Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage | KERA News

Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage

May 21, 2017
Originally published on May 23, 2017 11:15 am

It took an explosion and 13 pounds of iron to usher in the modern era of neuroscience.

In 1848, a 25-year-old railroad worker named Phineas Gage was blowing up rocks to clear the way for a new rail line in Cavendish, Vt. He would drill a hole, place an explosive charge, then pack in sand using a 13-pound metal bar known as a tamping iron.

But in this instance, the metal bar created a spark that touched off the charge. That, in turn, "drove this tamping iron up and out of the hole, through his left cheek, behind his eye socket, and out of the top of his head," says Jack Van Horn, an associate professor of neurology at the Keck School of Medicine at the University of Southern California.

Gage didn't die. But the tamping iron destroyed much of his brain's left frontal lobe, and Gage's once even-tempered personality changed dramatically.

"He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom," wrote John Martyn Harlow, the physician who treated Gage after the accident.

This sudden personality transformation is why Gage shows up in so many medical textbooks, says Malcolm Macmillan, an honorary professor at the Melbourne School of Psychological Sciences and the author of An Odd Kind of Fame: Stories of Phineas Gage.

"He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality," Macmillan says.

And that was a big deal in the mid-1800s, when the brain's purpose and inner workings were largely a mystery. At the time, phrenologists were still assessing people's personalities by measuring bumps on their skull.

Gage's famous case would help establish brain science as a field, says Allan Ropper, a neurologist at Harvard Medical School and Brigham and Women's Hospital.

"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," Ropper says. It was an ideal case because "it's one region [of the brain], it's really obvious, and the changes in personality were stunning."

So, perhaps it's not surprising that every generation of brain scientists seems compelled to revisit Gage's case.

For example:

  • In the 1940s, a famous neurologist named Stanley Cobb diagrammed the skull in an effort to determine the exact path of the tamping iron.
  • In the 1980s, scientists repeated the exercise using CT scans.
  • In the 1990s, researchers applied 3-D computer modeling to the problem.

And, in 2012, Van Horn led a team that combined CT scans of Gage's skull with MRI scans of typical brains to show how the wiring of Gage's brain could have been affected.

"Neuroscientists like to always go back and say, 'we're relating our work in the present day to these older famous cases which really defined the field,' " Van Horn says.

And it's not just researchers who keep coming back to Gage. Medical and psychology students still learn his story. And neurosurgeons and neurologists still sometimes reference Gage when assessing certain patients, Van Horn says.

"Every six months or so you'll see something like that, where somebody has been shot in the head with an arrow, or falls off a ladder and lands on a piece of rebar," Van Horn says. "So you do have these modern kind of Phineas Gage-like cases."

There is something about Gage that most people don't know, Macmillan says. "That personality change, which undoubtedly occurred, did not last much longer than about two to three years."

Gage went on to work as a long-distance stagecoach driver in Chile, a job that required considerable planning skills and focus, Macmillan says.

This chapter of Gage's life offers a powerful message for present day patients, he says. "Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible."

Gage lived for a dozen years after his accident. But ultimately, the brain damage he'd sustained probably led to his death.

He died on May 21, 1860, of an epileptic seizure that was almost certainly related to his brain injury.

Gage's skull, and the tamping iron that passed through it, are on display at the Warren Anatomical Museum in Boston, Mass.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

LULU GARCIA-NAVARRO, HOST:

And now the story of a man with an injury that changed our understanding of the brain. The man was Phineas Gage, and he died 157 years ago today. Gage became famous for surviving an accident that drove an iron rod through his head. NPR's Jon Hamilton looks at why doctors and scientists continue to study this very odd case.

JON HAMILTON, BYLINE: Brain geeks like Jack Van Horn know an awful lot about Phineas Gage.

JACK VAN HORN: In 1848, Mr. Gage was a 25-year-old foreman on a railroad crew who were preparing the track bed for the Rutland and Burlington Railroad outside of the town of Cavendish, Vt.

HAMILTON: Van Horn is an associate professor of neurology at the University of Southern California. He says Gage was in charge of blowing up rocks. He would drill a hole, place an explosive charge then pack in sand using a 13-pound metal bar known as a tamping iron. Van Horn describes what happened next with help from Allan Ropper of Harvard and the University of Melbourne's Malcolm Macmillan

MALCOLM MACMILLAN: On September 13, at 4 o'clock in the afternoon...

ALLAN ROPPER: ...In the process of tamping down one of these charges, he caused a spark...

VAN HORN: ...Which drove this tamping iron up and out of the hole...

MACMILLAN: ...Under the cheekbone...

VAN HORN: ...Behind his eye socket...

MACMILLAN: ...Through the inner part of the skull...

VAN HORN: ...And out of the top of his head.

HAMILTON: Gage didn't die, but his personality changed. Macmillan says the doctor who treated Gage described his patient this way.

MACMILLAN: He is fitful, irreverent, indulging at times in the grossest profanity which was not previously his custom.

HAMILTON: Macmillan says this dramatic transformation, documented by a physician, is why Gage shows up in so many medical textbooks.

MACMILLAN: He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality.

HAMILTON: That was a big deal. In the mid-1800s, phrenologists were still assessing people's personalities by measuring bumps on their skull. Harvard's Allan Ropper says Gage's case helped establish modern brain science.

ROPPER: If you talk about hardcore neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero 'cause it's one region, it's really obvious, and the changes in personality were stunning.

HAMILTON: And every generation of brain scientists seems compelled to revisit Gage's case. Since the 1940s, researchers have used sketches, CT scans and computer models to recreate his injury.

And in 2012, Jack Van Horn led a team that combined CT scans of Cage's skull with MRI scans of typical people to show how the wiring of Gage's brain had been affected. Van Horn says it's not just researchers who keep coming back to Gage, neurosurgeons still sometimes use what they've learned from his case.

VAN HORN: Somebody has been shot in the head with an arrow or falls off a ladder and lands on a piece of rebar, so you do have these modern kind of Phineas Gage-like cases.

HAMILTON: But Malcolm Macmillan, who wrote a book about Gage, says there's something about the famous patient many people don't know.

MACMILLAN: The thing is that that personality change, which undoubtedly occurred, did not last much longer than about two to three years.

HAMILTON: Gage went on to work as a long-distance stagecoach driver in Chile. And Macmillan says this chapter of Gage's life offers a powerful message.

MACMILLAN: Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible.

HAMILTON: Gage died in his mid-30s from a seizure that was probably caused by his injury. His skull and the tamping iron that passed through it are on display at the Warren Anatomical Museum in Boston. Jon Hamilton, NPR News.

(SOUNDBITE OF LOSCIL'S "FIRST NARROWS") Transcript provided by NPR, Copyright NPR.