Phineas Gage

Phineas Gage

Phineas Gage became famous because of a life threatening injury he suffered in 1848. A man surviving this type of injury was amazing for the time; however, the knowledge gained through observation of Dr. John Martyn Harlow was the first associate brain injury and changes in personality. Gage's case is mentioned in most psychology textbooks. Harvard Medical School's campus houses the Warren Anatomical Museum where Gage's skull, the tamping iron, and mask of Gage's face are kept. The Phineas Gage case has become one of the most famous in neuroscience (Twomey, 2010).

Phineas Gage

Gage's Railroad Work

Phineas Gage was a 25 year-old railroad supervisor working on September 13, 1848, in Vermont removing rock in the way of the progress of the railroad's track. Gage drilled holes, placed explosives, placed wicks, added sand on top, and used a tamping iron to pack the sand, wick, and explosive before it was ignited. The tamping iron weighed 13.25 pounds, was 43 inches in length, had a diameter of 1.25 inches, and after passing through Gage's head the iron landed about 25-feet away (Twomey, 2010).

The Accident that Made Gage Famous

Gage was a reliable, reasonable, and capable individual; however, this day Gage was distracted and forgot to place sand on top of the explosive and began to use the tamping iron. The resulting spark from the tamping iron caused an explosion that propelled the tamping iron through Gage's skull entering the left zygomatic arch, piercing the base of the skull behind the left eye socket, and exiting through the top of the skull. It is believed it exited slightly to the front and left of the bregma at the coronal and sagittal sutures (Macmillan, n.d.).

Gage regained consciousness quickly after he was injured. Witnesses were surprised Gage was still alive. Gage was sitting up and talking on the ride in the wagon to his home, and he walked from the wagon to a chair on the porch, and began telling his story to those present while waiting for the doctor to arrive. Dr. Edward Higginson Williams was the first doctor to arrive and Gage reportedly greeted him with 'Doctor, here is business enough for you.' Dr John Martyn Harlow arrived about an hour later, Williams and Harlow stopped Gage's hemorrhaging; however, more problems resulted from a severe viral infection. The infection that likely would have ended Gage's life was successfully treated by Harlow and Gage returned to his parent's farm after three months (Macmillan, n.d.).

The Aftermath

The viral infection resulting from the injury caused loss of sight in Gage's left eye and decreased sensation in the left side of his face. Gage was a well-mannered, hard-working man before the accident; however, had a long recovery, and it is reported he was a changed man (Wagar, 2004).

Gage did not return to the railroad, instead he worked in various positions, such as at a livery stable and as a stage coach driver. Gage traveled through New England as an exhibit with Barnum's American Museum lecturing at some point believed to be 1850. Sometime in 1860, Gage returned to his family; he was plagued by intensifying seizures. Gage survived 11½ years after his injury but died on May 21, 1860, after a successive series of seizures (Macmillan, n.d.).

Phineas Gage's Brain Injury

No autopsy was performed on Gage after his death in 1860; however, his body was exhumed in 1867. Harlow received Gage's skull in 1868, but there was no brain material left to study. There was disagreement regarding the rod's exit location to the bregma and regarding the positioning of the exit to the midline of the brain. Harlow placed a tamping iron through the entrance wound and out the exit wound of the skull, and believed that the majority of damage was to the left hemisphere of the brain leaving the right hemisphere intact. A 2004 study conducted by Ratiu and Talos using a three-dimensional representation of Gage's skull verified Harlow's theory. The line of fracturing along the left cheekbone to the left parietal bone and the exit of the tamping iron was left of the median line and slightly in front of the bregma (Macmillan, n.d.).

Phineas Gage was reportedly a hard-working, respectable, reliable, friendly, and peaceful man before his injury. He was well liked and respected by both peers and elders who knew him; however, he was a different man after his injury. Gage was described as unpredictable, moody, aggressive, untrustworthy, violently quarrelsome, and a drunken bully; a far different man from the Gage prior to his accident. Gage's personality had changed, and he could not keep his position as supervisor with the railroad; however, he was physically able to function in many capacities. Gage worked as a stage coach driver after his accident. In the course of his job as a coach driver, Gage would deal with customers, make change, load bags, follow a route to various stops, and also manage to feed and care for himself. Gage's motor and cognitive function related to the right hemisphere of the brain were not damaged; however, the left hemisphere's damage is associated with the personality changes that occurred (Macmillan, n.d.).

Role of the Brain

The various portions of the normal human brain play specific roles in cognitive functioning. The cerebral cortex is the area of the brain that separates humans from other primates, and the cortex has many sub-regions (Center for the Neural Basis of Cognition, 2013). The six regions of the brain are the frontal lobe, the parietal lobe, occipital lobe, temporal lobe, cerebellum, and the brain stem, and each play roles in healthy function, behavior, and well-being.

Frontal Lobe

The frontal lobe plays a role in linking and integrating the highest level components of behavior. The frontal lobe is responsible for emotion, impulse control, and social adjustment. Damage to portions of the frontal lobe are associated with inability to move portions or an entire side of the body, disorganized or halting speech, personality changes, and disregard of social rules. The frontal lobe is the area responsible for executive functions, planning, abstract reasoning, impulse control, sustained attention, and insight. The functions of the frontal lobe include initiation, problem solving, judgment, inhibition, self-monitoring, motor planning, personality, emotions, awareness of abilities, expressive language, and concentration (The Brain Injury Alliance of Utah, n.d.).

Parietal