Phineas Gage: Traumatic Brain Injury

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On September 13th 1848 Phineas Gage was working as part of a crew cutting a railroad in the bedrock of Vermont. Gage was using a tamping iron to pack explosives into a hole. The tamping iron - 1 metre long, 3 cm in diameter and roughly 6 kilograms in weight – ignited the explosives and shot the iron rod through the foramens left cheek, ripped into his brain and exited through his skull, before landing several metres away [1].

Blinded to his left eye with traumatic brain injury, when Mr Gage was presented to Dr John Harlow, he is reported to have remained lucid enough to tell a doctor, “Here is business enough for you”[1].

Such injury would inevitably cause notoriety amongst the locals, but instead, Dr Harlow etched it into history books
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He found work as a stable hand in New Hampshire, drove coaches in Chile and eventually joined relatives in San Francisco, where he died in May 1860, at the age of 36 [1-3].

An Odd Kind of Fame: Stories of Phineas Gage, by Malcolm Macmillan writes that two-thirds of introductory psychology textbooks mention Gage. Today, his skull, the tamping iron and a mask of his face made while he was alive are the most sought-out items at the Warren Anatomical Museum on the Harvard Medical School campus [1, 4].

For specialists, this was a staggering revelation. For the first time, this was evidence that damage to the brain could affect our behaviour and personality. Soon after the accident, different brain specialists used evidence from Phineas' case to support their own theories about the way the brain worked. Those in favour of localisation - the idea that different parts of the brain had different tasks - said his changes in personality vindicated their position. While others believed the fact that Phineas had survived at all showed that all parts of the brain could do everything and that one part could take over when another had failed. Clearly the one thing they all agreed on was that ones environment could have a dramatic affect on a person’s mental wellbeing [1,

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