September 13, 1848 (a Wednesday)

Phineas Gage (1823-1860) is one of the earliest documented cases of severe brain injury. Gage is the index case of an individual who suffered major personality changes after brain trauma. As such, he is a legend in the annals of neurology, which is largely based on the study of brain-damaged patients.

On this date, 25-year-old Phineas Gage and his crew were working on the Rutland and Burlington Railroad near Cavendish, Vermont. Gage was preparing for an explosion by compacting a bore with explosive powder using a tamping iron. While he was doing this, a spark from the tamping iron ignited the powder, causing the iron to be propelled at high speed straight through his skull. It entered under the left cheek bone and exited through the top of the head, and was later recovered some 30 yards from the site of the accident.

Gage recovered almost entirely from his physical disabilities, except for loss of sight in one eye. It is surprising, of course, that Gage survived such a traumatic event at all, but more surprising is the fact that his personality was completely changed as a result of the accident. Gage’s doctor describes how “the equilibrium or balance, so to speak, between his intellectual faculty and animal propensities” had been destroyed. The changes became apparent as soon as the acute phase of brain injury subsided. He was now “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 perniciously obstinate, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned. . . .” .

These new personality traits contrasted sharply with the “temperate habits” and “considerable energy of character” Phineas Gage was known to have possessed before the accident. Previously, he had “a well balanced mind and was looked upon by those who knew him as a shrewd, small businessman, very energetic and persistent in executing all his plans of action.” So radical was the change in him that friends and acquaintances could hardly recognize the man. They noted sadly that he was “no longer Gage.”  In fact, he was so different that his employers had to let him go shortly after he returned to work. The problem was not lack of physical ability or skill – it was his new character.

References:

• Damasio, Antonio R. Descartes Error: Emotion, Reason and the Human Brain, New York: Avon, 1994.

January 20, 1862 (a Monday)

On this date, in the city of Luxor, Egypt, the American Egyptologist Edwin Smith made an important historical discovery when he bought an ancient papyrus from a dealer named Mustapha Aga. After Smith died in 1906, his daughter, Leonora Smith, gave the papyrus to The New York Historical Society. In 1920, James Henry Breasted, founder of the Oriental Institute of Chicago, was asked to translate the papyrus. Finally, in 1930, Dr. Breasted published the English translation for The New York Historical Society (University of Chicago Press). The papyrus now resides at The New York Academy of Medicine, where it has been since December 2, 1948.

The Edwin Smith Papyrus is the first known medical document dating from the 17th century B.C.E. However, it is thought to have been based on earlier documents, possibly by the 27th century B.C.E. medical writer and architect Imhotep, among others, since the papyrus appears to be a compilation of work based on the writing of multiple authors. This would make it the oldest of all known medical papyri. According to Breasted, the papyrus is a copy of an ancient composite manuscript which contained, in addition to the original author’s text, a commentary added a few hundred years later in the form of 69 explanatory notes (glosses). The treatise contains 48 systematically arranged case histories, beginning with injuries of the head and proceeding downward to the thorax and spine, where the document unfortunately breaks off. These cases are typical rather than individual, and each presentation of a case is divided into title, examination, diagnosis, and treatment. The treatment of these injuries is rational and chiefly surgical; there is resort to magic in only one case out of the 48 cases preserved. The Edwin Smith Papyrus is of special interest to the anatomist because it describes the sulci and gyri on the surface of the brain, the meninges (coverings of the brain), and the cerebrospinal fluid for the first time in recorded history.

In medical knowledge, Egypt leaves the rest of the world behind. (The Odyssey, Homer)