Phineas Gage injury: the most incredible case in medicine

Phineas Gage lived in the late 19th century. He was involved in the construction of American railroads. Phineas had no remarkable abilities, except for one - he was able to survive after a crowbar-sized iron rod passed through his brain.

It happened like this. On September 13, 1848, Phineas worked in a crew that was blasting through rock for laying railway. First, the workers drilled a well, then they placed explosives in it, covered it with sand and compacted it all using an iron ramrod, which weighed 6 kilograms and had 3 centimeters in diameter.

At that time, apparently, they forgot to put sand in the well - so the ramrod knocked a spark out of the rock, which detonated the explosive.

A six-kilogram ramrod flew out of the hole like a bullet and hit Phineas right through the head. The ramrod was later found 25 meters from the scene, covered in blood clots and pieces of Phineas' brain.

From a direct hit to the head, the poor fellow was thrown onto his back, he convulsed several times. But, to the surprise of the other workers, within a few minutes he could talk and walk.

Half an hour later, Doctor Edward Williams arrived to see Phineas. Williams tells what he saw: “... There was a large crater in his head... He said that a piece of iron went through his head, but I didn’t believe him... He stood up and vomited. While he was vomiting, about a tea cup fell out of his head onto the floor brains..."

The left front lobe of Phineas' brain was almost completely destroyed. But he was fully conscious.

Phineas recovered long and hard. From the end of September to the beginning of October, the pressure in his brain changed dramatically, which led the poor fellow into a semi-comatose state. His friends thought he would die any day now. But already on October 7, Phineas got out of bed on his own and took the first step. A month later he was able to go up and down the stairs on his own, walk around the house and walk outside. At the same time, Phineas did not experience any headaches.

Soon Gage made a full recovery - from suffered trauma he was left with a huge dent on his head, decreased vision in his left eye and a “strange” feeling that he found it difficult to describe to doctors. Although Phineas's health did not deteriorate, certain changes occurred in his psyche. As one of his contemporaries writes, Phineas became more rude, began to swear, could not tolerate criticism and take advice from friends - although before he was a completely balanced person. As his friends said, “this is no longer Gage.”

Phineas died 12 years later from a series of epileptic seizures.

In May 2012, the results of research by a group of American neurologists were published, which explained the changes in the psyche of Phineas Gage after a head injury. Researchers modeled Gage's injury based on data computed tomography American skull, which is currently kept in the anatomical museum of the Harvard Medical School. To assess damage to the cerebral cortex and the pathways located in the area of ​​injury, the scientists used modern images of the brain of a 25-year-old right-handed person obtained by diffusion tensor imaging. Thus, the researchers found that as a result of the injury, Gage lost about 4% of the cortex, as well as almost 11% white matter brain

The Gage case study contributed to significant advances in the understanding of the functions of brain regions and their influence on emotion and personality. His medical history is given as one of the first indications that the damage frontal lobes may lead to changes in various aspects personality and influence socialization. Previously, it was believed that the frontal lobes did not have much influence on human behavior.

The science

Phineas Gage was an American builder who forever entered the history of medicine. In 1848, he was using a meter-long metal rod while blasting a railroad when an unexpected explosion caused the rod to pass through him. left cheek and came out at the top of the head.

Somehow, miraculously, Gage recovered, becoming the most famous case in the history of neurology, but not just because he survived a life-threatening injury that destroyed much of his left frontal lobe of his brain. After Gage is wounded literally became a “different person”. From a 25-year-old affable guy, he turned into an impulsive, rude and vulgar person. The changes in his personality and behavior were so profound that his friends and acquaintances declared that “this is no longer Gage.”

A New Look at a Legendary Brain Injury

For many years, various scientists have studied and debated exactly what area was affected by the injury and the extent of the damage, as well as the impact of this injury on the individual. This could explain the profound changes in Gage's personality, as well as the causes of some disorders such as Alzheimer's disease.

