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Phineas P. Gage
The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"—​his inscribed tamping iron​
Born	July 9, 1823 (date uncertain) Grafton Co., New Hampshire
Died	May 21, 1860(1860-05-21) (aged 36) In or near San Francisco
Cause of death	Status epilepticus
Resting place	Warren Anatomical Museum, Boston (skull) Cypress Lawn Memorial Park, California (other remains)
Occupations	Railroad construc­tion foreman blaster stagecoach driver
Known for	Personality change after brain injury
Spouse	None
Children	None

Phineas P. Gage (1823–1860) was an American railroad construc­tion foreman remembered for his improba­ble surviv­al of an accident in which a large iron rod was driven completely through his head, destroy­ing much of his brain's left frontal lobe, and for that injury's reported effects on his personal­i­ty and behavior over the succeed­ing twelve years—​effects so profound that (for a time at least) friends saw him as "no longer Gage."

Long known as "the American Crowbar Case"—​once termed "the case which more than all others is calculated to excite our wonder, impair the value of prognosis, and even to subvert our physio­log­i­cal doctrines" —​Phineas Gage influenced nineteenth-century discus­sion about the mind and brain, particu­lar­ly debate on cerebral localiz­a­tion, and was perhaps the first case to suggest that damage to specific parts of the brain might affect personality.​

Gage is a fixture in the curricula of neurology, psychology and related disciplines, and is frequently mentioned in books and academic papers; he even has a minor place in popular culture. Despite this celebrity the body of established fact about Gage and what he was like (before or after his injury) is remark­a­bly small, which has allowed "the fitting of almost any theory to the small number of facts we have" —​Gage having been cited, over the years, in support of various theories of the brain entirely inconsist­ent with one another. A survey of published accounts, includ­ing scientif­ic ones, has found that they almost always severely distort Gage's behavior­al changes, exaggerat­ing the known facts when not directly contradict­ing them.

Two photographic portraits of Gage, and a physician's report of his physical and mental condition late in life, were announced in 2009 and 2010. This new evidence indicates that Gage's most serious mental changes may have been temporary, so that in later life he was far more functional, and socially far better adjusted, than was previously assumed. A social recovery hypothesis suggests that Gage's employment as a stagecoach driver in Chile provided daily structure allowing him to relearn lost social and personal skills.

Background

The subject of it was Phin. P. Gage, a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temper­a­ment, five feet six inches in height, average weight one hundred and fifty pounds, possess­ing an iron will as well as an iron frame; muscular system unusually well dev­el­oped—​having had scarcely a day's illness from his childhood to the date of this injury.

Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage, of Grafton County, New Hampshire. Little is known about his upbringing and education, but he was almost certainly literate.​

He may have gained skill with explosives on the family's farms or in nearby mines and quarries,​ and by the time of his accident he was a blasting foreman (possibly an independ­ent contract­or) on railway construc­tion projects. His employers consider­ed him (as his physician later put it) "the most effi­­cient and capable foreman in their employ ... a shrewd, smart business­man, very energetic and persist­ent in executing all his plans of operation", and he had even commis­sioned a custom-made tamping iron—​an iron rod three feet seven inches long, and 1+1⁄4 inches (32 mm) in diameter—​for use in setting charges.

Gage's injury

External videos
Video reconstruction of tamping iron passing through Gage's skull (Ratiu et al. 2004)​

The accident occurred in Cavendish, Vt., on the line of the Rutland & Burling­ton Railroad, at that time being built, on the 13th of Septem­ber, 1848, and was occa­sioned by the premature explosion of a blast, when this iron, known to blasters as a tamping iron, and which I now show you, was shot through the face and head.

On September 13, 1848 Gage (aged 25) was directing a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. Setting a blast involved boring a hole deep into an outcropping of rock; adding blasting powder, a fuse, and sand; and then compact­ing this charge into the hole using the tamping iron.

Gage was doing this around 4:30 p.m. when (possibly because the sand was omitted) the tamping iron struck a spark against the rock and the powder exploded. The tamping iron rocketed out of the hole and "entered on the side of his face ... passing back of the left eye, and out at the top of the head." 

Despite 19th-century references to Gage as "the American Crowbar Case"  his tamping iron did not have the bend or claw sometimes associated with the term crowbar; rather, it was simply a cylinder, "round and rendered comparatively smooth by use":​

The end which entered first is pointed; the taper being inches long ... circumstances to which the patient perhaps owes his life. The iron is unlike any other, and was made by a neighbouring blacksmith to please the fancy of its owner.

Weighing 13+1⁄4 pounds (6 kg) this "abrupt and intrusive visitor"  was found some 80 feet (25 m) away, "smeared with blood and brain." 

Initial treatment

Gage "was thrown upon his back by the explosion, and gave a few convulsive motions of the extremities, but spoke in a few minutes,"  walked with little assistance, and sat upright in an oxcart for the +3⁄4-mile (1.2 km) ride to his lodgings in town. Dr. Edward H. Williams arrived some thirty minutes after the accident:

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, which fell upon the floor.

Dr. John Martyn Harlow took charge of the case about 6 p.m.:

You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. Pulse 60, and regular. His person, and the bed on which he was laid, were literally one gore of blood.

Convalescence

Despite Harlow's skillful care, Gage's recuperation was long and difficult. Pressure on the brain left him semi-comatose from September 23 to October 3, "seldom speaking unless spoken to, and then answering only in monosyllables. The friends and attendants are in hourly expectan­cy of his death, and have his coffin and clothes in readiness." 

But on October 7 Gage "succeeded in raising himself up, and took one step to his chair". One month later he was walking "up and down stairs, and about the house, into the piazza," and while Harlow was absent for a week, Gage was "in the street every day except Sunday," his desire to return to his family in New Hampshire being "uncontrol­la­ble by his friends ... got wet feet and a chill." He soon developed a fever, but by mid-November he was "feeling better in every respect ... walking about the house again; says he feels no pain in the head". Harlow's prognosis at this point: Gage "appears to be in a way of recovering, if he can be controlled." 

