Phineas Gage: "Neuroscience's Most Famous Patient"

Phineas P. Gage was a construction foreman who, in 1848, suffered an amazing injury as an explosion launched a tamping iron through his the cheek, skull, and brain, and out the other side. Incredibly, Gage survived, although the brain injury completely altered his personality. His physician wrote that "The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows." His friends said he was "no longer Gage." This transformation launched Gage into the annals of neuroscience. Until recently, there were no known photographs of Gage. But as previously mentioned on BB, antique photo collectors Jack and Beverly Wilgus posted a scan of a curious daguerreotype in their collection to Flickr in 2007. Database administrator Michael Spurlock happened to see the image on the site and suggested that it might be Gage. Smithsonian has a story about the strange tale of "neuroscience's most famous patient" and his delightful portrait. From Smithsonian:

The railroad-construction company that employed (Gage), which had thought him a model foreman, refused to take him back. So Gage went to work at a stable in New Hampshire, drove coaches in Chile and eventually joined relatives in San Francisco, where he died in May 1860, at age 36, after a series of seizures.

In time, Gage became the most famous patient in the annals of neuroscience, because his case was the first to suggest a link between brain trauma and personality change. In his book An Odd Kind of Fame: Stories of Phineas Gage, the University of Melbourne's Malcolm Macmillan writes that two-thirds of introductory psychology textbooks mention Gage. Even today, his skull, the tamping iron and a mask of his face made while he was alive are the most sought-out items at the Warren Anatomical Museum on the Harvard Medical School campus.

"Phineas Gage: Neuroscience's Most Famous Patient"

• [Anonymous]

  discovered a portrait of the younger Gage?
  Are these portraits of the same person? At a first look you might not think so. But at a second sight, considering several matching characteristics between the two photographs, your impression might change: there is a striking similarity!
  It’s on you to decide if the picture on this site may be attributed to the younger Phineas Gage. Please consult
  http://www.people.lu.unisi.ch/casagrar/Phineas_Gage.html and see some comparison studies and the opinions of some of the leading experts on Phineas Gage.

• [semiotix]

  Though blinded in his left eye, he might not even have lost consciousness, and he remained savvy enough to tell a doctor that day, “Here is business enough for you.”

  I’d take a spike through the brain just for the chance to drop an awesome line like that.

• [smegoid]

  #6, Macmillan makes a good case for Gage’s personality changes not being as dramatic as written. Nevertheless there’s a whole lot of missing information and to be fair to the accepted interpretation much of Macmillan’s theories are conjecture as well (e.g. because he managed to hold a job, he probably wasn’t so nutter). I know plenty of total nutters who can still show up for work. Another one is that the reason people thought “gage was no longer gage” was because they were responding to his horrible disfigurement. One thing the new daguerreotype shows is that he wasn’t as horribly disfigured as was thought. He could probably pull better than most!

• [Anonymous]

  As I mentioned in the previous entry, I work at the Countway Medical Library at Harvard Med, where Mr. Gage (or his skull, that is) currently resides. We have him on display with his famous crowbar, and his death mask. This picture is most certainly of Mr. Gage, as the crowbar and visage portrayed are perfect matches for the original articles.

  He’s on the 5th floor, btw, sharing display space with some truly beautiful (and terribly unsanitary) Victorian surgical implements, and some other examples of human misfortune – the rickets case will have you lunging for the bottle of Vitamin D!

  And no, you cannot simply walk in and see him. You have to ask nicely. Call ahead: [phone]

• [RedShirt77]

  Just a glance at the skull tells us that the object did not got through his cheek as the bone is indeed intact. It flew through his eye socket.

• [Anonymous]

  Phineas Gage artifacts, including the skull-piercing crowbar, are on display on the top floor of the Harvard Medical School Library (http://www.neurosurgery.org/cybermuseum/pre20th/crowbar/crowbar.html). They are indeed disturbing to stumble upon.

