In September, 1848, the Rutland & Burlington Railroad was expanding its line across Vermont. In order to keep the tracks as straight as possible, construction workers first had to remove a great deal of stone. The foreman of one group of men undertaking this difficult task was Phineas P. Gage. Twenty-five-year-old Gage was intelligent, kind, and well-liked. He was also quite athletic and agile, and impressed his employers as being exceptionally efficient at his work.

Gage was an expert at removing rock using explosives. The procedure was to drill into the rock, fill the hole halfway with explosive powder, insert a fuse, and then cover the powder with sand. The layer of sand was necessary to direct the force of the blast into the rock, rather than out the top of the hole, and the sand had to be packed down by pounding it with a specially designed iron tamping rod. Gage had a custom-made rod that weighed 13 pounds (5.9kg) and measured 3 1/2 feet (1.1m) long, with a diameter of 1 1/4 inches (3.2cm) at the bottom, tapering to a dull point at the top.

Sticks and Stones May Break My Bones
At 4:30 p.m. on September 13, Gage was preparing a charge, and apparently failed to notice that it had not yet been cushioned with sand before he began tamping it. When the iron rod scraped against the rock, it created a spark that ignited the powder. The resulting explosion propelled the rod out of the hole, through Gage’s left cheek, and out the top of his skull. The rod landed nearly 100 feet (25m) away.

Remarkably, despite the two new and rather large holes in his head and the significant bleeding that resulted, Gage did not even lose consciousness. He remained upright and lucid as his coworkers loaded him onto an ox cart and took him to the nearby town of Cavendish. A half hour later he was sitting on the hotel porch, chatting with the owner while waiting for the arrival of Dr. John Harlow, the local physician. Dr. Harlow treated Gage’s injury as best he could, piecing the remaining portions of the skull back together and cleaning and dressing the wound. Over the coming weeks Gage developed a series of infections but fought them successfully under Harlow’s care. Other than the loss of sight in his left eye, Gage was declared to have made a full recovery in just a couple of months.

Suddenly, I’m Not Half the Man I Used to Be
An experience like this is bound to make anyone a bit grumpy, but even as he healed physically, Gage underwent a profound change in personality. Although he never lost his language ability, memories, or motor skills, his temperament was completely different. He became profane, impatient, rude, obstinate, and unable to carry out any of the endless plans he made. His friends said that “Gage was no longer Gage”; it was as though all of his ethical filters had been turned off. Because he was such unpleasant company, he had difficulty keeping jobs, and at one point put himself on display at Barnum’s Museum in New York City. Several years later, having made his way to California after an extended stay in Chile, Gage began having epileptic seizures. These continued for several months until he suffered a series of major convulsions that led to his death on May 21, 1860—nearly twelve years after his accident.

Gage was buried without an autopsy, but seven years later his body was exhumed. The skull (along with the tamping iron, which had been buried with him) were sent to Dr. Harlow, who examined them and then donated them to the Warren Medical Museum of the Harvard Medical School. Later they were transferred to Harvard’s Countway Library of Medicine.

Brains and Personality
I first heard the story of Phineas Gage in a graduate course in cognitive science; anyone who studies the brain is bound to run across the story in textbook after textbook. Although no one can say with complete certainty exactly what parts of Gage’s brain were damaged, it seems the injury amounted to a very crude frontal lobotomy. This case became famous as the first hard evidence that aspects of one’s personality (and, by implication, behavior) were localized in portions of the frontal lobe.

Neurologist Antonio Damasio has spent years studying brain injuries similar to Gage’s. His research has led him to believe that emotion figures crucially into rational thought and decision-making. If the portion of the brain that processes emotion is damaged, it becomes difficult or impossible to make good decisions. The sad tale of Phineas Gage has produced valuable insights for the field of neuroscience, not to mention a lesson we can all heed: stay far away from explosives! —Joe Kissell

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Thanks to reader Bo Lockwood for suggesting today’s topic!

