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
cerebral localization, and was perhaps the first case to suggest that damage to specific parts of the brain might affect personality.[3]
: ch7-9
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.[C]
Despite this celebrity the body of established fact about Gage and what he was like (before or after his injury) is remarkably small,[D]
which has allowed "the fitting of almost any theory [desired] to the small number of facts we have"[E]—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.[D]
Two photographic portraits of Gage, and a physician's report of his physical and mental condition late in life, were published 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
leftCavendish, Vermont about twenty years after Gage's accident. (A)The two possible accident sites; (T)Gage's lodgings, where he convalesced; (H)Harlow's home and surgery.[F]
cut in rock south of Cavendish. Gage met with his accident while setting explosives to create either this cut or a similar one nearby.[F]
Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage, of Grafton County, New Hampshire.[A]
Little is known about his upbringing and education, but he was almost certainly literate.[3]: 17, 41
He may have gained skill with explosives on the family's farms or in nearby mines and quarries,[3]: 17–18
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 town doctor John Martyn Harlow 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 (1.1m) long, and 1+1⁄4 inches (3.2cm) in diameter—for use in setting charges.
Boston Post for Sept.21, 1848 (understating the dimensions of Gage's tamping iron and overstating damage to the jaw).[note 2]
Gage's skull "hinged" open as the iron passed through.[G]
On September 13, 1848 Gage (aged 25)
blasting powder, a fuse, and sand; then compacting this charge into the hole using the tamping iron.[note 3]
The blast hole, about 1+3⁄4 inches (4.5cm) in diameter and up to 12 feet (4m) 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.
}}
Gage was doing this around 4:30p.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 [left] side of his face... passing back of the left eye, and out at the top of the head."
Despite nineteenth-century references to Gage as "the American Crowbar Case"[11]: 54
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":[7]: 331
The end which entered [Gage's cheek] first is pointed; the taper being [twelve] inches [30cm] 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.[note 4]
Weighing 13+1⁄4pounds (6kg) this "abrupt and intrusive visitor"[note 5]
was found some 80feet (25m) away, "smeared with blood and brain."[1]: 331
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.[1]: 331
Dr.Edward H. Williams arrived some thirty minutes after the accident:
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.[note 6]
Harlow took charge of the case around 6p.m.:
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. His person, and the bed on which he was laid, were literally one gore of blood.
Convalescence
Despite Harlow's skillful care,{{refn|group=note| As to his own contribution to Gage's survival, Harlow merely averred, "I can only say... with good old Ambro[i]se Paré, I dressed him, God healed him"[1]: 346 —an assessment
Macmillan (2000) calls far too modest.[3]: 12, 59–62, 346–7
See Macmillan (2008), Macmillan (2001) and Barker (1995) for further discusssion of Harlow's management of the case.[6]{{rp />: 828–9 [16][17]: 679–80
}}
Gage's recuperation was long and difficult. Pressure on the brain{{refn|group=note| 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".[1]{{rp />: 335
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).[3]
: 54, 61–2
}}
left him semi-comatose from September23 to October3, "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 October7 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."[7]: 392–3
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 [5cm by 4cm] 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."[1]Template:338-9[19]
New England
Harlow says that Gage, unable to return to his railroad work,[1]: 339 appeared for a time at Barnum's American Museum[note 7]
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.[citation needed]
Recently, however, evidence has surfaced[citation needed] 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.[1]: 340
Chile and California
In August 1852 Gage was invited to Chile to work as a long-distance
Santiago
route.
After his health began to fail around 1859,[note 8]
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.[3]: 103–4 [1]: 340–1
Death and subsequent travels
[Fig. 4]Gage's skull (sawed to show interior) and iron, photographed for Harlow in 1868.[H]
In February 1860[B]
Gage had the first in a series of increasingly severe convulsions;[I]
he died status epilepticus[10]: E in or near[10]: B San Francisco on May21, just under twelve years after his injury, and was buried in San Francisco's Lone Mountain Cemetery.[B]
(Some accounts[22][23][24]
assert that Gage's iron was buried with him, but there appears to be no evidence for this.)[J]
Skull and iron
In 1866 Harlow (who had "lost all trace of [Gage], 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[20]: 6 delivered to Harlow back in New England.
