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Phineas Gage's Brain Injury

Article #96 • Written by Alan Bellows

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In 1848, a twenty-five-year-old construction foreman named Phineas Gage won nationwide fame by way of a hole in his head. While working on a railroad project in Vermont, he experienced a severe brain injury when a three-foot-long, fourteen pound tamping iron was violently propelled through his skull. Astonishingly, he lived to tell about it.

At the time of the accident, one of Gage's duties was to set explosive charges to remove unwanted sections of large rocks. Typically, a long, narrow hole was drilled into the rock which was then filled with gunpowder and ignited. Before lighting the fuse, the hole was topped off with sand, and a three-foot-long, 1.25" diameter iron tamping rod was used to pack down the gunpowder. However on 13 September 1848, Gage was distracted momentarily while in the process of preparing a blast, and he neglected to add the protective barrier of sand. When he thrust the iron tamper into the hole in the rock, it created a spark, and the gunpowder was ignited.

The resulting explosion propelled the fourteen pound iron rod straight into the air with the force of a cannon, causing it to pass through Gage's skull in the process. It entered through the bottom of his left cheekbone and exited through the top of his head, then continued to fly in an arc across the sky, landing almost 100 feet behind him.

The unscheduled explosion got the attention of his fellow railroad workers, who rushed over to see if there was a problem. What they found was Phineas Gage slumped on the ground with a hole through his skull. Amazingly, the man was still alive and breathing. Even more amazingly, within moments his eyes were open and he was speaking to his fellow workers. The injured Gage was quickly loaded into a cart, and transported back to his boarding house, some 45 minutes away.

When Dr. John Martyn Harlow arrived, Phineas was conscious and had a regular heartbeat, and both of his pupils reacted to light normally. He was reported to be "in full possession of his reason, and free from pain." He was under the care of Dr. Harlow for ten weeks, at which point he was sent home to Lebanon, New Hampshire. But while he was recovering, the doctor noted some changes in the man's demeanor and personality. People who had known him before the accident described him as hard-working, responsible, and popular with his workers, but after the traumatic injury, Phineas Gage was not the same man.

In regards to his patient, Dr. Harlow wrote:

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'.

Several months after the accident Gage felt strong enough to return to work, yet due to his personality changes, his previous employers would not entrust him with the foreman position he had previously held. In the following years, he took various jobs caring for horses, driving stagecoaches, and doing some farm work. He also briefly appeared at a museum in New York which was curated by the infamous P. T. Barnum, alongside the tamping iron which had impaled his brain.

Not much is known about his years after the injury, but eleven years after the accident, when he was aged thirty-seven years, Gage began to experience epileptic seizures. He died several months later, on 21 May 1860. His brain was not subjected to any medical examination at that time, but seven years later his body was exhumed so that his skull might be studied. It has since been subjected to much scrutiny.

It was determined that damage occurred to Gage's skull in three places: There is a relatively small area under the cheek bone where the tamping iron first impacted, the orbital bone behind the eye socket, and very large hole where the iron rod emerged. The bone fragments over the exit wound were very skillfully put back in place by Dr. Harlow-- so much so that it was hardly visible from outside the skull-- but the original hole was about three and a half inches long by two inches wide.

There is still some controversy over the extent of damage to Phineas' brain. It is certain that it passed through the anterior frontal cortex and white matter, but it has not been determined with certainty whether the lesion involved both frontal lobes or was limited only to the left side. In any case, the damage caused by the accident was roughly equivalent to a frontal lobotomy.

Today, Gage's skull and the tamping rod which damaged it are on permanent display at Harvard’s Countway Library of Medicine. The incident did much to advance the field of neurology, as it was among the first evidence suggesting that damage to the frontal lobes could alter aspects of personality and affect social skills. Before Gage's brain injury, the frontal lobes were largely thought to have little role in behavior.

Article written by Alan Bellows, published on 16 January 2006. Alan is the founder/designer/head writer/managing editor of Damn Interesting.

Article design and artwork by Alan Bellows.
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42 Comments
JustAnotherName
Posted 17 January 2006 at 06:03 am

Very interesting. What I REALLY find astonishing is that they did not save his brain.


