The Case of Phineas Gage, Research Paper Example

Perhaps one of the most widely recognized cases in neurology and physical injuries occurred in the mid 1800s when a man by the name of Phineas Gage experienced one of the most horrific accidents in history.  Essentially, the accident involved a puncture of the frontal lobe for Phineas Gage and has been analyzed due to the amazing fact that he continued to live afterwards.  Very few people survive any amount of brain damage, especially with little or no side effects.  The neurological departments at hundreds of universities across the globe have all studied this case because of the fascinating impact it has provided for the medical community.  On September 14, 1848, Phineas Gage experienced a work-related accident that would not only change his life but change the medical community forever.

The circumstances surrounding the accident are very unique and likely would have never occurred to anyone else given the same circumstances.  Phineas Gage was foreman group of railroad construction workers that were in responsible for blasting large amount of rocks to clear the way for laying railroad tracks.  Essentially, the workers would drill deep holes into the boulders and then replace the holes with sticks of dynamite.  After the fuse was inserted into the dynamite, the hole was completely filled with sand to ensure that the blast would only directed to the boulder (Mo, 2006, par. 2).  A large tool similar to that of a crow bar was used throughout this process to help drill the hole correctly, and the tool was called a tamping iron.  According to an account of the accident Gage’s local newspaper, the Free Soil Union, “Phineas P. Gage, a foreman on the railroad in Cavendish, was yesterday engaged in [tamping] for a blast, the powder exploded, carrying an iron instrument through his head … [t]he 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” (Ergenzinger, 2002, p. 3).  The blast occurred prematurely and forced the tamping iron rod to fly through his skull, and his brain, as a result of a devastating explosion on the railroad.  The rod pierced the base of his skull and moved completely “through the front of his brain before exiting at high speed from the top of his head” (Ergenzinger, 2002, p. 3).  After this horrific scene had ended, Gage spent just one week in the hospital as medical doctors and nurses examined the extent of the damage and tested him for personality, mental and physical side effects.  It quickly became apparent that Gage suffered very few side effects and was able to be released following his time in the hospital.  However, many medical professional continued to seek out Gage for testing and analysis.  Much of the remainder of his life was spent with doctors continuing to be tested and interviewed so that additional knowledge of the human brain could be gained from this very odd and amazing occurrence.

Gage was extremely lucky to not have suffered any major physical side effects to the knowledge of medical professionals at the time.  “Despite his injuries he remained conscious and only a few minutes later [he] was sitting in an ox cart writing in his work book.  He recognised and reassured Dr. John Martin Harlow, who had been summoned to the scene” (O’Driscoll & Leach, 1998, p. 1673).  Although he showed no immediate psychological issues, the physical wound continued to bleed for two days and was followed quickly by a virulent infection that forced Gage into a semiconscious state for roughly one month (O’Driscoll & Leach, 1998, p. 1673).  Even reports in the local newspaper and by individuals within his hometown community believed that the condition was so poor that a coffin had even been prepared for the event of his untimely death.  Still, doctors continued to analyze his condition and follow up with treatment.  Dr. Harlow noticed in the fifth week that the infection had disappeared, and within several days afterward, gage had regained consciousness (O’Driscoll & Leach, 1998, p. 1673).  “He experienced no paralysis or sensory deficits except for the loss of vision in his left eye, which was directly damaged by the rod.  His manual dexterity was intact, and there was no noticeable difficulty in his speech, language, or capacity for rational thought” (Ergenzinger, 2002, p. 4).  Dr. Harlow also noticed and reported in his notes afterward that Gage experienced facial weakness on the left side of his face but had experienced no “focal neurological deficits” of any kind (O’Driscoll & Leach, 1998, p. 1673).  While the obvious physical damage remained relatively light, Dr. Harlow continued to analyze Gage for some time following the immediate release from the hospital.

