« Stuff You Missed in History Class

SYMHC Classics: Phineas Gage

2020-05-23 | 🔗

A 2013 episode about Phineas Gage, who experienced a catastrophic brain injury and survived - though altered - for more than 11 years. Over time, he became one of the world's most famous case studies in how damage to the brain can affect behavior.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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Abby Saturday. Everybody is may twenty third and honest stay in eighteen. Sixty phineas gauge was buried as actual death. Date is a little bit unclear. The seemed like a good time to revisit our old episode on him, which originally came out on September. Eleven twenty thirteen- and that was right before the hundred and sixty fifth anniversary of the accident that made him famous just allow heads up here. There is a fair amount of detail about a traumatic brain injury in this episode, including descriptions of the injury itself, am how doctors of the day treated it so enjoy. Welcome to stuff, you missed in history class, a production of I radio, color
and welcomed the market. Is I'm trees emails that I'm Holly fry today? We have eight a massively popular listener, request yeah, it's one of our most requested of all time, so many people have asked us about to talk phineas gauge and we are coming up on the hundred and sixty fifth anniversary of the accident that made him and his brain famous. So here we go the bank's primary about him. So today it's pretty two common knowledge that different parts of your brain have different functions and and responsibilities, and this was far from it he's back in eighteen, forty eight when an explosion sent an iron ride through Phineas Gaiters head destroying his left frontal lobe, unlike any one else in history who had ever experienced such a catastrophic brain injury. At that point he lived, although altered more than eleven more years over time. Since then, he's kind of more
into one of the world's most famous case studies and how damage to the brain can affect behaviour, some of which is legit and some of which is made up. So we will talk about that in more detail. I am holding back my desire to talk about future alma who gain and fries messed up brain, but anybody who are just shoot your eminence front of dream up, as we don't really know much about Phineas, though before his accident now before he got put the map by the spike. His life really was recorded. We know he was twenty five on September thirteenth of eighteen, forty eight, when the incident happened at the time he was the foreman of a railroad crew work and they were at that time working on the bed for their rutland,
willing to railroad. He was in the words of a letter written by his doctor to the editor of the Boston, medical and surgical journal in eighteen. Forty, eight quote of middle stature, vigorous physical organization, temperate habits and possessed of considerable energy of character. He was also a good farming with a good reputation, and he was competent at his job and really good at managing the crew, who were all pretty fond of him and, as you can imagine building a railroad, particularly at that time was really Billy manual process when they had to cut through a hill, the crew would have to blast their way through rock, and one group of men would be put Hearing for the charge to be laid in another, had to be ready to clear away the rubble that happen afterwards and his foreman Phineas was responsible for the overall operation of these activities and he was the one who was in charge of making sure the detonations when as planned, which he had been doing without incident. He was successful and
he'll that fateful day right. So while they were blasting, three rock Phineas used a tamping iron This is an iron ride that was forty three inches long, one in a court inches in diameter, which one end of it tapered to a point. That was a quarter inch in diameter and it way third and a quarter pounds, so this thing was longer than your typical baseball bat and it was made of iron and first they would make a hole and they'd put gun powder into the bottom of this whole and then Phineas would use the pointed and of his tamping iron, to put the fuse into and they fill the rest of the whole soil and then he would use the broad into the iron to tear down the dirt before they lit the fuse he and his crew. Working on a stretch of track mere Cavendish Vermont the town that had about thirteen hundred people want
its green described where this happened, and it could actually describe two different cuts along the track. So we're not sure precisely where it happened, but we ve got a nerd down. So he said at the second cut south of Cavendish, where many potholes in the rock give indisputable evidence that Black River one went this way near where Roswell Downer built his lime kill later. I love that at that of giving direction and later on, there would be aligned him, but it wasn't there at the time when the accident happened. They had made the whole and already poured the powder in, but they hadn't covered it up with sand. Yet so, while he was getting ready to stamp it down, Phineas turned his head away from what he was doing and it seems as though he wrongly thought the gunpowder had.
