• Robb G. Best

The Strange Case of Phineas Gage, redux

In January of 2013, I wrote a post on one of neuroscience’s most famous cases. New details make it necessary to retell the story. It’s the tale of railroad foreman Phineas Gage.

Imagine a beautiful day on September 13, 1848 in the Vermont countryside. It’s about 4:30 in the afternoon. James K. Polk, ‘young hickory’, is the current president and the Civil War hasn’t ripped the country apart yet. The hottest thing in modern technology? The railroad train. To that end, a Rutland Burlington railroad crew is finishing up a long day of drilling holes several feet deep into the stubborn concrete granite.

Now the work of tamping explosive charges down into the holes has begun. When the explosives are discharged, the granite will be blown apart and the next section of track can be laid. It’s dangerous and deadly work if you’re a tamper. Mistakes are almost always fatal.

Five foot six Phineas Gage is a compact but strong tamper. He’s had his tamping rod engraved with his initials and built to his exact specifications by a blacksmith. It weighs 13.5 pounds, and it’s been honed to a sleek taper and carefully polished smooth. Looking at it, you might never guess its purpose. Gage is considered to be among the best at what he does. By all accounts a gentle and gregarious man, he is the kind of guy you can count on, the kind of guy you want as your friend or neighbor.

The dinner hour is fast approaching and an exhausted Gage leans over a newly drilled hole, takes up his custom made tamping rod and gives the explosive charge one last push.

But something has gone horribly wrong. The charge explodes on contact. In a split second, Gage’s iron rod has blown a hole through his left cheekbone and shot upwards behind his left eye socket, tearing through his prefrontal cortex, out the top of his skull. The rod lands with a thud some twenty-five yards away, sticking neatly upright in the ground, tapered end down.

Gage has been knocked violently backwards. Splattered in blood and bone fragment, somehow he remains conscious despite having lost what will later be referred to as "half a teacup’s worth of brain matter."

What happened next? According to Sam Kean in Phineas Gage: Neuroscience’s Most Famous Patient, Gage staggered to his feet, where he was helped to a nearby wooden oxcart and transported back to his hotel room in the town of Cavendish, Vermont.

When the doctor finally arrived, Gage was sitting on the front porch of the hotel to greet him. "Here’s business enough for you," he allegedly said. But his condition was worse than the jaunty greeting implied; for weeks, he suffered fevers and infection, his condition touch and go. But Gage didn't die in 1848. He recovered enough to last another twelve years.

Here is where the story gets fuzzy because of conflicting newspaper reports.

With the loss of a good portion of his prefrontal cortex, Gage is reported to have turned into a raving manic, driven by desire, prone to fights and fits of obscenity. His damaged upper brain meant he'd lost all self-restraint. The tamping iron had robbed him of more than just a half teacupful of brain matter; it had taken his willpower.

The problem with this account is there is really no solid evidence to substantiate it. All we really know is that Gage went on to make a living as a horse coach driver (a job that demonstrates a significant amount of manual dexterity), and died in 1860.

Because Gage's skull was preserved and available for public viewing, he has become a cause célèbre. People make pilgrimages from all over the world to see it at the little Warren Anatomical Museum at Harvard.

This includes neuroscientists, who have recently analyzed Gage’s skull using sophisticated fMRI technology. Their goal? To figure out which region of his brain was destroyed, what was the net effect on his rational decision-making, and what was the subsequent effect on his willpower.

But the skull was badly damaged by the tamping rod and the entry and exit holes are jagged and asymmetrical. Many bone fragments are missing. This makes any plotting of the tamping rod's exact path inconclusive. Despite specific claims made about Gage, the lack of evidence puts this case more in the realm of speculation than hard science.

So it’s unlikely we’ll ever understand Phineas Gage's frame of mind after his bizarre accident. But one thing is certain: he had one heck of a headache.


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