Subsequent life and travels

His mother, a most excellent lady, now seventy years age, informs me that Phineas was accust­omed to entertain his little nephews and nieces with the most fabulous recita­tions of his wonderful feats and hair-breadth escapes, without any found­at­ion except in his fancy. He conceived a great fondness for pets and souvenirs, especially for children, horses and dogs—​only exceeded by his attachment for his tamping iron, which was his constant companion for the remainder of his life. He took to travelling ...

Injuries

By November 25 Gage was strong enough to return to his parents' home in Lebanon, New Hampshire, where by late December he was "riding out, improving both mentally and physically." In April 1849 he returned to Cavendish and paid a visit to Harlow, who noted at that time loss of vision (and ptosis) of the left eye, a large scar on the forehead, and

upon the top of the head ... a deep depression, two inches by one and one-half inches wide, beneath which the pulsations of the brain can be perceived. Partial paralysis of the left side of the face. His physical health is good, and I am inclined to say he has recovered. Has no pain in head, but says it has a queer feeling which he is not able to describe." 

New England

Harlow says that Gage, unable to return to his railroad work, appeared for a time at Barnum's American Museum in New York City (the curious paying to see, presum­a­bly, both Gage and the instrument which had injured him) although there is no independ­ent confirmation of this. Recently, however, evidence has surfaced support­ing Harlow's statement that Gage made public appearances in "the larger New England towns". He subsequently worked in a livery stable in Hanover, New Hampshire.​

Chile and California

In August 1852 Gage was invited to Chile to work as a long-distance stagecoach driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the Valparaiso–​Santiago route. After his health began to fail around 1859, he left Chile for San Francisco, where he recovered under the care of his mother and sister (who had gone there from New Hampshire around the time Gage went to Chile). For the next few months he did farm work in Santa Clara.​

Death and subsequent travels

It is regretted that an autopsy could not have been had, so that the precise condition of the enceph­a­lon at the time of his death might have been known. In considera­tion of this important omission, the mother and friends, waiving the claims of personal and private affection, with a magnanim­i­ty more than praise­wor­thy, at my request have cheerful­ly placed this skull (which I now show you) in my hands, for the benefit of science.

I desire, here, to express gratefully my obligation, and those of the Profes­sion, to D. D.  Shattuck, Esq., brother-in-law of the deceased; to Dr. Coon, Mayor of San Francisco, and to Dr. J. D. B. Stillman, for their kind coopera­tion in executing my plans for obtaining the head and tamping iron, and for their fidelity in personally superin­tend­ing the opening of the grave and forward­ing what we so much desired to see.

In February 1860 Gage had the first in a series of increasingly severe convulsions. Apparently quoting Gage's mother, Harlow narrates that

hile sitting at dinner, he fell in a fit, and soon after had two or three fits in succession. ..." been ploughing the day before he had the first attack; got better in a few days, and continued to work in various places;" could not do much, changing often, "and always finding something which did not suit him in every place he tried." On the 18th of May, he left Santa Clara and went home to his mother. At 5 o'clock, A. M., on the 20th, he had a severe convul­sion. The family physician was called in, and bled him. The convulsions were repeated frequently during the succeed­ing day and night.

Gage died status epilepticus  in or near San Francisco at 10 p.m. on May 21, just under twelve years after his injury. He was buried in San Francisco's Lone Mountain Cemetery. (Many accounts assert that Gage's iron was buried with him, but there appears to be no evidence for this.)

Skull and iron

In 1866 Harlow (who had "lost all trace of , and had well nigh abandoned all expecta­tion of ever hearing from him again") somehow learned that Gage had died in California, and initiated a correspondence with Gage's family there. At Harlow's request they opened Gage's grave long enough to remove his skull, which the family then personally delivered to Harlow back in New England.

About a year after the accident, Gage had been persuaded by Bigelow to deposit his tamping iron in Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it and made what he called "my iron bar" his "constant companion during the remainder of his life"; now it too was delivered to Harlow. After studying them for a triumphal retrospective paper on Gage Harlow redeposited the iron—​this time with Gage's skull—​in the Warren Museum, where they remain on display today. The iron bears this inscription:

This is the bar that was shot through the head of M Phinehas P. Gage at Cavendish, Vermont, Sept. 14, 1848. He fully recovered from the injury & deposited this bar in the Museum of the Medical College of Harvard University. Phinehas P. Gage Lebanon Grafton Cy N–H Jan 6 1850.

Much later Gage's headless remains were moved to Cypress Lawn Cemetery as part of a systematic relocation of San Francisco's dead to new burial places outside city limits.

Brain damage and mental changes

Extent of brain damage

The favoring circumstances ... I will name briefly:

• 1st. The subject was the man for the man for the case. His physique, will, and capacity of endurance could scarcely be excelled.
• 2nd. The shape of the missle—​being pointed, round, and comparatively smooth, not leaving behind it prolonged concussion or compression.
• 3rd. The point of entrance outside of the superior maxillary bone—​the bolt did little injury until it reached the floor of the cranium, when, at the same time that it did irreparable mischief, it opened up its way of escape, as without this opening in the base of the skull, for drainage, recovery would have been impossible.
• 4th. The portion of the brain traversed, was, for several reasons, the best fitted of any part of the cerebral substance to sustain the injury.

The amount of Gage's brain tissue destroyed must have been substant­ial (consider­ing both the initial trauma and the subsequent infection) but debate as to whether this was in both frontal lobes, or primarily the left, began with the earliest papers by physicians who had examined Gage. The 1994 conclusion of H. Damasio et al., that both frontal lobes were damaged, was drawn by modeling not Gage's skull but a "Gage-like" one. Ratiu et al. (2004, using CT scans of Gage's actual skull, and present­ing a video reconstruction of the tamping iron passing through it) confirm Harlow's conclusion (based on probing Gage's wounds with his finger) that the right hemisphere remained intact. Van Horn et al. (2012) agree that the right hemisphere was undamaged and make detailed estimates of the locus and extent of damage to Gage's white matter, suggest­ing that this damage may have been more significant to Gage's mental changes than the cerebral cortex (gray matter) damage.