We been covered with sand, but of course, as we said it had not and he lowered the rod, attempt at down and hit the rock, and it made a spark and at that point the charge exploded that tamping iron flew upward it entered under his left cheekbone and travelled through the roof of his mouth and behind his eye through his brain and out his skull completely. I was misunderstanding this in my early, Like my knowledge, free podcast knowledge of this sort of thought hid law. lodged somewhere. No, no, it travelled come coyly through his head and landed several yards away, so this destroyed his skull and ro places along with obviously part of his brain. It also pushed against the back of his eyeballs, who was, I was sort of protruding a little bit he lost a whole lot of blood from the resulting face and scalp wounds and the damage to the vessels there were inside of his brain, and I I
And go back and look because I think similar to how you the vision of it being launched. I always had a vision of it being a spike above guide have been drawing or a piece of art at some point that was attributed as being Phineas gauge that someone drew They might have had it that way, because I have the same image in my head of it being a lodged yeah. My understanding of this whole accident was completely incur to give rise to learn more about it. It get came up from underneath under his his cheekbone yeah. I know it's crazy In the words of a news, article in the Boston Post, which has picked up from the Ludlow Vermont Free Soil Union quote, the most singular circumstance connected with this melancholy affair is that he was alive at two o clock this afternoon and in full possession of his reason and free from pain, Let us therefore eminent joy.
Not only did he live through this experience, he may not have even lost consciousness, although there was a lot of dust and debris following the the explosion that had to settle before people got to him. If he did lose conscious, it was really brief. He was able to sit right in the cart while being taken a town for a doctor, and once you got there, he was able to walk with Alina with some help up the stairs which sell their stunning yeah. I can't imagine who volunteered to help I mean I mean, can you imagine like that? I don't I don't want to do it while he was yet. He was kind of use a favoured yeah favoured boss via the crew. They were all fond of him and I think that it had to have been a bit gruesome. It was definitely gruesome make it more gruesome. So if, if you are tender of stomach, let's just say that this means you may want to just fast forward brace for impact. Have a friend screen it first yeah something cuz. It does
it really grouse yeah. I skip over some bits that are particularly disgusting because that it got to appoint winners. Reading that the day by day, notes of what happened is Congress? Yeah it'll make you squirm, it will still in town, Phineas went to Joseph atoms in inner his tavern in the towns. Doktor Doktor John Martin, Harlow wasn't it'll, be all right away. They couldn't find him so someone road to another nearby town to summon their doctor, who was Doktor, Edward Williams and once Williams got their phineas was feeling well enough to say. Well, here's work enough for you doctor. Yeah, oh about an hour later, Doktor Harlow got there. He and Doktor Williams conferred with each and eventually decided that Doctor Harlow, would be the one to treat Venice and here's a side. Note I will we ve come. be this into the ground at those points, if you're tired of hearing it. Sorry, though, the whole thing was so horrifying, an improbable that night
of the doctors, nor a reverend who happened to see them going by on the way to get the doktor believed what they, what the crew told them happen. They were like no way that is impossible. What you were saying cannot have just happened. They didn't Leave it until they saw the rod in the scene of the accident where there was blood in brain matter everywhere. This episode of stuffy miss than history glasses, brought to you by. Great. The great is the new Hulu original theories that follows, Catherine, the great unlikely and often hilarious journey to power young calves arrives in Russia for her arranged marriage to Emperor Peter, the third hoping for love and sunshine. What's he finds instead is the depraved, dangerous and backward world that she becomes determined to change, has to do with killer husband, beat the church baffled a military and get the court on her side with only occasional historical facts. The serious stars- l fanning as Catherine, the great and nickel,
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and our knowledge of the brain wasn't the only thing that was vastly different in eighteen. Forty eight medical practice was at a completely different point of its evolution on the germ theory of disease had not really happened, yet it was still to come, so many doctors were treating illnesses by balancing humours because they didn't realize the issues of germs and backed here. where I doktor Harlow specifically had graduated with his empty from Jefferson Medical College in eighteen. Forty four, although he probably also studied at Castleton Medical College in Vermont, Philadelphia School of anatomy before he went to Jefferson? His medical practice was often focused on antiphlogistics principles, and today that just means anti inflammatory. But at the time it was this body of ideas that disease came from various sources of over stimulation or excess. it needed to be balanced in order for the person to be cured, so
