Phineas Gage: Difference between revisions
see https://wiki.riteme.site/w/index.php?title=Talk:Phineas_Gage&oldid=624623059#A7_Image_link_issue and following section on A8 |
cites for ascribed mental changes and behaviors (whew!) |
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In the words of Barker,{{r|barker}} "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis", and even today (writes historian Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a [[wikt:psychopath#Noun|psychopath]]{{nbsp}}..."{{px1}}{{r|kotowicz|page=123}} |
In the words of Barker,{{r|barker}} "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis", and even today (writes historian Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a [[wikt:psychopath#Noun|psychopath]]{{nbsp}}..."{{px1}}{{r|kotowicz|page=123}} |
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Attributes |
Attributes and behaviors ascribed to the post-accident Gage which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children{{r|nye|moffat}} |
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(of which Gage had neither);{{r|northstar|okf|page2=39,327}} |
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inappropriate sexual behavior, promiscuity, or impaired sexuality;{{r|myers|crider|vincent|okf|page4=319,327{{ndash}}8}} |
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lack of forethought, concern for the future, or embarassment; parading his self-misery, and vainglory in showing his wounds;{{r|damasioA_descartes|page1=9,11,51|okf|page2=119,331}} |
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inability{{r|groves|kalat1981}}{{r|smithA1985|lahey}}{{r|okf|page=323}} |
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or refusal{{r|altrocchi|morris|okf|page3=107,323}} |
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to hold a job; irresponsibility and untrustworthiness;{{r|damasioH_return|page1=1102|blakesmore|okf|page3=116}} |
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vagrancy and begging;{{r|tow|restak|okf|page3=323}} |
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aggressiveness and violence;{{r|dimond|okf|page2=321,331}} |
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plus drifting{{r|hart|blakemore|brown|okf|page4=316,323}} |
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drinking,{{r|smithA1984|wilson|hughes|okf|page4=118,316,321}} |
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bragging,{{r|nye}} |
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lying,{{r|blakeslee|okf|page2=119,321}} |
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brawling,{{r|damasioA_descartes|page1=9|okf|page2=119}} |
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bullying,{{r|sdorow|okf|page2=321|macm_unravelling|page=830}} |
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psychopathy,{{r|changeux|okf|page2=321}} |
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inability to make ethical decisions, |
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loss of all respect for social conventions, |
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and acting "like an idiot".{{r|blakeslee|okf|page2=116,119,321}} |
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Macmillan found that none of these behaviors is mentioned by anyone who had met Gage or even his family;{{efn-ua |
Macmillan found that none of these behaviors is mentioned by anyone who had met Gage or even his family;{{efn-ua |
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|name=accounts_reliablesources |
|name=accounts_reliablesources |
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|year=1982 |title=A 'Yankee Invention': the celebrated American crowbar case |
|year=1982 |title=A 'Yankee Invention': the celebrated American crowbar case |
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|work=Neurology |volume=32 |page=A191 }} {{closed access}} }} |
|work=Neurology |volume=32 |page=A191 }} {{closed access}} }} |
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{{refn|name=blakemore|{{cite book |
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|last=Blakemore|first=Colin|title=Mechanics of the mind |
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|publisher=Cambridge University Press|year=1977. |
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}} }} |
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{{refn|name=dimond|{{cite book| |
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|last=Dimond |first=Stuart J.|year=1980|location=London|publisher=Butterworths |
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|title=Neuropsychology: A Textbook of Systems and Psychological Functions of the Human Brain |
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}} }} |
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{{refn|name=bramwell |{{cite journal |last1=Bramwell |first1=B. |title=The Process of Compensation and some of its Bearings on Prognosis and Treatment |doi=10.1136/bmj.1.1425.835 |
{{refn|name=bramwell |{{cite journal |last1=Bramwell |first1=B. |title=The Process of Compensation and some of its Bearings on Prognosis and Treatment |doi=10.1136/bmj.1.1425.835 |
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|location=Boston|publisher=Marsh, Capen & Lyon|year=1835 |
|location=Boston|publisher=Marsh, Capen & Lyon|year=1835 |
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|series=The phrenological library. |editor-first=Nahum|editor-last=Capen |
|series=The phrenological library. |editor-first=Nahum|editor-last=Capen |
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}} }} |
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{{refn|name=nye|{{cite book |
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|editor=Robert Nason Nye |year=1942|publisher=C. C. Thomas |
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|title=Medical Progress Annual: A Series of Reports Published in the New England Journal of Medicine |
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|url=http://books.google.com/books?id=sRmgAAAAMAAJ|pages=366{{ndash}}7 |
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}} }} |
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{{refn|name=vincent|{{cite book |
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|author1=Graham Beaumont |author2=Pamela Kenealy|author3=Marcus Rogers |
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|title=The Blackwell Dictionary of Neuropsychology |date=1991 |
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|url=http://books.google.com/books?id=g5ijQgAACAAJ |publisher=Wiley |
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}} }} |
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{{refn |name=moffat|{{cite book |
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|last=Moffat |first=Gregory K. |editor=Angela Browne-Miller|page=44 |
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|title=Fundamentals of Aggression|publisher=ABC-CLIO|isbn=978-0-313-38276-5 |
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|url=http://books.google.com/books?id=A-GXM9MFaB4C&pg=PA44|year=2012 |
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|work=Violence and Abuse in Society: Understanding a Global Crisis |
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}} }} |
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{{refn|name=myers|{{cite book |
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|last=Myers|first=David G.|url=http://books.google.com/books?id=qHR-uxY9Td8C<!--get pg#--> |
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|year=1995|publisher=Worth Publishers|isbn=978-0-87901-644-9|title=Psychology |
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}} }} |
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{{refn|name=crider|{{cite book |
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|last1=Crider |first1=A. B. |last2=Goethals |first2=G. R. |last3=Kavanagh |first3=R. D. |
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|last4=Solomon |first4=P. R. |year = 1983 |title=Psychology|publisher=Scott, Foresman |
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}} }} |
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{{refn|name=blakeslee|{{cite newspaper |
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|title=Old Accident Points to Brain's Moral Center|page=C1 |
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|date=May 24, 1994|work=New York times|first=Sandra|last= Blakeslee |
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}} }} |
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{{refn|name=groves|{{cite book |
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|last1=Groves | first1=Philip M. | last2=Schlesinger |first2=K.|location=Dubuque, Iowa |
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|title=Introduction to Biological Psychology|edition=2nd |year=1982 |publisher=Brown |
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}} }} |
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{{refn|name=kalat1981|{{cite book |
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|last=Kalat|first=James W. | year=1981 |publisher=Wadsworth|title=Biological Psychology |location=Belmont, California |
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}} }} |
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{{refn|name=smithA1984|{{cite book |
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|last=Smith | first=A. |year=1984|title=The Mind|location=London|publisher=Hodder and Stoughton |
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}} }} |
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{{refn|name=smithA1985|{{cite book |
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|last=Smith | first=A. |year=1985|title=The Body|location=Harmondsworth, England|publisher=Penguin |
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}} }} |
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{{refn|name=lahey|{{cite book |
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|last=Lahey |first=B. B. |year=1992 | page=63|title=Psychology: An Introduction |
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|edition=4th |location=Dubuque, Iowa|publisher=Brown |
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}} }} |
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{{refn|name=altrocchi|{{cite book |
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|year=1980|title=Abnormal Behavior|publisher=Harcourt, Brace, Jovanovich |
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}} }} |
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{{refn|name=morris|{{cite book |
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|year=1996|title=Psychology: An Introduction|edition=9th|publisher=Prentice-Hall|last=Morris|first=C. G. |
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}} }} |
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{{refn|name=hart|{{cite book |
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|last=Hart|first=Leslie A. |year=1975|publisher=Basic Books |
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|title=How the Brain Works: A New Understanding of Human Learning, Emotion, and Thinking |
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}} }} |
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{{refn|name=brown|{{cite book |
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|last=Brown|first=H. |year=1976|location=New York|publisher=Oxford University Press |
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|title=Brain and Behavior: A Textbook of Physiological Psychology |
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}} }} |
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{{refn|name=wilson|{{cite book |
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|last=Wilson|first=Andrew |date=January 1879|title=The old phrenology and the new|pages=68{{nbsp}}85 |
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|url=http://books.google.com/books?id=MRQJAAAAIAAJ&pg=PA68|volume=CCXLIV|work=Gentleman's Magazine |
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}} }} |
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{{refn|name=tow|{{cite book |
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|last=Tow, Peter Macdonald|year=1955|location=London, New York|publisher=Oxford University Press |
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|title=Personality changes following frontal leucotomy: a clinical and experimental study of the functions of the frontal lobes in man. With a foreword by Sir Russell Brain |
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}} }} |
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{{refn|name=hughes|{{cite journal |
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|work=Journal of the American Medical Association|title=Neurological progress in America|pages=315{{ndash}}23 |
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|url=http://jama.jamanetwork.com/article.aspx?articleid=454487|number=7|last=Hughes|first=C. D.|volume=29 |
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}} }} |
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{{refn|name=restak|{{cite book |
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|last=Restak |first=Richard M.|title=The brain|publisher=Bantam Books|year=1984 |
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}} }} |
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{{refn|name=sdorow|{{cite book |
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|last=Sdorow|first=Lester|title=Psychology|location=Dubuque, Iowa|publisher=Brown|year=1990 |
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}} }} |
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{{refn|name=changeux|{{cite book |
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|last=Changeux|first=Jean-Pierre|year=1985|title=Neuronal Man: The Biology of the Mind |
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|others=Tr. by Laurence Garey|publisher=Pantheon Books|edition=1st American ed.|pages=158{{ndash}}9 |
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}} }} |
}} }} |
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Revision as of 05:03, 8 September 2014
Phineas P. Gage | |
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![]() The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"—his inscribed tamping iron.[A] | |
Born | July 9, 1823 (date uncertain) |
Died | May 21, 1860 In or near San Francisco | (aged 36)
Cause of death | Status epilepticus |
Resting place |
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Occupations |
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Known for | Personality change after brain injury |
Spouse | None |
Children | None[1]: 39,319,327 [2] |
Phineas P. Gage (1823 – May 21, 1860) was an American railroad construction foreman remembered for his improbable[C] survival of a rock-blasting accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and behavior over the remaining twelve years of his life—effects so profound that (for a time at least) friends saw him as "no longer Gage."