Marius
Posted 17 January 2006 at 10:16 am

I guess he needed that job like he needed a hole in the head.


wasoxygen
Posted 17 January 2006 at 11:37 am

In his book Descartes' Error, Antonio R. Damasio uses this case in his argument that emotion plays an essential role in reason. The book quotes the first doctor who saw Gage, about an hour after the accident: "He at that time was sitting in a chair upon the piazza of Mr. Adams' hotel, in Cavendish. When I drove up, he said, 'Doctor, here is business enough for you.'"


thatsmyname
Posted 17 January 2006 at 05:56 pm

As a Psych Major I can tell you this case is good for 2..long, long lectures.

-L.


Hayley
Posted 24 May 2006 at 08:07 pm

We read about this in both philosophy and psychology. Philosophy, in particular, was interesting, as it used this example to illustrate that personal identity was at least somehow related to the physical aspects of the mind (materialist or dualist theory) and that the physical had an effect upon the mental if one could change the other. Seems obvious, but there are strong arguments against such.


Shandooga
Posted 02 June 2006 at 10:55 am

[insert amusing quip here] :-)


Mark
Posted 28 September 2006 at 05:02 am

Marius said: "I guess he needed that job like he needed a hole in the head."

Marius, you genius!


HarleyHetz
Posted 28 September 2006 at 05:08 am

This reminds me of a story about a local construction worker climbing a ladder behind a co-worker with a nail gun that had the trigger "locked on". It was common practice to tie something around the trigger of your nail gun so all you had to do was "slap" the gun against whatever you wished to nail and a nail would be fired out of it (it probably still is, but I'm not in construction any more so I can't say for sure). The guy going up first stopped for something, and the guy below him ran into the head of the gun, it fired, and drove the nail all the way into his head. He lived, and in fact, when he went in to have the nail removed, the doctor said that if he were going to insert a nail into his own head, this would be the EXACT spot that he would put it because it would cause absolutely no damage. Reports several years later are that the guy suffers no ill effects from the incident what-so-ever. I can remember this story going around back then. (This was some 15 - 20 years ago)

DI stuff the human brain.


another viewpoint
Posted 28 September 2006 at 05:19 am

...okay, Gage survived a steel rod getting blasted through his head. Hard to believe that the rock blast didn't do more bodily damage. Let alone, when an object enters the body at some velocity...it may only leave a pinhole on the entry...but it leaves a large crater on exit. Once again the laws of nature are obscured. Then again...I never studied law.

Marius said: "I guess he needed that job like he needed a hole in the head."

...and after the previous post left by HarleyHetz, ...I would have to say..."you hit the nail right on the head!"


nukebass
Posted 28 September 2006 at 06:30 am

He had survived this awful accident to be an a**hole to the rest of his life?

Man... sometimes God has some strange sense of humor :-P


Shandooga
Posted 28 September 2006 at 07:34 am

Marius said: "I guess he needed that job like he needed a hole in the head."

That was mean. Funny, but mean.


djsteiniii
Posted 28 September 2006 at 08:01 am

thatsmyname said: "As a Psych Major I can tell you this case is good for 2..long, long lectures.

-L."

I can relate! This was a topic of discussion for me both in Sociology (undergrad) and in Memory & Cognition (grad school). What a classic case of how physiology affects thinking and behavior (and a damn good DI article, too!).


djsteiniii
Posted 28 September 2006 at 08:18 am

Oh, I remember hearing in school that the doctor who treated Gage could feel the tips of his own fingers inside Gage's head when he inserted them in the opposing holes. Reminds me of a Far Side cartoon :-D.


SparkyTWP
Posted 28 September 2006 at 09:52 am

I'm pretty amazed that his wound didn't become infected, especially this happening in pre-civil war times.


orielbean
Posted 28 September 2006 at 10:14 am

@Another Viewpoint - I bet the reason there wasn't much rock damage was because the full force of the asplosion was shaped behind the rod, and not to the surrounding rock.


sulkykid
Posted 28 September 2006 at 12:42 pm

SparkyTWP said: "I'm pretty amazed that his wound didn't become infected, especially this happening in pre-civil war times."

It possibly was cauterized by the burning gunpowder.


blingblang
Posted 28 September 2006 at 12:50 pm

Marius said: "I guess he needed that job like he needed a hole in the head."

Hilarious!!!


circumstance
Posted 28 September 2006 at 12:51 pm

We watched a video about Gage in seventh grade. As a direct result, nine years later, I am finishing up a degree in psychology. DI stuff.