A lot of common techniques were bleeding copying leeches and giving people laxative and emetics to make them throw up, Doktor Harlow actually credited how much blood Phineas had lost at the scene of the accident, with helping him you eventually actually recover and the way he described to describe this wise quote. May we not infer that this prepared the system for the trying ordeal through which it was about to pass interesting medical concept. Yeah. Why there's like a tiny piece of truth due at the fact that he had open injury instead of it like being a closed injure here like his brain, had just well without putting pressure on itself like that, actually is true, but probably the massive bloodless us did not in fact make it easier overall work
body to heal IA and Arthur Harlow also was a follower of for knowledge, which you may have heard of its that concept, that the different parts of the skull relate to different parts of Europe. its character, then that was a really common belief at the time. Yet ever people are probably seen those pictures of skulls that have the little grid lines drawn around them in their labeled, with what their particular area pertains to the persons behavior personality right. There were no antibiotics or a surgical disinfectants. Then an handwashing before a medical procedure was not even a standard practice, so most of what Doktor Harlow did was to clean out obvious dirt
loose brain tissue and bone fragments out of the wound, I'm going to try to replace the biggest pieces of the top of the skull sort of put them back in place and then close at the scalp and bandage the whole thing he also treated and rest. Some pretty extensive burns on Phineas has arms and hands. Everyone has been so distracted by the dramatic facial and head injury that they didn't notice his injuries at first. But of course this was an explosion. related injury, so it makes sense that he would have had other damage right during the first few days after his injury. Phineas did surprisingly well, I mean he was definitely very ill, but he continued to ask after the work on the railroad. He would ask who was acting as the form and while he wasn't there, he also declined to see his friends saying that he would be back at work, ray to you, so he didn't really need have visitors
the bleeding gradually slowed and he was more or less able to sleep, but then he started to develop obsesses and fevers, and the wound became fetid. Doktor Harlow response was to balance the humours prescribing a medics unless laxative, as well as silver nitrate, to treat what he described, as quote fungus, which may have actually been fungus. Coming from the brain pretty discussed here I mean you, it's not a short walk to presume that wound of this nature, traded in the manner it was, would have some infection issue yeah. He also bled Phineas and drained the pass from the wound, both which were motivated by this idea of getting rid of the excess and balancing the humours, but of The things they may have been of actual real medical use in this case, since they would have reduced some of the pressure going on it
out of his skull and in the case of the pus removed infectious material from his body and had been able to see a little out of his left eye for a while after the accident, but he did eventually lose all site in it, along with the ability to open it, so it can permanently shut right. he got a lot worse before he started to get better and at some points he was nearly kilometres inception Amber his friends and family went ahead and picked out a coffin undecided what clothes they were going to give their when to put on him to be buried in and at least one of the people attending him, so that they should stop treating him since it was just prolonging the inevitable, but eventually he started to rally and changes in his behaviour began to be apparent. While he was still under Doktor Harlow, care. For example, on October eleventh Doktor Harlow offered him one thousand dollars for some pebbles that he had collected and Phineas refused.
a little later in October when he was really starting to improve pretty steadily after that in a dramatic downturn, He decided he was ready to go home any plan to walk there. It was miles away, so he went on
shopping for some provisions, he was going to need and he did so in bare feet with no coat on so remember. This was Vermont. This exposure set him back a little bit, but by the end of November he was able to go home to his family. So obviously he was having some judgment issues right point. He Juno would turn down a large sum of money for, for some rocks for some rocks, which who wouldn't want to. I would take a thousand dollars for pebbles right now, and then he put himself in danger kind of thoughtlessly yeah but Doktor Harlow attended to him. For ten weeks, an Phineas went home to Lebanon, New Hampshire, by carriage any stayed until April, continuing to recuperate. So, of course, one of the things I ain't apart from having his brain, partially destroyed by a giant iron ride, one of the things that he is really famous for is for the change in behaviour that came afterwards. L a lot of this is portrayed as like he just became unable to work and unable to hold a job enough
really accurate. His recuperation did continue to be pretty slow even after he left Doktor Harlow CARE, but he really wanted to get back to work and he started working on his parents farm by the middle of the following year, which was eighteen, forty nine. He was barely able to do a whole days work there. So even ass, he was recovering seemingly pretty well physically. His personality had changed and we described him before the accident as being very smart, competent and reliable. But after the accident, Doktor Harlow described him as fitful irreverent indulging at times in the grossest profanity, which had not previously been his custom manifesting, but little deference for his fellows impatient of restraint or advice when it conflicts with his desires.
