Here’s The Story Of Neuroscience’s Most Famous Patient: “The Man With The Iron Bar”

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An accident with a tamping iron made him the history's most famous brain-injury survivor. Here’s the real story of Phineas Gage, whose personality almost completely altered after what happened to him.

Phineas Gage was an American railroad construction foreman.

Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell Gage of Grafton County, New Hampshire. Little is known about his childhood and education.

He may have first worked with explosives on farms as a youth, or in nearby mines and quarries. According to his employers, he was "the most efficient and capable foreman ... a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation."

Among other tasks, he was assigned to sprinkle gunpowder into blasting holes and then tamp the powder down with an iron rod. Needless to say, this was such a task that required a great deal of concentration.

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When he was tamping iron, he turned his head to check on the other workers. His crew members were loading some busted rock onto a cart, and rumor has it that they distracted him. When his head was still turned, the tamping iron penetrated Gage’s left cheek, ripped into his brain and exited through his skull, landing several dozen feet away.

The tamping iron was 43 inches long, 1.25 inches in diameter and weighing 13.25 pounds.

Though blinded in his left eye, he might not even have lost consciousness, and he remained savvy enough to tell a doctor that day, “Here is business enough for you.”

About two months later, Gage was in good health, but his personality was drastically altered. He wasn’t the same person anymore.

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At first, doctors thought the alteration of his personality would be temporary, but he wasn't the old Gage at all. He could not stick to plans, uttered “the grossest profanity” and showed “little deference for his fellows.” The railroad-construction company that employed him refused to take him back.

The balance between his “intellectual faculties and animal propensities” seemed to be gone.

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Although a “smart, shrewd businessman” before, Gage now also lacked money sense. And although courteous and reverent before, Gage was now “fitful [and] irreverent, indulging at times in the grossest profanity.” John Martyn Harlow, the doctor who treated him said. More pithily, friends said that Gage “was no longer Gage.”

The reason why Gage’s personality altered was the damage in the prefrontal cortex.

There’s an integral link between a person's personality and the functions of the prefrontal cortex. This brain region has been implicated in planning complex cognitive behavior, personality expression, decision making, and moderating social behavior. The basic activity of this brain region is considered to be the orchestration of thoughts and actions in accordance with internal goals.

As a result of this change, and after the railroad refused to reinstate Gage as foreman, he began traveling around New England.

He started to display himself and his tamping iron for money. For an extra dime, skeptical viewers could “part Gage’s hair and see his brain ... pulsating” beneath his scalp. Gage finally found steady work driving a horse coach in New Hampshire.

After some time, Gage started to experience convulsions of increasing severity, and consequently died in 1860, somewhere near San Francisco.

After some time, Gage started to experience convulsions of increasing severity, and consequently died in 1860, somewhere near San Francisco.
After some time, Gage started to experience convulsions of increasing severity, and consequently died in 1860, somewhere near San Francisco.
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His skull is now kept at the Warren Anatomical Museum at Harvard Medical School, alongside the tamping iron that penetrated it, which is inscribed as follows:

"This is the bar that was shot through the head of Mr Phinehas [sic] P. Gage at Cavendish, Vermont, Sept. 14 [sic], 1848. He fully recovered from the injury & deposited this bar in the Museum of the Medical College of Harvard University. Phinehas P. Gage Lebanon Grafton Cy N-H Jan 6 1850."

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