Kevin
Posted 28 September 2006 at 02:27 pm

So that's what NIN's Head Like a Hole is all about. JK


Metryq
Posted 28 September 2006 at 03:19 pm

another viewpoint said: "when an object enters the body at some velocity…it may only leave a pinhole on the entry…but it leaves a large crater on exit"

A larger exit wound is because a bullet is deformed on entry, a feature specifically built-in to "hollow point" rounds. An iron tamping rod is harder than most bullets, plus the length would give it strength along the axis of travel. It must have been moving very fast to pass through Gage's head. If it had slowed down just a bit, or been slower to start with, the levering action of the rod might have snapped his head back and torn it off. In the movie ERASER victims hit by a rail gun projectile flew backwards. In reality, victims hit with such a high velocity round might not even be aware of it at first, let alone fly off the ground. Slow is what does the damage.


Drakvil
Posted 28 September 2006 at 03:22 pm

He probably did have some amount of infection from that. Doctors in those days were not in the habit of doing things like washing their hands between patients, or even before surgery. But infection and the resulting pus that formed was considered a normal part of the healing process, and they made no special note of anything like that. To them it was no more uncommon than the scab that forms over a cut.

I think it's interesting that he didn't start suffering seizures until 11 years after the accident. After I was struck by a car and had my skull fractured, it took 7 years before I had a seizure that was recognizable as such.


Coherent
Posted 28 September 2006 at 04:38 pm

Stuff like this makes me want to cry. Yes, I've heard about Gage before, so it's nothing new. It's very Flowers For Algernon-ish. Imagine having a wound, just a minor wound, and when you wake up, everything is the same. You feel the same, you think the same, and you feel better! But you aren't the same... and slowly you realize this, but only because people tell you it's true. You're not the same person that you were. Parts of your soul exited the roof of your head, and you never even knew they were there until they were gone.


etonalife
Posted 28 September 2006 at 07:20 pm

So fragile, and so resilient. Life. DI.


SparkyTWP
Posted 28 September 2006 at 08:39 pm

sulkykid said: "It possibly was cauterized by the burning gunpowder."

Yeah, you're probably right.

Drakvil said: "I think it's interesting that he didn't start suffering seizures until 11 years after the accident. After I was struck by a car and had my skull fractured, it took 7 years before I had a seizure that was recognizable as such."

Do you know the medical reason for this? I find it weird that something like this comes up years after the fact.


just_dave
Posted 28 September 2006 at 09:57 pm

... the damage caused by the accident was roughly equivalent to a frontal lobotomy.

I always thought that frontal lobotomies were usually administered to eliminate or reduce violent behaviors. Didn't this accidental lobotomy do pretty much the reverse?


Drakvil
Posted 28 September 2006 at 11:32 pm

SparkyTWP said: "Yeah, you're probably right. Do you know the medical reason for this? I find it weird that something like this comes up years after the fact."

I can extrapolate from my experience - the brain takes quite a while to heal from injuries, and it took several years for the scar tissue that caused them to fully form. That coupled with the almost undetectable outer symptoms of the type of seizures I had made it difficult for anyone to recognize as a seizure because I would not shake, and I just looked like I was lost in thought for a few seconds. But even that level of seizure was damaging the brain tissue around the scar tissue that caused the seizures. If I had not had the corrective surgery, I would eventually have died from the brain damage caused by undetected seizures that the medication I was on didn't control - only hid. So for Mr. Gage, with the severe extent of damage, and an open wound site as opposed to closed, it probably took quite a while for the full extent of scar tissue to form, and the seizures may have started much earlier than the 11 years - it just took longer for them to evolve into the type that is easily recognized as such (doctors now are much better than the ones then). I do think there is a good chance that brain damage from the seizures was the cause of his eventual death.

just_dave said: "I always thought that frontal lobotomies were usually administered to eliminate or reduce violent behaviors. Didn't this accidental lobotomy do pretty much the reverse?"

From what I have read about lobotomies (on this site and others), the goal of the lobotomy was to reduce or eliminate unwanted behavior, but that wasn't the direct result of the lobotomy... the direct result was a "change in the personality" [paraphrasing an earlier DI article about a 12 year old who was lobotomized for not wanting to go to bed early and other teenage behaviors] and I would theorize that said "change in personality" would usually as a by-product affect the behavior people were complaining about in some manner.


