“A Tiny Red Hole”: Horrible Stories of Needles

Sometimes the smallest objects can turn out to be the most useful. And the most frightening.
Who doesn’t feel at least a vague repulsion, a little shiver upon seeing a needle entering the skin?

You guessed it: this article is devoted to needles in bizarre clinical contexts. If you are among the 10% of the population who suffer from needle phobia, then you should skip this post… or maybe not.

Prehistoric Needles
An invention older than Man himself

Let’s begin with a little curiosity that isn’t really relevant to this article, but I find fascinating: pictured above is the most ancient needle ever recovered by archaeologists… and it’s not a human artifact.

7 centimeters-long, carved from the bone of an unidentified bird, this perfect needle (complete with an eye to insert a thread) was produced more than 50.000 years ago – not by proper Homo sapiens, but by the mysterious Denisova hominin: settled on mount Altaj in Siberia, these human predecessors are partly still an enigma for paleontologists. But this needle, found in 2016 from their cave, is a proof of their technological advancement.

Needles Under The Skin
The inexplicable delay of Western medicine

Going from sewing needles to medical needles was a much later conquest than you might imagine.
It shouldn’t have been that difficult to see how injecting a drug directly under the skin might be an effective kind of treatment. Norman Howard-Jones begins his Critical Study of the Origins and Early Development of Hypodermic Medication (1947) by noting that:

The effects of the bites of venomous snakes and insects pointed clearly to the possibility of the introduction of drugs through punctures in the skin. In primitive societies, the application for therapeutic purposes of plant and animal products through cutaneous incisions is practiced […], and the use of poisoned arrows may be regarded as a crude precursor of hypodermic and intramuscular medication.

We could trace another “crude precursor” of intramuscular injections back to Sir Robert Christison‘s 1831 proposal, suggesting that whalers fix a vial of prussic acid to their harpoons in order to kill whales more quickly.

And yet, despite of all these clues, the first proper hypodermic injection for strict medical purposes did not take place before mid-Nineteenth Century. Until then, syringes (which had been around for centuries) were mainly used for suction, for instance to draw the fluids which accumulated in abscesses. Enemas and nasal irrigation were used since Roman times, but nobody had thought to inject medications under the skin.

Physicians had tried, with varying results, to scar the epydermis with irritants and to deposit the drug directly on the resultin ulcer, or they sliced the skin with a lancet, as in bloodletting, and inserted salts (for example morphine) through the cut. In 1847, G. V. Lafargue was the first to have the intuition of combining inoculation with acupuncture, and to build a long and thick hollow needle filled with morphine paste. But other methods were being tested, such as sawing a silk thread, imbued in drugs, directly into the patient’s skin.

The first true hypodermic syringe was invented in 1853 by Scottish doctor Alexander Wood, as reported in his New Method of Treating Neuralgia by Subcutaneous Injection (1855). Almost at the same time, the French physician Charles Pravaz had devised his own version. By the end of the Nineteenth Century, hypodermic injections had become a widespread procedure in the medical field.

Needles In The Flesh
The bizarre clinical case of the “needle woman”

Published in 1829 by Giuseppe Ferrario, Chief Surgeon at the Ospedale Maggiore in Milan, La donna dagli aghi reports a strange case that began in June 1828.

A young 19-year-old woman, Maria Magni, “peasant, of scrofulous appearance, but with a passionate temper” was admitted to the hospital because of severe pain.
One April morning, the year before, she had found a light blue piece of paper on the ground which contained 70/80 steel sewing needles. In order not to lose them, she had pinned them on her blouse cuff. But Maria suffered from epileptic fits, and a few hours later, as she was working in the vineyard, “she fell victim of the usual spasms, and convulsive bouts. Under these abnormal and violent muscular movements […] she believes that she unwillingly pushed the needles she had pinned to her shirt through her right arm – which was naked, as is the case among our peasants – as well as through her breast”. The needles didn’t cause her any trouble until three months later, when the pain had become unbearable; she then decided to go to the hospital.

