An Odd Kind of Fame: Stories of Phineas Gage

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9780262632591: An Odd Kind of Fame: Stories of Phineas Gage

In 1848 a railway construction worker named Phineas Gage suffered an accident that made him a major curiosity of medicine and a significant figure in psychology and neuroscience: an explosion caused a tamping iron to be blown completely through his head, destroying the left frontal lobe of his brain. Gage survived the accident and remained in reasonable physical health for another eleven years. But his behavior changed markedly after the injury, and his case is considered to be the first to reveal the relation between the brain and complex personality characteristics. Yet almost nothing is known about him, and most of what is written is seriously in error.

In this book Malcolm Macmillan, a leading authority on Gage, covers all aspects of this fascinating story. He describes Gage's family and personal background, the context of his work and the accident, and Gage's subsequent history. He analyzes contemporary medical and newspaper reports of the accident and its consequences, and evaluates the treatment Gage received from Dr. John Martyn Harlow. He also looks at Harlow's own life and work. Macmillan examines Gage's place in the history of how functions came to be localized in the brain. He explores the many ways that Gage's tale has been represented and misrepresented through the years in popular, fictional, and scientific works. One of Macmillan's primary aims is to rescue the case from the predominantly fantastic accounts so that its real contribution to modern neuroscience can be understood. Partly for this reason, the appendices include facsimiles of Harlow's 1848 and 1868 reports, the primary sources about Gage, and previously unpublished CT scans of Gage's skull made in 1982.

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About the Author:

Malcolm Macmillan is Adjunct Professor in the School of Psychology at Deakin University, Australia.

From The New England Journal of Medicine:

The story of Phineas Gage is one of the oldest, most intriguing, and most told tales in the history of neuroscience. The key events occurred in rural Vermont more than 150 years ago. Gage, a railroad construction worker, had an accident in which an iron bar was propelled through the front part of his head, producing a massive injury to his brain, presumably in his frontal lobes. That Gage even survived was miraculous enough; that he survived without apparent changes in higher cognitive functions, including speech, learning and memory, and intellect, was almost beyond comprehension. But Gage's fame and the secure position of his case as a landmark in the annals of neuropsychology derive from another source. Although there was never an autopsy, the likelihood of frontal-lobe damage was high, and there were profound changes in Gage's personality and temperament. In retrospect, Gage's dramatic case was a clue to the critical role of frontal-lobe structures in social behavior and moral reasoning. Contemporary neuropsychology remains preoccupied with those relations.

There is, however, a story behind the story, and this is the impetus for Macmillan's account of the Gage tale. It seems that almost none of the numerous popular and scientific accounts of Gage have gotten all the facts right, and Macmillan's agenda is to set the facts straight and highlight the errors, from trivial to egregious, that punctuate many of the "Gage stories." An Odd Kind of Fame accomplishes both goals, although the author's axe-grinding style is unlikely to be greeted with enthusiasm by readers or the scientists and journalists who are repeatedly taken to the fact-straightening woodshed. The problem is that, beyond corrections of details, this book lacks new insights regarding the fundamental lesson of the Gage saga: namely, that the frontal lobes are intimately linked to personality and emotion.

For nearly two decades, Macmillan has been engaged in a punctilious and relentless pursuit of an accurate rendering of Gage's story. This book, the fruit of his efforts, is a historical tour de force that throws into bold relief the errors others have made in telling Gage's story. All the details of Gage's accident and recovery (documented in the primary sources) are revisited. For example, the iron bar that went through Gage's head was 1 1/4 in. (3.2 cm) in diameter (not in circumference, as reported by the Boston Post on September 21, 1848); the bar landed 4 to 5 rods (20 to 25 m) behind Gage after its journey through his skull (and did not remain lodged in his head, as reported in some scientific sources); and Gage's physician (John Harlow) confirmed the trajectory of the bar by touching his index fingers together through the openings in Gage's skull and brain.

Macmillan's exhaustive searches also reveal how much is not known about Phineas Gage and lead him to assert that "the lack of reasonably detailed knowledge about which parts of Phineas's brain were injured and about how his mental processes were changed means that we cannot draw other than the most general conclusions about brain-behavior relations from his case." This is no doubt correct -- it is, in fact, the very point, and highlights the general, rather than specific, value of the case. The Gage case illustrates a dramatic and novel relation between brain damage and changed behavior, but the specifics of this relation can only come from research based on comparable cases and modern neuroscientific approaches.

The book includes in several appendixes the original papers on Gage, including the two by Harlow (one written in 1848 immediately after the accident and the other produced 20 years later), and an 1850 paper by Henry Bigelow, a Harvard Medical School surgeon to whom Harlow sent Gage for evaluation (in part to establish the veracity of the case, since Harlow's account was received with considerable incredulity by the medical community). I would recommend that readers begin with these three papers, because they include virtually everything that is known for sure about Phineas Gage. The elegance and humility of the writing style make these papers at once beautiful and poignant: Harlow concludes his 1848 paper with the submission, "Should you think these notes of sufficient importance to deserve a place in your Journal, they are at your service"; his better-known final sentence in the 1868 paper reads, "I can only say, in conclusion... I dressed him, God healed him."

