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Living With Half a Brain: Phineas Gage

The man survived a hole in the head, yet his personality was severely altered. Such is the case of Phineas Gage.

The Warren Medical Museum in Boston is a fascinating place, named after Dr. John Collins Warren who performed the first surgery under ether anesthesia in 1846. On view is the actual flask that housed the ether used during the surgery. Also on display is the famous meter long rod that  passed completely through the skull of railroad company worker Phineas Gage in 1848 without killing him. It did, however, dramatically alter his personality.  

The unfortunate event turned out to be a landmark in the history of neurology, demonstrating that different parts of the brain had different functions. Apparently, catastrophic injury to the frontal lobes of the brain could be sustained without causing significant neurological deficits, but not without affecting behaviour.  To this day, a memorial plaque marks the spot where the spectacular accident occurred on September 13, 1848 in Cavendish, Vermont.  

Phineas Gage was employed as a foreman by a railroad company, in charge of a crew laying new track. One of his tasks was to blast apart huge rocks that were in the way with gunpowder. This involved boring a hole into the rock and filling it with gunpowder using a long iron tamping rod. One fateful day, a spark ignited the powder prematurally, propelling the five kilogram iron rod through Gage’s left cheek and out the top of his head, landing some distance away. Miraculously he survived, in spite of having lost a significant portion of his brain. Not only did Gage survive, within minutes he was walking and conversing normally. The only immediate consequence was loss of vision in the left eye which apparently did not prevent him from sitting down and recording the event in his notebook. 

Gage’s luck, however, did not last long, as he developed an infection that left him comatose for a month.  During this time he was carefully looked after by Dr. John Harlow, who skillfully covered the head wound and later recorded the fascinating case in the Boston Medical Surgery Journal. In his account Harlow described how the physical injury had altered the victim’s personality to an extent that he was “no longer Gage.” Although his memory was not altered, the formerly mild-mannered Gage now became capricious and obstinate, often peppering his words with obscenities. He lost his job and for a while exhibited himself with the famous iron rod at P.T. Barnum’s circus.  

Gage’s most unusual adventure stimulated Scottish neurologist David Ferrier to investigate the role of the prefrontal lobes in brain function.  Ferrier removed the lobes in monkeys and noted that there were no great physiological changes but the animals’ character and behaviour were altered. Today, it is well understood that the prefrontal cortex of the brain controls the organization of behaviour including emotions and inhibitions. Phineas Gage died twelve years after the celebrated accident of epilepsy, leaving behind a fascinating legacy, and altering our understanding of the relation between the mind and the brain. Gage’s skull has become a relic and is on display along with the famous iron rod at the Warren Anatomical Museum in Boston. One could say that Gage needed the job with the railway company like he needed a hole in the head.

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