The Curiously Tragic Tale
of Phineas Gage
The man who wrote this book offered some fascinating
insights into the inner workings of the human brain.
The human brain is the most complex machine in the known universe. Supercomputers, sixth-generation fighter planes, Mars rovers, and AI all pale in comparison. We don’t even begin to understand it.
Your brain weighs about three pounds and is mostly fat. It contains around 86 billion neurons. They form some 100 trillion connections.
The human brain yet remains a black box of sorts. Stuff goes in and other stuff comes out. We still don’t really comprehend how or why.
The guy who taught me neuroanatomy literally wrote the textbook. There are likely not a dozen human beings on Planet Earth who understood the brain as well as did he. I got to know him fairly well.
We spent months studying the dreaded homunculus and inculcating what parts of the brain controlled which parts of the body. Towards the end of the course, I approached this inimitably learned man with some basic questions. I asked why my favorite color was blue, why I really liked 1970s-vintage rock and roll, and why I adored my wife above all others. He just smiled and said, “We have no idea.”
This is Phineas Gage after his terribly unfortunate accident.
Photo: Jack and Beverly Wilgus.
The Guy
Phineas Gage was born in 1823 in Grafton County, New Hampshire. He was the oldest of Jesse and Hannah Gage’s five children. Little is known of his background save that he could read and write. His personal physician described his baseline health as follows, “A perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temperament, five feet six inches in height, average weight one hundred and fifty pounds, possessing an iron will as well as an iron frame; muscular system unusually well-developed—having had scarcely a day’s illness from his childhood…”
The boy had grown up around explosives, working on a rural farm as well as in local mines and quarries. By the time he reached adulthood, Gage was considered an expert in the field. Eventually, he was employed as a blasting foreman on railroad construction projects. The tamping iron he used to set his charges was custom-made to his personal specifications.
Phineas Gage was known as a personable man. His employer described him thusly, “A most efficient and capable foreman … a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation.”
This was the track the tamping rod followed through Gage’s skull.
Photo: Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al.
The Accident
On 13 September 1848, Gage was in charge of a work gang blasting rock to prepare a roadbed for the Rutland and Burlington Railroad near Cavendish, Vermont. This process involved boring a hole deep into a rock face and packing it with blasting powder and a fuse. Then the heavy iron tamping rod was used to press sand or clay down into the hole to better contain the blast so as to fracture the rock most efficiently. At around 4:30 pm, Gage glanced over his right shoulder and opened his mouth to speak to one of his men. At that precise moment, his tamping rod made a spark, and the charge detonated prematurely.
Gage’s tamping rod was 1.25 inches in diameter and 43 inches long. It weighed 13.25 pounds. This heavy piece of metal was instantly transformed into a missile.
The big tool entered Gage’s face on the left just ahead of the angle of the jaw. It then transited behind his left eye, through the left frontal lobe of his brain, and continued on like a javelin. It was later recovered some 80 feet away, smeared liberally with blood and brain matter.
Gage’s skull remains a popular tourist attraction even today.
Photo: Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al.
Nobody Saw This Coming…
Gage was rendered briefly unconscious. His arms and legs flailed in convulsions in the immediate aftermath. However, in short order, he was back on his feet and walking. His men loaded him in a wagon and took him into town in search of the local doctor. Gage remained conscious throughout the trek. Half an hour after the accident, Dr. Edward Williams met Gage, who was sitting in a chair outside a local hotel. Gage said simply, “Doctor, here is business enough for you.”
Dr. Edwards said of the scene, “I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct…Mr. Gage persisted in saying that the bar went through his head. Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.”
Over the next twelve days, Gage tried desperately to die. The subsequent infection demanded that his physicians aggressively debride the nonviable fungating brain matter from his wound as well as drain a massive facial abscess. He was eventually rendered unresponsive. His friends prepared the grave clothes and the coffin. And then, Phineas Gage miraculously began to get better. Twenty-four days after the accident, the injured 25-year-old got up out of his chair and took a step.
Gage’s mother donated her son’s damaged skull to the
Warren Anatomical Museum in Boston. Photo: Public domain.
Aftermath
The injury left Gage blind in his left eye. The rod’s transit also removed one of his molars. However, over time, he regained a remarkable lot of function. The weird thing was what this injury did to the young man’s personality.
Where previously Gage had been fastidious, responsible, and pious, he was later prone to emotional outbursts and disjointed thinking. The frontal lobes tend to inhibit outlandish behavior, and one of his was simply gone. At a time when relatively little was known about neurophysiology, Gage’s case was exhaustively studied.
A technical journal of the day described Gage’s subsequent mental state this way: “He was gross, profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people.”
That assessment has been subsequently called into question, but the accident definitely changed him. Miraculously, Gage later moved to Chile and held down a responsible job as a stagecoach driver for eight years. However, he came home in 1860 with ever-worsening seizures. Gage was cared for by his family until his death in California at age 36. It had been a dozen years since the initial injury.
Gage developed a weird attachment to the tamping rod and kept it on his person most all the time. After his death, both the rod and his skull were donated to the Warren Anatomical Museum at Harvard Medical School in Boston. They remain on display there to this day, a tribute to the imponderably complex nature of the human brain.
