菲尼亚斯·盖奇

受伤前

盖吉原本是大西部铁路公司的爆破工头，1848年9月13日接受任务：负责炸开掉在铁轨上挡着去路的大石头。工人们因为分心，未铺上防炸的泥土，盖吉无意用自己随身携带的长110公分、半径3公分的铁棒点燃引线，因为缺少了防炸，导致铁棒直接炸出，贯穿盖吉的左脸颊，从头顶贯穿飞出，铁棒掉落于25米外。原本被以为会命丧当场的盖吉，在两分钟后竟还可做出动作，被同事送去小镇医院。医生使用大黄和蓖麻油医治，三周之后即可以自由行动。

受伤后

盖吉在1848年9月13日遭遇意外脑部受创后，奇迹般逐渐康复，至11月25日已能够返回他父母在新罕布什尔州黎巴嫩镇的家中。

1849年4月，医生检查盖吉时，记录他左眼失去了视力而且眼睑下垂，前额有一个大伤疤（因医生需要排走脓肿而造成）。

转变

大家公认的盖吉原本是认真负责，做事有始有终，人缘良好的工头。意外受伤之后虽然康复很快但他已经不是大家认识的盖吉了，粗鲁不雅，不听劝导，自以为是，虎头蛇尾。智商变成小孩子般。

神经学家将盖吉作为前额叶皮质重要的研究资料，并确定前额叶皮质受损会使人容易产生冲动、反社会行为。

Phineas P. Gage (1823–1860) was an American railroad construction foreman remembered for his improbable[B1] survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and behavior over the remaining 12 years of his life‍—‌effects sufficiently profound that friends saw him (for a time at least) as "no longer Gage".

Long known as the "American Crowbar Case"‍—‌once termed "the case which more than all others is cal­cu­lated to excite our wonder, impair the value of prognosis, and even to subvert our phys­i­o­log­i­cal doctrines" ‍—‌Phineas Gage influenced 19th-century discussion about the mind and brain, par­tic­u­larly debate on cerebral local­i­za­tion,​[M][B] and was perhaps the first case to suggest the brain's role in deter­min­ing per­son­al­ity, and that damage to specific parts of the brain might induce specific mental changes.

Gage is a fixture in the curricula of neurology, psychology, and neuroscience,​[M7] one of "the great medical curiosities of all time"[M8] and "a living part of the medical folklore" [R] frequently mentioned in books and scientific papers;[M] he even has a minor place in popular culture. Despite this celebrity, the body of established fact about Gage and what he was like (whether before or after his injury) is small, which has allowed "the fitting of almost any theory [desired] to the small number of facts we have" [M]‍—‌Gage acting as a "Rorschach inkblot"  in which proponents of various conflicting theories of the brain all saw support for their views.……

Life

Background

Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell Gage (née Swetland) of Grafton County, New Hampshire. Little is known about his upbringing and education beyond that he was literate.​[M][M10]

Physician John Martyn Harlow, who knew Gage before his accident, described him as

Accident

On September 13, 1848, Gage was direct­ing a work gang blast­ing rock while pre­par­ing the road­bed for the Rut­land & Bur­ling­ton Rail­road south of the village of Cav­en­dish, Ver­mont.……

Mental changes and brain damage

Early observations (1849–1852)

Harlow ("virtually our only source of information" on Gage, according to psychologist Malcolm Macmillan)[M] described the pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ";……

Factors favoring Gage's survival

Harlow saw Gage's survival as demonstrating "the wonderful resources of the system in enduring the shock and in overcoming the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature", and listed what he saw as the circumstances favoring it:

1st. The subject was the man for the case.……

Early medical attitudes

Skepticism

Barker notes that Harlow's orig­i­nal 1848 report of Gage's sur­viv­al and recov­ery "was widely dis­be­lieved, for obvious reasons" [B] and Harlow, recall­ing this early skep­ti­cism in his 1868 ret­ro­spec­tive, invoked the biblical story of Doubting Thomas:[L1]

Theoretical misuse

Though Gage is considered the "index case for personality change due to frontal lobe damage", ​[B]​​[F1]​[M] the uncertain extent of his brain damage​[F1][M] and the limited understanding of his behavioral changes render him "of more historical than neurologic [sic] interest".……

Phrenology

Throughout the 19th century, adherents of phrenology contended that Gage's mental changes (his profanity, for example) stemmed from destruction of his mental "organ of Benevolence"‍—‌as phrenologists saw it, the part of the brain responsible for "goodness, benevolence, the gentle character ...……

Portraits

Two daguerreotype portraits of Gage, identi­fied in 2009 and 2010, are the only like­nes­ses​[W][T][W1] of him known other than a plaster head cast taken for Bigelow in late 1849 (and now in the Warren Museum along with Gage's skull and tamping iron).