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An odd kind of fame. Stories of Phineas Gage

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    An odd kind of fame. Stories of Phineas Gage. Edited by malcolm macmillan (Pp 552, £24.95). Published by Massachusetts Institute of Technology, USA, 2000. ISBN 0 262 13363 6.

    A brief description of the contents of this book, which is 562 pages long and deals purely with the case of Phineas Gage, would lead most potential readers to throw up their hands in horror and to assume that the book must be extremely repetitive and boring. Nothing could be further from the truth. Malcolm Macmillan's approach in this book has similarities to James Joyce's concept when writing Ulysses. Joyce thought that all of life's experiences could be encapsulated in the description of 1 day in the life of his Dublin characters. Malcolm Macmillan's unstated thesis is clearly similar and that a great deal of 20th century cognitive neuroscience can be understood by the analysis of the remarkable case of Phineas Gage.

    This book is the outcome of an obsession with Phineas Gage which must have extended over many years. It is superbly written and provides a fantastic reference source across a wide range of topics. The first few chapters describe, in detail, the events surrounding the fateful afternoon of 13 September 1848 when the unfortunate Phineas Gage was tamping an explosive charge close to Cavendish in Vermont. The tamping iron was propelled through Phineas' skull damaging his orbit and presumably destroying much of the orbitofrontal cortex. The iron landed 20 metres away and can be seen in the Anatomical Museum at Harvard University. There are many revelations in this part of the book. It was certainly not known to me that the original interest in Harlow's description of Phineas Gage revolved around the surgical procedures Harlow carried out which saved Gage's life. It was only 20 years later, in 1868, that Harlow described (very briefly) the changes in personality that have become enshrined in neurological and neuropsychiatric folklore.

    The second section of the book is in many ways the most fascinating. Malcolm Macmillan provides a scholarly account of the origins of the concept of cognitive localisation in the brain outlining the contributions of Laycock, Hughlings Jackson, Ferrier, Gall, and Broca. There is also a chapter on the contribution, or otherwise, of Gage's story to the origins of psychosurgery. Macmillan has unearthed a great deal of overlooked early literature on the use of various procedures used for the surgical treatment of insanity in the late 19th and early 20th centuries. I was particularly fascinated by the sections describing the effects of frontal lobe resection and ablation.

    The following section of the book deals with interpretations of the changes in Gage's personality and its contribution to both the scientific and popular literature. The final chapter details the life of Dr John Martin Harlow. The main text is followed by facsimiles of the Gage papers. There are also reproductions of the CT of Phineas Gage's skull.

    I can thoroughly recommend this book to anyone interested in the history of neuroscience, neuropsychology, or neuropsychiatry. It is also amazing value at just under £25.