Phineas gage (1823-1861) was a famous man in the field of neuroscience for the strange nature of the accident he suffered, for his surprising recovery and for the knowledge derived from his case.
Thanks to the Phineas case, aspects of the brain that were previously a mystery were discovered. Specifically, it has become the typical example of alterations in the frontal lobe and disorders of executive functions..
Phineas Gage was born in 1823. When the serious accident happened, he was only 25 years old. He was a healthy, active, energetic and strong man. He was known for being responsible, efficient in his work, intelligent and persevering with his goals. He was characterized by being a trustworthy, sensible, friendly and jovial person..
He worked as a foreman for a crew of workers in a railway company; They were in charge of blasting a path on rocky surfaces, so that the railway line could pass.
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When the accident occurred, Gage was near Cavendish in Vermont, United States. As Gage and his workers normally did, they drilled a hole in a rock, filled it with gunpowder, and pressed it with an iron bar..
On that fateful afternoon of September 13, 1848, Gage was attempting to place the iron bar when one of his men called out to him, distracting him. Accidentally, the iron bar was quickly detached and embedded in his face. It entered through his left cheek and pierced the front of his skull.
The bar passed behind his left eye and destroyed part of the right frontal lobe, coming out near the cranial vertex. Even so, the bar was strong enough to travel another 25 meters before hitting the ground full of blood and brain tissue..
According to witnesses, the iron bar was about 105 centimeters long, 3 centimeters in diameter, and 7 kilograms in weight..
Phineas Gage fell to the ground on his back and suffered some convulsions, although he did not lose consciousness. Surprisingly, Gage managed to sit up and after a few minutes he was able to talk and walk.
In fact, he himself addressed the doctor in an ox cart. In addition, he was able to tell those present what had happened.
When he got to the village, he greeted some people by name, and with a little help made it to a room at the nearest hotel, where he waited for medical attention. Thus, when he saw the doctor, Gage said: "doctor, here is work for you." The doctor who treated him and helped him throughout the recovery process was John Martyn Harlow.
He could observe the beating of the brain while the patient reported the event without difficulty. In addition, he responded in a rational and coherent way to the questions that were asked..
Curiously, the doctor did not find any problem in his memory, in his movements, in his sensory perceptions, balance, or language. The first thing Harlow did was stop the bleeding and remove the bone fragments that were embedded in the wound..
A week later, the newspapers announced the surprising accident. Whereas, three months later, Harlow also published this case in the Boston Medical and Surgical Journal, under the name of "Passing an iron bar through the head".
This caught the attention of Dr. Henry Bigelow, a prominent Harvard University professor of surgery. He invited Phineas to Boston to observe him, publishing an article that quickly attracted the scientific community..
Phineas Gage's recovery process was difficult, long, and checkered. The second day he seemed to lose his sanity. Whereas, on the fourth day, again, he had a rational appearance and recognized his friends.
After a week of improvements, everyone began to think that Gage could recover. However, this idea was short-lived. A few days later, Gage was struggling between life and death. He had periods of deep coma and the doctor realized that he had contracted a strong infection.
His companions and loved ones began to lose hope, becoming certain that he would die very soon. However, Harlow treated the infection as best he could, saving Gage's life..
Even today it is surprising how this patient managed to survive. Harlow saw it as a miracle, saying, "I took care of him and God saved him.".
Phineas Gage recovered and continued his life without serious physical problems, except for the loss of vision in the affected eye. Ten weeks later, he was able to return home to Lebanon, New Hampshire..
By the middle of the year 1849, Phineas felt ready to go back to work. However, his personality abruptly changed and his peers put him aside. After the accident, Gage became disrespectful, impatient, violent, irresponsible, cruel, capricious, etc..
Unlike her previous personality, she was now unable to carry out the plans she established, began to neglect her personal habits, and constantly complained of a reduction in her sexual drive..
In addition, he spoke uninhibitedly about sex and used profanity and profanity. When they talked about him, the companions kept saying: "this man is no longer Gage." Even his contractors had to fire him.