times, Pertinaciously obstinate, yet capricious and vacillating devising many plans, a future operation which are no sooner arranged and 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 so most of what we know about visas, behaviour after the accident comes from doktor heart and there's a little bit of question today as to whether this account is entirely reliable. His belief then for analogy might have colored his perception of finances behaviour, especially considering that some of his writings about him include specific for an illogical terms such as Morocco, bilious, but regardless. Even his friends and acquaintances were saying that he was no longer gauge. Consequently, when he felt physically ready to return to work again,
his old employer. Wouldn't have him back there's a lot of popular writing about him today. That sort of characterizes him at this point is a completely unreliable on him. Viable violent drifter. This is completely inaccurate. He did find steady work after here covered, although that work did not involve handling explosives anymore, which would make sense he went to Boston for a while in eighteen, fifty where he was under the observation of Henry J Bigelow of Harvard and he presented at the boss. He was presented at the Boston society, for medical improvement and to a medical class at the house. and Arthur Bigelow also made a life cast a Phineas his head, showing the outward physical damage. That was still evidence. Even once the initial wounded healed, thinking about adding popular music to your platform or have to power new music features and filters
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people say that you traveled around with a freakshow and he became his freak show performer, and that seems to be an exaggeration of what was more a couple of exhibitions or lectures that he was in an early one thousand, eight hundred and fifty one. He was hired by Jonathan Currier to work at a livery stable in New Hampshire. And he worked there for about a year and a half, then in August of eighteen, fifty to a man who was starting a new carriage company hired him to come. Work with him in Chile, Phineas worked in a stable and the stagecoach in Chile, for about seven years, and we ve talked about how demanding the job of the stagecoach driver is in our recent episode about Charlie Parkhurst. So it seems as though Contrary to some of the popular writing about him, he did recover some of his mental abilities or at least adapt to life without them
May even be that there really routine work of driving the steam the same stage coach routes day after day after day gradually helped his brain adapt and eventually, as his health began to fail, he went out to San Francisco, where his family had moved in pursuit of the gold rush. He was pretty when he got there, but he recovered somewhat and was able to work for a while on a farm and Santa Clara. But then he a series of seizures more and more serious and he died in May of eighteen. Sixty He was buried on May twenty third of that year, and there was no tops. There was no autopsy, but in eighteen sixty seven, his body was exude and his skull and the tamping iron were sent to Doktor Harlow and Doktor Harlow eventually sent those to the warrant anatomical museum at Harvard which already hand Doktor Bigelow Life cast. So you can actually see all three of these things at the word: museum, exe
fishing gallery at the count way library of medicine. Thanks to this skull and a lot of modern imaging work today, we have a much better idea of the exact extent of Phineas his injuries, especially where the rod went besides the obvious, through his head, his skull was damaged in multiple places that you would expect under the cheekbone at the back of the eye socket and the top of his head, and so he lived for the rest of his life with parts of his skull missing entirely, including a pretty significant five patch from the top of his head. A number of researchers have tried tackle the question of exactly how the rod travelled through his head and brain and exactly what parts of his brain were damaged because someone holes that were in his skull were smaller than the diameter of the ride which, like the one under his cheekbone, was smaller than the rod wise and then the one at the top His head was a lot bigger alot of their findings, didn
really agree with one another until we developed tools like see, take scans to look at the skull itself an mri of living, people's brains to create kind of a model for what gauges might have looked like in two thousand for researchers. You see tee scans the skull to create a three representation of Phinis Skull. to try to determine exactly where the damage occurred and their conclusion factors in that some of the bone at that Everyone must have moved out of the way, almost like a hinge and then closed back down and later healed over, since the entry wound on the skull under the cheekbone is smaller than the rob itself in twenty twelve, a team researchers, led by John they're. All Van Horn published a paper called mapping. Connectivity damage in the case of Phineas gauge
it used all kinds of medical imaging techniques to map out exactly which parts of the brain would have been damaged, MRS, where they used in our eyes of other patients to to sort of work up a model findings are in piano s one, so you can read them online for free and at this point most of the modern computational studies agree that the damage was really confined to the left: frontal Lobe phineas became really famous in the world of Nero psychology. Today he's a Hey study in many many psychology and neuroscience textbooks in chapters about how an injury to the brain can change a person's personality, but, alas, Other writing about him today. Really sort of retroactively gives his story a lot of credit for everything from the bottom ease to how doctors diagnosed tumors in people's frontal lobes, based on changes in their behaviour but alive. This is really hindsight, and sometimes it's kind of pulled out.