The doctor on duty hesitated to admit her, for fear she had syphilis: Magni had tried alternative treatments, and had applied “many varied remedies, catplasms, ointments, blistering drugs and other ulcerating substances, etc, with the intention of exciting the needles out of her skin”, but this only resulted in her body being covered by sores.
Enter Doctor Ferrario, who during the first 35 days of treatment submitted her to bloodletting for 16 times, applied more than 160 leeches to her temples, administered vesicants, frictions, decoctions, salts and various tinctures. But the daily epileptic fits were terrible, and nothing seemed to work: “all the physicians, stunned by the woman’s horrible condition, predicted an approaching and inevitable death”.

Upon hearing the story of the needles, though, Ferrario began to wonder if some of them were still sticking inside the young woman’s body. He examined her wounds and actually started feeling something thin and hard within the flesh; but touching those spots triggered some epileptic fits of unheard violence. Ferrario described these bouts with typical 19th-Century literary flourishes, in the manner of Gothic novels, a language which today sounds oddly inappropriate in a medical context:

the poor wretched girl, pointing her nape and feet, pushed her head between her shoulders while jumping high above the bed, and arched her bust and arms on the account of the spasmodic contraction of dorsal muscles […] she was shaking and screaming, and angrily wrapped her body in her arms at the risk of suffocating […]. There was involuntary loss of urine and feces […]. Her gasping, suffocated breath, her flaccid and wrinkled breast which appeared beneath her hirst, torn to pieces; the violence with which she turned her head on her neck, and with which she banged it against the walls and threw it back, hanging from the side of the bed; her red and bulging eyes, sometimes dazed, sometimes wide open, almost coming out of their socket, glassy and restless; the obscene clenching of her teeth, the foamy, bloody matter that she squirted and vomited from her dirty mouth, her swollen and horribly distorted face, her black hair, soaked in drool, which she flapped around her cranium […] all this inspired the utmost disgust and terror, as it was the sorrowful image of an infernal fury.

Ferrario then began extracting the needles out of the woman’s body, performing small incisions, and his record went on and on much in the same way: “this morning I discovered a needle in the internal superior region of the right breast […] After lunch, having cut the upper part of the arm as usual, I extracted the needle n. 14, very rusty, with its point still intact but missing the eye […] from the top of the mons pubis I extracted the needle n. 24, rusty, without point nor eye, of the length of eight lines.

The pins were hard to track down, they moved across the muscles from one day to the other, so much so that the physician even tried using big horseshoe magnets to locate the needles.
The days went by, and as the number of extracted needles grew, so did the suspect that the woman might be cheating on the doctors; Maria Magni just kept expelling needles over and over again. Ferrario began to wonder whether the woman was secretly inserting the needles in her own body.
But before accusing her, he needed proof. He had them searched, kept under strict surveillance, and he even tried to leave some “bait” needles lying around the patient’s bed, to see if they disappear. Nothing.

In the meantime, starting from extraction number 124, Miss Magni began throwing up needles.
The physician had to ask himself: did these needles arrive into the digestive tract through the diaphragm? Or did Magni swallow them on purpose? One thing is sure: vomiting needles caused the woman such distress that “having being so unwell, I doubt she ever swallowed any more after that, but she might have resorted to another less uncomfortable and less dangerous opening, to continue her malicious introduction of needles in the body”.
The “less uncomfortable opening” was her vagina, from which many a new needle was removed.

As if all this was not enough, rumors had spread that the “needle woman” was actually a witch, and hospital patients began to panic.

An old countrywoman, recovering in the bed next to Magni’s, became convinced that the woman had been victim of a spell, and then turned into a witch on the account of the magic needles. Being on the bed next to her, the old lady believed that she herself might fall under the spell. She didn’t want to be touched by the young woman, nor by me, for she believed I could be a sorcerer too, because I was able to extract the needles so easily. This old lady fell for this nonsense so that she started screaming all day long like a lunatic, and really became frenzied and delirious, and many leeches had to be applied to her head to calm her down.