Macmillan's claim that the papers by Harlow and Bigelow have been cited often but almost never read is surely on target, and his book provides ready access to these papers. Open to more debate, though, is his indictment of nearly everyone who has contributed to the scientific and vernacular literature on the riddle of frontal-lobe function. Also, the author's proclivity for enumerating every small error is distracting: does it make a difference, for example, that the time of the explosion was 4:30 p.m., not 4 p.m. as given in some accounts? Harlow's and Bigelow's descriptions of Gage are spare, to be sure, but the gist of their conclusions has been faithfully portrayed by contemporary neuroscientists, and the prescient observations of Harlow regarding the connection of the frontal lobes to personality have been confirmed repeatedly by modern studies of patients with similar types of brain damage.

In the end, An Odd Kind of Fame is an odd kind of book. It is engaging as a history lesson and conveys the energy and tenacity behind the author's quest to uncover every shred of factual information about Phineas Gage. The thinly disguised vendetta against other Gage experts, however, and the frequent aspersions cast on their scholarship -- not to mention their motives -- make the narrative rather unsavory. The best parts of this book were written by Harlow and Bigelow.

Daniel Tranel, Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Descrizione libro MIT Press Ltd, 2002. Condizione libro: New. The true story of the first case to reveal the relation between the brain and complex personality characteristics. Num Pages: 576 pages, 75. BIC Classification: BG; JMA; JMM; MBX; MNN. Category: (P) Professional & Vocational; (UP) Postgraduate, Research & Scholarly; (UU) Undergraduate. Dimension: 227 x 153 x 33. Weight in Grams: 908. . 2002. Reprint. Paperback. . . . . . Codice libro della libreria V9780262632591

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Descrizione libro MIT Press Ltd, United States, 2002. Paperback. Condizione libro: New. Revised ed.. Language: English . Brand New Book. In 1848 a railway construction worker named Phineas Gage suffered an accident that made him a major curiosity of medicine and a significant figure in psychology and neuroscience: an explosion caused a tamping iron to be blown completely through his head, destroying the left frontal lobe of his brain. Gage survived the accident and remained in reasonable physical health for another eleven years. But his behavior changed markedly after the injury, and his case is considered to be the first to reveal the relation between the brain and complex personality characteristics. Yet almost nothing is known about him, and most of what is written is seriously in error. In this book Malcolm Macmillan, a leading authority on Gage, covers all aspects of this fascinating story. He describes Gage s family and personal background, the context of his work and the accident, and Gage s subsequent history. He analyzes contemporary medical and newspaper reports of the accident and its consequences, and evaluates the treatment Gage received from Dr. John Martyn Harlow. He also looks at Harlow s own life and work.Macmillan examines Gage s place in the history of how functions came to be localized in the brain. He explores the many ways that Gage s tale has been represented and misrepresented through the years in popular, fictional, and scientific works. One of Macmillan s primary aims is to rescue the case from the predominantly fantastic accounts so that its real contribution to modern neuroscience can be understood. Partly for this reason, the appendices include facsimiles of Harlow s 1848 and 1868 reports, the primary sources about Gage, and previously unpublished CT scans of Gage s skull made in 1982. Codice libro della libreria AAU9780262632591

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Descrizione libro MIT Press Ltd, United States, 2002. Paperback. Condizione libro: New. Revised ed.. Language: English . Brand New Book. In 1848 a railway construction worker named Phineas Gage suffered an accident that made him a major curiosity of medicine and a significant figure in psychology and neuroscience: an explosion caused a tamping iron to be blown completely through his head, destroying the left frontal lobe of his brain. Gage survived the accident and remained in reasonable physical health for another eleven years. But his behavior changed markedly after the injury, and his case is considered to be the first to reveal the relation between the brain and complex personality characteristics. Yet almost nothing is known about him, and most of what is written is seriously in error.In this book Malcolm Macmillan, a leading authority on Gage, covers all aspects of this fascinating story. He describes Gage s family and personal background, the context of his work and the accident, and Gage s subsequent history. He analyzes contemporary medical and newspaper reports of the accident and its consequences, and evaluates the treatment Gage received from Dr. John Martyn Harlow. He also looks at Harlow s own life and work. Macmillan examines Gage s place in the history of how functions came to be localized in the brain. He explores the many ways that Gage s tale has been represented and misrepresented through the years in popular, fictional, and scientific works. One of Macmillan s primary aims is to rescue the case from the predominantly fantastic accounts so that its real contribution to modern neuroscience can be understood. Partly for this reason, the appendices include facsimiles of Harlow s 1848 and 1868 reports, the primary sources about Gage, and previously unpublished CT scans of Gage s skull made in 1982. Codice libro della libreria AAU9780262632591

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Descrizione libro MIT Press Ltd. Condizione libro: New. The true story of the first case to reveal the relation between the brain and complex personality characteristics. Num Pages: 576 pages, 75. BIC Classification: BG; JMA; JMM; MBX; MNN. Category: (P) Professional & Vocational; (UP) Postgraduate, Research & Scholarly; (UU) Undergraduate. Dimension: 227 x 153 x 33. Weight in Grams: 908. . 2002. Reprint. Paperback. . . . . Books ship from the US and Ireland. Codice libro della libreria V9780262632591

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