A Hole in the Head

Phineas Gage. Photograph by Jack and Beverly Wilgus of daguerreotype from their collection.

Late October is always a good time for a touch of the gruesome.

 

The story of Phineas Gage is one of those macabre stories that seem to stick in your mind. I feel like I always heard it referenced as one of those eureka science moments, where we finally got a glimpse into the human body through freak accident.

 

In reality it’s almost more an urban legend. There was a man who survived a hole being blown through his head, how much of the rest is true and how much it really influenced neuroscience is debatable. (And has been, at length.)

 

Phineas Gage was the foreman of a railroad construction gang working in the mountains of Vermont. Holes were drilled in the hard granite, coarse black powder was poured in, a fuse would gently be pressed into the powder, and then sand would be poured in to stopper the explosive.

 

Something went explosively wrong one fall day in 1848, and the tamping rod used to press in the wick and later to press down the sand was blown through Gage’s head, sharp end first.

 

It went through his cheekbone, behind his eye, and through the top of his skull. He remained conscious and baffled the doctor. He became incredibly ill and was lucky enough to have a doctor that was able to react well to the immediate injury and subsequent developments.

 

He was also lucky that it was what is now called an open brain injury.

 

In a closed brain injury the soft brain is rattled against the hard skull and there’s nowhere for the injured brain to swell without causing further brain injury. An open brain injury gives the brain room to swell and cope with the damage. The big problem with those is infection. The accident happened in a time before bacterial infection was understood.

 

Interestingly it seems like there’s still little agreement about what was actually learned, if anything.

 

He had a significant personality change after the accident, becoming more volatile and much less reliable while his memory and intelligence remained intact. This has long been attributed to the portions of the brain destroyed by the accident.

 

But even today, with scientists studying his skull, they’re not sure how much of his brain was destroyed.

 

Part of the problem is that his is a classic case of everyone manipulating facts to fit theories. The two doctors he saw most disagreed on the nature of his mental changes. Both were shaped by their respective backgrounds.

 

There is a decent amount of contemporary evidence that the change was not as extreme or permanent as often stated. He was able to find work and eventually redevelop social skills.

 

He was lucky to survive his injury, but he still died young, from an epileptic seizure at age 36. So his injury probably did kill him in the end, it just took twelve years to do so.