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.
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.
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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.
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.