Major Assignment

Psychology Topic: Case Study Submitted By: Mazhar Khan Mirza Haseeb Baig Muhammad Bilal 3818 3828 3829

Submitted To: Sir Adnan

City University of Science & Information Technology Peshawar

The Case Study of Phineas Gage

Biography:
Name Born Phineas P. Gage July 9th , 1823 Grafton Co., N.H.

Died

May 21, 1860 (aged 36) In or near San Francisco Cypress Lawn Cem., Calif. Warren Anatomical Museum, Boston

Resting place

Residence Occupation

New England, Chile, California Railroad construction foreman, blaster, stagecoach driver

Known for

Personality change after brain injury

Home town

Lebanon, N.H

Contents:
1. Introduction 2. Gages Accident 3. Subsequent Life And Travels 4. Death And Subsequent Travels 5. Brain Damage and Mental Changes 6. Effects 7. Bibliography

1- Introduction:
Phineas P. Gage (July 9, 1823 May 21, 1860) was an American railroad construction foreman now remembered for his incredible 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 behavioreffects so profound that friends saw him as "no longer Gage." Long called "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 19thcentury discussion about the brain, particularly debate on cerebral localization, and was perhaps the first case suggesting that damage to specific regions of the brain might affect personality and behavior. Gage is a fixture in the curricula of neurology, psychology and related disciplines, and is frequently mentioned in books and academic papers; he also has a minor place in popular culture. Relative to this celebrity, the body of known fact about the case is remarkably small, which has allowed it to be cited, over the years, in support of various theories of the brain and mind wholly contradictory to one another. A survey of published accounts has found that even modern scientific presentations of Gage are usually greatly distortedexaggerating and even directly contradicting the established facts.

A portrait of Gage"handsome...well dressed and confident, even proud," and holding the tamping iron which injured himwas identified in 2009.

One researcher points to it as consistent with a social recovery hypothesis, under which Gage's most serious mental changes may have existed for only a limited time after the accident, so that in later life he was far more functional, and socially far better adapted, than has been thought.

2- Gages Accident:
On September 13, 1848, 25-year-old Gage was foreman of a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. After a hole was bored into a body of rock, one of Gage's duties was to add blasting powder, a fuse, and sand, then compact the charge into the hole using a large iron rod. Possibly because the sand was omitted, around 4:30 PM: The powder exploded, carrying an instrument through his head an inch and a fourth in [diameter], and three feet and [seven] inches in length, which he was using at the time. The iron entered on the side of his face...passing back of the left eye, and out at the top of the head. Nineteenth-century references to Gage as "the American Crowbar Case" may mislead some readers. For Americans of the time a crowbar did not have the bend or claw sometimes associated with that term today. Gage's tamping iron was simply a cylinder, "round and rendered comparatively smooth by use. The end which entered first is pointed; the taper being [twelve] inches long...circumstances to which the patient perhaps owes his life. The iron is unlike any other, and was made by a neighboring blacksmith to please the fancy of its owner. Weighing 131/4 lb (6 kg), this "abrupt and intrusive visitor was said to have landed some 80 feet (25 m) away. Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3/4-mile ride to his lodgings in town.

The left frontal lobe (color), the forward portion of which was damaged by Gage's injury

The first physician to arrive was Dr. Edward H. Williams: I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage's statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head....Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor. Dr. John Martyn Harlow took charge of the case about an hour later: You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. Pulse 60, and regular. His person, and the bed on which he was laid, were literally one gore of blood. Despite Harlow's skillful care,] Gages recuperation was long and difficult. Pressure on the brain left him semi-comatose from September 23 to October 3, "seldom speaking unless spoken to, and then answering only in monosyllables. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness." But on October 7 Gage "succeeded in raising himself up, and took one step to his chair." One month later he was walking "up and down stairs, and about the house, into the piazza," and while Harlow was absent for a week, Gage was "in the street every day

except Sunday," his desire to return to his family in New Hampshire being "uncontrollable by his friends...got wet feet and a chill." He soon developed a fever, but by mid-November he was "feeling better in every respect...walking about the house again; says he feels no pain in the head." Harlow's prognosis at this point: Gage "appears to be in a way of recovering, if he can be controlled."

