Phineas gage injury

The Curious Case of Phineas Gage's Brain : Shots

The Curious Case of Phineas Gage's Brain : Shots - Health News In 1848, a railroad worker survived an accident that drove a 13-pound iron bar through his head. The injury changed his personality, and our understanding of the brain.

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May 21, 20175:00 AM ET

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Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage

Cabinet-card portrait of brain-injury survivor Phineas Gage (1823–1860), shown holding the tamping iron that injured him. Wikimedia hide caption

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Wikimedia

Cabinet-card portrait of brain-injury survivor Phineas Gage (1823–1860), shown holding the tamping iron that injured him.

Wikimedia

It took an explosion and 13 pounds of iron to usher in the modern era of neuroscience.

In 1848, a 25-year-old railroad worker named Phineas Gage was blowing up rocks to clear the way for a new rail line in Cavendish, Vt. He would drill a hole, place an explosive charge, then pack in sand using a 13-pound metal bar known as a tamping iron.

But in this instance, the metal bar created a spark that touched off the charge. That, in turn, "drove this tamping iron up and out of the hole, through his left cheek, behind his eye socket, and out of the top of his head," says Jack Van Horn, an associate professor of neurology at the Keck School of Medicine at the University of Southern California.

Gage didn't die. But the tamping iron destroyed much of his brain's left frontal lobe, and Gage's once even-tempered personality changed dramatically.

"He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom," wrote John Martyn Harlow, the physician who treated Gage after the accident.

This sudden personality transformation is why Gage shows up in so many medical textbooks, says Malcolm Macmillan, an honorary professor at the Melbourne School of Psychological Sciences and the author of An Odd Kind of Fame: Stories of Phineas Gage.

"He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality," Macmillan says.

And that was a big deal in the mid-1800s, when the brain's purpose and inner workings were largely a mystery. At the time, phrenologists were still assessing people's personalities by measuring bumps on their skull.

Gage's famous case would help establish brain science as a field, says Allan Ropper, a neurologist at Harvard Medical School and Brigham and Women's Hospital.

Dr. John Harlow, who treated Gage following the accident, noted his personality change in an 1851 edition of the American Phrenological Journal and Repository of Science.

The American Phrenological Journal and Repository of Science, Literature and General Intelligence, Volumes 13-14

"If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero," Ropper says. It was an ideal case because "it's one region [of the brain], it's really obvious, and the changes in personality were stunning."

So, perhaps it's not surprising that every generation of brain scientists seems compelled to revisit Gage's case.

For example:

In the 1940s, a famous neurologist named Stanley Cobb diagrammed the skull in an effort to determine the exact path of the tamping iron.
In the 1980s, scientists repeated the exercise using CT scans.
In the 1990s, researchers applied 3-D computer modeling to the problem.

And, in 2012, Van Horn led a team that combined CT scans of Gage's skull with MRI scans of typical brains to show how the wiring of Gage's brain could have been affected.

"Neuroscientists like to always go back and say, 'we're relating our work in the present day to these older famous cases which really defined the field,' " Van Horn says.

And it's not just researchers who keep coming back to Gage. Medical and psychology students still learn his story. And neurosurgeons and neurologists still sometimes reference Gage when assessing certain patients, Van Horn says.

"Every six months or so you'll see something like that, where somebody has been shot in the head with an arrow, or falls off a ladder and lands on a piece of rebar," Van Horn says. "So you do have these modern kind of Phineas Gage-like cases."

Two renderings of Gage's skull show the likely path of the iron rod and the nerve fibers that were probably damaged as it passed through. Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al./Wikimedia hide caption

toggle caption

Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al. /Wikimedia

Two renderings of Gage's skull show the likely path of the iron rod and the nerve fibers that were probably damaged as it passed through.

Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al./Wikimedia

There is something about Gage that most people don't know, Macmillan says. "That personality change, which undoubtedly occurred, did not last much longer than about two to three years."

Gage went on to work as a long-distance stagecoach driver in Chile, a job that required considerable planning skills and focus, Macmillan says.

This chapter of Gage's life offers a powerful message for present day patients, he says. "Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible."

Gage lived for a dozen years after his accident. But ultimately, the brain damage he'd sustained probably led to his death.

He died on May 21, 1860, of an epileptic seizure that was almost certainly related to his brain injury.