Now scientists from UCLA were able recreate the map nerve connections in Gage's brain. Since Gage's skull, which is in the Warren Anatomical Museum at Harvard medical school, is already quite fragile, scientists had to re-examine the 2001 data. Using computer modeling techniques, they determined the trajectory of the rod that pierced the brain, and also used images of the brains of men who matched Gage's age and were right-handed. As a result, they created a virtual skull to analyze the injury.

Jack Van Horn(Jack Van Horn), the study's author, and his colleagues found that approximately 4 percent of the cerebral cortex was crossed with a metal rod, which resulted in damage to about 10 percent of all white matter. This means that although the injury occurred in the left part of the cerebral cortex, the disruption of brain connections resulting from white matter damage spread throughout the brain, severing connections between other areas, despite the fact that the rod did not hit them.

This is visible and contributed to the profound changes that occurred in the personality of the unfortunate.

Although Gage's personality changed, he was able to travel and found work after living for several years in South America. He died 12 years after the accident.

On September 13, 1848, Phineas Gage went to work as usual, not suspecting that at the end of the day he would be considered the luckiest man in the world. His job was to supervise a team of road workers digging a tunnel through the rock for a railway line that was being built. He was an exceptionally good worker, diligent and careful, and was respected by his comrades. Gage was personally responsible for placing explosives in the pits. It was a dangerous job, but it suited Gage well given his methodical and meticulous nature. The procedure for placing explosives was always the same: first, gunpowder was poured into a hole drilled in the rock; Phineas carefully leveled it, after which an assistant set the fuse and filled the hole with sand. Phineas then used his meter-long metal spike to tamp down the sand so that the sand became a kind of plug in the pit and directed the force of the explosion downward to destroy the rock. Phineas was a recognized virtuoso of working with a tamping pin, which was made according to individual order local blacksmith. No one really knew who was really to blame for what happened, but Phineas began compacting the explosives before his assistant poured sand into the pit. Most likely, the spark generated when the metal pin hit the granite caused an explosion, as a result of which the pin flew out of the pit like a bullet and pierced Phineas's head.

A metal pin, stained with blood and pieces of Phineas' brain, landed about nine meters from the explosion site.

The skull of Phineas Gage and the iron stick that pierced it are now kept at Harvard University, but their models can be found in almost any American university. Photo: Brown University

It entered the head under the left cheekbone and a split second later came out in the middle of the forehead just above the hairline. Comrades rushed to the victim, thinking that he was dead. From a direct hit to the head, the poor fellow was thrown onto his back, he convulsed several times. But, to the surprise of the other workers, within a few minutes he could talk and walk. He was fully conscious and immediately began narrating the incident.

He was put on a wagon and taken to the nearest town, about a mile from the site of the explosion, to show local doctor. When Dr. Harlow appeared half an hour later, Phineas, sitting on the porch of the hotel where his comrades had taken him, made jokes about the severity of the injuries he had received. Although Phineas was in pain, his situation was alleviated by the fact that pain receptors are found only on the outer surface of the skull and are absent in the brain.

Phineas' injuries and conflict of viewpoints

Doctor Harlow, seeing Phineas's wound, could not believe his eyes. His medical experience could do little to help in such a situation, so he simply shaved Phineas’s head, removed bone fragments and fixed the displaced parts of the skull in their original places. He then disinfected the skin on the skull and applied a tight bandage. He didn't stitch up the hole in Phineas's cheek so the wound could dry out. The doctor had little doubt that Phineas would die within a few hours. A local undertaker came to take Phineas's measurements to make a coffin for him. But for the first few days after the injury, Phineas felt surprisingly well and remained cheerful and talkative. However, his wound soon began to emanate horrible smell, because it became infected, and mold began to grow from Phineas' brain. These days, doctors argued a lot about what should be done in such cases: some believed that the mold could be part of the recovering brain and that it should be pushed inside the skull; others insisted on the need for its removal. Dr. Harlow allowed the mold to grow until one of his friends pointed out to him that mold growing out of a patient's head was certainly not conducive to recovery! Distressed by the lack of necessary knowledge, Dr. Harlow agreed with the correctness of this comment and removed the mold.