3- Subsequent Life and Travels:

By November 25 Gage was strong enough to return to his parents' home in Lebanon, New Hampshire, where by late December he was "riding out, improving both mentally and physically." In April 1849 he returned to Cavendish and paid a visit to Harlow, who noted at that time loss of vision of the left eye, a large scar on the forehead, and "upon the top of the head...a deep depression, two inches by one and one-half inches wide, beneath which the pulsations of the brain can be perceived. Partial paralysis of the left side of the face." Despite all this, "his physical health is good, and I am inclined to say he has recovered. Has no pain in head, but says it has a queer feeling which he is not able to describe." Unable to return to his railroad work, Harlow says, Gage appeared for a time at Barnum's American Museum in New York City (the curious paying to see, presumably, both Gage and the instrument that injured him) although there is no independent confirmation of this. Recently however, evidence has surfaced supporting Harlow's statement that Gage made public appearances in "the larger New England towns."

Gage later worked in a livery stable in Hanover, New Hampshire and then for some years in Chile as a long-distance stagecoach driver on the ValparaisoSantiago route. After his health began to fail around 1859, he left Chile for San Francisco, where he recovered under the care of his mother and sister (who had gone there from New Hampshire around the time Gage went to Chile). For the next few months he did farm work in Santa Clara.

4- Death and Subsequent Travels:

In February 1860, Gage had the first in a series of increasingly severe convulsions, and he died in or near San Francisco on May 21 just under twelve years after his accident. He was buried in San Francisco's Lone Mountain Cemetery. In 1866, Harlow somehow learned where Phineas had been and opened a correspondence with his family, still in San Francisco. At his request they unearthed his patient long enough to remove the skull, which was then delivered to Harlow back in New England. About a year after the accident, Gage had allowed his tamping iron to be placed in Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it and made what he called "my iron bar" his "constant companion during the remainder of his life"; now it accompanied the skull on its journey to Harlow. After studying them for his second (1868) paper, Harlow redeposit the Iron, this time with Gage's skull, in the Warren Museum, where they remain on display today. The iron bears this inscription:

This is the bar that was shot through the head of Mr. Phineas P. Gage at Cavendish, Vermont, Sept. 14, 1848. He fully recovered from the injury & deposited this bar in the Museum of the Medical College of Harvard University. Much later, Gage's headless remains were moved to Cypress Lawn Cemetery as part of a systematic relocation of San Francisco's dead to new resting places outside city limits.

5- Brain Damage and Mental Changes:

Significant brain injury is often fatal, but Harlow called Gage "the man for the case. His physique, will, and capacity of endurance could scarcely be excelled," and as noted earlier the iron's 1/4inch leading point may have reduced its destructiveness. Nonetheless, the brain tissue destroyed must have been substantial (considering not only the initial trauma but the subsequent infection as well) though debate as to whether this was in both frontal lobes, or primarily the left, began with the earliest papers by physicians who had examined Gage. In his 1848 report, as Gage was just completing his physical recovery, Harlow had only hinted at possible psychological symptoms: "The mental manifestations of the patient, I leave to a future communication. I think the case...is exceedingly interesting to the enlightened physiologist and intellectual philosopher." And after observing Gage for several weeks in late 1849, Henry Jacob Bigelow, Professor of Surgery at Harvard, went so far as to say that Gage was "quite recovered in faculties of body and mind," there being "inconsiderable disturbance of function." In 1868 Harlow gave particulars of the mental changes found today (though usually in exaggerated or distorted form in most presentations of the case.

6- Effects:
i. In memorable language, he now described the preaccident Gage as having been 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." But these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again": The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinacious obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage."

ii.

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v.

Of the handful of available primary sources, Harlow's 1868 presentation of the case is by far the most informative, and despite certain errors in dating there seems no reason to doubt its general reliability. The description above, although not published until two decades after Harlow last saw Phineas, appears to draw on Harlow's own notes made soon after the accident. But other behaviors of Gage's which Harlow describes appear to draw on later communications from Gage's friends or family, and it is difficult to match these various behaviors (which range widely in their implied level of functional impairment) to the period of Gage's life during which each was present. This complicates reconstruction of what Gage was like during those several periods, a problem which takes on renewed importance in light of recent research indicating that Gage's behavior at the end of his life differed significantly from that in the years immediately after the accident.

7- Bibliography:

Wikipedias Link

http://en.wikipedia.org/wiki/Phineas_Gage