Gage's skull, and the tamping iron that passed through it, are on display at the Warren Anatomical Museum in Boston, Mass.

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Phineas Gage | Biography, Injury, & Facts

Phineas Gage

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Born:: July 1823 New Hampshire

Died:: 1860 (aged 36) California

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Phineas Gage, (born July 1823, New Hampshire, U.S.—died May 1860, California), American railroad foreman known for having survived a traumatic brain injury caused by an iron rod that shot through his skull and obliterated the greater part of the left frontal lobe of his brain.

Little is known about Gage’s early life other than that he was born into a family of farmers and was raised on a family farm in New Hampshire. At some point he took up work on the construction of railways and came under the employment of contractors who were working with the Rutland and Burlington Railroad company. Among Gage’s duties was to clear rocks to level the ground. The task involved placing an explosive charge deep into the rock by drilling a hole. The hole was then filled with gunpowder, and a fuse was set. Sand was added on top of the explosive material to prevent contact. A tamping rod was then used to pack the explosives into the rock. On the afternoon of September 13, 1848, near Cavendish, Vermont, Gage tamped down the powder without the addition of the sand. As his tamping rod, which measured 3.58 feet (about 1 metre) in length and 1.25 inches (about 3.2 cm) in diameter, struck against the side of the rock, it ignited the gunpowder. The rod shot completely through Gage’s head and landed almost 82 feet (25 metres) behind him. The 13.25-pound (6-kg) rod entered Gage’s head just below his left cheekbone and exited from the top of his skull.

Gage survived the accident and immediately afterward was conscious and able to speak. About 10 days later, however, he endured a brief period in which he was barely conscious; his doctors anticipated his death. But Gage quickly recovered, and, within a matter of months, he regained his physical strength and was able to return to work. He sustained no motor or speech impairments, and his memory remained intact. However, Gage’s personality appears to have changed (for a time at least), causing his colleagues to state that he was “no longer Gage.” While some have described Gage as restless, disrespectful, and unreliable following the accident, the true extent of the personality changes he experienced are unknown. Little was documented about his personality or behaviour prior to and after the accident.

In 1852 Gage took a job in Chile, working as a stagecoach driver, having apparently either regained or maintained at least some social skills. Seven years later, in poor health, he moved to California to live with his mother and sister (who had moved there from New Hampshire). Nearly 12 years after his injury, Gage died of epileptic seizures. His skull and iron tamping rod were put on permanent exhibition at Harvard Medical School’s Warren Anatomical Museum in Cambridge, Massachusetts.

Shannon GearhartThe Editors of Encyclopaedia Britannica

Ilyinskaya Hospital - a modern outpatient hospital center :: 11 percent of the brain was taken out by an American with a crowbar. The Amazing Story of Phineas Gage.

Iron rod entered Phineas Gage's head above the left cheekbone, pierced the brain, passing behind the left eye, and exited the top of the skull, breaking through the frontal bone. After that, smeared with blood and brain tissue, the tamping pin flew another 25 meters.

Phineas Gage was the eldest of five children born to farmer Jesse Eaton Gage and his wife Hannah from New Hampshire. Almost nothing is known about his early years - yes, in in general, and it doesn’t matter, because until the age of 25, when this happened to him an amazing story, Gage was of no interest to others. nine0005

By the age of 25, this was "a perfectly healthy, strong and active young man, five feet six inches tall (168 cm) and weighing 150 pounds (68 kg), with an iron will and unusually developed muscular system, ”according to the description of the observer Dr. John Martin Harlow. At the time described, Phineas earned his living life, leading a team of workers on the construction of railways - the USA then experienced a boom in railroad construction. Gage's specialty was demolition work - even in his youth he often practiced using explosives in the mines and quarries of his native New Hampshire. This occupation was rather nervous: industrial explosives did not exist then, they had to work with black (smoky) powder. Gage developed a consistent - and how it seemed to him safe - the procedure for using explosives to laying railway tunnels in the rocks. First in hard rock a deep hole was drilled - a pit - where gunpowder was poured. Gage carefully leveled the gunpowder, after which his assistant set the fuse and poured sand or clay into the hole. Then the most crucial stage began - Gage rammed the sand with a special tamping pin, which was made according to his custom order at a forge in Cavendish, Vermont. It was iron a rod 110 cm long, 3. 2 cm in diameter and weighing about 6 kg. With the help of this tool Gage formed a "cork" of viscous materials over a charge of gunpowder: as a result, the main blast wave went under the base of the rock. nine0005

