Phineas Gage: the iron rod, the brain and the story we got wrong

Some people become famous for what they discovered. Phineas Gage became famous for what happened to him. He was a 25-year-old railroad foreman, and one day in 1848 an iron rod went straight through his head. He lived, and his case became a fixture of psychology textbooks.

The textbook version is short: brain injury, new personality, sad ending. The records his own doctor left behind tell a longer and kinder story.

What happened in 1848

On 13 September 1848, Gage was leading a crew that was blasting rock for the Rutland & Burlington Railroad near Cavendish, Vermont. His job that day was to pack blasting powder into a hole drilled in the rock, using a long iron rod called a tamping iron.

Something his men were doing behind him caught his attention. Gage looked over his right shoulder, and at that same moment the rod dropped onto the charge. It struck a spark on the rock, and the powder exploded.

The tamping iron was about 1.1 meters long and weighed about 6 kilograms. It entered under his left cheekbone, passed behind his left eye, went up through the front of his brain and flew out of the top of his skull. It landed some distance behind him.

Here is the astonishing part. According to his doctor, John Harlow, Gage was talking within a few minutes. His men carried him to an ox cart, and he rode sitting up to his hotel, then walked up a long flight of stairs with a little help. He even pointed to the hole in his cheek and told Harlow that “the iron entered there and passed through my head.”

Getting better, slowly

Harlow treated Gage for weeks. By April 1849 Gage was back in Cavendish for a visit, standing straight, walking steadily and, in Harlow’s words, in good physical health. He had lost the sight in his left eye, and the left side of his face was partly paralyzed. Still, Harlow wrote that he was “inclined to say that he has recovered.” Gage also kept the iron, and Harlow called it “his constant companion during the remainder of his life.”

“No longer Gage”

The part that made Gage famous came next. Before the accident, his employers had seen him as their most capable foreman. Afterwards, they would not give him his old job back.

In 1868 Harlow described the change. Gage had become “fitful, irreverent,” at times swearing heavily, which he had not done before. He was impatient when advice got in the way of what he wanted, and he made plans only to drop them for new ones. Harlow wrote that his friends and acquaintances said he was “no longer Gage.”

That idea, that damage to the front of the brain could change who a person seems to be, is why Gage still matters. Malcolm Macmillan, who has studied the case closely, called it the most famous case of personality change after brain damage. His case pointed scientists toward the frontal lobe, and especially the prefrontal cortex at its very front. Researchers now link that region to what they call cognitive control: steering our thoughts and actions toward our goals.

Where exactly was the damage?

Unlike patient H.M., whose brain was cut into thin slices and studied after death, Gage’s brain was never examined. His skull and the iron, though, were kept at Harvard’s medical school, so scientists have measured them again and again.

• 1994: Hanna Damasio’s team used measurements of the skull and modern brain imaging to rebuild the accident. They concluded that the damage involved the prefrontal cortex on both sides. Modern patients with damage in a similar pattern, they noted, have trouble with rational decision making and with processing emotion.
• 2004: Peter Ratiu and colleagues made a 3D computer model from a thin-slice CT scan of the skull. Their answer was different: the injury stayed in the left frontal lobe and did not reach the other side.
• 2012: John Darrell Van Horn’s team simulated the rod’s path through the brain scans of modern young men. They estimated that the rod passed through about 4% of the cortex but damaged about 11% of the brain’s white matter, the long wiring that links regions together. The harm to those connections reached far beyond the hole itself, and it probably played a part in the changes people noticed. In other words, a brain is a web of circuits, and a small break in the wiring can affect places far away.

So even with the skull in hand, scientists still don’t fully agree on how far the damage reached.

The part of the story that usually gets left out

Here is what many retellings skip. Harlow’s own report follows Gage for years after the accident.

Gage traveled around New England with his iron and spent a while at Barnum’s in New York. Then he worked in a livery stable in Hanover, New Hampshire, for about a year and a half. In 1852 he sailed to Chile to work for a new coach line. There, near Valparaíso and Santiago, he looked after horses and often drove a heavily loaded coach pulled by six horses.

In 2000, Macmillan looked at how Gage is described in modern books. He found him in about 60% of the introductory psychology textbooks he checked, along with a good deal of inaccuracy. Writers often ignored the original records and gave Gage traits that belonged to other patients with frontal damage. In 2010, Macmillan and Matthew Lena went further. They argued that Gage eventually adapted surprisingly well to life after his injury. In their view, the daily structure of his work helped, and they compared this with ideas in modern rehabilitation.

Nobody can interview Gage now, so this is an argument from the records. But it changes the ending. In this reading, “no longer Gage” may describe the first years after the accident, not the rest of his life.

A face to go with the name

For a long time, there was no known picture of Gage’s face. Then, in 2009, collectors Jack and Beverly Wilgus published an old daguerreotype portrait they had owned for more than 30 years. They identified the man as Gage by comparing the picture with his life mask and the tamping iron kept at Harvard’s Warren Anatomical Museum. At the time, it was the only known picture of him.

Gage’s health began to fail in his last years in Chile, and he moved to San Francisco, where his mother and sister lived. He died there after a series of seizures, about 12 years after the accident. Harlow later arranged for the skull to be recovered, and he placed it and the iron in Harvard’s medical museum, where they are still kept.

In short

In 1848 a tamping iron passed through the front of Phineas Gage’s brain, and he survived. His doctor recorded a striking change in his personality, and his case became the best-known example of personality change after damage to the front of the brain. Scientists still debate how far the damage reached. The full record also shows a man who went on to work, travel and drive a six-horse coach in Chile. Gage’s brain changed, and so did his life. Both parts belong in his story.

#Phineas Gage #frontal lobe #prefrontal cortex #personality #history of neuroscience

Sources

1. Recovery from the passage of an iron bar through the head. Harlow JM. Publications of the Massachusetts Medical Society 2, 327–347 (1868); reprinted in History of Psychiatry 4, 274–281 (1993). Quotations checked against the 1868 text on Wikisource
2. The return of Phineas Gage: clues about the brain from the skull of a famous patient. Damasio H, Grabowski T, Frank R, Galaburda AM, Damasio AR. Science 264, 1102–1105 (1994)
3. The tale of Phineas Gage, digitally remastered. Ratiu P, Talos IF, Haker S, Lieberman D, Everett P. Journal of Neurotrauma 21, 637–643 (2004)
4. Mapping connectivity damage in the case of Phineas Gage. Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, Toga AW. PLoS ONE 7, e37454 (2012)
5. Restoring Phineas Gage: a 150th retrospective. Macmillan M. Journal of the History of the Neurosciences 9, 46–66 (2000)
6. Rehabilitating Phineas Gage. Macmillan M, Lena ML. Neuropsychological Rehabilitation 20, 641–658 (2010)
7. An integrative theory of prefrontal cortex function. Miller EK, Cohen JD. Annual Review of Neuroscience 24, 167–202 (2001)
8. Face to face with Phineas Gage. Wilgus J, Wilgus B. Journal of the History of the Neurosciences 18, 340–345 (2009)