Jump to content

Phineas Gage

From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by EEng (talk | contribs) at 06:04, 7 November 2013 (internal section links). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Phineas P. Gage
[Fig. 2]
The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"—​his inscribed tamping iron.​[B]
BornJuly 9, 1823 (date uncertain)
Grafton Co., New Hampshire[C]
DiedMay 21, 1860(1860-05-21) (aged 36)
In or near San Francisco[A]
Cause of deathStatus epilepticus
Resting place
Occupations
Known forPersonality change after brain injury
SpouseNone
ChildrenNone[3]: 319, 327 

Phineas P. Gage (1823–1860) was an American railroad construc­tion foreman remembered for his improba­ble[D] sur­vival of an 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 succeed­ing twelve years—​effects so profound that (for a time at least) friends saw him as "no longer Gage."

[Fig. 1] The "abrupt and intru­sive visitor".​[D][E]

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" [34]—​Phineas Gage influenced nineteenth-century discus­sion about the mind and brain, particu­larly debate on cerebral localiza­tion, and was perhaps the first case to suggest that damage to specific parts of the brain might affect personality.​[3]: ch7-9 [13]

Gage is a fixture in the curricula of neurology, psycholo­gy and related disciplines, and is frequently mentioned in books and academic papers; he even has a minor place in popular culture.[F] Despite this celebrity the body of established fact about Gage and what he was like (before or after his injury) is remark­a­bly small,[G] which has allowed "the fitting of almost any theory [desired] to the small number of facts we have" [H]—​Gage having been cited, over the years, in support of various theories of the brain entirely inconsist­ent with one another. A survey of published accounts, includ­ing scientif­ic ones, has found that they almost always severely distort Gage's behav­ioral changes, exaggerat­ing the known facts when not directly contradict­ing them.[G]

Two photographic portraits of Gage, and a physician's report of his physical and mental condition late in life, were published in 2009 and 2010. This new evidence indicates that Gage's most serious mental changes may have been temporary, so that in later life he was far more func­tional, and socially far better adjusted, than was previously assumed. 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.

Background

[Fig. 3] Caven­dish, Vermont about twenty years after Gage's accident. (A) The two possible accident sites; (T) Gage's lodgings, where he convalesced; (H) Harlow's home and surgery.[I]
[Fig. 4] Line of the Rutland & Burling­ton Railroad passing through cut in rock south of Caven­dish. Gage met with his acci­dent while setting explo­sives to create either this cut or a similar one nearby.​[I]

Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage, of Grafton County, New Hampshire.[C] Little is known about his upbringing and educa­tion, but he was almost certainly literate.​[3]: 17,41 

He may have gained skill with explosives on the family's farms or in nearby mines and quarries,​[3]: 17-18  and by the time of his accident he was a blasting foreman (possibly an independ­ent contract­or) on railway construc­tion projects. His employers consid­ered him (as town doctor John Martyn Harlow later put it) "the most effi­­cient and capable foreman in their employ ... a shrewd, smart business­man, very energetic and persist­ent in executing all his plans of opera­tion", 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 injury

External videos
video icon Video recon­struc­tion of tamping iron passing through Gage's skull (Ratiu et al. 2004).​[J]
[Fig. 5] The Boston Post for Sept. 21, 1848 (under­stat­ing the dimen­sions of Gage's tamp­ing iron and overstat­ing damage to the jaw).​[K]
[Fig. 6] Gage's skull "hinged" open as the iron passed through.[J]

On September 13, 1848 Gage (aged 25)[C] 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.[I]

Gage was doing this around 4:30 p.m. when (possibly because the sand was omitted) the tamping iron struck a spark against the rock and the powder exploded. The tamping iron rocketed out of the hole and "entered on the [left] side of his face ... passing back of the left eye, and out at the top of the head." [K] (See [Fig. 5],[Fig. 6])

Despite nineteenth-century refer­ences to Gage as "the American Crowbar Case" [54]: 54  his tamping iron did not have the bend or claw sometimes associ­ated with the term crowbar; rather, it was simply a cylinder, "round and rendered compara­tively smooth by use":​[46]: 331 

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.[L]

Weighing 13+1⁄4 pounds (6 kg) this "abrupt and intrusive visitor" [D] was found some 80 feet (25 m) away, "smeared with blood and brain." [1]: 331 

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 his lodgings in town. [1]: 331  Dr. Edward H. Williams arrived some thirty minutes after the accident:

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.[M]

Harlow took charge of the case around 6 p.m.:

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.[M]

Convalescence

Despite Harlow's skillful care,[N] Gage's recupera­tion was long and difficult. Pressure on the brain[O] left him semi-comatose from September 23 to October 3, "seldom speaking unless spoken to, and then answering only in monosyllables. The friends and attendants are in hourly expectan­cy of his death, and have his coffin and clothes in readi­ness." [M]

But 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." [46]: 392-3 

Subsequent life and travels

[Fig. 7] "Disfig­ured yet still handsome" [8]

Injuries

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." 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." [1]: 338-9 [47]

New England

Harlow says that Gage, unable to return to his railroad work,[1]: 339  appeared for a time at Barnum's American Museum[P] in New York City (the curious paying to see, presum­a­bly, both Gage and the instrument which had injured him) although there is no independ­ent confirma­tion of this.[citation needed] Recently, however, evidence has surfaced[citation needed] support­ing Harlow's statement that Gage made public appearances in "the larger New England towns". He subsequently worked in a livery stable in Hanover, New Hampshire.​[1]: 340 

