My Brain Hurts

09 13 phineas gageToday’s post starts with a word of warning. I am celebrating someone’s miraculous survival of a horrific accident. If you don’t like thinking about catastrophic physical injuries, don’t read this.

Phineas Gage was a strong and healthy twenty-five year old who made his living working with explosives. And already you see how this could go horribly wrong don’t you? He was working as a blasting foreman on the Rutland and Burlington Railroad just south of Cavendish, Vermont. I need to tell you at this point that he had asked a local blacksmith to make him a tamping stick of his own design. A tamping stick is a long metal rod used to push explosives into a hole, often into the barrel of a gun, but in this case into a hole in a rock that was too big to move and needed to be blasted out. Gage’s tamping stick was 3 ft 7 in (1.09 m) and 1¼ in (just over 3 cm) wide. It tapered to a point at the top and weighed more than thirteen pounds. There was no other like it.

On this day in the year 1848 he was charging a powder hole that had been drilled into a rock. What was supposed to happen was that sand would be poured in on top of the explosive. He directed his assistant to pour in the sand and then turned away momentarily. He did not see that his order had not been carried out. He dropped his tamping stick into the hole. The powder ignited and there was an explosion. His iron spike was thrust through his chin, out of the top of his head, high into the air and landed several yards away.

Gage was thrown onto his back but managed to speak after a few minutes. His friends helped him to an ox cart and he was taken back to his lodgings three quarters of a mile away. He was able to get out of the cart and walk, with a little assistance. When the doctor arrived he found his patient lucid and able to describe what had happened. Leaving out some of the gory details (though, if you’re so inclined, you can find them here), a second doctor was arrived and together they removed some loose fragments of bone and dressed his wounds. The next day his speech had deteriorated. The day after that he was delirious. But two days later he showed some improvement. The following month he took a turn for the worse and was almost comatose, but his doctor lanced a cerebral abscess and he began to recover. By the middle of November he was up and about and insisting on returning to his home town. It was a terrible injury but the pointed end of the stick was probably what saved him. It caused less trauma than a blunt object would have.

Although his physical recovery seemed to be going well, it seems his mental state was somewhat erratic. He returned to his parents home on November 25th but travelled in a closed carriage. What is meant by this is a carriage used to transport the insane. In the first few years following the accident his doctor, John Harlow, described him as being impatient, rude, obstinate and capricious. He tells us Gage was: A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Of course Harlow did not know his patient before the accident but his friends said that he was so changed that he was “no longer Gage”.

He must have recovered mentally to some extent because by the following February he was able to do some work on his parent’s farm. Later he exhibited himself, along with his iron spike at Barnum’s American Museum in New York and around the towns of New Hampshire and Vermont. After that he worked for the owner of a livery and coach service in New Hampshire. In 1852 he was offered a job as a stagecoach driver in Chile. His route took him from Valparaiso to Santiago, a distance of over a hundred miles. To do a job like that, which required a 4am start, caring for horses, dealing with passengers, loading their luggage and collecting their fairs as well as the gruelling journey, he must surely have made a significant psychological recovery. Especially as he did all this in a country unfamiliar to him. Gage kept this job until 1859 when he became ill. He returned to his parents home and began to recover but then began to suffer epileptic fits. The fits became gradually worse and he died in 1860, a little under twelve years after his accident.

09 13 phineas gage skullNo autopsy was carried out on Gage so no one will ever know what the extent of his injuries were. In 1866 Dr Harlow discovered that his patient had died and managed to obtain his skull (with his family’s permission) along with his iron spike. Both now reside in the Warren Anatomical Museum at Harvard. Harlow was able to conclude, after examining the skull, that the damage had been limited to the left frontal lobe of the brain. Little was known about the functions of different areas of the brain at that time but Harlow did realise that Gage would not have survived if the injury had damaged the back part of his brain. If his right frontal lobe had remained undamaged as the doctor suggested, it would have been able to adapt and take on some of the functions of the damaged area.

Gage’s case has been used to prove many (often conflicting) stories about the nature of the brain but in truth no one really knows enough about his demeanour, before of after the accident, or the extent to which his brain was damaged, to really draw any useful conclusions. Often they suggest that post-accident he was irresponsible, violent, untrustworthy and couldn’t hold down a job, that he mistreated his wife and child and that he was generally a psychopath. Yet he held down a difficult job for seven years and never married. If his case shows us anything it is how quickly facts can grow into a myth. His personality has been reconstructed to fit in with what people think they know about the function of the frontal lobes of the brain in regard to self control.

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