Gage was working as a construction foreman for the Rutland and Burlington Railroad, rock blasting for a new railway line in Vermont. An accidental explosion drove a tamping iron, 3 cm (1¼ in) in diameter and 109 cm (45 in) long, through Gage's head. It entered at the left cheek, passed upwards through the brain and exited the skull through the frontal bone close to the midline. Reconstruction of the injury from damage to the skull using modern neuroimaging techniques suggests that the ventral and medial areas of the prefrontal cortex, including the anterior cingulate gyri, were extensively damaged in both cerebral hemispheres (Damasio et al. 1994). Gage regained consciousness almost immediately and although he was debilitated for a time by infection he eventually recovered his physical health. Before the accident he had been conscientious, well socialized, and was said to have a shrewd business sense. His employers considered him the 'most efficient and capable' of their workers. The injury left him with no impairment of movement or speech, and his learning, memory, and natural intelligence seemed to be only partially impaired. However, his personality and mood had undergone severe changes. He had become irreverent, impatient, profane, irresponsible, insensitive to others, and unable to stick to plans he made for himself (Macmillan 2000). From 1851 until 1859 he worked in a relatively menial capacity in livery stables, looking after horses and driving coaches. He died after developing epilepsy in 1860 and was buried without a post-mortem examination of his brain.
Soon after the accident, news of Gage's personality change reached American phrenologists who had a ready explanation for it: the 'organs of benevolence and veneration' situated in the frontal lobes had been destroyed. However, orthodox medicine was in the process of rejecting phrenology and with it, for a time, the concept of localization of function in the cerebral cortex. Influential clinicians like Henry Bigelow played down Gage's antisocial behaviour and its possible significance (Barker 1995). Seven years after Gage's death, John Harlow, the railway physician who had treated him at the time of the accident, arranged for the body to be exhumed so that he could study the skull. He published an account of his findings which revealed to the medical community for the first time the selective effect of the brain damage on Gage's character, sparing movement and language (Harlow 1868). The appearance of this report within a few years of the discoveries of Broca, Wernicke, Ferrier, Fritsch, and Hitzig undoubtedly contributed to the renewal of interest in functional localization in the second half of the 19th century. A detailed theory of the functions of the frontal cortex in terms of its role in attention, planning, decision making, socialization and the control of emotional expression had to await the 20th century, for the behavioural effects of frontal lobotomy and the advent of neuropsychological and neuroimaging techniques. Although his behaviour could not be understood in his own time, Phineas Gage has become the classical example of the psychological effects of damage to the ventromedial frontal cortex.
(Published 2004)
— Stuart Butler
- Bibliography
- Barker, F. G., II (1995). 'Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localisation'. Journal of Neurosurgery, 82.
- Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M. and Damasio, A. R. (1994). 'The return of Phineas Gage: clues about the brain from the skull of a famous patient'. Science, 264.
- Harlow, J. M. (1868). 'Recovery from the passage of an iron bar through the head'. Publication of Massachusetts Medical Society, 2.
- Macmillan, M. (2000). 'Restoring Phineas Gage: a 150th retrospective'. Journal of the History of Neuroscience, 9.
