Phineas Gage : A Tale of the Frontal Lobe

 What is often regarded as an introductory lesson in psychology, the mysterious case of Phineas Gage is one of the most compelling stories in medical history. This famous incident seems to have made its mark in history even a century later. Scientists, doctors, and psychologists break down the narrative one piece at a time, with a fresh splash of perspective and wonder each time. The medical community owes its profound deep understanding of the brain and its functioning to the mystery of Phineas Gage. Hopefully, this account will furnish details in the context of the same.

 

PART I: THE ACCIDENT

The intricate details and chronology of events in the accident are variable in various accounts in medical literature, given that this incident occurred in the year 1848. A young railroad worker, Phineas Gage, was assigned the job of breaking down boulders and heavy rocks using explosives. The task involved ‘tamping’ the powder with three-and-a-half feet long crowbar sharply tapered at one end. It is said that on one such day, in a dramatic scale of events, the tamping iron may have struck a rock and lit a spark, lighting the powder and causing a high-scale explosion. The force of the explosion drove the hand-held crowbar right through the Gage’s skull; penetrating obliquely through the cheekbone, passing through the skull, through the left eye, the left side of the brain, and finally emerging at the top of the skull, and landing about 20 yards behind the site of the accident. Minutes after the unforeseen circuit of events, Gage experienced a few convulsions after which, with a little assistance he rose, walked himself to the nearest ox-cart, and seated himself. He was then taken to the nearest doctor where he claimed to have said, “Doctor, here is business enough for you.”

Phineas Gage and the famous tamping Iron
Source: Wikipedia 

 

PART II: THE MEDICAL WONDER

The Phineas Gage case is so compelling because of his improbable survival after this disastrous accident. Gage was monitored and treated by physician Dr.Edward Williams and surgeon Dr. J.M Harlow. Together, they carefully excised coagulated blood, bone fragments, and brain tissue that had been damaged in this accident. Dr. Harlow maintained a steady record of his findings up to 10 weeks after the accident. Barring a few days of delirium and a fetid fungal infection that complicated the wound, Harlow reports that at 10 weeks, Gage had improved physically. He had displayed a strong sense of willpower and was obstinate yet determined to get better and return to work and to his friends and family. In his own words, Dr. Harlow says, “His physical health is good, and I am inclined to say that he has recovered.”

 

Phineas Gage's skull with tamping rod
Source: Archives of Medicine and Health Sciences

PART III: “NO LONGER GAGE”

A part of Dr.Harlow’s account of Gage discusses the change in personality witnessed by him over the days he monitored him. It is said that before the accident, Gage was known to be a cheerful, amicable co-worker who was dutiful and efficient at his job and a “shrewd businessman.” According to Harlow’s account, he was now “fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom); A child in his intellectual capacity and manifestations, he has the animal passions of a strong man,” all traits that caused him to lose his job at the railroad company.

Unfortunately, this part of the story got out of hand and has now become the infamous – Frontal Lobe account. As the story goes, many physicians, scientists, and theorists of the time have modified this story to fit the perfect description of Frontal Lobe damage. As psychologist and historian Malcolm Macmillan claims, “Textbook writers are a lazy lot,” and this story has been regurgitated in different formats to satisfy the scientific claims of the phrenologists of the time and influence the impressionable audience.

"According to Harlow’s account, he was now “fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom)"

PART IV: NEUROSCIENCE TODAY

Phrenology is an old study founded by Franz Joseph Gall that dates back to the early 19th century. It states that a person's mental faculties and traits largely correlate with the shape and size of the skull. Through his theories, Gall indicated the brain was made of smaller organs that had different roles in human behavior. It in fact played a founding role in our understanding of the brain's functions and Phineas Gage's story today.

Diagram depicting Phrenology
Source: Britannica Encyclopedia

Back in the day, there were two schools of thought. One group, the phrenologists believed that certain areas of the brain are associated with a specific function. The conflicting party thought that the entire brain was responsible for all its functions and that no specialization was involved. In the case of Phineas Gage it was found that while his language, intellect, cognition, sensory, and motor skills were intact, the only abnormal feature seemed to be his changed personality after the accident. This concept would later be termed 'dissociation' in neuropsychology years later. Phineas Gage's story may have pointed to the fact that parts of the brain correlate with being able to live daily life based on acceptable social standards but can be lost to brain damage.

Gage succumbed to a series of fatal seizures in Chile more than 10 years later, where he was known to be a stagecoach to make a living. He is said to have kept the tamping iron close to him at all times and it was only after his death that was it handed over to the Warren Anatomic Museum as a relic on display. His skull was exhumed at the request of Dr. Harlow and has been studied extensively.

Many years later, scientist Hannah Damasio and her colleagues from Harvard Medical School carefully studied Phineas Gage's skull and recreated the damaged skull with photographs through state-of-the-art technology. Through their studies, Damasio found that Gage's skull suffered the most damage on the left side. The prefrontal cortex on the inner and ventral sides was found to be damaged. This correlates with Gage's poor decision-making and social conduct in his post-accident years. Other regions that are responsible for vital functioning were found to be intact.

"Through their studies, Damasio found that Gage's skull suffered the most damage on the left side. The prefrontal cortex on the inner and ventral sides was found to be damaged."

Damasio's reconstruction of Phineas Gage's Skull

The Phineas Gage story may have its share of irregularities. Some even attribute the unrequited fame to a series of unregulated morphed stories. The only reliable accounts of Gage are in the retellings by Dr. Harlow, Dr. Bigelow (another scientist who extensively studied Gage), and doctors from Harvard who have been researching his skull and remains. Nevertheless, Phineas Gage continues to baffle scientists across the world and saves its place as a centerpiece in the study of neuroscience and neurology for decades to come.

References:

1.      Phineas Gage - Wikipedia. (2016, May 16). Phineas Gage - Wikipedia. https://en.wikipedia.org/wiki/Phineas_Gage

2.      An Odd Kind of Fame. (n.d.). Google Books. https://books.google.com/books/about/An_Odd_Kind_of_Fame.html?id=Qx4fMsTqGFYC

3.      Phineas Gage – Unravelling the myth | BPS. (2008, September 3). BPS. https://www.bps.org.uk/psychologist/phineas-gage-unravelling-myth

4.      What Really Happened to Phineas Gage? (2019, May 20). YouTube. https://www.youtube.com/watch?v=oOkISlxST38

5.      CSE - IIT Kanpur. (n.d.). CSE - IIT Kanpur. https://cse.iitk.ac.in

6.     https://cse.iitk.ac.in/users/se367/14/Readings/kean-14_phineas-gage-most-famous-patient.pdf

7.       https://www.cse.iitk.ac.in/users/se367/14/Readings/damasio-descartes-error_chapt-1-2_phineas-gage.pdf

8.      Lessons of the brain: The Phineas Gage story. (2015, October 29). Harvard Gazette. https://news.harvard.edu/gazette/story/2015/10/lessons-of-the-brain-the-phineas-gage-story/