Phineas Gage's Astonishing Brain Injury

Phineas Gage

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Phineas Gage is often referred to as one of the most famous patients in neuroscience. He experienced a traumatic brain injury when an iron rod was driven through his entire skull, destroying much of his frontal lobe.

Gage miraculously survived the accident. However, his personality and behavior were so changed as a result that many of his friends described him as an almost different person entirely.

Phineas Gage's Accident

On September 13, 1848, the then-25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole.

Unfortunately, the powder detonated, sending the 43-inch-long and 1.25-inch-diameter rod hurtling upward. The rod penetrated Gage's left cheek, tore through his brain, and exited his skull before landing 80 feet away.

Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. He was still conscious later that evening and was able to recount the names of his co-workers. Gage even suggested that he didn't wish to see his friends since he would be back to work in "a day or two" anyway.

Descriptions of Gage's injury and mental changes were made by Dr. John Martyn Harlow. Much of what researchers know about the case is based on Harlow's observations.

After developing an infection, Gage then spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed and by October 11 his intellectual functioning began to improve.

Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating size and amounts of money. Within a month, Gage was well enough to leave the house.

Effects

In the months that followed, Gage returned to his parents' home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered.

Popular reports of Gage often depict him as a hardworking, pleasant man prior to the accident. Post-accident, these reports describe him as a changed man, suggesting that the injury had transformed him into a surly, aggressive alcoholic who was unable to hold down a job.

Evidence suggests that many of the supposed effects of the accident may have been exaggerated and that he was actually far more functional than previously reported.

Harlow presented the first account of the changes in Gage's behavior following the accident. Where Gage had been described as energetic, motivated, and shrewd prior to the accident, many of his acquaintances explained that after the injury he was "no longer Gage."

Since there is little direct evidence of the exact extent of Gage's injuries aside from Harlow's report, it is difficult to know exactly how severely his brain was damaged. Harlow's accounts suggest that the injury did lead to a loss of social inhibition, leading Gage to behave in ways that were seen as inappropriate.

Severity of the Damage

In a 1994 study, researchers utilized neuroimaging techniques to reconstruct Gage's skull and determine the exact placement of the injury. Their findings indicate that he suffered injuries to both the left and right prefrontal cortices, which would result in problems with emotional processing and rational decision-making.

Another study conducted in 2004 that involved using three-dimensional, computer-aided reconstruction to analyze the extent of Gage's injury found that the effects were limited to the left frontal lobe.

In 2012, new research estimated that the iron rod destroyed approximately 11% of the white matter in Gage's frontal lobe and 4% of his cerebral cortex.

Gage's Influence

Gage's case had a tremendous influence on early neurology. The specific changes observed in his behavior pointed to emerging theories about the localization of brain function, or the idea that certain functions are associated with specific areas of the brain.

Today, scientists better understand the role that the frontal cortex has to play in important higher-order functions such as reasoning, language, and social cognition.

In those years, while neurology was in its infancy, Gage's extraordinary story served as one of the first sources of evidence that the frontal lobe was involved in personality.

What Happened to Phineas Gage?

After the accident, Gage was unable to return to his previous job. According to Harlow, Gage spent some time traveling through New England and Europe with his tamping iron in order to earn money, supposedly even appearing in the Barnum American Museum in New York.

He worked briefly at a livery stable in New Hampshire and then spent seven years as a stagecoach driver in Chile. He eventually moved to San Francisco to live with his mother as his health deteriorated.

After a series of epileptic seizures, Gage died on May 21, 1860, almost 12 years after his accident.

Seven years later, Gage's body was exhumed and his skull and the tamping rod were taken to Dr. Harlow. Today, both can be seen at the Harvard University School of Medicine.

A Word From Verywell

Gage's accident and subsequent experiences serve as a historical example of how case studies can be used to look at unique situations that could not be replicated in a lab. What researchers learned from Gage's accident played an important role in the early days of neurology and helped scientists gain a better understanding of the human brain and the impact that damage to the brain could have on both functioning and behavior.

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