The Orange Garage: Phineas Gage

In this year's anatomy class the teacher wanted to review some of the material from last year's head and neck portion by having us wax up the various structures and "reverse dissect" them onto plastic skulls. He gave us a list of required structures then informed us that if we do them perfectly we will get an 80% for the project. To get a higher grade we have to include "a little something extra," whether that be additional structures or some sort of pathology. I decided to do a model of Phineas Gage.

On September 13, 1848, 25-year-old Phineas Gage was blasting rock for the Rutland & Burlington Railroad. After a hole was bored into a body of rock, one of Gage's duties was to add blasting powder, a fuse, and sand, then compact the charge into the hole using a tamping iron. After forgeting to add the protective sand, he proceeded to tamp down the charge. The tamping rod was rapidly ejected from the hole when the powder ignited. The iron entered on the side of his face...passing back of the left eye, and out at the top of the head, then flew an additional 80 yards.

Phineus was conscious for the ride back into town and even was able to sit up in the wagon, the following is a report from the first attending physician.

Dr. Edward H. Williams “I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. 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, which fell upon the floor”

The common story told is how he later became erratic, violent, and unable to hold employment, common symptoms of having bits of grey matter pop out through the top of your skull, but this seems to have only been temporary. He later was able to secure work as a stage coach driver, which he did for many years, then died with family in San Francisco.

There are several other cool parts to this story. The first is that when I first learned about this guy back in a neuroanatomy course there were no known surviving pictures. Then just in 2009 an antique collector uploaded some pictures labeled as "the whaler." Turns out it was Phineas himself...thank you awesome internet.

Another awesome factoid is that he carried that tamping rod with him for the rest of his life. I imagine it was an excellent conversation starter. Here is the other daguerreotype, once again sporting his tamping rod.