ABSTRACT
That changes to frontal lobe structure may be associated with profound changes in personality was suggested by the famous case of Phineas Gage, the American railroad worker who on September 13, 1848, at the age of 25 years, was the victim of a terrible accident. Having put blasting powder into a borehole, Gage forgot to add sand before tamping it down with a three-foot iron tamping bar, which consequently blasted out, entered his left cheek, destroyed his left eye, and passed out of his skull.1 Having survived this neurotrauma, Gage changed from being an energetic, reliable, systematic and hardworking individual to being impulsive, stubborn, and disorganized.1 Photographs of Gage’s skull are shown in Figure 3.1, while Figure 3.2 shows computergenerated models of the lesion, from which it appears that the tamping iron caused medial and lateral left orbitofrontal lesions and left dorsolateral prefrontal damage, but spared the supplementary motor cortex and Broca’s area. Gage suffered from neither contralateral hemiplegia nor dysphasia.2