HarleyHetz
Posted 29 September 2006 at 06:14 am

[paraphrasing an earlier DI article about a 12 year old who was lobotomized for not wanting to go to bed early and other teenage behaviors] and I would theorize that said "change in personality" would usually as a by-product affect the behavior people were complaining about in some manner."

WAIT WHAT??? They did a labotomy on a 12 year old kid because he didn't want to go to bed early??? That's kind of taking "spare the rod" to the freaking extreme isn't it???


sulkykid
Posted 29 September 2006 at 07:54 am

HarleyHetz said: "WAIT WHAT??? They did a labotomy on a 12 year old kid because he didn't want to go to bed early??? That's kind of taking "spare the rod" to the freaking extreme isn't it???"

Follow the "howard Dulley's lobotomy" link above. This DI article is still generating comments.


orc_jr
Posted 29 September 2006 at 10:12 am

Metryq said: "A larger exit wound is because a bullet is deformed on entry, a feature specifically built-in to "hollow point" rounds. An iron tamping rod is harder than most bullets, plus the length would give it strength along the axis of travel. It must have been moving very fast to pass through Gage's head. If it had slowed down just a bit, or been slower to start with, the levering action of the rod might have snapped his head back and torn it off. In the movie ERASER victims hit by a rail gun projectile flew backwards. In reality, victims hit with such a high velocity round might not even be aware of it at first, let alone fly off the ground. Slow is what does the damage."

a bullet flies with such speed that when it enters the body it pushes a kind of air bubble in ahead and around it - imagine the gases surrounding a comet - and this "cavitation" causes a much larger area of tissue damage than the round itself, including the large exit wound.


Dave Group
Posted 30 September 2006 at 05:30 pm

It seems kind of a paradox that the human mind can suffer such devastating injury and still function to a great degree, yet even seemingly innocuous events (using your head in soccer) can have long-term and severe consequences.


Tink
Posted 30 September 2006 at 08:28 pm

orc_jr said: "a bullet flies with such speed that when it enters the body it pushes a kind of air bubble in ahead and around it - imagine the gases surrounding a comet - and this "cavitation" causes a much larger area of tissue damage than the round itself, including the large exit wound."

Yep, and to comment off topic (please forgive me, I live in Dallas) JFK was shot from behind, from overhead, six stories. The "entry" wound in the back of his head was 3x4 the "exit" wound to his throat, apxy 1x1. Now I'm not a conspiracy theory type person, but this gives room for speculation, no?


Drakvil
Posted 01 October 2006 at 08:48 pm

Tink said: "Yep, and to comment off topic (please forgive me, I live in Dallas) JFK was shot from behind, from overhead, six stories. The "entry" wound in the back of his head was 3×4 the "exit" wound to his throat, apxy 1×1. Now I'm not a conspiracy theory type person, but this gives room for speculation, no?"

I would imagine that the discrepancy is caused by the difference in tissue types... orc_jr's comment about the exit wound being larger than entrance is for soft tissues, like the torso or abdomen (or eggs and apples), while the shot with JFK was to the skull for entrance - bone makes a very stiff tissue and reacts differently, and the energy of the impact was conducted to the softer tissues beneath over a greater area. This would be akin to a meteor crater on the moon. Since the the velocity of the round is signifigantly different after is has penetrated that much of the head, the damage on the way out has changed. IMHO if the round was coming from the opposite end of the same trajectory, the wounds would look fairly similar.


Dottie1985
Posted 02 October 2006 at 03:59 pm

Ok...first off...

Marius said: "I guess he needed that job like he needed a hole in the head."

Hahahaha...(sarcasm is bliss)

I think that this is completely amazing. I heard this story from a friend of mine years ago and i didn't believe it...I figured it was one of those bulls*** stories that people make up and pass along to others. But now that I have all the information...it's still hard to believe! (Not saying that I don't.) This is a truly amazing story! This reminds me of the story that I seen on a health special a few years ago where a pregnant women fell over the railing of her upstairs to the downs stairs and landed on a microphone stand...that went straight through her abdomen! Now, you would of thought that this would of definately killed the baby and possibly the mother. It's just crazy how injuries happen like this..but they happen the right way...like the stand going through a certain spot that doesn't hit the baby or cause any long term affect to the mother. Definately DI!


cornerpocket
Posted 04 October 2006 at 08:48 pm

Word is that Phineas's wife left him and his friends abandoned him. He died penniless and pitiably and was no longer of interest to medicine, which, aside from academia, was the only 'science' around. It was in one of my graduate school texts that the 'personality change' wasn't really a 'new personality' as much as it was the loss of inhibitions and social self-awareness that was part of the 'old' one. That is, he didn't have a personality change as much as he lost what he had and became more animalistic, more crude, less civilized and controlled, etc. He was, after all, severely brain-damaged!! He took to drinking and thus couldn't hold a job in a carnival freak show...but he probably wasn't all that interesting either, once the wound healed. You see one tamping rod, you've pretty much seen them all... and the same is often said about beer sots.


