October 08, 2012
Phineas Gage is one of the earliest documented cases of severe brain injury. He is the index case of an individual who suffered major personality changes after brain trauma, which makes him a legend in the annals of neurology. Gage worked as a foreman on a crew that did railroad construction and was excavating rocks to make way for the railroad track. This particular job required drilling holes deep into the boulders and filling them with dynamite. This was done with a crow bar-like tool known as a tamping iron. On September 13th of 1848, the then 25 year old Gage and his crew were working and as Gage was preparing for an explosion compacting a bore with explosive powder using a tamping iron a spark from the tamping iron ignited the powder, causing the iron to be propelled at high speed straight through Gage’s skull. (Word press, 2006) It remains unknown whether or not Gage lost consciousness, but, remarkably, he was conscious and able to walk within minutes of the accident. He was then transported by an oxcart about three-quarters of a mile to the boarding house where he was staying. It was at this time he was attended to a local physician named Harlow, he cleaned Gage’s wounds by removing small fragments of bone, and replaced some of the larger skull fragments that remained attached but had been displaced by the tamping iron. He then closed the larger wound at the top of Gage’s head with adhesive straps, and covered the opening with a wet compress. His wounds were not treated surgically, but were instead left open to drain into the dressings. (Word press, 2006) Harlow’s case report would later appear as a letter to the editor of the Boston Medical and Surgical Journal, which was met with much criticism as it was believed that nobody could have survived such an extreme injury. In a second report published by Henry J. Bigelow in 1850, a professor of...