The Phineas Gage Case
The story of Phineas Gage illustrates some of the first medical knowledge gained on the relationship between personality and the functioning of the brain's frontal lobe. A well-liked and successful construction foreman, Phineas Gage was contracted to work on the bed preparation for the Rutland & Burlington Railroad in Cavendish, Vermont in late 1840’s. On the 13th of September 1848, while preparing the railroad bed, an accidental explosion of a charge he had set blew a 13-pound tamping iron straight through Gage’s head, landing many yards away.
From all accounts, the front part of the left side of his brain was destroyed. Incredibly, almost immediately after the accident, Gage was conscious and able to talk, and insisted on walking to the cart that would take him into town to be treated. Despite his torn scalp and fractured skull, Gage remained lucid and rational during the ride and was able to speak with his attending physician, Dr. John Martyn Harlow. Dr. Harlow, a young physician in Cavendish, noted that although the tamping iron appeared to have gone directly through Gage’s frontal lobes, Gage was still able to speak rationally and answer questions about the injury. Gage was treated by Harlow and returned home to Lebanon, New Hampshire 10 weeks later.
Unfortunately, Gage’s recovery was not a complete success. The once friendly and well-liked man became "fitful, irreverent, and grossly profane, showing little deference for his fellows." He was also "impatient and obstinate, yet capricious and vacillating, unable to settle on any of the plans he devised for future action." Those who knew him before the accident said he was "no longer Gage."
Gage never worked at the level of a foreman again. The undesirable changes in his personality ensured that the contractors who had previously employed him would never hire him again. After the accident Gage had several odd jobs: exhibiting himself at Barnum’s American Museum in New York, working in the livery stable of the Dartmouth Inn (Hanover, NH), and driving coaches in Chile. In 1859, after his health began to fail, Gage moved to San Francisco to live with his mother. In February 1860, he began to experience the epileptic seizures that would lead to his death on May 21, 1860.
In 1867 Gage’s body was exhumed, and his skull, along with the tamping iron, was sent to Dr. Harlow, then in Woburn, Massachusetts. In 1868 Dr. Harlow authored a report on the Gage medical case, which appeared in the Publications of the Massachusetts Medical Society (v. 2 (1868): 327-347). Harlow eventually donated the skull and tamping iron to the Warren Anatomical Museum, which already housed a plaster head cast of Gage taken by physician Henry Jacob Bigelow in 1850. The skull, life cast and tamping iron are currently on display in the Warren Museum Exhibition Gallery at the Countway Library of Medicine.
More information on Gage and the collections associated with Gage at the Warren Anatomical Museum can be found in the online exhibit Phineas Gage.