidence of his concern about his future, no sign of forethought” (Damasio, 1995). He also seemed to present a strong affiliation with the tamping iron itself, which he kept as he travelled around having been deemed unfit to continue working on the construction. To those around him, it was coined his ‘constant companion.’
In the immediate aftermath of the event, Gage sought the advice of Dr Edward H. Williams who, upon the first consultation, declared disbelief that an iron bar of such length and girth could have caused such a wound. Gage, in spite of his injuries, was still able to walk, communicate and seek medical attention without assistance, despite others’ descriptions of seeing “the pulsations of the brain being very distinct.” and upon vomiting watched as “about half a teacupful of the brain, fell upon the floor.” Although Williams was the first physician to observe the injuries obtained by Gage, the case was then transferred to Dr John Martyn Harlow
These reports however, all lead to one conclusion that has been pointed out by many, which is the oftenblurry boundary between science and popular scientific myth. The inconsistency and questionable reliability of sources leads us to wonder what truly happened in the mind of Phineas Gage and how much we can learn from his accident. His brain injury galvanised the drive of functional mapping of the brain and directly led to the temporal lobes association with cognitive skills, emotional expression and behaviour, but the extent to which is still unknown.
Harlow’s account of the passage of the rod was described in a letter to the Boston Medical and Surgical Journal which allows us to understand the depth of nineteenth century medical knowledge. “[The tamping iron] entered the cranium, passing through the anterior left lobe of the cerebrum, and made its exit in the medial line, at the junction of the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the parietal and frontal bones extensively, breaking up considerable portions of the brain, and protruding the globe of the left eye from its socket, by nearly half its
Henry Wellcome set up the Wellcome Trust an archive of his research and collections throughout his life and an ever expanding library of medical knowledge. The history of Phineas Gage lies in the archives of neuropsychology, but, similarly to the Wellcome Trust, his story has provided the platform upon which advancements in medicine have, and continue to be made. 14
