Phineas Gage is one of the most famous patients in the history of neuroscience. He was 25 years old when he experienced a serious accident at his work place, where a tamping iron was shot through his head - entering under his eye socket at exiting through the top of his head - after an explosive charge went off. The tamping iron was over a metre long, and after exiting Gage’s head landed 25m away.
Initially Gage collapsed and went into minor convlusions, but recovered quickly and was able to speak after a few minutes. He walked with little assistance to an ox-cart and was brought to a nearby physician. Initially the physician did not believe his story because he was in such good condition, but was convinced when:
Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.Gage exhibited a number of dramatic behavioural changes following the accident. Harlow, the physician who initially treated Gage, described this change “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 or advice when it conflicts with his desires”. However the surgeon Henry Jacob Bigelow described his condition as improving over the course of recovery, stated he was “quite recovered in faculties of body and mind”. This may have been early evidence of neural plasticity. This recovery was also reported by a physician who knew Gage while he lived in Chile, who described his ability to hold on a full time job as a Concord coach driver, a job that required exceptional social skills.
Gage’s neurological deficits following his traumatic brain injury is thought to have been exaggerated and distorted over the course of history, to the point that he is often portrayed as a ‘psychopath’. Scientific analysis of the historical accounts of Gage’s life following his accident, namely by the psychologist Malcolm Macmillan, find that these distorted accounts are most likely untrue, and that Gage made a very good recovery.
Post-mortem analysis of the Gage case concluded that it was the left frontal lobe that was damaged in the accident, although further neurological damage may have resulted from infection. Combined examination of the Phineas Gage case with the other famous cases of Tan and H.M. have concluded that social behaviour, memory, and language are dependent on the co-ordination of a number of different brain areas rather than a single region.