Tink
Posted 05 October 2006 at 01:40 am

Drakvil said: "I would imagine that the discrepancy is caused by the difference in tissue types… orc_jr's comment about the exit wound being larger than entrance is for soft tissues, like the torso or abdomen (or eggs and apples), while the shot with JFK was to the skull for entrance - bone makes a very stiff tissue and reacts differently, and the energy of the impact was conducted to the softer tissues beneath over a greater area. This would be akin to a meteor crater on the moon. Since the the velocity of the round is signifigantly different after is has penetrated that much of the head, the damage on the way out has changed. IMHO if the round was coming from the opposite end of the same trajectory, the wounds would look fairly similar."

Thank you, that makes sense. :)

Dottie1985 Says: "...This reminds me of the story that I seen on a health special a few years ago where a pregnant women fell over the railing of her upstairs to the downs stairs and landed on a microphone stand…that went straight through her abdomen! Now, you would of thought that this would of definately killed the baby and possibly the mother. It's just crazy how injuries happen like this..but they happen the right way…like the stand going through a certain spot that doesn't hit the baby or cause any long term affect to the mother. Definately DI!"

I've seen this story also, maybe on one of those touched by angels or miricle shows.Yes it was truly amazing.

HarleyHetz, I also seem to remember a story just this past year on Yahoo! news about a guy who went to the hospital last year complaining of a horrid headache...come to find out he had 12 sheetrock nails in his head from a power gun. It seems that he was trying to commit suicide But didn't feel the nails pierce his skull, and thought the gun was broke or something,so he dropped that plan and just went on about his business, till the headache kicked in about a week later. Ha!


a pirates life 4 me
Posted 10 January 2007 at 05:30 pm

i am related 2 phineas gage and i am not kidding....hes my great great great great great great great great great uncle.......my mom is a gage but my dad isnt obviously so yeah.........i think its amazing that he lived 8 more years


a pirates life 4 me
Posted 10 January 2007 at 05:31 pm

im so bored


calista
Posted 20 March 2007 at 01:52 pm

circumstance said: "We watched a video about Gage in seventh grade. As a direct result, nine years later, I am finishing up a degree in psychology. DI stuff."

hey, i was just wondering if you could tell me please the exact title and year of the movie...i need the video really desperatly for a huge paper i am writing about phineas gage,
so i hope to hear soon from you,
calista


Lord_Lothar
Posted 25 May 2007 at 06:30 pm

Yeah, we examined this case in several philosophy classes in college. The funny thing was that one of my classmates in several of these classes was a direct descendant of Phineas Gage. Talk about your small world, eh? And that, dear friends, is my claim to fame.


CountriKitten
Posted 20 December 2007 at 01:56 pm

Tink said: HarleyHetz, I also seem to remember a story just this past year on Yahoo! news about a guy who went to the hospital last year complaining of a horrid headache…come to find out he had 12 sheetrock nails in his head from a power gun. It seems that he was trying to commit suicide But didn't feel the nails pierce his skull, and thought the gun was broke or something,so he dropped that plan and just went on about his business, till the headache kicked in about a week later. Ha!"

He was actually high on meth when he was playing pin-cushion with himself & a nailgun. If you look up articles online about the incident, they are all published in march or april, and often they make reference to the man being "suicidal & high on meth last year" so it was at least 3 or 4 months before he sought treatment.


violentjallday
Posted 04 April 2008 at 05:23 pm

yall stfu i know more about phineas than all yall bitches


violentjallday
Posted 04 April 2008 at 05:28 pm

u aint related to him and tink u stupid

a pirates life 4 me said: "i am related 2 phineas gage and i am not kidding….hes my great great great great great great great great great uncle…….my mom is a gage but my dad isnt obviously so yeah………i think its amazing that he lived 8 more years"

sike!


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