1. Medical Case Study #1

2. What is a medical case study? Why are they important?

3. Medical Case Study #1 13th September 1848
Phineas Gage (PG), a healthy 23 year old man was working on a railroad site, tamping down explosives with a iron bar. While distracted, the iron bar caused a spark, which detonated the explosive charge. The iron bar shot out of the rock, and entered PG’s skull from the bottom, through his left cheek – avoiding the jar bone. The explosion caused the bar to blow clean through the skull, causing an exit wound at the top of cranium, roughly four inches posterior to the brow. After approximately two minutes of convulsions, PG regained consciousness, despite the open wound in his head. He was taken to his hotel and seen to by a doctor.

4. Medical Case Study #1 13th September 1848 Dr. Edward H. Williams
Did not believe the story as presented by PG’s colleagues, then saw the injury for himself.
After being inspected PG stood up too quickly and vomited, losing a small amount of brain matter from the motion. Williams and an assistant wrapped the injury in bandages. PG spent 10 weeks recovering from the injury under the care of Williams, and was then discharged.

5. Medical Case Study #1
In the early months of recovery, PG showed unusual symptoms. Most reports say that his demeanour changed, from a friendly and outgoing guy to an irritable man, prone to outbursts and impulsive behaviour. PG had clearly not suffered any detriment to his intelligence; he agreed to exhibit himself working with P.T. Barnum as part of a circus type attraction, and then went on to tour medical institutions for money. Years later he would proceed to drive a horse drawn coach – and reports say he became more mild mannered and able to control his impulsiveness. He died age 36 from epilepsy believed to have developed as a consequence of his now infamous injury.

6. Medical Case Study #1 Discussion:
What are the flaws of an observational study?
How can brain regions be attributed to function?