Long known as "the American Crowbar Case"—once termed "the case which more than all others is calculated to excite our wonder, impair the value of prognosis, and even to subvert our physiological doctrines"[3]—Phineas Gage influenced nineteenth-century discussion about the mind and brain, particularly debate on cerebral localization,[1]: ch7–9 [4] and was perhaps the first case to suggest that damage to specific parts of the brain might induce specific personality changes.[1]: 1 [5]: C
Gage is a fixture in the curricula of neurology, psychology and related disciplines (see neuroscience),[6]: 149 and is frequently mentioned in books and academic papers; he even has a minor place in popular culture.[D] Despite this celebrity the body of established fact about Gage and what he was like (before or after his injury) is small,[E] which has allowed "the fitting of almost any theory [desired] to the small number of facts we have" [F]—Gage having been cited, over the years, in support of various theories of the brain entirely contradictory to one another. Historically, published accounts (including scientific ones) have almost always severely distorted and exaggerated Gage's behavioral changes, frequently contradicting the known facts.[E]
A report of Gage's physical and mental condition shortly before his death implies that Gage's most serious mental changes were temporary, so that in later life he was far more functional, and socially far better adapted, than in the years immediately after his accident. A social recovery hypothesis suggests that Gage's employment as a stagecoach driver in Chile provided daily structure allowing him to relearn lost social and personal skills.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/CavendishVermont_1869Map_Beers_AnnotatedPhineasGageLocations_cropped.jpg/310px-CavendishVermont_1869Map_Beers_AnnotatedPhineasGageLocations_cropped.jpg)
Background
![](http://upload.wikimedia.org/wikipedia/commons/thumb/6/6d/RailroadCutCavendishVermontPresumedToBePhineasGageAccidentSite_cropped.jpg/260px-RailroadCutCavendishVermontPresumedToBePhineasGageAccidentSite_cropped.jpg)
Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage, of Grafton County, New Hampshire.[B] Little is known about his upbringing and education, though he was almost certainly literate.[1]: 17,41,90 He may have gained skill with explosives on his family's farms or in nearby mines and quarries,[1]: 17–18 and by the time of his accident he was a blasting foreman (possibly an independent contractor) on railway construction projects.[1]: 18,21,32n9
Town doctor John Martyn Harlow described Gage as "a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temperament,[H] five feet six inches [1.68 m] in height, average weight one hundred and fifty pounds [68 kg], possessing an iron will as well as an iron frame; muscular system unusually well developed—having had scarcely a day's illness from his childhood to the date of this injury." [13]: 4 His employers considered him "the most efficient and capable foreman in their employ ... a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation",[13]: 13 and he had even commissioned a custom-made tamping iron—an iron rod three feet seven inches (1.1 m) long and 1+1⁄4 inches (3.2 cm) in diameter—for use in setting charges.
Gage's accident
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On September 13, 1848, Gage was directing a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. Setting a blast involved boring a hole deep into an outcropping of rock; adding blasting powder, a fuse, and sand; then compacting this charge into the hole using the tamping iron.[G] Gage was doing this around 4:30 p.m. when (possibly because the sand was omitted) the iron "struck fire" against the rock and the powder exploded. Rocketing from the hole, the iron "entered on the [left] side of [Gage's] face ... passing back of the left eye, and out at the top of the head." [I]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/3e/PhineasGage_IronPaths_BigelowVanHornCombined.jpg/260px-PhineasGage_IronPaths_BigelowVanHornCombined.jpg)
Despite nineteenth-century references to Gage as "the American Crowbar Case" [17]: 54 [4]: 678 his tamping iron did not have the bend or claw sometimes associated with the term crowbar; rather, it was a pointed cylinder something like a javelin,[18] "round and rendered comparatively smooth by use":[13]: 5
The end which entered [Gage's cheek] first is pointed; the taper being [twelve] inches [30 cm] long ... circumstances to which the patient perhaps owes his life. The iron is unlike any other, and was made by a neighbouring blacksmith to please the fancy of its owner.[J]
Weighing 13+1⁄4 pounds (6.0 kg), this "abrupt and intrusive visitor"[C] was found some 80 feet (25 m) away, "smeared with blood and brain." [13]: 5
Gage "was thrown upon his back by the explosion, and gave a few convulsive motions of the extremities, but spoke in a few minutes," walked with little assistance, and sat upright in an oxcart for the 3⁄4-mile (1.2 km) ride to town.[13]: 5 About thirty minutes after the accident, Dr. Edward H. Williams found him sitting in a chair outside his lodgings:
When I drove up he said, "Doctor, here is business enough for you." I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. The top of the head appeared somewhat like an inverted funnel, as if some wedge-shaped body had passed from below upward. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage's statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head. Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.[K]
Harlow took charge of the case around 6 p.m.:
You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. His person, and the bed on which he was laid, were literally one gore of blood.[K]
Initial treatment
With Williams' assistance Harlow shaved the scalp around the region of the tamping iron's exit, then removed coagulated blood, small bone fragments, and an ounce [30 mg] of protruding brain. After probing for foreign bodies and replacing two large detached pieces of bone, Harlow closed the wound with adhesive cloth strips, leaving it partially open for drainage;[1]: 60–1 the entrance wound in the cheek was bandaged only loosely, for the same reason. A wet compress was applied, then a nightcap, then further bandaging to secure these dressings. Harlow also dressed Gage's hands and forearms (which along with his face had been "deeply burned") and ordered that his head remain elevated.
