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Phineas P. Gage (1823 - May 21, 1860) was a railroad worker who suffered a traumatic brain injury which inflicted severe damage to parts of his frontal lobes during a work accident. He survived but had a markedly altered personality, providing some of the first clues that specific parts of the brain, particularly the frontal lobes, might be involved in specific psychological processes involved with emotion, personality and problem solving.
Gage's injury
In September 1848, Phineas Gage was working outside the small town of Cavendish, Vermont on the construction of a railroad track where he was employed as a foreman. One of his duties was to set explosive charges in holes drilled into large pieces of rock so they could be broken up and moved. This involved filling the hole with gunpowder, adding a fuse, and then packing in sand with a large tamping iron. When Gage was momentarily distracted, the tamping iron sparked against the rock and ignited the gunpowder, causing the iron to be blown through Gage's head with such force that it landed almost thirty metres behind him.
 Life cast and skull of Phineas Gage The 4-foot-long tamping iron entered his skull below his left cheek bone and exited after passing through the front part of the frontal lobes (specifially, the ventromedial areas of the prefrontal cortex). Remarkably after such a dramatic accident, Gage was speaking within a few minutes and managed to sign off his time sheet and walk home, where he sat outside and waited for the doctor. After a seemingly complete recovery from such a serious injury, and due largely to the work of Dr. John Harlow, Gage was soon back at work.
However, whereas previously he had been hard-working, responsible, and popular with the men under his charge, his personality seemed to have been radically altered after his accident. Dr Harlow reported that:
- "He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom)Â… capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandonedÂ… Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew his as shrewd, smart businessman, very energetic and persistent in executing all his plans of operation."
Gage led a checkered life after his injury, and at one time was part of P. T. Barnum's travelling circus, showing his injury, and the tamping iron which caused it, to the fee-paying public.
Significance for Brain Science
 This computer-generated graphic shows how the tamping rod penetrated Phineas Gage's skull Gage's case was among the first evidence that damage to the frontal lobes could alter aspects of personality and affect socially appropriate interaction. Before this time the frontal lobes were largely thought to have little role in behaviour.
Neurologist Antonio Damasio has written extensively on Gage, and various patients he has studied with similar brain injuries. In a theory he calls the 'somatic marker hypothesis', Damasio suggests a link between the frontal lobes, emotion and practical decision making. He sees Gage's case as crucial in the history of the brain sciences, arguing that Gage's story "was the historical beginnings of the study of the biological basis of behavior".
It is occasionally suggested that Gage's case inspired the development of frontal lobotomy, a now-obselete psychosurgical procedure that blunted emotional response and affected personality. However, historical analysis seems not to be able to support this claim. It seems that consideration of Gage's injury had little influence on the development of this practice.
Gage's skull is currently held by the Warren Anatomical Museum at Harvard Medical School in Boston.
See also
Further Reading
- Damasio, A.R. (1995) Descartes' Error : Emotion, Reason, and the Human Brain. ISBN 0380726475.
- Fleischman, J. (2002) Phineas Gage: A Gruesome but True Story About Brain Science. ISBN 0618052526
- Damasio H., Grabowski T,. Frank R., Galaburda AM., Damasio AR. (1994) (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8178168&dopt=Abstract) The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264 (5162), 1102-5.
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