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Phineas Gage – Dead Man Talking

                                                                                             pre-bar

The remarkable story of Phineas Gage begins in mid-nineteenth Century America. Phineas,  at the age of 25, was

doing well in his career. He had attained the position of Construction Foreman, much of his work being on the

USA's growing railroad network.

 

tamping  In September 1848, Phineas was preparing to blast some rock out of the way, to create a  

  flat surface for track laying. He was working on the Rutland & Burlington Railroad near the

  town of Cavendish in Windsor County, Vermont.  The  accepted procedure for blasting was

  to drill a hole down into the rock, put in a length of fuse, pour in a measure of  gunpowder  

  and pack the hole with sand. Gunpowder works most effectively when it's confined , so 

  the worker doing the blasting would ram the inert sand firmly into the hole with a tamping

  iron. Then, it was just a matter of  lighting the fuse, and watching the spectacular explosion

                                         from a safe distance.

 

Unlucky for Some

cavendish cut

On the 13th September 1848, Phineas was approaching the final stages

of the blasting process at Cavendish Cut. Some unexplained distraction

made him forget to add sand before tamping down the explosive charge.

A tamping iron was one-and-a-quarter inches in diameter, about four

feet long,  flat at one end and tapered to a point at the other end. Phineas

was using the  blunt end of his iron to settle the charge. Lacking the

protection of a filling of sand, the rod stuck a spark in the rock, igniting

the gunpowder.

At 4.30pm, Phineas Gage's fellow workers heard the unexpected explosion. They saw Phineas lying on the

ground, with a huge hole in the top of his head. The tamping iron had landed some 85 feet away and had on it

blood and pieces of bloodstained brain matter.

The unscheduled explosion attracted the attention of his fellow railroad workers, who rushed over to see if there

was a problem. What they  found was Phineas Gage slumped motionless on the bloodied ground. Aware that

Phineas had accidentally shot himself through the head with four-foot long, 14-pound iron bullet, the

co-workers were astonished to find that he was still alive and drawing breath. Moments later, he was conscious

and talking to them. Thinking quickly, they walked Phineas to a cart and took him on a 45-minute journey, to the

boarding house where he lived.

Serious Head Trauma

    

Dr williams  Dr. Edward H. Williams was the first medical man to examine Phineas's injury. he received  

  a message about Phineas from an Irish railroad worker: "...'he is hurted, doctor, he had a

  tamping bar blown through his head...he is waiting for you at the Hotel Beyant."

  Dr. Williams found Phineas sitting on the lowest step with his feet in the road; with his

  elbows on his knees; holding his  head between his hands and spitting blood. When asked

  what was the matter, the patient said nothing. Instead, he lifted up his hat to show the hole

in his skull. Amazed, Dr. Williams found that Phineas's heart was beating regularly, his breathing was normal and

both his pupils reacted normally to light. Soon afterwards, Phineas vomited, the action causing about a teacupful of

his brain tissue to spill on the floor.

The doctor nevertheless noted that Phineas was, "… in full possession of his reason, and free from pain."

Phineas was carried up to the third floor of the hotel, and laid on a rough operating table made of a pile of

mattresses, washed, and made as comfortable as possible. Dr. Williams could look into the hole in the skull and see

Phineas's brain pulsating....Phineas was not expected to survive.

But Phineas Gage had other ideas. When Dr. Williams saw that he might be strong enough to be saved, he

trephined (cut out) and cleansed Phineas's wound. Then Dr. Harlow, the railroad company surgeon appeared and,

as he was the surgeon of the company, the case was placed in his hands

 

It's a Long, Long Road…

…with many a winding turn, as the song says. Of course, so massive an injury as dr harlow

Phineas had suffered was not to be taken lightly. Dr. Harlow operated on Phineas's head,

and continued to care for him for ten weeks. Phineas was then permitted to go home, to

Lebanon, New Hampshire.

The good doctor did a great deal more than tend Phineas's shattered skull, as best he

could. He interviewed a number of people who had known Phineas before the accident.

Phineas was universally described as a hard-working, responsible and popular fellow. It

isn't too surprising to learn that, after the accident, Phineas Gage was a changed man.

 

The notes concerning Phineas reveal that Dr. Harlow was a keen observer…

 

'Gage was fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom),

manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires,

at times pertinaciously obstinate, yet apricious and vacillating, devising many plans of future operations, which

are no sooner arranged than 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 man.

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'.

 

 

Back to Life

After a few months, Phineas felt well enough to go back to work. Knowing of the changes in  his personality, the

railroad company wouldn't entertain his returning to the position of foreman. As time passed, Phineas tried a

number of different jobs. He cared for horses, drove a stagecoach and worked on farms. He even, albeit briefly,

went on show at a New York museum, together with the tamping iron. This  museum's curator was none other

than P. T. Barnum.