Fatal for day September 13, 1848. Phineas Gage led the work brigade, tunneling for the Rutland-Burlington Railroad in Vermont. It was already evening; a charge of gunpowder was laid in the pit, but for some reason the assistant did not pour sand on top. Not knowing this, Gage went to the pit and began to carefully tamp what he considered a sand cushion, an iron rod. AT At that moment, behind his back, the workers were arguing loudly about something. Gage turned to him, leaning on a tamping pin - and already opened his mouth to call on the workers to the order, but did not have time to utter a word. Somewhere under his feet resounded a monstrous roar, a blinding flash flashed, something flew out of the pit into clubs of black smoke and flying a decent distance, crashed with a ringing on stones. nine0005

When the smoke scattered, the workers saw that their foreman, covered in blood, was sitting on the edge shaft torn apart by the explosion. Approaching the living, but swearing at what the light is on, Gage, they were horrified to find that there was a gaping hole in his head.

As it turned out later, Gage's ramming pin struck a spark from the rock deep in the pit. If gunpowder was sealed with a sand or clay cork, nothing would have happened, but as we remember, there was neither sand nor clay in the pit that day. Gunpowder exploded pushing the iron bar on which Gage was leaning like a bullet from a barrel revolver. And the bullet hit the target. nine0005

The skull of Phineas Gage. Warren Anatomical Museum

Iron rod entered the head of Phineas above the left cheekbone, pierced the brain, passing behind the left eye, and exited the top of the skull, breaking through the frontal bone. After that, smeared with blood and brain tissue, the tamper rod flew another 80 feet (about 25 meters)

Gage remained in alive only because the blacksmith, to whom he ordered a tamping pin, made pointed at one end - so that the tool did not look like a crowbar, but rather, a spear. The tip of this spear is 27 centimeters long and 7 mm wide. passed through Phineas' skull like a needle through a sheet of paper. nine0005

Gage was shaking from pain and nervous shock - still, just flashed through his head 6 kilograms of iron - but he was alive and did not seem to be going to die. Him laid on his back in an ox-cart and taken to a nearby town, where he rented a hotel room. There and rushed caused by alarmed workers Dr. Edward H. Williams.

"When I drove up, - Williams recalled, - Mr. Gage shouted to me: “Doctor, here for you enough business!" He was sitting in a chair in the hotel garden, but I noticed a wound on his head even before he got out of the carriage. The brain pulsations were very distinct. The top of the head was a bit like an inverted funnel, as if some kind of wedge-shaped body passed from the bottom up ... While I was examining the wound, Mr. Gage told me how the accident happened. Then I didn't believe him, thinking that he had been deceived. Then Mr. Gage got up and vomited. This the effort pushed a piece of his brain the size of half a teacup through a hole in the top of the skull, and he fell to the floor…”

Soon to Williams was joined by Dr. Harlow, who observed Gage until the unfortunate case. Together they tried to provide Phineas with the necessary assistance. Gage was in conscious, but was rapidly losing strength due to blood loss. The whole bed which they laid him down was literally soaked in blood.

Using Williams Harlow shaved Gage's head around the wound, removed the gore, small fragments of bone and about an ounce (30 grams) of marrow, protruding above the edges of the opening in the skull. The wound was sealed with a band-aid, leaving small hole for drainage. The wound on the cheek was bandaged, on the head of the patient put on a nightcap and bandaged again. From the point of view of neurosurgery of the 21st century such manipulations look barbaric, but it should be borne in mind that the doctor Harlow was an experienced military surgeon. Among other things, Harlow ordered Gage should never lower his head and even sleep while sitting in pillows. Hours passed, and Gage, despite his terrible wound, was conscious and even showed signs of improvement. During the night, Harlow wrote in his diary: “The patient's mind is clear. Constant excitement of the legs, he bends them one by one and pulls out ... He says that he does not want to see his friends, as he will return to work in a few days. nine0005

