The Curious Case of Phineas Gage: Traumatic Brain Injury

The story of Phineas Gage is an extraordinarily famous one and is known to every introductory psychology student. In fact, it is one of the first cases that scholars learn when they are presented with topics related to brain anatomy and brain functions. So what happened to the poor old Phineas Gage?

Phineas Gage was a railway worker in the US in charge of a crew of men working on the Rutland and Burlington Railroad near Cavendish, Vermont.  On September 18, 1848, at 25 years of age, Gage suffered an accident. He was preparing for an explosion for which he had to put dynamite in a hole and using an iron rod of approximately two centimeters in diameter, compact the explosive charge into the hole. The iron rod produced a spark inside the hole that ignited the powder and in the explosion the rod ending up injuring Phineas. It went through his chin and then came out on top of his forehead. His crew later found the iron rod 10 meters away covered with blood and brain matter.

The Curious Case of Phineas Gage
The Curious Case of Phineas Gage

Now, what do you think happens next? Is he rushed to the hospital and treated? Well yes, he gets treated by a local doctor, named John Harlow, who categorizes the injury as severe.

[The tamping iron] entered the cranium, passing through the anterior left lobe of the cerebrum, and made its exit in the medial line, at the junction of the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the parietal and frontal bones extensively, breaking up considerable portions of the brain, and protruding the globe of the left eye from its socket, by nearly half its diameter. Doctor John Harlow

However, immediately after the accident Phineas was talking and walking. He could hold a conversation and he was conscious of everything that was going on in front of him.

Dr. Harlow replaced large bone fragments that had shifted and closed the large wound on his head. Unfortunately, it became infected and Gage fell into a comatose state. However, despite his family being certain he would die, by January 1849, Gage was fully recovered.  He did lose eyesight in his left eye and had scarring, but other than that there were no visible changes in his physical appearance.

People who surrounded him, however, noticed many changes in the way he acted, communicated and related to others. Apparently, before he got injured, he was a very content, relaxed person and he followed all the appropriate social norms. After the accident, however, he became very aggressive, often canceled plans, and was very inappropriate and hostile. He started using very colorful language in his everyday speech, something which he never used to do before the accident and even started to molest children.

He went on to lead a normal life, even though his personality changed drastically causing him to change jobs regularly. When he turned 36, he started experiencing seizures which increased in frequency and severity. Gage eventually died in a status epilepticus, which is a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them. Today his skull is kept at the Warren Anatomical Museum at Harvard Medical School, alongside the tamping iron that penetrated it.

Phineas Gage sparked a lot of controversy in the scientific community and, of course, how could he not? He was the first ever indication that brain parts and functions had an effect on personality. That is the reason why he became so famous. He did not have any impairment on memory, speech or movement but his personality features were severely altered, especially regarding emotions and decision-making abilities.

Phineas Gage Controversy – The Emergence Of Localization

At that time, the term localization emerged. Localization means that specific areas of the brain were responsible for specific brain functions. Nowadays, of course, we know that various parts of the brain are in charge of different functions and carry out complex processes that help us function normally on a day to day basis. Back in the day, however, it was quite a big discovery and many scientists and researchers debated the role of the brain in personality characteristics. Gage was specifically injured in the frontal lobe, which is responsible for a lot of inhibition behaviors, executive functions, and social cognition so, of course, it tampered with some important components of his personality.

Factors favoring Phineas Gage’s recovery

If we can say anything is that Phineas Gage’s recovery was something unexpected. It proves that the brain has many resources for overcoming lesions and restructuring itself to recovery.  

Dr. Harlow established four circumstances that happened with Phineas Gage that favored his rapid recovery:

  1. The subject of injury: Phineas Gage was a healthy, fit, 25-year-old man, which made for cerebral plasticity and tissue to rewire faster.
  1. The shape of the iron rod: It was pointed, round and smooth, which made it as so it didn’t leave a prolonged concussion or produce many concussion symptoms.
  1. The point of entrance: even though the injury was quite severe, the opening the iron created as it passed through the skull created a drainage, without which it would have been impossible to recover.
  2. The portion of the brain: Gage’s injury proved that impairments in the front part of the brain are less dangerous than those in the rear. It’s been proven that injuries to the rear or cerebellum tend to cause mortal damage, usually interrupting vital functions such as breathing or circulation.

In March a possible breakthrough to how we deal with brain injury was made. Watch the following video.

A case of Phineas Gage is certainly an interesting one. It has sparked a dialogue in the field of neuroscience and is a still prominent page or two in every chapter of books dedicated to studies of the brain and mental processes.

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