Name:_________________

The Strange Tale of Phineas Gage

by Joanna Schaffhausen

Phineas Gage began the day of September 13, 1848 as a man remarkable only to those
who knew him personally. He worked as the foreman of a railway construction gang in
Vermont. At just twenty-six years old, Gage was already a success story. Full of vim and
vigor, he was well liked by the men in his charge, and his superiors were impressed with
his skill at handling dangerous explosives. Gage had a combination of intelligence and
athletic ability that made him perfect for the task of clearing rock from the path of the
coming railroad. As his bosses noted, he was "the most efficient and capable man" in
their employ.

The essence of Gage's job was to remove large sections of rock by shattering it from the
inside out. First, a hole was drilled deep into the boulder, and then it was filled halfway
with explosive powder. To direct the explosion into the rock instead of back out the hole,
the sand had to be "tamped down" with an iron rod. Gage, who was a master at tamping,
had his own rod manufactured to his specifications. It was 3 feet 7 inches long, weighed
13 1/2 pounds, and was 1 1/4 inches in diameter at one end, tapering over a distance of about 1 foot to a diameter of 1/4 inch
at the other. By all accounts, Gage had used the iron hundreds of times without incident, and there was no reason to think the
afternoon of September 13th would prove any different. But his lucky streak ended abruptly at four-thirty on that late
summer day.

Gage had drilled a hole into the rock and filled it with powder, indicating to the man helping him that it was time to put in
the sand. At that point, someone called to Gage and he must have become distracted. He failed to notice that his colleague
had not yet added the sand to the hole and began tamping directly onto the explosive powder. Almost immediately the
sparks struck fire in the hole and the charge blew up in Gage's face. The force of the explosion drove his three-foot long iron
rod at high speed into Gage's left cheekbone, through his skull and out the top of his head. It landed nearly 300 feet away.

Amazingly, Gage survived the terrible blow. Witnesses reported that while he was thrown to the ground and exhibited a few
convulsions, he was alert and rational within a few minutes after the accident. His men picked him up and took him by ox
cart to a nearby hotel, where they summoned one of the town's physicians, Dr. John Harlow.

Gage was still conscious at the time of the exam and able to answer questions about his accident, but his survival was not yet
assured. Dr. Harlow was knowledgeable enough about infection to understand its life-threatening risk and kept vigilant
watch over Gage's wound, cleaning and draining it regularly. Gage's youth and previous health proved stronger forces than
the infection, and within two months he was cured. Or was he?

No Longer Gage

Miraculously, Gage suffered no motor or speech impairments as a result of his accident. His memory was intact, and he
gradually regained his physical strength. Dr. Harlow initially concluded that Gage was fortunate because his injury involved
an expendable part of the brain. But in fact something was lost to Gage that terrible afternoon. His personality underwent a
dramatic shift, changing his disposition to such a degree that his friends barely recognized him. "Gage," they said, "was no
longer Gage."

Once a polite and caring person, Gage became prone to selfish behavior and bursts of profanity. Dr. Harlow said it was if
Gage lost the balance between "his intellectual faculty and animal propensities." He had no respect for social graces and
often lied about his accomplishments. Previously energetic and focused, he was now erratic and unreliable. He had trouble
forming and executing plans. There was no evidence of forethought in his actions, and he often made choices against his
best interests. No amount of pleading or lecturing from Dr. Harlow made any difference to Gage. Eventually, his capricious
and offensive behavior cost him his job with the railroad contractors. It was not any physical disability that prevented Gage
from working; it was his character.

It took years for Dr. Harlow to admit that while his most famous patient survived, he never really recovered. By 1868, he
was ready to accept the surprising message inherent in Gage's tragic story, namely that observing social convention,
behaving ethically, and making good life choices requires knowledge of strategies and rules that are separate from those
necessary for basic memory, motor and speech processing. Even more startling, it appeared as though there are systems in
the brain dedicated primarily to reasoning. The search to find these specific brain areas has stretched from Gage's time right
up to the present day. Scientists now have a pretty good idea of what happened to Gage's brain, thanks to clues from animal
studies, patients with unfortunate brain damage and some unorthodox brain surgeries performed on psychiatric patients
during the middle of the twentieth century.

