Speaking of famous cases in neuroscience, did you hear the one about the guy who survived having his head skewered by an industrial crowbar – and lived to tell the tale?
I am not making this up. Phineas P. Gage was born in 1823 and died in 1860. He labored as an American railroad construction foreman
On September 13, 1848, 25-year-old Gage was preparing a railroad bed near Cavendish, Vermont, packing explosive powder into a hole with an iron tamping rod. The powder detonated and hurled the 43-inch long, 1.25-inch diameter rod upward.
The rod pierced Gage’s left cheek, ripped through his brain, and exited his skull. The force of the explosion hurtled the projectile to its landing site 80 feet away – after the friction of passing through Gage’s head had slowed it down a bit.
It sounds unbelievable but Gage was still able to speak after his close encounter with a flying metal spear. He walked to a nearby cart for transport to the local town for treatment. That service was provided by Dr. Edward H. Williams who documented the singular event:
“I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage’s statement at that time but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head…Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.”
You read that right: the good doctor could see Gage’s brain pulsing and barfed up a small cupful of his own brain tissue. Ew.
The accident destroyed much of the victim’s cranial left frontal lobe. This is the part of the brain that is deemed the center of our emotional control, where personality originates. People who knew the unfortunate man best before an iron rod tore through his noggin said he was “no longer Gage” for the 12 years remaining in his life.
Dr. John Martyn Harlow took over the case not long after Gage suffered his horrific injury. The physician described the incident as “literally one gore of blood.”
According to records left by Dr. Harlow, Gage remained conscious later that evening and was able to list the names of his co-workers. The explosives handler refused the company of his colleagues since he would see them again in “a day or two” when he returned to work.
That didn’t happen. Gage developed an infection that put him in a semi-comatose state from September 23 to October 3. By October 7, he managed his first steps out of bed. By October 11, his cognitive functioning saw signs of improvement.
Harlow recorded that Gage could state much time had passed since the accident and had very clear memories of how the accident happened – but had trouble estimating size and amounts of money. Not more than a month later, the patient was able to leave his house and take to the street.
After this medical complication, Gage recuperated in his parent’s home in New Hampshire for some months. The following year, Gage saw Dr. Harlow again and the doctor noted that his patient had lost sight in his injured eye. Otherwise, the man who survived a severe head wound was in good physical health and appeared fully recovered.
Dubbed the American Crowbar Case, Gage’s injury and subsequent treatment made it “the case which more than all others is calculated to excite our wonder, impair the value of prognosis, and even to subvert our physiological doctrines.”
The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior.
On his road to recovery, Gage traveled through New England and Europe with his tamping iron to make a living. He allegedly appeared in the Barnum American Museum in New York. Gate worked briefly in a livery stable in New Hampshire before moving to Chile where he drove stagecoaches for seven years. He then returned stateside to California and lived with his mother as he tried his hand at farm work.
Some observers believe that a structured daily routine helped the former railroad worker heal his personality and recultivate social skills lost temporarily after his incredible injury.
Gage’s physical and mental condition were assessed shortly before his death. The case report indicated that his most serious mental changes had been restored. Later in life, Gage became far more functional and far better adapted socially, compared to the years immediately after his accident.
The amazing survivor’s health began to decline. After undergoing a series of epileptic seizures, Gage died on May 21, 1860 – almost 12 years to the day after his egregious accident.
Seven years after the burial, Gage’s body was exhumed. His punctured skull and the iron tamping rod were donated to Dr. Harlow. Today, both items are exhibited at the Harvard University School of Medicine.