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How Was Phineas Gage’s Brain Damaged

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What Is The Famous Accident That Happened To Phineas Gage

The Man With a Hole in His Brain

On September 13th, 1848, when Phineas Gage was 25 years old, he was using his iron tamping road to pack the dangerous explosive powder into a hole at work.

Suddenly the powder exploded and sent the iron rod upward. The iron rod penetrated his left cheek and tore through his brain.

Fortunately, he not only survived the initial wound but was also able to talk. Dr. Edward H. Williams was the person to care for Gage after the accident.

As Dr. Williams was not a military doctor, he was not accustomed to these types of wounds but nonetheless he cleaned the coagulated blood.

Dr. Williams recorded every unbelievable aspect of his wound. Below is the bar that was shot through Gages head.

Here is business enough for you, Gage told Dr. Williams after the premature detonation of explosive powder, turning the tamping iron rod into a missile.

The first thing that Dr. Williams noticed was the wound on Gages head. During examination, Gage was explaining how he got injured.

Dr. Williams did not believe his statement at that time he thought he was lying. Gage insisted that a heavy iron bar shot through his head.

He stood up and suddenly vomited, putting pressure on his wound. Below is a photo of Gages skull with an iron rod through it.

Now Gages case has been sent to another doctor, named Dr. John Martyn Harlow.

Harlows observation of the wound and his description of Gages accident provides us with a lot of information about his case.

Evidence Suggests That He Was Actually Far More Functional Than Previously Reported

Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard, his mind was radically changed, so decidedly that his friends and acquaintances said he was no longer Gage, said Harlow.

Although, because of a lack of evidence of the extent of Gages injuries aside from Harlows report, it is difficult to know the extent of how much brain damage the accident caused.


Harlow, J. M. . Recovery after Severe Injury to the Head. Bulletin of the Massachusetts Medical Society. Reprinted in History of Psychiatry, 4, 274-281 doi:10.1177/0957154X9300401407

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Living With Half A Brain: Phineas Gage

The Warren Medical Museum in Boston is a fascinating place, named after Dr. John Collins Warren who performed the first surgery under ether anesthesia in 1846. On view is the actual flask that housed the ether used during the surgery. Also on display is the famous meter long rod that passed completely through the skull of railroad company worker Phineas Gage in 1848 without killing him. It did, however, dramatically alter his personality.

The unfortunate event turned out to be a landmark in the history of neurology, demonstrating that different parts of the brain had different functions. Apparently, catastrophic injury to the frontal lobes of the brain could be sustained without causing significant neurological deficits, but not without affecting behaviour. To this day, a memorial plaque marks the spot where the spectacular accident occurred on September 13, 1848 in Cavendish, Vermont.

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The Damage To Phineas Gage’s Brain

Within weeks of Phineas Gage’s accident differences of opinion emerged among those who examined him about the extent and location of the damage to his skull and brain. Over time these differences increased. There are two problems: first, can the path of the tamping iron be estimated accurately from the damage to his skull, and, second, can the damage to his brain be inferred from that path?

Differences over the damage to the skull

In summary, the main injury to Gage’s skull was at the exit, where the tamping iron created an irregular area of damage about 3.5 inches long and 2 inches wide. The main problem in estimating the trajectory of the iron is to know exactly through which part of each of these areas the iron passed. It is a problem that is most acute for the exit area on the top of the skull.

Differences over the passage of the tamping iron

John Martin Harlow and Edward Higginson Williams, the two physicians who saw Gage on the day of the accident, said nothing specific about the entry under the zygomatic arch or the damage at the base, but Harlow was definite that the tamping iron had emerged at the junction of the coronal and sagittal sutures, and in the midline. Phelps, who examined Gage six weeks later, thought the point was about 0.5 inches in front of the junction and 1 inch to the left of the mid line.

Jack Van Horn and his colleagues have since verified that the damage was left-sided.

Differences over the damage to the brain

What to make of the differences?

Abstract No 4phineas Gage: The Brain And The Behavior

The Curious Case of Phineas Gage

Phineas Gage has long occupied a privileged position in the history of science. Few isolated cases have been as influential, in the neurological and neuroscientific thinking, and yet the documentation on which conclusions and interpretations rest are remarkably incomplete , . We do have a number of sure facts:

Gage did suffer a well-described accident, which resulted in major damage to his skull and brain

we do know that after the accident his personality underwent a major change and that his reliability was compromised

we do have his actual, damaged, skull as well as the weapon that traversed it, both preserved as museum artifacts.

By undertaking a direct analysis of the skull and taking direct advantage of novel neuroimaging techniques, we took a new look at the Gage case . After analyzing, measuring and photographing the skull at the museum of the Harvard Medical School, we modeled a restricted number of trajectories for the weapon and for the respective sites of brain injury. We were then able to interpret aspects of Gage’s behavior that were credibly compromised in the setting of Gage’s presumed lesions.

