Phineas P. Gage (1823 - May 21, 1860) was a railroad worker who suffered a traumatic brain injury which inflicted severe damage to parts of his frontal lobes during a work accident. He survived but had a markedly altered personality, providing some of the first clues that specific parts of the brain, particularly the frontal lobes, might be involved in specific psychological processes involved with emotion, personality and problem solving.

Gage's injury

On September 13, 1848, Phineas Gage was working outside the small town of Cavendish, Vermont on the construction of a railroad track where he was employed as a foreman. One of his duties was to set explosive charges in holes drilled into large pieces of rock so they could be broken up and moved. This involved filling the hole with gunpowder, adding a fuse, and then packing in sand with a large tamping iron. When Gage was momentarily distracted, the tamping iron sparked against the rock and ignited the gunpowder, causing the iron to be blown through Gage's head with such force that it landed almost thirty meters behind him.

Life cast and skull of Phineas Gage

The 4-foot-long tamping iron entered his skull below his left cheek bone and exited after passing through the front part of the frontal lobes (specifially, the ventromedial areas of the prefrontal cortex). Remarkably after such a dramatic accident, Gage was speaking within a few minutes and managed to sign off his time sheet and walk home, where he sat outside and waited for the doctor. After a seemingly complete recovery from such a serious injury, and due largely to the work of Dr. John Harlow, Gage was soon back at work.

However, whereas previously he had been hard-working, responsible, and popular with the men under his charge, his personality seemed to have been radically altered after his accident. Dr Harlow reported that:

[Gage was] fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was 'no longer Gage'.

J. M. Harlow, 1868 (Publications of the Massachusetts Medical Society 2: pp. 339-340)

Gage led a checkered life after his injury, and at one time was part of P. T. Barnum's travelling circus, showing his injury, and the tamping iron which caused it, to the fee-paying public.

Significance for Brain Science

Gage's case was among the first evidence that damage to the frontal lobes could alter aspects of personality and affect socially appropriate interaction. Before this time the frontal lobes were largely thought to have little role in behaviour.

Neurologist Antonio Damasio has written extensively on Gage, and various patients he has studied with similar brain injuries. In a theory he calls the 'somatic marker hypothesis', Damasio suggests a link between the frontal lobes, emotion and practical decision making. He sees Gage's case as crucial in the history of the brain sciences, arguing that Gage's story "was the historical beginnings of the study of the biological basis of behavior".

It is occasionally suggested that Gage's case inspired the development of frontal lobotomy, a now-obsolete psychosurgical procedure that blunted emotional response and affected personality. However, historical analysis seems not to be able to support this claim. It seems that consideration of Gage's injury had little influence on the development of this practice.

There is no doubt that Gage suffered the accident, and that it had a dramatic effect on his life. Nevertheless, Australian psychologist Malcolm Macmillan illustrates in his book "An Odd Kind of Fame: Stories of Phineas Gage", the account that has entered both scientific and popular discourse is flawed. Firstly, we know very little about Gage's personality and habits before the accident, and secondly the after effects were not, contemporaneously, reported as being quite so dramatic.

Within twenty-four hours of the accident, a first report was (anonymously) printed in the Ludlow, Vermont Free Soil Union. Having described the accident, the paper reports that "the most singular circumstance connected with this melancholy affair is, that he was alive at two o'clock this afternoon, and in full possession of his reason, and free from pain."

Harlow mentioned very few psychological changes in his initial report of 1848. Henry Bigelow, Professor of Surgery at Harvard, wrote in 1850 that Gage was "quite recovered in faculties of body and mind." It was Harlow's account of 1868 that introduced the now-textbook changes. Later writers began to embellish even more, adding drunkenness, braggadocio, a vainglorious tendency to show off his wound as part of Barnum's Traveling Exhibition and an utter lack of foresight - all unmentioned by Harlow.

Gage's skull is currently held by the Warren Anatomical Museum at Harvard Medical School in Boston.

See also

• cognitive neuropsychology

Further Reading

• Damasio, A.R. (1995) Descartes' Error : Emotion, Reason, and the Human Brain. ISBN 0380726475.
  
• Fleischman, J. (2002) Phineas Gage: A Gruesome but True Story About Brain Science. ISBN 0618052526
  
• Damasio H., Grabowski T,. Frank R., Galaburda AM., Damasio AR. (1994) The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264 (5162), 1102-5.
  
• Macmillan, M. (2002) An odd kind of fame: Stories of Phineas Gage. ISBN 0262632594.
• The Tale of Phineas Gage, Digitally Remastered
• More on Phineas Gage Lymphangitis after Self-Administration of ... from the New England Journal of Medicine. Login required.

External links

• Phineas Gage homepage
• Phineas Gage roadside memorial
• Analysis of Gage's influence on psychosurgery