Phineas developed a fever and began to become delirious. His eyes began to fester. At that time, doctors knew nothing about bacterial infection, but the forecasts were disappointing. Dr. Harlow used the method of bloodletting (at the time, doctors mistakenly believed that patients suffered from having “too much blood” in their bodies). Fortunately for Phineas, this method really helped him greatly, as it reduced blood pressure, which had the effect of easing the pressure on his swollen brain. The presence of a "hole" in his head meant that he had an "open cranial wound" allowing his swollen brain to expand. To everyone's surprise, less than a month after the accident, Phineas began to recover, and ten weeks later he was declared fully recovered. He lost sight in his left eye, but otherwise physical state returned to normal. However mental condition, unlike the physical one, was not restored.

"No More Gage"

Dr. Harlow reported that Phineas was able to perform all the tasks that he performed before the accident, although some strange things were observed. Dr. Harlow became concerned about his patient's mental state. Six months after the injury, Phineas returned to his employers to take up his previous job. His physical abilities appeared to be restored, his speech was correct, and his memory remained intact. Although many reports stated that Phineas had fully recovered physically, there were still reports of him being physically disabled. However, much more noticeable was the change in Phineas's character: he became impatient, aggressive and rude; he began to use obscene language and constantly changed his plans. He did not tolerate any objections and easily took unnecessary risks. In this state he could not inspire confidence, and his doctor and friends said of him that he was “no longer Gage.” No amount of exhortation or reasonable argument could make him behave differently; he apparently could not change his aggressive and unpredictable behavior, even though it was affecting his life adversely. After the end of the probationary period, employers had no choice but to refuse the services of Phineas.

Meanwhile, his case attracted the attention of other doctors, in particular Dr. Bigelow of Harvard University in Boston, Massachusetts. Bigelow invited Phineas to come to Harvard to undergo a thorough examination. At that time, there were no established ways to study the brain, and doctors were still trying to figure out how it worked. A case like Phineas's was one of the opportunities for research into how the brain works. In those days, there were two main scientific schools that had their own views on how the brain works. Some scientists, like Dr. Bigelow, believed that a person's thinking and behavior were controlled by the entire brain and that damage to one part of the brain would cause other parts of the brain to try to compensate for the weakening of its capabilities.

Representatives of the competing school adhered to the concept of the so-called localization of brain function (Dr. Harlow also agreed with it). This concept assumed that specific brain regions have specific functions and that damage to one region results in impairment of corresponding mental or behavioral functions. The “science” of phrenology, which was emerging in those years, supported this point of view and tried to provide a visual representation of it with the help of phrenological models of skulls. (The phrenological paradigm was widely used in the 19th century to explain the functioning of the brain. The functions of each part of the brain were determined by studying external characteristics skulls Convexities and depressions on the skull were associated with the character traits of its owner and, thus, a “mental map” of the brain was drawn. The phrenological concept was especially popular with women: since it was impossible to detect fundamental differences between the skulls of men and women, this fact helped women in their struggle for equality with men.)

Supporters of both schools had an understandable interest in all cases like that of Phineas Gage. Doctors have not often had the opportunity to study the effects of such severe damage to the frontal lobes of the brain. In almost all cases, people who received such injuries died. As often happens in disputes between scientific schools, Gage's case began to be interpreted by supporters of each of the schools as confirming the correctness of their views. On the one hand, it was argued that other areas of Phineas's brain took over the functions of the damaged areas, since in otherwise the victim would either die or experience deeper effects of his injury and would likely be unable to reason properly, control his movements, speak, etc. Gage's case has also been cited in support of the idea that the brain is integral comprehensive body, working as a single mechanism, and that it has an innate flexibility that allows intact areas to perform the functions of damaged ones. Dr. Bigelow believed in the correctness of these ideas and may have deliberately underestimated the nature of the changes that occurred in Gage after the accident in order to support his point of view.

