If you’ve ever taken an introductory psychology class, then you probably know the story of Phineas Gage, the 25-year-old railroad worker whose personality dramatically changed after a rod pierced his skull.

Gage lost portions of his frontal lobe and went from being a kind and mild-mannered man to rude and unrestrained.

On September 21, 1848, The Boston Post reported on the incident. The article was called “Horrible Accident” and said:

As Phineas P. Gage, a foreman on the railroad in Cavendish, was yesterday engaged in tamping for a blast, the powder exploded, carrying an instrument through his head an inch in length, which he was using at the time. The iron entered on the side of his face, shattering the upper jaw, and passing back of the left eye, and out at the top of the head.

In Incognito: The Secret Lives of the Brain (where the newspaper passage was cited), author and neuroscientist David Eagleman also cites the writings of Gage’s doctor, Dr. John Martyn Harlow. In 1868, Dr. Harlow wrote about Gage and his marked personality changes.

The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. 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, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man.

Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage.”

Eagleman also notes that while Gage wasn’t the first to have such an injury, he was the first to live with it at the time, and he didn’t even lose consciousness.

But a piece in the August issue of The Psychologist finds evidence to the contrary. (You can download the PDF here.)

Writer Jim Horne, the Director of the Sleep Research Centre at Loughborough University, says that there were other people who suffered similar injuries as Gage and not only survived but also didn’t sustain significant damage. Many of these cases, he explains, were soldiers, who’d either been hit by their own muskets backfiring or by musket balls from others’ weapons.

According to Horne, in 1853, the British Medical Journal featured an editorial called “Cases of recovery after loss of portions of the brain,” which recounted a variety of wounds sustained at war. The piece also referred to a very early article by Dr. James Younge from 1682 “where the latter had amassed opinions of 60 other authors covering over 100 observations, even including those of Galen.”

In the same editorial, there was a case from 1815 of a solider with frontal lobe injuries at the Battle of Waterloo. At first, the soldier experienced “left side hemiplegia” (paralysis on the left side of the body) and some memory loss (for instance, he couldn’t remember names). But he ended up making a full recovery, served in the army again and lived for 12 years. He eventually passed away from tuberculosis.

The case of a young solider is even more remarkable. According to Horne:

The next case, a few years later, was based on a report by Dr John Edmonson, in the Edinburgh Medical and Surgical Journal of April 1822 (p.199), of a 15-year-old soldier who was wounded by the bursting breech of an overloaded small cannon. Shrapnel blew through his forehead, resulting in the loss of a piece of frontal bone measuring 21⁄2 x 11⁄4 inches together with 32 other pieces of bone and metal that were removed from the frontal part of his brain, together with, ‘more than a tablespoon of cerebral substance… portions of brain were also discharged at three dressings’.

The account went on to say, ‘at no period were there any symptoms referable to this injury… during the time that the brain was discharged he is reported as giving correct answers to questions put to him, and as being perfectly rational’. By three months the wound had closed, and ‘he was reported in perfect health, and having suffered no derangement of his mental capacities’.

In two other similar cases, soldiers also didn’t have any severe or sustained injuries. Horne writes:

In 1827 came a report by a Dr Rogers in the Medico-Chirurgical Transactions, where a young man received a frontal impact, again from a breech explosion. It was not until another three weeks, when the soldier, ‘discovered a piece of iron lodged within the head in the bottom of the wound from which a considerable quantity of bone had come away… it proved to be the breech pin of the gun three inches in length and three ounces in weight’.

Four months later he was ‘perfectly cured’. Another case, here, was of an exploding breech pin penetrating 11⁄2 inches into the brain, making a hole 3⁄4 inch in diameter, resulting in an ‘escape of cerebral substance’. But ‘no severe symptoms occurred, and recovery took place in less than 24 days’.

Infections during the 19th century were a big problem and could cause irreparable damage. So it was surprisingly fortunate that these soldiers’ heads were coated in gunpowder. Horne notes that gunpowder was a “strong antiseptic, which soldiers would sprinkle on battle wounds.”

Even though some individuals had similar injuries as Phineas Gage, the question remains: Why did his personality suffer while the above men seemed to be OK?

Horne speculates that Gage might’ve suffered much more extensive trauma to the front part of his brain than the others. Plus, Gage’s doctor became quite well known after treating Gage, and it’s possible that he embellished the details. It’s also possible that the doctors who treated the other men just didn’t know them enough to identify personality changes. Horne writes:

The apparently benign outcomes of these cases seems to contrast with that of Phineas Gage, whose personality apparently markedly changed, his behaviour becoming risqué, bawdy and uninhibited, which might well be due to his having a more extensive (orbito) frontal trauma. Of course, as Macmillan (2008) noted, this might not have been as great as is thought: much of what we know about Gage comes from his physician Dr John Martyn Harlow, who enjoyed much fame and fortune as a result of Gage’s accident, culminating in a 20-page paper, eight years after Gage’s death (Harlow, 1868).

On the other hand, maybe the physicians treating these other cases I’ve mentioned might not have been familiar enough with their patients to spot more subtle changes in behaviour, given the usual deference and respect that would usually have been paid to their doctors.

What do you know about Phineas Gage? Why do you think he had significant personality changes while others with similar injuries did not?