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. After his health began to fail around 1859,[A] he left Chile for San Francisco, where he recovered under the care of his mother and sister (who had gone there from New Hampshire around the time Gage went to Chile). For the next few months he did farm work in Santa Clara.​[3]: 103-4 [1]: 340-1 

Death and subsequent travels

[Fig. 8] Gage's skull (sawed to show inte­ri­or) and iron, photo­graphed for Harlow in 1868.​[Q]

In February 1860[A] Gage had the first in a series of increasingly severe convulsions;[R] he died status epilepticus [2]: E  in or near[2]: B  San Francisco on May 21, just under twelve years after his injury, and was buried in San Francisco's Lone Mountain Cemetery.[A] (Some accounts[40][38][48] assert that Gage's iron was buried with him, but there appears to be no evidence for this.)[S]

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 initiated a correspondence with Gage's family there. At Harlow's request they opened Gage's grave long enough to remove his skull, which the family then personally[21]: 6  delivered to Harlow back in New England.

About a year after the accident, Gage had given his tamping iron in Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it[32]: 22n [29][3]: 46-7  and made what he called "my iron bar" his "constant companion during the remainder of his life";[1]: 339  now it too was delivered to Harlow.(See [Fig. 8]) After studying them for a triumphal retrospective paper on Gage[1] Harlow redepos­ited the iron—​this time with Gage's skull—​in the Warren Museum, where they remain on display today.[T] The iron bears this inscrip­tion:[U] (See [Fig. 16])

This is the bar that was shot through the head of M r 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.

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 burial places outside city limits.[3]: 119-120 

Brain damage and mental changes

[Fig. 9] The left frontal lobe (red), the forward portion of which was dam­aged by Gage's injury, per Harlow's dig­ital exam­i­na­tion and the dig­ital analy­ses of Ratiu et al. and Van Horn et al.​[J]

Extent of brain damage

The amount of Gage's brain tissue destroyed must have been substant­ial (consider­ing both the initial trauma and the subse­quent infec­tion) but debate as to whether this was in both frontal lobes, or primarily the left, began with the earliest papers by physicians who had examined Gage.[V] The 1994 conclu­sion of H. Damasio et al.,[40] that both frontal lobes were damaged, was drawn by modeling not Gage's skull but a "Gage-like" one.[4]: 829-30  Ratiu et al. (2004, using CT scans of Gage's actual skull, and present­ing a video reconstruc­tion of the tamping iron passing through it)[23][22] confirm Harlow's conclu­sion (based on probing Gage's wounds with his finger)[W] that the right hemisphere remained intact.[J] Van Horn et al. (2012) agree that the right hemisphere was undamaged, and make detailed estimates of the locus and extent of damage to Gage's white matter, suggest­ing that this damage may have been more signifi­cant to Gage's mental changes than the cerebral cortex (gray matter) damage.[X] (See [Fig. 13])

[Fig. 10] Harlow's 1868 paper, pre­sent­ing Gage's skull and late-life history.[1]
[Fig. 11] "I dressed him, God healed him." Physician John Martyn Harlow, who attended Gage after his accident and obtained his skull for study after his death, in later life.[20]

First-hand reports of mental changes

Gage certainly displayed some kind of change in behavior after his injury,[21]: 12-15  but the nature, extent, and duration of this change are very uncertain: little is reliably known about what Gage was like (either before or after the accident),[G] the mental changes described after his death were much more dramatic than anything reported while he was alive, and the few descrip­tions which seem credible do not specify the period of his post-accident life to which they are meant to apply.

Harlow's 1848 report

In his 1848 report, as Gage was just completing his physical recovery, Harlow had only hinted at possible psycho­log­i­cal symptoms: "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." [46]: 393  And after observing Gage for several weeks in late 1849, Harvard Professor of Surgery Henry Jacob Bigelow (in keeping with his anti-localiza­tion­ist training)[H] went so far as to say that Gage was "quite recovered in faculties of body and mind," there being only "inconsid­er­a­ble distur­bance of function".[32]: 13-14 

Harlow's 1868 report

Not until 1868 did Harlow (having obtained Gage's skull, tamping iron, and late-life history) deliver the "future communica­tion" he had promised twenty years earlier, detailing the mental changes found today in most presenta­tions of the case (though usually in exaggera­ted or distorted form—​see Distortion of mental changes, below). In memorable language, Harlow now 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".[1]

This oft-quoted descrip­tion appears to draw on Harlow's own notes set down soon after the accident,​[3]: 90,375  but other behaviors he describes​[3]: 117-8 [1]: 340,345  appear to draw on later communica­tions from Gage's friends or family,[Y] and it is difficult to match these various behaviors (which range widely in their implied level of func­tional impairment)[Z] to the particu­lar period of Gage's post-accident life during which each described behavior was present.[3]: 90-5  This complicates recon­struc­tion of how Gage's behavior changed over time, a critical task in light of evidence that his behavior at the end of his life was very different from his behavior (described by Harlow above) immediately post accident.[21]: 6-9 

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[3]: 307 

In the only book dedicated to the case, An Odd Kind of Fame: Stories of Phineas Gage (2000),[3] psycholo­gist Malcolm Macmillan surveys scores of accounts of Gage, both scien­tific and popular, finding that they almost always distort and exagger­ate his behav­ioral changes well beyond anything described by those who had direct contact with him.[G] In the words of Barker,[13] "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 ..." [17]

