An Accidental Lobotomy| A Medical History

Accidental but nonfatal destruction of parts of the brain has afforded many clues to the function of various regions. One of the most famous incidents occurred in 1848 to Phineas Gage, a laborer on a railroad construction project in Vermont. Gage was packing blasting powder into a hole with a 31/2 ft tamping iron when the powder prematurely exploded. The tamping rod was blown out of the hole and passed through Gage's maxilla, orbit, and the frontal lobe of his brain before emerging from his skull near the hairline and landing 50 ft away, Gage went into convulsions, but later sat up and conversed with his crewmates as they drove him to a physician in an oxcart. On arrival, he stepped out on his own and told the physician, "Doctor, here is business enough for you." His doctor, John Harlow, reported that he could insert his index finger all the way into Gage's wound. Yet 2 months later, Gage was walking around town carrying on his normal business.

He was not, however, the Phineas Gage people had known. Before the accident, he had been a competent, responsible, financially prudent man, well liked by his associates. In an 1868 publication on the incident, Harlow said that following the accident, Gage was "fitful, irreverent, indulging at times in the grossest profanity." He became irresponsible, lost his job, worked for a while as a circus sideshow attraction, and died a vagrant 12 years later.
A 1994 computer analysis of Gage's skull indicated that the brain injury was primarily to the ventromedial region of both frontal lobes. In Gage's time, scientists were reluctant to attribute social behavior and moral judgment to any region of the brain. These functions were strongly tied to issues of religion and ethics and were considered inaccessible to scientific analysis. Based partly on Phineas Gage and other brain injury patients like him, neuroscientists today recognize that planning, moral judgment, and emotional control are among the functions of the prefrontal cortex.
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