Phineas Gage: History’s Great Brain Injury Survivor

Phineas Gage and the iron rod
Originally from the collection of Jack and Beverly Wilgus, and now in the Warren Anatomical Museum, Harvard Medical School.

What do you do if you have a destructive implement shot clean through your skull? Death seems like the type of activity you’d take up. Phineas Gage (1823-1860) didn’t do that.

After a large iron rod was blasted through his brain whilst laying railroads in Cavendish, Vermont, he was left not in the best of nick.

But he survived and went on to become one of the most essential figures in neurology, psychology, and neuroscience. This is his story.

Phineas Gage’s Contributions to Neuroscience

Phineas gage skull injury and tamping iron
Gage’s skull (after his death, obviously) with the tamping iron in question.

The image at the top of this post was identified as Gage only in 2009, so until that point it was uncertain what he looked like and whether some of the stories of his life are true.

But you can see there he’s looking handsome and proud – casually holding the tamping iron that should have left him for dead.

Hollywood movies tell us that such an accident is instant death – in video games, make a head shot and another enemy is down. But the human brain is such a complex thing that we can survive without certain chunks of it. If you get lucky.

On the day that was September 13, 1848, Gage was leading a group of men with blasting rocks to make room for a railroad track. This involved boring a hole into rock outcrops, adding TNT powder, and using a tamping iron rod to jam the mixture into the hole.

Approaching 5pm in the evening, his troop was tired from working all day. As he turned to speak to a group of them – apparently opening his mouth to speak – he brought his head in line with a blast point.

Unfortunately, someone forgot to add certain components to the bored hole – as it blew up, the 1 1⁄4 inches diameter rod of three feet seven inches (1.1 m)  weighing 13 1⁄4 pounds (6.0 kg)‍ blasted through mid-air.

Phineas gage skull injury

That’s the angle it went through his head. He was immediately knocked onto his back and lay prone on the floor. The rod landed 80 feet away smeared with his blood and brain matter.

His colleagues could actively see through the centre of his skull, with his brain openly pulsating within. Naturally, most of them thought he was done for.

The Aftermath of Gage’s Head Trauma

Gage was far from dead. Within a few minutes he was up and about walking and talking. Miraculously, it appeared as if he was almost uninjured, in what we’d normally expect would result in immediate death.

Dr. Edward H. Williams was the first to treat him, finding the man calmly sitting waiting for him. It was only half an hour after the incident. The doctor’s written statement was as follows – and this isn’t for the squeamish:

“I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. The top of the head appeared somewhat like an inverted funnel, as if some wedge-shaped body had passed from below upward. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage’s statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head. Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain [through the exit hole at the top of the skull], which fell upon the floor.”

The poor bloke expected to be back to work in a handful of days, but ended up (no big surprise) slammed out for 10 weeks. He flitted in and out of a coma, had delusional episodes, and seizures. Over time, he was able to return to something of a normal life.

What proves so fascinating for the medical community is what happened over the subsequent years.

Post-accident, his personality changed dramatically—that’s according to various accounts from the time. Some of his friends went as far as suggesting he simply wasn’t the same man anymore.

Was that chunk of brain ejected from his skull really what made the man who he was? 20 years after the accident, Harlow noted in a medical society bulletin:

“His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again. He is 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 of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. In this regard, his mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage’.”

A feature in The Guardian from 2010 adds to his apparent shift in character.

“Most popular accounts of Phineas Gage describe him as having undergone profound personality changes because of his injury. He is often reported as having permanently lost his inhibitions, so that he started to behave inappropriately in social situations. Some reports state that he became violent and ‘uncontrollable’, and even that he started to molest children.”

But in the piece, developmental neurobiologist and a freelance science writer Mo Costandi adds of the conflict his story is causing in the medical community.

There’s now a great deal of debate over just how much this iron rod changed the guy’s temperament.

“We actually know next to nothing about Gage’s personality before the injury, so it is difficult to understand exactly how it changed afterward, and the story is further complicated by our incomplete knowledge of the extent of his injury. Despite this, the case of Phineas Gage has been used and abused ever since it first appeared. Neurologists have cited it as evidence in support of their pet theories, and even creationists have been known to cite it as evidence that personality is not a product of brain function.”

Despite some folks going overboard, there is a consistent, underlying account of a definite personality change.

How dramatic that was depends on the records you read. And whether Dr. Harlow’s notes are accurrate – medical men back in 1848 were hardly trustworthy. Check out Roy Porter’s Blood & Guts or The Madness of King George to see what we mean.

In fact, all the medical bickering reminds us of the ongoing debate about Mozart’s apparent bout of scatological humour. No one can agree what’s going on there, either.

For a subdued account about Gage, we have the 1994 book Descartes’ Error: Emotion, Reason, and the Human Brain by neurologist António Damásio. It states:

“[Gage] displayed the lack of social skills and forward planning we now associate with the frontal lobe syndrome. He died in penury.”

A more pragmatic and logical overview, it seems (with our extensive education in neurology backing us up), than a creationist getting their hands on the story to spin it to meet their agenda.

Now, apparently frontal lobe syndrome is an impairment caused through disease or a head injury. That bit of brain is what helps us write pieces like this.

It gives the Professional Moron team higher mental functions (allegedly): motivation, planning, conceptualisation etc. But it’s also how we produce speech and consider our social actions.

Whatever, the problem is in 1848 documenting injuries was medically difficult, largely due to the frightening lack of medical knowledge humanity could turn to in the 19th century. Nowadays, we all know a heck of a lot more.

If you’re the doctor arriving to find the man 30 minutes after his accident, with nothing like this on record available, you’d likely think divine intervention was afoot.

Now, there’s a vast amount of medical literature to wade through regarding this incident. Should you want to learn more about Gage, his brain, and what happened after the accident, have a Google – buy a book or two. Take a degree in neuroscience.

Whilst time is distorting his story, what is clear is he did suffer this accident, it dramatically altered his life, and it’s astonishing he was able to survive for 12 years after it all.

As such, doctors were able to understand certain areas of the brain control different functions for us humans. And the injury suggests the frontal lobes are essential for personality.

Unfortunately for the victim, if we’re to believe the written records available he didn’t have the best life. He became something of a museum exhibit. And he struggled with worsening seizures.

In 1860, at the age of 36, he suffered a series of convulsions and ultimately died of status epi­lep­ti­cus.

The Legacy of Phineas Gage

Finally, the above video highlights much of what we pointed out above. But we want to include the most excellent Answers With Joe here.

As we really like his YouTube channel and think he deserves some extra recognition.

Dispense with some gibberish!

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