Attributes typically ascribed to the post-accident Gage which are either unsupported by, or in contradic­tion to, the known facts include mistreat­ment of wife and children (of which Gage had neither), inappro­pri­ate sexual behavior,[AA] an "utter lack of fore­sight", "a vainglori­ous tendency to show off his wound", inability or refusal to hold a job, plus drinking, bragging, lying, gambling, brawling, bullying, thievery, and acting "like an idiot". Macmillan's detailed analysis shows that none of these behaviors is mentioned by anyone who had met Gage or even his family;[G] as Kotowicz writes, "Harlow does not report a single act that Gage should have been ashamed of." [17][AB]

For example, prominent modern discus­sions of Gage by Antonio Damasio and Hanna Damasio​[40][38][39] misinterpret 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'" [1]: 341 —​as implying Gage could not hold a job after his accident and "never returned to a fully independ­ent exist­ence". 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; and until then Gage had supported himself throughout his adult life.[AC]

Theoretical use, misuse, and nonuse

[Fig. 12] Phrenolo­gists contended that destruc­tion of the mental "organs"​ of Benevo­lence and Venera­tion (top-right) caused Gage's behav­ioral changes.

Though Gage is considered the "index case for personal­ity change due to frontal lobe damage" [13][55][14] his scien­tific value is under­mined by the uncertain extent of his brain damage[14] combined with the lack of information about his behav­ioral changes.[citation needed] 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," the paucity of evidence having allowed "the fitting of almost any theory [desired] to the small number of facts we have".[H] This concern had been 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") 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 ...[H]

More recently Sacks[52] refers to the "interpreta­tions and misinterpreta­tions, from 1848 to the present," of Gage.

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;​[13][3]: ch9  for example, soon after Dupuy[41] wrote that Gage proved that the brain is not localized, Ferrier cited Gage as proof that it is.[45] 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".[53]: 194  (See [Fig. 12])

A. Damasio, in presenting 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.[38][39] However, A. Damasio's presenta­tion of Gage has been criticized as

grotesque fabrica­tion ... ["perpetrating"] the myth of Gage the psycho­path ... Damasio changes [Harlow's] narrative, omits facts, and adds freely to his story ... It seems that the growing commitment to the frontal lobe doctrine of emotions brought Gage to the limelight and shapes how he is described.[AD]

Or 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.[AE]

Psychosurgery and lobotomy

It is frequently said that what happened to Gage played a part in the later develop­ment of various forms of psychosur­gery, particu­larly lobotomy.[AF] Aside from the question of why the unpleasant changes usually (if errone­ously) attrib­uted to Gage would inspire surgical imita­tion,[AG] careful inquiry turns up no such link, according to Macmillan:

[T]here is no evidence that Gage's case contributed directly to psychosur­gery ... As with surgery for the brain generally, what his case did show came solely from his surviving his accident: major opera­tions could be performed on the brain without the outcome necessarily being fatal.[3]: 250;ch10-11 [2]: F 

[Fig. 13] False-color represen­ta­tion of cerebral fiber pathways affected, per Van Horn et al.​[26]

Social recovery

In 2008 an advertisement for a previously unknown public appearance by Gage was discovered, as well as a report of his physical and mental condition during his time in Chile, a descrip­tion of what may well have been his daily work routine there as a stage­coach driver, and more recently an ad for a second public appearance. This new evidence implies that the seriously maladap­ted Gage described by Harlow existed for only a limited time after the accident—​that Gage eventually "figured out how to live" despite his injury,[AH] and was in later life far more func­tional, and socially far better adapted, than previously assumed.[4]: 831 

Macmillan hypothesizes that this change represents a social recovery undergone by Gage over time, citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills"​ (in Gage's case, his highly structured employ­ment in Chile).[AI]

If this is so, he points out, then along with theoretical implica­tions it "would add to current evidence that rehabili­ta­tion can be effective even in difficult and long-standing cases" [4]: 831 —​and asks, if Gage could achieve such improvement without medical supervi­sion, "what are the limits for those in formal rehabili­ta­tion programs?" [7]

Portraits

[Fig. 14] The second portrait of Gage to be identified (2010).​[AJ]

In 2009 a daguerreotype portrait of Gage was discovered, the first likeness of him identified other than a life mask taken in late 1849.​[32]: 22n [3]: ii  It shows "a disfigured yet still-handsome" Gage[8] with one eye closed and scars clearly visible, "well dressed and confident, even proud" [9][AK] and holding his iron, on which portions of the inscrip­tion (recited above) can be made out. (For decades the daguerre­otype's owners had imagined it showed an injured whaler with his harpoon.)[11] Authenticity was confirmed in several ways, including photo-overlay­ing the inscrip­tion visible in the portrait against that on the actual tamping iron in Harvard's Warren Anatomical Museum, and matching the injuries seen in the portrait against those preserved in the life mask.[9]

Macmillan cites the daguerre­otype as consistent with the social recovery hypothesis already described.[7] To better under­stand the question, he and collaborators are actively seeking addi­tional evidence on Gage's life and behavior, and describe certain kinds of historical material (see "Phineas Gage: Unan­swered ques­tions" in External links, below) for which they hope readers will remain alert, such as letters or diaries by physicians whom their research indicates Gage may have met, or by persons in certain places Gage seems to have been.​[2]: B [4]: 831 

