Phineas Gage

Gage, Phineas

Phineas Gage (1823 - 1861, USA) was considered until the autumn of 1848 to be an able, intelligent, very judicious and responsible and generally popular construction worker.

In the fall of 1848, Gage, as foreman, worked on blasting work in connection with the construction of a railroad in Vermont, New England. Gage's task was, among other things, to use an iron rod to pack up the explosive charges with which the boreholes were filled. The charges consisted of gunpowder covered with a layer of cushioning sand. Gage's gasket rod was custom made, 3 cm in diameter and just over a meter long with a blunt and a pointed end.
On September 13, 1848, the accident occurred!!! An explosive charge lacked sand cover!!!! When Gage bumped down the blunt end of the rod, the gunpowder exploded. The iron rod shot like a rocket out of the borehole and straight through Gage's head. The rod went in under and at the side of the left eye. It passed through the brain, leaving the head at the front of the crown of the head in the midline.

Now the first peculiarity occurs. PHINEAS GAGE IS ALIVE !!! Not only that, but he is fully conscious, able to speak and walking with the support of the scene of the accident. He will be plastered and cared for in the coming weeks by Dr. John Harlow.
The second, and even more astonishing, strangeness begins to make itself felt in the weeks after the accident and over time becomes more and more prominent.
He transforms into almost the opposite of his former self. The image of a moody, unreliable, careless and rude fellow is becoming increasingly clear, coupled with disastrous social incompetence. The peculiarity is enhanced by the fact that Gage does not exhibit any motor difficulties or speech disorders. His intelligence and ability to learn and reason as well as mathematical skills are also unaffected.

After the wound healed, Gage led a wandering existence unable to maintain a steady job. A few years after Gage's death, his former physician, John Harlow, had the opportunity to study Gage's exhumed skull. In 1868, Dr. Harlow published a work in which he gave an account of Gage's accident and its consequences. Here, Harlow suggested that the iron rod had damaged such parts of the frontal lobes of Gage's brain, where important parts of his original personality and social skills had their seat. The idea was not accepted. Admittedly, at that time people were prepared to accept that motor skills and speech skills (Broca 1861) were tied to specific parts of the brain, but that such qualities as a sense of responsibility and social competence should also be so seemed almost unreasonable.

Dr. Harlow has now gotten his revenge, not least through the work of Hanna Damasio and co-workers from 1994. Here, Phineas Gage's skull (on loan from The Warren Anatomical Medical Museum at Harvard University) is analyzed using modern radiographic and computer-based reconstruction techniques. The result shows that the iron bar should have damaged the anterior parts of the lower and inner sides of the frontal lobes, e.g. Brodmann areas 8, 10, 11, 12 and 24 = the anterior part of the gyrus cingulis . A comparison of the symptoms of a current patient group with lesions in these areas is very consistent with Gage's symptoms.

Damasio H., Grabowski T. R Frank., Galaburda A.M., Damasio A.R. The return of Phineas Gage: clues about the brain from the skull of a famous patient.. Science, 264(5162):1102-5, 1994.