However, recovery Gage dragged on. Although the next morning he recognized those who had come to him from New Hampshire mother and uncle, on the second day after the Phineas incident, by according to Dr. Harlow, “lost control of his mind and fell into madness". Two days later, Gage seemed to come to his senses - he again became "rational, recognized his friends." The patient's condition improved very quickly, and Harlow acknowledged for the first time that Phineas could make a full recovery - but then, 12 days after the incident, Gage fell into a semi-comatose condition. He became drowsy, answered questions rarely and in monosyllables. Cause complication of his condition, apparently, was an infection that got into the wound - according to according to Harlow, a "fungus" appeared in the eye socket and along the edges of the wound. "The smell of of the mouth and from the wound in the head, terribly fetid. Answers in monosyllables only if he force it. Will not eat unless force-fed. Friends and Ministers hotel expect his death from hour to hour and have already prepared a coffin and a suit, "- the doctor wrote in his diary. nine0005

However, Harlow is not gave up. He cut out the fungus-affected tissue that filled the opening of the wound and burned its edges with a lapis pencil (silver nitrate). Then cut with a scalpel soft tissues of the head from the wound outlet to the upper part of the nose: from eight ounces (250 ml.) of fetid, blood-mixed pus flowed from the incision. This operation saved Gage's life.

"Gage was lucky that he met Dr. Harlow, - wrote one of the modern researchers this amazing case. - Few doctors in 1848 had experience surgical treatment of brain abscess, and Harlow specialized in him at Jefferson Medical College. nine0005

From now on Gage's real recovery began. On the 24th day, for the first time, he managed get up from a chair on your own. A month later, he was already moving freely and around the house and on the streets. Harlow left town for a week, leaving his an amazing patient in the care of friends, and this almost crossed out all of his Proceedings: Gage ran away from the "nannies" and stumbled all day in the pouring rain, got his feet wet and caught a cold. However, if the metal pin did not kill him, then the fever was all the more beyond the power. Returning Harlow noticed that Gage would likely recover if only he could be kept control. nine0005

And Phineas Gage really recovered! It seems incredible, but it only took him two and a half months to return to normal after meter iron rod weighing 6 kg. deprived him of a decent part of the brain. He returned to his parents' home in New Hampshire and within a few weeks began to do the usual work on the farm: he looked after horses and cows, worked in the field. The family tried not to overload him with work, but Phineas did not wanted to be treated as an invalid, and even got angry if he noticed that he is being "favoured". But he loved to gather his little ones around him. nephews and nieces (he had no children of his own) and entertained them incredible stories of miraculous deeds (fictitious) and battles with bandits, in who allegedly received his terrible wounds. nine0005

Spring The following year, Gage returned to Cavendish to see Dr. Harlow. He noted that, despite the loss of the left eye and partial paralysis of the left side of the face, the patient's physical condition is "good", and it can be considered that he is generally healthy. However, Gage suffered from depression, and although Gage did not complained, he confessed to Harlow that he was experiencing some kind of "strange feeling", which cannot be described.

Gage titled physicians became interested. Gage made famous throughout America Henry Jacob Bigelow is Professor of Surgery at Harvard Medical School. AT within the walls of this school, the “Gage phenomenon” was studied for several weeks by both professors and and medical students. nine0005

Some time Gage made his living playing the role of a "living museum exhibit" in Barnum American Museum in New York (but not Barnum Circus, which later traveled all over America showing curiosities like bearded women and mermaids). Anyone who wanted to pay a quarter could admire a man with a hole in his skull and the famous ramming pin that he held in his hands. Whatever irresponsible journalists wrote, Gage still did not spoke - but with lectures about his amazing cure, he really traveled to most major cities in New England. Bigelow recalled that Gage “I was quite inclined to do something like that to earn a couple of honest penny", but the audience was not too interested in lectures, and Phineas refused speeches. nine0005

Monstrous However, the injury did not go unnoticed for him. Gage's character has deteriorated. He became intolerant, aggressive and rude, fickle, easily changing his plans, disrespectful to others, capricious and stubborn. Phineas started swearing - he had never had such a tendency before. Easily insulted family and friends. The only beings he's still with found a common language, there were horses and dogs. Before the injury, the examiner wrote Bigelow, although he did not go to school, he had a developed mind and a balanced character; those who knew him spoke of Phineas as shrewd and intelligent business person, very energetic and persistent in achieving his goals. Everybody these wonderful qualities disappeared after an accident with a metal with a pin, as if they had leaked out, along with part of the brain, from the hole in Gage's skull. Friends bitterly said that he was "no longer Gage." nine0005

After examinations at Boston Medical School and performances at the Barnum Gage Museum became known throughout America. Couplets were sung about him:

Virtuous Gage, Vermont

Rammed gunpowder using the probe

The probe sped off will,

Having broken his left frontal lobe -

Gage now swearing and drinking.

