The Strange Case of Phineas Gage

1. The Strange Case of Phineas Gage The Accident • On September 13, 1848, the then 25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole. Unfortunately, the powder detonated, sending the 43 inch long and 1.25 inch diameter rod hurtling upward. The rod penetrated Gage's left cheek, tore through his brain, and exited his skull before reportedly landing some 80 feet away. . Though blinded in his left eye, he might not even have lost consciousness, and he remained savvy enough to tell a doctor that day, “Here is business enough for you.”

2. Shockingly, Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. Dr. Edward H. Williams, the first physician to respond later described what he found: • "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." Soon after, • Dr. John Martyn Harlow, took over the case. It is through Harlow's observations of the injury and his later descriptions of Gage's mental changes that provide much of the primary information that we now know about the case. Harlow described the initial aftermath of the accident as "literally one gore of blood." • Later in a published description of the case, Harlow wrote that Gage was still conscious later that evening and was able to recount the names of his co-workers. Gage even suggested that he didn't wish to see his friends, since he would be back to work in "a day or two" anyways. • After developing an infection, Gage then spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed and by October 11 his intellectual functioning began to improve. Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating size and amounts of money. Within a month, Gage was even venturing out of the house and into the street.

3. The Aftermath • In the months that followed, Gage returned to his parent's home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered. • Gage’s initial survival would have ensured him a measure of celebrity, but his name was etched into history by observations made by John Martyn Harlow, the doctor who treated him for a few months afterward. Gage’s friends found him“no longer Gage”. • The balance between his “intellectual faculties and animal propensities” seemed gone. He could not stick to plans, uttered “the grossest profanity” and showed “little deference for his fellows.” The railroad-construction company that employed him, which had thought him a model foreman, refused to take him back. • Not much is known about his years after the injury, but eleven years after the accident, when he was aged thirty-seven years, Gage began to experience epileptic seizures. He died several months later, on 21 May 1860. His brain was not subjected to any medical examination at that time, but seven years later his body was exhumed so that his skull might be studied. It has since been subjected to much scrutiny. • In time, Gage became the most famous patient in the annals of neuroscience, because his case was the first to suggest a link between brain trauma and personality change. Read more: http://www.smithsonianmag.com/history-archaeology/Phineas-Gage-Neurosciences-Most-Famous-Patient.html#ixzz2iEYewt6cFollow us: @SmithsonianMag on Twitter

4. Teen Brains and Teen Behaviour • What does Phineas Gage have to do with the teen brain? • How does the teen brain differ from that of adults? • How do these differences cause teens to behave differently than adults?

5. Teen Brains and Teen Behaviour • What does Phineas Gage have to do with the teen brain? • How does the teen brain differ from that of adults? • How do these differences cause teens to behave differently than adults?

15. Myelination is not finished in the Frontal Lobes until one’s early 20s

17. Nucleus Accumbens • An area of the teenager's brain that is fairly well-developed early on, though, is the nucleus accumbens • The area of the brain that seeks pleasure and reward • At the base of the forebrain

18. In imaging studies that compared brain activity when the subject received a small, medium or large reward, teenagers exhibited exaggerated responses to medium and large rewards compared to children and adults • When presented with a small reward, the teenagers' brains hardly fired at all in comparison to adults and children. • So what does it mean to have an undeveloped prefrontal cortex in conjunction with a strong desire for reward? • ---As it happens, this combination could explain a lot of stereotypical teenage behavior.

21. http://de.slideshare.net/teenmentalhealth/everything-you-need-to-know-about-the-teen-brain-presentationhttp://de.slideshare.net/teenmentalhealth/everything-you-need-to-know-about-the-teen-brain-presentation • http://de.slideshare.net/nationalsafeplace/adolescent-brain-development-and-its-effects