Eventually one day it was discovered where Magni had been hiding the needles that she stuck in her body:

Two whole needles inside a ball of yarn; four whole needles wrapped in paper between the mattress and the straw, all very shiny; a seventh needle, partly rusted, pinned under a bed plank. Several inmates declared that Maria Magni had borrowed four needles from them, not returning them with the excuse that they had broken. The ill-advised young woman, seeing she was surrounded and exposed […] faked violent convulsions and started acting like a demon, trashing the bed and hurting the assistants. She ended by simulating furious ecstasy, during which she talked about purely fictional beings, called upon the saints and the devils, then began swearing, then horribly blasphemed angels, saints, demons, physicians, surgeons and nurses alike.

After a couple of days of these performance, Magni confessed. She had implanted the needles herself under her skin, placed them inside her vagina and swallowed them, taking care of hiding the pierced areas until the “tiny red hole” had cicatrized and disappeared.
In total, 315 needles were retrieved from Maria Magni’s body.
In the epilogue of his essay, Ferrario points out that this was not even the first recorded case: in 1821, 363 needles were extracted from the body of young Rachel Hertz; another account is about a girl who survived for more than 24 years to the ingestion of 1.500 needles. Another woman, Genueffa Pule, was born in 1763 and died at the age of 37, and an autopsy was carried out on her body: “upon dissecting the cadaver, in the upper, inner part of each thigh, precisely inside the triceps, masses of pins and needles were found under the teguments, and all the muscles teemed with pins and needles”.

Ferrario ascribes the motivations of these actions to pica, or superstition. Maria claimed that she had been encouraged by other women of the village to swallow the needles in order to emulate the martyr saints, as a sort of apotropaic ritual. More plausibly, this was just a lie the woman told when she saw herself being cornered.

In the end, the physician admits his inability to understand:

It is undoubtedly a strange thing for a sane person to imagine how pain – a sensation shunned even by the most ignorant people, and abhorred by human nature – could be sometimes sought out and self-inflicted by a reasonable individual.

I wonder what would Ferrario say today, if he could see some practices such as play piercing or body suspension performances.

Needles In The Brain
A dreadful legacy

As I was going through pathology archives, in search of studies that could have some similarities with the Magni story, I came upon one, then two, then several other reports regarding an even more unbelievable occurrence: sewing needles found in the encephalon of adult patients, often during routine X-rays.

Intracranial foreign bodies are rare, and usually result from trauma and operations; but neither the 37-year-old patient admitted in 2004, nor the 45-year-old man in 2005, nor the 82-year-old Italian woman in 2010, nor the 48-year-old Chinese woman in 2015 had suffered any major cranial trauma or undergone head surgery.
An apparently impossible enigma: how did those needles get there?

The answer is quite awful. These are all cases of failed infanticide.

The possibility of infanticide by inserting pins through the fontanelle is mentioned in the Enciclopedia legale ovvero Lessico ragionato by F. Foramiti (1839), where the author includes a (chilling) list of all the methods with which a mother can kill her own child, among which appears the “puncturing the fontanelle and the brain with a thin sharp dagger or a long and strong needle”.

But the practice, properly documented in medical literature only by 1914, already appeared in Persian novels and texts: perhaps the fact that the method was well-known in the ancient Middle East, is the reason why most of the forty recorded cases were documented in Turkey and Iran, with a minority coming from Southeast Asia, Europe and the United States. In Italy there were two known cases, one in 1987 and the 2010 case mentioned above.

Most of these patients didn’t show any particular neurological symptom: the sewing needles, having been embedded in the brain for so many years, are not even removed; a surgical procedure, at this point, would be more dangerous than leaving them in situ.
This was the case for the only known occurrence reported in Africa, a 4-year-old child carrying a 4,5 cm needle through his brain. At the time the report was filed, in 2014, the needle was still there: “no complications were noted, the child had normal physical and mental development with excellent performance at school”.

