Phineas P. Gage (1823-1860) is an American railroad construction foreman who is remembered for the irredeemable [21]: 19 life of iron rods is driven entirely through his head, destroying much of the left frontal lobe of his brain, and for the effects of injuries reported on his personality and behavior over the remaining 12 years of his life? -? the effect is quite deep (for the time being) at least) that friends see it as "no longer a Gage". [H]: 14
Long known as "American Crowbar Case"? -? Once termed "a case that more than all others are weighed to awaken our miracles, undermine the value of prognosis, and even to overthrow the doctrine physÃ,¬ÃooÃ,logÃ,iÃ,cal"? -? Phineas Gage influenced 19th century discussions about mind and brain, parÃ,ticÃ,u debate on cerebral localÃ,iÃ,zaÃ,tion,
Gage is a fixture in the curriculum of neurology, psychology, and neuroscience, [M7]: 149 one of the "greatest medical curiosities of all time" references [ M8] and "the living part of the medical folklore" [R]: 637 often mentioned in books and scientific papers;
A report about Gage's physical and mental state just before his death implies that his most serious mental changes are temporary, so that he is much more functional later, and socially much better adapted, than in the immediate years after his accident. The social recovery hypothesis shows that Gage's work as a postal supervisor in Chile fostered this recovery by providing a daily structure that enabled him to regain lost social and personal skills.
Video Phineas Gage
Life
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Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage of Grafton County, New Hampshire. Little is known about his education and the education beyond that he is literate.
City doctor John Martyn Harlow described Gage as "a very healthy, strong and active, twenty-five-year-old, nervous temperament, five feet six inches [168Ã, cm] in height, weighing an average of one hundred and fifty pounds [68 kg, has the strength of iron and also the iron frame, the extraordinary muscular system develops well? - almost never sick a day from childhood until [his injury] date. [H]: 4 (In pseudoscience phrenology, which has just ended its habit, nervo-bilious signifies an unusual combination of "mental strength passionate and active "with" energy and power [mind] and body [making] possible great mental and physical endurance ".) [M]: 346- 47 : 6
Gage may have first worked with explosives on a farm as a youth, or in nearby mines and quarries. [M]: 17-18 He is known to have worked on the construction of the Hudson River Railroad near Cortlandt Town, New York, [M10]: 643 and at the time of the accident he was a blasting foreman (possibly an independent contractor) on a railway construction project. [M]: 18-22,32n9 His most efficient and highly capable employer... a smart, intelligent businessman, very energetic and persistent in carrying out all his work. operating plan ", [H]: 13-14 he even assigns custom-made iron tamping? -? big iron rods? - for use in explosive charge arrangements. > [B1]: 5 [M]: 25
Accident
On September 13, 1848, Gage was directing a stone blasting gang while preparing the road for Rutland & amp; Burlington Railroad in the southern city of Cavendish, Vermont. Defining the explosion requires boring the hole deep into the outcrop of rock; adding explosive powder and fuse; then use iron tamping to pack ("condense") sand, clay, or other inert material into the hole above the powder.
When Gage does this around 4:30, his attention is drawn by his men working behind him. Looking out of his right shoulder, and accidentally carrying his head into the line with the blast hole, Gage opened his mouth to speak; At the same time the iron tamping attacked the stone and (possibly because the sand had been removed) the powder exploded. Taken from a hole, iron tamping? -? 1 1 / 4 inch (3.2 cm) in diameter, three feet seven inches (1.1 m) long, and weigh 13 1 / 4 pound (6.0 kg)? -? entering the left side of Gage's face in an upward direction, just forward from the angle of the lower jaw. Continuing upwards outside the upper jaw and possibly breaking the cheekbones, it passes behind the left eye, through the left side of the brain, and exits the top of the skull through the frontal bone.
Although the 19th-century reference to the Gage as "American Crowbar Case", its tamping iron has no bends or claws attached several times to the term "crowbar"; more precisely, it's just a pointed cylinder object like javelin, [K] round and pretty smooth: [H]: 5
The first incoming tip is pointy; taper (eleven inches (27 cm) in length, ending in 1 / 4 -inch (7 mm) dots] [V]: 17 ... the circumstances in which the patient may owe his life. The iron was unlike any other, and was made by the neighbor of the blacksmith to please the owner.