In 2010 a second portrait of Gage was identified. This new image, copies of which are in the posses­sion of at least two different branches of the Gage family, depicts the same subject seen in the Wilgus daguerre­otype identi­fied in 2009, according to Gage research­ers consulted by the Smithson­ian Institu­tion.[AJ]

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

Date of Burial: 1860 May 23Name: Phineas B.(sic) GageAge (yrs mos ds): 36Nativity: New HampshireDisease: EpilepsyPlace of Burial (tier grave plot): VaultUndertaker: Gray

[Fig. 15]‍ Excerpt from record book for Lone Mountain Cemetery, San Francis­co, reflect­ing the May 23, 1860 inter­ment of Gage by under­takers N. Gray & Co.‍[A]Template:Print version

[Fig. 16] Detail of in­script­ion from Miller–​Hartley image
  1. ^ a b c d e f g Gage's death and (original) burial are discussed at Macmillan (2000).[3]: 108-9  Harlow (1868)[1] gives the date of Gage's death as May 21, 1861, but undertaker's records[28] (See [Fig. 15]) show conclusively that Gage was buried May 23, 1860. That Harlow (though in contact with Gage's mother as he was writing) 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 in correct­ing those dates (each of which carries this annota­tion).
  2. ^ Daguerreotype from the collec­tion of Jack and Beverly Wilgus. The original, like almost all daguerre­otypes, shows its subject laterally (left-right) reversed, making it appear that Gage's right eye is injured; however, there is no question (Lena & Macmillan, 2010) that all Gage's injuries, including to his eye, were on the left.[6] Therefore, in presenting the image here a second, compensat­ing reversal has been applied in order to show Gage as he appeared in life. See Harlow (1868)[1]: 340  for "constant companion".
  3. ^ a b c d Macmillan (2000)[3]: 11,17,490-1  discusses Gage's ancestry and what is and isn't known about his birth and early life. Possible birthplaces are Lebanon, Enfield, and Grafton (all in Grafton County, New Hampshire) though Harlow (1868) refers to Lebanon in particu­lar as Gage's "native place" and as "his home"​ (probably that of his parents) to which he returned ten weeks after the accident.

    The vital records of neither Lebanon nor Enfield list Gage's birth. The birthdate July 9, 1823 (the only definite date given in any source) is from a comprehen­sive Gage genealogy, via Macmillan (2000),[3]: 16  and is consist­ent with agree­ment, among the numerous contemporary sources addres­sing the point, that Gage was 25 years old at the time of the accident, as well as with Gage's age—​36 years—​as given in undertaker's records after his death on May 21, 1860.

    There is no doubt Gage's middle initial was P [4]: 839fig. [46][1][32] but there is nothing to indicate what the P stood for (though his paternal grandfather was also named Phineas). See also note regarding the spelling of Gage's first name as inscribed on the tamping iron.

    Gage's mother's maiden name is variously spelled Swetland, Sweatland, or Sweetland.

  4. ^ 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—​see Macmillan 2000).[3]: 66-7  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".[32]: 13,19  This endorse­ment by Bigelow, Professor of Surgery at Harvard, helped end scoffing about Gage among physic­ians in general—​one of whom, Harlow (1868) later recalled, had dismissed the matter as a "Yankee in­vention":
    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.[1]: 329,344 

    Indeed Jackson (1870) wrote that, "Unfortu­nately, and notwith­stand­ing the evidence that Dr. H. has furnished, the case seems, generally, to those who have not seen the skull, too much for human belief."[50]: v  But after Gage was joined by such later cases as a miner who survived traversal of his head by a gas pipe,[citation needed] 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"),[42] 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." [30] The Transac­tions of the Vermont Medical Society (Smith 1886) 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." [54]: 53-54 

    The reference to Gage's iron as an "abrupt and intrusive visitor" appears in the Boston Medical & Surgical Jouurnal's review[29] of Harlow (1868).

  5. ^ Harlow (1868): "Front and lateral view of the cranium, represent­ing the direction in which the iron traversed its cavity; the present appearance of the line of fracture, and also the large anterior fragment of the frontal bone, which was wholly detached, replaced and partially re-united." [1]: 347,fig.2 
  6. ^ For scientific and academic discus­sions see Macmillan;[3]: 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." [25]: 89 

    For popular culture, see Macmillan (2000)[3]: ch13  and Macmillan (2008);[4]: 830  for example, several musical groups call themselves Phineas Gage (or some variation).

  7. ^ a b c d e Accounts of Gage are compared to one another, and against the known facts, at Macmillan (PGIP)[2]: C  and in Macmillan 2000.[3]: esp.116-19, ​chs.13-14 According to Macmillan & Lena (2010, and see also Macmillan 2000)​[3]: 11,89,93,116  available sources which offer detailed informa­tion on Gage, and for which there is evidence (if merely the source's own claim) of contact with him or with his family, were limited (until 2008) to Harlow (1848, 1849, 1868);[46][47][1] Bigelow (1850);[32] Jackson (1870);[50]; Jackson (1849).[49] Macmillan & Lena (2010) present previously unknown sources discovered post 2008.

    Macmillan (2001)[20]: 161  and Macmillan (2000)[3]: 94  discuss the high general reliability of Harlow (1868), and its primacy as a source.

    The contrast between Gage's celebrity, and the small amount known about him, is discussed in Macmillan (2000):[3]: 1-2,11  "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."

