Phineas Gage and the effect of an iron bar through the head on personality

“The photograph above, which was uncovered earlier this year, is one of only two known images of an otherwise unremarkable man named Phineas Gage who attained near-legendary status in the history of neuroscience and psychology one fateful day in 1848 at the age of 25.

Gage earned his place in the neurological hall of fame in a most unusual – and extremely unfortunate – way. A railroad construction foreman in the US, he was in charge of a crew of men who were working on the construction of the Rutland and Burlington Railroad near Cavendish, Vermont. On 18 September, he and his crew were excavating rocks to make way for the railroad. Gage was preparing for an explosion, using the tamping iron he holds in the photograph to compact explosive charge in a borehole. As he was doing so, the iron produced a spark that ignited the powder, and the resulting blast propelled the tamping iron straight through his head.

John Harlow, the physician who attended to Gage at the scene, noted that the tamping iron was found some 10 metres away, “where it was afterward picked up by his men, smeared with blood and brain”. He provides a detailed description of the “hitherto unparalleled case” in a letter to the editor of the Boston Medical and Surgical Journal, entitled “Passage of an Iron Rod Through the Head”:

“[The tamping iron] entered the cranium, passing through the anterior left lobe of the cerebrum, and made its exit in the medial line, at the junction of the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the parietal and frontal bones extensively, breaking up considerable portions of the brain, and protruding the globe of the left eye from its socket, by nearly half its diameter. ”

Remarkably, Gage survived this horrific ordeal, and by all accounts was conscious and walking within minutes. Back at Gage’s nearby lodgings, Harlow removed small bone fragments from the wounds, replaced larger fragments that had been displaced by the passage of the tamping iron, and closed the large wound at the top of Gage’s head with adhesive straps.

Several days later, one of the wounds became infected and he fell into a semi-comatose state. Fearing the worst, his family prepared a coffin, but Gage soon recovered and by January 1849 was leading an apparently normal life. But those closest to him began to notice dramatic changes in his behaviour.”

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