[B1]: 14
Iron tamping landed the first point about 80 feet (25 m), [M]: 29 "smeared with blood and brain". [H]: 5
Gage is thrown onto his back and gives some short spasms of his arms and legs, but speaks in minutes, walks with a little help, and sits upright on the ox cart to 3 / 4 -mile (1.2 km) ride to his inn in town. Around 30 minutes after the accident, Doctor Edward H. Williams, found Gage sitting in a chair outside the hotel, was greeted with "one of the greatest statements about medical history" : [M5]: 244
When I drove, he said, "Doctor, this is enough business for you." I first saw the wound on my head before I got off my train, the pulse of the brain became very different. The top of the head appears rather like an inverted funnel, as if some wedge-shaped bodies had passed from the bottom up. Mr. Gage, as long as I examine this wound, tells the way he was hurt to the observers. I do not believe Mr.'s statement. Gage at the time, but thought he had been deceived. Mr. Gage insisted that the bar pass his head. Mr. G. rose and vomited; the effort of vomiting presses about half a cup of the brain [through an outlet at the top of the skull], which falls to the floor.
Harlow took over the case at about 6 pm.
You will forgive me for commenting here, that the picture presented is, for someone unaccustomed to military operations, really great; but the patient endured her suffering with the most heroic constancy. He recognized me at once, and said he hoped he was not much hurt. She seems very conscious, but starts to exhaust from the bleeding. The person, and the bed in which he is placed, is literally one blood blood.
Initial treatment
With the help of Williams, Harlow shaved his scalp around the iron tamping out area, then dabbing the clumped blood, small bone fragments, and 30 grams of prominent brain. After searching for a foreign object and replacing two separate bone pieces, Harlow covered the wound with an adhesive band, leaving it partly open for drainage, loosely, for the same reason. Wet compresses are applied, then taken at night, then a further bandage to secure this bandage. Harlow also dressed Gage's hands and arms (which along with his face had been "very burned") and ordered that the Gage's head be kept elevated.
At the end of the night Harlow noted: "The clear mind, the constant movement of his legs, is gradually drawn and elongated like the axis of a mill, saying he" does not care to see his friends, for he will work in a few days.. ' "
Convalescence
Despite its own optimism, Gage's recovery period is long, difficult, and uneven. While acknowledging his mother and uncle (summoned from Lebanon, New Hampshire, 30 miles away) [H]: 12 [M]: 30 in the morning after the accident, on the second day he "lost control of his mind, and became clearly delirious". On the fourth day, he was again "rational... knows his friends", and after further refinements Harlow entertained, for the first time, the thought that it might be for Gage to recover. However, this increase is short-lived. "
Starting 12 days after the accident, [M]: 53 Gage is semi-coma, "rarely talk unless spoken to, and then answered only in single letter", and on 13 Harlow noted, "Failure of power... coma deepens, left eyeball becomes louder, with [" fungus? "- worsens, infected tissue] [M]: 61.282 pushes out quickly from the internal canthus [also] from the injured brain, and exits at the top of the head. "On day 14," Loss of the mouth and head is very rotten. Comatose, but will answer in monosyllables if aroused, will not take food unless it is urgent.Friends and officers are in the hourly hope of his death, and his crates and clothes are in readiness. "
Galvanized, Harlow "cuts the fungus that grows out of the top of the brain and fills the opening, and makes the application free of caustic [ie the silver nitrate crystal] [M]: 54
On the 24th day, Gage "managed to raise himself, and took a step into his chair". One month later, he walked "up and down the stairs, and about the house, to the piazza," and when Harlow was absent for a week, Gage "was on the road every day except Sunday", his desire to return to his family in New Hampshire became " by his friends... he left without a coat and with thin boots, had wet feet and cold ". She soon had a fever, but in mid-November she "felt better in everything... walking around the house again". Harlow's prognosis at this point: Gage "seems to be in the way of recovering, if he can be controlled".
