TY  - CHAP
M1  - Book, Section
TI  - Structural and Functional Organization of the Nervous System
A1  - Mosconi, Tony
A1  - Graham, Victoria
Y1  - 2017
N1  - 
T2  - Neuroscience for Rehabilitation
AB  - >  CASE  1No  Longer  Phineas  GageIn  1848,  a  25-year-old  railroad  foreman  named  Phineas  Gage  was  in  charge  of  a  work  crew  tasked  with  blasting  rock  to  lay  track  for  the  Rutland  &  Burlington  Railroad  in  Vermont.  As  he  had  countless  times  before,  Gage  prepared  to  pack  the  charge  into  a  hole  in  the  rock,  using  a  three-and-a-half-foot-long  tamping  iron.  This  time,  however,  the  charge  was  improperly  placed.  As  he  plunged  it  into  the  hole,  the  rod  set  off  a  spark  that  detonated  the  charge  and  blew  the  tamping  iron  through  Gage's  left  cheek  and  orbit,  and  clear  through  his  left  frontal  lobe  and  skull,  landing  80  feet  away.  Incredibly,  some  accounts  tell  that  he  never  lost  consciousness,  spoke  soon  after  the  tragic  event,  and  helped  himself  into  a  cart  to  leave  the  site.  Dr.  John  Martyn  Harlow  became  Gage's  physician  throughout  the  ordeal  and  for  a  time  afterward  during  his  recovery.  He  returned  to  his  family  home  in  New  Hampshire,  and  after  a  few  days  in  a  semi-comatose  state,  Gage  sat  up  and  began  an  almost  miraculous  recovery.  He  spent  several  months  convalescing  at  his  family  home,  then  returned  to  Vermont,  where  Dr.  Harlow  pronounced  him  in  good  health  except  for  loss  of  vision  in  his  left  eye,  ptosis  (drooping)  in  his  left  eyelid,  and  a  large  scar  and  indentation  in  his  forehead.  Dr.  Harlow  remained  Gage's  physician  throughout  his  recovery.Over  the  ensuing  years,  Phineas  Gage's  personality  underwent  a  profound  change.  No  longer  was  he  the  quiet,  competent  work  foreman,  so  he  lost  his  job  on  the  railroad.  He  performed  numerous  jobs  afterward,  including  driving  stagecoaches  in  Chile.  His  behavior  and  demeanor  became  increasingly  erratic,  prone  to  outburst,  and  inappropriate,  until  his  friends  stated  that  he  was  “no  longer  Gage.”  He  died  in  May  1860,  12  years  after  his  tragic  accident,  but  his  skull  and  the  offending  tamping  iron  currently  reside  in  Harvard  Medical  School's  Warren  Anatomical  Museum.Both  Dr.  Harlow's  original  observation  of  Gage's  injury,  including  probing  the  wound  by  inserting  his  finger  into  the  hole,  and  subsequent  modern  computed  tomography  (CT)  reconstructions  based  on  images  from  Gage's  actual  skull,  suggest  that  the  iron  destroyed  Gage's  left  frontal  lobe,  largely  sparing  his  right  hemisphere  and  the  rest  of  his  brain.  The  reconstruction  infers  significant  damage  to  the  prefrontal  cortex  and  the  underlying  white  matter  tracts  that  likely  contributed  to  the  prolonged  behavior  and  personality  changes.  Because  of  the  incomplete  understanding  of  his  brain  injury  and  the  often  contradictory  reports  of  Gage's  mental  deterioration,  both  sides  of  the  nineteenth-century  discussion  of  whether  function  is  localized  in  specific  parts  of  the  brain  were  able  to  cite  Gage's  case  as  supporting  their  hypotheses.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessphysiotherapy.mhmedical.com/content.aspx?aid=1148429441
ER  -