Phineas Gage
“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 consciousness 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 changed 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 the absence of modern-day neurosurgical procedures or even the antibiotics we take for granted, Phineas lived.
Gage’s personality and behaviour were said to have dramatically changed by the time he had made his physical recovery. Previously a responsible and popular individual, he was described as a changed man, “Gage was no longer Gage” is popularly quoted as being said by his friends. Recently, reviving the case, Portuguese neurologists Drs. Hanna and Antonio Damasio concluded that it was the ventromedial region of the frontal lobes that was primarily damaged. Even though most of the damage was on the left side, the parts of the brain that process speech and language were not affected.
Although Gage retained the faculty of speech 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 was 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 became poorly mannered, prone to telling ludicrous stories and life plans, and somewhat socially disinhibited.
The loss of the underside of the frontal lobes and ventromedial region damage produced the 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 to decision-making is also affected.
Gage developed epilepsy, which in those 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 wherein 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 recommended reading.