Friends and family of Phineas Gage, as well as Dr. Harlow, quickly realized that his personality had been greatly impacted.  “Specifically, Gage was no longer able to behave appropriately as a social being, and instead made choices that were consistently disadvantageous to him” (Ergenzinger, 2002, p. 4).  Upon further review, Dr. Harlow produced a complete analysis of Gage’s situation by explaining that:

“His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again.  He is 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 of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible.  In this regard, his mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage’” (Mo, 2006, par. 10)

This great change in his personality has been the main reason that neurological professionals have studied Gage’s case for over a century.  It is hypothesized that somewhere in the frontal lobe there exists neurons that control an individual’s personality.  Gage’s particular incident involved the tamping iron flying through the top of his head entering the frontal lobe and exiting through his left cheek.  Dr. Harlow continued to note that Gage’s “intellectual manifestations [were] feeble, being exceedingly capricious and childish, but with a will as indomitable as ever; is particularly obstinate; will not yield to restraint when it conflicts with his desires” (O’Driscoll & Leach, 1998, p. 1674).  In other words, Gage had become very childish and stubborn, which were traits that he had not previously shown prior to the accident.  His wife and fellow co-workers no longer recognized Gage as the same person, and he was no longer allowed to work in a position that required high levels of responsibility, maturity and poise.

Modern technological reconstruction of Gage’s case has been very beneficial for the neurological industry in analyzing the exact medical consequences of the accident.  Perhaps the chief role that his case held in the 1800s was to spark an immediate medical debate regarding the organization of the brain, and more specifically leading to the assignment of parts of the brain to specific bodily processes and physiological actions.  Neurology and brain research had just begun to emerge during this time period, although previous history has shown brain surgeries and experiments prior to Gage’s case.  The idea that specific parts of the brain were responsible for sensory and motor functions within the body was a fairly new concept, and prior to Gage, “the idea of an area responsible for personality was beyond the pale for the vast majority of physicians and scientists” (Ergenzinger, 2002, p. 4).  Immediately, the debate sparked additional research and hypotheses that could be proven or negated through experimental research in Neurology than had ever been performed previously.  Today, computerized research has been able to continue to draw upon this debate and the physical imagery that could be reconstructed regarding Gage’s case.  “Modern computer reconstructions of his skull estimate that the damage was localized to the ventromedial prefrontal cortices, located immediately behind the forehead on the underside of the brain” (Ergenzinger, 2002, p. 4).  There has been quite an explosion of research into the frontal cortex and frontal lobes of the brain in the twentieth century.  O’Driscoll & Leach (1998) further discussed that Dr. Harlow would be fascinated to learn today that “the cardinal function of the prefrontal cortex is the temporal organization of behavior supported by the subordinate functions of short term memory, motor attention, and inhibitory control” (p. 1674).  Furthermore, “the change in Gage’s personality [is] consistent with damage to the orbitofrontal cortex of the ventral aspect of his frontal lobe, affecting affect and emotion” (O’Driscoll & Leach, 1998, p. 1674).  It is clear that none of this research would have been possible in the medical community without the case of Phineas Gage to spark neurological discussion, debate and theory.

Phineas Gage was extremely lucky to have survived his bizarre accident that for all intents and purposes should have taken his life.  Although he survived with relatively no physical damage, except being blind in his left eye and having partial facial impairment, Gage’s personality defects have historically been the object of much advancement in the medical community.  The realization that spatial portions of the brain contain neurons that control physical behaviors and psychological processes had never previously been discussed prior to Gage’s accident.  With the advancement of technology in modern day, scientists and researchers are able to reconstruct the image of Gage’s cranium with a fairly precise model of where the tamping iron had traveled through the brain.  Nevertheless, Phineas Gage lived on for almost 13 more years after the accident, but his legend and his medical case have continued to survive the test of time for over 150 years.

References

(2009, July 29). Phineas Gage and brain surgery. Retrieved from http://www.deakin.edu.au/hmnbs/psychology/gagepage/PgSurger.php

Ergenzinger, E.R. (2002). Conversations with phineas gage: a neuroscientific approach to negotiation strategies. Retrieved from http://www.abanet.org/dispute/essay/ergenzinger.doc

Mo. (2006). The incredible case of Phineas Gage. Neurophilosophy at WordPress, Retrieved from http://neurophilosophy.wordpress.com/2006/12/04/the-incredible-case-of-phineas-gage/

O’Driscoll, K., & Leach, J.P. (1998). “no longer gage”: an iron bar through the head. British Medical Journal, 317(7174), 1673-1674.