Next life and journey
On November 25 (10 weeks after the injury), Gage was strong enough to return to his parents' home in Lebanon, New Hampshire, traveling there with a "near-carriage" (closed carriage used for transporting crazy people). [H]: 12 [M]: 92 Though "pretty weak and thin... weak and childish " [M]: 93 upon arrival, at the end of December he" rises, improves both mentally and physically ", [H2] and in February 1849 he "could do little work on horses and cages, feed cattle etc. [and] as a time to plow come [ie around May or June] he was able to do half the day's work afterwards and gave birth with good ". In August, his mother told a doctor who asked that his memory seemed somewhat distracted, although it was quite a bit that strangers would not notice.
Injuries
In April 1849, Gage returned to Cavendish and visited Harlow, who noted at the time the loss of eyesight (and ptosis) of the left eye, a large scar on the forehead (from the decomposition of Harlow's abscess)
overhead... fractional rectangular bone ... raised and prominent enough. Behind this is deep depression, [2 Ã,/span> by 1 1/2 in width, 5 cm with 4 Ã, cm], underneath the brain pulsation can be felt. Partial paralysis from the left side of the face. His physical health is good, and I tend to say he has recovered. Did not have any pain in the head, but said it had a strange feeling that he was not able to describe. [H]: 12-13
Although a year later some weaknesses persist, Harlow writes that "physically, the recovery is complete enough for four years immediately to replace the injury". New England and New York (1849-1852)
In November 1849, Henry Jacob Bigelow, Professor of Surgery at Harvard Medical School, brought Gage to Boston for several weeks and, after satisfying himself that the iron tamping has actually passed through the head of Gage, presenting him to the Boston Society for Medical Improvement meeting and (presumably) to medical school classes.
Can not retrieve his railroad job (see Ã,§ Initial observation, below) Gage for a while "sort of live museum exhibition" at Barnum's American Museum in New York City. (This is not Barnum's later circus, there is no evidence that Gage has ever exhibited with a group or circus, or in the exhibition arena.) The ad has also been found for public performances by Gage? -? Which he may have set up and promoted himself? -? in New Hampshire and Vermont, support the Harlow statement that Gage made a public appearance in "much of New England's larger city". [H]: 14 [M1]: 829 (Many years later Bigelow wrote that Gage is "an intelligent and smart and really want to do such a thing to change the penny honestly, "but to stop such an attempt because" [such a thing] does not interest the general public much. ")
For about 18 months, he worked for stable service owners and coaches in Hanover, New Hampshire. [H]: 14 [M]: 101
Chile Chile and California (1852-1860)
In August 1852, Gage was invited to Chile to work as a long-distance carriage chauffeur there, "taking care of horses, and often driving a coach who is very laden and attracted by six horses" on the ValparaÃÆ'so-Santiago route. [M]: 103-4 [H]: 14 After his health started failing in mid-1859, [H]: 14-15 he left Chile for San Francisco, arrived (in the words of his mother) "in a weak condition, has failed since leaving New Hampshire... Many turns sick while in Valparaiso, especially during the past year, and suffers from many difficulties and exposures. "In San Francisco he recovered under the care of his mother and sister, [H]: 15 there from New Hampshire around the time he went to Chile.
In February 1860, Gage began to experience epileptic seizures. He lost his job, and (Harlow wrote) because his shock increased in frequency and severity he "continued working in various places [though he] could not do much". [M]: 14 [H]: 16
Death and excavation
On May 18, Gage "left Santa Clara and went home for his mother.At 5 am, morning, on the 20th, he suffered severe disturbances, the family doctor called on him and scolded him, his frequent recurrences during successful days and nights" [H]: 15 and he died in status epiÃ,lepÃ,tiÃ,cus , [M2] : E in or near San Francisco, ending on May 21, 1860. He was buried at Lone Mountain Cemetery San Francisco.