The definitive book on Phineas Gage, covering every conceivable detail, is An Odd Kind of Fame: Stories of Phineas Gage by Malcolm Macmillan. John Fleischman’s Phineas Gage: A Gruesome but True Story About Brain Science was written for children, but is great for adults too. To learn more about what this accident and others like it have revealed about the nature of personality and behavior, see Descartes’ Error: Emotion, Reason, and the Human Brain by Antonio R. Damasio.

The best place to go on the Web for information about Phineas Gage is the Phineas Gage Home Page, compiled by Malcolm Macmillan (author of An Odd Kind of Fame). Other sites include The Amazing Case of Phineas Gage and the Phineas Gage memorial at Roadside America.

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At lunch time one day a few years ago, I walked into a cafeteria near the building where I was working. I wasn’t in the mood for a salad or sandwich that day, so I looked at the hot entrees. Behind the glass was a heated serving pan full of rice, and next to it another pan containing a mixture I couldn’t quite identify, though there were some clearly recognizable vegetables and on the whole it looked fairly appetizing. The “daily specials” sign was missing, so I asked the server what it was. She looked down at the food, thought hard for a few seconds, looked back up at me, and said matter-of-factly, “Ingredients over rice.” Another few seconds passed and it was clear that was the only answer I was going to get. I said, “Fine, I’ll have some of that.” It was delicious—though to this day I have no idea what it was supposed to be.

Sometimes I feel comfortable living in a state of blissful ignorance about the ingredients in my food. Other times—especially when purchasing heavily processed, prepackaged foods—I like to know that at least some part of what I’m eating originally came from a well-known plant or animal source. More and more food products, particularly dietetic foods, list something called sugar alcohols on their labels. Whatever that is, it sounds delightfully unhealthy, so what’s it doing in foods that are supposed to support good health?

Sweet and Low-Cal
A sugar alcohol (also known as a polyol) is any one of a class of sweeteners including sorbitol, xylitol, isomalt, mannitol, hydrogenated starch hydrolysates (HSH), and several other compounds. Despite their artificial-sounding names, each of these sweeteners occurs naturally in various plants. Some sugar alcohols can be just as sweet as sugar—and almost indistinguishable in taste. Their main appeal is that they have a lower caloric value than more common sugars such as sucrose and fructose. They also serve as texturizers, lending foods the same kind of moistness and chewiness they’d have if sugar were used. And they actually reduce, rather than increase, the incidence of tooth decay. All this without the potentially serious side effects of non-nutritive artificial sweeteners such as aspartame and saccharin.

The reason sugar alcohols are lower in calories is that the body cannot digest them as quickly or as completely as sugars. Consumed in moderation, sugar alcohols have little or no effect on blood sugar level, making them appealing to diabetics looking for a sugar substitute. But this lack of digestibility also means that sugar alcohols can have a laxative effect, in severe cases even causing diarrhea.

Carb-O-Rater
The term “sugar alcohol” is somewhat misleading, as polyols are neither sugars nor alcohols. Technically, they are hydrogenated carbohydrates that, at the molecular level, have some of the structural properties of alcohols. But the fact that they are a type of carbohydrate has led to much debate among those concerned about carbohydrates in their diets. Some manufacturers subtract the amount of sugar alcohols in their products from the total quantity of carbohydrates to yield a much lower “net carb” figure for their labels. They base this practice on the fact that indigestible carbohydrates, such as fiber, cannot by definition have the same effect on the body as carbohydrates that are converted to glucose. But sugar alcohols are only partially indigestible. So some people feel they should be counted as carbohydrates in their entirety, while others feel that only half the sugar alcohol in a product should count as a carbohydrate.

Then there are people who don’t believe in counting carbs at all. Personally, I have nothing against either sugar or carbohydrates. Or fat or salt, for that matter. I know, call me unhip or old-fashioned, but the principle “all things in moderation” has served me pretty well. So I might make a special effort to find chewing gum that contains xylitol, but I won’t be using it in my next batch of chocolate chip cookies. —Joe Kissell

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