However, Gage did not remain without work: his talent for dealing with horses in the eyes owners of large stables atoned for all the newly acquired shortcomings of his character. After all, one of his employers recommended him Chilean transport company, and Gage left for Chile. He's been there for seven years. worked as a coachman of a stagecoach drawn by six horses and cruising on the route Valparaiso-Santiago. Mid 1859he felt that his health is deteriorating sharply, and returned to the United States. Gage settled in California and there, patronized by his mother and sister, he was on the mend again - but in February 1860 he began to have epileptic seizures. During one of these Gage's seizures and died on May 21, 1860 - almost 12 years after an iron tamping pin pierced his head.

Six more passed years, and Dr. Harlow, who all these years unsuccessfully tried to find out at least anything about the fate of his former patient, found out that Gage had died in California, and wrote to his family. At the request of the doctor who has done so much for her son, Gage's mother agreed to the exhumation and gave Harlow the grave skull of a son with a hole from an iron rod, as well as the rammer itself a pin with which Gage did not part until his last day (according to legend, this instrument was placed with him in the coffin). Carefully examining the skull and rod, Harlow donated them to the Warren Anatomy Museum at Harvard School medical research, where they are kept to this day. nine0005

Case of Gage remained one of the greatest mysteries of medicine for over a hundred years. years. How did the loss of a large piece of brain tissue not kill Gage, but completely changed his character? Only in 2012 a group of American neurologists led by John Van Horn from of the University of California simulated the injury received by Gage, and received answers to these questions. To assess damage to the cerebral cortex and pathways located in the area of injury were used modern brain images of a 25-year-old right-handed white male obtained by diffuse tensor imaging. The resulting image was superimposed on the model of the skull Gage - and a century and a half secret, finally, ceased to be such. nine0005

Researchers found that as a result of Gage's injury lost about 4 percent of the cortex, as well as almost 11 percent of the white matter brain. According to Van Horn, despite the fact that the bark was damaged only in area of the frontal lobe of the left hemisphere, at the same time its connections with left temporal and right frontal lobes, as well as the limbic system. This caused changes in the psyche and behavior of Gage, who from "virtuous men" became rude and capricious foul language. nine0005

The injury was not fatal precisely because the areas of the brain responsible for behavior, will and emotions, but the deeper structures of the brain that regulate the functions of internal organs were not affected. This is the key to the Phineas Gage phenomenon.

Phineas Gage injury. The Surprising Story of a Patient

In 1848, an incident occurred while laying a railroad in Vermont. As a result of the blast wave, a metal rod about 1.2 m long entered the head of one of the workers. The victim survived after a serious brain injury, but others could not help but be surprised at how much this injury changed the personality of the worker. nine0005

Phineas Gage demonstrates the iron rod that changed his life. His only physical impairment was the loss of an eye. Accounts vary greatly as to how much his personality changed.

The unfortunate worker was Phineas Gage, foreman on the railroad between Rutland and Burlington. Gage was engaged in stuffing and ramming black powder into a hole hewn in the rock, and he did this with the help of an iron rod. But a spark inside the cavity caused the gunpowder to explode, causing the metal rod to pierce his face in an instant and pass through Gage's left cheek, so that the exit hole was at the top of the head. The victim did not die, and when medical assistance arrived, he said: "Doctor, you will have to work hard." nine0005

For two weeks, Gage alternately came to himself, then lost consciousness, tossing and turning in a feverish delirium, but in the end he quickly and miraculously recovered and was able to walk within a month. This story turned Gage into a celebrity, he spent some time on a tour of the country, then settled down, becoming the owner of a stable and a mail coach. In 1860, he began to have epileptic seizures, so that he could no longer work. Gage died a few months later.

No autopsy was performed on Gage's body, but he was exhumed in 1866. Examination of the skull showed that Gage's frontal bone had been severely damaged after the incident, and in accordance with the postulates of the phrenology that prevailed at the time, Gage should have lost his higher human abilities and lost control of his animal instincts. nine0005

Phineas Gage's skull is on display at Harvard Medical School.

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