What was the Phineas Gage Study

Phineas Gage: How an iron bar in the skull made medical history

Because he chased an iron bar through his head, a rail worker helped neuroscience to gain new knowledge in the 19th century. His case promoted the understanding that the regions of our brain are responsible for different tasks

The year is 1848. Progress is still rolling on rails, and North America is served by a railroad network. This progress is a backbreaking job for individuals, including 25-year-old Phineas Gage. His group of workers is supposed to blast the railroad's way through heavy rock. The men drill deep holes in the rocks, pour gunpowder and sand into them, compact the layers with an iron pipe and lay the detonator. Most of the time it works, but not on the afternoon of September 13, 1848.

Gage is distracted, maybe he's joking with colleagues, maybe his mind wanders through the local farm in New Hampshire. He drills a hole in the rock and fills it with gunpowder, as usual. Then he forgets to pour a layer of sand into the hole before pushing the iron rod into the hole to plug. A fatal mistake: the iron rubs against the rock and ignites the gunpowder. The rod - it has a diameter of 3.2 centimeters, is one meter long and weighs around six kilograms - literally shoots out of the hole. Its pointed end bores into the flesh below Gage's left cheekbone and emerges again at the top of the skull - it lands a good 20 meters behind him, a smooth bullet.

Gage survived but is no longer the same person

Gage is thrown on his back and his colleagues rush over. A few minutes after the accident, he can speak again, even walk, with his colleagues supporting him. Doctor John Harlow examines Gage. Harlow later wrote in his notes that he was able to put his index finger into the hole in Gage's skull and touch the other finger, which he put into the hole in his cheek. Gage did not fight back.

Initially, the doctor gives his patient little chance of survival. However, against all odds, Gage recovers almost completely. Within a few months he will be with old staff and return to his job. He is blind in his left eye, but otherwise he seems to have sustained hardly any damage: Gage can speak as before, is skilled with tools, and his memories are intact.

Yet he is no longer the same person. Before his accident with the iron bar, his superiors and colleagues had always described him as an exemplary worker, responsible and quiet, but now he curses constantly and roughly, is moody and disrespectful. If someone gives him advice or an instruction, Gage reacts harshly and angrily.

The unlucky fellow becomes a godsend for science

The balance between Gages “mental abilities and his animal passions” has been lost, notes his attending physician Harlow. It thus corresponds to the dominant anthropology of the western world in the 19th century: humans as the cleverest among animals because they have the mind to restrain themselves, to act rationally and to control their instincts. All of that seems to have lost Gage. He is even unable to make consistent plans and stick to them, no longer able to make well-considered decisions.

Shortly after his accident, Gage had already become a small celebrity: a man who shoots an iron rod through his head and survives is found food for the press. In addition, Gage quickly became a living exhibit and research object for science: in November 1848 it was presented to a medical meeting in Boston, and it was repeatedly shown in a museum in Manhattan.

When Gage became too much public, he moved south: he became a coachman in Chile, after a few years he traveled to relatives in San Francisco. The now 36-year-old former railroad worker died there of an epileptic fit in 1860, probably a late consequence of his accident. The public is fast moving and hardly anyone takes any notice of his death.

It is his former doctor, John Harlow, who made Phineas Gage arguably the most famous case in neuroscience. When he learned of his death in 1866, he arranged for the body to be exhumed. With the limited resources of his time, Harlow can only theoretically work out how the iron rod must have pierced Gage's skull - no autopsy was performed on his corpse when the internal organs were still intact.

Like all physicians of his time, Harlow had to rely on such so-called lesion studies. The researchers tried to use the behavior of brain injured persons to infer which processes take place where in the brain. In order to be able to "look into the brain" of living people, modern technologies such as activity measurements by electroencephalographs (EEG) or imaging methods such as positron emission (PET) and magnetic resonance imaging (MRI) are required. For Harlow, however, Gage seems to be the perfect case Localizing decision-making skills, morals and character traits in the brain - the idea that certain regions in the brain are responsible for certain functions is given an empirical foundation.

For a long time the prevailing opinion was that the iron bar only destroyed large parts of Gage's left frontal lobe. Therefore his comprehension and language ability remained largely intact; whereas it became an almost impossible task for Gage to make decisions that should allow for new situations.

But the research on Gage's brain was far from over: In 1994, almost 150 years after the accident in Vermont, an American research team tried to show that Gage's right frontal lobe was also hit. To do this, the scientists are using a three-dimensional model of Gage's skull for the first time, which they created on the basis of photographs and X-rays. But ten years later, a digital reconstruction shows that the right frontal lobe has remained unharmed after all. Research from 2012 confirms this, but shows that neural connections in the right frontal lobe have been damaged - this could also explain Gage's extreme behavioral changes.

To this day, Gage's case and all its riddles appear in many textbooks. His skull and fateful iron bar are kept on the Harvard Medical School campus, and are some of the most sought-after objects in the accompanying museum.

As is so often the case in scientific discourse, the last word has probably not yet been spoken in the Phineas Gage case. The distracted rock sprinkler has certainly achieved one thing, however: His mishap was a spark for exploring the different regions of our brain.

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