On September 13th, 1848, a man named Phineas Gage was working as a foreman on a railway construction site, where he would be impaled by a tamping iron due to a premature explosion charge (1).

On the job, Gage was preparing to excavate a rock by blasting tamping powder into a drill hole, but a premature spark was created, causing the powder to explode. The 3’7” long tamping iron then shot through Gage’s head, entering through his left cheek, passing through his eye socket, the front left side of the brain, and finally exiting through the top of his school on the right side (1). He remained conscious after the injury, and was treated by Dr. John Martyn Harlow, who would then be his physician for the rest of Gage’s life. He suffered from heavy amounts of blood loss and was semi-comatose for 2+ weeks, but nonetheless, miraculously survived (2).

The newspaper report above was published the day after the accident. It is also to be noted in the scientific literature, the measurement of 1 ¼ in was for the diameter of one end of the rod instead of circumference (1).

Sources:

(1) https://www.uakron.edu/gage/story.dot

(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC1114479/

Dr. David Ferrier is the man chosen to be docent for this exhibit. This is because Dr. Ferrier played a huge role in the contribution of information we gained through evidence after Gage’s death. He was a Scottish neurologist motivated by Gage’s personality shift in the role of frontal lobe function. He was also an early proponent of cerebral brain function localization, and discussed Gage in his Goulstonian lectures. Some of the studies Ferrier conducted included removing frontal lobes of monkeys, in which none showed any changes in sensory, motor, or perceptual processes (no major physiological changes), but he noticed that the animals’ behavior/character were different. He then compared the studies to human observations with frontal lobe lesions, and then formed a parallel between his findings (1, 2).

Gage’s case was specifically a huge cornerstone in Ferrier’s research, as he was very intrigued by its specific findings. One of the findings noted by Ferrier was that he could “perceive a very excited alteration in the animals, character and behavior, while it is difficult to stay in precise terms the nature of the change” (3). He also concluded that Gage’s behavioral and personality changes could be attributed to damage in the orbital frontal cortex of the ventral aspect of the front lobe, which would impact human affect and emotion (2).

Dr. Ferrier was very interested and intrigued with Gage’s case during and after his injury, as well as after his death, as his case served as a very valuable portion of evidence that aligned with his own previous work. 

(1)

https://www.sciencedirect.com/science/article/pii/S2173580812001198

(2)

https://pmc.ncbi.nlm.nih.gov/articles/PMC7735047/

(3)

https://pmc.ncbi.nlm.nih.gov/articles/PMC1114479/#B42 

Phineas Gage’s radical personality change was a huge deal in the mid 19th century, a time where phrenologists assessed personality according to the bumps on one’s skull His personality shift started the conversation about the relationship between physical trauma to the brain and behavior (3). It helped to further the inquiry of localization and function, as well as being the first instance of scientific evidence that would indicate the frontal lobes were responsible for personality and emotion (1). 

(1) https://www.npr.org/sections/health-shots/2017/05/21/528966102/why-brain-scientists-are-still-obsessed-with-the-curious-case-of-phineas-gage

(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC1114479/

(3) https://www.npr.org/sections/health-shots/2017/05/21/528966102/why-brain-scientists-are-still-obsessed-with-the-curious-case-of-phineas-gage 

Following unemployment, Gage then travelled around the world with his tamping iron companion, even displaying himself as a curiosity at various exhibit “freak shows”. The above document is an advertisement for one of these said exhibits. He was particularly popular at Barnum’s American Museum, New York City. Not only would he display himself as a spectacle, but Gage would also conduct lecture exhibits to New England towns (1). 

After a few years, Gage decided to move to Chile and worked as a long-distance stagecoach driver. This job specifically required extraordinary planning and motor skills, as well as focus and diligence in order to be conducted properly (2). The fact that these were feats that Gage could not have achieved shortly post accident, gave evidence to the thought that his personality was in the works of reverting back to normal (3). It was reported that his initial personality changes only lasted for about 4 years following the brain trauma, which also was a major key for developing ideas regarding neuroplasticity and brain rehabilitation (2, 3). 