In 1866, Harlow (who had "lost all traces of [Gage], and almost left all statements heard from him again") somehow knew that Gage had died in California, and made contact with his family there. Upon Harlow's request the family had the Gage skull unearthed, then personally sent it to Harlow's reference,
About a year after the accident, Gage had given his tamping iron to the Warren Anatomy Museum at Harvard Medical School, but he later reclaimed
The tamping iron bears the following inscription, commissioned by Bigelow along with the original iron deposit at the Museum (though the date given for the accident was a day off):
This is a bar that is fired through the head of Mr. Phinehas [sic] P.Ã, Gage in Cavendish Vermont September 14, [sic] 1848. He is fully recovered from injuries & store this bar at Harvard University Medical University Museum. Ã, o Phinehas P. Gage Ã, Lebanon GraftonÃ, Cy NH Ã, o Jan 6 650
The date 6 Jan 1850 fell in the period in which Gage was in Boston under Bigelow's observation.
In 1940, Gage's headless body was transferred to Cemara Lawn Cemetery as part of the relocation of the dead San Francisco mandate to new resting places outside the city limits (see San Francisco's burial grave) . [M]: 119-20
Maps Phineas Gage
Mental changes and brain damage
Mental changes
Gage shows significant behavioral changes after the injury, but the nature, range, and duration of this change are difficult to establish. Initial observation (1849-1852)
Harlow ("actually our only source of information" in Gage, according to psychologist Malcolm Macmillan) [M]: 333 describes Gage before the crash as a hard worker, responsible, and " big favorites "with responsible people, his employers consider him" the most efficient and competent foreman in their work "; he also went to great lengths to note that Gage's memory and general intelligence seemed undisturbed after an accident (beyond the delirium period). [M]: 30,91 Nevertheless, these same masters, after the Gage accident, "consider the change in their minds so as to indicate that they can not give it anymore":
Equilibrium or balance, so to speak, between the faculty of intellect and the preservation of animals, seems to have been destroyed. He is disobedient, disrespectful, indulges occasionally in the most disgusting dirty words (which are not customary before), manifests but little respect for his colleagues, impatient refrain or advice when it goes against his wishes, sometimes perÃ, tiÃ,naÃ,ciousÃ,ly stubborn, yet volatile and vacÃ,ilÃ,lating, composing many future operating plans, which are not organized much faster than those left in turn for others seem more viable. A child in his intellectual and human capacities, he has a strong animal passion. Previously to injury, though not trained in schools, he had a well-balanced mind, and was seen by people who knew him as a smart, intelligent, highly energetic and persistent businessman in carrying out all his operational plans. In this case his mind changed radically, so it was clear that his friends and acquaintances said he was "no longer a Gage". [H]: 13-14
This description ("is now routinely quoted", Kotowicz says) [K2]: 125 is from Harlow's observations set shortly after the accident, [M]: 90,375
Meanwhile, Harlow's report in 1848, published just as the Gage emerged from its recovery period, only hints at psychological symptoms: [M]: 169
The mental manifestation of the patient, I reserved for future communication. I think the case... is of great interest to enlightened intellectuals and physiologists. [H1]: 393
But after Bigelow termed Gage "quite recovered in the faculties of body and mind", with only "unimaginable dysfunction", [B1]: 13-14 a rejoinder in < i> American Phrenological Journal ? -?
That there is no difference in his mental manifestations after the restoration is not true... he is dirty, profane, rude, and vulgar, in such a way that his society is unbearable for a decent person.
? -? apparently based on information supplied anonymously by Harlow. [M]: 350-1 Show that while "a large section of Harlow's article [1848] is cited verbatim by Bigelow, [Harlow's] promise of future reports on 'mental manifestations 'not,' Barker describes a contradictory evaluation (less than a year apart) by differences in the educational background of Bigelow and Harlow, in particular their attitudes toward cerebral localization (the idea that different regions of the brain are devoted to different functions) and phrenology (century pseudoscience nineteenth that states that talent and personality can be inferred from a person's skull form):
Harlow's interest in phrenology prepares him to accept changes in the character [Gage] as a significant clue to the feasible function of the brain. Bigelow has been taught that damage to the cerebral hemisphere has no intellectual effect, and he does not want to consider a significant Gage deficit... The use of one case [including Gage] to prove opposing views on phrenology is not uncommon. sup class = "reference nowrap"> [B]: 672,676,678,680
The reluctance to assume the biological basis for "higher mental function" (functions? - like language, personality, and moral judgment?) Outside of sensory and motor only) may have been the reason further Bigelow discounted behavioral changes in the Gage noted by Harlow. [M]: 169-70 [M1]: 838 (See Dualism. )
Next observation (1852-1858)
In 1860, an American doctor who had known Gage in Chile described him as still "involved in the driving phase [and] in good health enjoyment, without any interruption of his mental ability."
