This Thursday let’s throw it all the way back to 1868 when a doctor named John M. Harlow finally had enough. For twenty years he had endured incredulous disbelief at his initial report of a patient – a man named Phineas Gage - who survived a tamping iron exploding through his head. Now that the man had unfortunately passed away, and the doctor had the good fortune of procuring the skull as indubitable proof of the event, he compiled his notes and published a case study:
You can read it here in full (and I strongly encourage you to do so. Far from the dry, esoteric tone of many academic journals today, the paper is full of action, drama, and opinion). Here are some personal highlights.
Harlow begins the paper acknowledging that many doctors and surgeons believed the story of Phineas Gage to be physiologically impossible….
…but now he’s about to change everyone’s mind.
He goes on to recount the incident of the tamping iron blasting through Gage’s brain in great detail, as well as the immediate aftermath (he got up immediately with little assistance, was able to walk up a flight of stairs, and upon seeing the doctor (Harlow), proclaimed ‘I hope I am not much hurt’). His recovery over the next few months is astonishing. But what’s even more incredible than his survival is the observation that, upon not dying, Gage appeared to live on with a different personality than he had previous to the injury. Harlow observes:
His description of Gage's selective deficits in executive functioning and decorum is among (if not exclusively) the first insights into understanding the role of the prefrontal cortex. Harlow's observations above were also a defining moment for the burgeoning theory of 'cerebral localization': that specific parts of the brain are specialized in different functions (now a fact we take for granted, this was a controversial and hotly debated topic in the 20th century). That last sentence - 'In his regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage"' could probably be considered somewhat of a birthplace for 'cognitive neuroscience'. Harlow's account (in combination with others) was so influential that the change in Gage's personality following his brain damage has become inextricably mired in our biological understanding of what it means to be oneself.
The impetus for writing this case study twenty years following the incident was the unfortunate event of Gage's death. Harlow was saddened to learn of his death, and gravely disappointed that an autopsy had not been performed to analyze the condition of Gage's cortex. However, Gage's mother entrusted his skull to Harlow, which bore the gruesome evidence of the injury decades before. Armed with this new data, Harlow finally felt ready to defend his initial account of the incident which he had published 18 years previously and had been widely discredited as impossible. He included drawings of the skull and tamping iron to scale.
Harlow ends on a philosophical note on the recuperative powers of nature and the role of the intervening surgeon.
It is difficult to imagine a case study published in the 21st century concluding in such a manner.
- Harlow, J.M. Recovery From The Passage Of An Iron Bar Through The Head. Massachusetts Medical Society, 3 June 1868