Aware of the need to not disclose confidential information about the patient, Dr. Harlow nevertheless told several reliable colleagues that Phineas was not the same as he had been before. This was taken as evidence that the damaged areas of the brain were responsible for specific mental and behavioral functions that were now apparently lost. Their loss was manifested mainly in the deterioration of planning and logical reasoning abilities and in a general disinhibition of feelings towards other people, which manifested itself in a lack of respect and the use of harsh language. Quite by chance, the phrenological model placed the areas of "benevolence" and "pleasantness" almost exactly in the place that was damaged in Phineas. Thus, phrenologists and those who believed in the localization of brain functions also began to view Gage's case as confirming the correctness of their views. Since Harlow did not speak publicly about Gage's changes in character until many years after his death, Bigelow's account of the incident was considered the most reliable, although it stated that the accident had little effect on Gage.

The interesting thing about this story is that the same information can be used to validate the ideas of both competing schools of thought. However, assessing the past taking into account modern knowledge, it seems unsurprising that both groups used Gage's case to bolster their ideas, and each was right in their own way. We now know that the brain is an extremely complex, interconnected organ that contains 100 billion neurons but does not function as a single unit. It may be more accurate to think of separate circuits working together in our brains, but simultaneously performing their own specific functions. Even functions localized to specific parts of the brain (such as recognizing faces or remembering names) are interconnected with other areas. Essentially, the brain can be considered to be composed of both autonomous and interconnected regions. The only thing we can say with absolute certainty is that phrenology is a pseudoscience.

"The only person who lives with a hole in his head"

Dr. Bigelow called Gage's case "the most remarkable of all famous stories about damage human brain" A plaster cast was made of Gage's skull, which is still kept at the Harvard Medical School. After several weeks at Harvard, where he attracted the attention of the local medical community, Phineas went home. There is no consensus on how it proceeded future life. Perhaps he began to travel around major cities New England, telling his story and showing his skull and famous iron spike to curious people who were willing to pay money for it. But there is also other information. For a long time he was believed to have worked as a living exhibit at Barnum's American Museum on Broadway. They say that he held in his hands his tamping iron pin and a cast of a skull with a drilled hole. With their help, he showed visitors what kind of head injury he received. He was called “the only person living with a hole in his head”, and on some posters he was depicted with an iron pin sticking out of his head! Despite the popularity of this story, there is little evidence confirming its veracity, but if it were real, it would certainly be reflected in many documents. Indeed, it is unlikely that Phineas would have become the star of such a panopticon in which orangutans were shown, bearded women and "mermaids".

More plausible is the statement that over the next nine years Phineas was engaged in various jobs, mainly related to horses. He first worked in a horse rental stable and then apparently spent several years in Chile working as a stagecoach coachman. In 1859 he returned to his mother in San Francisco, where he was engaged in various agricultural work. But he did not stay in any job for long, as he constantly had problems in relationships with people. Phineas began to suffer epileptic seizures, the frequency and severity of which gradually increased. Doctors did not know the cause of these seizures, but it was likely that they were partly caused by the head injury he had sustained. Finally, on May 21, 1860, Phineas Gage died.

He was buried quietly in a small cemetery in San Francisco, and since then no one has heard anything new about him, except for the fact that in 1866 Dr. Harlow tried to find out some details about the life of his most famous patient. Harlow managed to track down Phineas' mother, who eventually agreed to have her son's body exhumed and his skull donated to Harvard University's medical school. Another unusual item was also recovered from Phineas's coffin - a tamping pin.

Having received Phineas' skull and no longer caring about maintaining confidential information, Dr. Harlow published a description of the case of Phineas Gage. He claimed that the injury changed Gage's character and that he suffered greatly from deteriorating communication skills. Harlow could demonstrate that, eleven years after the accident, his patient's skull had not fully recovered and that Phineas had actually been living with a hole in his head all this time. Dr. Harlow must be given credit for bringing Phineas's case back to prominence and preventing it from falling into oblivion in the annals of medical history.

