LULU GARCIA-NAVARRO, HOST:
And now the story of a man with an injury that changed our understanding of the brain. The man was Phineas Gage, and he died 157 years ago today. Gage became famous for surviving an accident that drove an iron rod through his head. NPR's Jon Hamilton looks at why doctors and scientists continue to study this very odd case.
JON HAMILTON, BYLINE: Brain geeks like Jack Van Horn know an awful lot about Phineas Gage.
JACK VAN HORN: In 1848, Mr. Gage was a 25-year-old foreman on a railroad crew who were preparing the track bed for the Rutland and Burlington Railroad outside of the town of Cavendish, Vt.
HAMILTON: Van Horn is an associate professor of neurology at the University of Southern California. He says Gage was in charge of blowing up rocks. He would drill a hole, place an explosive charge then pack in sand using a 13-pound metal bar known as a tamping iron. Van Horn describes what happened next with help from Allan Ropper of Harvard and the University of Melbourne's Malcolm Macmillan
MALCOLM MACMILLAN: On September 13, at 4 o'clock in the afternoon...
ALLAN ROPPER: ...In the process of tamping down one of these charges, he caused a spark...
VAN HORN: ...Which drove this tamping iron up and out of the hole...
MACMILLAN: ...Under the cheekbone...
VAN HORN: ...Behind his eye socket...
MACMILLAN: ...Through the inner part of the skull...
VAN HORN: ...And out of the top of his head.
HAMILTON: Gage didn't die, but his personality changed. Macmillan says the doctor who treated Gage described his patient this way.
MACMILLAN: He is fitful, irreverent, indulging at times in the grossest profanity which was not previously his custom.
HAMILTON: Macmillan says this dramatic transformation, documented by a physician, is why Gage shows up in so many medical textbooks.
MACMILLAN: He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality.
HAMILTON: That was a big deal. In the mid-1800s, phrenologists were still assessing people's personalities by measuring bumps on their skull. Harvard's Allan Ropper says Gage's case helped establish modern brain science.
ROPPER: If you talk about hardcore neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero 'cause it's one region, it's really obvious, and the changes in personality were stunning.
HAMILTON: And every generation of brain scientists seems compelled to revisit Gage's case. Since the 1940s, researchers have used sketches, CT scans and computer models to recreate his injury.
And in 2012, Jack Van Horn led a team that combined CT scans of Cage's skull with MRI scans of typical people to show how the wiring of Gage's brain had been affected. Van Horn says it's not just researchers who keep coming back to Gage, neurosurgeons still sometimes use what they've learned from his case.
VAN HORN: Somebody has been shot in the head with an arrow or falls off a ladder and lands on a piece of rebar, so you do have these modern kind of Phineas Gage-like cases.
HAMILTON: But Malcolm Macmillan, who wrote a book about Gage, says there's something about the famous patient many people don't know.
MACMILLAN: The thing is that that personality change, which undoubtedly occurred, did not last much longer than about two to three years.
HAMILTON: Gage went on to work as a long-distance stagecoach driver in Chile. And Macmillan says this chapter of Gage's life offers a powerful message.
MACMILLAN: Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible.
HAMILTON: Gage died in his mid-30s from a seizure that was probably caused by his injury. His skull and the tamping iron that passed through it are on display at the Warren Anatomical Museum in Boston. Jon Hamilton, NPR News.
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