An Odd Kind of Fame: Stories of Phineas Gage (review)

Malcolm Macmillan. An Odd Kind of Fame: Stories of Phineas Gage. Cambridge, Massachusetts, MIT Press, 2000. xiii, 562 pp., illus. $39.95.

Central to Malcolm Macmillan’s book is the fascinating case of Phineas Gage, a railroad construction worker who, in 1848, was involved in an accident in which an iron bar shot though his head, entering under the left eye and exiting his skull on top of his forehead, slightly to the right of center. To everyone’s surprise, Gage survived the accident and, with the help of some co-workers, returned to town where John Harlow, a railroad physician, tended his wounds. After his recovery, it turned out that he was unable to return to his job. Gage traveled around quite a bit and held a number of odd jobs before he died twelve years later. According to a number of accounts, Gage’s personality had profoundly changed as a consequence of the accident, providing interesting indications for the relationship between brain, behavior, and personality.

Macmillan brings together all first-hand accounts of the accident and Gage’s subsequent treatment, the most important of which are reprinted in the appendices. He then places Harlow’s treatment in the historical context of the rise of phrenology, the decline of heroic medicine, and an emphasis on cleanliness, in which Harlow was ahead of his time. After reviewing all modern medical research on Gage’s skull (including recently made CT scans), Macmillan reviews the accounts of the Gage case in psychology and brain physiology textbooks, concluding that virtually all claims made there cannot be substantiated by the available facts, both medical and historical. This in itself is not surprising, and therefore the long passages that debunk these accounts appear somewhat superfluous; they could have more fruitfully focused on the functions and uses of Gage’s, as well as several other almost mythological case histories in the professional literature. Macmillan provides such an analysis when he recounts the family folklore around another doctor who had seen Gage before Harlow arrived and who, so the story goes, was robbed of his famous case by Harlow. While this family folklore’s main purpose is symbolic and self-serving, the disciplinary and scientific folklore, of which the Gage case obviously is part, serves a variety of purposes that the author could have analyzed.

In his historical research on the role of the Gage case in the development of brain physiology, the research into the localization of brain function, the development of lobotomy, and the growth of psychology, Macmillan convincingly demonstrates that the Gage case has played virtually no role in any of those histories but that it had been inserted later to provide an interesting precursor and an illustrious case history. In other words, after extensive research which fills many pages, Macmillan’s verdict is that the Gage case was of a mere minor importance, which then opens up the question why he propounded on it to such exhaustive extent in the first place.

Macmillan’s research is painstakingly thorough and accurate, and obviously driven by the desire to find out what actually had happened to Gage and what role the Gage case played in the history of medicine, brain physiology, and psychology. With respect to the first, he concludes that most accounts of Gage’s life are mistaken; with respect to the second he finds that Gage played a negligible role. These conclusions are interesting and convincingly supported. But it leaves the reader feeling rather empty-handed–knowing everything there is to know about Gage while being convinced of the minor importance of his case. The author’s attacks on a social constructionist view of history that allegedly disregards facts seem misplaced and irrelevant, but do not detract from the main arguments.

Reviewed by Hans Pols, Ph.D., Institute for Health, Health Care Policy,
and Aging...