Harvard University’s Warren Anatomical Museum is a must-visit for anyone interested in the history of medicine. Displays include an ether inhaler as used by dentist William Morton that allowed surgeon John Collins Warren to carry out the surgery in 1846 that introduced ether anesthesia along with the famous painting by Robert Hinckley depicting the first operation under ether. Also exhibited are historical herbals, amputation saws, early stethoscopes, and the skull of Johann Gaspar Spurzheim, a chief proponent of phrenology in the early 19th century. But the most popular display is the skull of Phineas Gage and the iron rod that passed through his brain 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 have 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 that propelled the iron rod through Gage’s skull occurred on September 13, 1848, in Cavendish, Vermont. Gage was employed by a railroad company as a foreman in charge of a crew laying new track. One of his tasks was to blast apart any huge rocks that were in the way. This involved boring a hole into the rock and filling it with gunpowder using a long iron tamping rod. On the fateful day, a spark ignited the powder prematurely, thrusting 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 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 the 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 language 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. He removed the lobes in monkeys and noted that while there were no great physiological changes, the animals’ character and behaviour were altered. Today, it is well understood that the prefrontal cortex of the brain controls the organization of behavior, including emotions and inhibitions. Phineas Gage died of epilepsy twelve years after the celebrated accident, leaving behind a fascinating legacy, and altering our understanding of the relation between the mind and the brain. Little wonder that Gage’s skull and the famous iron rod are prime attractions at the Warren Anatomical Museum. Not many people survive a literal hole in the head.