First-hand reports of mental changes

It is due to science, that a case so grave, and succeeded by such remark­a­ble results, should not be lost sight of; that its subsequent history, termination, and pathological evidences, in detail, should have a permanent record. My desire to lay before the profession the sequel of this case, has not permitted me to remain altogether oblivious as to the whereabouts of my patient, and after tracing him in his wanderings over the greater part of this continent, I am able to present to you indubitable evidence that my report of the case, in the Boston Medical and Surgical Journal, was no fiction.

Gage certainly displayed some kind of change in behavior after his injury, but the nature, extent, and duration of this change are very uncertain: little is reliably known about what Gage was like (either before or after the accident), the mental changes described after his death were much more dramatic than anything reported while he was alive, and the few descriptions which seem credible do not specify the period of his post-accident life to which they are meant to apply.

Harlow's 1848 report

In his 1848 report, as Gage was just completing his physical recovery, Harlow had only hinted at possible psycho­log­i­cal symptoms: "The mental manifestations of the patient, I leave to a future communication. I think the case ... is exceedingly interest­ing to the enlightened physiologist and intellectual philosopher."  And after observing Gage for several weeks in late 1849, Harvard Professor of Surgery Henry Jacob Bigelow (in keeping with his anti-localization­ist training) went so far as to say that Gage was "quite recovered in faculties of body and mind," there being only "inconsiderable disturbance of function".

Harlow's 1868 report

Not until 1868 did Harlow (having obtained Gage's skull, tamping iron, and final history) deliver the "future communication" he had promised twenty years earlier, detailing the mental changes found today in most presentations of the case (though usually in exaggera­ted or distorted form—​see next section). In memorable language, Harlow now described the pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ". But these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again":

The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifest­ing but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage".

This oft-quoted description appears to draw on Harlow's own notes set down soon after the accident,​ but other behaviors he describes​ appear to draw on later communications from Gage's friends or family, and it is difficult to match these various behaviors (which range widely in their implied level of functional impairment) to the particular period of Gage's post-accident life during which each described behavior was present. This complicates reconstruction of how Gage's behavior changed over time, a critical task in light of evidence that his behavior at the end of his life was very different from his behavior (described by Harlow above) immediately post accident.

Distortion of mental changes

A moral man, Phineas Gage
Tamping powder down holes for his wage
Blew his special-made probe
Through his left frontal lobe
Now he drinks, swears, and flies in a rage.

The composite of modern writers has the accident transform­ing into a rest­less, moody, unpre­dict­a­ble, untrust­wor­thy, depraved, sloven­ly, violent­ly quarrel­some, aggres­sive and boast­ful dissi­pat­ed drunk­en bully, display­ing fits of temper, and with impaired sexual­ity. He is a waster: unwilling to work and unable to settle down. He spends most of the rest of his life in travel­ling circuses or drifting around fair­grounds to exhibit himself as a human freak, and dies penni­less. The facts about the real Phineas ... can hardly be recognised in .

In the only book dedicated to the case, An Odd Kind of Fame: Stories of Phineas Gage (2000), psychologist Malcolm Macmillan surveys scores of accounts of Gage, both scientific and popular, finding that they almost always distort and exagger­ate his behavioral changes well beyond anything described by those who had direct contact with him. In the words of Barker, "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis", and even today (writes historian Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a psychopath ..." 

Attributes typically ascribed to the post-accident Gage which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children (of which Gage had neither), inappropriate sexual behavior, an "utter lack of foresight", "a vainglorious tendency to show off his wound", inability or refusal to hold a job, plus drinking, bragging, lying, gambling, brawling, bullying, thievery, and acting "like an idiot". Macmillan's detailed analysis shows that none of these behaviors is mentioned by anyone who had met Gage or even his family; as Kotowicz writes, "Harlow does not report a single act that Gage should have been ashamed of." 

For example, prominent modern discussions of Gage by Antonio Damasio and Hanna Damasio​ misinterpret a passage by Harlow—​"'... continued to work in various places;' could not do much, changing often, 'and always finding something that did not suit him in every place he tried'" —​as implying Gage could not hold a job after his accident and "never returned to a fully independ­ent existence". In fact Harlow's words refer not to Gage's post-accident life in general, but only to the months just before his death, after convulsions had set in; and until then Gage had supported himself throughout his adult life.

Theoretical use, misuse, and nonuse

It is interesting to note the ingenuity with which advocates of various theories will explain away the evidence of their opponents.

Though Gage is considered the "index case for personal­ity change due to frontal lobe damage"  (and more specifical­ly, orbito­front­al cortex damage) the case's scientific value is severely under­mined by the large and uncertain extent of the damage and the small amount known about Gage's behavior­al changes. Instead, Macmillan writes, "Phineas' story is worth remember­ing because it illustrates how easily a small stock of facts becomes trans­formed into popular and scientific myth," the paucity of evidence having allowed "the fitting of almost any theory to the small number of facts we have". This concern was expressed as far back as 1877, when British neurologist David Ferrier (writing to Harvard's Henry Pickering Bowditch in an attempt "to have this case definitely settled") complained that

In investi­gat­ing reports on diseases and injuries of the brain, I am constant­ly amazed at the inexacti­tude and distortion to which they are subject by men who have some pet theory to support. The facts suffer so frightful­ly ...

More recently Sacks refers to the "interpretations and misinterpretations, from 1848 to the present," of Gage.

Thus in the nineteenth-century controversy over whether or not the various mental functions are localized in specific regions of the brain, both sides managed to enlist Gage in support of their theories;​ for example, soon after Dupuy wrote that Gage proved that the brain is not localized, Ferrier cited Gage as proof that it is. Phrenologists made use of Gage as well, contend­ing that his mental changes resulted from destruction of his "organ of Vener­a­tion" and/or the adjacent "organ of Benev­o­lence".

Damasio, in presenting his "somatic marker hypothesis"​ (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he attributes to Gage and those of modern patients with damage to the orbitofrontal cortex and amygdala. However, Damasio's presentation of Gage has been criticized as

grotesque fabrication ... the myth of Gage the psychopath. ... Damasio changes narrative, omits facts, and adds freely to his story ... It seems that the growing commitment to the frontal lobe doctrine of emotions brought Gage to the limelight and shapes how he is described.