Of course, discovering at the age of forty that someone – your parents, or maybe your grandparents – tried to kill you when you were just months old must be a shock.
It happened to Luo Cuifen, a chinese lady who was born in 1976, and who showed up at the hospital because of blood in her urine in 2007, and who discovered she had 26 sewing needles in her body, piercing vital organs such as lungs, liver, kidneys and brain. Her story is related to the discriminations towards female newborn children in rural China, where a son is more welcome than a daughter because he can carry on the family name, perform funeral rituals for ancestors, and so on. In Luo’s case, it was most likely her grandparents who attempted the infanticide when she was but months old (even if this theory cannot be proven, as her grandparents already passed away).

In more recent cases, recorded in Tunisia, China and Brazil, it was discovered that the children had respectively three, twelve and even fifty needles stuck in their bodies.

The cases of people surviving for decades with a needle in their brain are obviously an exception – as one of the studies put it, this is the “tip of the iceberg”.
A needle wound can be almost invisible. What is really disquieting is the thought of all those infanticides who are carried out “successfully”, without being discovered.

Sometimes the smallest objects can turn out to be the most useful. And the most lethal.

My gratitude goes to Mariano Tomatis, who recommended La donna dagli aghi, which he discovered during his studies on 19th-century magnetism, and which started this research.

Mater incerta

In 2002 Lydia Fairchild, a 26-year-old woman living in Washington state, was already a mother of two kids, with a third one on her way, and without a steady job; she had decided to seek public assistance.
The procedure required her children to undergo DNA testing to confirm that their father was indeed Jamie Townsend, Fairchild’s former partner. It should have been a routine check, but some days later the woman received a strange call, asking her to come in the prosecutor’s office at Social Services.
And that is when her world almost fell apart.

Once she went in, the officers closed the door behind her and started drilling her: “Who are you?”, they kept asking her repeatedly, without her understanding what was going on.
The reason behind the relentless questioning was absolutely unpredictable: the DNA tests had proven that Jamie Townsend was actually the children’s father… but Lydia was not their mother.

Although the woman kept repeating that she had carried and delivered them, the results categorically excluded this possibility: the genetic profiles of her children were in fact made up for one half from their father’s chromosomes, and for the other half from the chromosomes of an unknown woman. Lydia Fairchild was facing the risk of having her kids taken away from her.
Before the woman’s despair, Social Services ordered a new test, which gave exactly the same results. Lydia showed no genetic link with her children.

During the following 16 months, things got worse. The officers launched court action to remove her custody rights, as this could turn out to be a case of abduction, and the state even had a court officer witness her third child’s delivery, so that DNA test could be run immediately after birth. Once again, the newborn baby showed no genes in common with Lydia, who then became a suspect of acting as a surrogate for payment (which in Washington state is considered gross misdemeanor).
Lydia Fairchild was living a true nightmare: “I’d sit and have dinner with my kids and just break out crying. They would just look at me like, ‘What’s wrong, Mum.’ They’d come get me a hug, and I couldn’t explain it to them, because I didn’t understand“.

Her lawyer Alan Tindell, though initially perplexed by the case, decided to investigate and one day stumbled upon a similar story that happened in Boston, as described in a paper on the New England Journal of Medicine: a 52-year-old woman, Karen Keegan, had undergone a hystological exam in view of a transplant, and the results had shown no link between her DNA and her children’s.
Quite often the solution for the most intricate mysteries turn out to be disappointing, but in this case the explanation was just as incredible.
The lawyer understood that, just like the mother the scientific paper was about, Lydia too was a chimera.

Tetragametic chimerism happens when two egg cells are fertilized by two different sperm cells and, instead of developing into two fraternal twins, they fuse together at a very early stage. The chimeric individual is equipped with two different genetic makeups, and can develop whole organs having different chromosomes from all the others. Most chimeras do not even know they are, because the existence of two cellular lines is not often noticeable; but they carry inside them for instance the liver, or some other gland, that should have been part of their unborn twin.
In Fairchild’s case, the “foreign” organs were her ovaries. Inside of them were hidden those unknown chromosomes that formed the genetic makeup of Lydias’s children, as was confirmed by the examination of the cells obtained via pap test.

