The intriguing case of Phineas Gage | by Julia | March 2022

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The most famous patient in neuroscience

Phineas Gage holds his iron bar with an illustration of the accident. Photo credit: Wikimedia Commons

in thein the In 1848, a 25-year-old man named Phineas Gage was working on a railroad construction when an iron bar was driven through his skull. In most cases, especially before the 20th century, such brain-damaging accidents ended in death. However, Gage miraculously survived. His case quickly gained a reputation. Today his story is so famous that almost everyone who has anything to do with biology has heard of him.

To spare you the details of exactly how the accident happened, you can take away that Gage survived what was thought to be non-survivable. People were so convinced he wouldn’t make it that they had already prepared his coffin. He was left with one eye and damage to his left frontal lobe — a brain area linked to decision making, planning, organization, language, impulse control, concentration, problem solving and emotional processing.

He reportedly made a quick recovery: after two months, Gage was able to walk, speak, and his memory seemed perfectly intact. His doctor, John Harlow, described him as perfectly healthy physically. However, over time, people noticed that Gage had changed.

personality changes

After the injury, Gage’s personality seemed different. One of his friends described him as “not paying anymore”. He became impulsive, impatient, stubborn, indecisive, and generally unstable in his behavior and opinions. All of this led to socially inappropriate behavior: Gage came across as cold and disrespectful to those around him.

“HHe is restless, disrespectful, and sometimes indulges in the crudest obscenity, which was not his habit before” – Dr. Harlow (1848)

Before his accident, Gage was one of the best railway workers, but although he was physically able to work, his personality changes prevented him from continuing in his position. There are multiple records reporting Gage traveling around trying new jobs, as well as records of him physically assaulting himself and even abusing children. However, it is debatable whether these reports are accurate. In his later years, Gage’s health began to fail. He developed seizures and died in 1860.

The Birth of Neuroscience

It is often said that Phineas Gage’s accident marked the birth of neuroscience. His injury has given us much to ponder about how various brain functions work, and debunked some false popular theories about the brain of the time – one of which was that personality was linked to bumps in the skull.

Who knows how our understanding of personality would have developed over the years without his accident. Had Gage not survived his accident, it would still be an impressive testimonial from Dr. Harlow’s work and dedication and it would still have been an interesting medical case.

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