The curious case of Phineas Gage

Take a good look at the vintage photograph above. For a time well before selfies, when taking photographs was rare, why is his left eye closed? Furthermore, what is the strange object he is holding in his hand?

Original owners of the photo themselves could not provide answers to those questions themselves. Jack and Beverly Wilgus, collectors of vintage photographs, had come in possession of it some 30 years ago but couldn’t figure out the context behind it. That is until, in 2007, Beverly posted it on Flickr, asking if anyone has a clue about the identity of the man. Soon enough one of the commentators suggested that the man in the image might be one Phineas Gage. Beverly Wilgus knew nothing about the man but soon she discovered a quite fascinating story.

The story

Over time Phineas Gage has attained a somewhat celebrity-like status, at least among neuroscience and psychology experts and enthusiasts.  The reason he held it was rather peculiar, to say the least.

Wednesday the 13th of September 1848 was supposed to be a routine working day for Phineas, a 25 year old railroad foreman in Cavendish, Vermont. He and his construction team were laying the tracks for the future railroad. Phineas’ job consisted of determining which rocks should be removed, i.e. blasted, and putting the igniting powder, fuse, a layer of sand and gently condensing it with a crowbar-like iron rod before blasting.  However at 4:30pm that day Gage, possibly distracted, began tamping before the sand had been poured. The tamping iron struck the rock causing a spark to light the powder. It resulted with an explosion which propelled the 1 meter long iron bar out of the hole and completely through his head. It entered point first, under the left cheekbone, penetrated the base of the skull, just behind the bony socket of the left eye. Finally it emerged at the top of the skull and landed some 20 meters behind him.

After being rendered unconscious within minutes he regained consciousness and discovered that his crewmen had carried him to a nearby inn and summoned a physician to examine him. He was well enough to stand and explain what happened to him while they waited for the doctor to arrive. When doctor Edward Higginson Williams arrived at the scene Gage greeted him with “Doctor, here is business enough for you”. Another doctor, John Martyn Harlow, arrived about an hour later and he and Williams managed to stem the profuse hemorrhage.

After initial, nearly fatal, infection which dr. Harlow managed to cure, Gage remained under dr. Harlow’s care for next three months. By then he was well enough to return to his family farm and lead a normal life.

 

phineas gage

 

 

Normal life?

However, dr. Harlow noted that although Gage physically recovered his friends found that he is “no longer Gage” as he would describe twenty years later in Bulletin of the Massachusetts Medical Society. Furthermore, his contractors “who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again.” According to Harlow he lost his job and his friends described him as “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 of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating”. He reportedly also become violent and lost all of his inhibitions and started behaving inappropriately in social situations.

After losing his job Gage is said to have traveled around towns, making public appearances with his tamping iron, to which he had apparently become very much attached. After many years driving stagecoaches on routes in United States and even in Chile, Phineas decided in June 1859 to return to his family. He had had ‘some kind of illness and arrived in a weakened condition’ as Harlow writes in 1868. Several months elapsed before he was strong enough to work on farms south of San Francisco. Not long after, in February 1860, and after ploughing the day before, ‘while sitting at dinner, he fell in a fit’. ‘Unquestionably epileptic’, his seizures gradually increased in severity and on 18 May he returned to his mother’s house where he suffered a successive series of them. By May 21st 1860 the seizures had killed him, at age 36.

Facts and fictions

The case of Phineas Gage became so famous in scientific circles because it was the first case that suggested a link between brain trauma and personality change. At that time the exact function of certain regions of the brain in particular and the brain itself in general was largely unknown so it helped scientists of the mid-19th century realize for the first time that personality and certain behaviors are controlled by specific regions of the brain.

However, as psychologist Malcom McMillan demonstrates in his research, although recent CT scans and 3D model reconstructions of the Gages’ skull have recently been made and we do have a clue what regions of the brain might have been incapacitated, because an actual autopsy of the brain hasn’t been made and because of unreliability of the primary sources, i.e. the doctors who examined him, it is impossible to say what is fact and what is fiction regarding personality alterations.

McMillan suggests and tries to demonstrate that Gages’ behavioral changes were temporary and that he may have made a “social recovery”.

Whatever may be the case, his story is worth remembering, he points out, because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth.

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