Finally the court dismissed the case. In the court hearing, the judge openly wondered how reliable could DNA tests be, as they are even today held essential in forensic cases — but what if the criminal is a chimera?
Today Lydia Fairchild is back to her normal life, leaving this terrible adventure behind. And some years ago she gave birth to her fourth daughter; or, if you will, the fourth daughter of that sister she never had.

The New England Journal of Medicine paper mentioned in the post can be read here. To discover some less-known istances of chimerism, I suggest this articolo.

Mary Toft

Il 19 novembre 1726 un breve ma insolito articolo apparve sul Weekly Journal, giornale inglese:

“Da Guildford ci arriva una strana ma ben testimoniata notizia. Che una povera donna che vive a Godalmin, vicino alla città, è stata il mese scorso aiutata da Mr. John Howard, Eminente Chirurgo e Ostetrico, a partorire una creatura che assomigliava ad un coniglio, ma con cuore e polmoni cresciuti fuori dal torace, 14 giorni dopo che lo stesso medico le aveva fatto partorire un coniglio perfettamente formato; e pochi giorni dopo, altri 4; e venerdì, sabato e domenica, un altro coniglio al giorno; e tutti e nove morti vedendo la luce. La donna ha giurato che due mesi fa, lavorando in un campo con altre donne, incontrarono un coniglio e lo rincorsero senza un motivo: questo creò in lei un desiderio così forte che (essendo incinta) abortì il suo bambino, e da quel momento non è capace di evitare di pensare ai conigli”.

Letta così sembra una di quelle leggende scaturite dall’idea, diffusa all’epoca, che qualsiasi cosa impressionasse la mente di una donna incinta (un sogno, o un animale veduto durante la gravidanza) poteva marchiare in qualche modo anche il feto, dando origine a difetti di nascita. Eppure questa storia si sarebbe presto tramutata in uno dei più grossi scandali medici degli albori.

La donna dell’articolo era Mary Toft, contadina di 24 o 25 anni, sposata e con tre figli. Come tutte le compaesane, Mary non aveva smesso il lavoro nei campi con la gravidanza; e quando, nell’agosto precedente, aveva avvertito dei dolori al ventre, si era accorta con orrore di aver espulso dei pezzi di carne. Poteva forse essere un aborto, ma stranamente la gravidanza continuò e quando il 27 settembre Mary partorì, uscirono soltanto delle parti che sembravano animali. Questi resti vennero inviati a John Howard, il medico citato nell’articolo, che inizialmente si dimostrò scettico. Si recò ciononostante a visitare Mary Toft ed esaminandola non trovò nulla di strano; eppure nei giorni successivi le doglie ricominciarono, e nuove parti di animali continuarono a essere espulse dall’utero della donna: gambe di gatto, gambe di coniglio, budella e altri pezzi di animali irriconoscibili.

A quel punto la storia stava cominciando a fare scalpore, anche perché la stampa esisteva da poco, ed era la prima volta che un caso simile veniva seguito contemporaneamente, “in diretta”, in tutta l’Inghilterra. Un altro chirurgo, Nathaniel St. André, si interessò al caso, e su ordine della Famiglia Reale si recò a Guildford, dove Howard aveva condotto Mary Toft offrendo a chiunque dubitasse della storia di assistere a uno degli straordinari parti. Nel frattempo la donna aveva infatti dato alla luce altri tre conigli, non completamente formati, che apparentemente scalciavano nell’utero prima di morire e venire espulsi.

St. André, arrivato a Guildford, potè quindi investigare il caso direttamente e restò impressionato: il 15 novembre, nel giro di poche ore, Mary Toft partorì il torso di un coniglio. St. André esaminò il torso, immerse i polmoni in acqua per vedere se l’animale avesse respirato aria (e infatti i polmoni galleggiavano) ed esaminò accuratamente la donna. La sua diagnosi fu che i conigli si sviluppavano sicuramente all’interno delle tube di Falloppio. Nei giorni seguenti dall’utero della donna uscirono un altro torso, la pelle di un coniglio e, pochi minuti dopo, la testa.

