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How Much IS Half a Teacupful of Brains? Ask Phineas Gage!

A couple of years ago I had to quit a job because my depression had gotten so bad that I no longer had the energy to go to work. My friends and family were wonderfully understanding, and I slowly worked my way towards recovery and not feeling guilty for being unable to work due to problems with my brain.

Then I read about Phineas Gage and felt like I would never ever be able to justify brain problems as the reason I do not work in an office full time.

Gage was a blasting foreman in Vermont in the late 1840s, known for being a hearty individual who worked diligently and intelligently. His doctor described him as having “energy and strength [of] mind and body [making] possible the endurance of great mental and physical labor.” He was a tough dude. His job as blasting foreman required him to follow a very specific process: bore a hole into rock, fill it with blasting powder and a fuse, then pack sand or clay on top. Once these steps were complete, his team could light the fuse and blow up the rock safely. If the fuse was lit before the sand was done being tamped down, Gage would risk having a combination of rock, sand, and other debris explode in his face. That’s exactly what happened on September 13, 1848.

I would think that most people take an explosion to the face in the same way: face explodes, person dies. Phineas Gage, though, was not most people. His face did not explode, but it was pierced by his tamping iron — 1 1⁄4 inches (3.2 cm) in diameter, three feet seven inches (1.1 m) long, and weighing 13 1⁄4 pounds (6.0 kg). The iron shot through Gage’s face and landed several feet behind him, “smeared with blood and brain.” Again, most people would react to this by dying, but Gage, after a few convulsions, stood up, made conversation, and rode ¾ mile home in an oxcart.

Upon being greeted by the town’s accident physician, Gage announced, “Doctor, here is business enough for you.” He described what had happened, then vomited. The act of vomiting caused some of Gage’s brain (“about half a teacupful” according to the physician) to fall onto the floor. Around 6pm that evening he was entrusted into the care of his family physician, John Harlow, who proceeded to save his life several times over the next few weeks.

Two days after the accident, Gage was delirious, but two days after that he was once again lucid, recognizing his friends and convincing everyone that he was on the road to recovery. A week after that, Gage was semi-comatose and had developed a bulging eye. Harlow noted the rank stench coming from Gage’s head and mouth, adding that the patient’s friends and family had burial clothes ready and were poised to plan a funeral. Perhaps inspired by Gage’s refusal to see his friends initially, insisting he would be back to work in a few days, Harlow did not take the man’s death as inevitable. Instead he removed granulation tissue and more pieces of Gage’s brain, draining the cerebral abscess that had formed.

Ten days later Gage was sitting upright and able to take one step. Within a month he was climbing stairs, walking through town, and trying to make plans to see his family in New Hampshire. His plans came to fruition by the end of November, when he returned to his parents’ home to rest for three more months. In February he was working some around the farm, and in April 1849 he returned to Vermont to see Dr. Harlow. The doctor described Gage’s physical health as good, and suggested that the man had recovered. He added that Gage said his head had “a queer feeling which he is not able to describe.” Rumors swirled that Gage experienced a complete personality transformation, shifting from a respectable, moral man to an angry, profane one.

Gage went on to become a stagecoach driver in Chile, returning to the U.S. less than a decade later due to seizures that were too frequent and violent for him to handle alone. Three months later he died in his mother’s home in San Francisco, nearly twelve years after the initial accident. In 1866, six years after Gage passed away, his family received a request from Dr. Harlow to have the skull exhumed — a request they were more than happy to fulfill. Harlow recalls that the mother and friends, “with a magnanimity more than praise­worthy, at my request have cheerfully placed this skull in my hands, for the benefit of science.” Two years later, Harlow reunited the tamping iron with Gage’s skull and donated both to​ The Warren Anatomical Museum, where they remain today.

Further reading/listening:
The Unkillable Phineas Gage — Sawbones
Phineas Gage: Neuroscience’s Most Famous Patient — Scientific American

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