Phineas Gage

Print More

(HOST) Whenever he’s muscling fieldstone to build stone walls, commentator Peter Gilbert can’t help but think of an industrial accident that happened in Vermont – and made medical history.

(GILBERT) Summer’s the time I build stone walls. Although I’m not particularly skilled at it, I love doing it. When I’m gathering fieldstone for walls, my one essential tool is a crowbar – a straight, heavy steel bar. I use it to find rocks below the surface of the ground, to pry them out, and to lever the biggest stones into place. Every time I use that crowbar, I think of Phineas Gage, a Vermonter whose rare combination of terrible misfortune and miraculous good fortune – furthered our understanding of the human brain.

Phineas Gage was a railroad construction foreman. He used an iron rod – three-and-a-half feet long, an inch and three-quarters in diameter, and tapered at one end, like mine – to tamp gunpowder, fuse, and sand down into the blasting holes that had been drilled in the rock. One September day in 1848, when working near Cavendish, Vermont, Gage didn’t notice that the sand had not been poured in a hole on top of the black powder. When he tamped the charge down, a spark ignited the powder and sent the iron bar shooting up as if from the barrel of a gun.

The bar entered Gage’s head just below his left cheekbone; it passed behind his left eye, and exited the middle of his forehead at about the hair line. The bar landed on the ground thirty yards away. As others ran to his side, Gage sat up, and began to speak. He rode into town in a cart, and, ever the foreman, he called for his time book and wrote an entry in it. A half-an-hour later, covered with blood, he greeted the town doctor cheerfully and told him about the accident. The doctor was, obviously, incredulous! Gage should have been dead – if not killed instantly from the bar through the brain, then from the bleeding, shock, and brain-swelling thereafter. The doctor cleaned his wounds and put Gage to bed.

Gage lived another eleven years. He was able to work, talk, and walk. Despite his horrific accident, he seemed fine. But, in fact, he had changed. Before the accident, he was pleasant and reliable; afterwards he became crude, impatient, and unpredictable. Gage’s friends said he was “no longer Gage.”

What happened? Recent computer simulations suggest that the part of the brain responsible for speech and motor functions was spared. However, the damage that was done in the area where the frontal lobes meet affected his rational decision-making process and his processing of emotion.

Phineas died in 1860 of seizures that had grown more violent over time.

His tragedy furthered scientific understanding; indeed, his skull and tamping iron are still part of the collections of Harvard Medical School. As one researcher observed, it was “the beginning of the study of the biological basis of behavior.” But this medical story is fundamentally a human story – of an ordinary Vermonter who suffered an extraordinary accident. While he miraculously survived, his personality was fundamentally altered, and ultimately the accident proved fatal.

Peter Gilbert is the executive director of the Vermont Humanities Council. He spoke from our studio in Montpelier.

Comments are closed.