"Phineas Gage: A Gruesome but True Story about Brain Science"

Original title: "Gruesome but True"

Copyright © 2006 by Jim Mahood. All rights reserved.

Students of neurology and psychology will likely recognize the grisly tale of Phineas Gage, a railroad construction foreman with a hole in his head. Blasting rock with gunpowder while laying track in the Green Mountains of Vermont, something goes very wrong. A tamping rod is accidentally blasted through Phineas’s head, entering under his left cheekbone.

The iron rod weighs 13 pounds, measures 3 feet 7 inches long, and is 1 and 1/4 inches in diameter along most of its length, tapering to a sharp point at one end like a spear. From under the cheekbone, the pointy end passes behind Phineas’s left eye, through the front of his brain, and out the middle of his forehead just above the hairline and slightly left of center. It takes just a fraction of a second for the rod to crash completely through Phineas’s head and land with a clang 30 feet away.

Amazingly, Phineas is left alive. The blast throws him to the ground on his back, but by the time his men rush to his aid, he is sitting up and talking. Blood pours down his face as he discusses the accident. His men gently place him in an ox cart and take him to a physician. Phineas Gage is alive, but the person of Phineas Gage, the man everyone knew and loved, died instantly in the blast. Another Phineas Gage is born with a far less appealing personality.

In Phineas Gage: A Gruesome but True Story about Brain Science, John Fleischman explores both the neurological and psychological dimensions of this famous accident that took place in 1848 before the birth of modern medicine and psychology. Fleischman’s book of 86 pages features lots of horrific photographs illustrating how and where the tamping rod passed through Phineas’s skull.

Fleischman relates how a local physician does his best to put Phineas’s head together again, but some of the bone is missing, leaving a hole in the top of his cranium under the scalp. Eventually Phineas returns to work but discovers his social skills gone. It becomes almost impossible for him to keep a job that involves much contact with other adults. Drifting from job to job, he keeps trying to find a niche until he discovers he’s good at working with children, horses, and dogs. He leaves the United States to work as a high-speed stagecoach driver in Chile.

More than a century passes before brain science evolves to the point of understanding what happened to Phineas at the instant his head exploded. Modern neurology reveals how lucky he was, for the rod narrowly missed vital centers in his brain, such as Broca’s area that controls the ability to speak and Wernicke’s area that controls speech recognition.

Phineas’s skull, his doctors’ meticulous notes, and the iron tamping rod, which became Phineas’s constant companion throughout the rest of his life, have proven useful to generations of scientists and researchers in various fields.

In the 1990s, Antonio and Hanna Damasio, husband-and-wife team brain researchers at the University of Iowa, used data collected from Phineas to test a theory for explaining certain types of emotional unpredictability. Using modern scientific and medical techniques, the Domasios built a computer image of Phineas’s long-gone brain to study the exact route of the tamping iron through it. Phineas’s reconstructed brain matches brain scans of patients who have cortex-tumor surgery followed by sociability problems like those of Phineas.

The Domasios credit Phineas for lending support to the theory that humans are “hard wired” to be sociable, for the tamping rod carried away part of Phineas’s left frontal lobe, where the “executive” functions—the abilities to predict, to decide, and to interact socially—are thought to be located.

After the 1848 accident, 11 years will pass before epilepsy, an effect of the blast, will kill Phineas at the age of only 37. But unlike most people, who are quickly forgotten after death, Phineas’s usefulness to science and medicine continue strong more than a century and a half later.