Or as Kihlstrom put it,

any modern commentators exagger­ate the extent of Gage's personality change, perhaps engaging in a kind of retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex in self-regulation.

It is frequently said that what happened to Gage played a part in the later development of various forms of psychosurgery, particularly lobotomy. Aside from the question of why the unpleasant changes usually (if erroneously) attributed to Gage would inspire surgical imitation, careful inquiry turns up no such link, according to Macmillan:

here is no evidence that Gage's case contributed directly to psychosurgery. ... As with surgery for the brain generally, what his case did show came solely from his surviving his accident: major operations could be performed on the brain without the outcome necessarily being fatal.

Social recovery

No attempt will be made by me to cite analogous cases, as after ransack­ing the literature of surgery in quest of such, I learn that all, or nearly all soon came to a fatal result. ... This case is chiefly interest­ing to me, as serving to show the wonderful resources of the system in enduing the shock and in in overcom­ing the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature.

In 2008 an advertisement for a previously unknown public appearance by Gage was discovered, as well as a report of his physical and mental condition during his time in Chile, a description of what may well have been his daily work routine there as a stagecoach driver, and more recently an ad for a second public appearance. This new evidence implies that the seriously maladapted Gage described by Harlow existed for only a limited time after the accident—​that Gage eventually "figured out how to live" despite his injury, and was in later life far more functional, and socially adapted, than previously thought.

Macmillan hypothesizes that this change represents a social recovery undergone by Gage over time, citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills"​ (in Gage's case, his highly structured employment in Chile).

If this is so, he points out, then along with theoretical implications it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases" —​and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?" 

Portraits

In 2009 a daguerreotype portrait of Gage was discovered, the first likeness of him identified other than a life mask taken in late 1849.​ It shows "a disfigured yet still-handsome" Gage with one eye closed and scars clearly visible, "well dressed and confident, even proud"  and holding his iron, on which portions of the inscription (recited above) can be made out. (For decades the daguerreotype's owners had imagined that it showed an injured whaler with his harpoon.) Authenticity was confirmed in several ways, including photo-overlay­ing the inscription visible in the portrait against that on the actual tamping iron in Harvard's Warren Anatomical Museum, and matching the injuries seen in the portrait against those preserved in the life mask.

Macmillan cites the daguerreotype as consistent with the social recovery hypothesis already described. To better understand the question, he and collaborators are actively seeking additional evidence on Gage's life and behavior, and describe certain kinds of historical material (see "Phineas Gage: Unanswered questions" in External links, below) for which they hope readers will remain alert, such as letters or diaries by physicians whom their research indicates Gage may have met, or by persons in certain places Gage seems to have been.​

In 2010 a second portrait of Gage was identified. This new image, copies of which are in the possession of at least two different branches of the Gage family, depicts the same subject seen in the Wilgus daguerreotype identified in 2009, according to Gage researchers consulted by the Smithsonian Institution.

See also

• Anatoli Bugorski—​scientist through whose head a particle-accelerator proton beam accidentally passed
• Eadweard Muybridge—​another early case of head injury leading to mental changes

Notes

1. Daguerreotype from the collection of Jack and Beverly Wilgus. The original, like almost all daguerreotypes, shows its subject laterally (left-right) reversed, making it appear that Gage's right eye is injured; however, there is no question (Lena & Macmillan, 2010) that all Gage's injuries, including to his eye, were on the left. Therefore, in presenting the image here a second, compensating reversal has been applied in order to show Gage as he appeared in life. See Harlow (1868) for "constant companion".
2. ^ Macmillan (2000) discusses Gage's ancestry and what is and isn't known about his birth and early life. Possible birthplaces are Lebanon, Enfield, and Grafton (all in Grafton County, New Hampshire) though Harlow (1868) refers to Lebanon in particular as Gage's "native place" and as "his home"​ (probably that of his parents) to which he returned ten weeks after the accident.

   The vital records of neither Lebanon nor Enfield list Gage's birth. The birthdate July 9, 1823 (the only definite date given in any source) is from a comprehensive Gage genealogy, via Macmillan (2000), and is consist­ent with agreement, among the numerous contemporary sources addres­sing the point, that Gage was 25 years old at the time of the accident, as well as with Gage's age—​36 years—​as given in undertaker's records after his death on May 21, 1860.

   There is no doubt Gage's middle initial was P  but there is nothing to indicate what the P stood for (though his paternal grandfather was also named Phineas). See also note regarding the spelling of Gage's first name as inscribed on the tamping iron.

   Gage's mother's maiden name is variously spelled Swetland, Sweatland, or Sweetland.

3. ^ Gage's death and (original) burial are discussed at Macmillan (2000). Harlow (1868) gives the date of Gage's death as May 21, 1861, but undertaker's records show conclusively that Gage was buried May 23, 1860. That Harlow (though in contact with Gage's mother as he was writing) was mistaken by exactly one year implies that certain other dates he gives for events late in Gage's life—​his move from Chile to San Francisco and the onset of his convulsions—​must also be mistaken, presum­a­bly by the same amount; this article follows Macmillan in correct­ing those dates. (Each date so corrected carries this annotation).
4. ^ A tone of bemused wonderment was common in 19th-century medical writing about Gage (as well as about victims of other unlikely-sounding brain-injury accidents—​see Macmillan 2000). Noting dryly that, "The leading feature of this case is its improbability ... This is the sort of accident that happens in the pantomime at the theater, not elsewhere," Bigelow (1850) emphasized that though "at first wholly skeptical, I have been personally convinced", calling the case "unparalled in the annals of surgery". This endorsement by Bigelow, Professor of Surgery at Harvard, helped end scoffing about Gage among physicians in general—​one of whom, Harlow (1868) later recalled, had dismissed the matter as a "Yankee invention": "The case occurred nearly twenty years ago, in an obscure country town ..., was attended and reported by an obscure country physician, and was received by the Metropolitan doctors with several grains of caution, insomuch that many utterly refused to believe that the man had risen, until they had thrust their fingers into the hole of his head,"​ (see Doubting Thomas) "and even then they required of the Country Doctor attested statements, from clergymen and lawyers, before they could or would believe—​many eminent surgeons regarding such an occurrence as a physiological impossibility, the appearances presented by the subject being variously explained away." 

