Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization

Abstract

In 1848, Mr. Phineas Gage suffered destruction of his left frontal lobe in a unique fashion: passage of a metal rod through his head after a freak explosion. His change in character after the accident is the index case for personality change due to frontal lobe damage. Yet, from 1848 to 1868, it was widely believed among American physicians that he was mentally intact. The case was used as evidence against phrenology, a crude precursor of modern cerebral localization theories. The two original reports of the case by Drs. John Harlow (Gage's physician) and Henry J. Bigelow show subtle differences in attitude toward Gage's posttraumatic character change. In his 1848 report, Harlow promised a further communication that would address Gage's "mental manifestations." Bigelow's article portrayed Gage as fully recovered. Although delayed by 20 years, Harlow's second report rapidly changed the perception of the case in the medical community, as reflected by contemporary citations. The educational backgrounds of Harlow and Bigelow are examined to explain their differing attitudes toward the case. Harlow's interest in phrenology prepared him to accept the change in character as a significant clue to cerebral function which merited publication. Bigelow had learned that damage to the cerebral hemispheres had no intellectual effect, and he was unwilling to consider Gage's deficit significant. Although Bigelow's paradigm was initially more influential, Harlow's more closely matched emerging theories of cerebral localization. His version of the case was used by David Ferrier as the keystone in the first modern theory of frontal lobe function, and this is how the case is remembered today.

Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso

“…acometendo indivíduos com transtornos psiquiá-tricos, usualmente tratando-se de objetos pequenos [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Sua ocorrência, seu tratamento e conseqüên-cias despertam interesse desde 1848 quando Phineas Gage sobreviveu a um trauma penetrante por barra de ferro atingindo seu lobo frontal esquerdo, tornando-se um marco no estudo da função do lobo frontal e da localização cerebral ("brain mapping") 4,[20][21][22] . O caso aqui relatado torna-se especial em virtude das grandes dimensões do objeto penetrante (15 x 12 cm) e do bom resultado funcional alcançado.…”

Penetrating screwdriver wound to the head

“…Unusual PWH, most commonly, occur in the thin bones of the skull, especially in the orbital surfaces and the squamous portion of the Medical reports of bizarre stab wounds to the brain date from as early as 1806 3,4 . One of those first cases regarding PWH was reported in 1848.…”

“…He had a piece of iron blown into his head. He is probably the most famous patient to have survived such a severe damage to the brain in the nineteenth century and for sure he is also the first patient from whom we soundly learned about the relationship between cerebral functions and brain structural lesions [3][4][5] .…”

A Unifying Approach to High- and Low-Level Cognition

“…For instance, damage to the cortical region in the occipital pole was found to lead to a loss of visual function and perceptual awareness. Additionally, to name just a few, blindsight results from a lesion of early visual areas (Weiskrantz 1968, Stoerig andCowey 1997); visual agnosia was shown to be the result of lesions to the occipitotemporal cortex (Farah 2000); prosopagnosia can be elicited by lesions to the inferior occipital cortex or fusiform gyrus (Steeves et al 2009); akinetopsia by lesioning paroetal cortex (Zihl et al 1983); achromatopsia by lesions to the ventral occipital cortex (Zeki 1990); and personality and behavior were shown to be affected by lesions to the frontal lobe (Barker 1995). Today, this view is complemented by studies applying modern imaging techniques, such as fMRI, PET, EEG, and MEG that demonstrate a functional compartmentalization in far reaching areas of cognition.…”