The glass cases at the Warren Anatomical Museum in Boston are filled with a variety of fascinating items that have played a role in the history of medicine. On display is a one- meter long iron rod that doesn’t appear to have any special medicinal properties, and indeed it has none. Its fame, or one might say notoriety, rests on having passed completely through the skull of one Phineas Gage in 1848 without killing him! The dreadful injury didn’t kill him, but it did dramatically alter his personality.
The unfortunate event turned out to be a landmark in the history of neurology, demonstrating that different parts of the brain have different functions. Apparently, catastrophic injury to the frontal lobes of the brain can be sustained without causing significant neurological deficits, but not without affecting behaviour. To this day, a memorial plaque marks the spot where the spectacular accident occurred on September 13, 1848, in Cavendish, Vermont. Gage was employed as a foreman by a railroad company, in charge of a crew laying new track. One of his tasks was to blast apart huge rocks that were in the way with gunpowder. This involved boring a hole into the rock and filling it with gunpowder using a long iron tamping rod. On the fateful day, a spark ignited the powder prematurely, propelling the five-kilogram iron rod through Gage’s left cheek and out the top of his head, landing some distance away. Miraculously he survived, in spite of having lost a significant portion of his brain. Not only did Gage survive, within minutes he was walking and conversing normally. The only immediate consequence was loss of vision in the left eye which apparently did not prevent him from sitting down and recording the event in his notebook.
Gage’s luck, however, did not last long, as he developed an infection that left him comatose for a month. During this time, he was carefully looked after by Dr. John Harlow, who skillfully covered the head wound and later recorded the fascinating case in the Boston Medical Surgery Journal. In his account, Harlow described how the physical injury had altered the victim’s personality to an extent that he was “no longer Gage.” Although his memory was not altered, the formerly mild-mannered Gage now became capricious and obstinate, often peppering his words with obscenities. He lost his job and for a while exhibited himself with the famous iron rod at P.T. Barnum’s circus.
Gage’s most unusual adventure stimulated pioneering Scottish neurologist David Ferrier to investigate “localization” in the brain. He demonstrated that stimulating different parts of the brain electrically caused movement in different parts of their body. These experiments became a lightning rod for the anti-vivisectionist movement that was gathering speed in England. In 1876 the British Parliament responded to the outcry of the anti-vivisectionists bypassing the Cruelty to Animals Act that did not outlaw animal experiments but required approval from the Home Office for performing any. Dr. Ferrier became the prime target for the anti-vivisectionists and in 1881 they actually managed to have him legally prosecuted for not having obtained approval for his experiments. The case was dismissed after it was revealed that the experiments were actually performed by Ferrier’s assistant who had obtained the required documents.
In one experiment, Ferrier studied monkeys that had a prefrontal lobe removed, and while he noted no great physiological changes, he observed an alteration in the animals’ character and behaviour. Such experiments were questioned not only based upon the ethics of animal experimentation but were also reviled by many who ascribed to the belief that the human brain was not such the sum of its anatomical parts, but had an intangible aspect, the soul, that had been infused by a Creator. The debate about the existence of a soul will never be resolved, but it is now well established that the prefrontal cortex of the brain controls the organization of behaviour including emotions and inhibitions. Gage’s behaviour was certainly reorganized when the iron spike passed through his prefrontal cortex.
Bram Stoker, author of Dracula (1897) came from a family of Irish physicians and had an interest in the nervous system experiments going on in the late 19th century. His notes for the writing of Dracula include references to sleepwalking and hypnotic trance states that are not the result of conscious thought but rather of reflex action as suggested by Ferrier’s experiments. He and other scientists at the time postulated that such automatic behaviours were the result of the body being stimulated by some sort of involuntary, possibly electrical, activity in the brain stem. Such theories were opposed by those who thought they undermined the notion that humans have free will and an immortal soul.
Could it be that Dracula is some sort of commentary on the debate between those scientists who believed that human behaviour can be explained by localized physiological activity in the brain and those who believed that there is an intangible component to the brain, the mind, that cannot be described in terms of simple chemical activity. In the novel, Dr. John Seward is the administrator of an insane asylum and has a strong interest in the workings of the brain and actually mentions Dr. Ferrier by name. Based on Stoker’s obvious familiarity with Ferrier’s work, some critics have argued that Dracula is a metaphor for contemporary science sucking the blood out of religious belief. The count’s victims become soulless automata incapable of independent thought or feeling and are governed by external influences, such as Dracula’s mesmeric powers. Perhaps Bram Stoker was concerned that tracing the control of all behaviour to specific locations in the brain casts a shadow on the existence of a soul, a shadow that needs to be eliminated by turning on the light. Count Dracula, as we know, abhorred light. Or, maybe, Bram Stoker just wanted to write a good horror story.
In any case, Phineas Gage died of epilepsy twelve years after the celebrated accident, leaving behind a fascinating legacy, and altering our understanding of the relation between the body, mind and the brain. Gage’s skull has become a relic and is on display along with the famous iron rod at the museum. One could say that Phineas Gage needed the job with the railway company like he needed a hole in the head. As for Dracula, he would not be perturbed by an iron rod aimed at his brain. As everyone knows, he can only be stopped by driving a wooden stake through his heart.