15 Facts About The Curious Case Of Phineas Gage

Over the course of history, certain moments have stood out. This isn't necessarily because these moments have changed the course of the world, either. Sometimes these moments stick out because the events were just really interesting, or impact the world in a way that we might not feel all the time. One such moment is the story of the life of Phineas Gage. Phineas Gage was just an ordinary man when he was essentially lobotomized by a big iron spike. Miraculously, he survived, but he wasn't the same after he recovered. His brush with death and subsequent recovery was a major event for neurology because it showed that messing with the brain can have far-reaching effects.

Phineas Gage, apart from the iron spike incident, was an ordinary man. He had a job, a family, and friends. He tried going back to life as he knew it before the incident, but his own brain managed to get in the way. After he recovered, he only lived for a few more years before dying of a seizure disorder, but his story has lived on to the point where we still talk about it today. It's considered a major moment in the history of medicine, and it's just a cool story to hear about. Here are fifteen things you need to know about Phineas Gage, his early days, the aftermath of his death, and his legacy.

15 Phineas Gage Wasn't Much Older Than Your Average College Grad

A lot of people tend to think that history is made by older people. That the things that change the way we think about things were done by people who'd already lived their lives. That couldn't be further from the truth. For example, Phineas Gage was only 25 when the accident happened. He wasn't much older than the average college student today, and he's definitely younger than you'd expect your average railroad worker to be. In reality, Phineas Gage hadn't gone to work that day expecting to be remembered centuries later. He was just looking to have a good day at work, then come home. That's not unlike the way many of us approach our jobs now. He's a good example of how events that serve to change the course of your life are really unexpected and are sometimes less than welcome.

14 September 13, 1848 – The Iron Rod Goes Through His Skull

On September 13th, 1848, Phineas Gage was at work, having an ordinary day. He was blowing up rocks to make way for a new railroad line in Cavendish, Vermont. That job entailed drilling holes, placing explosive charges, then packing those charges in sand using a tamping iron, a big metal bar that's designed for that purpose. Unfortunately, the tamping iron created a spark on this day, and that spark triggered the charge that set off the explosion. This made it so the iron "drove this tamping iron up and out of the hole, through his left cheek, behind his eye socket, and out of the top of his head," says Jack Van Horn, an associate professor of neurology at the Keck School of Medicine at the University of Southern California. The iron basically destroyed his left frontal lobe, and it seemed like he wouldn't live through it.

13 The Iron Weighed 13 Pounds

We need to talk about how big this tamping iron was. First, the iron was thirteen pounds. There are some people out there who have trouble lifting thirteen pounds with their hands, and Gage got the full force of it driven into his head. According to the doctor on the scene, John Harlow, the tamping iron was found about ten meters away with blood and brain all over it. [The tamping iron] entered the cranium, passing through the anterior left lobe of the cerebrum, and made its exit in the medial line, at the junction of the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the parietal and frontal bones extensively, breaking up considerable portions of the brain, and protruding the globe of the left eye from its socket, by nearly half its diameter." he wrote in a letter to the editor of the Boston Medical and Surgical Journal, entitled "Passage of an Iron Rod Through the Head." Ouch.

12 He Was Walking And Talking Within A Few Minutes

Despite the astronomically long odds, not only was Gage still alive, he was walking and talking within just a few minutes. He even claimed that he hadn't lost consciousness, either, which is even more remarkable. He felt steady enough to get into an oxcart on his own, and when someone took the reins and made the horses go faster, he actually sat upright for the whole ride into Cavendish.

That ride was only about a mile long, but in 1848, with half of your brain decorating a thirteen pound tamping iron, that ride must have felt like it took forever. They took him home, which wasn't far from the railroad site, where Harlow took small bits of bone out of his wounds and replaced what had been forcibly removed by the tamping iron. He even greeted the doctor by saying “Here’s business enough for you.” Even he didn't know what those words foreshadowed at the time.

11 The Doctor Could See His Brain Falling Out

While his head was eventually patched up, the scene those around him were greeted with was one of blood and gore, and definitely not for the faint of heart. The iron went in below his left cheekbone, passed behind his eye, destroyed one of his upper molars, and went right through the underside of his left frontal lobe. It came out through the top of his skull by his midline, right behind where his headline would start. The rod passed all the way through his head, popping out and flying through the air so fast that witnesses could hear it whistle as it went. It finally landed about 25 yards away, sticking upward in the dirt like a flagpole. People who happened to be around at the time described it as greasy to the touch thanks to all of that fatty brain tissue. It's gross, but it's the reality of an injury like that.

10 An Infected Wound, Semi-Comatose State, And Full Recovery

The wound was closed up that day, with the doctor using adhesive straps to keep the wound closed. Unfortunately, this was still 1848, and despite the doctor's best efforts, Gage's wound became infected. That infection caused him to fall into a semi-comatose state within days. His family feared the worst, even getting him a coffin in case he did succumb to his injuries and die. Against all odds, though, Gage survived, and by January 1849, he'd made a full recovery. For most, this miraculous survival would have been the end of the story, but it wasn't for Phineas Gage. For him, this was just the beginning of his journey to becoming a major source of fascination for people then and now. While Gage lived for several more years, the man before the accident had basically died, leaving a post-injury Gage behind.

9 Extreme Personality Changes – He Lived But He Was "No Longer Gage"

After his brush with death, Phineas Gage went back to living a normal life. However, things didn't go back to normal, especially not for those around him. I'll let his doctor, John Harlow, describe what he was like for those around him after his accident.

"His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again. 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 of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. In this regard, his mind was radically changed, so decidedly that his friends and acquaintances said he was 'no longer Gage,'" he wrote in the Bulletin of the Massachusetts Medical Society.

