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The Curious Case of Phineas Gage

Updated on September 16, 2012

The brain plays major roles in cognitive functions. Different areas of the brain support different cognitive functions as evident in the case of Phineas Gage. After his accident, Gage suffered major personality changes due to the damage to different parts of his brain. Gage’s case confirmed researchers’ conclusions that injury to the prefrontal cortex could cause personality changes, while other neurological functions were left undamaged (Scott, 2006). Phineas Gage’s accident was one of the first instances in which evidence was provided that human social cognition and personality was related to the frontal cortex.

Curious Case of Phineas Gage

Gage’s Accident

In the fall of 1848, twenty-five year old, Phineas Gage was a construction foreman on a crew of workers, who at the time were digging out rocks to clear the area for the railroad tracks. In order to excavate these rocks a hole had to be drilled into these rocks and stick of dynamite implanted inside the rock, and then the hole refilled with sand and plugged by use of a tamping iron (Costandi, 2010).

On the fateful day of September 13th 1848, Gage and his crew were working on a section of railroad near Cavendish, Vermont. Gage was finishing up placing explosives into a boulder when a spark from Gage’s tamping iron set off explosive powder. This caused the tamping iron to be driven at great force through his skull. The tamping iron came in below the left cheek bone and left out the top of his head. A little more about the tamping iron: it was about 3ft 8 inches in length, weighed more than 6 kg and was about 1.25 inches in diameter. According to doctor John Martin Hollow, who later attended to Gage, was found “several rods behind him where it was afterward picked up by his men smeared with blood and brain.”

Treatment & Recovery of Gage

Although it is unknown if Gage lost consciousness, it was documented that he was capable of walking within moments after the accident and was sitting upright in a cart that transported him to his home after his great turmoil. He was attended to by physician John Martin Hollow, who dressed Gage’s wounds by removing the smaller pieces of skull fragments and placing the larger pieces of skull fragments into the correct location after they had been moved by the projectile. Hollow secured the bigger wound with adhesive belts, and enclosed the hole in his head with a wet poultice.

After a couple of days after Gage’s unfortunate accident, the part of his brain that was exposed turned out to be septic and “he lapsed into a semi-comatose state” (Macmillan, 2009). Gage recovered. Approximately two weeks after the incident, Gage’s doctor, released about 8 ounces of fluid from an abscess located under his scalp, and according to all accounts Gage was back to leading an apparently normal life by January 1st, 1849 .

After Effects of Gage’s Injury

According to Doctor Harlow, Gage did keep “full possession of his reason” after the accident. Shortly after his recovery, Gage’s wife and others began to notice intense personality changes (Costandi, 2010). Dr. Harlow did not document the “mental manifestations” of his brain injuries until 1868 in the Bulletin of the Massachusetts Medical Society, in which he stated:

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. He is 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, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. In this regard, his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage.” (Harlow, 1868)

Consequently, the injury to his frontal cortex gave rise to a complete loss of his social inhibitions, which in turn led to unsuitable and unsociable behavior (MacMillan, 2010). The damage of Gage’s brain can be indirectly seen from the route of the iron all the way through his skull, which can only be concluded by the damage to his skull (Ratiu, 2004).

The skull was shattered in three different areas: first under the left zygomatic arch there was a small hole, where the tamping iron penetrated, the second area is located in the orbital bone behind the left eye socket, and the third but largest damaged area is located at the top of the skull where the iron made its exit (Ratiu, 2004). From the information provided by the skull, it appears that the tamping iron had executed a non-surgical frontal lobotomy (Costandi, 2010). A frontal lobotomy entails the cutting of the connections in the prefrontal cortex. This area of the brain is associated in personality expressions, planning complex cognitive behaviors, and regulating social conduct. “These procedures often result in major personality changes. Lobotomies have been used in the past to treat a wide range of mental illnesses including various anxiety disorders, depression and schizophrenia” (Frontal Lobotomy, 2011).

Gage & His Contributions to Cognitive Sciences

Gage’s accident made important contributions to early studies of the human brain. His accident was one of the first major brain traumas to be recorded. From his accident researchers have been able to connect personality traits with parts of the brain. This opened the door for other experiments that allowed people to chart which part of the brain controls what part of the personality, as well as other human functions such as speech and vision. For example in 1865, Paul Broca theorized that the speech center to be located in the left hemisphere of the brain, now aptly named the Broca’s area. Also during the late 1860’s David Ferrier and John Hughlings-Jackson carried out physiological studies that indicated the localization of cerebral functions (Costandi, 2010). John Hughlings-Jackson was the first that theorized that brain damage to be correlated to psychopathological conditions and “localized the auditory cortex in the brain and confirmed Broca’s finding in that speech was localized to a specific area of the left temporal lobe” (Scott, 2006).

Conclusion

After his accident, Gage suffered major personality changes due to the damage to different parts of his brain. Gage’s case confirmed researchers’ conclusions that injury to the prefrontal cortex could cause personality changes, while other neurological functions were left undamaged (Scott, 2006). Phineas Gage’s accident was one of the first instances in which evidence was provided that human social cognition and personality was related to the frontal cortex. The brain plays major roles in cognitive functions. Different areas of the brain support different cognitive functions as evident in the case of Phineas Gage.


References

Costandi, M. (2010). Phineas Gage and the effect of an iron bar through the head on personality [Video file]. Retrieved from http://www.guardian.co.uk/science/blog/2010/nov/05/phineas-gage-head-personality

Frontal Lobotomy. (2011). In Dictionary.com. Retrieved from http://www.ask.com/dictionary?q=frontal+lobotomy&qsrc=8&o=0&l=dir

Harlow, J. M. (1848). Passage of an Iron Rod through the Head. Retrieved from: The Journal of Neuropsychiatry & Clinical Neurosciences, MAY 1999. VOL. 11, 281-283: http://www.neuro.psychiatryonline.org/cgi/content/full/11/2/281

MacMillan, M. (2009). Phineas Gage Information Page. Deakin University . Retrieved from http://www.deakin.edu.au/hmnbs/psychology/gagepage/index.php

Ratiu, P., & Talos, Ion-Florin. (2004, December). The Tale of Phineas Gage, Digitally Remastered. New England Journal of Medicine , 351(21). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMicm031024?ck=nck

Scott, S. (2006). Neurophilosophy . Retrieved from http://neurophilosophy.wordpress.com/2006/12/04/the-incredible-case-of-phineas-gage/

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