Phineas Gage's Contribution to Brain Surgery

Abstract

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.

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.…”

Legendary name of neuroscience: Phineas Gage (1823–1860)

“…He crossed the bregma point and got out of the skull and fell 30 m ahead. Gage's survival as a result of this great injury in his brain and his personality change after brain injury made him known as the "man who began neuroscience" [1,2]. Doctor Edward Williams, who first examined Gage after the accident, thought he might die due to a big injury to his skull but was quite surprised when he saw a person who was seriously injured but could speak.…”

“…Gage, who was a very kind and thoughtful person before the accident, after the accident, it was seen that he was disrespectful, abusive, crusher, and a very harsh person when his requests were opposed. In addition, 2 years after the accident, he told Gage's nephews unreal heroism and escape stories [2,3].…”

“…In the article "Passage of an iron rod through the head" published by Harlow in 1848, Gage's treatment and its various changes were reported [4]. What is known about the amount of damage to Gage's brain is Harlow's work [2,3].…”

Prefrontal damage in childhood and changes in the development of personality: A case report

“…The relationship between frontal lobe lesions and personality changes has been highlighted since the paradigmatic description of Phineas Gage's case (apud Macmillan). 1 Another source of evidence includes prefrontal lesions that occur during childhood, a period in which the personality is being formed. In comparison to such lesions occurring during adulthood, personality changes caused by these prefrontal lesions in children tend to be more severe, with consequences that become apparent during development.…”