The otherwise unremarkable railway worker from the 19th-century became little more than a circus freak after his incredibly traumatic injury but his case deserves more of our attention and sympathy from a modern viewpoint.

 

Unless you’ve worked in psychology or neurobiology, the name Phineas P. Gage probably rings only the faintest of bells. It’s on the tip of your memory’s tongue — something you read in Ripley’s Believe it or Not! when you were a youngster. If I mention The American Crowbar Case, you might start to recall the specifics.

On 13 September 1848, the railway construction worker Gage was using a large iron rod — shaped rather fortunately like a javelin — to tamp explosives into a pre-drilled hole in an outcrop of rock so that the rock could be explosively removed from the path of the ever growing ribbons of steel that were to eventually connect Vermont with other parts of what we now know as the United States of America. Gage was somehow both the least and most lucky man in the world that day.

He was unlucky because while distracted by another worker, the iron rod caused a spark that ignited the substantial quantity of blasting powder (a precursor to dynamite and other subsequent explosives used to this day) already in the rock, propelling the iron bar upwards into and through his skull. The bloodied and brain-covered tool was found 25 meters from the site of the incident, embedded in the ground like a javelin.

For reference, a 50 calibre round, the one you see hurling lead from automated machine guns on fighting vehicles at armored emplacements is 0.5 inches or 1.27 cm in diameter. Using anything bigger on humans is a war crime.

But Gage was incredibly lucky because he survived a rod 1.25 inches or 3.25 cm in diameter shooting upwards through his skull. The rod was 1.1m in length. For reference, a 50 calibre round, the one you see hurling lead from automated machine guns on fighting vehicles at armored emplacements is 0.5 inches or 1.27 cm in diameter. Using anything bigger on humans is a war crime.

Nobody is meant to be able to live through this.

Nobody but Phineas P. Gage.

According to reports at the time, Gage was up and walking in minutes, and sat upright in an oxcart for his 1.2km ride back into town. When he met his doctor, Edward H. Williams, Gage reportedly said “Doctor, here is business enough for you”, and shortly after stood up and vomited hard enough that he pushed out some of his brain from his wounds.

His case was quickly taken up by John Martyn Harlow,


After the obviously life-saving treatment of Drs Williams and Harlow (who performed surgeries and treatments never seen before away from a battlefield) Gage spent a long period of convalescence during which his personality was said to have changed so dramatically that people started referring to him as “No Longer Gage”.

According to Harlow in 1868:

[Gage] is fitful, irreverent, indulging at times in the grossest profanity (which was previously not his custom) manifesting little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinatiously obstinate, yet capricious and vacillating, devising many plans of future operations which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he was possessed of a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was so radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage”.

In this, the 21st century, the case of Phineas Gage is studied in psychology, psychiatry, and neuroscience in schools all across the globe. His case has been described as a kind of Rorschach test that exposes the mental model the reader holds of how the brain actually works. His case brought to life the idea of cerebral location (he lost the part of his brain, this model suggests, that pertains to morality.) For philosophers, it brings to light the possibility that morality is a pure biological brain function, and therefore in some way innate to humans.

But was if this case was something simpler? What if someone presented tomorrow to a doctor with this injury, and was then followed up with psychological and psychiatric care? I have little to no doubt that Gage would be diagnosed with Post-traumatic stress disorder. His symptoms and behaviors fit the bill, as does the fact that after many years passed, Gage moved to Chile and had a relatively successful further career as a coach driver.

Gage suffered a traumatic injury the likes of which we can barely imagine, he had a period of behavior where he acted out, and then finally got his life together enough to regain a long period of employment.

I’m not a doctor, and I’m certainly not a trained psychologist or psychiatrist. But I do have the insight of what I would call having lost about 18 months to PTSD after a traumatic accident that left me unable to work. In the descriptions of Gage after his accident, I see glimpses of what I became for a year.

Gage’s skull, and the rod that went through it are now on display at Harvard University. Perhaps it’s time they put this poor tortured soul to rest.

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