Later studies

Similar human skulls, pierced by arrows or trepanned, can be seen in the Natural Science Museum in London. Craniotomy is the oldest brain surgery known to us. In ancient times, it involved drilling a hole in the patient's skull in the hope that through it it would be possible to expel evil spirits or demons. This operation can be considered one of the oldest forms of psychosurgery. Trepanation can help get rid of severe headaches caused by increased intracranial pressure, and in such cases it may turn out useful method treatment.

A year after Gage's death, a scientist named Paul Broca made important step advances in understanding brain function through the study of one of his patients named Leborgne, who suffered from a stroke. Leborgnier could understand speech, but he himself could only pronounce one word “tan” (that is what this patient was usually called in the hospital). After Leborgnier's death, it was determined that he had suffered particularly severe damage to a small area of ​​the brain in the lower left frontal lobe. Similar damage has been observed in other paralyzed patients, and this area of ​​the brain is called Broca's area, or "speech center." In 1874, Carl Wernike discovered another area of ​​the brain that was key to understanding language. People who have neurophysiological damage to this area (now known as Wernicke's area) are unable to understand the specific meaning or content of speech addressed to them and cannot produce meaningful sentences; as a result, their speech is structured grammatically, but does not make sense. Given these findings, it is surprising that Phineas did not suffer from any speech or language impairment, despite the nature of his injury.

Of course, given the state of brain science at that time, it was impossible to determine exactly how much damage Phineas suffered. However, after this accident, no less than twelve studies were carried out to find out the exact trajectory of the iron pin through his head. Perhaps the most recent one provides the most accurate information. It was conducted in 1994 by Hanna Damasio and her team. The study involved studying Gage's skull using three-dimensional computer modeling techniques. Knowing the entry and exit points of the pin from Gage's head, they calculated the possible trajectories of its movement and came to the conclusion that one of the trajectories was the most likely. They even tried to take into account those minor features that each individual's brain has. However, even with an accurately calculated trajectory, it was impossible to say with complete certainty which areas of the brain were actually damaged. Damasio and her team compared Gage's skull to three dozen normal skulls and identified seven brain types that matched the anatomical parameters of Gage's skull almost perfectly. They then simulated the movement of a metal pin through each of these seven types and found that the damaged areas of the brain were the same in all seven cases. This way, they could be confident that they had identified both the most likely trajectory and the areas of the brain damaged by the accident. They identified the damaged parts of the brain as "the anterior half of the orbital frontal cortex... the polar and medial orbital cortex." frontal cortex and the most anterior sector of the anterior marginal gyrus.” However, even here there are problems, since we cannot know for sure how much of the damage was caused by the concussion at the time of impact and how much by infection; Studying the skull alone does not provide answers to these questions. Moreover, even if we decide that we know exactly all the details of the damage to his brain, we still cannot say with certainty what effect this damage had on Gage's personality or behavior, since he never underwent comprehensive examination. In those days, there were no systematic methods for assessing the neuropsychological status of patients.

P.S

Gage's case is not just a curious medical incident - the injury he received changed our understanding of the localization of brain functions, especially in the anterior subcortex. This case made an important contribution to the development of neurosurgery, as it helped to understand that serious surgical interventions the work of the brain can be carried out without fatal consequences. The importance of the Phineas Gage case is further demonstrated by the fact that it is still mentioned in 60% of all psychology textbooks.

Although science knows of equally important cases, the story of Phineas Gage and his injury remains the most famous example how a person managed to survive after serious brain damage. For this reason, it is no exaggeration to say that since that fateful September day in 1848, Gage has been considered the luckiest of all men. For the remaining eleven years of his life, he often referred to himself as “a man living with a hole in his head,” and that is what he will likely continue to be called in scientific literature.