Il re Giorgio I, affascinato dalla storia, decise di inviare un altro medico a Guildford: si trattava di Cyriacus Ahlers – e questa fu la svolta. Ahlers, infatti, era segretamente scettico sull’intera vicenda, e tenne gli occhi ben aperti. Non trovò segni di effettiva gravidanza sulla donna, ma anzi notò una cosa piuttosto sospetta: prima dei famosi parti, la donna sembrava stringere le ginocchia come per impedire che qualcosa cadesse. Ahlers cominciò a dubitare anche di Howard, l’ostetrico, che si rifiutava di lasciare che fosse Ahlers ad assistere la donna durante le contrazioni. Non lasciò trapelare i suoi dubbi, ma disse a tutti i presenti di credere alla storia, e con una scusa lasciò Guildford, portando con sé alcuni pezzi di coniglio. Esaminandoli con più cura, scoprì che sembravano essere stati macellati con uno strumento da taglio, e notò tracce di grano e paglia nei loro intestini, come se provenissero da un allevamento. Riportò tutto questo al Re e in poco tempo lo scandalo esplose.

Mary fu portata a Londra e alloggiata in carcere, per ulteriori esami, e nella comunità scientifica si formarono immediatamente due fazioni: da una parte gli scettici, Ahlers in prima linea; dall’altra Howard e St. André, che erano convinti sostenitori della genuinità dei prodigiosi eventi. La stampa diede eccezionale risonanza al dibattito e le cose precipitarono quando un inserviente della prigione ammise di essere stato corrotto dalla cognata di Mary Toft affinché introducesse un coniglio nella cella della donna.

Il 7 dicembre, dopo essere stata esaminata da decine di medici e sottoposta ad estenuanti interrogatori e alle minacce di una dolorosa operazione chirurgica, Mary Toft cedette e confessò: era stata tutta una truffa. Dopo il suo aborto spontaneo, quando la cervice era ancora dilatata, aveva con l’aiuto di un complice inserito nell’utero le zampe e il corpo di un gatto, e la testa di un coniglio. In seguito,  le parti di animali erano state posizionate più esternamente, nella vagina. Mary Toft venne immediatamente incarcerata con l’accusa di “vile truffa e impostura”. Anche i diversi medici implicati, Howard e St. André su tutti, vennero citati in tribunale e a loro discolpa si dichiararono all’oscuro della frode.

Ma lo smascheramento dell’inganno fu una bomba soprattutto per l’immagine della medicina nell’opinione pubblica: articoli satirici apparvero in ogni giornale, prendendosi beffa della credulità dei chirurghi implicati nel caso, e dei medici tout court. Le ballate popolari si incentrarono immediatamente sui dettagli più volgari della vicenda e le barzellette si affollarono di conigli maliziosi e grandi luminari della scienza fatti fessi da una contadina. La risonanza fu internazionale e persino Voltaire, dalla Francia, indicò il caso di Mary Toft come un esempio di quanto gli Inglesi protestanti fossero influenzati da una Chiesa ignorante e da antiche superstizioni.
La professione sanitaria venne talmente danneggiata in poco tempo che decine e decine di medici cercarono disperatamente di dichiararsi estranei ai fatti o di provare che erano stati fin dall’inizio scettici sul caso. Molte carriere vennero stroncate dall’abbaglio preso, e altre ci misero lustri a riprendersi dal tonfo.

La folla stazionava davanti alla prigione in cui Mary Toft era rinchiusa, nella speranza di vederla anche solo di sfuggita. Nel 1727 Mary fu liberata e tornò a casa. Da allora di lei si seppe poco, se non che ebbe una figlia e qualche altro piccolo guaio con la legge, fino alla sua morte nel 1763. Ma nonostante questo suo forzato “ritiro” dalle scene, il suo nome visse ancora a lungo nelle canzoni, e venne immancabilmente rispolverato ogni volta che i grandi geni della scienza facevano un clamoroso, ridicolo passo falso.

Phineas Gage

Phineas Gage era un semplice operaio americano, capocantiere addetto alla costruzione di ferrovie. Era un uomo umile, affettuoso, amichevole e gentile, certo, ma poteva aspettarsi tutto… tranne che per una tragica sfortuna la sua vita cambiasse la storia.

