The Strange Tale of Phineas Gage

The following is an article from Uncle John's Bathroom Reader Plunges into the Universe. Cabinet-card portrait of Phineas Gage, shown holding the tamping iron which injured him. From the Gage family of Texas collection. Even if you're not a neurologist or a psychotherapist, you may have heard of Phineas Gage. When a guy survives being impaled with a three-foot iron rod in the skull, he tends to gain a certain notoriety. What makes Gage's case interesting isn't the fact that he survived, it's how he changed after his accident. A HOLE IN ONE Phineas Gage considered himself a lucky man. At the age of 25, he had a responsible, well-paid job as construction foreman for Rutland and Burlington Railroad in Vermont. On September 13, 1848, as Gage was packing a load of explosives into the ground, the charge exploded without warning. The iron rod he was using to tamp the explosives into the earth flew into the air with the force and speed of a rocket, hitting Phineas Gage directly in the head. The 3'7" rod (109 cm), which weighed 13 pounds (6 kg), entered his left cheek, careened straight through his skull and brain, and emerged out of the top of his head like a yard-long bullet. SURVIVOR They loaded him into an ox cart and took him - still conscious - to a hotel where some local doctors treated him. They never expected him to live; he was bleeding horribly and blind in his left eye. Yet, Gage was still able to walk, talk, even to work. He returned home just ten weeks after his accident. However, Gage wasn't unscathed, not by any means. The iron bar that had practically destroyed the front left lobe of his brain had irrevocably changed his personality. I FEEL LIKE A NEW MAN A few months after the accident he was feeling well enough to return to work, but his old boss wouldn't hire him back at the same position because - even though Gage was almost back to normal physically, emotionally, and mentally - he was a changed man. Before his accident he'd been efficient, capable, kind, and polite; now he was foul-mouthed, rude, and easily annoyed. A FREAK, ALIVE OR DEAD Gage never worked as foreman again. He drove coaches and cared for horses in New Hampshire and in Chile. He exhibited himself (and the rod) as a curiosity at P.T. Barnum's Museum in New York. All in all, he lived 13 years after his dreadful accident and died in 1860 after a series of epileptic seizures. Gage's skull (and the rod) are now on display at Harvard Medical School, where they've been studied intensively over the years by neuroscientists. FIRST THE GOOD STUFF Gage's abrupt personality changes clues neurologists in to the fact that certain portions of the brain corresponded with personality functions. And in fact, Gage's case made the very first brain tumor removal operation possible in 1885. After studying what had happened to Gage, the operating physician concluded that lesions or tumors located in the frontal lobes of the brain didn't affect the brain's ability to take in sense information. Nor did they have an impact on physical movements or speech. However, such localized lesions or tumors did produce highly characteristic and unusual personality changes like Gage's. In 1894, that same surgeon removed a tumor from a patient's left frontal lobe. The patient had complained his thinking was becoming increasingly slow and dull. Seeing the similarities between this patient's mental faculties and Gage's, the doctor successfully removed the tumor that lay, just as he expected, in the left frontal lobes of the brain. THE BIRTH OF THE LOBOTOMY Gage's case put scientists on alert. Now they knew that certain areas of the brain were responsible for certain functions. In 1890, after a German scientist discovered that dogs were tamer and calmer after their temporal lobe was removed, the attending doctor at a Swiss insane asylum began to perform lobotomies on his patients - six in 1892. The patients who had been hard to handle, restless, and even violent, seemed much calmer after their surgeries. Lobotomies fell out of favor for a time, but were revived in the 1930s. Suddenly, a sort of lobotomy frenzy overtook the American psychiatric world. THE ICE PICK TRICK Along came enterprising physician and neurologist Walter Freeman, a.k.a. the Lobotomy King, who performed over 3,000 lobotomies from the 1930s to the 1960s. Impatient with the slowness of other brain surgery methods, Freeman even created the superquick ice pick lobotomy. Instead of surgically opening a hole in the patient's head, he put his patients under local anesthesia and plunged an ice pick through the skull and into the brain. Once in, Freeman would swing the ice pick swiftly back and forth, severing the prefrontal lobe. An ice pick lobotomy took only a few minutes. The lobotomy-happy Freeman would set up production lines at mental hospitals, operating on as many as ten patients in a single afternoon. EVERBODY'S DOING IT Lobotomies were the psychiatric cure-all of choice in the 1940s and 1950s. They were used not just on uncontrollable patients, but homosexuals, political radicals, “troublesome" personalities, and other so-called undesirables who veered from established norms. Even amateur surgeons got into the act; they performed hundreds of lobotomies without first performing psychiatric evaluations. Joseph Kennedy ordered a lobotomy on his “difficult" daughter Rosemary in 1941 without consulting anyone else in the family. Playwright Tennessee Williams was devastated to find in 1937 that his schizophrenic sister Rose Williams had been lobotomized, altering her personality utterly and permanently. The movie, Frances, is a true story of fiercely independent actress Frances Farmer (as played by Jessica Lange), who, after her lobotomy is a tragic picture of blandness. LOBOTOMY TODAY? Lobotomies are now outlawed in most countries, although they're still occasionally performed to control violent behavior in Japan, Australia, Sweden, and India. Even though Phineas Gage needed that 1848 accident like a, well, like a hole in the head, his case revolutionized brain surgery - in good ways and bad. __________ The article above is reprinted with permission from Uncle John's Bathroom Reader Plunges Into the Universe. Since 1988, the Bathroom Reader Institute had published a series of popular books containing irresistible bits of trivia and obscure yet fascinating facts. If you like Neatorama, you'll love the Bathroom Reader Institute's books - go ahead and check 'em out!

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The above photo of poor Phineas is not post mortem. Take a look at the photo here http://www.flickr.com/photos/20939975@N04/3722838673/ Judging by the identical clothes, the 2 photos were taken at the same, and in the second photo he is definitely holding his spike in a rather alive way.

(The story of finding this photo is pretty neat if you care to read it btw).
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The reason he is holding the rod with 2 fingers is so that you can see the words on the rod which says

"This is the bar that was shot through the head of Mr. Phinehas P. Gage"
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I don't think that picture is postmortem. The rod is blurry at the top which indicates that it was moving around slightly while the picture was being taken.

I don't think any surgery today is as bad as lobotomies. The issue with gastric bypass surgery are clear, but they do not alter a person's humanity.
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@ trialex,
I was thinking the same thing. I've studied psychology for 5 years in Australia and I think I can safely say that we do NOT perform lobotomies in Australia.

On another note, Walter Freeman is often used as an example by scientologists and others who profess the alleged evils of psychology. That claim that a profession with such a sordid history as psychology must be up to no good. It should be noted here that Freeman was not a psychologist or a psychiatrist. He was a neurologist with no surgical training, and an idiot.
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