Late that evening Harlow noted: "Mind clear. Constant agitation of his legs, being alternately retracted and extended like the shafts of a fulling mill. Says he 'does not care to see his friends, as he shall be at work in a few days.'" [K]
Convalescence
![](http://upload.wikimedia.org/wikipedia/commons/thumb/e/ec/PhineasGage_BostonPostStory.jpg/260px-PhineasGage_BostonPostStory.jpg)
Despite his own optimism, Gage's convalescence was long, difficult, and uneven. Though recognizing his mother and uncle (summoned from Lebanon, thirty miles away) on the day after the accident, on the second day he "lost control of his mind, and became decidedly delirious". Two days later he was again "rational ... knows his friends", and after a further week of general improvement it occurred to Harlow, for the first time, "that it was possible for Gage to recover ... This improvement, however, was of short duration."[K]
Beginning September 25[1]: 53 Gage was semi-comatose, "seldom speaking unless spoken to, and then answering only in monosyllables" and the next day Harlow noted, "Failing strength ... coma deepened; the globe of the left eye became more protuberant, with [granulation tissue][L] pushing out rapidly from the internal canthus [as well as] from the wounded brain, and coming out at the top of the head." [K]
By September 27, "The exhalations from the mouth and head [are] horribly fetid. Comatose, but will answer in monosyllables if aroused. Will not take nourishment unless strongly urged. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness." Galvanized, Harlow "cut off the [granulation tissue] sprouting out from the top of the brain and filling the opening, and made free application of caustic [i.e. crystalline silver nitrate][1]: 54 to them. With a scalpel I laid open the integuments, between the [exit wound and the top of the nose] and immediately there were discharged eight ounces [250 ml] of ill-conditioned pus,[M] with blood, and excessively fetid."[K] ("Gage was lucky to encounter Dr. Harlow when he did," wrote Barker. "Few doctors in 1848 would have had the experience with cerebral abscess with which Harlow left [Jefferson Medical College] and which probably saved Gage's life.")[N]
On October 7, Gage "succeeded in raising himself up, and took one step to his chair". One month later he was walking "up and down stairs, and about the house, into the piazza", and while Harlow was absent for a week, Gage was "in the street every day except Sunday", his desire to return to his family in New Hampshire being "uncontrollable by his friends ... got wet feet and a chill." He soon developed a fever, but by mid-November he was "feeling better in every respect ... walking about the house again; says he feels no pain in the head". Harlow's prognosis at this point: Gage "appears to be in a way of recovering, if he can be controlled." [10]: 392–3
Subsequent life and travels
Injuries
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/3b/Phineas_Gage_Daguerreotype_WilgusPhoto2008-12-19_CroppedHeadOnly_Unretouched_BW.jpg/150px-Phineas_Gage_Daguerreotype_WilgusPhoto2008-12-19_CroppedHeadOnly_Unretouched_BW.jpg)
By November 25, Gage was strong enough to return to his parents' home in Lebanon, New Hampshire, where by late December he was "riding out, improving both mentally and physically" [33] and (as recorded in the notes of a physician who spoke to Gage's mother) "abt. February he was able to do a little work abt. ye horses & barn, feedg. ye cattle &c; that as ye time for ploughing came he was able to do half a days work after that & bore it well."[34][1]: ix,93–4 Nonetheless, a year later some physical weakness was still manifest.[1]: 93 [35]
In April 1849 he returned to Cavendish and paid a visit to Harlow, who noted at that time loss of vision (and ptosis) of the left eye, a large scar on the forehead, and
upon the top of the head ... a deep depression, two inches by one and one-half inches [5 cm by 4 cm] wide, beneath which the pulsations of the brain can be perceived. Partial paralysis of the left side of the face. His physical health is good, and I am inclined to say he has recovered. Has no pain in head, but says it has a queer feeling which he is not able to describe." [O]
New England and New York
In November 1849, Harvard Professor of Surgery Henry Jacob Bigelow presented Gage to a meeting of the Boston Society for Medical Improvement and (possibly) to a Harvard Medical School class.[12]: 20 [1]: 43,95 [36]
Harlow says that Gage, unable to return to his railroad work,[13]: 13 appeared for a time at Barnum's American Museum in New York City (not the later Barnum's circus—there is no evidence Gage ever exhibited with a troupe or circus)[37]: 3–4 though there is no confirmation of this.[1]: 498 But advertisements for two public appearances by Gage, which he may have arranged and promoted himself,[37]: 3 support Harlow's statement that Gage made public appearances in "most of the larger New England towns".[13]: 13 (Years later Bigelow wrote that Gage had been "a shrewd and intelligent man and quite disposed to do anything of that sort to turn an honest penny", but had given up such efforts because "[that] sort of thing has not much interest for the general public".)[38]: 28
For about eighteen months he worked for the owner of a livery and coach service in Hanover, New Hampshire.[13]: 14 [1]: 101
Chile and California
In August 1852, Gage was invited to Chile to work as a long-distance stagecoach driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the Valparaiso–Santiago route. (A visitor wrote—though not referring to Gage specifically—that "the departure of the coach was always a great event at Valparaiso—a crowd of ever-astonished Chilenos assembling every day to witness the phenomenon of one man driving six horses.") [39]: 73
After his health began to fail, in mid-1859,[13]: 14–15 [P] he left Chile for San Francisco, where he recovered under the care of his mother and sister,[13]: 15 who had relocated there from New Hampshire around the time Gage went to Chile.[1]: 103–4 Then, "anxious to work", he found employment with a farmer in Santa Clara.[13]: 15
Death and subsequent travels
![](http://upload.wikimedia.org/wikipedia/commons/thumb/d/de/JacksonJBS_A_descriptive_catalogue_of_the_Warren_Anatomical_Museum_1870_frontispiece_623x1024.jpg/260px-JacksonJBS_A_descriptive_catalogue_of_the_Warren_Anatomical_Museum_1870_frontispiece_623x1024.jpg)
In February 1860[P] Gage had several epileptic seizures.[1]: 14 [13]: 16 As the seizures increased in frequency and severity over the succeeding three months he lost his job, but (writes Harlow) "continued to work in various places [though he] could not do much."
On May 18 he "left Santa Clara and went home to his mother. At 5 o'clock, A.M., on the 20th, he had a severe convulsion. The family physician was called in, and bled him. The convulsions were repeated frequently during the succeeding day and night,"[13]: 15 and he died status epilepticus,[5]: E in or near[5]: B San Francisco, late on May 21, 1860, just under twelve years after his injury. He was buried in San Francisco's Lone Mountain Cemetery.[P] (Though some accounts[41]: 1103 [42]: 22 [43] assert that Gage's iron was buried with him, there is no evidence for this.)[R]
Skull and iron
In 1866, Harlow (who had "lost all trace of [Gage], and had well nigh abandoned all expectation of ever hearing from him again") somehow learned that Gage had died in California, and wrote to his family there. At his request they opened Gage's grave long enough to remove his skull, which the family then personally delivered to Harlow,[1]: 108–11 [13]: 341–2 [37]: 6 by then a prominent physician, businessman, and civic leader in Woburn, Massachusetts.[1]: 351–64 [6]
About a year after the accident, Gage had given his tamping iron to Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it[12]: 22n [20][1]: 46–7 and made what he called "my iron bar" his "constant companion during the remainder of his life";[13]: 13 now it too was delivered to Harlow.[37]: 6 After studying them for a triumphal[C] 1868 retrospective paper on Gage[13] Harlow redeposited the iron—this time with Gage's skull—in the Warren Museum, where they remain on display today.[S] The iron bears the following inscription (though the date it gives for the accident is one day off, and Phinehas is not the way Gage spelled his name):[8]: 839fig
This is the bar that was shot through the head of Mr Phinehas[sic] P. Gage at Cavendish, Vermont, Sept. 14,[sic] 1848. He fully recovered from the injury & deposited this bar in the Museum of the Medical College of Harvard University. Phinehas P. Gage Lebanon Grafton Cy N–H Jan 6 1850.[T]
Much later Gage's headless remains were moved to Cypress Lawn Cemetery as part of a systematic relocation of San Francisco's dead to new resting places outside city limits.[1]: 119-20
Brain damage and mental changes
![](http://upload.wikimedia.org/wikipedia/commons/thumb/5/54/Frontal_lobe_animation.gif/190px-Frontal_lobe_animation.gif)
Extent of brain damage
![](http://upload.wikimedia.org/wikipedia/commons/thumb/e/e2/Simulated_Connectivity_Damage_of_Phineas_Gage_4_vanHorn_PathwaysDamaged_left.jpg/150px-Simulated_Connectivity_Damage_of_Phineas_Gage_4_vanHorn_PathwaysDamaged_left.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/37/Simulated_Connectivity_Damage_of_Phineas_Gage_4_vanHorn_PathwaysDamaged_right.jpg/150px-Simulated_Connectivity_Damage_of_Phineas_Gage_4_vanHorn_PathwaysDamaged_right.jpg)
Debate as to whether the trauma and subsequent infection had damaged both of Gage's frontal lobes, or only the left, began almost immediately after his accident.[U] The 1994 conclusion of Hanna Damasio et al.,[41]: 1104 that both of Gage's frontal lobes (right as well as left) had been damaged, was drawn by modeling not Gage's skull but rather a "Gage-like" one.[8]: 829-30 Using CT scans of Gage's actual skull, Ratiu et al.[15] and Van Horn et al.[16] rejected that conclusion, agreeing with Harlow's belief (based on probing Gage's wounds with his fingers)[V] that only the left frontal lobe had been damaged.[13]: 19
