Fairy Tales and Fury Trails…..




Let me take you back in time to the mid nineteenth century and tell you the story of an American railway construction worker named Phineas Gage. He was known amongst his colleagues and employers as ‘the most efficient and capable foreman … a shrewd, smart businessman, very energetic and persistent’.  One fine September day in 1848, aged 25, Phineas Gage was carrying out his usual work, i.e, some rock blasting with explosives outside the town of Cavendish, Vermont, in preparation for laying a railway line. However, this fateful day an unplanned blast caused a 4 foot long rod of iron to burst out of the ground straight up toward the sky, and it found Phineas’ head in its path, and landed many feet away smeared with his blood and brain.

To the men present at the site, the initial shock of this accident was compounded by the fact that a few minutes later Phineas got up, and spoke normally and even sat himself down in the ox-cart to be taken back to the nearest town…… all this with a severely wounded head, (particularly the front of the head), through which the brain could clearly be seen pulsating out. The doctors who attended him have made very interesting observations about his condition, and were obviously shocked how he could maintain his senses and condition with an injury that was clearly life threatening. He recognized his doctor, Dr Harlow, and remained more or less conscious until his hemorrhage (bleeding) caused him to pass out.
Despite good care (available at the time) Phineas’ recuperation was prolonged and painful, so much so that his attendants had prepared for his death. However, after spending a few weeks in a semi-comatose state, he started recovering and was back on his feet. After a few months’ time, the his doctors noted that apart from a  loss of vision of his left eye, a deep depression on the top of his head, and partial paralysis of his left face, his physical health was good and they thought he had recovered. He had no pain in his head except a queer feeling which he found difficult to describe.
Having lost contact with his primary doctor, Dr Harlow, since recovering from the accident, Phineas Gage remained alive for about 12 years and then died during a prolonged convulsion. After news of his death reached his doctor, he opened correspondence with Gage’s family. At Dr Harlow’s request, Gage’s skull was exhumed from his grave and sent to him for further study. It was thenceforth placed alongside the infamous ‘rod’, that had caused Gage’s accident, in Harvard Medical School Museum.
Over the last century and a half, Phineas Gage’s case has been the subject of a lot of interest and referenced multiple times in fields of Neurology, Surgery, Psychiatry, litigation and even folklore. 
For neurologists in particular, this story has historic importance as it gave important pointers of the brain’s functions being specific to anatomically defined areas. Some people even say that this was the first referenced case, but it would be safer to say that it certainly came at a time when knowledge about different parts (or lobes–as we like to call them) of brain was in its infancy.
Why did this person not die straight away although the rod went right through his brain and not only injured but took a huge chunk of his brain out? This led scientists to understand that the underlying functions of life, like breathing, heart rate, blood circulation, etc are located away from the site of this particular injury.
So what happens if this part of the brain is lost? In Phineas Gage’s case, it was the frontal lobes (the part of the brain right behind his forehead). If an injury to this part is not life-threatening, then surely it must be an ‘unimportant’ part of the brain? Is this the reason that he managed to be physically fit and mentally sound despite a grave injury?
This is where one of the most interesting discoveries of neuroscience was made. After his death, when Dr Harlow got in contact with Phineas Gage’s friends and family, he discovered that despite apparent recovery, he had become a completely different person.  Such remarkable was the change in his personality that his old employers refused to employ him again. In Dr Harlow’s own words, the following often quoted description is an avid account of what a frontal lobe injury can do:
“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. 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 or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage”.
Historically as well as in individual experiences, most of the study and information about brain function arises when a part of it is not working, by virtue of accident, injury or disease. It is ironic, that one has to lose something in order to realize how important it is.
Phineas Gage’s case is instructional from a scientific and historic point of view, and if nothing else, its a great story. 

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