Spurlock knew the Gage story well enough to know that any photograph of him would be the first to come to light.
But the man in the Flickr photogragh seemed well-dressed and confident. It was Spurlock who told the Wilguses that the man in their daguerreotype might be Gage. After Beverly finished her online research, she and Jack concluded that the man probably was. She e-mailed a scan of the photograph to the Warren museum.
It had to be Gage, he determined. How many midth-century men with a mangled eye and scarred forehead had their portrait taken holding a metal tool? A tool with an inscription on it? The Wilguses had never noticed the inscription; after all, the daguerreotype measures only 2. Phinehas P. Date October 29, March 8, Then imagine that this happened in , long before modern medicine and neuroscience.
That was the case of Phineas Gage. Whether the Vermont construction foreman, who was laying railroad track and using explosives at the time of the industrial accident, was lucky or unlucky is a judgment that Warren Anatomical Museum curator Dominic Hall puzzles over to this day. He also developed a fungal infection in the exposed brain that needed to be surgically removed.
His condition slowly improved after doses of calomel and beaver oil. By mid-November he was already walking around the city. For three weeks after the accident, the wound was treated by doctors. During this time, he was assisted by Dr. John Harlow, who covered the head wound and then reported the case in the Boston Medical Surgery Journal. In his reports, Harlow described that the physical injury profoundly altered Gage's personality. Although his memory, cognition and strength had not been altered, his once gentle personality slowly degraded.
He became a man of bad and rude ways, disrespectful to colleagues, and unable to accept advice. His plans for the future were abandoned, and he proceeded without thinking about the consequences.
His mind had changed radically. As a result of this personality change, he was fired for indiscipline and could no longer hold a steady job. He became a circus attraction and even tried life in Chile, later returning to the United States. However, there is something still little known about Gage: his personality changes lasted for about four years, slowly reverting later. As a proof of this, he worked as a long-haul driver in Chile, a job that required considerable planning and focus skills.
He died on May 21, , 12 years after the accident, from an epileptic seizure that was almost certainly related to his brain injury. He was not submitted to an autopsy, but his mother, after exhumation of the body, donated his skull and iron rod at the request of Dr. Harlow, which, in turn, sometime later donated them to Harvard University Figure 2. Gage's case is considered to be one of the first examples of scientific evidence indicating that damage to the frontal lobes may alter personality, emotions and social interaction.
Scottish neurologist, David Ferrier, was motivated by this fact to investigate the role of frontal lobes in brain function. Ferrier removed the frontal lobes in monkeys and noted that there were no major physiological changes, but the character and behavior of the animals were altered.
Knowledge that the frontal lobe was involved with emotions continued to be studied. The surgeon Burkhardt in performed a series of surgeries in which he selectively destroyed the frontal lobes of several patients in whom he thought might control psychotic symptoms, being the modern prototype of what was later known through Egas Moniz as psychosurgery.
Folkloric as it may be, but nonetheless remarkable, the contribution of Phineas Gage's case should not be overlooked, as it provided scientists the baseline for the promotion of studies in neuropsychiatry, and a source of inspiration for world medicine. Medical and psychology students still learn about Gage from their history lessons. Neurosurgeons and neurologists still sometimes use Gage as a reference when evaluating certain cases.
Therefore, Gage — inadvertently — made a huge contribution to neurology in several areas, including the study of brain topography in behavioral disorders, the development of psychosurgery, and finally the study of brain rehabilitation. Also, Gage's case had a tremendous influence on early neuropsychiatry. The specific changes observed in his behavior pointed to theories about the localization of brain function and correlated with cognitive and behavioral sequelae, thereby acquainting us with the role of the frontal cortex in higher-order actions such as reasoning, behavior and social cognition.
In those years, while neuropsychiatry was in its infancy, Gage's extraordinary story served as one of the first pillars of evidence that the frontal lobe is involved in personality, which helped solidify his remarkable legacy in world medical history.
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