A Hole in the Head: The Serendipity of Losing Your Mind

Words by Bella Spencer
Art by Harrison Buchanan

The year was 1848, and the accepted dogma of neuroscience was Phrenology- the idea that the shape of the skull correlated to character and mental ability. However, on the the 3rd of September a horrific accident altered the understanding of neuroscience forever. During a routine procedure to clear away rocks from the railway, one worker made a mistake and his iron tamping rod directly hit an explosive. The rod was propelled upwards and penetrated the side of his face, shattering his jaw, passing through his eye, his frontal cortex and out of the top of his head. The worker was Phineas Gage.

Phineas Gage survived the accident and within minutes he was able to walk to a cart and was taken to receive medical attention. It was recorded that during Gage’s initial examination approximately half a teacupful of brain fell to the floor as he vomited. This mass correlated to a oooss of a whopping  4% of his cortex. At the time the cortex was regarded as a non-functional, homogenous and protective covering for the ventricles- fluid filled cavities of the brain. Following from this thinking, the damage to the cortex should not have resulted in any major change to Gage’s behaviour and capabilities.  However, upon Gage’s apparent recovery and release from the hospital, his personality was profoundly altered. Although seemingly healthy and functioning, he had converted from a well respected, diligent man to an irreverent and disinhibited character.

Gage’s personality change proved fundamental to the developing theory that, contrary to the belief of phrenology, the brain must have a role in personality. Furthermore, the fact that damage of the frontal lobe had caused Gage to lose his social inhibition provided crucial evidence in support of localisation- a theory that stated that each brain area has specific role. In this case, it was illustrated that the frontal cortex has involvement in behaviour.

The serendipity doesn’t stop there. Fast forward to 2012 and Phineas Gage’s brain was still impacting the spheres of neuroscience.  Researchers at UCLA used brain-imaging data to map Gage’s loss of white matter- the collection of axons and myelin that connect brain areas. It is theorised that Gage lost 10% of his white matter, and that this was the major contributing factor to his personality change. The damage disrupted connections between his left frontal cortex and his limbic system- part of the brain associated with emotions and motivations. This demonstrated that the frontal cortex is also involved in the regulation of emotions.   

After his accident, Gage worked as a coach driver in Chile until his health deteriorated in 1859. He returned to live with his mother in New Hampshire until he died on the 20th of May 1860 as a result of an epileptic seizure. It is theorised that the epilepsy may have been a result of his brain injury. According to urban legend, he was buried with his tampering rod, until 1866 when his his body was exhumed and his brain was examined.

It seems beyond the realms of science fiction, let alone science, that such a horrific accident could have such value to medicine. Gage’s brain proved integral for the end of phrenology and the dawn of the theories of modern neuroscience. In a final burst of serendipity, in 2007 a collector of vintage photographs uploaded a photo titled ‘One-Eyed Man with Harpoon’. Through a series of Flickr comments it was concluded that picture was not of a harpooner but was in fact the only photo in existence of Gage. Phineas Gage was the master of serendipity and the neuroscience community has a lot to thank his frontal cortex for.

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