Tuesday, June 23, 2009

Phineas Gage Case (Frontal Lobe Damage)

In September, 1848, Phineas Gage, foreman of a road construction gang, had an iron rod blown through his head, achieving immortality. But Phineas Gage did not become immortal in the usual way by going directly to his heavenly reward, for he survived. In fact, it was the details of his survival which constituted the basis for the very considerable amount of fame that came his way.

It seems that Phineas Gage had poured a charge of powder into a hole in a rock, prior to a routine blasting operation. The usual procedure was then for an assistant to cover the powder with sand. For some reason this had not been done, and Gage neglected to check on the matter. Instead, supposing the sand covering to be in place, he dropped a heavy tamping iron into the hole. The result was catastrophic: the iron rod struck upon rock, made a spark, ignited the powder inside the hole, and took off for the stratosphere. On its way the rod, which was nearly 4 feet long, passed cleanly through Phineas' brain, entering high in his left cheek and coming out from the top of his head, causing frontal lobe damage.

Phineas Gage was stunned for an hour, after which, with some assistance, he was able to walk off to see a surgeon, talking on the way about the hole in his head. Eventually he recovered from the infection that developed in the wound and lived for another twelve years. Scientists verified the story by actual examination of the damaged brain. It was found that not only the left frontal lobe had been severely damaged, but the damage had spread to the right frontal lobe as well.

Gage's surprising survival of such a spectacular injury was followed by equally surprising aftereffects. The aftereffects were remarkable precisely because of their nonspectacular nature. For Gage could still displayed no loss of memory and he was still able to perform his job. For a man with such extensive damage of the very portion of the cerebrum which had long been believed to be the seat of the higher intellectual processes, Gage displayed a disproportionately small decrease in his mental capacities. Yet, there were some changes in Phineas Gage, though, but they were of quite a different nature from what what would have been predicted by the then prevailing theories.

It seemed that his personality rather than his memory had been mainly affected. Before the accident Phineas Gage had been considerate, efficient, and well-balanced. Afterward he was fitful and irreverent, indulging frequently in gross profanity and manifesting little consideration for others. He had become obstinate yet capricious and vacillating. With these new traits Gage could no longer be trusted to supervise others. In fact, he showed little inclination toward work of any kind, but instead chose to travel around, making a living by exhibiting himself and his tamping iron.