The Amazing Case of Phineas Gage
Significant Changes in Gage's Character
Phineas Gage (1823-1860) provided a landmark medical case in brain injury. He was a railroad construction foreman who got injured in the head. Despite the severe injury, Gage miraculously survived. This incident started a series of medical studies that contributed to the development of modern neurology.
Phineas Gage's Accident
On September 13, 1848, Phineas Gage was performing his usual work when an accident occurred. His routine was to add gunpowder, fuse and sand together then compress the mixture with a large iron rod.
Unfortunately, Phineas forgot to add the sand one time and the explosive mixture blew to his face resulting in the iron rod piercing his head. It entered the side of his head and went out at the top. Amazingly, Gage never lost consciousness after the accident. As a matter of fact, he was speaking a few minutes after and was able to travel to town three-quarters of a mile away to seek medical attention.
He was attended by physicians Dr. Edward Williams and John Harlow. They found him suffering from hemorrhage but his pulse was normal. A few days after the accident, Gage’s exposed brain got infected with ‘fungus’ and he was in a semi-comatose state. His family prepared his coffin but miraculously he recovered.
Personality Changes Noted in Phineas Gage
Two weeks after the accident, Dr. Harlow let out 8 fluid ounces of pus from the abscess which could have killed Gage had it leaked into the brain. On January 1, 1849, Gage seemed to appear normal again except that he exhibited very childish behavior.
Dr. John Harlow, the doctor who attended to Gage, said in his initial 1848 report, “The mental manifestations of the patient, I leave to a future communication.” In 1850, Henry Jacob Bigelow, Professor of Surgery at Harvard, made a second report on Gage’s condition. He stated that he was "quite recovered in faculties of body and mind." Bigelow’s report was considered as the official report by the medical community for the next 20 years.
Harlow countered Bigelow’s claims when he published in the Bulletin of the Massachusetts Medical Society in 1868 his latest findings on Gage. He stated that Gage may have enjoyed full reasoning abilities but the people around him particularly his wife noticed significant changes in his personality.
Harlow’s second report written in 1868 after he studied Phineas Gage's skull included a checklist of mental changes in Gage. Before the accident, Gage was industrious, responsible and “a great favorite” with the men. His employers thought he was “the most efficient and capable foreman in their employ."
But after his accident, the employers “considered the change in his mind so marked that they could not give him his place again". His friends even remarked that he was “no longer Gage”.
The damage to Gage’s skull was said to occur in three places: a gash under the left zygomatic arch or cheekbone; second, in the orbital bone behind the eye and lastly, in the top part of his head when the iron rod went out of his skull. The third wound was the largest and it never healed.
The damage to Gage’s frontal cortex had caused complete loss of social inhibitions, which consequently led to unacceptable behavior. The iron made a frontal lobotomy on Gage.
Phineas Gage was never the same again but his miraculous recovery never ceases to amaze the medical world. Gage's case is truly a source of wonder. It contributes to the development of modern neurology.
Phineas Gage
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