  8. ^ a b c d Quotations are from Ferrier (1877–9)[44], Macmillan (2000)[3]: 290  and Smith (1886);[54] other 19th-century exaspera­tion was expressed by Dupuy (1877)[41] and Jackson (1870).[50] See Macmillan (2000)[3]: pass.  and Macmillan (2008)[4]: 831  for surveys and discus­sion of theoret­ical misuse of Gage, and Barker (1995)[13]: abstr.  for, specifically, the way in which 19th-century reports of Gage were colored by various writers' doctrinal leanings: "The educa­tional backgrounds of Harlow and Bigelow [explain] their differing attitudes toward the case. 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."
  9. ^ a b c See Macmillan (2000)[3]: 25-27  and Macmillan (PGIP)[2]: A  for the steps in setting a blast and the location and circum­stan­ces of the accident. 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 statement that Gage's employers had consid­ered him "the most efficient and capable foreman in their employ" prior to the accident.
  10. ^ a b c d Ratiu et al.[22][23] was the first study to account for the hairline fracture running from behind the exit region down the front of the skull, as well as fact that the hole in the base of the cranium (created as the iron passed through) has a diameter about half that of the iron itself—​hypothe­siz­ing that the skull "hinged" open as the iron entered the base of the cranium, and was afterward pulled closed by the resilience of soft tissues once the iron had exited at the top.[4]: 830 
  11. ^ a b (See [Fig. 5])Boston Post, Septem­ber 21, 1848,[27] crediting an earlier report (unknown date) in the Ludlow Free Soil Union (Ludlow, Vermont). This early report misstates the length of the tamping iron, and confuses its circumfer­ence with its diameter. Also, despite its reference to the "shatter­ing [of the] the upper jaw", that did not in fact happen. See Harlow (1868) for a descrip­tion of the iron's path.[46]: 342 
  12. ^ Bigelow describes the iron's taper as seven inches long, but the correct dimension is twelve (corrected in the quotation).​[46]: 331 [3]: 26 
  13. ^ a b c Excerpted from Williams' and Harlow's statements in: Harlow (1848);[46]: 390,2  Bigelow (1850);[32]: 16  Harlow (1868).[1]: 335-6 
  14. ^ As to his own contribution to Gage's survival, Harlow merely averred, "I can only say ... with good old Ambro[i]se Paré, I dressed him, God healed him" [1]: 346 —​an assess­ment Macmillan (2000) calls far too modest.[3]: 12,59-62,346-7  See Macmillan (2008), Macmillan (2001) and Barker (1995) for further discuss­sion of Harlow's management of the case.[4]: 828-9 [20][13]: 679-80 
  15. ^ Harlow's notes for September 24: "Failing strength ... During the three succeed­ing days the coma deepened; the globe of the left eye became more protuberant, with fungus pushing out rapidly from the internal canthus ... also large fungi pushing up rapidly from the wounded brain, and coming out at the top of the head".[1]: 335  Here fungus does not mean an infecting mycosis but instead (Oxford English Diction­ary) a "spongy morbid growth or excrescence, such as exuberant granula­tion in a wound"​ (that is, part of the body's own reaction to the injury).[3]: 54,61-2 
  16. ^ Unlike Barnum's later circus, his Barnum's American Museum was not a traveling show but a station­ary installa­tion in New York City. There is no evidence Gage exhib­ited with a troupe or circus, or on a fair­ground (Macmillan & Lena 2010).[21]: 3-4 
  17. ^ Here reproduced from Jackson (1870),[50] these images were commis­sioned by Harlow from photo­grapher Samuel Webster Wyman and were the basis for the woodcuts seen in Harlow (1868).​[1]: 348 [3]: 26,115,479-80 
  18. ^ Apparently[21]: 6-7  quoting Gage's mother, Harlow narrates that
    while sitting at dinner, [Gage] fell in a fit, and soon after had two or three fits in succes­sion ... "[Phineas had] been ploughing the day before he had the first attack; got better in a few days, and continued to work in various places;" could not do much, changing often, "and always finding something which did not suit him in every place he tried." On the 18th of May, [1860][A] 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.[1]
  19. ^ Macmillan & Lena: "Only Harlow[1]: 342  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." [21]: 7 
  20. ^ Jackson (1870): "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." [50]: v 
  21. ^ Text of inscription from Macmillan (PGIP).[2]: D  The inscription's date for the accident is one day off, and Phinehas seems not to be how Gage spelled his name (Macmillan 2008).[4]: 839fig.  The inscrip­tion was commis­sioned by Harvard's Dr. Bigelow[citation needed] in prepara­tion for the iron's deposit in the Warren Anatomical Museum; the date following Gage's "signa­ture" corresponds to the latter part of the period during which Gage was in Boston under Bigelow's observa­tion.[citation needed]
  22. ^ Early authors attempting to estimate the extent of damage include: Harlow (1848);[46]: 389  Bigelow (1850);[32]: 21-2  Harlow (1868);[1]: 343,5  Dupuy (1877);[41] Ferrier (1878).[45] See also Bramwell (1888);[33] Tyler & Tyler (1982);[24] Cobb (1940, 1943).[36][37]
  23. ^ See Macmillan & Lena (2010);[21]: 9  Harlow (1868);[1]: 332,345  Bigelow (1850);[32]: 16-17  Harlow (1848);[46]: 390  Macmillan (2000).[3]: 86 
  24. ^ Specifically, Van Horn et al.[26] estimated that although "extensive damage occurred to left frontal, left temporal polar, and insular cortex, the best fit rod trajec­tory did not result in the iron crossing the midline as has been suggested by some authors"​ (such as H. Damasio). "Fiber pathway damage extended beyond the left frontal cortex to regions of the left temporal, parietal, and occipital cortices as well as to basal ganglia, brain stem, and cerebel­lum. Inter-hemi­spheric connec­tions of the frontal and limbic lobes as well as basal ganglia were also af­fected."​ (Quota­tions abridged to remove quantita­tive estimates of damage to each locus.)
  25. ^ Macmillan (2000)[3]: 106-8,375-6  also discusses potential reluctance on the part of Gage's friends and family (and of Harlow himself) to describe Gage negatively, especially while he was still alive, and argues[3]: 350-1  that an 1850 communica­tion calling Gage "gross, profane, coarse, and vulgar" was anony­mously supplied by Harlow.[citation needed]
  26. ^ For example, the "fitful, irreverent ... capri­cious and vacillating" Gage described in Harlow (1868)[1] is somewhat at variance with Gage's stage­coach work in Chile, which demanded 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"​ (Macmillan 2000,[3]: 106  citing Austin 1977)[31]—​and note Gage was hired by his employer in advance, in New England, to be part of the new coaching enterprise in Chile.[3]: 376-7 [4]: 831 
  27. ^ Though Macmillan (2000)[3]: 327  refers to the complete lack of informa­tion on Gage's sexual life, and Macmillan & Lena (2010)[21] discusses the continued absence of such informa­tion, curricu­lar materials at one medical school[51] go so far as to present Gage as having been "accused of sexually molesting young children".
  28. ^ See also Van Horn (2012):[26] "Macmillan has noted that many reports on Gage's behav­ioral changes are anecdotal, largely in error, and that what we formally know of Mr. Gage's post-accident life comes largely from the follow-up report of Harlow according to which Gage, despite the descrip­tion of him having some early difficul­ties, appeared to adjust moder­ately well for someone experienc­ing such a profound injury."
  29. ^ For end-of-life employ­ment difficulties see Macmillan (2000), p. 107; for misinter­pre­ta­tion and self-support, see Macmillan & Lena (2010) passim, as well as Kotowicz (2007): "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."
  30. ^ Kotowicz (2007),[17] which continues, "[A. Damasio's] account of Gage's last months [is] such a grotesque fabrica­tion that it leaves one baffled," then quotes A. Damasio (1994):[38]: 9 
    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 would put it decades later, and a few hundred miles to the south, "had come to Califor­nia to die".
    Kotowizc comments: "This little literary flourish is pure inven­tion ... There is something callous in insinuat­ing that Gage was some riff-raff who in his final days headed for Califor­nia to drink and brawl himself to death."