 

                                                                                     gage iron

 

One year after the accident, Phineas visited Dr. Harlow for a follow-up examination. Harlow noted that Phineas's

left eye vision was totally absent and that there was scarring on the left side of the forehead. Above this was a

shallow depression measuring two inches by one inch.The doctor noted that here, "…the pulses of the brain could

be perceived."


Despite his injuries, Phineas was found to be in good physical health. He had partial left-side  paralysis of the face

but reported no feelings of pain in the head. However, he said that his head felt 'weird', a feeling he coudn't put

into words adequately.

Not too much is known about the subsequent years but Phineas was clearly capable of working, personality

changes notwithstanding. But in 1859, eleven years after his accident, Phineas began to suffer from epileptic

seizures. Several months later, he died at the age of 36, on the 21st May 1860. The cause of his death was

recorded as Status epilepticus – a continuous seizure lasting more than 5 minutes, or recurrent seizures between

which the patient remains unconscious for more than 5 minutes.

Phineas wasn't subjected to further medical examination; he was laid to rest in peace. However, such was the

interest generated in medical circles by his case, his skull was later exhumed for study. In 1867 Gage's skull, and

the tamping iron, were sent to Dr. Harlow, who was by then practicing in Woburn, Massachusetts.

As might be expected, the skull later became the subject of intense scrutiny, by medical personnel, historians and

the media.

                                                                                                                                                                              skullcase

 

Learning from the damage.

Careful examination of Phineas's skull revealed a lot. A surprisingly small aperture behind the cheekbone

indicated the beginning of the tamping iron's pathway through the skull. The iron went on to shatter the left orbit,

Phineas's eye socket, before going on to burst out through the frontal bone, the upper, forward part of the

cranium. 

 

                                   track

 

Studying the frontal bone showed how remarkably skilful Dr. Harlow had been in treating Phineas's wounds. The

exit hole left by the rod measured about 3 ½ inches by two inches – approximately seven square inches of the

frontal bone had been blasted into fragments by the passage of the rod.

                  

    lifemask                             skull&mask

 

 

Dr. Harlow had reassembled the wrecked bone so expertly that the wound was comparatively well concealed by

the healing tissue covering it. Nevertheless, the damage was visible, as were the tracks of fractures radiating from

the wound to the front and top of the skull.

 

                 basal                                                                                     cranium

 

 

                                                 iron

 

Plotting the extent of the damage to Phineas's brain has to be subject to some guesswork. Examination established

beyond doubt that the frontal cortex and white matter of the brain were penetrated and injured by the rod's

violent passage through. Whether or not the damage was limited to the left side or affected both frontal lobes

remains arguable.

 

Applying the new-found knowledge

Naturally enough, Dr. Harlow published a scientific paper on the Phineas Gage case, merely mentioning, rather

than detailing, the effect of the accident on Phineas's behaviour and personality traits. The medical world jeered at

this paper, convinced that it would be impossible for a human being to live through such a trauma and survive

afterwards.

bigelow  Harvard University professor Henry J. Bigelow also published a

  report of   the case, emphasizing the completeness of Gage's mental

  recovery. This paper enjoyed wider acceptance within medical circles.

  Before long, it was being cited as positive proof that the cerebral

  hemispheres of the human brain bore no relation to the functioning of

  the intellect. 

  Things changed in 1868, eight years after Phineas Gage died. Dr.  

  Harlow,  personal physician to Phineas Gage, and therefore first- 

  hand witness to his health, published a second paper, reporting the

  transformation in Phineas's personality and behaviour. This report,

  though published in a relatively unknown medical journal, soon gained

                                                                             a positive reputation and was widely quoted.

 

The case finally achieved full acceptance in the 1870s, when pioneering Scottish neurologist and psychologist Sir

David Ferrier quoted Dr. Harlow's report in his 1876 work, The Functions of the Brain.

End Analysis

Phineas Gage probably never knew it but he in effect – and inadvertently – performed brain surgery on himself.

Crude though this 'surgery' was, it turned out to have many positive outcomes for medicine. The science of

neurology benefited greatly. Whether a human brain had been afflicted by mechanical damage, affected by disease

or been compromised by infection of some kind, the effects on personality and social skills could be observed and

traced to the frontal elements.

The had repercussions in many areas, brain surgery, medicine and psychology among them.

                                            rodskull   skull 2

Phineas Gage's skull – and the tamping rod that passed through it – are on display with other items, at Harvard

University's Warren Anatomical Museum (WAM) in Harvard's Countway Library of Medicine, in Boston,

Massachusetts. Phineas Gage's fame might have been born of curiosity but we can take it as read that the world of

medicine and humanity in general owe him quite a lot.

In honour of this feeling community members organised this monoument to the passing of Phineas Gage. 

Inscribed,

Erected by the Cavendish Chamber of Commerce and the Cavendish Historical Society, September 13th 1998.,

the monument marks the 150th anniversary of Phineas Gage's death.

      gagemon           detail

 

                                               This monument could, arguably, be considered as a fitting tribute

                                                 to an unfortunate man...who one day had the Devil's own luck.


 

                                                                              Copyright Gatekeeper 2014