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Who Was Phineas Gage?

Phineas Gage is often referred to as one of the most famous patients in neuroscience. He suffered 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, but was so changed as a result that many of his friends described him as an almost different man entirely.The 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 reportedly landing some 80 feet away.

Shockingly, 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. Dr. Edward H. Williams, the first physician to respond later described what he found:

“I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. 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, which fell upon the floor.”

Soon after, Dr. John Martyn Harlow, took over the case. It is through Harlow’s observations of the injury and his later descriptions of Gage’s mental changes that provide much of the primary information that we now know about the case. Harlow described the initial aftermath of the accident as “literally one gore of blood.”

Later in a published description of the case, Harlow wrote that Gage 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” anyways.

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 even venturing out of the house and into the street.

The Aftermath

In the months that followed, Gage returned to his parent’s 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.

Unable to return to his railroad job, Gage held a series of jobs including work in a livery stable, a stagecoach driver in Chile and farm work in California. 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 drunkard who was unable to hold down a job.

The myths surround the effects of Gage’s injury seem to have grown after his death, and many of these claims are not supported by any direct evidence from primary sources. Neither Harlow nor any others who had actual contact with Gage reported any of these behaviors. “Phineas’ story is worth remembering because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth,” explains psychologist Malcolm Macmillan, author of An Odd Kind of Fame: Stories of Phineas Gage.

So was Gage’s personality as changed as some of the reports after his death have claimed? Recently, Macmillian has suggested that the most marked changes in Gage may have been limited to the period of time immediately after the accident. Evidence suggests that many of the supposed effects of the accident were exaggerated and that he was actually far more functional than previously reported.