    Macmillan (2000)[3]: 116-119,326,331  gives detailed criticism of A. Damasio's various presenta­tions of Gage (some of them in joint work with H. Damasio and others).

  31. ^ Kihlstrom (2010).[16] See also Grafman:[15]: 295 : "Although the classic story of the nineteenth-century patient Gage who suffered a penetrat­ing PFC [pre­frontal cor­tex] lesion has been used to exemplify the problems that patients with ventromedial PFC 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" (citing Macmillan 2000).[3]
  32. ^ See for example Carlson (1994);[35]: 341  addi­tional examples and discus­sion are at Macmillan (2000).[3]: 246;252-3n9,10 
  33. ^ "[No one involved in the early development of psychosur­gery] argued that psychiat­ric patients would benefit from having disinhib­ited behaviors like [Gage's] deliberately induced in them"​ (Macmillan 2000).[3]: 250 
  34. ^ Fleischman (2002).[12]: 75  See also Kotowicz (2007): "There is coherence and dignity in the way Gage dealt with his predicament. He deserves deep respect." [17]
  35. ^ Macmillan & Aggleton (2011):[5] "Phineas' survival and rehabili­ta­tion demon­strated a theory of recovery which has influenced the treatment of frontal lobe damage today. [Macmillan explains,] 'There are something like 15 or 20 cases of people who've recovered from very serious frontal brain injury, of the kind that Phineas suffered from, without any profes­sional assis­tance. In every case, what's common in the reports is that someone, or something, has taken over the lives of these people and given them structure.' 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 worked as a stage-coach driver,' continues Professor Macmillan. 'The job is one that has got an external structure. You've got to be here for this part, then there's that part, then there's something else. Just as with these cases who have recovered.'"
  36. ^ a b Lena & Macmillan (2010),[6] citing also B. & J. Wilgus.. The image seen here is in the posses­sion of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey. (Gage had no known children—​see Macmillan 2000;[3]: 319,327  these are descendents of certain of his relatives—​see Macmillan & Lena 2010.)[21]: 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 (left-right) reversing early-process photograph; therefore a second, compen­sat­ing reversal has been applied here to show Gage as he appeared in life. The shirt and tie Gage is wearing in the Miller–​Hartley image are different from those seen in the Wilgus image, though he is wearing the same waistcoat in both, and possibly the same jacket.[10]
  37. ^ "Indeed, the recent discovery of daguerre­otype portraits of Mr. Gage show a 'hand­some ... well dressed and confident, even proud' man in the context of 19th-century portraiture. That he was any form of vagrant following his injury is belied by these remark­a­ble images."​ (Van Horn 2012,[26] quoting Wilgus 2009)[9]