A Brain Location for Personality?

When Gage died in 1861 there was no autopsy performed, so no one was able to verify the exact brain regions damaged in
his accident. Fortunately for later researchers, Dr. Harlow had Gage's body exhumed in 1866, at which point the skull and
the tamping iron he was buried with went to the Warren Medical Museum of Harvard Medical School, where they have
remained ever since. It was obvious from looking at Gage's skull that the rod had pierced through the very front part of the
brain, but at the time no one knew very much about the sort of processing that occurs in this region. Gage's accident seemed
to suggest that the prefrontal cortex controls decision making, especially in social situations, and has a great deal of
influence on temperament. Later evidence from other patients with brain damage supported this idea.

Some of the first indications that Gage's personality shift was not just a fluke came
from other people with injuries to the prefrontal cortex. In the years that followed Dr.
Harlow's 1868 report, other physicians began noting patients who underwent radical
personality changes similar to Gage's after suffering damage to the frontal lobe. They
had trouble holding a job, had little respect for social convention, and seemed
indifferent to those around them. They formulated plans but could never seem to carry
them out. They made life choices that were clearly against their own best interests. In
nearly all cases, an autopsy of these individuals revealed severe damage to the
prefrontal area. Further evidence linking personality changes to prefrontal lobe
damage came from a Yale Study on chimpanzees. The researchers had two monkeys
who were especially difficult to work with because they frustrated easily and tended to
lash out in retaliation. Researchers then performed surgeries on these monkeys that
damaged their frontal lobes. After the surgery, both chimpanzees were docile and
cooperative. When the results of this study came to light at a medical conference in 1935, scientists wondered if this kind of
surgery could produce similar results in humans. This hypothesis led to an infamous kind of psychiatric surgery performed
during the 1940s and 50s known as the frontal lobotomy. Patients with various kinds of psychosis underwent surgery to
purposefully damage their frontal lobes in an effort to cure them of their illnesses. Interestingly, the surgery did seem to help
some people, especially those with terrible anxiety, but the overall emotional blunting proved no great cure. It did, however,
strengthen the link between the social aspects of personality and the prefrontal cortex.

These days, scientists know a lot more about the anatomy of the prefrontal cortex. It is an association area of the brain,
which means that it integrates many processes from other brain regions, including those specialized for memory and
emotion. Damage to the prefrontal cortex does not disrupt the basic function of sensory, memory or emotional systems; it
disrupts a person's ability to synthesize these systems and produce organized social behavior. Nearly 150 years after Gage's
accident, researchers finally zeroed in on the brain regions responsible for his strange personality change.

A Question of Timing

Phineas Gage's timing was off on the afternoon of September 13, 1848. If he had waited a few more seconds until the sand
was poured into the hole, his tamping iron would not have triggered the explosion that caused his terrible injury. He could
have continued his career as a successful foreman instead of winding up as display in P.T. Barnum's museum for freaks of
nature.

But for neuroscientists, the timing of Gage's accident was fortuitous. Scientists were becoming extremely interested in the
mind/brain connection, and their knowledge of anatomy was expanding rapidly. Gage's case was among the first indications
that the brain is not just specialized for walking, talking and the like, but also contains regions tailored for more complex
behaviors such as reasoning, adapting to social convention and planning future events. This insight still drives many
researchers today, as they build on the knowledge gained from Gage's fateful accident.
As much as Gage's story hinges on timing, it is also a timeless one. Terrible in its description and haunting in its tragedy,
Gage's story will be forever remembered as a peek into how three pounds of gray matter somehow combine to make us
uniquely human, and each human unique.

Name:______________________

Response: Phineas Gage

1. What was Phineas Gage doing when he was injured?

2. Describe Phineas Gage’s injury.

3. Describe Gage’s personality before and after the accident. What symptoms
finally prompted doctors to conclude that Gage had not made a full recovery?

4. What understandings about the brain did Phineas Gage’s injury lead to? Provide
two pieces of evidence gathered by doctors or scientists that led to this
understanding.

5. Which two brain regions are mentioned, and what are their roles?
6. What lasting understanding or knowledge about Psychology do you take from
this article?