The medical prescience of Edgar Allan Poe

Sara Reardon, San Francisco reporter

(Image: Courtesy Everett Collection/Rex Features)

The macabre story of Phineas Gage, a US railroad worker who survived when an iron spike penetrated his skull in 1848, is truly stranger than fiction. Gage?s impaled head became the darling of a budding medical profession who flocked to study his strange condition: fully functional, though his personality changed. But little did that profession realise that just such a fiction had already been created by the master of the macabre himself, Edgar Allan Poe.

Written eight years prior to Gage?s accident, but published posthumously in 1850, Poe?s story The Business Man,?described a similar case. But how Poe was able to describe so precisely the symptoms of what is now known as frontal lobe syndrome is doomed to remain a mystery. When Eric Altschuler, a neurologist at New Jersey Medical School in Newark realised that the story describes the antisocial personality disorder and obsessions that are common to frontal lobe syndrome, he thought it was possible, although not likely, that the Gage case had inspired it. This conjecture was recently blown out of the water when he and reporter Seth Augustine, who were looking through Poe?s stories, realised Poe had written an earlier version in 1840. ?It?s so exact that it?s just weird, it?s like he had a time machine,? says Altschuler.

Like many of Poe?s stories, The Business Man is told by an unnamed and unreliable narrator. He relates how he came to suffer a head trauma: a childhood nurse ?took me up one day by the heels, when I was making more noise than was necessary, and swinging me round two or knocked my head into a cocked hat against the bedpost... a bump arose at once on my sinciput, and turned out to be as pretty an organ of order as one shall see on a summer's day. Hence that positive appetite for system and regularity which has made me the distinguished man of business that I am.?

That incident defines the man?s life; he develops a slavish adherence to exactness and obsession with methods that are characteristic of a modern diagnosis of frontal lobe syndrome. After losing his job over a matter of two pennies, Poe?s hero becomes an increasingly violent sociopath, going into the ?Assault and Battery trade? and is eventually thrown into prison. But he never loses his sense of order. ?I am a businessman. I am a methodical man. Method is the thing, after all.?

??There?s a dozen symptoms and he knows every single one,? Altschuler says. The only way Poe could have possibly described the disease so exactly, he believes, was if he had a childhood friend who?d been knocked on the head as a child and spent the rest of his life descending into orderly madness.

Poor Phineas Gage probably suffered a similar fate. His personality is described as having changed, although few specifics are known. By the end of his life, he was travelling with a freak show, a far cry from the respected railroad foreman he had been.

Even today, it?s hard to describe the symptoms of frontal lobe syndrome, Altschuler says. But incredibly, Poe?s narrator was injured as a child and shows symptoms specific to a paediatric case: paediatric frontal lobe syndrome wasn?t formally described until 1999. (Nature Neuroscience, DOI:10.1038/14833). ?There?s everything in that story, We?ve hardly learned anything more,? Altschuler says, putting the comprehensiveness down to Poe?s incredible powers of observation.

This isn?t the only strange case of Poe?s prescient knowledge of modern medicine;? his 1845 story, The Facts of the Case of M. Valdemar contains one of the first descriptions of informed consent, long before the concept was used in medicine (The Lancet, DOI:10.1016/S0140-6736(03)14710-1).?The narrator of the story is a hypnotist who believes that mesmerism will preserve a dying person on a plane of consciousness and ?the encroachments of death might be arrested by the process?. He decides to test the technique on a dying patient, but first, interviews his patient to ensure he?s willing to have the procedure performed, and has witnesses to confirm it. ?It?s like Poe?s writing something for the internal review board,? says Altschuler. (To find out if the procedure is a success, read the chilling story.)

Altschuler says he?s still looking for other examples of medical mysteries from Poe. ?The weird thing about Poe is that everything about him is a mystery. We?ve had 120 years to think about it and Poe?s life has been researched but we still don?t know... why his stories are so bizarre.?

Journal reference: Brain Injury, DOI: 10.3109/02699052.2012.676224

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