Retrospectacle: A Neuroscience Blog

The Curious Case of Phineas Gage

As I mentioned earlier in the week, I’m trying to raise money for a classroom-in-need to buy some books about neuroscience, using the case of Phineas Gage as a jumping off point. (And if you haven’t yet donated, they would be most grateful for even a dollar!) I thought it would be interesting and appropriate to discuss what happened to Mr. Gage and how it impacted neuroscience. It all began when a large piece of metal exploded through his brain.

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Phineas Gage was the ultimate average joe–a railway foreman who was laying down track outside Cavendish, Vermont in the fall of 1848. It was on the job that he suffered an extremely traumatic injury to his brain which altered his personality forever. As he was loading a hole with gunpowder, he was distracted and packed it wrong, bringing down an large tamping iron into the hole without the requisite sand. The gunpowder exploded, blasting the 3-foot-long tamping iron straight through Gage’s left cheek and out the top of his skull. Amazingly, he survived, but the iron had severely damaged his anterior frontal cortex (there is debate as to both sides, or only the left was destroyed). Despite profuse bleeding, Gage regained consciousness rapidly and after being seen by a Dr. Harlow, seemed to make a full recovery.

You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage, which was very profuse both externally and internally, the blood finding its way into the stomach, which rejected it as often as every 15 or 20 minutes. Pulse 60, and regular. His person, and the bed on which he was laid, were literally one gore of blood.

(Continued below the fold…)

Within a few weeks, Gage’s personality, which had been described as hardworking, congenial, calm, and respectful, took a turn for the worst. He became uncontrollable.

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Gage was fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage.’

Interestingly, while he remembered about half his friends from before the accident, he lost all account of the value of money. When his doctor offered him $1000 for a few pebbles Gage had saved, Gage refused, not seeming to understand if it was a lot or a little.

Due to these changes, he was not given his old job back, but instead worked at Barnum’s museum ain New York. He lived another 10 years until he began to suffer from epilepsy and died. He kept the tamping iron with him his entire life, and was buried with it in 1860. His body was exhumed in 1867 to undergo further study, and his skull and the iron reside at Harvard Medical School’s Warren Anatomical Museum in Boston.

The case of Phineas Gage is a significant one in neuroscience, facilitated by his unlikely survival of a rather focused traumatic brain lesion. It was the first clear case that damage to the frontal lobes could seriously impact social interactions and behavioral restraint, and his skull is studied to this day in the form of MRI scans and modeling.

Here’s a cool and interesting account of Gage’s recovery, from the article that originally described it to science, by Harlow in 1848.

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Comments

  1. #1 Brian
    October 4, 2007

    Perhaps this question will belie my ignorance, but I’m curious why the behavioral changes were not immediate following the injury.

  2. #2 darkman
    October 4, 2007

    the behavioral changes might have been apparent directly after the injury, except that it took Gage several weeks to recover form the trauma enough to begin socially interacting with people again. Harlow’s 1848 account (last hotlink in the blog post) shows that it takes at least 4 weeks for Gage to recover enough to leave the house (including 2 weeks in a semi-comatose state). It also mentions him acting delusional in the notes (his change in behavior combined with a wicked infection-fever), though this was probably discounted at the time since he was still pretty bent outta shape masking the behavioral changes.

  3. #3 Shelley Batts
    October 4, 2007

    I agree with darkman: likely the massive changes in behavior were not noticed until he was well enough to interact with friends and people who knew him prior to the injury. He was probably extremely ill for many weeks directly following, under which condidtions his attending doctor might have chalked up weird behavior to his extreme injury.

  4. #4 KevinC
    October 5, 2007

    How much of the change was from the injury and how much was from PTSD. A serious injury is a life changing event, probably more so in 1848 then now.

    Unfortunately it looks like we have a large number of soldiers returning from Iraq with similar injuries.

  5. #5 darkman
    October 5, 2007

    Kevin,

    I’m gonna go out on a limb here and suggest that most of the behavioral changes seen in Gage were directly due to the injury itself (essentially the first frontal lobotomy). The behavioral changes as described: childish behavior, impulsivity, erratic mood-swings, etc. are characteristic changes seen following damage to the prefrontal cortex (PFC).

    You’re right to point out that PTSD is associated with behavioral changes as well and additionally an injury such as the one Gage had is sure to be enough to induce some form of PTSD. If I’m not mistaken (and PTSD isn’t a primary research focus of mine), behavioral changes following PTSD are more akin to anxiety disorders and the symptoms of clinical depression than what is seen with Gage.

    PTSD is certainly an unfortunate side effect of war, and one that the US government seems to ignore and trivialize. Soldiers coming back from Iraq with physical head injuries, similar to Gage, will at least be acknowledged as injured vets, but what about the soldiers who come home physically unharmed yet still scarred for life?

  6. #6 beth
    October 5, 2007

    I highly recommend the Phineas Gage book that you mention on the donations site. I have been using that book in my classroom for 2 years now when discussing the prefrontal cortex. I’ve only had 1 student blanche white and get faint at the images:)

    I teach english and social studies, not science, but I think the Gage story is important to children of this age because they are struggling with their own brain development. Some parts are developed, but some parts aren’t, like the prefrontal cortex. Perhaps I’m totally off base there. We give them all planners at the beginning of the year and I tell them that they are their artificial prefrontal cortex, which will remember all their homework assignments and to-do lists that their own prefrontal cortex can’t do yet (can it ever, really?).

