A Wonderful Journey through Skull and Brains:The Travels of Mr. Gage’s

Tamping Iron

di M. B. MacmillanMonash University, Clayton, Victoria, Australia

Biographical Notes• September 9, 1823: Phineas gage borns in Lebanon,

New Hampshire, son of Jesse E. Gage e Hannah Sweatland, first of 5 children.

• September 13, 1848, 4.30 p.m.: the crowbar starts traveling...

• May 20, 5 1861 a.m.: He has a very severe sezure

• Phineas dies after a day and a night having convulsions...

“10 p.m., May 21, 1861 - twelve years six months and eight days after the date of his injury”

(Harlow, 1868)

Gage, Harlow said, was possessed of “a well-balanced mind”, and was looked upon by those

who knew him as a shrewd, smart business man, very energetic and persistent in executing

all his plans of operation

(Harlow, 1868)

[he was] regarded by his superiors as “the most efficient and capable in their employ”

(Harlow, 1868)

Tamping an explosive charge

The Tamping Iron and his owner

6 Kg

1,09 m

3,1 cm6,3 mm

30 cm

Gage was1,68 m talland weighed 68 Kg.

The accidentGage dropped the tamping iron

while distracted by his men,with his head turned towards them

The iron hit the rock, struck a spark,ignited the charge and immediately

reversed its initial direction(Harlow, 1848, 1868)

#1Powder and fuse were in, and Gage was waiting

for an assistant to pour the sand in the hole.While waiting, Gage turned his head away, and after some seconds he dropped the iron, as he

supposed sand was in.

#2

The real placesAfter emerging from the top of Gage’s head, the tamping iron continued high into the air, landing behind Gage, about 30m, from its launching place

(Harlow, 1848, 1868; Bigelow, 1850; Vermont Mercury, 22/9/1848)

Gage himself was “thrown upon his back and gave a few convulsive movements of the

extremities but spoke in a few minutes”(Harlow, 1848)

He then rode, unassisted, in the cart to his lodgings at Mr. Joseph Adam’s tavern, making

an entry in his time-book in the way.

“Doctor, hereis business

enough for you”

Williams, in Bigelow, 1850 et al.

Unknown damages

No postmortem studies were carried out immediately after Gage’s death, and they

would not have been very revealing, even had they been carried out, when his body was

exhumed some 5 or 6 years later.[There was] no certainty about the damage

it had done on the way.

The skull

Gage’s Skull

da “Ratiu P and Talos I-F. The Tale of Phineas Gage, Digitally Remastered. N Engl J Med 2004;351(23):e21”

da “Ratiu P and Talos I-F. The Tale of Phineas Gage, Digitally Remastered. N Engl J Med 2004;351(23):e21”

The first travel of the Tamping Iron

da “Ratiu P and Talos I-F. The Tale of Phineas Gage, Digitally Remastered. N Engl J Med 2004;351(23):e21”

Harlow’s treatment of GageLiberal doses of calomel, rhubarb and caster oil

Four circumstances worked in Gage’s Favor:•His physique, will and endurance;•the pointed shape and

smoothness of the missile reduced damage by concussion and compression;•the entrance through the base of the skull created a natural drainage point for the wound;•the portion of the brain traversed, was, for several reasons, the best fitted of any [...] to sustain the injury.

The treatment•Gage was in a semirecumbent position;•bone fragments got removed from inside the skull;•several pieces from the skull were reunited and applied with dressings;•the wound was kept clean and disinfected very often;•purging and blood letting “favourably influenced the outcome”.

These views were very in advance of his time!

The aftermath Gage

His desire to be out and to go home in Lebanon has been uncontrollable by his friends, and he has been making arrangements to that effect. Yesterday [14

November, 1848] he walked half a mile and purchased some small articles at the store. The atmosphere was

cold and damp, the ground wet, and he went without an overcoat, and with thin boots. He got wet feet and a chill.

(Harlow, 1848)

He is fitful, irreverent, indulging at times in the grossest profanity, manifesting but little deference for his fellows,

impatient of restraint or advice, obstinate, capricious, vacillating.His equilibrium between his intellectual faculties and his animal

propensities seems to have been destroyed.(Harlow, 1868)

He was “no longer Gage”

Three similar cases...

Noyes’ case (1882) of Lewis Avery

In September 1881, Avery’s musket exploded in his face. The breech pin had been driven through the skull above the right eye,

lodging in the right frontal lobe, destroying the tissue

around it.

The case of Lewis Avery

The case of Joel Lenn

The case of the mill worker[His head] had been cut open by a circular saw, 3 mm thick, spinning at 2000 rpm. The cut extended 1.3 cm above the nose for a distance of about 23 cm to the “occipital

protuberance” and was about 7,6 cm deep. 6 weeks later, he fully recovered.