In addition, Ratiu et al. pointed out that the hole between the roof of the mouth and the base of the cranium (created as the iron passed through) has a diameter about half that of the iron itself;[15] combining this with the hairline fracture running from behind the exit region down the front of the skull, they concluded that the skull "hinged" open as the iron entered the cranium, then (once the iron had exited at the top) was pulled closed by the resilience of soft tissues.[51]: 640 [8]: 830
Van Horn et al. concluded that damage to Gage's white matter (of which they made detailed estimates) was as or more significant to Gage's mental changes than cerebral cortex (gray matter) damage.[16]: abstr
First-hand reports of mental changes
Gage certainly displayed some kind of change in behavior after his injury,[37]: 12–15 but the nature, extent, and duration of this change have been difficult to establish. Only a handful of sources give direct information on what Gage was like (either before or after the accident),[E] the mental changes described after his death were much more dramatic than anything reported while he was alive,[1]: 375–6 and few of the sources are explicit about the period of Gage's life to which their various descriptions of him (which vary widely in their implied level of functional impairment) are meant to apply.[37]: 6–7
Early observations (1849–1852)
Harlow described the pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ". But these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again":
The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is 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 capricious 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".[13]: 13–14
![](http://upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Henry_Jacob_Bigelow_c1854_cropped.jpg/220px-Henry_Jacob_Bigelow_c1854_cropped.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/1/10/John-m-harlow_cropped.jpg/220px-John-m-harlow_cropped.jpg)
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This oft-quoted[53]: 125 description is from Harlow's notes set down soon after the accident,[1]: 90,375 [37]: 6–9 but Harlow—perhaps hesitant to describe his patient negatively while he was still alive[1]: 375–6 —left them unpublished until 1868 (after Gage had died and his family had forwarded "what we so much desired to see", as Harlow termed Gage's skull).[13]: 16
In the interim, Harlow's 1848 report (published just as Gage was emerging from his convalescence) only hinted at psychological symptoms:[1]: 169
The mental manifestations of the patient, I leave to a future communication. I think the case ... is exceedingly interesting to the enlightened physiologist and intellectual philosopher.[10]: 393
But after Bigelow (who had kept Gage in Boston for several weeks' observation in late 1849)[12]: 20 [13]: 4n [1]: 43 termed Gage "quite recovered in faculties of body and mind", with only "inconsiderable disturbance of function",[12]: 13–14 a rejoinder in the American Phrenological Journal—
That there was no difference in his mental manifestations after the recovery is not true ... The man was gross, profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people.[54]
—was apparently based on information anonymously supplied by Harlow.[1]: 350–1
Barker explains these contradictory evaluations (only six months apart) by differences in Bigelow's and Harlow's educational backgrounds:
Harlow's interest in phrenology prepared him to accept the change in character as a significant clue to cerebral function which merited publication. Bigelow had [been taught] that damage to the cerebral hemispheres had no intellectual effect, and he was unwilling to consider Gage's deficit significant ... The use of a single case [including Gage's] to prove opposing views on phrenology was not uncommon.[4]: abstr,678 [F]
Later observations (1852–1858)
In 1860, an American physician returned from Chile reported that he had known Gage "well" there,[clarification needed] and "that he is in the enjoyment of good health, with no impairment whatever of his mental faculties." [18] Together with the fact that Gage was hired by his employer in advance, in New England, to be part of the new coaching enterprise in Chile,[1]: 376–7 [8]: 831 this implies that Gage's most serious mental changes had been temporary, so that the "fitful, irreverent ... capricious and vacillating" Gage described by Harlow (who last saw Gage less than a year after the accident) became, over time, far more functional, and socially far better adapted.[8]: 831 [37]: 2,15
This conclusion is reinforced by the responsibilities and challenges faced by drivers on the stagecoach route worked by Gage in Chile,[1]: 104–6 [37]: 4–5 including the general requirement that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers."[56] Gage had also (writes psychologist Malcolm Macmillan) "to deal with political upheavals that frequently spilled into everyday life ... All this—in a land to whose language and customs Phineas arrived an utter stranger—militates as much against permanent disinhibition [i.e. an inability to plan and self-regulate] as do the extremely complex sensory-motor and cognitive skills required of a coach driver."[37]: 5 [8]: 831
Social recovery
Macmillan hypothesizes that this change in Gage over time represents a social recovery, citing people with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills" [8]—in Gage's case, his highly structured employment in Chile:
Phineas' survival and rehabilitation demonstrated a theory of recovery which has influenced the treatment of frontal lobe damage today. In modern treatment, adding structure to tasks by, for example, mentally visualising a written list, is considered a key method in coping with frontal lobe damage. Phineas job as a stage-coach driver provided that external structure to aid in his recovery.[57]
Macmillan writes that if Gage made such a recovery—if he eventually "figured out how to live" (as Fleischman put it)[58]: 75 despite his injury—then it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases";[8]: 831 and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?" [59] As author Sam Kean put it, "If even Phineas Gage bounced back—that's a powerful message of hope." [18]
Distortion of mental changes
A moral man, Phineas Gage
Tamping powder down holes for his wage
Blew his special-made probe
Through his left frontal lobe
Now he drinks, swears, and flies in a rage.
— Anonymous[1]: 307
Macmillan's survey of accounts of Gage (scientific and popular) found that they almost always distort and exaggerate his behavioral changes well beyond anything described by anyone who had contact with him.[E] In the words of Barker,[4] "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis", and even today (writes historian Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a psychopath ..." [53]: 123
Attributes and behaviors ascribed to the post-accident Gage which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children[60][61] (of which Gage had neither);[2][1]: 39,327 inappropriate sexual behavior, promiscuity, or impaired sexuality;[62][63][64][1]: 319,327–8 lack of forethought, concern for the future, or embarassment; parading his self-misery, and vainglory in showing his wounds;[42]: 9,11,51 [1]: 119,331 inability[65][66][67][68][1]: 323 or refusal[69][70][1]: 107,323 to hold a job; irresponsibility and untrustworthiness;[41]: 1102 [71][1]: 116 vagrancy and begging;[72][73][1]: 323 aggressiveness and violence;[74][1]: 321,331 plus drifting[75][76][77][1]: 316,323 drinking,[78][79][80][1]: 118,316,321 bragging,[60] lying,[81][1]: 119,321 brawling,[42]: 9 [1]: 119 bullying,[82]: 830 [1]: 321 [8] psychopathy,[83][1]: 321 inability to make ethical decisions, loss of all respect for social conventions, and acting "like an idiot".[81][1]: 116,119,321 Macmillan found that none of these behaviors is mentioned by anyone who had met Gage or even his family;[E] as Kotowicz put it, "Harlow does not report a single act that Gage should have been ashamed of." [53]: 122–3
For example, several authors misinterpret[1]: 119,316,323 [53]: 130n6 [8]: 830 a passage by Harlow— "'... continued to work in various places;' could not do much, changing often, 'and always finding something that did not suit him in every place he tried'" [13]: 15 —as meaning Gage could not hold a regular job after his accident,[84] "was prone to quit in a capricious fit or be let go because of poor discipline",[42]: 8–9 "never returned to a fully independent existence",[41]: 1102 and died "in careless dissipation".[85] In fact Harlow's words refer not to Gage's post-accident life in general, but only to the months just before his death, after convulsions had set in;[1]: 107 [21]: 147 and until then Gage had supported himself throughout his post-accident life.[37]: 14–15 In Kotowicz's words, "What Harlow is telling us is clear and unambiguous: Gage returns from South America to his mother to recuperate. As soon as he is fit, he goes back to work with horses, which is what he has been doing for years."[53]: 130n6
Theoretical use, misuse, and nonuse
![](http://upload.wikimedia.org/wikipedia/commons/thumb/8/8d/PhrenologyPix_CroppedUpperFront.jpg/260px-PhrenologyPix_CroppedUpperFront.jpg)
Though Gage is considered the "index case for personality change due to frontal lobe damage" [4]: abstr [86][87][43][1]: 1 his scientific value is undermined by the uncertain extent of his brain damage[87] and the lack of information about his behavioral changes.[E] Instead, Macmillan writes, "Phineas' story is [primarily] worth remembering because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth,"[8]: 831 the paucity of evidence having allowed "the fitting of almost any theory [desired] to the small number of facts we have".[F] A similar concern was expressed as far back as 1877, when British neurologist David Ferrier (writing to Harvard's Henry Pickering Bowditch in an attempt "to have this case definitely settled as it is one of more than usual interest in a localisation point of view") complained that
