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Who was Phineas Gage?

A cabinet-card portrait of Phineas Gage

It took 13 pounds of iron and an explosion to bring the world to the modern era of neuroscience. Thanks to Phineas Gage, a railroad worker who survived a terrible brain injury at work in 1848. While the doctors and his friends expected him to die, Gage still became able to speak, work, and live normally for years after his accident. However, the tamping iron, which destroyed much of his brain’s left frontal lobe, caused a change in his personality. This rare case of sudden personality transformation and survival is the reason why Gage shows up in many medical textbooks.

His accident is the reason how brain scientists connected the brain to human personality. And it was a big deal in the mid-1800s when the purpose and the inner workings of the brain were still a mystery. During that time, phrenologists were assessing people’s personalities by measuring bumps on their skulls. Gage’s unique infamous case helped establish neuroscience as a field.

What is the Story behind Phineas Gage’s Brain Injury?

Little is known about Gage’s early life before the injury, other than he was born into a family of farmers, raised on a family farm in New Hampshire, and was literate. When he was 25 years old, he was under the employment of contractors working for the Rutland & Burlington Railroad company.

Among his duties was to clear the rocks to level the ground. To do this, he must place an explosive charge deep into the rock by drilling a hole. Then, the hole must be filled with gunpowder and a set fuse. The sand was added on top of the explosives to prevent contact, then a tamping rod made of iron was used to pack the explosives to the rock.

On September 13, 1948, near Cavendish, Vermont, Gage was tamping down the gunpowder but did not add sand. As his tamping rod struck against the side of the rock, it ignited the gun powder. It sparked against the rock, and the powder exploded, the tamping iron – which was 1 ¼ inch in diameter, three feet seven inches long, and weighing 13 ¼ pounds – shot completely through Gage’s head. His mouth was open during the explosion, and the rod entered the left side of Gage’s face just forward of the angle of the lower jaw. It passed behind the left eye, through the left side of his brain, and then completely out of the top of his skull.

Gage’s accident was referred to as the “American Crowbar Case” in the 19th century, but his tamping iron did not have a bend or a claw, but it was simply a pointed cylinder that is round and smooth. The pointed end of the tamping iron entered Gage’s cheek, and the taper is 11 inches long, ending in a ¼ inch point. It landed point first for some 80 feet away, obviously smeared with blood.

Gage was thrown to his back and had some brief convulsions of the limbs, but he spoke within a few minutes, sat upright in an oxcart, and walked with little assistance. He was attended by his physician Edward H. Williams about 30 minutes after the accident in his lodging hotel.

According to Williams, the pulsations of Gage’s brain was distinct, as the top of his head looked like an inverted funnel. Gage was even able to share how he was injured to the bystanders. Williams did not believe it at the time, but Gage insisted on his story. What’s impressive was Gage seemed to be perfectly conscious, but moments later, it was obvious that he was getting exhausted from the hemorrhage. Gage, and the bed which he was laid, was a gore of blood.

John Martyn Harlow treated him after that. Harlow noted that Gage’s mind was clear, and his legs were constantly being retracted and extended. Gage also said that he wanted to see his friends, and he will go to work in a few days.

What Happened After the Accident?

Surprisingly, Gage still lived for 12 years more after the incident. But his journey wasn’t a smooth-sailing one.

The morning after, Gage lost control of his mind and became delirious. But by the fourth day, he was rational again and knew all his friends and family. Harlow became optimistic that Gage could recover.

However, after 12 days, Gage became semi-comatose, speaking only when spoken to, and answering only in monosyllables. On the 13th day, Gage’s strength was failing, and the globe of his left eye became more protuberant with a fungus pushing rapidly from the brain and coming out of the top of his head. His friends and attendants are expecting his death, and they even had his coffin and clothes ready.

Harlow decided to cut off the fungus and applied caustic to it. By the time, only a few doctors would have had the experience with cerebral abscess, which Harlow successfully removed. It made a big deal in saving Gage’s life. But Harlow also saw a dramatic change in Gage’s personality as the once even-tempered man became irreverent, fitful, and indulging at gross profanity, which wasn’t his previous custom.

On the 24th day, Gage can raise himself up, and after a month, he was able to walk up and down the stairs and around the house. After ten weeks, he returned to his parents’ home. By February 1849, he was able to do work on the farm, feeding the cattle and doing a half-day job plowing.

Gage was unable to reclaim his railroad job and became a living museum exhibit for a while, as a professor of surgery at Harvard brought him to Boston and New York.

In 1852, Gage was invited to Chile to work as a stagecoach driver, caring for horses. His health began to fail in the mid-1859, and by February 1860, he began to have epileptic seizures. He went home to his mother on May 18, and on the 20th, he suffered from a severe convulsion. He died the next day. The epileptic seizures were most probably related to the brain damage he sustained.

Gage’s skull and the tamping iron that passed through it are on display at the Warren Anatomical Museum in Boston, Massachusetts.

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