Macmillan writes that this conclusion is reinforced by responsibilities and challenges associated with railroad work as did Gage in Chile, including the requirement that drivers be "reliable, resourceful, and have great endurance, but above all they must have the kind of personality that allows them to get along well with their passengers. " Social Recovery
Macmillan writes that this difference? -? Among Gage's initial behavior, compared later, post-accident? -? Reflects his "gradual change" of the impulsively and unhindered person who is generally portrayed as the one who makes a "reasonable social recuperation" , quoting people with the same injury to whom "a person or something gives structure enough for their lives for them to relearn the lost social and personal skills ": [M1]: 831
Phineas's survival and rehabilitation demonstrate a recovery theory that has affected the treatment of current frontal lobe damage. In modern care, adding structure to tasks with, for example, visualizing mentally written lists, is considered a key method in overcoming frontal lobe damage. [M4]
According to contemporary accounts by visitors to Chile,
get up early, prepare, and care, feed, and control the horses; he must be at the point of departure at the appointed time, load his belongings, collect fees and keep passengers on board; and then had to take care of the passengers on the way, unpacking their belongings at the destination, and guarding the horses. The tasks form a structure that requires whatever impulsive control it may have. [M9]
Trip route (Macmillan continues):
much foresight is needed. Riders should plan far turns, and sometimes react quickly to maneuver around other coaches, carts, and birlochos traveling at various speeds... Adaptations should also be made for the physical condition of the route: although some parts are made well, others are very steep and very rough.
Thus, Gage stagecoach work? -? "A highly structured environment where a clear task sequence is required [but where] a contingency that requires future review and planning to emerge every day"? -? It resembles a rehabilitation regimen first developed by Soviet neuropsychologist Alexander Luria for the reestablishment of self-regulation of World War II soldiers suffering from frontal lobe injuries. [M10]: 645,651-2,655 [L2]
The neurological basis for such recovery can be found in emerging evidence "that the damaged [nerve] tract can rebuild their original connections or build alternative pathways when the brain recovers" from injury. Macmillan added that if Gage made a recovery like that? -? If he finally "knows how to live" (like Fleischman put it) [F]: 75 despite the injury? -? then it "will add to current evidence that rehabilitation can be effective even in difficult and long-standing cases"; Altitude and distortion of mental changes
Macmillan's analysis of Gage's popular and scientific reports found that they almost always distort and exaggerate his behavior changes beyond anything described by anyone who has direct contact with him, concluding that the facts are known to be "inconsistent with the Gage's general view as arrogant, fighting, foul-mouthing, useless useless talents, unable to withhold work, who die without money at an institution. " In Barker's words, "As time passes, the case takes its own life, adding new additions to the Gage story without factual basis". [B]: 678 Even today (writes Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others say about Gage, that is, that after an accident he became a psychopath "; [K2]: 125 Grafman has written that "the details of social cognitive impairment [Gage] have sometimes been inferred or even decorated to fit the story teller's enthusiasm"; [G]: 295 and Goldenberg calls Gage "an empty sheet (almost) where authors can write stories that illustrate their theory and entertain the public."
For example, Harlow's statement that Gage "continues to work in various places, can not do much, change frequently, and always finds something that does not suit him in every place he tries to" [H] : 15 only refers to the last months of the Gage, after the seizures have been set.
