Amazon.com: An Odd Kind of Fame: Stories of Phineas Gage: Malcolm Macmillan: Books

From The New England Journal of Medicine, January 25, 2001
The story of Phineas Gage is one of the oldest, most intriguing, and most told tales in the history of neuroscience. The key events occurred in rural Vermont more than 150 years ago. Gage, a railroad construction worker, had an accident in which an iron bar was propelled through the front part of his head, producing a massive injury to his brain, presumably in his frontal lobes. That Gage even survived was miraculous enough; that he survived without apparent changes in higher cognitive functions, including speech, learning and memory, and intellect, was almost beyond comprehension. But Gage's fame and the secure position of his case as a landmark in the annals of neuropsychology derive from another source. Although there was never an autopsy, the likelihood of frontal-lobe damage was high, and there were profound changes in Gage's personality and temperament. In retrospect, Gage's dramatic case was a clue to the critical role of frontal-lobe structures in social behavior and moral reasoning. Contemporary neuropsychology remains preoccupied with those relations.

There is, however, a story behind the story, and this is the impetus for Macmillan's account of the Gage tale. It seems that almost none of the numerous popular and scientific accounts of Gage have gotten all the facts right, and Macmillan's agenda is to set the facts straight and highlight the errors, from trivial to egregious, that punctuate many of the "Gage stories." An Odd Kind of Fame accomplishes both goals, although the author's axe-grinding style is unlikely to be greeted with enthusiasm by readers or the scientists and journalists who are repeatedly taken to the fact-straightening woodshed. The problem is that, beyond corrections of details, this book lacks new insights regarding the fundamental lesson of the Gage saga: namely, that the frontal lobes are intimately linked to personality and emotion.

For nearly two decades, Macmillan has been engaged in a punctilious and relentless pursuit of an accurate rendering of Gage's story. This book, the fruit of his efforts, is a historical tour de force that throws into bold relief the errors others have made in telling Gage's story. All the details of Gage's accident and recovery (documented in the primary sources) are revisited. For example, the iron bar that went through Gage's head was 1 1/4 in. (3.2 cm) in diameter (not in circumference, as reported by the Boston Post on September 21, 1848); the bar landed 4 to 5 rods (20 to 25 m) behind Gage after its journey through his skull (and did not remain lodged in his head, as reported in some scientific sources); and Gage's physician (John Harlow) confirmed the trajectory of the bar by touching his index fingers together through the openings in Gage's skull and brain.

Macmillan's exhaustive searches also reveal how much is not known about Phineas Gage and lead him to assert that "the lack of reasonably detailed knowledge about which parts of Phineas's brain were injured and about how his mental processes were changed means that we cannot draw other than the most general conclusions about brain-behavior relations from his case." This is no doubt correct -- it is, in fact, the very point, and highlights the general, rather than specific, value of the case. The Gage case illustrates a dramatic and novel relation between brain damage and changed behavior, but the specifics of this relation can only come from research based on comparable cases and modern neuroscientific approaches.

The book includes in several appendixes the original papers on Gage, including the two by Harlow (one written in 1848 immediately after the accident and the other produced 20 years later), and an 1850 paper by Henry Bigelow, a Harvard Medical School surgeon to whom Harlow sent Gage for evaluation (in part to establish the veracity of the case, since Harlow's account was received with considerable incredulity by the medical community). I would recommend that readers begin with these three papers, because they include virtually everything that is known for sure about Phineas Gage. The elegance and humility of the writing style make these papers at once beautiful and poignant: Harlow concludes his 1848 paper with the submission, "Should you think these notes of sufficient importance to deserve a place in your Journal, they are at your service"; his better-known final sentence in the 1868 paper reads, "I can only say, in conclusion... I dressed him, God healed him."

Macmillan's claim that the papers by Harlow and Bigelow have been cited often but almost never read is surely on target, and his book provides ready access to these papers. Open to more debate, though, is his indictment of nearly everyone who has contributed to the scientific and vernacular literature on the riddle of frontal-lobe function. Also, the author's proclivity for enumerating every small error is distracting: does it make a difference, for example, that the time of the explosion was 4:30 p.m., not 4 p.m. as given in some accounts? Harlow's and Bigelow's descriptions of Gage are spare, to be sure, but the gist of their conclusions has been faithfully portrayed by contemporary neuroscientists, and the prescient observations of Harlow regarding the connection of the frontal lobes to personality have been confirmed repeatedly by modern studies of patients with similar types of brain damage.

In the end, An Odd Kind of Fame is an odd kind of book. It is engaging as a history lesson and conveys the energy and tenacity behind the author's quest to uncover every shred of factual information about Phineas Gage. The thinly disguised vendetta against other Gage experts, however, and the frequent aspersions cast on their scholarship -- not to mention their motives -- make the narrative rather unsavory. The best parts of this book were written by Harlow and Bigelow.

Daniel Tranel, Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review
“Malcolm Macmillan’s history of the case of Phineas Gage is an impressive achievement.”
-- James Beebe, Metapsychology

“Thanks to Macmillan, Phineas Gage can now take his appropriate place in the history of medicine.”
-- Jonathon Erlen, The Quarterly Review of Biology

“Macmillan sees many inconsistencies in Gage’s story and seeks to set the record straight...”
-- Science News

“This book...is a historical tour de force...”
-- Daniel Tranel, Ph.D., The New England Journal of Medicine

“The book’s success lies in...Macmillan’s skill as a writer...and his passion for collecting and presenting evidence.”
-- Ian Glynn, Nature

"I highly recommend An Odd Kind of Fame to anyone interested in the history of neuroscience."
-- Randolph W. Evans, MD, Journal of the American Medical Assocation

"This fascinating book is as compelling as a detective story. I could not put it down, and I learned so much. It is a brilliant combination of serious scholarship and popular history that will surely attract many readers."
-- Michael Ruse, Lucyle T. Werkmeister Professor of Philosophy, Florida State University

"An Odd Kind of Fame is a meticulously researched and fascinating chapter in the history of neuroscience. It tells the story of Phineas Gage--perhaps the most famous brain-injured person--whose fate has been continually interpreted and misinterpreted ever since an iron rod passed through his brain in 1848."
-- Charles G. Gross, Professor of Psychology, Princeton University

"Malcolm Macmillan has long had an interest in the history of the neurosciences. He is a thoughtful scholar who knows more about Phineas Gage than anyone else."
-- Stanley Finger, Professor of Psychology, Washington University, and Editor, Journal of the History of the Neurosciences

See all Editorial Reviews

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

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