In investigating reports on diseases and injuries of the brain, I am constantly amazed at the inexactitude and distortion to which they are subject by men who have some pet theory to support. The facts suffer so frightfully ...[1]: 1,75,197–9,464–5 [88]
More recently, neurologist Oliver Sacks refers to the "interpretations and misinterpretations, from 1848 to the present," of Gage.[89]
Thus in the nineteenth-century controversy over whether or not the various mental functions are localized in specific regions of the brain, both sides managed to enlist Gage in support of their theories;[4]: 678 [1]: ch9 for example, soon after Dupuy[45] wrote that Gage proved that the brain is not localized, Ferrier cited Gage as proof that it is.[46] Phrenologists made use of Gage as well, contending that his mental changes resulted from destruction of his "organ of Veneration" and/or the adjacent "organ of Benevolence".[W]
In a more recent example A. Damasio, in support of his somatic marker hypothesis (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he attributes to Gage and those of modern patients with damage to the orbitofrontal cortex and amygdala.[42]: ch3 [95] But A. Damasio's depiction of Gage has been criticized by Kotowicz as "grotesque fabrication ... ['perpetrating'] the myth of Gage the psychopath ... Damasio changes [Harlow's] narrative, omits facts, and adds freely ... It seems that the growing commitment to the frontal lobe doctrine of emotions brought Gage to the limelight and shapes how he is described."[X]
As Kihlstrom put it:
[M]any modern commentators exaggerate the extent of Gage's personality change, perhaps engaging in a kind of retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex in self-regulation.[Y]
Psychosurgery and lobotomy
![](http://upload.wikimedia.org/wikipedia/commons/thumb/8/8c/Phineas_Gage_GageMillerPhoto2010-02-17_Unretouched_Color_Cropped.jpg/220px-Phineas_Gage_GageMillerPhoto2010-02-17_Unretouched_Color_Cropped.jpg)
It is frequently said that what happened to Gage played a part in the later development of various forms of psychosurgery, particularly lobotomy.[Z] Aside from the question of why the unpleasant changes usually (if hyperbolically) attributed to Gage would inspire surgical imitation, there is no such link, according to Macmillan:
There is simply no evidence that any of these operations were deliberately designed to produce the kinds of changes in Gage that were caused by his accident, nor that knowledge of Gage's fate formed part of the rationale for them[5]: F ... [W]hat his case did show came solely from his surviving his accident: major operations [such as for tumors] could be performed on the brain without the outcome necessarily being fatal.[1]: 250
Portraits
Two daguerreotype portraits of Gage, identified in 2009 and 2010,[A] are the only known likenesses[100]: 343 [32][101]: 8 of him other than a life mask taken for Bigelow in late 1849 (and now in the Warren Museum along with Gage's skull and iron).[12]: 22n [1]: ii,42 The first shows "a disfigured yet still-handsome" Gage[32] with one eye closed and scars clearly visible, "well dressed and confident, even proud" [100]: 343 and holding his iron, on which portions of its inscription can be made out.[99] (For decades the portrait's owners had imagined it showed an injured whaler with his harpoon.) [99]
The second, copies of which were found in the possession of two different branches of the Gage family, shows Gage in a somewhat different pose, wearing a different shirt and different tie, but the same waistcoat and possibly the same jacket.[103]
Authenticity was confirmed in several ways (including photo-overlaying the inscriptions seen in the portraits against that on the actual tamping iron, and matching the subject's injuries to those preserved in the life mask)[100]: 342–3 but about when, where, and by whom they were taken nothing is known, except that they were created no earlier than January 1850 (when the inscription was added to the tamping iron),[37]: 4 on two different occasions, and are likely by different photographers.[101]: 8
The portraits reinforce the social recovery hypothesis already described.[59] "Although just one picture," Kean wrote in reference to the first image, "it exploded the common image of Gage as a dirty, disheveled misfit. This Phineas was proud, well-dressed, and disarmingly handsome."[AA]
See also
- Anatoli Bugorski—scientist through whose head a particle-accelerator proton beam accidentally passed
- Eadweard Muybridge—another early case of head injury leading to mental changes
Notes
- ^ a b c The 2009-identified image is from the collection of Jack and Beverly Wilgus.[32][99][100][101]
This artifact, like almost all daguerreotypes, shows its subject laterally (left-right) reversed, making it appear that Gage's right eye is injured;[100][101] however, all Gage's injuries, including to his eye, were on the left.
Therefore in presenting the image here a second, compensating reversal has been applied in order to show Gage as he appeared in life.[102][100]
The 2010-identified image is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey.[102] (Gage had no known children;[1]: 319,327 these are descendents of his brother Roswell Rockwell Gage.)[37]: 4 Unlike the Wilgus portrait, which is itself a daguerreotype, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a daguerreotype or other laterally reversing early-process photograph;[101] here again a second, compensating reversal has been applied.[102]
- ^ a b c Macmillan[1]: 14–17,31n5,490–1
discusses Gage's ancestry and what is and isn't known about his birth and early life. His parents were married April 27, 1823.
The birthdate July 9, 1823 (the only definite date given in any source) is from a comprehensive Gage genealogy (C. V. Gage);[9] Macmillan[1]: 16 notes that while C. V. Gage gives no source for this date, it is consistent with agreement, among contemporary sources addressing the point,[10]: 389 [11][12]: 13 [13]: 4 that Gage was 25 years old on the date of his accident, as well as with his age—36 years—as given in undertaker's records after his death on May 21, 1860.
Possible homes in childhood and youth are Lebanon or nearby East Lebanon, Enfield, and/or Grafton (all in Grafton County, New Hampshire), though Harlow refers to Lebanon in particular as Gage's "native place" [13]: 10 and "his home" [13]: 12 (probably that of his parents),[1]: 30 to which he returned ten weeks[5]: C after his accident.
There is no doubt Gage's middle initial was P [10]: 389 [12]: 13 [13]: 4 [1]: 490 [8]: 839fig but there is nothing to indicate what the P stood for (though his paternal grandfather was also a Phineas and brother Dexter's middle name was Pritchard).[1]: 490 Gage's mother's first and middle names are variously given as Hannah or Hanna and Trussell, Trusel, or Trussel; her maiden name is variously spelled Swetland, Sweatland, or Sweetland.[1]: 490
- ^ a b c A tone of amused wonderment was common in 19th-century medical writing about Gage (as well as about victims of other unlikely-sounding brain-injury accidents—including encounters with axes, bolts, low bridges, exploding firearms, a revolver shot to the nose,[19] more tamping irons, and "even falling gum tree branches").[1]: 62–7
Noting dryly that, "The leading feature of this case is its improbability ... This is the sort of accident that happens in the pantomime at the theater, not elsewhere", Bigelow (1850) emphasized that though "at first wholly skeptical, I have been personally convinced", calling the case "unparalleled in the annals of surgery",[12]: 13,19
and this endorsement by the Professor of Surgery at Harvard "finally succeeded in forcing [the case's] authenticity upon the credence of the profession ... as could hardly have been done by any one in whose sagacity and surgical knowledge his confrères had any less confidence".[20]: 116
Indeed, Harlow later recalled, "a distinguished Professor of Surgery in a distant city" had dismissed Gage as a "Yankee invention":[13]: 18
- The case occurred nearly twenty years ago, in an obscure country town ..., was attended and reported by an obscure country physician, and was received by the Metropolitan doctors with several grains of caution, insomuch that many utterly refused to believe that the man had risen, until they had thrust their fingers into the hole [of] his head, [see Doubting Thomas] and even then they required of the Country Doctor attested statements, from clergymen and lawyers, before they could or would believe—many eminent surgeons regarding such an occurrence as a physiological impossibility, the appearances presented by the subject being variously explained away.[13]: 3,18
But after Gage was joined by such later cases as a miner who survived traversal of his head by a gas pipe,[1]: 66 [22] and a lumbermill foreman who returned to work soon after a circular saw cut three inches (8 cm) into his skull from just between the eyes to behind the top of his head (the surgeon removing from this incision "thirty-two pieces of bone, together with considerable sawdust"),[23] the Boston Medical & Surgical Journal (1869) pretended to wonder whether the brain has any function at all: "Since the antics of iron bars, gas pipes, and the like skepticism is discomfitted, and dares not utter itself. Brains do not seem to be of much account now-a-days." [24] The Transactions of the Vermont Medical Society was similarly facetious: "'The times have been,' says Macbeth [Act III], 'that when the brains were out the man would die. But now they rise again.' Quite possibly we shall soon hear that some German professor is exsecting it." [17]: 53–4
The reference to Gage's iron as an "abrupt and intrusive visitor" appears in the Boston Medical & Surgical Journal's review[20] of Harlow (1868).
- ^ For scientific and academic discussions see Macmillan;[1]: ch14
in particular, Macmillan found Gage cited in some 60% of introductory psychology textbooks in three university libraries.