Other behaviors that are deemed to arise from post-accident Gage are not endorsed by, or contrary to, known facts including the following:
None of these behaviors are mentioned by anyone who meets Gage or even his family, and as Kotowicz says, "Harlow does not report an act that should make Gage embarrassed." [K2]: 122-3 Gage is "a great story to illustrate the need to return to the original", writes Macmillan, most authors have "content to summarize or Cite accounts who are already serious in error ". [M]: 315
Nevertheless (writing Daffner and Searl) "telling the story of [Gage] has increased interest in understanding the mysterious role played by the frontal lobes in behavior and personality," and Ratiu has said that in teaching about the frontal lobe, anecdotes about Gage are like "ace [up] your sleeves Just like whenever you talk about the French Revolution, you are talking about guillotine, because it's so cool. " [K] Benderly points out that instructors use the Gage case to illustrate the importance of critical thinking.
Brain damage rate
The debate over whether trauma and subseftar infections have damaged both frontal Gage lobes (left and right), or just left, starting immediately after the accident. The 1994 conclusion from Hanna Damasio et al., That iron tamping did physical damage to both lobes, taken not from the Gage skull but from "Gage-like" one? -? The skull of a corpse is defective to match the Gage dimension
In addition, Ratiu et al. noting that the hole at the base of the skull (made as iron tamping passes through the sphenoidal sinuses to the brain) has a diameter of about half of the iron itself; combining this with a hairline fracture that begins behind the outgoing area and flows in front of the skull, they conclude that the "hinged" skull opens when iron enters from below, then is drawn closed by soft tissue resistance after the iron has come out through the top of the head. [R]: 640 [M1]: 830
Van Horn et al. concluded that the Gage's white matter damage (which they made detailed forecasts) was as or more significant to Gage's mental change than the damage of the cerebral cortex (gray matter). [V]: abstr Thiebaut de Schotten et al. estimates of white matter damage at Gage and two other well-known patients ("Tan" and "HM"), concluded that these three cases "suggest that social behavior, language, and memory depend on the coordinated activity of different regions of the brain rather than an area in the lobe frontal or temporal. " [T1]: 12
Factors that support Gage's survival
Harlow sees Gage's survival as demonstrating "the tremendous resources of the system in resisting shocks and in overcoming the terrible effects of lesions, and as the beautiful appearance of the restoring natural forces," and noting what he sees as favorable circumstances. I t:
1. The subject is the man for this case. Physical, willpower, and endurance capacity, can hardly be exceeded. [H]: 18
For Harlow's description of the Gage before the crash, see Ã,§ Background, above.
2d. Missile shapes? -? Being spiky, round and relatively smooth, leaving no concussions or compression prolonged. [H]: 18
Although the diameter and mass are very large (compared to fired-off projectiles) the relatively low speed of iron tamping drastically reduces the energy available for compression and concussive "shock waves".
Harlow melanjutkan:
3d. Point of entry...? -? [Iron tamping] does a bit of injury until it reaches the floor of the skull, when, at the same time as irreparable damage, it [creates] the opening at the base of the skull, for drainage, [without which] the recovery is unlikely to happen.
Barker writes that "[Head injury] from falling, horse kicking, and shooting, is already known in pre-American Civil War [and] any contemporary lecture on surgery describes the diagnosis and treatment" of the injury. But for the benefit of Gage, surgeon Joseph Pancoast has performed "the most notorious surgery for head injury before Harlow's medical class, [trepanning] to drain pus, resulting in temporary recovery.Unfortunately, the symptoms of relapse and the patient died.At autopsy, the accumulated pus was found: the granulation tissue has blocked the opening in the dura. "By letting open wounds open, and lifting the Gage's head to push the drainage from the skull into the sinus (through a hole made by iron tamping), Harlow" does not repeat Professor Pancoast's mistakes ".