Dinner news, a little bit of making things up going on so his accident. The fact that he survived it and the fact that he basically cupboard and lived for more than a lemon more years. All of that definite, contributed to the fields of Nero surgery and narrow psychology and end may were on their own pretty incredible here. Really was long dead by the time. Surgery and sterilization techniques progressed to the point that Nero third surgery was even a survivable event and a lot of the writing about him also crimes. What we later learned about Lobata me and brain tumor patients to Phineas himself sort of applying other people's behaviour after the destruction of their frontal lobes to phineas his behaviour when he lived. But these descriptions, which we mentioned before that he became violent and shift, listen, couldn't hold a job. They just
match up with the descriptions of people that actually examined him nearly were around him, be kind of gets conflated with descriptions of other patients with completely different conditions. That also am involved There- frontal lobe in some way, yet their symptoms get attributed to his behaviour, ascribed to his behaviour when they weren't really going on gag alot of people also cite him as one of the patients who helped neurologists figure out the different parts of our means do different jobs, and this definitely was not the case at the time. I'm doctors really knew very little about the brain and they were two contradictory and competing theories. One was it. The brain was basically this undifferentiated thing with all of the parts of the brain able to handle any task and the other, which included the chronology that we ve talked about before believe. The different locations in the brain had different functions. Both of these groups claimed that gauge was supporting their theory. The
people who thought that the brain could I'd do anything from any part were like, while he survived clearly all the other parts of the brain made up for it, and the people who thought that the different parts of the brain had different Sanctions were like well, his behavior change. So clearly he supports our theory, so this did add to the whole field and the whole world of things that we know about the brain, but there are other doctors and other patients whom actually had a much bigger impact on this idea that the different parts of the brains do two things in particular: Doktor Carl Worthy and Doktor Paul Broker, who each worked with patients who have had damage to specific areas that affected their ability to use language so warranty and broke out, have parts of the brain named after them, based on their research. Without those kind of developments we we could not have jumped to the idea that different parts of the brain dead, different things just based on Phineas gauges.
Case rates, and we do have a couple pictures of Phineas, gage vintage photo collectors, Jack and Beverly will get us acquired one somewhere along the line. I don't really remember where they put it on Flickr in two thousand and seven and eventually internet chatter identified it as likely be engaged, and this was eventually confirmed by matching the photo to the light cast. That's at the museum and Gages family released another picture in twenty ten. The life mask of His head and his skull amber tamping iron are all at Warren Anatomical Museum at Harvard Medical School. The rod has this inscription. This is the bar that was shot through the head of Mr Phineas P gage at Cavendish Vermont September 14th, one thousand eight hundred and forty eight new Philly. Word from injury and deposited this bar in the museum at the Medical College of Harvard University There is a name and, and some other dating. So, what's funny, there's a couple funny things about this
One is that his name is spelled wrong and the other is that the data is wrong in exactly how this all came to be kind of lost, a history at some. he gave the ride to Harvard Medical School Museum, and then he asked for it back in eighteen, fifty four, but the inscription is dated one thousand eight hundred and fifty. So this all sort of, in addition to being kind of weird and misspelled, it calls into question This frequent thing that you may hear about Phineas, which is that he carried the rod around with him forever after the accident. Clear He did his hat, but clearly He also who did want it because he asked for it back from Harvard. So that's a little unclear at this point. There is also a commemorative plaque in the camp in Cavendish, for
HANS and it was unveiled on September, thirteenth of ninety ninety eight, which was the hundred fiftieth anniversary of Phineas accidents. There is also the book an odd kind of fame stories of Phineas gauge by Malcolm Macmillan. It's not the only book. About him, but it came out in the year two thousand, and it gives a really thorough history of Phineas and accident Edit debunks a lot of the pact. their perception of him and his life and how he behaved afterward. So it is, I think, the most thorough work on him. They can get in one place today year, which is good, could search the lot of mythology. Let's go in. I understand how that happened at such a bizarre, phenomenal thing. Yeah. It's easy to then accept some other, pretty incredible details about the store
right. Well, in its it's one of those stories now, it's almost is interesting for how it became the sort of neuroscience juggernaut ass for the actual accident happened, so yes fascinating. gauge hundred and sixty five years ago, a tamping rod had a little acts it had through his entire skull. Thank you so much for joining us today for this matter to a classic. If you have heard any kind of key mail address, there may be a facebook. You are l during the course of the opposite that might be obsolete. It might be doubly obsolete because we have changed our Emil address again. You can now reach us at history, podcast that I heart radio, dot com and we're all over social media at missed in history, and you can subscribe to our shared on Apple POD, CAS Google Podcast, the eye heart radio app and wherever else to us in the pod gas
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first ever social music. Api song clip is an easy and cost effective solution for bringing fully compliant popular music to your platform through an easy to integrate and fully customizable api visit song clip dot com to learn more today. This might surprise you, but growing up in a funeral home isn't as fun as it sounds sure. I get to see a lot of interesting things and the pay is all right. But I'll tell you one thing: I can't wait to quit this job. My name is grant, and these are my funeral home stories. Iheartradio is number one for podcast, but don't take our word for it. Listen to my funeral home stories on the Iheartradio, app apple podcasts or wherever you listen to podcast, see you soon.