    I also use Gage as an example of the childish behavior mentioned above. I ask them to seek out surrogate prefrontal cortexes in adults, asking them if this action is a good action. “Should I jump off this swing?” “Should I try to make dynamite for the science fair?” They should use our developed PFCs until theirs grow in a bit:) They have begun asking me about judgments they should make more over the last 2 years than ever before. Also, knowing that theirs is still developing is very helpful, and they try so hard to control impulsivity. Knowing about Gage is just so helpful!

    Anyways, thanks for the post and best of luck to that classroom!

  7. #7 Clyde Adams III
    October 6, 2007

    You say Gage “became a sideshow freak for P.T. Barnum’s circus.” This is false. He appeared at Barnum’s museum in New York. (Barnum did not start his circus until 1871, long after Gage’s death.)

    A quick Google search reveals the Phineas Gage information page, maintained by Australian psychologist Malcolm Macmillan, author of the book An Odd Kind of Fame: Stories of Phineas Gage.

    Macmillan says

    “According to Dr. Harlow, Phineas appeared at Barnum’s Museum in New York, worked in the livery stable of the Dartmouth Inn (Hanover, NH), and drove coaches and cared for horses in Chile. In about 1859, after his health began to fail he went to San Francisco to live with his mother. After he regained his health he worked on a farm south of San Francisco. In February 1860, he began to have epileptic seizures and…died on 21st. May 1860…

    “Most of the accounts of Gage’s life after 1848 are strange mixtures of slight fact, considerable fancy, and downright fabrication. Harlow says, for example, that Phineas exhibited himself in the larger New England towns and was with Barnum’s in New York for a time. These remarks are frequently elaborated…Phineas is often pictured as exhibiting himself, usually as a freak, in circuses or fairgrounds around the country. Part of this fancy comes from Barnum now most often being remembered as the proprietor of a circus rather than the owner of the New York Museum to which Harlow unmistakably refers. Similarly, these stories turn Gage into a fairground freak because it is in such places that freaks are or were once seen.”

  8. #8 Shelley Batts
    October 6, 2007

    Correct you are, Clyde. I changed it, and thanks for letting me know.

  9. #9 Christopher Green
    October 6, 2007

    You have indulged, I’m afraid, in a number of common misconceptions about the Gage story, many of them repeated in the Damasios’ work (which, like so many before them, used Gage to advance their own particular theory rather than to find out about Gage in his own right). As another commentator mentioned, see Malcolm MacMillan’s book, or listen to the interview I did with him last year in my podcast series, “This Week in the History of Psychology” http://www.yorku.ca/christo/podcasts/

    Shelley: Thanks for letting me know. Apparently there’s a lot of misinformation on the subject floating around out there….I’m listening to the podcast now and will correct where necessary.

  10. #10 SeanH
    October 9, 2007

    Unfortunately it looks like we have a large number of soldiers returning from Iraq with similar injuries.

    No. We have way more than enough injured soldiers returning, but we definitely do not have a large number of them that survived being lobotomized by an explosive projectile.

  11. #11 Doug
    October 9, 2007

    Hi Shelly,

    RE: your post ‘Suicide By Ballpoint Pen’; contrasted with Gage

    I have only read the abstract you provided about the “pen” case.

    With speculation, that poor individual may have “pithed” himself from an anterior insertion, possibly into some vital nucleus of the pons?

    Gage did not have any vital structures damaged which otherwise may have resulted in a more immediate death.

  12. #12 Mihai
    October 24, 2007

    Somehow related, about a pedophile who lost his urge once he had a brain tumor removed http://www.usatoday.com/news/health/2003-07-28-pedophile-tumor_x.htm

  13. #13 Ms. Ryan
    January 28, 2008

    I’m one of the teachers that is benefiting from the Phineas Gage. I posted a proposal on Donors Choose for a class set of books. I work in a low-income, urban school. These kids LOVE this book. From the first 8 pages, they were hooked. These are the same kids that frequently receive an F on tests and project and don’t turn in homework. On any day, I can ask them what happened to Phineas and they can recount the story for me. What an inspiration! Our project was fully funded by one donor. Thank you so much for helping us get these books. You’ve shown a group of underpriveldged, under-motivated kids that reading and science can be fun. Thank you so much!!!

  14. #14 Shelley Batts
    January 28, 2008

    Ms. Ryan, thank you so much for commenting on your class’s progress! I’m *so* happy that they liked the Gage books and you are finding them to be useful teaching tool. It warms my heart that I was able to help get kids interested in science. They are lucky to have such a concerned teacher. Best of luck, Shelley

  15. #15 film indir
    December 10, 2008

    You’ve shown a group of underpriveldged, under-motivated kids that reading and science can be fun. Thank you so much!!!

  16. #16 m connelly
    April 13, 2009

    This case has interested me since I attended
    “Phineas Gage Day” in Proctorsville VT about 15 years ago. You may find more info from the historical society there as they made quite an occasion out of it as I recall

  17. #17 Nino Guevara Ruwano
    January 12, 2010

    Nice Article . . . amazing story of Phineas Gage
    Rgds,
    Nino Guevara Ruwano
    (www.AstroDigi.com)

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