Unfortunately, Gage had developed epilepsy about 12 years after the accident (presumably due to his brain injury), and died due to epileptic seizure (2). 

(1) https://www.uakron.edu/gage/adaptation.dot

(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC7735047/

(3) https://pmc.ncbi.nlm.nih.gov/articles/PMC1114479/

A computerized tomography scan (aka a CT scan), uses x-ray imaging in order to create detailed images of the body. A computer is used to create cross-sectional images afterwards to give more detail to the images. The first one done on a patient was in 1971, and began a new era for medicine and diagnostics by providing detailed imaging of the body that was never before seen (1). 

This new technology would later be used to create new, modern models of Gage’s skull and further our knowledge on his injury and the causes of his condition. 

In 1982, Rick and Ken Tyler conducted a CT study on Gage’s skull that specified the range of the point of exit his tamping iron would’ve taken. In 1994, Hanna Damasio and colleagues took a further examination into the matter, and ended up projecting likely trajectories of the bar in relation to the left cheekbone. A notable discovery made by the study was that all of the trajectories lie “to the right of the midline and so far forward of the junction” having the tamping iron “emerge under the reunited but otherwise undamaged frontal flap” (2). 

The most recent CT study done on the case was in 2012 by John Darrel Van Horn and colleagues, where they used a combination of magnetic resonance imaging (MRI) and CT image data to compare Gage’s skull to those of contemporary male subjects (25-36 years old). They were specifically looking at white and gray matter mapping and any respective damages. The study found there was indeed significant damage to the brain, localized in the left frontal cortex. This tells us that the physical trauma to this region impacted the network connectedness to other regions - making it a huge contributor to Gage’s behavioral changes. The images above were created by Van Horn and colleagues, which modeled the path of injury and its impacts on white matter in the brain (3). 

(1)

https://pmc.ncbi.nlm.nih.gov/articles/PMC8555965/

(2)

https://www.uakron.edu/gage/damage.dot

(3)
https://pubmed.ncbi.nlm.nih.gov/22616011/

After Gage’s death, he was buried on May 23, 1860, and was not submitted to be autopsied prior (according to cemetery interment records) (1,2). His mother allowed for the exhumation of his body and donated the skull and tamping iron to Dr. Harlow who did his own studies and publications about the case, who also then donated both to Harvard University years later (2). 

Today, Gage’s skull and his tamping iron are both on display at the Warren Anatomical Museum at Harvard University for the public to see. Harvard also possesses two portraits of Gage (one being seen in section 2), various manuscripts/records on Gage’s life during and post-recovery by his doctors, as well as published articles on his case (in The Boston Medical and Surgical journal, The American Journal of the Medical Sciences, etc). There is even an entry that marks the initial donation of Gage’s tamping iron that he donated himself, but requested back in 1854 (3). 

Evidently, the scientific evidence we’ve collected from Gage and his accident have been paramount to develop neuropsychiatry, medicine, and psychology to what we know today (2).

(1) https://www.uakron.edu/gage/story.dot

(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC7735047/

(3) https://collections.countway.harvard.edu/onview/exhibits/show/beyond-the-bone-box/the-case-of-phineas-gage 

Along with his changes in personality, it is also important to recognize that Gage’s cognitive functions being intact was a key factor of the historic event as well. Subsequent to personality changes that were experienced by family, friends, and peers, Dr. Harlow observed Gage’s cognitive abilities. It was reported that Gage remembered passing/past events easily and correctly immediately after recovering from the injury; his intellectual faculties were only slightly impaired, “not totally lost”, and “nothing like dementia”. His mental operations were “perfect in kind, but not in degrees or quantity”, according to Dr. Harlow. His memory, cognition, and strength reportedly had not been significantly impacted, which was an incredible and miraculous feat considering the injury he had sustained. The entirety of Gage’s case report by Dr. Harlow was submitted to The Boston Medical and Surgical Journal (1,2). 

(1) https://pmc.ncbi.nlm.nih.gov/articles/PMC7735047/

(2) http://pmc.ncbi.nlm.nih.gov/articles/PMC1114479/#B4