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phineas gage

6 august 2016

Phineas Gage is one of the most famous patients in medical history, a man who survived the loss of much of his brain. But one of John Fleischman's themes, in his 2002 book about Gage for young readers, is that Phineas' organism survived. What made him Phineas arguably did not.

Phineas Gage is the fellow who lived to be 36 years old even though, when he was 25, an unbelievably large projectile shot completely through his skull and took various parts of his brain with it. Though extremely well-documented, the story is perfectly incredible. You can die from a nail to the brain. People have probably died from a bobby pin to the brain. Gage survived the impact of a "tamping rod" that dwarfed his skull. You could fire tamping rods at skulls at the rate of one a minute for a year and not find any survivors. If you could get a grant to do that in the first place.

And if you did and got a few survivors, they would likely be very changed people. Phineas Gage got on well with animals, especially horses, after his recovery, but he couldn't handle people. He couldn't understand risks and rewards; he couldn't read other people's intentions. His symptoms mirror the side-effects of drastic and far more sanitary brain surgeries in the later medical record. He alerted medical science to the intricacies of the physical seat of personality.

Fleischman takes on the sensitive task of making Phineas Gage's story accessible to younger readers: I'd say about 5th-8th grade or so, but I know little about how books are graded or recommended. He doesn't do a bad job for adults, I'll say. He has to put Gage's grisly skull on the cover, with the word "gruesome," so that he doesn't get complaints from parents. But there's no sparing of the reader, and no patronizing, either. Anyway, kids love stuff like guys getting tamping rods thrust through their brains. Just hope they have the sense not to try it on their little brother.

Fleischman's book joins ones by Oliver Sacks and Suzanne Corkin in trying to account physiologically for what makes us human and makes us ourselves. Fleischman debunks phrenology hilariously but thoroughly, and presents the 19th-century debate between "Whole Brainers" and "Localizers" in brisk, even suspenseful terms, to show ultimately how neither side of the argument was stupid or wrong – but that the truth was more complicated and wonderful than either side imagined. Ultimately the Localizers were less wrong. Parts of the brain do have dedicated functions, and the organism can keep going without some of those functions (in Gage's case, social awareness and self-control).

Gage led a limited and troubled life after his accident, but as Fleischman concludes,

He found a way to live, working with horses. He took care of himself. He saw the world. He died with his family around him, the only people who knew both the old and new Phineas. And he drove a six-horse stagecoach. I bet Phineas Gage drove fast. (75)

Fleischman, John. Phineas Gage: A gruesome but true story about brain science. New York: Houghton Mifflin Harcourt, 2002. Kindle Edition. RC 387.5 .F565