A Case of Lodgment of a Foreign Body in the Cavities of the Nose, Orbit, and Cranium, where it remained Five Months; Removal by Operation; Subsequent Trephining for Pus in the Brain; Death Autopsy

Noyes, Henry D.

doi:10.1097/00000441-188207000-00002

Cited by 3 publications

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“…Over the next 2 weeks, he ordered vinum colchichum (a sedative for brain and nerves which also purged the bowels 112 ) and three other purgatives: magnesium sulphate, calomel, and rhubarb. 84 He had not repeated Professor Pancoast's mistake. Gage initially improved, only to lapse again into coma.…”

Section: Gage's Treatment and Harlow's First Reportmentioning

confidence: 99%

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

Barker

1995

Journal of Neurosurgery

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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.

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Section: Gage's Treatment and Harlow's First Reportmentioning

confidence: 99%

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

Barker

1995

Journal of Neurosurgery

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A wonderful journey through skull and brains: The travels of Mr. Gage's tamping iron

Macmillan

1986

Brain and Cognition

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Phineas Gage's Contribution to Brain Surgery

Macmillan

1996

Journal of the History of the Neurosciences

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In much contemporary literature the Phineas Gage case is described as contributing to the development of lobotomy and leucotomy but the historical evidence shows this to be an almost completely erroneous view. His case was, however, important in the development of brain surgery itself. I begin this paper by briefly mentioning four early cases of brain surgery and describing the Gage case. I then set out the context of the localisation debate, concentrating particularly on Broca's clinical observations, because Macewen planned the first operation on the brain in the light of Broca's findings. I then turn to that context as it was developed through Jackson's observations and Ferrier's experiments, because Bennett and Godlee used it in planning the first operation for the removal of a brain tumour. It was also in the localisation context that Starr first drew attention to the significance of the changes in Gage for localising frontal tumours. By the turn of the century, several operations had been performed on the frontal lobes and various difficulties with Starr's criteria had become apparent. The reasons for the difficulties will be brought out and I conclude with a brief discussion of the relation between the Gage case and the operations performed by Burckhardt, Moniz, and Freeman.

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A Case of Lodgment of a Foreign Body in the Cavities of the Nose, Orbit, and Cranium, where it remained Five Months; Removal by Operation; Subsequent Trephining for Pus in the Brain; Death Autopsy

Cited by 3 publications

References 0 publications

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

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

A wonderful journey through skull and brains: The travels of Mr. Gage's tamping iron

Phineas Gage's Contribution to Brain Surgery

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