Sources and further reading

For general audiences (Gage)
  1. ^ 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
    Harlow, John Martyn (1868). "Recovery from the Passage of an Iron Bar through the Head." Publ Massachusetts Med Soc 2:327–347. Open access icon
  2. ^ a b c d e f g h
    Macmillan, M. (PGIP). "The Phineas Gage Informa­tion Page". The University of Akron. Retrieved July 22, 2013. Includes:
    A. "Phineas Gage Sites in Cavendish". Open access icon
    B. "Phineas Gage: Unan­swered questions". Open access icon
    C. "Phineas Gage's Story". Open access icon
    D. "Correc­tions to An Odd Kind of Fame". Open access icon
    E. "Phineas Gage: Psychosoc­ial Adapta­tion". Open access icon
    F. "Phineas Gage and Frontal Loboto­mies". Open access icon
  3. ^ 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
    Macmillan, M. (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). Appendices reproduce Harlow (1848, 1849, and 1868), Bigelow (1850) and other key sources, some unavailable elsewhere. Open access icon
     • See also "Correc­tions to An Odd Kind of Fame". Open access icon
  4. ^ a b c d e f g h i j k l
    Macmillan, M. (2008). "Phineas Gage—​Unravell­ing the myth". The Psychologist 21(9):828–831. British Psychological Society. Open access icon
  5. ^ a b
    Macmillan, M.; 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}}: Check date values in: |date= (help); Unknown parameter |callsign= ignored (help); Unknown parameter |program= ignored (help)CS1 maint: multiple names: interviewers list (link) Open access icon

     For general audiences (portraits)
  6. ^ a b c d Lena, M.L. and M. Macmillan (2010). "Picturing Phineas Gage"​ (invited comment). Smithsonian. March 2010. p. 4 Open access icon
  7. ^ a b c Macmillan, M (July 2009). "More About Phineas Gage, Especially After the Accident". Retrieved July 27, 2013. {{cite web}}: Check date values in: |accessdate= (help) Open access icon
  8. ^ a b c Twomey, S. (2010). "Finding Phineas". Smithsonian. 40 (10): 8–10 (January 2010). Open access icon
  9. ^ a b c d Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1080/09647040903018402 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1080/09647040903018402 instead. Closed access icon
  10. ^ a b Wilgus, B. & J. "A New Image of Phineas Gage". Retrieved March 10, 2010. {{cite web}}: Check date values in: |accessdate= (help)CS1 maint: multiple names: authors list (link) Open access icon
  11. ^ a b Wilgus, B. & J. "Meet Phineas Gage". Retrieved October 2, 2009.{{cite web}}: CS1 maint: multiple names: authors list (link) Open access icon[full citation needed]

     For middle-school students
  12. ^ a b c Fleischman, J. (2002). Phineas Gage: A Gruesome but True Story About Brain Science. ISBN 0-618-05252-6. Open access icon

     For specialists
  13. ^ a b c d e f g Barker, F.G. II (1995) "Phineas among the phrenolo­gists: the American crowbar case and nineteenth-century theories of cerebral localiza­tion." J Neurosurg 82:672–682 Closed access icon
  14. ^ a b c Fuster, Joaquin M. (2008). The prefrontal cortex. Elsevier/Academic Press. p. 172. ISBN 0-12-373644-7.
  15. ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1093/acprof:oso/9780195134971.003.0019 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1093/acprof:oso/9780195134971.003.0019 instead.
  16. ^ a b 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. Open access icon
  17. ^ a b c d e Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1177/0952695106075178 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1177/0952695106075178 instead. Closed access icon
  18. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1016/0278-2626(86)90062-X , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1016/0278-2626(86)90062-X instead. Closed access icon
  19. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1076/0964-704X(200004)9:1;1-2;FT046 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1076/0964-704X(200004)9:1;1-2;FT046 instead. Closed access icon
  20. ^ a b c d Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1076/jhin.10.2.149.7254 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1076/jhin.10.2.149.7254 instead. Closed access icon
  21. ^ a b c d e f g h i j
    Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1080/09602011003760527 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1080/09602011003760527 instead. Closed access icon
  22. ^ a b c Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1056/NEJMicm031024 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1056/NEJMicm031024 instead. Open access icon
  23. ^ a b c Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1089/089771504774129964 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1089/089771504774129964 instead. Closed access icon
  24. ^ a b Tyler, K.L. and Tyler, H.R. (1982) "A 'Yankee Inven­tion': the celebrated American crowbar case". Neurology 32:A191.
  25. ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1207/S15328023TOP2702_02 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1207/S15328023TOP2702_02 instead. Open access icon
  26. ^ a b c d e Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1371/journal.pone.0037454 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1371/journal.pone.0037454 instead. Open access icon

