A Curious Case in Neuropsychology: The Man Who Survived a Rod Through His Skull

Featured, Health, Science 2018-11-05

Phineas Gage could, in some respects, be considered as somewhat of a ‘celebrity’ in the world of neuropsychology; his case is certainly infamous in medical history.

Why is he so well-known? To put it simply, Phineas Gage is famous for sustaining terrible damage to his brain after a small metal rod passed completely through his skull. Miraculously, he survived, and actually lived for a further 12 years. The effects of this trauma to his personality provided a ground-breaking insight into the localisation of different brain functions, uncovering the relationship between personality and frontal neural structures.

In September 1848, at the age of 25, Phineas Gage was working as a railroad foreman in Vermont when an accident changed his life forever.1 Whilst clearing away rock to allow rail tracks to be assembled, an unplanned explosion drove an iron rod – 1.1 m long, 6 mm in diameter, and weighing 6 kg – into his left cheekbone. The rod travelled through his left frontal cortex and out of the back of his skull with incredible force.

To the surprise of onlookers and subsequent medical attendees, Phineas remained conscious in spite of his injuries, eventually making a seemingly full recovery within 5 weeks. In addition, no short-term deficiencies in memory or cognition were observed despite the extensive brain injury that had occurred.

However, it later became clear that the accident had in fact resulted in several major neurological consequences after all.

The once capable and efficient foreman was now unpredictable, rude and disinhibited; unable to maintain any job or relationship. The personality change observed in Phineas was so extreme that it even resulted in his friends and colleagues referring to him as ‘no longer Gage’.

In the world of neuroscience, this abrupt personality change following a traumatic event was a staggering revelation. It provided contemporary scientists with the first evidence that brain damage can directly affect behaviour, personality and emotion. Specifically, it taught us about the importance of the frontal lobes in these functions.

Modern research and innovative computerised neuroimaging techniques have since allowed us to digitally reconstruct Phineas Gage’s skull using measurements recorded at the time of his death (a result of a severe epileptic seizure; almost certainly related to his brain injury).2 These methods were used by John Van Horne and his colleagues at UCLA’s Laboratory of Neuroimaging, who defined the damage as restricted to the left and right prefrontal cortices. From their research, it has been estimated that as much as 11 percent of the total white matter in Gage’s frontal lobes was destroyed in the accident.3

The computational model generated by Van Horne and his team also suggested that the connections between the frontal cortex and the limbic system may have been damaged in Phineas’ brain.3 As the limbic system is well known as the main neural regulator of emotional responses, this explains why his personality change included the occurrence of abnormal emotional behaviour.

Later studies using patients with lesions to the prefrontal area of the brain demonstrate that the prefrontal cortex is fundamental for many executive functions, like decision-making, impulsiveness and social judgement.4 This explains why people with frontal brain injuries, such as Phineas Gage, are more likely to display a risk-seeking behaviour pattern and are less able to understand the consequences of their actions, plan for the future or complete goal-related tasks.

Today, both Gage’s skull and the iron rod are on permanent display at the Warren Anatomical Museum in Harvard’s Countway Library of Medicine, after being donated seven years after his death in 1860.5

What do you think of Phineas Gage’s story? Let me know at @SophieAtNotch.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114479/
2. http://science.sciencemag.org/content/264/5162/1102
3. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037454
4. https://www.sciencedirect.com/science/article/pii/S0028393203000393
5. https://www.countway.harvard.edu/center-history-medicine/collections/notable-holdings