I plan to discuss these results in light of current knowledge of frontal lobe dysfunction.

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Who Is Phineas Gage

Phineas Gage was an American railroad constructor foreman in Cavendish, Vermont and was born in July 1823. He died in May 1860 in California.

He is remembered for his improbable survival after a 42 inch tamping iron rod weighing 13.25 pounds was driven straight through his head.

Gage is referred to as the most famous patient in the history of neuroscience because his case was the first to suggest a link between personality change and brain trauma.

After his accident, he suffered from traumatic brain wound that destroyed much of the left frontal lobe of his brain. His friends described him as no longer Gage.

His skull with a tamping iron rod and a mask of his face are housed in the Warren Anatomical Museum at Harvard Medical School.

He remains one of the worlds most strange cases in the medical field because of his horrifying accident. He died at the age of 36.

Why Do We Study Phineas Gage

· His unfortunate situation contributed a lot of important data for neuroscience.

· To this day, doctors study life and continue to learn about how he was able to survive after the accident.

· We were able to learn vital information about character and personality which was affected after his brain damage.

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Phineas Gage And The Effect Of An Iron Bar Through The Head On Personality

Mo Costandi

The photograph above, which was uncovered earlier this year, is one of only two known images of an otherwise unremarkable man named Phineas Gage who attained near-legendary status in the history of neuroscience and psychology one fateful day in 1848 at the age of 25.

Gage earned his place in the neurological hall of fame in a most unusual and extremely unfortunate way. A railroad construction foreman in the US, he was in charge of a crew of men who were working on the construction of the Rutland and Burlington Railroad near Cavendish, Vermont. On 18 September, he and his crew were excavating rocks to make way for the railroad. Gage was preparing for an explosion, using the tamping iron he holds in the photograph to compact explosive charge in a borehole. As he was doing so, the iron produced a spark that ignited the powder, and the resulting blast propelled the tamping iron straight through his head.

John Harlow, the physician who attended to Gage at the scene, noted that the tamping iron was found some 10 metres away, “where it was afterward picked up by his men, smeared with blood and brain”. He provides a detailed description of the “hitherto unparalleled case” in a letter to the editor of the Boston Medical and Surgical Journal, entitled “Passage of an Iron Rod Through the Head”:

Mo Costandi writes the Neurophilosophy blog

Further reading

Factors Favoring Gage’s Survival

Lessons of the brain: the Phineas Gage case

Harlow saw Gage’s survival as demonstrating “the wonderful resources of the system in enduring the shock and in overcoming the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature”, and listed what he saw as the circumstances favoring it:

1st. The subject was the man for the case. His physique, will, and capacity of endurance, could scarcely be excelled.:18

For Harlow’s description of the pre-accident Gage, see §Background, above.

2d. The shape of the missilebeing pointed, round and comparatively smooth, not leaving behind it prolonged concussion or compression.:18

Despite its very large diameter and mass the tamping iron’s relatively low velocity drastically reduced the energy available to compressive and concussive “shock waves”.

Harlow continued:

3d. The point of entrance … did little injury until it reached the floor of the cranium, when, at the same time that it did irreparable damage, it opening in the base of the skull, for drainage, recovery would have been impossible.

No attempt will be made by me to cite analogous cases, as after ransacking the literature of surgery in quest of such, I learn that all, or nearly all, soon came to a fatal result.

J. M. Harlow :344


4th. The portion of the brain traversed was, for several reasons, the best fitted of any part of the cerebral substance to sustain the injury.:18

Scientific American

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Phineas Gage: A Closer Look

On September 13, 1848, a 25-year-old railroad foreman named Phineas Gage was injured in a horrific accident. While using an iron rod to tamp explosive powder into a hole, the powder ignited and sent the 43-inch long rod hurtling upward. The rod pierced through Gages cheek, passing though the frontal lobe of his brain before exiting the top of his skull and landing approximately 80 feet away.

Amazingly, Gage not only survived the accident, he also went on to become one of the earliest and most famous cases in the then just emerging field of neurology.

An Illustration Of Gages Injury

This image depicts the path of the iron rod through Gages skull. The illustration was included in Dr. Harlows account of the accident and subsequent impact on Gage, which was first published in 1868 in the Bulletin of the Massachusetts Medical Society.

The missile entered by its pointed end, the left side of the face, immediately anterior to the angle of the lower jaw, and passing obliquely upwards, and obliquely backwards, emerged in the median line, at the back part of the frontal bone near the coronal suture, Harlow wrote.

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A View Of The Accident Site

This image depicts an area of railroad approximately three-quarters of a mile outside of Cavendish, Vermont. It was in this area where Gage was working for former Rutland & Burlington Railroad to prepare the railroad bed. It was in this area or a site nearby that Gage suffered from the accident that would change his life and make him famous in the annals of neurology.

Phineas Gage’s Astonishing Brain Injury

A reconstruction of the brain of Phineas Gage who suffered ...