Here are a few more cases:

In April 1998, a 41-year-old American named Michael Hill was attacked, as a result of which a huge 20 cm long army knife was pierced into his head, piercing his skull. After the attack, Michael was able to walk down the street on his own to the house of his friend, who took him to the hospital. Four hours after the attack, the knife was removed from Michael's head. However, what is interesting is that after extracting this " foreign object"from the head, around the wound did not arise infectious infection, and a week after the operation, Michael left the hospital on his own. The injury had virtually no effect on Michael's psyche. Although he initially had headaches and some memory impairment, by the time he left the hospital they had already stopped. Doctors could not identify any other mental disorders in Michael Hill. It is difficult to say what is the reason for such survivability. The only rational explanation, it seems to me, is that when struck from above, the knife entered the space between the hemispheres, accordingly damaging less brain tissue than if the blow was struck from the side or behind.

Also in 1998, the scientific journal Arquivos de Neuro-Psiquiatria described the case of a 39-year-old man who decided to commit suicide and hammered two (!) huge nails into the middle of his head. Oddly enough, this man survived. Although the nails touched the motor cortex, no motor disorders Doctors were unable to identify him. As for the psyche, this is not reported. The very method of suicide indicates that he was not doing well with her.

One 29-year-old man was hit in the head by a harpoon. He was fishing in one of the reservoirs and his partner, shooting a harpoon at a fish, hit him in the head. The harpoon passed over the left eye through the brain and exited, piercing the skull, through the top of the head. After the operation, during which the harpoon was removed, this young man reported that he felt fine and was going to return to his favorite pastime - spearfishing. According to the journal Surgical neurology, where this case was described in 1983, neurological impairment in this man before and after surgery was minimal.

In 1888, the Medical Press of New York published a story about amazing case which happened to a river tugboat sailor. One day this sailor climbed onto the boxes that the barge was transporting to check if they were loosened. While busy with the boxes, he did not notice that the barge began to pass under the arch of the low bridge, and, as a result, a sharp beam of the bridge span cut off his skull at a level of five centimeters above his right eye. Covered in blood, the sailor fell, and everyone who saw this believed that he would soon die. However, when he was taken to the hospital a couple of hours later, he was still alive. Moreover, as soon as the doctors began to treat his wound, he suddenly opened his eyes and asked what happened to him. When the doctors bandaged his head, which had shrunk by a quarter, the sailor suddenly got off the operating table and demanded his robe, declaring that he wanted to go home. Just two months later he returned to the ship. This sailor did not experience any mental problems, except for occasional dizziness; in all other respects he was also quite healthy person. Only 26 years after this incident he became partially paralyzed left hand and leg.

It is difficult to say how true this story of the sailor is - after all, it happened too long ago. However, there is another well-documented story that happened relatively recently.

As a result of the accident, fourteen-year-old Ahad Israfil lost a significant part of his brain. Subsequently, he was given a silicone prosthesis that hid this defect. Since then, Ahad has led a life virtually no different from that of his peers who use wheelchairs. Still from the film “101 Things Removed from the Human Body”

In 1987, a 14-year-old American boy named Ahad Israfil was working part-time in a gun store. One day, his boss accidentally hit the butt of a loaded gun on the floor and a shot was fired. The bullet hit Ahad in right side head and destroyed part of his skull. Right hemisphere His brain was so badly damaged that doctors had to almost completely remove it.

Ahad is still alive. Although he uses a wheelchair, his psyche, according to doctors and his parents, is not damaged. He is able to talk like a reasonable person. Moreover, if before the accident Ahad did not like to read, then after the injury he developed a thirst for knowledge - he began to read books all the time free time. He successfully completed school, and currently appears periodically on television shows, telling his story.

More recently, in July 2007, a short article, “The Clerk’s Brain,” was published in the prestigious medical scientific journal Lancet. It described a striking case of hydrocephalus in a 44-year-old French civil servant. One day this man went to a Marseille hospital complaining of weakness in his left leg, but when he had a brain scan, the doctors who saw the pictures were shocked. It turned out that the ventricles of this clerk's brain were so expanded that they occupied almost the entire cavity of the skull. Nevertheless, although almost three-quarters of his brain was missing, this man lived (and still lives) quite well. normal life: work, family, children...

Amazing, isn't it? What's even more surprising is that this has already happened.

