[Phineas Gage and the enigma of the prefrontal cortex]

Abstract

Perhaps the most famous brain injury in history was a penetrating wound suffered by a rail road worker named Phineas Gage on September 13, 1848. Twelve years after his injury, on the 21st of May, 1860 Phineas Gage died of an epileptic seizure. In 1868 Dr. Harlow gave an outline of Gage's case history and first disclosed his remarkable personality change. One might think this report would assure Gage a permanent place in the annals of neurology, but this was not the case. There was a good reason for this neglect: hardly anyone knew about Harlow's 1868 report. Dr. David Ferrier, an early proponent of the localisation of cerebral function, rescued Gage from obscurity and used the case as the highlight of his famous 1878 Goulstonian lectures. Gage had, through a tragic natural experiment, provided proof of what Ferrier's studies showed: the pre-frontal cortex was not a "non-functional" brain area. A rod going through the prefrontal cortex of Phineas Gage signalled the beginning of the quest to understand the enigmas of this fascinating region of the brain.