History's most famous brain-lesion victim, whose injury indicated that personality and executive functions reside in the frontal lobes of the brain.
On the afternoon of September 13, 1848, Phineas Gage, the foreman on a Vermont railroad construction site, was preparing to set off a blast, when he glanced up to check on his crew. Accounts vary as to what happened next, but somehow the gunpowder exploded. Gage's 1-m (3.3-ft.), 6-kg (13-lb.) tamping rod slammed through his head just below the left cheekbone, passed through the left frontal lobe of his brain, and exited through the top of his skull. It left a 9-cm (4-in.) diameter hole clear through his head.
Gage never lost consciousness. After climbing into an oxcart, he was taken to a hotel where he walked up a steep flight of stairs. When Dr. John Harlow arrived, Gage greeted him with: “Here's business enough for you.” The wound became infected, and Gage eventually slipped into a coma. Harlow performed emergency surgery, and the patient recovered but lost his left eye.
Returning home to New Hampshire at the end of November, Gage appeared perfectly normal—except that he had a different personality. Before the accident, Gage was considered the best foreman in the region— smart, efficient, responsible, and well-liked. After the accident, friends and family declared that he was “no longer Gage.” He had difficulty planning, organizing, and maintaining a course of behavior. John Harlow (1819–1907) wrote in an 1868 article: “The equilibrium or balance … between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity … manifesting but little deference for his fellows, impatient of restraint or advice…. His mind was radically changed.” Gage lost his job and drifted, earning money displaying his head and the infamous tamping iron, although he eventually found steady work. In 1852, he sailed to Chile where, for the next seven years, he drove stagecoaches over rugged, mountainous trails.
After sailing back to San Francisco, Gage worked as a farm laborer. However, he experienced increasingly severe seizures and died in May 1860 at age 36. Harlow tracked down Gage's sister and, in 1867, convinced her to open the grave and hand-deliver Gage's skull and tamping iron to him in New York. Harlow then wrote up a full report of Gage's injury and mental status.
Over the decades, Gage's story has been embellished and reinvented, and his injury has been reinterpreted using the latest discoveries in neuroscience. For example, sophisticated computer modeling has indicated that the rod never crossed to Gage's right hemisphere. However, the extent of damage to connections between neurons was probably much more extensive than previously believed, perhaps even similar to neurodegenerative disorders such as Alzheimer disease. Nevertheless, the reports of Gage's erratic behavior are vague and contradictory; by many accounts he appears to have resumed a fairly normal life. Dr. Henry Bigelow (1818–1890) took him to Harvard Medical School in 1849 and determined that he was “quite recovered in his faculties of body and mind.” Malcolm Macmillan of the University of Melbourne, who has studied Gage stories for years, has questioned how an impulsive man with uncontrollable behaviors could have performed such a highly skilled job as driving a stagecoach over narrow, dangerous mountain trails, presumably sometimes at night. A statement found in 2010, written by a doctor who knew Gage well in Chile, indicated that Gage had been in good health with absolutely no mental impairments. Yet another line of evidence suggests the stories of Gage's personality changes are myths or that any impairments were temporary. For years, a Baltimore couple believed that they owned a daguerreotype of a whaler holding the harpoon that had taken out his eye. However, when they posted the image on Flickr, they were informed that the “harpoon” was actually a tamping iron. Following a suggestion that it might be an image of Phineas Gage, they compared it to his life mask made in 1849. The daguerreotype of a handsome, well-dressed, dignified young man was indeed Phineas Gage, looking nothing like a disheveled drifter. A second, similar image subsequently turned up. Thus, Gage's injury may be one of the first known examples of the ability of the adult brain to heal itself and/or compensate for extreme injury.
Phineas Gage has reached new heights of popularity in the twenty-first century, with a fan club, plays, and thousands of YouTube videos, some of them reenacting the fateful accident. His skull and tamping iron remain the centerpiece of Harvard Medical School's Warren Anatomical Museum. It has been suggested that Gage's most important contribution to neuroscience was the recognition that the brain is the physical embodiment of personality and identity; in other words, the brain and the mind are one and the same.
See also Brain injuries .
Bear, Mark F., Barry W. Connors, and Michael A. Paradiso. Neuroscience: Exploring the Brain. 4th ed. Philadelphia: Wolters Kluwer, 2016.
Macmillan, Malcolm. An Odd Kind of Fame: Stories of Phineas Gage. Cambridge, MA: MIT Press, 2002.
Munsil, Janet. That Elusive Spark. Toronto: Playwrights Canada, 2014.
Griggs, Richard A. “Coverage of the Phineas Gage Story in Introductory Psychology Textbooks: Was Gage No Longer Gage?” Teaching of Psychology 42, no. 2 (July 2015): 195.
Harlow, J. M. “Recovery from the Passage of an Iron Bar Through the Head.” Publication of the Massachusetts Medical Society 2 (1868): 329–47.
Kean, Sam. “Beyond the Damaged Brain.” New York Times (May 4, 2014): SR8.
Twomey, Steve. “Phineas Gage: Neuroscience's Most Famous Patient.” Smithsonian (January 2010). http://www.smithsonianmag.com/history/phineas-gageneurosciences-most-famous-patient-11390067 (accessed August 22, 2015).
Kean, Sam. “Phineas Gage, Neuroscience's Most Famous Patient.” Slate. May 7, 2014. http://www.slate.com/articles/health_and_science/science/2014/05/phineas_gage_neuroscience_case_true_story_of_famous_frontal_lobe_patient.html (accessed August 22, 2015).
Society for Neuroscience. “Three Lesions, Three Lives.” BrainFacts.org. November 6, 2014. http://www.brainfacts.org/Diseases-Disorders/Injury/Articles/2014/Three-Lesions-Three-Lives (accessed August 22, 2015).