Akhirnya,
4. The part of the brain that passes is, for some reason, the most fitting of any part of the cerebral substance to sustain an injury. [H]: 18
It is precisely what "some of the reasons" Harlow is unclear, but he may refer, at least in part, to an understanding (slowly evolving since ancient times) that injuries on the front of the brain are less dangerous than the backward, since the latter often interferes with vital functions such as breathing and circulation. For example, surgeon James Earle wrote in 1790 that "most of the cerebrum can be taken away without destroying the animal, or even robbing its ability, whereas the cerebellum will be removed." [M]: 126,142 rarely receive the smallest wound, without being followed by mortal phenomena. " [M]: 128
Ratiu et al. and Van Horn et al. both conclude that the superior sagittal sinus must remain intact, either because Harlow did not mention the loss of cerebrospinal fluid through the nose, and because otherwise Gage would almost certainly suffer from a blood loss or a fatal air embolism. [R]: 642
For his own role in the survival of the Gage, Harlow simply affirmed, "I can only say... with the nice old Ambroise ParÃÆ' Â ©, I dress it up, God heals it", [H]: 20 but Macmillan calls this self-esteem too simple. Noting that Harlow had become an "inexperienced local physician... graduated four and a half years earlier", the macmillan discussion on "Harlow's skilful and imaginative adaptation" [M]: 12 [of] the conservative and progressive elements of the therapies available for the particular needs generated by Gage's injuries "stresses that he" does not apply rigidly what he has learned ", eg before a complete search for bone fragments (which risk both bleeding and bronchitis injury) and apply the caustic to the "fungus" instead of emptying it (which is at risk of bleeding) or forcing it into the wound (which is at risk of compressing the brain). class = 58-62
Initial medical attitude
Skepticism
Barker notes that the original 1848 report on survival and recovery of the Gage "is very unbelievable, for obvious reasons" and Harlow, in retrospective in 1868, recalls doubt:
This case occurred almost twenty years ago, in an unclear city city..., attended and reported by an obscure state doctor, and accepted by the Metropolitan Doctor with some warning points, in such a way that many really refused to believe that men have risen, until they put their fingers into the hole in his head [see [i] Doubting Thomas], [L1]: 178 and even then they require the statement of the Doctors of the State, from pastors and lawyers, before they can or will believe it? - many prominent surgeons on such occurrences as physiological impossibilities, appearances presented by subjects described in various ways.
"The distinguished Professor of Surgery in a distant city," Harlow wrote, even refusing Gage as a "Yankee discovery." [H]: 3,18
According to Boston Medical and Surgical Journal (1869) it is the 1850 report on Gage by Bigelow? -? Harvard Surgery Professor and "a magnificent and authoritative figure in the medical world of that era"? -? That "ultimately succeeded in forcing the authenticity of the case on the belief of the supporters... because it is almost impossible to do by anyone who has knowledge of his wisdom and his surgery is less confident". "The main characteristic of this case is his imperfections... This is the kind of accident that happens in pantomime in the theater, not elsewhere", Bigelow stressed that although "at first fully skeptical, I have personally been convinced."
Nevertheless (Bigelow wrote just before Harlow's 1868 presentation of Gage's skull) though "the nature of Gage's injury and its reality is now without a doubt ... I has received a letter in a month [confess] to prove that... the accident was impossible . " [B2]
Standard for other brain injuries
Because the reality of accidents and safety Gage gained trust, it became "the standard used to deal with other brain injuries", and has maintained that status despite competition from a list of other apparently inaudible brain-injury accidents, including meeting with axes, bolts, bridges low, firearms exploded, guns fired into the nose, other tamping iron, and falling Eucalyptus branches. [M]: 62-7 For example, after the miner survived the skull with a gas pipe diameter 5 / 8 inches (1,6Ã,Â, cm) (extracted "not without difficulty and enough strength, because of the bend in the stem in his skull") his doctor summoned Gage as "the only case comparable to this, in the amount of injury brain, which I see reported ".