A small study found Gage to be easily the topic most frequently mentioned when, at the end of an introductory psychology course, students were asked to list "the first 10 things that come to your mind as you answer the question: What do you remember from this course? "; investigators noted that, "The Phineas Gage video [used in the course] re-creates the famous tamping rod piercing Gage's skull. Students ... always react emotionally to this video clip." [7]: 89
For popular culture, see Macmillan;[1]: ch13 [8]: 830 for example, several musical groups call themselves Phineas Gage (or some variation).
- ^ a b c d e f Macmillan[1]: 116–19,ch13–14 [5]: C compares accounts of Gage (especially relating to his pre- and post-accident behavior) to one another and to the known facts.
Until 2008[37]: 2–3 [8]: 830 the available sources offering significant information on Gage, and for which there is evidence (if even merely the source's own claim) of contact with him or with his family, were limited to Harlow (1848, 1849, 1868);[10][33][13] Bigelow (1850);[12] and Jackson (1849, 1870).[34][21]
Macmillan notes that descriptions of Gage's behavior total just 300 words[1]: 90
and emphasizes the primacy of Harlow's three papers as a source.[1]: 94
(His case notes have not survived.)[1]: 90
Macmillan & Lena[37]: 3–6,8 present previously unknown sources found since 2008.
The contrast between Gage's celebrity and the small amount known about him is discussed by Macmillan: "From my student days I had some appreciation of the importance ascribed to the case and expected there would be a reasonably extensive literature on it. This turned out not to be true. There were many mentions of him, but few papers solely or mainly about him ... [In my early research I had assumed that] because Phineas Gage was said to be important in psychology, everyone would have been interested in him; because his survival was so remarkable, someone must have made a major study of him. Neither was the case."[1]: 1–2,11
- ^ a b c [1]: 290 See Macmillan[1]: ch5–6,9–14 [8]: 831 [55] for surveys and discussion of theoretical use and misuse of Gage. Smith noted "the ingenuity with which the advocates of various theories [of the brain] will explain away the evidence of their opponents." [17]: 51
- ^ a b c Macmillan gives the steps in setting a blast, the location and circumstances of the accident, and the location of Gage's lodgings and Harlow's home and surgery.[1]: 23–9 [6]: 151-2 [5]: A The blast hole, about 1+3⁄4 inches (4.5 cm) in diameter and up to 12 feet (4 m) deep, might require three men working as much as a day to bore using hand tools. The labor invested in setting each blast, the judgment involved in selecting its location and the quantity of powder to be used, and the often explosive nature of employer-employee relations on this type of job, all underscore the significance of Harlow's statements that Gage has been a "great favorite" with his men, and that his employers had considered him "the most efficient and capable foreman in their employ" prior to the accident.[1]: 13,22–3,25
- ^ Harlow's reference to Gage's "temperament" reflects his interest in phrenology, which termed nervo-bilious a subject possessing an unusual combination of "excitable and active mental powers" with "energy and strength [of] mind and body [making] possible the endurance of great mental and physical labor" (Macmillan),[1]: 346–7 "[uniting] great power with great activity, and, although it seldom gives great brilliancy, it produces that kind of talent which will stand the test, and shine in proportion as it is brought into requisition" (Fowler).[14]: 6
- ^ a b [25] The Boston Post credits an earlier report (of unknown date) in the Ludlow (Vermont) Free Soil Union, which appears to have been the first printed report of Gage's accident anywhere;[1]: 11 although reprinted by several New England papers[1]: 35–36 it is itself no longer extant.[1]: 70–1n1 This report confuses the iron's circumference with its diameter,[1]: 12 and despite the reference to "shattering the upper jaw", that did not in fact happen.[10]: 389 [12]: 21 [13]: 16 [1]: 36–7
- ^ [12]: 14 Bigelow describes the iron's taper as seven inches (18 cm) long, but the correct dimension is twelve (30 cm).[13]: 5 [1]: 25–6
- ^ a b c d e f Excerpted from Williams' and Harlow's statements in: Harlow (1848);[10]: 390–2 Bigelow (1850);[12]: 16 Harlow (1868).[13]: 7–10
- ^ In keeping with usage of the day[26]: 107 Harlow used the term fungus (a word possibly related to the Greek word for "sponge")[citation needed] in reference to the sponge-like granulation tissue.[1]: 53
- ^ In the pre-asepsis era in which Harlow practiced,[1]: 62 wrote surgeon Frederick Treves,
- Practically all major wounds suppurated [i.e. became pussy]. Pus was the most common subject of converse, because it was the most prominent feature in the surgeon's work. It was classified according to degrees of vileness.[27]: 347
- ^ a b [4]: 679–80 Barker writes that "[Head injuries] from falls, horse kicks, and gunfire, were well known in pre–Civil War America [and] every contemporary course of lectures on surgery described the diagnosis and treatment" of such injuries. But to Gage's benefit, surgeon Joseph Pancoast had performed "his most celebrated operation for head injury before Harlow's medical school class, [trephining] to drain the pus, resulting in temporary recovery. Unfortunately, symptoms recurred and the patient died. At autopsy, reaccumulated pus was found: granulation tissue had blocked the opening in the dura." By keeping the exit wound open and elevating Gage's head to encourage drainage from the cranium through the hole in the roof of the mouth, Harlow "had not repeated Professor Pancoast's mistake." [4]: 675 [1]: 58
Noting that Harlow had been a "relatively inexperienced local physician ... graduated four and a half years earlier", Macmillan's discussion of Harlow's "skillful and imaginative adaptation of traditional methods"[1]: 12, 60 emphasizes that Harlow "did not apply rigidly what he had learned", for example foregoing an exhaustive search for bone fragments (which risked hemorrhage and further brain injury) and applying caustic silver nitrate to the granulation tissue instead of excising it (which risked hemorrhage) or forcing it into the wound (which risked compressing the brain).[1]: 58–62
As to his own role in Gage's survival, Harlow merely averred, "I can only say ... with good old Ambro[i]se Parè, I dressed him, God healed him" [13]: 20 —an assessment Macmillan calls far too modest.[1]: 62 See Barker[4]: 675 and Macmillan[1]: 12,ch4 [8]: 828–9 [6]: 151-3 for further discussion of Harlow's management of the case.
- ^ [13]: 12–13 Bigelow[12]: 20–1 gives a more detailed and technical description of Gage's post-recovery appearance.
- ^ a b c Gage's death and (first) burial are discussed by Macmillan[1]: 108–9 (and see also "Corrections to An Odd Kind of Fame"),[5]: D noting that while Harlow[13]: 15 gives the date of Gage's death as May 21, 1861, undertaker's bound, chronologically consecutive records[40] show conclusively that Gage was buried on May 23, 1860.[1]: 122n17 That Harlow (though he had likely discussed Gage's history, in person, with Gage's mother and sister in 1868)[37]: 6 was mistaken by exactly one year implies that certain other dates he gives for events late in Gage's life—his move from Chile to San Francisco and the onset of his convulsions—must also be mistaken, presumably by the same amount; this article follows Macmillan[1] in correcting those dates (each of which carries this annotation).
- ^ [13]: 16 Here reproduced from Jackson's Descriptive Catalog of the Warren Anatomical Museum,[21] these images were commissioned by Harlow from photographer Samuel Webster Wyman and were the basis for the woodcuts seen in Harlow (1868).[13]: 21 [1]: 26,115,479–80
- ^ Macmillan & Lena: "Only Harlow[13]: 16 writes of the exhumation and he does not say the tamping iron was recovered then. Although what he says may be slightly ambiguous, it does not warrant the contrary and undocumented account[s] ... that Gage's tamping iron was recovered from the grave." [37]: 7
- ^ [44] Jackson: "The most valuable specimen that has ever been added to the Museum, and probably ever will be, was given two years ago by Dr. John M. Harlow ... For the professional zeal and the energy that Dr. H. showed, in getting possession of this remarkable specimen, he deserves the warmest thanks of the profession, and still more, from the College [i.e. the "Medical College of Harvard University"], for his donation." [21]: v
- ^ [5]: D The inscription was commissioned by Bigelow in conjunction with the iron's deposit in the Warren Anatomical Museum.[20]: 116 The Jan 6 1850 following Gage's "signature" corresponds to the period during which Gage was in Boston under Bigelow's observation.[12]: 20 [13]: 4n
- ^ Early authors attempting to estimate the extent of damage include: Harlow;[10]: 389 Bigelow;[12]: 21–2 Harlow;[13]: 343–5 Dupuy;[45] Ferrier;[46] Bramwell;[47] Cobb;[48][49] Tyler & Tyler.[50]
- ^ See Macmillan & Lena;[37]: 9 Harlow;[13]: 332,345 Bigelow;[12]: 16–17 Harlow;[10]: 390 Macmillan.[1]: 86
- ^ [90]: 194 According to phrenology's founder Franz Joseph Gall, the organ of Benevolence was responsible for "goodness, benevolence, the gentle character ... [and] to dispose man to conduct himself in a manner conformed too the maintenance of social order".