     Of historical interest
  27. ^ a b "Horrible Accident". Boston Post. September 21, 1848. {{cite news}}: Check date values in: |date= (help)
  28. ^ a b 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.
  29. ^ a b c "Bibliographical Notice". Boston Medical & Surgical Journal. 3n.s. (7): 116–7. March 18, 1869. {{cite journal}}: Check date values in: |date= (help)
  30. ^ a b "Medical Intelligence. Extraordinary Recovery". Boston Medical & Surgical Journal. 3n.s. (13): 230–1. April 29, 1869. {{cite journal}}: Check date values in: |date= (help)
  31. ^ a b K.A. Austin (1977). A Pictorial History of Cobb and Co.: The Coaching Age in Australia, 1854–1924. Sydney: Rigby. ISBN 0-7270-0316-X.
  32. ^ a b c d e f g h i j
    Bigelow, Henry Jacob (1850). "Dr. Harlow's case of Recovery from the passage of an Iron Bar through the Head." Am J Med Sci 20:13–22 (July 1850). Reproduced in Macmillan (2000).[3]
  33. ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1136/bmj.1.1425.835 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1136/bmj.1.1425.835 instead. Open access icon
  34. ^ a b Campbell, H. F. (1851) "Injuries of the Cranium—​Trepan­ning". Ohio Med & Surg J 4(1), pp. 20–24, crediting the Southern Med & Surg J (unknown date)
  35. ^ a b Carlson, N.R. (1994). Physiology of Behavior. p. 341. ISBN 0-205-07264-X.
  36. ^ a b Cobb, S. (1940) "Review of neuropsychi­atry for 1940". Arch Intern Med 66:1341–54
  37. ^ a b Cobb, S. (1943) Borderlands of psychi­atry. Harvard Univ. Press.
  38. ^ a b c d e Damasio A.R. (1994). Descartes' Error: Emotion, Reason, and the Human Brain. ISBN 0-14-303622-X. (2nd ed.: 2005)
  39. ^ a b c Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1098/rstb.1996.0125 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1098/rstb.1996.0125 instead. Closed access icon
  40. ^ a b c d Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1126/science.8178168 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1126/science.8178168 instead.
  41. ^ a b c d Dupuy, E. (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 v. II pp. 356–8.
  42. ^ a b Folsom, A.C. (1869). "Extraordinary Recovery from Extensive Saw-Wound of the Skull". Pacific Medical and Surgical Journal. pp. 550–555. {{cite news}}: Unknown parameter |month= ignored (help)
  43. ^ 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.{{cite book}}: CS1 maint: multiple names: authors list (link) Open access icon
  44. ^ a b Ferrier, D. (1877–9) Correspondence with Henry Pickering Bowditch. Countway Library (Harvard Univ.) Mss., H MS c 5.2 (transcribed in Macmillan 2000, pp. 464–5).
  45. ^ a b c Ferrier, D. (1878) "The Goulstonian lectures of the localisa­tion of cerebral disease." Lecture I (concluded). Br Med J 1(900):443–7
  46. ^ a b c d e f g h i j k
    Harlow, John Martyn (1848). "Passage of an iron rod through the head". Boston Med & Surg J 39(20):389–393. Reproduced in Macmillan (2000).[3] Open access icon
  47. ^ a b c Harlow, John Martyn (1849). Letter in "Medical Miscellany." Boston Med & Surg J 39:506–7. Reproduced in Macmillan (2000).[3]
  48. ^ a b Hockenbury D.H. and Hockenbury S.E. (1997) Psychology.[full citation needed]
  49. ^ a b Jackson, J. B. S. (1849) Medical Cases (Vol. 4, Case 1777) Countway Library (Harvard Univ.) Mss., H MS b 72.4.
  50. ^ a b c d e f Jackson, J. B. S. (1870) A Descriptive Catalog of the Warren Anatomical Museum Frontis. and Nos. 949–51, 3106 (Republished in Macmillan 2000, in which see also p. 107). Open access icon
  51. ^ a b Nicholl, Jeffrey S., M.D. (2009). "Dementia Cases—​Problem #1". Neurology Clerkship. New Orleans: Tulane Univ. School of Medicine. Retrieved November 1, 2009.{{cite web}}: CS1 maint: multiple names: authors list (link) Open access icon
  52. ^ a b Sacks, Oliver (1995). An Anthropolo­gist on Mars. pp. 59–61. ISBN 0-679-43785-1. OCLC 30810706.
  53. ^ a b Sizer, Nelson (1888). Forty years in phrenol­ogy; embracing recol­lec­tions of history, anecdote, and experience. New York: Fowler & Wells. Open access icon
  54. ^ a b c d Smith, William T. (1886) "Lesions of the Cerebral Hemispheres". T Vermont Med Soc for the Year 1885. pp. 46–58. Open access icon
  55. ^ a b Stuss, D. T.; Gow, C. A.; Hetherington, C. R. (1992). " 'No longer Gage': Frontal lobe dysfunc­tion and emotional changes". Journal of Consulting and Clinical Psychology. 60 (3): 349–359. doi:10.1037/0022-006X.60.3.349. PMID 1619089. Closed access icon
Cite error: A list-defined reference with the name "okf" has been invoked, but is not defined in the <references> tag (see the help page).
[Fig. 17] Gage's skull, Warren Museum
Wikisource has original works by or about:
Phineas Gage
Wikimedia Commons has media related to Phineas Gage.
  • Macmillan, M. "Phineas Gage: Unan­swered questions".—​Lists research questions related to Gage in localities throughout the United States and Chile, for which Gage researchers request assis­tance from the public.
  • 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—​The story of how the owners of the 2009-identified daguerre­otype learned it depicted Gage.
  • Phineas Gage roadside memorial, Cavendish, Vermont

Template:Persondata

Retrieved from "https://en.wikipedia.org/w/index.php?title=Phineas_Gage&oldid=580558215"