Phineas Gage's
Tamping Iron

PHINEAS P. GAGE: Foreman of a railway construction crew preparing the railbed for the Rutland and Burlington Railroad just outside of Cavendish, Vermont. He was the company's most capable and efficient foreman, with a well-balanced mind and a shrewd business sense.

TAMPING IRON: a crowbar-like tool used to compact an explosive charge into the bottom of a bore hole. 3 feet 7 inches in length; 1-1/4 inches in diameter at one end tapering over a distance of about 1 foot to a diameter of 1/4 inch at the other end; and weighing 13-1/2 pounds.

SEPTEMBER 13, 1848: the accidental explosion of a charge Gage had just set blew his tamping iron out of the borehole and through the left side of his skull: it entered point first under his left cheek bone, exited through the top of his head and landed some 25 to 30 yards away. Gage was knocked over but may not have lost consciousness, according to some accounts. Most of the left frontal lobe was destroyed, but Gage was treated with such skill by Cavendish physician Dr. John Harlow that he returned to his home in Lebanon, New Hampshire by December.

Just seven months later, Gage was strong enough to resume work, but despite exemplary work prior to the accident, his employer would not return him to his former position. He had become fitful, irreverent, and grossly profane, showing little deference for other workers. Impatient and obstinate yet capricious and vacillating, he was unable to settle on any of the plans he devised for future action. According to his friends, he was "No longer Gage".

Gage never again worked at the level of foreman, instead performing a variety of odd jobs. He appeared at Barnum's Museum in New York; worked in the stable of the Dartmouth Inn in Hanover, New Hampshire; and drove coaches and cared for horses in Chile. Sometime in 1859, as his health began to fail, he went to live with his mother in San Francisco. Seizures commenced in February, 1860 and he died on May 21.

No post mortem studies were made. In 1867, Gage's body was exhumed from San Francisco's Lone Mountain Cemetery. The skull and the famous tamping iron were delivered by his brother-in-law to Dr. Harlow (then living in Woburn, Massachusetts). Harlow reported his findings, including his estimate of the brain damage, in 1868. The skull and tamping iron were donated to the Warren Museum at Harvard University's School of Medicine, where they remain on display.

The case created a good deal of interest in both medical and lay circles at the time and which continues to this day. Gage had survived a horrendous injury; his case began to have an influence on the science of localization of brain function. For nearly twenty years knowledge of the profound personality change was not widely disseminated. It was true that he was physically unchanged except for obvious scars, and that his mental capacity was unchanged.

But, without knowledge of the personality difference, most people thought he had survived totally unchanged. His case was therefore used as evidence against the doctrine that any functions were localized in the brain, especially against the phrenological version of it. Later it was also used as negative evidence in the medical debates regarding aphasia and frontal lobe function. The real story was published after 1868 by David Ferrier, the notable English doctor and physiological research worker. Even today, the case continues to generate controversy.

There is more info about Phineas Gage here.

More information about Phineas Gage is contained in the following publications:

1. J.M.Harlow's original reports and H.J.Bigelow's comment: J.M.Harlow (1848).

Passage of an iron rod through the head. Boston Medical and Surgical Journal 39, 389-393.

J.M.Harlow (1868). Recovery from the passage of an iron bar through the head. Publications of the Massachusetts Medical Society, 2, 327-347 (also in booklet form published in Boston in 1869 by D.H.Clapp. H.J.Bigelow (1850).

Dr. Harlow's case of recovery from the passage of an iron bar through the head. American Journal of the Medical Sciences, 19,13-22.

More recent comments:

2. H.Damasio, T.Grabowski, R. Frank, A.M.Galaburda, and A.R.Damasio (1994). The return of Phineas Gage: The skull of a famous patient yields clues about the brain. Science, 264, 1102-1105. A.R.Damasio (1994), Descartesí Error. New York: Gross/Putnam

M.B.Macmillan (1996). Phineas Gage; A case for all reasons. In C Code, C.W.Wallesch, A.R.Lecours, and Y.Joanette (Eds.), Classic Cases in Neuropsychology (pp.243-262). East Sussex: Erlbaum.

M.B.Macmillan (1986). A wonderful journey through the skull and brains: The travels of Mr. Gage's tamping iron. Brain and Cognition, 5, 67-107.

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October 14, 2013