   Indeed Jackson (1870) wrote that, "Unfortunately, and notwith­stand­ing the evidence that Dr. H. has furnished, the case seems, generally, to those who have not seen the skull, too much for human belief." But after Gage was joined by such later cases as a miner who survived traversal of his head by a gas pipe, and a lumbermill foreman who returned to work soon after a circular saw cut three inches into his skull from just between the eyes to behind the top of his head (the surgeon removing from this incision "thirty-two pieces of bone, together with considerable sawdust"), the Boston Medical & Surgical Journal (1869) pretended to wonder whether the brain has any function at all: "Since the antics of iron bars, gas pipes, and the like skepticism is discomfitted, and dares not utter itself. Brains do not seem to be of much account now-a-days." The Transactions of the Vermont Medical Society (Smith 1886) was similarly facetious: "'The times have been,' says Macbeth [Act III], 'that when the brains were out the man would die. But now they rise again.' Quite possibly we shall soon hear that some German professor is exsecting it."

   The reference to Gage's iron as an "abrupt and intrusive visitor" appears in the Boston Medical & Surgical Jouurnal's review of Harlow (1868).

5. Harlow (1868): "Front and lateral view of the cranium, represent­ing the direction in which the iron traversed its cavity; the present appearance of the line of fracture, and also the large anterior fragment of the frontal bone, which was wholly detached, replaced and partially re-united." 
6. For scientific and academic discussions see Macmillan; in particular, Macmillan found Gage cited in some 60% of introductory psychology textbooks in three university libraries. A small study found Gage to be easily the topic most frequently mentioned when, at the end of an introductory psychology course, students were asked to list "the first 10 things that come to your mind as you answer the question: What do you remember from this course? "; investigators noted that, "The Phineas Gage video re-creates the famous tamping rod piercing Gage’s skull. Students ... always react emotionally to this video clip." 

   For popular culture, see Macmillan (2000) and Macmillan (2008); for example, several musical groups call themselves Phineas Gage (or some variation).

7. ^ Accounts of Gage are compared to one another, and against the known facts, at Macmillan (PGIP) and in Macmillan 2000. According to Macmillan & Lena (2010, and see also Macmillan 2000) available sources which offer detailed information on Gage, and for which there is evidence (if merely the source's own claim) of contact with him or with his family, were limited (until 2008) to Harlow (1848, 1849, 1868); Bigelow (1850); Jackson (1870);; Jackson (1849). Macmillan & Lena (2010) presents previously unknown sources discovered post 2008.

   Macmillan (2001) and Macmillan (2000) discuss the high general reliability of Harlow (1868), and its primacy as a source.

   The contrast between Gage's celebrity, and the small amount known about him, is discussed in Macmillan (2000): "From my student days I had some appreciation of the importance ascribed to the case and expected there would be a reasonably extensive literature on it. This turned out not to be true. There were many mentions of him, but few papers solely or mainly about him. ... because Phineas Gage was said to be important in psychology, everyone would have been interested in him; because his survival was so remark­a­ble, someone must have made a major study of him. Neither was the case."

8. ^ Quotations are from Ferrier (1877–9), Macmillan (2000) and Smith (1886). Other 19th-century exasperation was expressed by Dupuy (1877) and Jackson (1870). See Macmillan (2000) and Macmillan (2008) for surveys and discussion of theoretical misuse of Gage, and Barker (1995) for, specifically, the way in which nineteenth-century reports of Gage were colored by various writers' doctrinal leanings: "The educational backgrounds of Harlow and Bigelow their differing attitudes toward the case. Harlow's interest in phrenology prepared him to accept the change in character as a significant clue to cerebral function which merited publication. Bigelow had that damage to the cerebral hemispheres had no intellectual effect, and he was unwilling to consider Gage's deficit significant ... The use of a single case to prove opposing views on phrenology was not uncommon."
9. ^ See Macmillan (2000) and Macmillan (PGIP) for the steps in setting a blast and the location and circumstances of the accident. The blast hole, about 1+3⁄4 inches (44 mm) in diameter and up to twelve feet (1.8 m) deep, might require three men working as much as a day to bore using hand tools. The labor invested in setting each blast, the judgment involved in selecting its location and the quantity of powder to be used, and the often explosive nature of employer-employee relations on this type of job, all underscore the significance of Harlow's statement that Gage's employers had considered him "the most efficient and capable foreman in their employ" prior to the accident.
10. Among phrenology's various "temperaments", nervo-bilious denotes a rare combination of "excitable and active mental powers" with "energy and strength mind and body possible the endurance of great mental and physical labor"​ (Macmillan 2000) Fowler (1838) wrote that it "unites great power with great activity, and, although it seldom gives great brilliancy, it produces that kind of talent which will stand the test, and shine in proportion as it is brought into requisition." 

    Harlow's use of this term reflects his interest in phrenology.

