Faculty of Health, Medicine and Life Sciences

Case 1: Horrible accident

Part I

That was the headline of a newspaper report in the Boston Daily Courier on 20
September 1848. Phineas Gage had been working as a foreman when a new railway
was being laid through Vermont. An iron rod that he was using to pack an explosive
charge into a drilled hole caused a spark that detonated the charge. The rod was 3
centimetres in diameter and a metre in length, weighing 6 kilograms. It shot into his
head at high speed through the left cheek, damaging his frontal cortex (see the 3-D
reconstruction of this injury in Figure 1.1). Other parts of the cortex, including the
basal nuclei, the cerebellum and the brain stem, were intact. Gage was conscious
immediately after the accident and recovered within 2 months. He was able to walk
and talk and his memory functioned normally as well. However, after the accident his
personality was changed in a remarkable way.
Whereas he had previously been a responsible, calm and socially well-adjusted person,
his behaviour was now impulsive and aggressive. He also had more difficulty planning
his activities. This meant that he was no longer able to function in his job, and ended
up as a circus attraction (Figure 1.2) until his death from an epileptic attack 11 y ears
later.

The case history was published by his doctor, J.M. Harlow (1). This publication was one
of the first indications that the frontal lobe of the brain plays an important role in
personality and cognitive processes. His case led to a vigorous prof essional debate
about the localisational approach in neurology: some researchers saw the case as an
argument in favour of the localisation of particular functions in specific parts of the
brain. This was supported by the fact that other developments were a lso pointing in
that direction, such as the discovery of the two language/speech centres by Broca and
Wernicke, and the structures in which motor control, the senses and visual perception
were localised. Other researchers, however, saw arguments in it against the principle
of localisation: if as large a part of the brain as that could be lost without clear
impairment of function, then it would not seem logical that specific functions are
localised in small areas of the brain. The discovery that particular (macroscopic) brain
structures were responsible for specific brain functions furthermore led to microscopic
research into the histological differentiation of these areas. Amongst others these
researchers were Ramon y Cajal and Brodmann.

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 Faculty of Health, Medicine and Life Sciences

Figure 1.1: 3-D visualization of the Figure 1.2: P. Gage after recovering
traumatic injury to P. Gage from his injury

References:
1. J.M. Harlow. Recovery from the passage of an iron bar through the head. Publications
of the Massachusetts Medical Society 1868;2:327-347.
2. Damasio A.R. Descartes Error. Avon Books 1994 (ISBN 0-380-72647-5).

Part II

The following article refers to culture-dependent differences in brain development.

Your brain on culture: the burgeoning field of cultural neuroscience has found that
culture influences brain development, and perhaps vice versa.
http://www.apa.org/monitor/2010/11/neuroscience.aspx
We all experience, culture defines our personality and therefore has an important
relation to brain development. Read the article and discuss the differences between
East-Asian and Western cultures and the impact of this on behaviour and brain
development.

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