So Antonio Damasio's book, Descartes' Error, begins its narrative with the discussion of the sad tale of the by now famous patient known as Phineas Gage. Gage was a rail worker, and he was kind of a foreman for a crew. At the time at which the action occurs, he is helping build some line through Vermont, a rocky, hilly, sometimes quite mountainous state. There's a lot of dynamiting that has to happen in order to make a flat, well to the straight rail line going across the state. On a hot afternoon this summer, Gage has drilled a hole in some rock, filled it up with some gun powder. And after putting a fuse is about to add sand on top of it. Someone calls his name, he turns his head, absentmindedly takes this long metal specially built tamping tool. Absentmindedly taps the gunpowder with it, which causes an explosion. The tool now gets catapulted through the air. But before doing so, literally goes through Gage's head. Gage is thrown through the air and ends up unconscious, and there is now a hole in his head out of which blood is coming. But after not too long, he regains consciousness, and he's taken to a nearby hotel. People tend to him, and although he's bleeding and needs care and so forth, he's able to carry on a conversation. He's clearly in pain, but he's not been killed. He's not been terribly deformed thus far. And then over the next several weeks, a Dr. Harlow is brought in to help care for the patient. And although medical science was much less sophisticated in the 1840s than it is today, Miraculously perhaps, Harlow manages to get Gage back to health. The wound seems to have closed up or at least is covered with a bandage well enough so it's not bleeding anymore. And although the steel rod has gone through Gage's head, he has survived the accident and seems to be getting back to normal. There's just one problem. As Harlow and others observe, Gage has become a bit different, his personality seems to have undergone a transformation. Harlow writes, the equilibrium or balance, so to speak, between his 'intellectual faculty and his animal propensities' has been destroyed. That is to say he's become, as Harlow writes, fitful, irreverent, indulging, at times in the greatest profanity. Women, at the time, had to be warned before being in Gage's presence because he would often be very profane, very obnoxious, very rude and so forth. And he was no longer able to keep his job with the railway company because he could not be depended upon to get jobs done, To follow through on a task, be polite to his fellow workers and so on, and so he left employment there. He travelled around, he ended up in South America at some point. He went to the West Coast, lived in San Francisco for a certain amount of time. Worked sometimes as a farm hand in some of the farms outside of San Francisco, but would always be unable to keep a job for very long. Often would have a temper tantrum, or just walk away from the job, on the spur of the moment, and ended up dying relatively young. Unhappily, more or less alone, more or less impoverished, and having had his personality, so to speak, fall apart in the process. Damasio and his wife and fellow neuroscientist, Hana Damasio did a great deal of research on what happened with Gage. And did the best they could to reconstruct this patient's story, as well as the medical diagnosis, and the actual physical situation of what happened in this accident. And Dr. Hanna Damasio primarily was able to reconstruct the trajectory of the steel rod that went through Gage's head. It helps that we still have Gage's cranium available to us, so we can take a look at where the actual holes are. From the size of the actual steel rod that we still have available, we can also get a sense of its diameter and so on. So Dr. Hanna Damasio is able to reconstruct the path, showing that the steel rod went through a trajectory that pierced the bottom of Gage's chin. Went under his mouth, and then through the part of his brain that's right behind the bridge of his nose. So the hole was somewhere towards the center front of his head. The rod went in through somewhere like here and miraculously didn't kill him. But did cause a serious lesion in the part of his brain known as the ventromedial prefrontal area. Before the frontal cortex, pre the frontal cortex, the area of brain, essentially, behind the bridge of one's nose. And Antonio Damasio, having got a sense about where the actual damage was done. Was then left to contemplate and wonder why damage to that particular part of the brain had the specific effect on Gage that it did. And it helped that later on, Damasio was able to get access to other patients during his own career. And Damasio's career span from the 1980s until today, was able to get access to patients that seemed to have had similar behavioral features. Similar aspects to their personalities that enabled Damasio to put together a syndrome that he was able to call the Gage Matrix. That collection of behaviors and personality characteristics that were fairly similar to those of Gage that allowed him to come up with a kind of generalization.
