An odd kind of fame: Stories of Phineas Gage
Malcolm Macmillan
MIT Press, 2000; £26.50
ISBN 0 262 13363 6
Rating: 1/4
Over 150 years ago, in an industrial
accident, a tamping iron was blown
through Phineas Gage's head. The
resulting personality change - he was "no
longer Gage" - has featured widely in neuroscience and psychology courses.
Take a moment to marvel at the unlikely
occurrence: an iron bar, thicker than a
broomhandle, crashes through a man's
head. He "is able to walk off, talking with
composure and equanimity of the hole in
his head. This is the sort of accident that
happens in pantomime."
While the choice of subject is laudable,
the book itself is rather dry. There is a great
deal of historical detail about working on the
railroad and Gage's employment. This is
undoubtedly a fine piece of research clarifying precisely what we do and do not know
about Gage's story. That we do not know
details, such as when he was born, and have
only vague reports of the famous personality
change, is revelatory.
Chapters seven and eight give a fair
report of evolving understanding of brain
structure and function, from Hippocrates's
humors, via the ventricular model and phrenology, to an understanding of reflexes.
Chapter nine gives a clear account of the
work of scientists on brain function. For
example, Jackson's work on epileptogenic
scars as the origin of partial seizures and
others' work mapping the motor cortex and
outlining the inhibitory functions of the
frontal lobes (as damaged in Gage) is
described. Macmillan analyses the contribution of the Gage case towards brain surgery
and psychosurgery - for example, frontal
lobotomy - and finds it probably had a
greater effect on the former than the latter.
It is difficult to see a niche for this book on
your bookshelf. Perhaps we have been spoilt
by the works of Sacks and Ramachandran
and their easy to read style. There are other
books (such as basic neuroanatomy texts) that
will give you a greater understanding of functional anatomy. Read it if you are fascinated
by Gage or have an interest in historical
detail, but for most people, the book gives far
more detail than you require and so is a reference source rather than something you must
read from cover to cover.
SallyAnn S Price, fourth year medical student, University of Leeds
Email: ugm6sasp@leeds.ac.uk
studentBMJ 2001;09:171-216 June ISSN 0966-6494
