How Phineas Gage’s freak accident changed brain science

How Phineas Gage’s freak accident changed brain science

Cavendish may seem like any other small town in Vermont. Nestled between rolling hills and the Black River, with one main street running through town, it is a launching point for trout fishermen, snowmobilers and skiers. But this rural town with a population of just over a thousand people can lay claim to a great historical figure: Phineas Gage.

Frontispiece, showing multiple views of the exhumed skull, iron, of brain injury survivor Phineas Gage. J. B. S. Jackson, Maryland – Descriptive Catalog of the Warren Anatomical Museum (1870) (CC0)

Gage was a young construction foreman who was involved in a terrible accident that changed the history of brain science.

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In 1848, while blasting rock to build the new railroad, an explosion sent a 3-foot-long, 13-pound iron rod through his cheekbone and out the top of his skull. The tamper rod landed 80 feet away, “stained with blood and brains.”

Remarkably, Gage lived another 11 years. He was missing an eye and there was a permanent hole in his skull covered by a thin layer of skin.

Gage was a medical marvel.

There was a long-standing debate in the 19th century about whether different regions of the brain controlled different behaviors. Here was a case of severe damage to the left frontal lobe, followed by a radical personality shift. It seems to prove this point once and for all.

“It paved the way for the first true brain surgery in 1885,” Margo Caulfield, director of the Cavendish Historical Society, told the website “As far as we know.” “It’s opened up a whole new horizon. You can survive a brain injury, you can touch the brain, which means you can have surgery. It’s really, really huge.”

https://www.youtube.com/watch?v=yXbAMHZYGJ0

Gage was never the same after the accident.

He was well-liked by his co-workers and his employer, but later, his doctor reported that he had become “volatile, disrespectful, and occasionally indulged in the most horrific profanities.”

“Gage is no longer Gage,” said a friend.

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Gage was unable to work on the railroad, but he still needed a job.

For a while, he made money by parading himself around New England as a curiosity, showing off the holes in his head and his famous tamping iron.

He was then offered work as a long-distance rickshaw driver on the Val Paraíso-Santiago route in Chile. The route was 100 miles long, and took 13 hours of handling a coach and six horses, plus passengers, over rough terrain.

Gage lived in Chile for seven years and then began having epileptic seizures.

He died in 1860 at the age of 36.

Margo Caulfield
Margo Caulfield, director of the Cavendish Historical Society, shows Anne Strinchamps and Steve Paulson the site of the Phineas Gage accident in Cavendish, Vermont. The path he launched will become a railway corridor. Steve Paulson/TBook

Over the years, scholars have interpreted Gage’s story in different ways.

Initially, it was seen as a victory for human survival. It then became for decades a paradigmatic case of post-traumatic personality change. More recently, Gage’s case has been interpreted as a story of resilience. For a man who was supposedly volatile and antisocial, Gage’s ability to hold on to a difficult job in Chile suggests that he has regained his independence and ability to socially adapt.

Gage’s story may be a textbook of another kind, demonstrating the brain’s ability to rewire after trauma. This gift of neuroplasticity is why we are able to handle so much of what life throws at us.

“I’m amazed at what he overcame to survive this long,” Caulfield said. “The resilience part of his story fascinates me…I think resilience is in our DNA.”

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