This is the true tale of Phineas P. Gage, the healthy, muscular 25-year-old foreman for a Rutland & Burlington Railroad excavating crew. Reportedly well-liked and respected by his workers, his employers also found him capable and efficient with a well-balanced mind. More, he was also said to be a shrewd and smart businessman and seems to have been an all-around fine fellow. But on September 13, 1848, in Cavendish, Vermont, while engaged in a blasting operation, the powder used for the blasting process was accidentally discharged resulting in a calamitous series of events. They began when Gage’s iron tamping rod, 3 ft.7 in. long, 1-1/4 inches wide at its widest end (imagine something about the length of an average broom handle but a bit wider at one end and tapered to a point at the other, and smooth from wear of being used to tamp the powder into place), was accidentally dropped onto the powder. When metal rod struck hard ground it caused a spark much as a flint in a cigarette lighter does, and the powder ignited prematurely. The explosion hurled the rod forth like a missile.

Such were the positions of rod and foreman Gage, it speared its way completely up through Gage’s face behind his cheekbone and thence through his head, piercing his brain through the frontal lobe on the way, leaving his jaw shattered and a huge gaping hole in the top of his skull.

Amazingly Gage survived the accident. Some of the hole in his skull was filled in by bone pieces replaced by his physician, and presumably his skin healed over it, but thereafter his personality was completely changed. He became irreverent and grossly profane and exhibited an erratic personality, was impatient and obstinate, and his former employers found him no longer employable. Eventually he suffered a series of epileptic seizures, and died 12 years after the accident - more likely from bloodletting treatments for the seizures than as a result of the accident.

There are 3 places where Gage's skull is damaged. There is a relatively small area under the zygomatic arch (or cheek bone) where the tamping iron first impacted. The second place is the orbital bone of the base of the skill behind the eye socket. After healing this area is about 1 inch wide by 2 inches in the anterior-posterior direction and must have been larger at the time of injury (upper left of left image). The total area of bone damage cause by the tamping iron where it emerged is truly enormous. As can be seen in the middle image, there is an unhealed irregular, roughly triangular shaped area of total bone destruction at the top of the skull. Lying mainly to the left of the midline, it is about 2 inches wide and 4 inches in circumference, and there is another on the lower left side about 2.7 inches in circumference. Between them there is a flap of frontal bone about 2.5 inches long and about x 2 inches wide at the widest point (far right image). Behind the main area is a second flap of parietal bone about 2 wide and 0.75 to 1.5 inches long. Harlow replaced both flaps; the rear (parietal) reuniting so successfully that it is actually difficult to see from outside the skull. In the far right image it has been copied from a photograph of the underside of the skull and "pasted" to the outside.

http://www.deakin.edu.au/hbs/GAGEPAGE/Pgdamage.htm

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