Author: Katherine Chen
Editors: Ian Cho, Maria Flores
Artist: Christina Chen
On September 14, 1848, 25-year-old construction foreman Phineas Gage was undertaking a project for the Rutland & Burlington Railroad near Cavendish, Vermont which required preparation of leveling and compacting the soil to lay railroad tracks. Gage was assigned to blast a rock and was pressing gunpowder into a hole using an iron tamping rod when friction caused sparks and the powder exploded. The explosion sent the 3.5 feet long and over an inch wide rod in through his left cheek and into his skull—destroying his left eye—and out on the top of his skull on the right side, landing about 30 yards behind him. From several accounts, it was said that Gage was thrown back and suffered brief convulsions, but woke up and spoke in a few minutes, and with a little help, was able to walk to a nearby ox cart so he could be taken into town and seen by doctors. At the time, he was conscious and even humorous as he stated the obvious: “I think I’m going to need to see Dr. Harlow.”
The young Cavendish attending physician Dr. John Martyn Harlow would go on to document Gage’s injury and his recovery. Most of what we know about the case was based on his observations. Reports show that Gage recovered pretty quickly. Although Gage lost vision in his left eye and acquired some evident scars from the incident, within four weeks, Dr. Harlow recorded that his memory was without fault. A visiting doctor remarked that a stranger would notice nothing particularly wrong about him.
Ten weeks after the incident, Gage was able to return home to Lebanon, New Hampshire. Months later, Dr. Harlow wrote that Gage was fully recovered and Gage set out to resume work. Yet, back at home, people began noticing changes in his personality. Instead of his old gentle, well-mannered self, he became harder to work with and was unwilling to take on advice, at one point described as “fitful, irreverent, and grossly profane, showing little deference for his fellows.” Gage who had previously been praised for his work as a “shrewd businessman” was instead now just around average. He could not commit to plans he made for the future nor reflect on the consequences of his actions. His friends commented that he was “no longer Gage.” Gage was fired and never worked a job at the previous level of his foreman position again.
Why is it that Gage exhibited these radical changes in personality? A 1994 study that used neuron aging techniques to reconstruct Gage’s skull found that Gage had injuries to both the left and right prefrontal cortexes which may explain the impairments in roles like emotional processing, decision-making, and planning. Another study in 2004, which used three-dimensional, computer-aided reconstruction to examine the trajectory of the iron rod found that damages were largely to the left frontal lobe. In a 2012 study published in PlosOne, Van Horn and a team of neuroscientists used computed tomography of Gage’s skull with typical brain MRI scans to find that most of the damage from the rod occurred to white brain matter instead of gray matter. White matter is brain tissue made of myelinated axons that connect neurons, whereas grey matter is made mostly of neuron cell bodies. Research showed that Gage lost about 11 percent of his white matter and about four percent of his cerebral cortex (grey matter). The accident severed major white matter tracts in the left frontal lobe: the uncinate fasciculus, which connects the frontal cortex to the limbic system, a key component of emotional regulation; and the superior longitudinal fasciculus, a long fiber bundle that connects all the lobes of the brain. With key components of his brain being unable to communicate, Gage loses his sense of emotional intelligence as his immediate emotional input from the limbic system is separated from his ability to reason with emotions in the frontal lobe.
The loss of white matter connectivity, as Van Horn claims, is not unlike modern patients who suffer traumatic brain injury. Losing white matter shares many commonalities with degenerative diseases which result in drastic behavioral changes such as Alzheimer’s and frontotemporal dementia. This also highlights why researchers keep coming back to Gage’s case and why neurosurgeons and neurologists still use Gage as a reference when evaluating similar cases.
But Gage’s life and prospects didn’t end with the injury. What’s less talked about is that his personality deficits lasted only about four years and slowly returned later on. According to Dr. Harlow, Gage held several responsible positions after the incident; one such job was as a carriage driver, a job that required him to exhibit considerable social, motor, and planning skills. Researchers say his recovery could be partially explained by the possibility of regeneration of white matter. His final stages showed how even with such massive damage to the brain, rehabilitation still stood a chance.
At the time, no one realized that different regions of the brain were specialized. Rather, people believed that the brain was homogenous and that its various functions were evenly distributed across its mass. In fact, the biggest proponents of brain specialization during that era were phrenologists, -people who believed that personality and intelligence were linked to the size of bumps on skulls and racist pseudoscientists who used distorted scientific ideas to justify inequalities . Phineas Gage’s story was the one of first to suggest specialization and linkage between the parts of the brain and who we are and also how resilient our brain can be.
Eleven years after the incident, Gage passed away from epileptic seizures. It is widely believed that his death is linked to the brain damage that lingered from the accident, about 12 years after the injury occurred. His skull was later exhumed, along with the iron tamping rod, and sent to Dr. Harlow in Woburn, Massachusetts, who authored a detailed report on the medical case which appeared in Massachusetts Medical Society. Eventually, both the skull and the rod were donated to the Warren Anatomical Museum at Harvard Medical School, where they remain on display today. If you ever have the chance to visit, take a moment to appreciate this discovery in neuroscience and to reflect on the resilience of the human brain and the value of our rational minds.
Citations:
Bradberry, Travis. “The Life-Changing True Story That Reveals the Secret to Success.” World
Economic Forum, 2 Apr. 2015, www.weforum.org/stories/2015/04/the-life-changing-true-
Costandi, Mo. “Phineas Gage’s Connectome.” The Guardian, Guardian News and Media, 16
“Phineas Gage’s Story.” The University of Akron, www.uakron.edu/gage/story.dot. Accessed 14 Dec. 2024.
“Q. Who Was Phineas Gage?” Who Was Phineas Gage? - Countway LibAnswers,
asklib.hms.harvard.edu/faq/153359. Accessed 14 Dec. 2024.
Teles, Ricardo Vieira. “Phineas Gage's great legacy.” Dementia & neuropsychologia vol. 14,4
(2020): 419-421. doi:10.1590/1980-57642020dn14-040013
“UCLA Researchers Map Damaged Connections in Phineas Gage’s Brain.” UCLA Health, 16
May 2012, www.uclahealth.org/news/release/ucla-researchers-map-damaged-
Van Horn, John Darrell et al. “Mapping connectivity damage in the case of Phineas Gage.”
PloS one vol. 7,5 (2012): e37454. doi:10.1371/journal.pone.0037454
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