Phineas Gage.

 

The curious accident of Phineas Gage The Iron bar shown here is in the collection of the Museum of Harvard Medical School, a relic of a terrible accident. In September 1848 Phineas Gage, a twenty-five-year-old railroad worker in Vermont, was tamping a charge of black powder into a hole drilled deep into rock in preparation for blasting. The powder unexpect­edly exploded, blowing the tamping iron, over three feet long and weighing thirteen pounds, through Gage’s head and high into the air. (Illustration from Psychology by Rod Plotnik)Incredibly, Gage regained consciousness and was taken by wagon to his hotel, where he was able to walk upstairs. T.M. Harlow, the physician who attended him noticed that the hole in Gage’s skull was 2″ by 31/2 wide, with shreds of brain all around it. He cleaned and dressed the wound, but two days later Gage became delirious and remained near death for the next two weeks. The wound became seriously infected, but eventually healed. In a month Gage could get out of bed without help; in two months he could walk unassisted.Gage lived on for over twelve years. Physical impairment was remarkably slight. He lost vision in his left eye and the left side of his face was partially paralyzed, but his posture, movement, and speech were all unimpaired. Yet, psychologically, he was a changed man, as a summary by Harlow makes clear:       his physical health is good, and I am inclined to say that he has recovered. Has no pain in head, but says it has a queer feeling, which he is not able to describe. Applied for his position as foreman, but is undecided whether to work or travel. His contractors, who regarded him as the most efficient and capable foreman within their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again. The equilibrium or balance, so to speak, between his in­tellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulg­ing at times in the grossest profanity (which was not previously his custom), manifesting but little de­ference for his fellows, impatient of restraint or advice when It conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, though untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart, businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer ‘Gage’” (Bigelow, 1850, pp. 13-22) Gage’s case is one of the earliest documented examples of massive damage to the frontal regions of the brain, and it illustrates the great subtlety of the psychological symptoms that accompany such lesions. Indeed, it was Gage’s family and friends, rather than his doctor, who noticed the changes in him. Gage’s symptoms, such as “obstinacy” or “capriciousness,” are hardly so remarkable that we would attribute them to brain damage in someone whose history we didn’t know. Yet, it is interesting to note that they represent the very kinds of antisocial behavior that prefrontal lobotomies are supposed to prevent.

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