The problem was not in his physical abilities, but, rather, in the ability to notice the effects his actions had on others. This would correspond to an excellent description of what is today considered a typical prefrontal syndrome..
Gage was switching from job to job. There are authors who say that it became part of the Barnum Circus, as if it were just another show.
Between the years 1852 and 1860 more details of his life are not known with exactitude. It seems that in those years he was in Valparaíso and Santiago de Chile, working as a carriage driver.
In approximately June 1859 he returned to the United States, specifically to San Francisco. Soon he began to suffer a series of seizures. These recurrent epileptic seizures are what led to his death on May 21, 1860.
After about 5 years, Harlow convinced Gage's family to allow him to exhume the body. Thus, in 1867, the skull and metal bar were sent to Dr. Harlow.
In 1868 Harlow wrote a short book on the life of Phineas Gage. Thanks to the collaboration of witnesses and interviews with the family, it mainly describes the experiences of the patient in the 12 years, 6 months and 8 days after his accident.
The best account of a change in behavior due to a change in the prefrontal cortex is still considered. However, it must be said that not everyone accepted Gage's amazing story. Many came to think that it was false.
The person who prevented this story from falling into oblivion was Dr. David Ferrier, who in 1870 announced that the Phineas Gage case was proof that the prefrontal cortex was a functional area of the brain. Thanks to this, the unknown functions of this area began to be investigated.
Phineas Gage's skull and the iron bar that pierced it are in the Warren Museum at Harvard Medical School. Later studies have been carried out on the possible brain injuries of Gage according to his skull and three-dimensional reconstructions.
In 1990 Hanna Damasio et. to the. they reconstructed in a three-dimensional way Gage's brain and his injury. They show that the damage encompasses the prefrontal ventromedial region of both cerebral hemispheres.
However, in 2004, the radiology team at Brigham and Women's Hospital in Boston performed a new reconstruction. It indicated that the lesions only affected the left frontal lobe, leaving the vital vascular structures intact..
The story of Phineas Gage was also central to phrenology, a discipline that was in full swing at the time..
Phrenologists believed that the mental faculties were in specific areas of the brain. They also relied on the shape of the skull, head, and face to analyze character and personality traits..
It is currently known that the cerebral cortex plays a fundamental role in mental functions. However, before the 18th century, it was thought that this part of the brain was not functional, but that its objective was to protect the rest of the brain. That is, the cerebral cortex was considered a mere envelope of the cerebral ventricles.
Today, with the case of Phineas Gage, the cerebral cortex is known to be linked to executive functions. These functions are what allow us to solve problems, inhibit behaviors, self-regulate our behavior, cognitive activity and emotions, create flexible problem-solving strategies, etc. The prefrontal cortex is also considered the place where emotions and cognition are integrated..
Phineas Gage's disturbances were simply located on an emotional level, describing external behavioral changes. However, the cognitive level is not discussed, probably because there were no evaluation instruments that could measure them..
Through various investigations, it has been concluded that the damage was greater in the left hemisphere than in the right, and exclusively affected the prefrontal cortex, especially the ventromedial area of said cortex..
This area is essential to make decisions, establish future plans, self-regulate according to the social rules that have been learned and choose the most appropriate behaviors.
In contrast, attention, cognitive flexibility and calculation were preserved, since these functions correspond to the lateral or external part of the prefrontal cortex..
Therefore, the prefrontal cortex is an area of great complexity and each portion participates in different functions.
In the case of Phineas Gage, the main component affected is the ability to socialize, as the injured part of the brain establishes circuits with the limbic system that is associated with emotions. The frontal areas contribute to determine, in this way, the affective tone of relationships with others.
The case of Phineas Gage has produced numerous debates between authors on very different topics. First, some argue that during Gage's stay in Chile, there was probably an improvement in his symptoms. This is because he managed to stay a long time working as a horse carriage driver.
As this work requires some planning and participation of the executive functions, some argue that this was an indicator of their recovery.
On the other hand, different authors defend the need to recognize in this case the socio-cultural factors of Phineas Gage.
That is, they criticize neuroscience stating that the fact that he had a strange physical appearance after the injury could contribute to Gage's symptoms..
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