Phineas Gage
He had a headache

"Gage's story was the historical beginnings of the study of the biological basis of behaviour..."
Dr. Antonio Damasio.

13th September 1848. Previously described by his employers as capable and hard working, Phineas Gage lost the majority of the front of the left side of his brain when an explosion sent a 13 pound tamping iron through his skull. It is said that despite his appalling injury he did not lose conscious for very long and appeared curiously indifferent to his situation.

Although Gage initially made a full physical recovery, it was the changes to his personality that change much of the thinking about the origins of thought and behaviour. Possibly this connection had never been made before because no one with such damage to the brain had previously survived.

Whilst it was Phineas Gage's name that was entered in the popular lexicons of neurology, credit must go to his physician Dr. John Harlow for the very fact that he survived at all. In absence of modern day neurosurgical procedures or even the anti-biotics we take for granted, Phineas lived.

Gage's personality and behaviours were said to have dramatically changed by the time he had made his physical recovery. Previously a responsible and popular individual he was decribed as a changed man, "Gage was no longer Gage" is popularly quoted as being said by his friends. Recently reviving the case, Portugese neurologists Drs. Hanna and Antonio Damasio concluded that it was the ventromedial region of the frontal lobes that were primarily damage. Despite the majority of the damage occuring on the left side, speech and language processing areas were left intact.

Although Gage retained the faculty of speach and suffered no permanent sensory-motor impairment (in fact, it is often said that immediately after the accident, Gage fell into a convulsion bleeding heavily, after which he got up and was immediately walking and talking) the subsequent changes in his behaviour and personality were pronounced.

Suggested by Dr. Harlow that "the equilibrium...between his intellectual faculties and animal instincts seems to have been destroyed" the full extent of Gage's behavioural changes were not apparent for a couple of months until after the initial accident. Probably due in part to the fact that no one would be expected to be entirely normal following such physical injuries, the expectation was that once physical healing had taken place, Gage would be his normal self (after all, up until this point (1848) no connection between brain and behaviour had ever been popularised). This wasn't the case however and Gage become poorly mannered, prone to telling ludicrous stories and life plans and somewhat socially disinhibited.

The loss of the underside of the frontal lobes, the ventromedial region damage produced behaviours seen today in some patients undergoing brain surgery for trauma or lesions etc where rational decision making is seriously impaired and mediation of emotion in relation decision making is also affected.

Gage developed epilepsy, which in these times had no treatment* and died 13 years after the accident during an epileptic seizure.

(*note: Until the advent of phenobarbitone in the treatment of epilepsy, the social stigma rendered epileptics as a potential threat to society and special schools and 'hospitals' were created. A strong parallel between the stigmatisation of leprosy and epilepsy can be observed across cultures where in one culture it is the threat of infection that threatens the populace (Asia), in the other, it is the threat of unrestrained behaviour that threatens the populace (The West) - reflecting the religious and cultural ideation of the times.)

For further information on Gage, visit Prof. Malcolm Macmillan, President-Elect, International Society for the History of the Neurosciences website. Highly reccomended reading.