Phineas Gage is often referred to as one of the most famous patients in neuroscience. He experienced a traumatic brain injury when an iron rod was driven through his entire skull, destroying much of his frontal lobe.

Gage miraculously survived the accident. However, his personality and behavior were so changed as a result that many of his friends described him as an almost different person entirely.

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With the lucid, masterful explanations and razor-sharp wit Sam Keans fans have come to expect, Kean explores the brains secret passageways and recounts the forgotten tales of the ordinary people whose struggles, resilience, and deep humanity made neuroscience possible.

If you want to learn more about the history of the human brain while being entertained and on the edge of your seat, this book is for you!

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How Phineas Gage’s Freak Accident Changed Brain Science

  • Saturday, October 17, 2020, 10:15am

Cavendish might look like any other small Vermont town. Nestled between rolling hills and the Black River, with one main street running through town, its a launching point for trout anglers, snowmobilers and skiers. But this rural town of just over a thousand people can claim a remarkable historical figure: Phineas Gage.

Frontispiece, showing multiple views of the exhumed skull, and tamping iron, of brain injury survivor Phineas Gage. J.B.S. Jackson, MD – A Descriptive Catalog of the Warren Anatomical Museum

Gage was a young construction foreman who suffered a gruesome accident that changed the history of brain science.

In 1848, while blasting through rock to build the new railroad, an explosion sent a 3-foot, 13-pound iron rod up through his cheekbone and out the top of his skull. The tamping rod landed 80 feet away, “smeared with blood and brain.”

Remarkably, Gage lived for another 11 years. He lost one eye and had a permanent hole in his skull, covered by a thin layer of skin.

Gage was a medical marvel.

There had been a long-running debate in the 19th century on whether different regions in the brain govern different behaviors. Here was a case of severe damage to the left frontal lobe, followed by a dramatic personality shift. It seemed to prove the point once and for all.

Gage himself was never the same after the accident.

A friend said, “Gage is no longer Gage.”

He died in 1860 at the age of 36.

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No Longer Gage: An Iron Bar Through The Head

In September 1848, in Cavendish, Vermont, an incident occurred which was to change our understanding of the relation between mind and brain. Phineas P Gage, a 25 year old railroad foreman, was excavating rock. In preparation for blasting he was tamping powder into a drill hole when a premature explosion drove the tamping iron1.1m long, 6 mm in diameter, and weighing 6 kgthrough his left cheek and out of the vault of his skull with such force that it threw him on his back and fell several rods behind, smeared with brain. Despite his injuries he remained conscious and only a few minutes later was sitting in an ox cart writing in his work book. He recognised and reassured Dr Harlow, who had been summoned to the scene. The wound continued to bleed for two days then followed a virulent infection that rendered Gage semiconscious for a month. His condition was so poor that a coffin had been prepared. Nevertheless, Dr Harlow continued treatment, and by the fifth week the infection had resolved and Gage had regained consciousness. He was blind in the left eye and had left facial weakness but no focal neurological deficits. Had the story ended there it would have been a remarkable account of Gages endurance and Dr Harlows therapeutic skill.

What Is In The Left Frontal Lobe

Vomiting Up Brain? A Fungus in his Skull? The Gruesome Story of Phineas Gage | Well, I Never

The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities.

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The Case Was Later Taken Over By Dr John Martyn Harlow Who Described It As Literally One Gore Of Blood

After developing an infection, Gage was in a semi-comatose state for the next two weeks. On October 7th, he took his first step out of bed and his intellectual functioning began to improve by October 11th. According to Harlow, Gage clearly remembered how the accident had happened but had difficulty estimating amounts of money. Gage was seen venturing into the streets within a month.

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Imagine the modern-day reaction to a news story about a man surviving a three-foot, 7-inch, 13½-pound iron bar being blown through his skull taking a chunk of his brain with it.

Then imagine that this happened in 1848, long before modern medicine and neuroscience. That was the case of Phineas Gage.

Whether the Vermont construction foreman, who was laying railroad track and using explosives at the time of the industrial accident, was lucky or unlucky is a judgment that Warren Anatomical Museum curator Dominic Hall puzzles over to this day.

It is an impossible question, because he was extraordinarily unlucky to have an iron bar borne through his skull, but equally lucky to have survived, on such a low level of care, said Hall. We are lucky, to have him.

Gages skull, along with the tamping iron that bore through it, are two of the approximately 15,000 artifacts and case objects conserved at the Warren, which is a part of the Center for the History of Medicine in Harvards Francis A. Countway Library of Medicine.

The resultant change in Gages personality when he went from being well-liked and professionally successful to being fitful, irreverent, and grossly profane, showing little deference for his fellows and unable to keep his job is widely cited in modern psychology as the textbook case for post-traumatic social disinhibition.

But as the years have gone by and weve learned more about his life, argued Hall, the teachings have changed.

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