Gage, Phineas (1823-1860), an American railroad worker, became an important medical curiosity. Gage survived a traumatic head injury that drastically changed his behavior and personality. The study of his case provided important insights into the role of the brain in human behavior. Medical historians consider Gage’s experience to be a key event in the early development of neuroscience. Neuroscience involves the study of the structure, function, and composition of the brain.
Gage was born in Grafton County, New Hampshire, on July 9, 1823. Little is known about his early life. When he was 25 years old, Gage was working with a crew using explosives to clear land for the construction of a railway line near Cavendish, Vermont. His work involved packing explosive charges into holes drilled into the bedrock using a 13-pound (6-kilogram) iron tamping bar. On Sept. 13, 1848, Gage accidentally struck the iron bar on the rock, creating a spark that ignited the explosives. The blast sent the bar upward with great force, striking Gage in the head. The bar was driven up through his left cheek and eye, piercing all the way through the top of his skull.
Remarkably, Gage not only survived the accident, but he was conscious and able to walk and speak. John Harlow, a local doctor, was summoned to administer aid. He noticed that a portion of Gage’s brain was visible as he dressed the wound with bandages. An infection of the wound left Gage semiconscious and near death for several weeks. Eventually, Gage recovered from the infection, and his wounds healed. The accident left him blind in his left eye and with some weakness and scars on the side of his face, but he was otherwise in good physical health. However, Gage’s friends soon noticed a drastic change in his personality and behavior. Before the accident, Gage was known as a friendly, calm, and agreeable person. Afterward, he became impatient, fitful, impulsive, and stubborn. He had difficulty making decisions and often used profanity or acted inappropriately, which had not been his custom.
Gage was unable to return to railroad work following his injury. He later traveled around the country and often posed for photographs with the iron bar that caused his injury. He became an attraction at the American Museum in New York City, New York, run by the showman P. T. Barnum. He later worked as a carriage driver and also sought work in South America. Gage left South America to return to the United States in 1859, settling in San Francisco, California. He died on May 21, 1860, after suffering a seizure. Today, doctors believe the seizure resulted from his injury.
Harlow examined Gage’s skull after having the body exhumed in 1866. He noted that the accident had destroyed a part of the brain at the front of the skull called the prefrontal cortex. Harlow compared Gage’s personality and behavior before and after the accident in a medical report he published in 1868. Harlow and other scientists suggested that the prefrontal cortex has an important role in planning and logical thought, decision making, impulse control, and temperament. The report marks one of the earliest occasions in which doctors identified specific parts of the brain associated with certain behaviors, marking an important development in the history of neuroscience. Today, Gage’s skull is kept at the Warren Anatomical Museum of the Harvard Medical School in Boston, Massachusetts.