Often this comparison brings clues to humor, competitiveness, or both. [M]: 66 The Boston Medical and Surgical Journal , for example, is termed Gage "Patients whose cerebral organisms are relatively little disturbed by their sudden- arrive and disturb "; and a Kentucky doctor, reported the survival of a patient from a shot through the nose, boasting, "If you Yankees can send tamping bars through your fellow brains and not kill them, I do not think many can shoot bullets between a man's mouth and his brain, stop just short of the medulla oblongata, and not touch as well. "Similarly, when the lumbermill foreman returns to work as soon as the saw cuts three inches (8 cm) into his skull from just between the eyes to the back of the top of his head, his surgeon removed from this wound) thirty-two pieces of bone, along with large sawdust ") is called the case" nothing is reported, save the famous iron tamping case. Harlow ", although apologizing that" I can not satisfy the desire of my professional brethren to have [the patient] the Skull, until he has no further use for itself. "
Like this and the remnants of another extraordinary brain injury accumulated, Boston Medical and Surgical Journal pretended to wonder whether the brain has any function at all: "Because of the iron rod antics, gas pipes, and the like uncomfortable skepticism, and not daring to say it yourself.The brain does not seem to be very influential now-a-days. "The Transactions of the Vermont Medical Society are both geniuses: " 'Already time, 'said Macbeth [ActÃ, III],' that when the brain came out the man would die but now they rise again 'It is very likely we will soon hear that some German professors are ending it. " [L1]: 183 : 53-4
Theoretical abuse
Although Gage is considered to be an "index case for personality changes due to frontal lobe damage", Cerebral localization
In the nineteenth-century debate about whether various mental functions or not localized in certain areas of the brain (see Cerebral localization) , both sides successfully asked Gage to support their theory. Phrenology
Throughout the nineteenth century, phrenology believed that Gage's mental change (for example, his deviation, for example) came from the mental destruction of the "virtues"? -? As the phrenologists see it, the part of the brain is responsible for "kindness, virtue, gentle character... [and] to dump man to do himself in a manner consistent with the maintenance of the social order"? -? and/or "worshiping organs" nearby? -? Relating to religion and God, and respect your peers and those in power.
Harlow writes that Gage, during its recovery, does not "estimate size or money accurately [,] will not take $ 1000 for some pebbles" [H1]: 392 and not specifically about the price when visiting a local shop; [H]: 337 by these examples Harlow may imply damage to the "Organ of Comparison" of phrenology.
Psychology and lobotomy
It is often asserted that what happens to the Gage plays a role in the subsequent development of various forms of psychosurgery? -? Especially the lobotomy? -? Or even a Gage accident which is the "first lobotomy". Aside from the question of why unhappy changes usually (if hyperbolic) associated with Gage will inspire a surgical imitation, there is no such link, according to Macmillan:
There is no evidence that any one of these operations is intentionally designed to produce any kind of change in the Gage caused by the accident, or that knowledge of the fate of Gage is part of the reason for their [M2]: F ?... [W] his case hat did appear solely from him surviving his accident: major surgery [like for a tumor] could be performed on a brain without fatal result. [M]: 250
Hypothetical somatic hypothesis
Antonio Damasio, to support his soto hypothesis (related to decision-making for their emotions and biological basis), draws parallels between the behavior he gave to the Gage and the modern patient with damage to the orbitofrontal cortex and amygdala. : ch3 But Damasio's description of Gage : ch1 has been criticized all out, for example by Kotowicz:
Damasio is the main protagonist of Gage's psychopathic myth...... Damasio changed Harlow's narrative, omitted the facts, and added freely ... His account of the last Month Gage was oddly fabricated [insinuating] that the Gage were some of the riffs that in his last days headed for California to drink and brawl him to death ... It seems that growth is a commitment to the frontal lobe's doctrine of emotion bringing Gage to the limelight and shape how he is depicted. [K2]: 125,130n6
As Kihlstrom puts it, "[M] every modern commentator exaggerates to what extent Gage's personality changes may be involved in a retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex within-" [K1] Macmillan [M]: 116-19,326,331 gives detailed criticisms of Gage Antonio Damasio's various presentations (some of whom work together with Hannah Damasio and others).
Portrait
Two portraits of the Gage daguerreotype, identified in 2009 and 2010, are the only ones that resemble
Authenticity is confirmed by photo-overlay of inscriptions on iron tamping, as seen on portrait, against it on actual tamping iron, and matching subject's injury to that preserved in life mask.
Source of the article : Wikipedia
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