Aged 25 and working on the US railroad in Vermont in 1848, Phineas Gage was lucky to survive when a three foot long, tampering iron was propelled through his skull! The blast was caused by Gage neglecting to place a layer of protective sand between the fuse of the dynamite and the tampering pole. Remarkably Gage survived, at the time of his injury he remained conscious and did not even report any pain. He was treated by Dr. John Martyn Harlow, who cared for him during his recovery.
Whilst Gage was recovering well physically, Dr. Harlow noticed changes in his demeanour. An extract from the Doctor’s medical notes reads,
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’.
It appeared that post his brain injury Gage quite literally became a new man, and this was not a change for the better. Gage died aged 37 after the onset of severe epileptic seizures, no examination of his brain took place at his death. However, his body was exhumed in order that his skull could be examined. From this it has been possible to deduce which brain areas were more likely to have been damaged, which might have implications for the role of particular areas involving personality.
It is likely that the anterior frontal cortex was most significantly damaged. It was the first real case that gave strong evidence that frontal lobes are likely to be important in aspects of human nature such as personality, decision making, and moral approach.
It seems likely now given some recent evidence that Gage did learn to adapt to the changes in his personality and those aspects reported by Harlow might have been only short term. This would be expected as generally adaptation occurs following brain injury, the brain is highly plastic in its nature, which means that even the most severe of injuries can become less impacting on mental and physical wellbeing over time.
It’s important that we remember that this is a single case study, based on evidence from well over one hundred years ago. It makes a nice story to tell in class and keeps people interested, but we aren’t studying history. There was never any real information collected based on the actual physical injuries to Gages brain, if this type of injury occurred today they could have popped him into an MRI scanner and had a proper look at what was going on. Alas, psychologists have relied on mere speculation to develop their theories of brain and personality based on Gage’s case. It is pretty bloody cool though.