When we think of unexplored domains and mysterious frontiers, many of us may look to the uncharted wildernesses of the world, to the deep sea abysses, or to the vast, yawning chasm of space. Yet often just as impenetrable and unexplored are the mysteries within each and everyone of us, and the human body in many ways remains little understood. There are numerous cases that seem to defy everything we think we know about the way our body works, and such medical miracles serve to show us that just as strange and mysterious as the fringes of our known world are the unknown realms within our own bodies. One such case concerns a simple railway foreman who miraculously survived an injury that should have killed him, and which would vault him into the history of medical curiosities, where he remains 170 years later.
The story begins on September 13, in the year 1848, with a 25-year-old railroad construction crew foreman by the name of Phineas Gage. On this day the crew was involved in the dangerous task of blowing up rocks and boulders in order to clear a path for a railroad line in Cavendish, Vermont, in the United States. This was perilous work to say the least, which involved stuffing explosive charges into holes drilled into the rocks and then tamping it all down with sand using a long metal bar called a “tamping iron,” that was 43 inches long, 1.25 inches in diameter and 13.25 pounds in weight. The idea was that the explosive force would be directed downward into the rock to blow it to smithereens, and with few safety regulations in place it was a harrowing proposition. Whether due to carelessness or a freak accident, as Gage was working on one of these charges the explosive powder was accidentally detonated by a wayward spark, sending the tamping iron rocketing up through his left cheekbone, right on through his brain, and out of the top of his head in a geyser of blood, ultimately landing about 30 yards away covered in blood and brain matter.
In most cases this would be the end of the story, game over, but incredibly Gage was not only found to be alive, but by many accounts conscious and getting up to walk around within minutes of the accident. Although blinded in one eye and a bit shaken, he seemed to be none the worse for wear considering an iron rod had just been propelled completely through his head to leave a gaping exit wound, and he would allegedly calmly tell the doctor who saw him, “Here is business enough for you,” as the physician went about removing flecks of bone from his head and trying to replace the larger fragments like pieces of a puzzle. The whole thing would be covered with a flap of scalp, wrapped up with adhesive tape, and Gage was sent on his way under his own power as if he had just been in for a routine check-up rather than having just had his head put back together. The massive exit would more or less remain open, never really totally healing and leaving a permanent hole in his skull measuring about 2 inches wide and 4 inches in circumference.
In an age when medical technology and the ability to treat brain trauma was in its infancy and not nearly what it was today, and considering that even in modern times one would not expect someone to live through this sort of grievous injury, the initial report was met with skepticism and even downright disbelief by other medical professionals. However, it slowly came to be accepted under further scrutiny, much to the amazement of everyone. Phineas Gage’s miraculous survival with so little medical attention made him somewhat of a celebrity at the time both with the public and within the field of medicine, and his case launched up into the upper ranks of the world’s greatest medical mysteries.
Despite his incredible story, the days after the accident would show that all was not totally well with Gage, as those around him began to notice dramatic personality changes within him. Whereas before he had been a calm, level-headed leader and a model foreman, he was now boisterous, irrational, vulgar, and confrontational, spouting off profanity at a moment’s notice and showing little concern for those around him. His own doctor, a John Martyn Harlow, said of his character shift, “He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom, manifesting but little deference for his fellows, impatient of restraint of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating,” and explained this all as him losing his sense of control of his baser instincts and the balance between his “intellectual faculties and animal propensities.” He became reckless, violent and impulsive, with little ability to concentrate on any one thing for long and almost no social inhibitions, which was far from what his employers had once described as a reasonable, efficient and focused worker, and who his friends described as an even-tempered man of good cheer.
Such was the extent of his steady descent into bizarre behavior and his inability to get along with others that he lost his job with the railway and many of his friends as well, who claimed to not even recognize him anymore. He wound up doing odd jobs such as driving a coach along the Valparaiso-Santiago route in Chile, working at a livery stable in New Hampshire, and working at a small, modest farm in Santa Clara, California. In addition to his dramatic personality shifts and diminished mental state, Gage also started to fall victim to epileptic fits, a condition almost certainly related to his horrific injury, possibly due to the formation of scar tissue upon the brain. As his health deteriorated, he eventually moved to the San Francisco area to live with his mother, brother-in-law and sister, where he would remain until his death in 1860 in the aftermath of a particularly intense seizure.
Gage would go on to become rather a sensation in the world of neuroscience, in an era when the inner workings of the brain were poorly understood at best, and his case was latched onto by the medical field, and some might even argue that it ushered in the area of brain science as a proper field. The main attraction to Gage was not only had he survived major trauma to the brain while remaining more or less healthy, but that his marked transformation in personality suggested for the first time that there were parts of the brain that regulated and controlled such things, and that there was a correlation between the brain and a person’s character and behavior, which was a concept that had never been really understood or demonstrated to any appreciable degree, and indeed it was not really even understood what functions different parts of the brain had at all, if any. Even today such things are poorly understood, so at the time it was an incredible revelation. A neurologist at Harvard Medical School and Brigham and Women's Hospital named Allan Ropper nicely explained the significance of Gage’s case thus:
If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero, it was an ideal case because it's one region [of the brain], it's really obvious, and the changes in personality were stunning.
Since this was the first time that an injury to a specific part of the brain, in this case the frontal lobe, could be definitively linked to a subsequent change in personality, Gage became a common fixture in medical textbooks and medical lectures, and was used to bolster the suspicions of various doctors at the time who had long suspected that different areas of the brain correlated to different facets of character. One of these was a Scottish neurologist named David Ferrier, who used Gage’s case to cement his theories on brain damage in relation to behavior that he had observed in experiments of cerebral function with primates. Indeed, the case was pounced on by a variety of medical professionals, all of whom used Gage as a way to justify their own various disparate theories on how they thought the brain was supposed to work.
Gage’s body was dug up a mere 7 years after his death so that his skull could be examined, and has in the decades since been extensively studied. The skull has been mapped, scanned, and modelled in various ways all the way up to the present, and it continually surprises. For instance, in 2012 one 3D digital model of the skull conducted by UCLA’s Laboratory of Neuroimaging found that the extent of the damage to Gage’s brain was even worse than previously thought, with around 11% of the frontal lobe totally destroyed in the accident, along with 4 % of the cerebral cortex, making it even more spectacular that he should have survived at all, let alone with most of his facilities intact. To this day the curious case of Phineas Gage is a compelling one, not yet fully understood, and it still used as a textbook example of the mysteries of the brain and is discussed by neurologists, doctors, and psychologists. Gage's skull and the tamping iron that sent him into the annals of medical legends can be seen amongst the 15,000 medical curiosities housed at the Warren Anatomical Museum at Harvard University School of Medicine, part of the Center for the History of Medicine in Harvard’s Francis A. Countway Library of Medicine.
Despite the dramatic advances in our technology and understanding of medicine, it is clear that in many respects the human body, and in particular our brains, remains an unexplored wilderness, harboring oddities and surprises that we have yet to fully comprehend. Cases like that of Phineas Gage occasionally pop up to remind us of this fact, and to show us that some frontiers lie not out there in the far-reaches of the world and universe, but also within each and every one of us.