Joel had had a blasting barrel shot through his head, through the right frontal and left temporal lobes,

lacerating the longitudinal sinus.Eight months later, Lenn was physically as well as ever.

(Jewett, 1868)

It has been frequently demonstrated, that a great part of the cerebrum may be taken away without destroying the animal, or even depriving it of its faculties; whereas the cerebellum will scarcely admit the smallest injury, without being followed by mortal symptoms.

(Pott, 1808, p. 148 &n.)

The localization debateMany cases are recorded in which large portions of the cerebrum have been lost without any immediate or subsequent derangement of the

mental and corporeal functions.(“The exploding gun case”, Tyrrell, Rogers, 1825)

Injuries of the head affecting the brain on are difficult to distinguish, doubtful in their character, treacherous in their

course, and for the most part fatal in their result.(Guthrie, 1842, p. 1)

“every part of the brain is not equally concerned in the execution of its functions”

The phrenologists debateDr. Franz Joseph Gall insisted that:•the external surface of the brain had a regular structure;•the convolutions were not randomly arranged.

He was the first to:•differentiate the gray and the white matter;•dissect the brain from below upward.

And finally, he was the most important contributor to the doctrine that the brain was the organ of the mind, in both intellectual and affective respects.

DeductionsGall showed that the faculty responsible for word-memory was located in the frontal lobes, more particularly in that

part which rested on the posterior roof of the orbit.He is credited with “the first complete description of aphasia

due to a wound of the brain”(Head, 1926, pp. 9-11)

Flourens concluded that the effect of ablation depended upon the amount of cortical tissue removed and not upon its location. He was wrong, basing his experiments on birds.

Magendie discovered that the dorsal roots of spinal nerves “seemed to be particularly destined for sensibility while the ventral roots seemed to be

especially concerned with movement”(Magendie, 1822)

The big turningMagendie couldn’t relate abstract functions

(hemisphere) with sensory-motor functions (“lower down in the nervous system”)

In the next decade, Marshall Hall discovered the spinal reflex, stating that “the motor nerves were distinct from sensation and voluntary or instinctive motion”

(Hall, 1832)

He studied the by-him-called “cerebral system”, that controlled respiration, swallowing, retention and expulsion of feces and urine, and ejaculation of semen.

He stated that “all these functions are strictly psychical. They imply consciousness.”

The brain as a pianistThe fibres of all the motor, cerebral and spinal nerves may be imagined as spread out in the

medulla oblongata, and exposed to the influence of the will like the keys of a piano-forte. The will

acts only on this part of the nervous system, but the influence is communicated along the

fibres by their action.(Müller, 1842, p. 934)

the Associationism theory:so close to how the brain works.

Every complex psychic process comes from simplerpsychic elements, “associated” among themselves

The right ideaFerrier maps motor centers in

over 30 animals, including monkey, and refers it to human brain.

He notes that ablating frontal lobes in monkeys make them apathetic,

without the faculty of attentive and intelligent observation

(Ferrier, 1876, pp. 231-232)

The idea the frontal lobes have an inhibitory function begins being accepted

by Ferrier...

The “cordo-cephalic” progression goes on.

In 1940s, Moniz starts lobotomizing patients.

Localizing the speechBouillaud first distinguished between losses due to

distruction of “the organ for the memory of words” and those due to the “alteration of the nervous principle

which presides over the movements of speech”(Bouillaud, 1825)

Offers a 500 francs prize for anyone who could produce a case with severe frontal lobe lesion without loss of speech

Auburtin confirms it, without the money prize

Broca joins the debate. The second case he presents, aphasia connected

to a circumscribed lesion of the second and third frontal

convolutions, clinches the matter.

Gage was first counted against Broca

localization of speech, then dr. Hammond

(1871) noted that the third frontal convolution

[...] escaped all injury.

Damasio H, Grabowski TJ, Frank RJ, Galaburda AM, Damasio AR, "The Return of Phineas Gage: Clues About the Brain from the Skull of a Famous Patient," Science, Vol 264, 20 May 1994.

Gage and phrenology

It’s more than likely than young Dr. Harlow was influenced by phrenology.

Fowler and Wells lectures in New England...

According to phrenologists, the tamping iron had gone in “[...] the neighborhood of Benevolence and

the front part of Veneration.”(Sizer, 1882, pp. 193-194)

Does the slightly downcast expression discernible on

Gage’s life mask foreshadow his disappointment with the status finally granted to him?

ReferencesPer i contributi non specificati:

M. B. Macmillan, A Wonderful Journey through Skull and Brains: The Travels of Mr. Gage’s Tamping Iron, Brain and Cognition 5, 67-107 (1986)

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