Revealed: picture of a Victorian medical miracle

Collectors thought their image was of a one-eyed whaler. In fact it was of a man who changed science

For 30 years, the old black-and-white portrait of a handsome man holding a metal stake had stood in anonymity in the photographic display case of Jack and Beverly Wilgus, a Massachusetts couple who had built up a small library of old daguerreotypes in their spare time.

He was well-dressed and seemed confident and self-assured, despite the loss of a left eye and a fearful scar from some unexplained accident. The Wilguses thought he could have been a 19th-century whaler, a real-life Captain Ahab carrying the harpoon and scars of a brutal encounter with a Moby-Dick. "It has had a spot in the display case with a select group of daguerreotypes," said the couple, explaining that the portrait was one of their favourite acquisitions. "During all those years it was never cycled into a storage drawer as many of the others have been.

"We gave it a name and had a story we told about it. We called it 'The Whaler' because we thought the pole he held was part of a harpoon. His left eye is closed so we invented an encounter with an angry whale that left him with one eye stitched shut."

But it has turned out that the man in the photograph was not a whaler but Phineas P Gage, a railroad worker who suffered a terrible accident with a metal stake in 1848 that left his brain permanently damaged and his changed behaviour the subject of intense scientific discussion about the physical basis of personality.

It was only when the Wilguses posted the photograph online that they realised the folly of their invented whaler story. People with a knowledge of whaling said that the metal pole had nothing to do with whale harpoons.

But someone did point out that the man looking out from the photograph might be Phineas Gage, and the metal stake could be the one that passed clean through his skull when Gage was using it as a tamper to prod sand and explosives into the cavity of a rock blocking the new Rutland and Burlington Railroad in Vermont in 1848.

It now seems almost certain that the anonymous man in the old photograph is indeed Phineas P Gage. It is the first portrait of the man who has become a medical phenomenon and one of the most famous historical figures in university courses on the brain and personality.

The story began in September 1848 when Gage was the 25-year-old foreman of a railroad blasting crew. Someone is said to have called his name as he tamped and, as he turned, a spark from the metal stake ignited the explosive, sending the pole clean through the underside of his left cheek behind his eye socket, exiting through the top of his forehead and landing some 80ft away. The stake was 3ft 7ins long and one and a quarter inches wide at its thickest point. It was nearly 14lbs of solid iron and in its journey through Gage's skull it had destroyed one or both of his frontal lobes, the parts of the outer cortex above the eyes.

Reports from the time suggest that despite the hole in his head he was able to sit upright in an ox-cart and talked animatedly while he was being taken to a nearby hotel for medical treatment by a local doctor, who noted that when Gage vomited, half a teacupful of his brains oozed from the injured skull.

Although he recovered physically, Gage underwent a dramatic personality change. Before the accident he was good-natured, courteous and quick-witted. Afterwards, reports said he became abusive, rude and incapable of making decisions.

John Harlow, a physician who had treated him after the accident, wrote: "The equilibrium or balance, so to speak, between his intellectual facilities and animal propensities, seems to have been destroyed. His speech is fitful, irrelevant, indulging at times in the grossest profanity (which was not previously his custom)."

More recently, brain scientists have suggested how the damage to Gage's frontal cortex could have brought about the personality change. It is this part of the brain that controls the instinctual desires rooted deeper, evolutionarily ancient parts of the brain, they suggested.

Yet the discovery of Gage's portrait, obviously taken in the 12 years separating the accident and his death, suggests that he may have actually overcome some of his personality problems. He had left his family and had become a long- distance stagecoach driver in Chile, which suggested that, to some extent, he was able to come to terms with his handicap.

He carried the metal stake wherever he went but his terrible accident was to plague him to the end. He started having epileptic fits and returned to San Francisco where he was nursed by his devoted mother until he suffered his last fit in 1861 and died.

Seven years later, his skull and tamping-iron were deposited in the Warren Anatomical Museum in Boston where they remain to this day. But now, medical students will finally be able to put a face to a famous medical name.

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