Phineas Gage

September 13, 1848 marked the day that Phineas Gage, a twenty –six year old foreman of a railroad construction outfit, experienced a horrific accident that not only changed his life forever but impacted man’s scientific understanding of the brain, both then and today. In Cavendish, Vermont, Phineas’ job was to blast solid rock into pieces small enough for his crew to dislodge and haul away. Necessary to conduct his job was a special tool, called a tampering iron. His custom-made tool was 3 feet, 7 inches long, weighing thirteen and a half pounds. The fat end of the tool was one and three quarters in diameter and the other end came to a sharp narrow point. To prepare an area for demolition, an explosive material was placed in a hole, a rope-like wick was implanted and more explosive material packed around. On this day an error in preparation caused a premature explosion, which shot the tampering rod through Phineas’ left under eye area and exited from the top of his head, where it landed approximately thirty feet away from him. He lived another eleven years, six months and nineteen days, eventually dying from this injury.
As most would conjecture, this occurrence should have caused immediate death. Surprisingly, he was talking to his men while in the back of an oxen-drawn cart into town. In fact, he was sitting on the porch of his hotel when the town’s physicians Dr. Edward Williams and Dr. John Harlow arrived. Although bleeding profusely, he remains “alert, uncomplaining, and still telling anyone who’ll listen about the accident” (Fleischman, 8-9). Subsequent to the incident, the profuse bleeding should have killed him. After that, swelling to the brain caused by the bleeding should’ve surely caused him to die. Also, the accident occurred before the understanding of bacteria and the causes of infection, no antibiotics existed, and sterile conditions were non-existent. Many attribute his survival to either luck or God.
Dr. Harlow took over his care as the town’s primary physician. He walked Phineas up the stairs to his bedroom, shaved his head, and dressed his wound. He did this without a sterile environment or even washing his hands. It was noted in Dr. Harlow’s medical records that indeed there was a hole in his head, which science has later confirmed that this is why there was no swelling in his brain as he had an ‘open’ injury vs. a ‘closed’ injury (referred to as a concussion today). He developed an infection a couple weeks after the accident in which the prescribed treatment was to drain the abscess. He physically improved and was pronounced healed just ten weeks after the accident. However, though apparently physically healed, Phineas had changed in character significantly from his prior self.
Previously a respected, efficient and capable foreman, Phineas insulted his colleagues, was unreliable in terms of showing up to work and extremely vulgar and cruel in his language. He was now impatient, quickly angered, and as is described throughout the book, has become void of social abilities. Phineas migrates towards animals and young children since his accident, and although he can understand logic, often his choices are not based on logic, but some innate desire.
Two years after the accident in 1850, Dr. Harlow brings Phineas to Harvard Medical College in Boston for examination. At the time of his accident there were two prevalent theories. The Whole Brain theory believed that the brain is one interconnected mind and that thoughts and commands can originate anywhere in the brain. The opposing theory, called Localizers or Phrenologists believe that the brain is divided into specific areas or organs that control specific things. We do know that specific areas of the brain control specific functions and behaviors, but not always as logically as thought back then. A plaster mold of Phineas head was taken which was used to mainly support/explain the Phrenologist