• [Matthew L Lena]

  @#2: At the risk of seeming like a prissy nitpicker, I need to correct one thing: the mask on display at the Warren Musuem of Harvard’s Countway Library is a *lifemask*, not a deathmask. It’s an important point, actually, since if there was a deathmask we’d probably also know the name of doctor who was caring for Gage when he died, and from that we could probably discover more about what he was like at the end of his life.

• [hijukal]

  Man, we just don’t have names like Phineas any more.

• [Matthew L Lena]

  @#6: In point of fact John Martyn Harlow, the physician who treated Gage after the accident (and famously wrote up the case 20 years later) certainly did know Gage prior to the accident: as Harlow tells it, Gage “recognized me at once, and said he hoped he was not much hurt.” And we should probably stay away from hip-sounding medical lingo referring to Gage’s accident as an “op,” which plays into the idea that what happened to him was some kind of lobotomy, or inspired the later development of lobotomy, both of which are untrue.

  @#8: You are incorrect. The tamping iron did not enter through the eye socket, but indeed through the left cheek. The actual path is graphically (to say the least — complete with the skull “hinging” open as the iron passed through) presented in the video at http://content.nejm.org/content/vol351/issue23/images/data/e21/DC1/e21v2.mpg — perhaps you could take just a glance. (The exit area is open to debate to some extent, but the entry area, which is what you are questioning, is very much constrained by the damage visible in the preserved skull.)

  @#7: Macmillan’s argument is nothing so simple as: “because [Gage] managed to hold a job, he probably wasn’t so nutter,” or anything resembling that. What Macmillan does say is that Gage supported himself all his post-accident life in just two or three steady, honest jobs (there is no question of this) ergo the usual presentation of a drifting, nonworking ne’er-do-well is categorically false. Furthermore, the last of these jobs, of about seven years’ duration, demanded reliability, judgment and planning in catering to paying customers under difficult conditions (a conclusion which requires “connecting the dots” of the available evidence, but which is no kind of “conjecture”) ergo even the moderate functional impairment suggested by Harlow must have to a large extent ameliorated by the end of Gage’s life.

  The context of Harlow’s famous “no longer Gage” passage makes it clear that friends and acquaintances who expressed this were reacting to Gage’s behavior, not to his appearance.

  Full disclosure: Macmillan and I have been collaborating on Gage for several years. Reference: The video linked above is from P. Ratiu and I.F. Talos (2004), “Images in Clinical Medicine: The Tale of Phineas Gage, Digitally Remastered,” NEJM 351(23): e21, http://content.nejm.org/cgi/content/full/351/23/e21.

• [Anonymous]

  Phineas Gage is a classic case of exaggeration and misinformation.

  His post-op doc never met him pre-op, and his radical personality changes are rather suspect anyway.

  Read up.

• [David Pescovitz]

  Thanks for the info about the medical library! Good times!

• [Anonymous]

  The case of Gage is amazing, there are people on so many levels who have been misinformed. Listening to the 50 minute interview on the Gage story tells about his many years after the accident and how even driving a stage coach was a job that required intellegance and motor skills. Here is the link if you are interested… http://www.yorku.ca/christo/podcasts/. Perhaps people believed he was a roamer due to his side show event prior to moving to California, but those were not long lived. He moved to South America and held a good long (to many it was long) job and he came home to Cali only then was he off in his personality when he became affected with seizures which he ultimately died from. Of course just after he was injured he was slightly off because he was injured, but who isn’t. But it is believed he healed from (as much as you could heal) from this massive inury not creating any long term affects. However, my only thought is these infections that he withstood during the healing process of the initial injury, could they have caused his epilepsy later on? Although he didn’t die from it, could he have hit his head again in a manner that was slight but enough to have caused injury to the already damaged brain while he was in South America. There is not any information I have found from his life in Chili, and I would be curious to know if either would be the cause that a healthy normal brain would have been able to live through a minor injury, but because of his abnormalities maybe just maybe it affected it. Just a curious mind I am!