Remembering Vermont man with holes in head Physicians still study changes wrought by bizarre 1848 accident


CAVENDISH, Vt. -- With a pancake breakfast, prized Holsteins on display and children riding horse-drawn carts past sugar maples, the weekend commemoration here could have been set in any small Vermont town.

Except for the souvenirs.

One table offered up inch-high plastic skull paperweights impaled with thin, iron bars. Festival T-shirts sported the same grisly image.

The local postmaster offered a stamp cancellation featuring a skewered skull -- all in tribute to the poor skull's owner, one Phineas P. Gage.

On Sept. 13, 1948, Gage and his work crew were blasting their way through a rocky outcrop just outside of town to lay track for the Rutland & Burlington Railroad.

Gage, who tamped down blasting powder for dynamite charges, accidentally sparked an explosion. The blast sent a 3 1/2 -foot-long iron tamping rod rocketing through Gage's left cheek, brain and skull.

The 13-pound rod exploded out the top of his head and landed several yards away.

Remarkably, Gage not only survived; he walked away from the episode and even greeted the doctor who treated him.

Survival alone was enough to ensure Gage a place in medical history. The reason scientists remain captivated by the ill-fated man 150 years after his accident, though, is because of the peculiar effects the accident wrought on Gage's personality.

While he still walked and talked normally, the 25-year-old, well-liked and responsible foreman had turned into a foul-mouthed and fitful vagabond given to childish fits and ill manners.

To his friends, Gage "was no longer Gage."

During the weekend, as the town commemorated the 150th anniversary of the accident with a festival, dozens of scientists .. gathered in a rustic ski lodge here as well to discuss what Gage continues to tell us about the workings of the brain.

At lunch, they joined townspeople to walk through Town Hall in single-file lines past the perforated skull of Gage and the fateful tamping iron, both transported to Cavendish from the Harvard Medical School by limousine.

Gage's case is pivotal because his Jekyll-and-Hyde shift provided some of the first evidence for what was a radical idea at the time -- that a particular part of the brain might be in large part responsible for personality.

"At the time, most people thought you loved with your heart and hated with your spleen," said Dr. H. Richard Tyler, a professor of neurology at Brigham and Women's Hospital in Boston.

"The brain was considered a supporting structure, and of course, it produced mucus for the nose."

Gage's frontal lobes were injured in the accident. They sit directly behind the forehead and eyes. Gage's accident provided evidence that the area might serve as a kind of internal police force, controlling impulses for swearing, rude behavior and risky ventures.

As his perceptive country doctor John Harlow told the Massachusetts Medical Society a few years after the accident: "The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed."

Today, the frontal lobes remain one of the brain's least understood regions.

They are strikingly large in humans compared with animals and probably are responsible for many of our uniquely human capabilities, from our propensity to linger in the past or anticipate the future to our ability to control violent and inappropriate impulses.

"The frontal lobes are what most separate the human brain from the animal brain," said Dr. Robert Knight, a neurologist from the University of California at Berkeley. "And we're just beginning to see what's going on."

Despite Gage's infamy, critical details about his injury and behavior remain unknown.

That's not for lack of trying from scientists, who seem committed to keeping Gage from resting in peace.

While Gage's skull was exhumed for study after his death in 1860 and a virtual autopsy using computer imaging was conducted on the skull in 1994, the true location of the damage was lost with the brain.

Pub Date: 9/14/98

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