11. ^ Ratiu et al. was the first study to account for the hairline fracture running from behind the exit region down the front of the skull, as well as fact that the hole in the base of the cranium (created as the iron passed through) has a diameter about half that of the iron itself—​hypothe­siz­ing (as seen in their video reconstruction of the iron passing through Gage's head) that the skull "hinged" open as the iron entered the base of the cranium, and was afterward pulled closed by the resilience of soft tissues once the iron had exited at the top.
12. ^ Boston Post, Septem­ber 21, 1848, crediting an earlier report (unknown date) in the Ludlow Free Soil Union (Ludlow, Vermont). This early report misstates the length of the tamping iron, and confuses its circumference with its diameter. Also, despite its reference to the "shattering the upper jaw", that did not in fact happen. See Harlow (1868) for a description of the iron's path.
13. Bigelow describes the iron's taper as seven inches long, but the correct dimension is twelve (corrected in the quotation).​
14. ^ Excerpted from Williams' and Harlow's statements in: Harlow (1848); Bigelow (1850); Harlow (1868).
15. ^ As to his own contribution to Gage's survival, Harlow merely averred, "I can only say ... with good old Ambrose Paré, I dressed him, God healed him" —​an assessment Macmillan (2000) calls far too modest. See Macmillan (2008), Macmillan (2001) and Barker (1995) for further discussion of Harlow's management of the case.
16. Harlow's notes for September 24: "Failing strength ... During the three succeed­ing days the coma deepened; the globe of the left eye became more protuberant, with fungus pushing out rapidly from the internal canthus ... also large fungi pushing up rapidly from the wounded brain, and coming out at the top of the head". Here fungus does not mean an infecting mycosis but instead (Oxford English Dictionary) a "spongy morbid growth or excrescence, such as exuberant granulation in a wound"​ (that is, part of the body's own reaction to the injury).
17. Unlike Barnum's later circus, his Barnum's American Museum was not a traveling show but a station­ary installa­tion in New York City. There is no evidence Gage exhibit­ed with a troupe or circus, or on a fair­ground (Macmillan & Lena 2010).
18. Here reproduced from Jackson (1870), these images were commissioned by Harlow from photographer Samuel Webster Wyman and were the basis for the woodcuts seen in Harlow (1868).​
19. Macmillan & Lena: "Only Harlow writes of the exhumation and he does not say the tamping iron was recovered then. Although what he says may be slightly ambiguous, it does not warrant the contrary and undocumented account ... that Gage's tamping iron was recovered from the grave." 
20. Jackson (1870): "The most valuable specimen that has ever been added to the Museum, and probably ever will be, was given two years ago by Dr. John M. Harlow ... For the professional zeal and the energy that Dr. H. showed, in getting possession of this remark­a­ble specimen, he deserves the warmest thanks of the profession, and still more, from the College , for his donation." 
21. Text of inscription from Macmillan (PGIP). The inscription's date for the accident is one day off, and Phinehas seems not to be how Gage spelled his name (Macmillan 2008). The inscription was commissioned by Harvard's Dr. Bigelow in preparation for the iron's deposit in the Warren Anatomical Museum; the date following Gage's "signature" corresponds to the latter part of the period during which Gage was in Boston under Bigelow's observation.
22. Early authors attempting to estimate the extent of damage include: Harlow (1848); Bigelow (1850); Harlow (1868); Dupuy (1877); Ferrier (1878). See also Bramwell (1888); Tyler & Tyler (1982); Cobb (1940, 1943).
23. See Macmillan & Lena (2010); Harlow (1868); Bigelow (1850); Harlow (1848); Macmillan (2000).
24. Specifically, Van Horn et al. estimated that although "extensive damage occurred to left frontal, left temporal polar, and insular cortex, the best fit rod trajectory did not result in the iron crossing the midline as has been suggested by some authors"​ (such as H. Damasio). "Fiber pathway damage extended beyond the left frontal cortex to regions of the left temporal, parietal, and occipital cortices as well as to basal ganglia, brain stem, and cerebellum. Inter-hemispheric connections of the frontal and limbic lobes as well as basal ganglia were also affected."​ (Quotations abridged to remove quantitative estimates of damage to each locus.)
25. Well before Harlow (1868) appeared, Harlow had left Cavendish, and after some travel in the United States, established a new practice in Woburn, Massachusetts, where he remained for the rest of his life.
26. Macmillan (2000) also discusses potential reluctance on the part of Gage's friends and family (and of Harlow himself) to describe Gage negatively, especially while he was still alive, and argues that an 1850 communication calling Gage "gross, profane, coarse, and vulgar" was anonymously supplied by Harlow.
27. For example, the "fitful, irreverent ... capricious and vacillating" Gage described in Harlow (1868) is somewhat at variance with Gage's stagecoach work in Chile, which demanded that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers"​ (Macmillan 2000, citing Austin 1977)—​and note Gage was hired by his employer in advance, in New England, to be part of the new coaching enterprise in Chile.
28. Though Macmillan (2000) refers to the complete lack of information on Gage's sexual life, and Macmillan & Lena (2010) discusses the continued absence of such information, curricular materials at one medical school go so far as to present Gage as having been "accused of sexually molesting young children".
29. See also van Horn (2012): "Macmillan has noted that many reports on Gage's behavioral changes are anecdotal, largely in error, and that what we formally know of Mr. Gage's post-accident life comes largely from the follow-up report of Harlow according to which Gage, despite the description of him having some early difficulties, appeared to adjust moderately well for someone experi­enc­ing such a profound injury."
30. For end-of-life employment difficulties see Macmillan (2000), p. 107; for misinterpretation and self-support, see Macmillan & Lena (2010) passim, as well as Kotowicz (2007): "What Harlow is telling us is clear and unambiguous: Gage returns from South America to his mother to recuperate. As soon as he is fit, he goes back to work with horses, which is what he has been doing for years."
31. Kotowicz (2007), which continues, " account of Gage's last months such a grotesque fabrication that it leaves one baffled," then quotes A. Damasio (1994):

    In my mind is a picture of 1860's San Francisco as a bustling place, full of adventurous entrepreneurs engaged in mining, farming, and shipping. That is where we can find Gage's mother and sister, the latter married to a prosperous San Francisco merchant (D. D. Shattuck, Esquire), and that is where the old Phineas Gage might have belonged. But that is not where we would find him if we could travel back in time. We would probably find him drinking and brawling in a questionable district, not convers­ing with the captains of commerce, as astonished as anybody when the fault would slip and the earth would shake threateningly. He had joined the tableau of dispirited people who, as Nathanael West would put it decades later, and a few hundred miles to the south, "had come to California to die".

    Kotowizc comments: "This little literary flourish is pure invention. ... There is something callous in insinuat­ing that Gage was some riff-raff who in his final days headed for California to drink and brawl himself to death."

    Macmillan (2000) gives detailed criticism of Damasio's various presentations of Gage (some of them in joint work with Hanna Damasio and others).

