Meet the two versions of Phineas Gage

Senior Research Fellow, Professor Ken Donaldson, first encountered the story of Phineas Gage during a major course Psychology at University of Stirling in 1974 and this fascinating tale has stuck with him ever since. In this blog he tells us more about the curious case of Phineas Gage.

A moral man, Phineas Gage
Tamping powder down holes for his wage
Blew his special-made probe
Through his left frontal lobe
Now he drinks, swears, and flies in a ra
ge
 – Anonymous limerick

Phineas Gage had a hole in his head,
And ev’ryone knew he oughta be dead.
Was it fate or blind luck, though it never came clear,
kept keepin’ on year after year
-Popular song by Dan Linder

There were two versions of Phineas Gage– the first was born in July 1823 in New Hampshire in the USA; the second Phineas Gage emerged on September 13 1848. By 1848 Phineas was a construction worker for a railroad company laying lines, his job being to clear rock and boulders to make a flat course for the rails. On 13th September Phineas went through his usual routine for breaking up large rocks. This was accomplished by drilling a large hole deep into the rock and tamping a stick of dynamite into it with a tamping iron that was a metre long and 3 cm in diameter. Then, after retiring a safe distance, the dynamite was ignited. On that fateful day however, as he was tamping the dynamite into place, Phineas caused a spark and the dynamite exploded. The tamping iron shot out of the drill-hole like a rocket and passed through his left cheek, left eye and exited through the top front of his skull on the left side (See diagram), landing 25 metres away; his hands and arms were burned.

Diagram showing the estimated trajectory of the tamping iron through the skull of Phineas Gage his mouth was open when it happened; the direction is shown by the arrows.
Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al., CC BY 2.5 https://creativecommons.org/licenses/by/2.5, via Wikimedia Commons

Within a few minutes he was talking, although obviously shocked and after being taken in a cart, sitting upright, the quarter of a mile to his hotel, he walked to his room and lay down on the bed. The first physician to attend him was a Dr Williams, who reported that, on meeting him, Phineas said, with obvious irony, ‘Doctor here is business enough for you ‘.  As Williams examined him, Phineas vomited and to Williams’ astonishment ‘the effort of vomiting pressed out about half a teacupful of the brain [through the exit hole at the top of the skull], which fell upon the floor’. There was considerable bleeding from his wounds some of which found its way down his throat because of the internal damage done as the projectile passed through his head.

Phineas Gage after the accident, with the tamping iron which he took with him everywhere. Originally from the collection of Jack and Beverly Wilgus, and now in the Warren Anatomical Museum, Harvard Medical School., CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons

Doctor Williams dressed the wound, noting ‘the appearance of the wound in the top of his head, the fragments of bone being lifted up, the brain protruding from the opening and hanging in shreds upon the hair,’. Phineas was then seen by a Dr Harlow who had known him prior to the accident and who went on to record Phineas’ case throughout his life and write it up for publication. The wound became infected and 2 days later Phineas was delirious, but the bleeding had stopped. Against all expectations he was much-recovered by 10 days post-accident. He did however suffer further declines in his health with discharges from his skull wound, periods of coma and the loss of his eye due to infection (this was the pre-antibiotic era and infection was unchecked), but by one month after the accident he was going out and he moved back home to convalesce at 10 weeks.  

However, a new Phineas Gage emerged following the dramatic loss of brain tissue from his left frontal lobe. The personality of this Phineas was a considerable contrast to the first Phineas that everyone knew. Dr Harlow, who knew him pre-accident, described him thus –

‘Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation’.

Harlow noted that post- accident his personality was so changed that his friends regarded him as ‘no longer Gage’. In characterizing this change Harlow described it as – 

‘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 operations, 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.’

His previous employers chose not to employ him because of the change in his personality and Phineas worked for a time as an exhibit in Barnum’s American Museum in New York City, telling his remarkable story and showing the tamping iron. He then became a coachman in Chile and over the 12 years following the injury there was some evidence of a return of the old Phineas, as his behavior moderated, in keeping with the ability of the brain to find new pathways following injury. The remarkable two lives of Phineas Gage came to an end in San Francisco on May 21, 1860 following epileptic convulsions that were very likely a late sequel of his brain injuries. He was buried along with the tamping iron but at Dr Harlow’s request his body was later exhumed. Phineas’s skull and the tamping iron that shot through it, are now on display in the Warren Anatomical Museum, Boston, Massachusetts, USA.

The link between damage to the frontal lobes of the brain and personality change, first illustrated by the case of Phineas Gage, are now well understood.   The frontal lobes are the seat of the neural networks that determine our personalities –   problem solving, spontaneity, memory, language, initiation, directed movement, judgement, impulse control, and social and sexual behavior.  The emergence of Phineas number 2 becomes understandable on the basis that the tamping iron obliterated a large amount of this frontal lobe tissue on the left side, thereby interfering with some of these functions and changing his personality.

The skull of Phineas Gage; the exit wound through the frontal bone of the skull is evident.
J.B.S. Jackson, MD, Public domain, via Wikimedia Commons

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