Miracle survivor Phineas Gage

Still a case for neuroscience

Created date

May 25th, 2010

At 4:30 one summer afternoon in 1848, Phineas Gage was in the midst of blasting bedrock from the Green Mountains near Cavendish, Vt., to make way for new tracks along the Rutland & Burlington Railroad. In a matter of seconds, this strong, dependable foreman s life would change forever. [caption id="attachment_12013" align="alignright" width="280" caption="Daguerreotypes are produced as mirror images, so the photo here of Phineas Gage, as shown, has been reversed to reflect a naked-eye depiction of the subject. (Photo copyright Jack and Beverly Wilgus)"]

Patron saint of neuroscience

Some say it all started with this man, who astonishingly had the presence of mind to sign out from work as he lay bleeding in a cart headed for the town doctor. John Fleischman, author ofPhineas Gage: A Gruesome but True Story about Brain Science (Houghton Mifflin, 2002), goes so far as to canonize him the patron saint of neuroscience. Phineas is important in many ways, especially since he comes along just as doctors begin to figure out how the brain works, he says. Most significant is that his is the first documented case of behavioral change due to a head injury. While Gage made a full physical recovery, thanks in large part to his physician, John Harlow, those close to him sensed that he wasn t the same mentally. This railroad foreman, who before the accident managed a 60-man crew, afterward had trouble getting along with anyone save for animals and children. Around most others, he was often ill-tempered and foul-mouthed.

Focus on the frontal lobe

According to Fleischman, herein lies one of the many lessons that Gage has taught medical science. The location of his injury along with his change in behavior shed light on the functions for which the frontal lobe is responsible. [caption id="attachment_12012" align="alignright" width="280" caption="Phineas Gage s life cast and skull are the most popular exhibits at Harvard University s Warren Anatomical Museum in Boston, Mass. Right after the accident, Gage was said to have remarked to one of the town physicians, Well, here s work enough for you, Doctor. (Photo courtesy of the Warren Anatomical Museum)"][/caption] Probably one of the biggest things that we learned from him was that personality, executive decisions, and social learning are all hardwired to the front of our brains, he explains. It s with this part that we make judgments and interact socially with others. But perhaps most amazing to physicians of his day was the fact that he survived at all something that Fleischman says is still beyond calculation and largely the product of luck. Dr. Henry Bigelow was so skeptical that, in 1850, he invited Gage to Boston to examine him personally. There Gage allowed him to make a cast of his head, which currently resides at Harvard University s Warren Anatomical Museum along with his skull and tamping iron. In addition to the thousands of visitors who file past this exhibit for a look at Phineas and his world-famous head injury, neuroscientists around the country request access to his skull to conduct studies of their own. Gage remains important to modern medicine because he is literally the textbook example of post-traumatic personality change, says Dominic Hall, curator of the Warren Museum. For the most part, he was able to live a relatively productive life after the accident, and I think that drives a lot of people to study him. Since at least the early 1980s, radiologists have performed CAT scans of the skull, and as recent as 2005, one group published their findings in an issue ofThe New England Journal of Medicine. Even so, Fleischman notes that Gage raises as many questions as he does answers. One of the things that Phineas did in the time between the accident and his death in 1860 was he drove a stage coach in Chile, he says. Did his brain injury affect his ability to learn Spanish? Did he drive recklessly? I would love to answer questions like these. To this day, his case remains a blend of knowledge and mysteries yet explored. More than 150 years ago, he set us on the path to understanding the human brain, and as medical imaging technology progresses, we re sure to learn more. Certainly, Phineas Gage was lucky to have survived such an injury, and medical science equally as fortunate to study him today. [caption id="attachment_12011" align="aligncenter" width="620" caption="This three-foot, seven-inch tamping iron shot through Phineas Gage s head. He carried the 13-pound bar everywhere he went for the rest of his life and was buried with it upon his death in 1860. Though the inscription commemorates the day of the accident as September 14, 1848, it actually occurred on September 13. (Photo courtesy of the Warren Anatomical Museum)"][/caption]