32. Kihlstrom (2010). See also Grafman:: "Although the classic story of the nineteenth-century patient Gage who suffered a penetrat­ing PFC [pre­front­al cor­tex] lesion has been used to exemplify the problems that patients with ventromedial PFC lesions have in obeying social rules, recogniz­ing social cues, and making appropriate social decisions, the details of this social cognitive impairment have occasionally been inferred or even embellished to suit the enthusiasm of the story teller—​at least regarding Gage" (citing Macmillan 2000).
33. See for example Carlson (1994); additional examples and discussion are at Macmillan (2000).
34. " argued that psychiatric patients would benefit from having disinhib­it­ed behaviors like deliberately induced in them"​ (Macmillan 2000).
35. Fleischman (2002). See also Kotowicz (2007): "There is coherence and dignity in the way Gage dealt with his predicament. He deserves deep respect." 
36. Macmillan & Aggleton (2011): "Phineas' survival and rehabilitation demonstrated a theory of recovery which has influenced the treatment of frontal lobe damage today. 'There are something like 15 or 20 cases of people who've recovered from very serious frontal brain injury, of the kind that Phineas suffered from, without any professional assistance. In every case, what's common in the reports is that someone, or something, has taken over the lives of these people and given them structure.' In modern treatment, adding structure to tasks by, for example, mentally visual­is­ing a written list, is considered a key method in coping with frontal lobe damage. 'Phineas worked as a stage-coach driver,' continues Professor Macmillan. 'The job is one that has got an external structure. You've got to be here for this part, then there's that part, then there's something else. Just as with these cases who have recovered.'"
37. ^ Lena & Macmillan (2010), citing also B. & J. Wilgus.. The image seen here is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey. (Gage had no known children—​see Macmillan 2000; these are descendents of certain of his relatives—​see Macmillan & Lena 2010.) Unlike the Wilgus portrait, which is itself a daguerreotype, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a daguerreotype or other laterally (left-right) reversing early-process photograph; a second, compen­sat­ing reversal has been applied here to show Gage as he appeared in life. The shirt and tie Gage is wearing in the Miller–​Hartley image are different from those seen in the Wilgus image, though he is wearing the same waistcoat in both, and possibly the same jacket.
38. "Indeed, the recent discovery of daguerreotype portraits of Mr. Gage show a 'handsome ... well dressed and confident, even proud' man in the context of 19th century portraiture. That he was any form of vagrant following his injury is belied by these remark­a­ble images."​ (van Horn 2012, quoting Wilgus 2009)

Sources and further reading

For general audiences (Gage)

1. ^
   Harlow, John Martyn (1868). "Recovery from the Passage of an Iron Bar through the Head." Publ Massachusetts Med Soc 2:327–347. 
2. ^ Macmillan, M. (PGIP). "The Phineas Gage Information Page". The University of Akron. Retrieved July 22, 2013.  Includes:

   A. "Phineas Gage Sites in Cavendish". 

   B. "Phineas Gage: Unanswered questions". 

   C. "Phineas Gage's Story". 

   D. "Corrections to An Odd Kind of Fame". 

   E. "Phineas Gage: Psychosocial Adaptation". 

   F. "Phineas Gage and Frontal Lobotomies". 

3. ^
   Macmillan, M. (2000). An Odd Kind of Fame: Stories of Phineas Gage. MIT Press. ISBN 0-262-13363-6 (hbk, 2000) ISBN 0-262-63259-4 (pbk, 2002). Appendices reproduce Harlow (1848, 1849, and 1868), Bigelow (1850) and other key sources, some unavailable elsewhere. 
    • See also "Corrections to An Odd Kind of Fame". 
4. ^
   Macmillan, M. (2008). "Phineas Gage—​Unravell­ing the myth". The Psychologist 21(9):828–831. British Psychological Society. 
5. ^ Macmillan, M.; Aggleton, John (March 6, 2011). "Phineas Gage: The man with a hole in his head" (Audio interview). Interviewed by Claudia Hammond; Dave Lee. {{cite interview}}: Unknown parameter |callsign= ignored (help); Unknown parameter |program= ignored (help)CS1 maint: multiple names: interviewers list (link) 
   
   

    For general audiences (portraits)

6. ^ Lena, M.L. and M. Macmillan (2010). "Picturing Phineas Gage"​ (invited comment). Smithsonian. March 2010. p. 4 
7. ^ Macmillan, M (July 2009). "More About Phineas Gage, Especially After the Accident". Retrieved July 27, 2013. 
8. ^ Twomey, S. (2010). "Finding Phineas". Smithsonian. 40 (10): 8–10 (January 2010). 
9. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1080/09647040903018402 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1080/09647040903018402 instead. 
10. ^ Wilgus, B. & J. "A New Image of Phineas Gage". Retrieved March 10, 2010.{{cite web}}: CS1 maint: multiple names: authors list (link) 
11. ^ Wilgus, B. & J. "Meet Phineas Gage". Retrieved October 2, 2009.{{cite web}}: CS1 maint: multiple names: authors list (link) 
    
    

     For middle-school students

12. ^ Fleischman, J. (2002). Phineas Gage: A Gruesome but True Story About Brain Science. ISBN 0-618-05252-6. 
    
    

     For specialists

13. ^ Barker, F.G. II (1995) "Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localiza­tion." J Neurosurg 82:672–682 
14. ^ Fuster, Joaquin M. (2008). The prefrontal cortex. Elsevier/Academic Press. p. 172. ISBN 0-12-373644-7.
15. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1093/acprof:oso/9780195134971.003.0019 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1093/acprof:oso/9780195134971.003.0019 instead.
16. ^ Kihlstrom, J.F. (2010). "Social neuroscience: The footprints of Phineas Gage". Social Cognition. Vol. 28. pp. 757–782. 
17. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1177/0952695106075178 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1177/0952695106075178 instead. 
18. Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1016/0278-2626(86)90062-X , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1016/0278-2626(86)90062-X instead. 
19. Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1076/0964-704X(200004)9:1;1-2;FT046 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1076/0964-704X(200004)9:1;1-2;FT046 instead. 
20. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1076/jhin.10.2.149.7254 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1076/jhin.10.2.149.7254 instead. 
21. ^
    Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1080/09602011003760527 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1080/09602011003760527 instead. 
22. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1056/NEJMicm031024 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1056/NEJMicm031024 instead. 
23. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1089/089771504774129964 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1089/089771504774129964 instead. 
24. ^ Tyler, K.L. and Tyler, H.R. (1982) "A 'Yankee Invention': the celebrated American crowbar case". Neurology 32:A191.
25. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1207/S15328023TOP2702_02 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1207/S15328023TOP2702_02 instead. 
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     Of historical interest