8 All Doctors Could Do Was Wait And Watch The Changes

Gage's surviving this railroad accident was nothing short of a miracle. Think about it: there are people who have this injury in this century that don't survive it. The fact that Gage's brain was able to take a hit like that was totally unprecedented and shocking for the people of the nineteenth century. Back then, people really didn't know all that much about the brain. They definitely didn't know what would happen after someone survived a traumatic injury like that.

All scientists and doctors of the day could do was watch and wait to see if something changed. The changes that Gage went through allowed us to understand how the brain is organized. After all, if personality changes happen when the front part of the brain is damaged on the left side, where are other things located in the brain? This is why he's so important to the study of neurology, according to Malcolm McMillan, an honorary professor at the Melbourne School of Psychological Sciences and the author of An Odd Kind of Fame: Stories of Phineas Gage. "He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality." he told NPR.

7 We Still Have His Skull

Phineas Gage's skull can still be seen today. After he died, he was buried the subsequently exhumed. It eventually became the property of John Harlow, the doctor who'd treated him, and he ended up giving it to Harvard University. However, it didn't stay there for all that long. Currently, the skull is sitting on a glass shelf in the Warren Anatomical Museum. Unfortunately, this skull isn't really distinguishable from all the other oddities and novelties in their skeleton section. The thing that sets his skull apart from the others isn't the way it's displayed, but what it's next to. Next to the skull lies the iron rod on a presentation stand, with an inscription that talks about what happened and mentions that he made a full recovery.

6 He Had "Fungus" In His Head

It stands to reason that an injury as gory and serious as Gage's would be susceptible to infection, especially in the nineteenth century. We don't know what infection he got that made him slip into a state of unconsciousness, but we do know that it was described as a "fungus." Considering the grossness of what needed to be done in order to clean up the injury, it seems like Gage got off light! People with weak stomachs should probably skip ahead at this point, because the dirty details of dealing with brain injuries are not for the faint of heart.

First, Harlow needed to shave his scalp and peel off the dried blood and brain matter. He then needed to go in and get the skull fragments with his bare hands, kind of like a Chinese finger trap. The whole time, Gage was awake, and retching every twenty minutes or so because blood and bits of his brain were reportedly falling down his throat. Despite that, he stayed conscious and even rational, going so far as to say he'd be back to work within a couple of days.

5 His Face Was Paralyzed

Brain damage aside, an injury like that would obliterate the nerves in a person's face, and Gage was no exception. The tissue inside his nose needed to be punctured so the wound could be drained, and he eventually lost sight in his left eye and needed to have it sewn shut for the remainder of his life. It took awhile. But he eventually recovered. By November of 1848, he went back home to Lebanon, New Hampshire, taking the tamping iron with him. His recovery was so miraculous, some doctors didn't believe that the event had even occurred. As for John Harlow, he chose not to attribute Gage's survival and full recovery (sort of) to his own efforts, choosing instead to give the credit to a higher power. “I dressed him,” he wrote, “God healed him.”

4 He Kept The Rod And Would Pose With It

One thing that was established about Gage's life post-injury is that he had a weird attachment to the tamping rod that went through his brain. He was known to carry the iron around with him everywhere, even posing with it from time to time. He gave it to Harvard for awhile, but then he asked for it back in 1854. It wasn't his security blanket or anything, but it was definitely an important object in his life. This might seem weird for us to hear about today. After all, who would want to carry around a reminder of the time a big piece of metal permanently damaged your brain? Believe it or not, this is actually a normal thing for people. People tend to get very attached to different objects, even identifying with them emotionally. The objects people get attached to are appropriately called "attachment objects."

3 He Toured The US

After the injury, Gage went back to work. We don't know too much about his life post-accident. We don't even really know how Gage changed after the incident. We know that something was different with him, but it's impossible to tell how much he changed because of he tabloid-like dramatization surrounding coverage of him. What we do know is that he held down a few jobs over the years after his injury. He worked at a stable in New Hampshire for awhile, and even had a job as a long distance coach driver in Chile. He settled down in California in 1859. While he was living in New England, he toured the bigger towns, making public appearances. He even presented himself to Barnum's American Museum in New York City. We don't know if people paid to see him there, but we can assume that that probably happened.

2 His Personality Went Back To Normal Before He Died

After Gage settled down in California after his stint in Chile, his health started to decline. He started having seizures, and by the end of the night, they were full on convulsions. This seizure disorder was a result of the injury that made him famous. When he died, he was living in San Francisco. While we know a lot about him now, it's been impossible to parse out the true events of Gage's life without coming into contact with all of the myths. Every new generation, it's kind of like he's reborn. Some symptoms get amplified while others get downplayed, and it's different with every retelling. Back in the 1800s, his profanity was explained by the destruction of the "organ of veneration" while scientists today are all about fitting him into every psychological and neurological science trend the modern age has to offer.

1 His Doctor Kept His Skull

After he died, his skull was given to his doctor, John Harlow. This is almost fitting, considering that everything we know about Gage comes from Harlow, especially about his life after his accident. We wouldn't know that he spent time in South America and traveled a lot for work if it weren't for John Harlow. It's thanks to his work that we know that Gage was actually able to return to a somewhat normal life because of how his life was structured when he lived in Chile.

We know now that people with frontal lobe damage don't do very well with open-ended schedules, so Gage's regimented life was a help to him since he never had to worry about planning his day. He's an example of how we treat people with frontal lobe injuries today: give people structure to keep them focused. It's because of Harlow that we know anything about Gage at all, and if it weren't for his quick thinking and nerves of steel, Gage wouldn't have made it. This story is worth remembering because he shows that even an obscure story can turn into something bigger than any of the players if people are fascinated enough by it.

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