John Fleischman - Phineas Gage: A Gruesome but True Story About Brain Science

PHINEAS GAGE

A Gruesome but True Story About Brain Science

by JOHN FLEISCHMAN

Houghton Mifflin Company Boston

Copyright 2002 by John Fleischman

A LL RIGHTS RESERVED . For information about permission to reproduce
selections from this book, write to Permissions, Houghton Mifflin Company,
215 Park Avenue South, New York, New York 10003.

www.houghtonmifflinbooks.com

Book design by Lisa Diercks
The text of this book is set in Janson Text.

Library of Congress Cataloging-in-Publication Data
Fleischman, John.
Phineas Gage: a gruesome but true story about brain science / by John Fleischman
p. cm.
RNF ISBN 0-618-05252-6 PAP ISBN 0-618-49478-2
1. Gage, PhineasMental health. 2. Brain damagePatientsUnited States
Biography. 3. Brain damageComplications. 4. Personality disordersEtiology. I. Title.
RC387.5 .F565 2002
362.1'97481044'092dc21
[B] 2001039253

Printed in Singapore
TWP 20 19 18 17 16

As always, for Mary

To Tim Clark, who gave me the time and place to begin. To my medical readers, Dr. Robert Pressberg, Dr. Barbara Skolnick, and Dr. Jeffrey Macklis, who are responsible only for correct anatomical facts, the author being responsible for all errors. To Virginia Hunt of the Countway Library of Medicine, Harvard Medical School, who was so generally helpful. To Dr. Denise Natale of the Cavendish Chamber of Commerce, who never lost patience with Phineas. To Dr. Joseph Gall and the American Society for Cell Biology for Hooke's flea and Hooke's cells. To Dr. Malcolm Macmillan of Deakin University, Australia, who knows more than anyone about Phineas Gage, and to Amy Flynn, who did not blanch at first glance.

The most unlucky/lucky moment in the life of Phineas Gage is only a minute or two away. It's almost four-thirty in the afternoon on September 13, 1848. Phineas is the foreman of a track construction gang that is in the process of blasting a railroad right-of-way through granite bedrock near the small town of Cavendish, Vermont. Phineas is twenty-six years old, unmarried, and five feet, six inches tall, short for our time but about average for his. He is good with his hands and good with his men, "possessing an iron will as

well as an iron frame," according to his doctor. In a moment, Phineas will have a horrible accident.

It will kill him, but it will take another eleven years, six months, and nineteen days to do so. In the short run, Phineas will make a full recovery, or so it will seem to those who didn't know him before. Old friends and family will know the truth. Phineas will never be his old self again. His "character" will change. The ways in which he deals with others, conducts himself, and makes plans will all change. Long after the accident, his doctor will sum up his case for a medical journal. "Gage," his doctor will write, "was no longer Gage." Phineas Gage's accident will make him world famous, but fame will do him little good. Yet for many otherspsychologists, medical researchers, doctors, and especially those who suffer brain injuriesPhineas Gage will become someone worth knowing.

That's why we know so much about Phineas. It's been 150 years since his accident, yet we are still learning more about him. There's also a lot about Phineas we don't know and probably never will. The biggest question is the simplest one and the hardest to answer: Was Phineas lucky or unlucky? Once you hear his story, you can decide for yourself. But right now, Phineas is working on the railroad and his time has nearly come.

Building a railroad in 1848 is muscle work. There are no bulldozers or power shovels to open a way through Vermont's Green Mountains for the Rutland & Burlington Railroad. Phineas's men work with picks, shovels, and rock drills. Phineas's special skill is blasting. With well-placed charges of black gunpowder, he shatters rock. To set those charges, he carries the special tool of the blasting trade, his "tamping iron." Some people confuse a tamping iron with a crowbar, but they are different tools for different jobs. A crowbar is for lifting up or prying apart something heavy. A tamping iron is for the delicate job of setting explosives. Phineas had his tamping iron made to order by a neighborhood blacksmith. It's a tapering iron rod that is three feet, seven inches long and weighs thirteen and a half pounds. It looks like an iron spear. At the base, it's fat and round, an inch and three quarters in diameter. The fat end is for tampingpacking downloose powder. The other end comes to a sharp, narrow point and is for poking holes through the gunpowder to set the fuse. Phineas's tamping iron is very smooth to the touch, smooth from the blacksmith's forge as well as from constant use.

His task is to blast the solid rock into pieces small enough for his crew to dig loose with hand tools and haul away in ox carts. The first step is to drill a hole in the bedrock at exactly the right angle and depth, or the explosion will be wasted. All day, Phineas must keep an eye on his drillers to make sure they stay ahead. All day, Phineas must keep an eye on his diggers to make sure they keep up. All the time between, Phineas and his assistant are working with touchy explosives.

They follow a strict routine. His assistant "charges" each new hole by filling the bottom with coarse-grained gunpowder. Phineas uses the narrow end of his iron to carefully press the ropelike fuse down into the powder. The assistant then fills up the rest of the hole with loose sand to act as a plug. Phineas will tamp the sand tight to bottle up the explosion, channeling the blast downward into the rock to shatter it. While his assistant is pouring the sand, Phineas flips his tamping iron around from the pointy end to the round end for tamping. Black powder is ticklish stuff. When it's damp, nothing will set it off.

This is the face of the man with a hole in his head. It's a plaster life mask of Phineas Gage made in Boston after his accident, and it shows exactly what the "recovered" Phineas looked like a year after his accident. He was twenty-seven. Notice the big scar on his forehead. To see what lies beneath the scar, compare this to the picture of his skull on . Photograph by Doug Mindell; life mask courtesy of the Warren Anatomical Museum, Countway Library of Medicine, Harvard Medical School

When it's too dry or mixed in the wrong formula, almost anything can set it off, without warning. But Phineas and his assistant have done this a thousand timespour the powder, set the fuse, pour the sand, tamp the sand plug, shout a warning, light the fuse, and run like mad.

But something goes wrong this time. The sand is never poured down the hole; the black powder and fuse sit exposed at the bottom. Does his assistant forget, or does Phineas forget to look? Witnesses disagree. A few yards behind Phineas, a group of his men are using a hand-cranked derrick crane to hoist a large piece of rock. Some of the men remember seeing Phineas standing over the blast hole, leaning lightly on the tamping iron. Others say Phineas was sitting on a rock ledge above the hole, holding the iron loosely between his knees.