As is known, even the slightest violations brain function can manifest itself in the form of strong mental disorders. Thus, a lesion of several millimeters in size can, depending on its location, lead to disturbances in speech, memory, consciousness, perception, etc. However, our “brainless” clerk from Marseille, oddly enough, did not experience any special mental problems. Although, to be honest, he was somewhat stupid - his average intelligence quotient (IQ) was only 75, with the norm ranging from 80 to 114. However, some types of his intelligence were better developed. For example, his verbal IQ was already equal to 84, which is quite comparable, for example, with the IQ of US President George W. Bush, who is said to have it at 91. The clerk lived ordinary life: regularly went to work, was married and had two children. If he had not had problems with his leg, then perhaps no one would have known that in his head most of the “living space” is occupied not by the brain, but cerebrospinal fluid(cerebrospinal fluid).

There was almost no brain in the head of the forty-four-year-old clerk from Marseille: all the dark space in the photographs on the left is occupied by liquid. For comparison, a typical human brain is shown on the right in the same projections. Photo: Feuillet et al./The Lancet
Something similar was already described in 1980 in the journal Science. Roger David Lewin published his article "Do You Really Need a Brain?" (Is your brain really necessary?), in which he described several cases of hydrocephalus from the practice of Professor of Pediatrics at the University of Sheffield John Lorber (1915–1996). Among them is the case of a student who, in the mid-1960s, went to the doctor complaining of a minor illness. The doctor noted that the head size young man slightly exceeded the norm and for a more detailed examination sent him to his friend, Professor Lorber. The scan showed that the entire space cranium the student was occupied by ventricles filled with cerebrospinal fluid. The nervous tissue of his brain was only a thin layer of a few millimeters around them. However, this student did not suffer from any mental disorders (his IQ was even slightly higher than normal and amounted to 126). He studied successfully (especially excelled in mathematics) and was even able to graduate from university with honors.

The same Levin described another similar case from Lorber's practice. In 1970, a New Yorker died at the age of thirty-five. When to determine the cause premature death an autopsy was performed and it was also discovered that complete absence brain This man worked as a concierge and was popular in his circle. Residents of the house where he worked said that he usually spent his time doing routine activities: watching the steam boiler, reading newspapers.

It’s not easy to explain how this is possible, but let’s try. It can be assumed that hydrocephalus in these people was congenital (alas, there is little data, but, according to at least, the French clerk definitely had one). Accordingly, it can be assumed that their head size was slightly larger than average. And if so, then the inner surface of their skull was larger than the statistical average and, therefore, a thin layer nerve tissue occupied large area. Thus, the volume of their atrophied brain could be greater than it seems at first glance. The second explanation is that the ventricles increased in volume very slowly, and the brain, due to its plasticity, had time to gradually restructure itself. And finally, the third explanation is that the ventricles, enlarging, crushed the white matter of the brain and displaced subcortical structures, but the gray matter of the cortex, which is responsible for higher cognitive functions, was affected to a lesser extent. I understand that these explanations are rather shaky and based on insufficient data, and therefore I will not insist on them when someone can give another.

On the other hand, there is evidence that mental disorders The problems that Gage suffered from were mostly temporary. In particular, his sister and mother told reporters that although Gage suffered from amnesia, it was not so much that a person who did not know him closely could notice it. They also made no mention of the short temper and uncontrollable behavior Harlow mentioned. After some time, Gage got a job as a stagecoach driver in New Hampshire and was in good standing with his employer, so much so that he recommended him for a similar position in Chile, fully expecting that he would come to court, despite the fact that Gage did not know Spanish language. Moreover, witnesses who saw him in Chile stated that he was in good physical and mental health and did not show any pathological symptoms. Towards the end of his life, however, Gage's health deteriorated and he was forced to leave his physically demanding job as a coachman, returning to the United States and settling in the area around San Francisco, where he took up farming with the support of his mother and sister, who moved in with him. His health improved somewhat, but remained fragile. In February 1860, Gage began to suffer from epileptic seizures, which became increasingly worse until he died during one of them on May 18 or 21, 1860.