Immediately adjacent was an organ for religion and God, later named Veneration by Johann Spurzheim (who expanded its responsiblity to include respect for peers and, especially, for those in authority).[1]: 150,171n10 [91]
Phrenology held that the organs of the "grosser and more animal passions are near the base of the brain; literally the lowest and nearest the animal man [while] highest and farthest from the sensual are the moral and religions feelings, as if to be nearest heaven." Thus Veneration and Benevolence are at the apex of the skull[92][93][94]—the region of exit of Gage's tamping iron.
- ^ [53] Kotowicz continues, "Damasio's account of Gage's last months [is] such a grotesque fabrication that it leaves one baffled," then quotes á passage from A. Damasio:[42]: 9–10
- In my mind is a picture of 1860's San Francisco as a bustling place, full of adventurous entrepreneurs engaged in mining, farming, and shipping. That is where we can find Gage's mother and sister, the latter married to a prosperous San Francisco merchant (D. D. Shattuck, Esquire), and that is where the old Phineas Gage might have belonged. But that is not where we would find him if we could travel back in time. We would probably find him drinking and brawling in a questionable district, not conversing with the captains of commerce, as astonished as anybody when the fault would slip and the earth would shake threateningly. He had joined the tableau of dispirited people who, as Nathanael West [see The Day of the Locust] would put it decades later, and a few hundred miles to the south, "had come to California to die."
Macmillan[1]: 116–19,326,331 gives detailed criticism of A. Damasio's various presentations of Gage (some of them in joint work with H. Damasio and others).
- ^ [96] See also Grafman: "Although [Gage] has been used to exemplify the problems that patients with ventromedial prefrontal cortex lesions have in obeying social rules, recognizing social cues, and making appropriate social decisions, the details of this social cognitive impairment have occasionally been inferred or even embellished to suit the enthusiasm of the story teller—at least regarding Gage"[97]: 295 (citing Macmillan).[1]
- ^ See for example Carlson;[98]: 341 additional examples and discussion are given by Macmillan.[1]: 246;252–3n9,10
- ^ [18] Van Horn: "That [Gage] was any form of vagrant following his injury is belied by these remarkable images." [16]: 13
Sources and further reading
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci cj ck cl cm cn co cp
Macmillan, Malcolm B. (2000). An Odd Kind of Fame: Stories of Phineas Gage. MIT Press. ISBN 0-262-13363-6 (hbk, 2000) ISBN 0-262-63259-4 (pbk, 2002).
• See also "Corrections to An Odd Kind of Fame". - ^ a b "Alive from the Dead, Almost". North Star. Danville, Vermont. November 6, 1848. p. 1, col. 2.
- ^ Campbell, H. F. (1851). "Injuries of the Cranium—Trepanning". Ohio Medical & Surgical Journal. 4 (1): 20–24. (crediting the Southern Medical & Surgical Journal (unknown date).
- ^ a b c d e f g h i j k Barker, F. G. II (1995). "Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization". Journal of Neurosurgery. 82 (4): 672–682. doi:10.3171/jns.1995.82.4.0672. PMID 7897537.
- ^ a b c d e f g h i
Macmillan, Malcolm B. (PGIP). "The Phineas Gage Information Page". The University of Akron. Retrieved July 22, 2013.{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) Includes: - ^ a b c d ——— (2001). "John Martyn Harlow: Obscure Country Physician?". Journal of the History of the Neurosciences. 10 (2): 149–162. doi:10.1076/jhin.10.2.149.7254. PMID 11512426.
- ^ Vanderstoep, S. W.; Fagerlin, A.; Feenstra, J. S. (2000). "What Do Students Remember from Introductory Psychology?" (PDF). Teaching of Psychology. 27 (2): 89. doi:10.1207/S15328023TOP2702_02.
- ^ a b c d e f g h i j k l m n o p Macmillan, Malcolm B. (2008). "Phineas Gage—Unravelling the myth" (PDF). The Psychologist. 21 (9). British Psychological Society: 828–831.
- ^ Gage, Clyde Van Tassel (1964). John Gage of Ipswich, Mass. and his descendants: an historical, genealogical and biographical record, as developed from sources explained herein. Worcester, N.Y.: C.V. Gage.
- ^ a b c d e f g h i Harlow, John Martyn (1848). "Passage of an Iron Rod Through the Head" (PDF). Boston Medical & Surgical Journal. 39 (20): 389–393.
(Transcription.)
- ^ "Incredible, But True Every Word". National Eagle. Claremont, New Hampshire. March 29, 1849. p. 2. Transcribed in Macmillan (2000), pp. 40–1
- ^ a b c d e f g h i j k l m n o p q Bigelow, Henry Jacob (July 1850). "Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head". American Journal of the Medical Sciences. 20: 13–22.
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao Harlow, John Martyn (1868). "Recovery from the Passage of an Iron Bar through the Head".
{{cite journal}}
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(help)(Transcription.) Originally published in Publications of the Massachusetts Medical Society. 2: 327–347.
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(help) - ^ Fowler, O. S. (1838). Synopsis of phrenology: and the phrenological developments: together with the character and talents of ________ as given by ________: with references to those pages of "Phrenology proved, illustrated and applied," in which will be found a full and correct delineation of the intellectual and moral character and manifestations of the above-named individual. New York: Fowler & Wells. p. 6.
- ^ a b c d e Ratiu, P.; Talos, I. F. (2004). "The Tale of Phineas Gage, Digitally Remastered". New England Journal of Medicine. 351 (23): e21. doi:10.1056/NEJMicm031024. PMID 15575047.
- ^ a b c d e f Van Horn, J. D.; Irimia, A.; Torgerson, C. M.; Chambers, M. C.; Kikinis, R.; Toga, A. W. (2012). "Mapping Connectivity Damage in the Case of Phineas Gage". PLoS ONE. 7 (5): e37454. doi:10.1371/journal.pone.0037454. PMC 3353935. PMID 22616011.
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- ^ a b c d Kean, Sam (May 6, 2014), "Phineas Gage, Neuroscience's Most Famous Patient", Slate
- ^ Sutton, W. L. (1850). "A Centre Shot". Boston Medical & Surgical Journal. 3: 151–2.
- ^ a b c d "Bibliographical Notice". Boston Medical & Surgical Journal. 3 n.s. (7): 116–7. March 18, 1869.
- ^ a b c d e Jackson, J. B. S. (1870). "A Descriptive Catalog of the Warren Anatomical Museum".
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- ^ Folsom, A. C. (May 1869). "Extraordinary Recovery from Extensive Saw-Wound of the Skull". Pacific Medical and Surgical Journal. pp. 550–555.
- ^ "Medical Intelligence. Extraordinary Recovery". Boston Medical & Surgical Journal. 3 n.s. (13): 230–1. April 29, 1869.
- ^ "Horrible Accident". Boston Post. September 21, 1848.
- ^ Hooper, Robert (1809). "Injuries to the Brain from External Violence. Of the Consequences of Injuries to the Brain. Fungus and Hernia Cerebri". The surgeon's vade-mecum: containing the symptoms, causes, diagnosis, prognosis, and treatment of surgical diseases: accompanied by the modern and approved methods of operating, select formuae of prescriptions, and a glossary of terms. London: Printed for John Murray, Fleet Street; Adam Black, Edinburgh; and Wogan and Cumming, Dublin. p. 107.
- ^ a b c Nuland, Sherwin B. (2011). Doctors: The Biography of Medicine. Knopf Doubleday. ISBN 978-0-307-80789-2.
- ^ Van Hoosen, Bertha (Autumn 1947). "A Woman's Medical Training in the Eighties". Quarterly Review of the Michigan Alumnus: A Journal of University Perspectives. University of Michigan Libraries: 77–81. UOM:39015006945235.
- ^ Scott, William (1922). An indexed system of veterinary treatment. Chicago: Eger. p. 603.
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- ^ Williams, Charles J. B. (1848). Principles of Medicine: Comprising General Pathology and Therapeutics, and a Brief General View of Etiology, Nosology, Semeiology, Diagnosis, and Prognosis: With Additions and Notes by Meredith Clymer. Churchill. p. 306.
- ^ a b c d Twomey, S. (January 2010). "Finding Phineas". Smithsonian. 40 (10): 8–10.
