Phineas Gage - Gage's Accident

Gage's Accident

On September 13, 1848 twenty-five-year-old Gage was foreman of 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 a body of rock; adding blasting powder, a fuse, and sand; then compacting this charge into the hole using a tamping iron—a large iron rod. Gage was doing this around 4:30 PM when (possibly because the sand was omitted) the iron struck a spark against the rock and

the powder exploded, carrying an instrument through his head an inch and a fourth in, and three feet and inches in length, which he was using at the time. The iron entered on the side of his face ... passing back of the left eye, and out at the top of the head.

(See image above left.) Nineteenth-century references to Gage as "the American Crowbar Case" bear clarification. Gage's 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 said to have landed some 80 feet (25 m) away, "smeared with blood and brain."

Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3⁄₄-mile (1.2 km) ride to his lodgings in town. The first physician to arrive was 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.

Dr. John Martyn Harlow took charge of the case about an hour later:

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.

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."