Il 13 settembre 1848, nei pressi di Cavendish nel Vermont, Phineas stava inserendo una carica esplosiva all’interno di una roccia che andava fatta saltare per poter far passare i binari che i suoi uomini stavano costruendo. Con la sicurezza dettata dall’abitudine, Phineas stava pressando della polvere da sparo nella fenditura della roccia con un ferro di pigiatura, quando improvvisamente la polvere esplose. Il lungo palo che egli aveva in mano fu sparato verso l’altro, conficcandosi nella guancia proprio sotto all’occhio sinistro, e uscendo dalla parte superiore del cranio. Il ferro aveva trapassato i lobi frontali del suo cervello, andando poi ad atterrare 25 metri più in là.

Eppure, miracolosamente, dopo pochi minuti Phineas era già cosciente e in grado di parlare. Affrontò senza problemi il viaggio di 4 miglia fino allo studio di un dottore. Il medico, nonostante l’evidente, tremenda emorragia, non poteva credere al racconto di Gage, che insisteva nel dire che un ferro gli avesse trapassato la testa: chi poteva essere tanto fortunato da raccontare una storia simile, vivo e vegeto, e perfettamente razionale? Il medico pensò che forse era successo qualcosa di meno grave, finché Gage non si alzò per vomitare. Lo sforzo fece emergere dal foro sul cranio un pugno di materia cerebrale che cadde sul pavimento. A quel punto, era chiaro che non si trattava di un paziente sotto shock che blaterava a vanvera: una parte del cervello di Phineas era davvero stata maciullata dal trauma.

La convalescenza di Gage fu difficoltosa, passata per molto tempo in stato semi-comatoso, con risposte a monosillabi solo se interpellato direttamente. Eppure, il 7 ottobre Phineas si alzò dal letto, e meno di un mese dopo camminava già tranquillo nella piazza del paese, saliva e scendeva le scale, e si riprendeva a vista d’occhio, senza dolori o sintomi fisici preoccupanti. Ma non tutto era come prima. Il suo carattere era cambiato, si era fatto oscuro e imprevedibile.

A causa dell’incidente, Gage divenne talmente irascibile, e privo di qualsiasi freno inibitore, che nemmeno gli amici intimi potevano più riconoscerlo. Non sopportava il minimo diniego o consiglio, si lasciava andare a bestemmie e volgarità che contrastavano con il suo precedente contegno, faceva mille progetti che abbandonava minuti dopo: venne descritto come un bambino con gli istinti animaleschi di un adulto. La sua antisocialità lo portò a perdere il lavoro, e molte delle sue amicizie.


Nonostante il suo cambiamento di personalità sia stato nel corso del tempo grandemente esagerato, in molti degli scritti e degli studi a lui dedicati, Phineas Gage rimane comunque un esempio unico nel campo della neurologia, della psicologia e delle materie correlate. Gli studi sulle condizioni di Gage hanno apportato grandi cambiamenti nella comprensione clinica e scientifica delle funzioni cerebrali e della loro localizzazione nel cervello, soprattutto per quanto riguarda le emozioni e la personalità, e le diverse competenze dei due emisferi cerebrali. È anche in seguito alle riflessioni teoriche avviate in conseguenza di questo caso che, per alcuni decenni della metà del XX secolo, sono stati usati metodi, oggi in totale disuso, come la lobotomia prefrontale (già affrontata su Bizzarro Bazar, in questo articolo)  per curare certi tipi di disturbi del comportamento. Il caso Gage è ancora oggi citato e studiato ampiamente nella saggistica neurologica.

Il teschio di Gage e il bastone di ferro che ha causato il suo trauma cranico sono esposti al pubblico nel museo della Harvard Medical School. Una vita sfortunata, a cui dobbiamo la grande fortuna di conoscere meglio la struttura e le funzionalità dell’organo a tutt’oggi più misterioso, il nostro cervello.

Phineas Gage su Wikipedia (pagina inglese).