- ^ a b Harlow, John Martyn (1849). "Medical Miscellany (letter)". Boston Medical & Surgical Journal. 39: 507. Reproduced in Macmillan (2000).[1]
- ^ a b Jackson, J.B.S. (1849). Medical Cases. 4 (Case 1777).
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- ^ a b Bennett, W. (1986). "Dr. Warren's Possessions". Harvard Magazine. 89: 24–31. PMID 11617033.
- ^ Merwin, Mrs. George B. (1863). Three Years in Chili. New York: Follett, Foster and Company.
- ^ Volume 3: Lone Mountain register, 1850–1862, Halsted N. Gray – Carew & English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285.
- ^ a b c d Damasio, H.; Grabowski, T.; Frank, R.; Galaburda, A. M.; Damasio, A. R. (1994). "The return of Phineas Gage: Clues about the brain from the skull of a famous patient". Science. 264 (5162): 1102–1105. doi:10.1126/science.8178168. PMID 8178168.
- ^ a b c d e f Damasio, Antonio R. (1994). Descartes' error: emotion, reason, and the human brain. Quill. ISBN 978-0-380-72647-9.
- ^ a b Hockenbury, Don H.; Hockenbury, Sandra E. (2008). Psychology. p. 74. ISBN 978-1-429-20143-8.
- ^ "The Phineas Gage Case". Francis A. Countway Library (Harvard Medical School). Center for the History of Medicine. Warren Anatomical Museum. Retrieved 2013-01-10.
- ^ a b Dupuy, Eugene (1877). "A critical review of the prevailing theories concerning the physiology and the pathology of the brain: localisation of functions, and mode of production of symptoms. Part II". Med Times & Gaz. II: 356–8.
- ^ a b Ferrier, David (1878). "The Goulstonian lectures of the localisation of cerebral disease. Lecture I (concluded)". Br Med J. 1 (900): 443–7.
- ^ Bramwell, B. (1888). "The Process of Compensation and some of its Bearings on Prognosis and Treatment". BMJ. 1 (1425): 835–840. doi:10.1136/bmj.1.1425.835. PMC 2197878. PMID 20752265.
- ^ Cobb, S. (1940). "Review of neuropsychiatry for 1940". Archives of Internal Medicine. 66: 1341–54.
- ^ ——— (1943). Borderlands of psychiatry. Harvard Univ. Press.
- ^ Tyler, K.L.; Tyler, H.R. (1982). "A 'Yankee Invention': the celebrated American crowbar case". Neurology. 32: A191.
- ^ Ratiu, P.; Talos, I. F.; Haker, S.; Lieberman, D.; Everett, P. (2004). "The Tale of Phineas Gage, Digitally Remastered". Journal of Neurotrauma. 21 (5): 637–643. doi:10.1089/089771504774129964. PMID 15165371.
- ^ Eliot, Samuel Atkins, ed. (1911). "John M. Harlow". Vol. 1. Massachusetts Biographical Society.
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- ^ "A most remarkable case". American Phrenological Journal and Repository of Science, Literature, and General Intelligence. 13. Fowler & Wells. p. 89, col. 3. 1851.
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Macmillan, Malcolm B.; Aggleton, John (March 6, 2011). "Phineas Gage: The man with a hole in his head" (Audio interview). Interviewed by Claudia Hammond; Dave Lee.{{cite interview}}
: Unknown parameter|callsign=
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- ^ a b Macmillan, Malcolm B. (July 2009). "More About Phineas Gage, Especially After the Accident". Retrieved July 27, 2013.
- ^ a b Robert Nason Nye, ed. (1942). Medical Progress Annual: A Series of Reports Published in the New England Journal of Medicine. C. C. Thomas. pp. 366–7.
- ^ Moffat, Gregory K. (2012). Angela Browne-Miller (ed.). Fundamentals of Aggression. ABC-CLIO. p. 44. ISBN 978-0-313-38276-5.
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- ^ Crider, A. B.; Goethals, G. R.; Kavanagh, R. D.; Solomon, P. R. (1983). Psychology. Scott, Foresman.
- ^ Graham Beaumont; Pamela Kenealy; Marcus Rogers (1991). The Blackwell Dictionary of Neuropsychology. Wiley.
- ^ Groves, Philip M.; Schlesinger, K. (1982). Introduction to Biological Psychology (2nd ed.). Dubuque, Iowa: Brown.
- ^ Kalat, James W. (1981). Biological Psychology. Belmont, California: Wadsworth.
- ^ Smith, A. (1985). The Body. Harmondsworth, England: Penguin.
- ^ Lahey, B. B. (1992). Psychology: An Introduction (4th ed.). Dubuque, Iowa: Brown. p. 63.
- ^ Abnormal Behavior. Harcourt, Brace, Jovanovich. 1980.
- ^ Morris, C. G. (1996). Psychology: An Introduction (9th ed.). Prentice-Hall.
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- ^ Restak, Richard M. (1984). The brain. Bantam Books.
- ^ Dimond, Stuart J. (1980). Neuropsychology: A Textbook of Systems and Psychological Functions of the Human Brain. London: Butterworths.
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- ^ Blakemore, Colin (1977.). Mechanics of the mind. Cambridge University Press.
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- ^ Smith, A. (1984). The Mind. London: Hodder and Stoughton.
- ^ Wilson, Andrew (January 1879). The old phrenology and the new. Vol. CCXLIV. pp. 68 85.
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- ^ a b Blakeslee, Sandra (May 24, 1994). "Old Accident Points to Brain's Moral Center". New York times. p. C1.
- ^ Sdorow, Lester (1990). Psychology. Dubuque, Iowa: Brown.
- ^ Changeux, Jean-Pierre (1985). Neuronal Man: The Biology of the Mind. Tr. by Laurence Garey (1st American ed. ed.). Pantheon Books. pp. 158–9.
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- ^ Damasio, A. R.; Van Hoesen, G. W. (1983). Paul Satz; Kenneth M. Heilman (eds.). Emotional disturbances associated with focal lesions of the limbic frontal lobe. New York: Guilford Press. pp. 85–110. ISBN 978-0-89862-200-3.
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- ^ a b Fuster, Joaquin M. (2008). The prefrontal cortex. Elsevier/Academic Press. p. 172. ISBN 0-12-373644-7.
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- ^ Sizer, Nelson (1888). Forty years in phrenology; embracing recollections of history, anecdote, and experience. New York: Fowler & Wells.
- ^ Gall, Franz Joseph (1835). Capen, Nahum (ed.). On the functions of the brain and of each of its parts: with observations on the possibility of determining the instincts, propensities, and talents, or the moral and intellectual dispositions of men and animals, by the configuration of the brain and head. The phrenological library. Translated from the French by Winslow Lewis, Jr. Boston: Marsh, Capen & Lyon.
- ^ Davidson, James Wood (July 1866). How We Read Each Other. Phrenology. Vol. 2. Atlanta: J.J. Toon. pp. 557–62, 559.
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- ^ Phrenology for "Tim Bobbin". Vol. XXIV. February 13, 1897. p. 302.
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- ^ Kihlstrom, J. F. (2010). "Social neuroscience: The footprints of Phineas Gage". Social Cognition. 28 (6): 757–782. doi:10.1521/soco.2010.28.6.757.
- ^ Grafman, J. (2002). "The Structured Event Complex and the Human Prefrontal Cortex". pp. 292–310. doi:10.1093/acprof:oso/9780195134971.003.0019. ISBN 978-0-195-13497-1.
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- ^ a b c Wilgus, B. & J. "Meet Phineas Gage". Retrieved October 2, 2009.
- ^ a b c d e f Wilgus, B. & J. (2009). "Face to Face with Phineas Gage". Journal of the History of the Neurosciences. 18 (3): 340–345. doi:10.1080/09647040903018402. PMID 20183215.
- ^ a b c d e Wilgus, B. & J. (July–September 2009). "Phineas Gage – Hiding in Plain Sight". The Daguerreian Society Newsletter. 21 (3): 6–9.
- ^ a b c Lena, M. L.; Macmillan, Malcolm B. (March 2010). "Picturing Phineas Gage (Invited comment)". Smithsonian. p. 4.
- ^ Wilgus, B. & J. "A New Image of Phineas Gage". Retrieved March 10, 2010.
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<references>
tag (see the help page).External links
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- Warren Anatomical Museum, Center for the History of Medicine, Francis A. Countway Library of Medicine (Harvard Medical School) – Home of Gage's skull and iron.
- Meet Phineas Gage – How the owners of the 2009-identified daguerreotype learned it depicted Gage.
- Phineas Gage roadside memorial, Cavendish, Vermont.