ABSTRACT
The history of medicine contains many bizarre incidents, but none more so than the extraordinary case of Phineas Gage. On 13 September 1848 Phineas Gage was working as a railroad engineer in New England, his job being to lay explosive and then detonate it. The procedure involved boring a hole, placing the explosive in the hole, and then covering it over with sand. After this a fuse and a tamping iron were used to set off the explosive. By mistake, Gage placed the tamping iron directly on the explosive, at which point it exploded, sending the tamping iron right through his skull and then 20 or so feet into the air (see figure 7.1). Remarkably, Gage did not lose consciousness, and was able to walk to the cart that took him to hospital. Gage’s body was exhumed in 1866, and the skull, along with the offending tamping iron, have been preserved for posterity. This enabled Damasio and colleagues (1994) to examine Gage’s skull with modern neuro-imaging techniques. Using a reconstructed brain similar to that of Gage and an estimate of the tamping iron’s most likely trajectory, they concluded that his lesion would have involved several parts of the left and right frontal lobes, but no other brain region.