27. ^ "Horrible Accident". Boston Post. 1848. {{cite news}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)
28. ^ Volume 3: Lone Mountain register, 1850-1862, Halsted N. Gray – Carew & English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285.
29. ^ "Bibliographical Notice". Boston Medical & Surgical Journal. 3n.s. (7): 116–7. 1869. {{cite journal}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)
30. ^ "Medical Intelligence. Extraordinary Recovery". Boston Medical & Surgical Journal. 3n.s. (13): 230–1. 1869. {{cite journal}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)
31. ^ K.A. Austin (1977). A Pictorial History of Cobb and Co.: The Coaching Age in Australia, 1854–1924. Sydney: Rigby. ISBN 0-7270-0316-X.
32. ^
    Bigelow, Henry Jacob (1850). "Dr. Harlow's case of Recovery from the passage of an Iron Bar through the Head." Am J Med Sci 20:13–22(July 1850). Reproduced in Macmillan (2000).
33. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1136/bmj.1.1425.835 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1136/bmj.1.1425.835 instead. 
34. ^ Campbell, H. F. (1851) "Injuries of the Cranium—​Trepanning". Ohio Med & Surg J 4(1), pp. 20–24, crediting the Southern Med & Surg J (unknown date)
35. ^ Carlson, N.R. (1994). Physiology of Behavior. p. 341. ISBN 0-205-07264-X.
36. ^ Cobb, S. (1940) "Review of neuropsychiatry for 1940". Arch Intern Med 66:1341–54
37. ^ Cobb, S. (1943) Borderlands of psychiatry. Harvard Univ. Press.
38. ^ Damasio A.R. (1994). Descartes' Error: Emotion, Reason, and the Human Brain. ISBN 0-14-303622-X. (2nd ed.: 2005)
39. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1098/rstb.1996.0125 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1098/rstb.1996.0125 instead. 
40. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1126/science.8178168 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1126/science.8178168 instead.
41. ^ Dupuy, E. (1877) "A critical review of the prevailing theories concern­ing the physiology and the pathology of the brain: localisation of functions, and mode of production of symptoms." Part II. Med Times & Gaz v. II pp. 356–8.
42. ^ Folsom, A.C. (1869). "Extraordinary Recovery from Extensive Saw-Wound of the Skull". Pacific Medical and Surgical Journal. pp. 550–555. {{cite news}}: Unknown parameter |month= ignored (help)
43. ^ Fowler, O. S. (1838). Synopsis of phrenology: and the phrenological developments: together with the character and talents of ________ as given by ________: with references to those pages of "Phrenology proved, illustrated and applied," in which will be found a full and correct delineation of the intellectual and moral character and manifestations of the above-named individual. New York: Fowler & Wells. p. 6.{{cite book}}: CS1 maint: multiple names: authors list (link) 
44. ^ Ferrier, D. (1877–9) Correspondence with Henry Pickering Bowditch. Countway Library (Harvard Univ.) Mss., H MS c 5.2 (transcribed in Macmillan 2000, pp. 464–5).
45. ^ Ferrier, D. (1878) "The Goulstonian lectures of the localisation of cerebral disease." Lecture I (concluded). Br Med J 1(900):443–7
46. ^
    Harlow, John Martyn (1848). "Passage of an iron rod through the head". Boston Med & Surg J 39(20):389–393. Reproduced in Macmillan (2000). 
47. ^ Harlow, John Martyn (1849). Letter in "Medical Miscellany." Boston Med & Surg J 39:506–7. Reproduced in Macmillan (2000).
48. ^ Hockenbury D.H. and Hockenbury S.E. (1997) Psychology.
49. ^ Jackson, J. B. S. (1849) Medical Cases (Vol. 4, Case 1777) Countway Library (Harvard Univ.) Mss., H MS b 72.4.
50. ^ Jackson, J. B. S. (1870) A Descriptive Catalog of the Warren Anatomical Museum Frontis. and Nos. 949–51, 3106 (Republished in Macmillan 2000, in which see also p. 107). 
51. ^ Nicholl, Jeffrey S., M.D. (2009). "Dementia Cases—​Problem #1". Neurology Clerkship. New Orleans: Tulane Univ. School of Medicine. Retrieved November 1, 2009.{{cite web}}: CS1 maint: multiple names: authors list (link) 
52. ^ Sacks, Oliver (1995). An Anthropologist on Mars. pp. 59–61. ISBN 0-679-43785-1. OCLC 30810706.
53. ^ Sizer, Nelson (1888). Forty years in phrenology; embracing recol­lec­tions of history, anecdote, and experience. New York: Fowler & Wells. 
54. ^ Smith, William T. (1886) "Lesions of the Cerebral Hemispheres". T Vermont Med Soc for the Year 1885. pp. 46–58. 
55. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1037/0022-006X.60.3.349 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1037/0022-006X.60.3.349 instead. 

External links

• Macmillan, M. "Phineas Gage: Unanswered questions". Retrieved August 9, 2013. Lists research questions related to Gage in localities throughout the United States and Chile, for which Gage researchers request assistance from the public.
• Warren Anatomical Museum, Center for the History of Medicine, Francis A. Countway Library of Medicine (Harvard Medical School)—​home of Gage's skull and iron.
• Meet Phineas Gage—​the story of how the owners of the 2009-identified daguerreotype learned it depicted Gage.
• Phineas Gage roadside memorial, Cavendish, Vermont

Template:Persondata

• 1823 births
• 1860 deaths
• History of neuroscience
• American people in rail transportation
• American expatriates in Chile
• People from Grafton County, New Hampshire
• People from Windsor County, Vermont
• Burials in California
• People with brain injuries