The remarkable story of Phineas P. Gage

This is Mr Phineas P. Gage. Born in July 9, 1823 in New Hampshire and died on May 21 1860 aged 36. If this name sounds at all familiar, you will know this story, because it DOES NOT LEAVE YOU.

Little is known about Gage’s childhood. By age 25, Gage was a blasting foreman working on railway construction programs. His employers saw him as a “most efficient and capable foreman…” At this time, setting a blast meant drilling a deep hole into an outcrop of rock, adding blasting powder (basically gunpowder) then packing an inert material such as clay or sand with a tamping iron, which was simply a large rod.
Phineas was very proud of his custom made 1 meter (3 feet seven inches), 6 kilogram (13.25 pounds) tamping iron with the inscription ‘Phinehas P. Gage at Cavendish, Vermont, Sept. 14, 1848’ This iron was in the shape of a javelin, cylindrical, smooth and round.
This is what Phineas P. Gage was doing on 13th September, 1848 when at round 4:30pm, Gage’s attention was attracted to his co-workers behind him. As ol’ Phineas opened his mouth to speak, the tamping iron sparked against the rock, and the gunpowder exploded. A big new projectile was formed in the heavy tamping iron. Phineas’s pride and joy entered the left side of his face, just forward of the lower jaw. It’s next stop was the upper jaw, the cheekbone, just behind the left eye, through the left side of Gage’s brain and out through the top of his skull. It landed point first 25 meters (80 feet), qoute “Smeared with blood and brain”.
What follows is not for the faint of heart
Gage was thrown on his back, gave some brief convulsions, and started speaking a few minutes later. He Walked with little help to an oxcart, in which he was able to sit perfectly upright for the 1.2km (3/4 mile) ride to his lodgings in town. About 1/2 and hour after the accident, Edward H. Williams, a physician was greeted by Gage sitting in a chair outside the hotel. The following is a recount from Williams.
When I drove up he said, “Doctor, here is business enough for you.” 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 [through the exit hole at the top of the skull], which fell upon the floor.
The Town doctor, John Martyn Harlow took over the case at around 6 pm. He said that Gage “… bore his sufferings with the most heroic firmness.” With Williams’ assistance, Harlow shaved the area around Phineas’ brain hole then removed coagulated blood, small bone pieces and 30 grams (1 ounce) of protruding brain matter. After probing for foreign bodies and replacing 2 large pieces of bone, they closed the wound with adhesive straps, leaving it partially open to drain. A wet compress was applied and a nightcap and extra bandaging to secure the dressings.
Gage also had burns to his face, hands and forearms which were tended to, but let’s be real here. That was not his biggest problem.
Harlow said that Gage had a clear mind and believed that he will be back to work in a couple of days.
Phineas was able to recognise his aunt and uncle on the morning after the incident, however by the second day he had become “decidedly delirious” and had lost his mind. By the fourth day, he was back to being rational and recognising his friends. After another week of improvement, Harlow believed that it was possible for Phineas to recover. 12 days after the accident, Gage became semi-comatose, hardly speaking, unless spoken to, and even then only in one syllable words. The next day, Gage had worsened, and his left eye started sticking out of it’s socket. A fungal infection had set in. By the 14th day, Harlow wrote : “The exhalations from the mouth and head [are] horribly fetid. Comatose, but will answer in monosyllables if aroused. Will not take nourishment unless strongly urged. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness.”
Our hero, it seemed was done for. Harlow, however, was a stubborn son of a bitch. He treated the infection, and on day 24, Gage rose himself and walked a step to his chair. Another month later, had was walking around town. He developed a fever after wearing an overcoat and thin boots, but recovered by mid-November.
Gage returned to his hometown of Lebanon, New Hampshire a mere 10 weeks after his accident. He arrived “feeble and thin” but by late December he was improving both mentally and physically. By February 1849 he was “able to do a little work about the horses and barn, feeding the cattle etc. [and] as the time for ploughing came [i.e. about May or June] he was able to do half a day’s work after that and bore it well”.
Harlow wrote that “physically, the recovery was quite complete during the four years immediately succeeding the injury”.
From 1849 to 1852, Gage spent some time at Barnum’s American Museum and toured New Hampshire and Vermont. During this time, he worked for 18 months, he worked for the owner of a coach service in Hanover, New Hampshire.
For the next 7 years, Gage worked as a long-distance stagecoach driver in Chile on the Valparaiso-Santiago route. By mid 1859, Phineas left Chile for San Francisco because his health was failing. His mother wrote that he arrived “in a feeble condition, having failed very much since he left New Hampshire … Had many ill turns while in Valparaiso, especially during the last year, and suffered much from hardship and exposure.”
In February of 1860, Phineas began to have epilectic seizures. These seizures worsened until on the 20th of May, 1860 at around 5 am, Phineas P. Gage died in status epilepticus.

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