About a year after the accident, Gage had given his tamping iron in Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it[3]: 46–7 [8]: 22n [15]
and made what he called "my iron bar" his "constant companion during the remainder of his life";[1]: 339
now it too was delivered to Harlow.(See[Fig. 4]) After studying them for a triumphal retrospective paper on Gage[1]
Harlow redeposited the iron—this time with Gage's skull—in the Warren Museum, where they remain on display today.[K]
The iron bears this inscription:[L](See[Fig. 5])
This is the bar that was shot through the head of Mr Phinehas[sic] P.Gage at Cavendish, Vermont, Sept.14,[sic] 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 Jan6 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.[3]: 119–120
Brain damage and mental changes
[Fig. 6]The left frontal lobe (red), the forward portion of which was damaged by Gage's injury, per Harlow's digital examination and the digital analyses of Ratiu etal. and Van Horn etal.[G]
Extent of brain damage
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.[M]
The 1994 conclusion of H.Damasio etal.,[22]
that both frontal lobes were damaged, was drawn by modeling not Gage's skull but a "Gage-like" one.[6]: 829–30
Ratiu etal. (2004, using
CT scans of Gage's actual skull, and presenting a video reconstruction of the tamping iron passing through it)[31][32]
confirm Harlow's conclusion (based on probing Gage's wounds with his finger)[N]
that the right hemisphere remained intact.[G]
Van Horn etal. (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.[O](See[Fig. 7])[Fig. 8]Harlow's 1868 paper, presenting Gage's skull and late-life history.[1][Fig. 9]"I dressed him, God healed him." Physician John Martyn Harlow, who attended Gage after his accident and obtained his skull for study after his death, in later life.[16]
First-hand reports of mental changes
Gage certainly displayed some kind of change in behavior after his injury,[20]: 12–15
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),[D]
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."[7]: 393
And after observing Gage for several weeks in late 1849, Harvard Professor of Surgery
went so far as to say that Gage was "quite recovered in faculties of body and mind," there being only "inconsiderable disturbance of function".[8]: 13–14
Harlow's 1868 report
Not until 1868 did Harlow (having obtained Gage's skull, tamping iron, and late-life 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 Distortion of mental changes, below).
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".[1]
This oft-quoted description appears to draw on Harlow's own notes set down soon after the accident,[3]: 90, 375
but other behaviors he describes[3]: 117–8 [1]: 340, 345
appear to draw on later communications from Gage's friends or family,[P]
and it is difficult to match these various behaviors (which range widely in their implied level of functional impairment)[Q]
^ abcdMacmillan (2000)[3]: 11, 17, 490–1 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 July9, 1823 (the only definite date given in any source) is from a comprehensive Gage genealogy, via Macmillan (2000),[3]: 16 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 May21, 1860.
There is no doubt Gage's middle initial was P[1][6]: 839 [7][8]
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.
^ abcdeCite error: The named reference death was invoked but never defined (see the help page).
^For scientific and academic discussions see Macmillan;[3]: ch14 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 [used in the course] re-creates the famous tamping rod piercing Gage’s skull. Students... always react emotionally to this video clip."[5]: 89
For popular culture, see Macmillan (2000)[3]: ch13 and
Macmillan (2008);[6]: 830
for example, several musical groups call themselves Phineas Gage (or some variation).
^ abcAccounts of Gage are compared to one another, and against the known facts, at Macmillan (PGIP)[10]: C and in Macmillan 2000.[3]: 116–19 chs.13-14
According to Macmillan& Lena (2010,
and see also Macmillan 2000)[3]: 11, 89, 93, 116 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);[1][7][19] Bigelow (1850);[8] Jackson (1870);[12] Jackson (1849).[34]
Macmillan& Lena (2010) present previously unknown sources discovered post 2008.
Macmillan (2001)[16]: 161 and Macmillan (2000)[3]: 94 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):[3]: 1–2, 11
"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... [In my early research I had assumed that] 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."
^ abQuotations are from Ferrier (1877–9),[35] Macmillan (2000)[3]: 290 and Smith (1886);[11]
other 19th-century exasperation was expressed by Dupuy (1877)[25] and Jackson (1870).[12]
See Macmillan (2000)[3]: pass.
and Macmillan (2008)[6]: 831 for surveys and discussion of theoretical misuse of Gage, and Barker (1995)[17]: abstr.
for, specifically, the way in which 19th-century reports of Gage were colored by various writers' doctrinal leanings:
"The educational backgrounds of Harlow and Bigelow [explain] 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 [been taught] 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 [including Gage's] to prove opposing views on phrenology was not uncommon."
^ abCite error: The named reference steps_setting was invoked but never defined (see the help page).
^ abcdRatiu etal.[31][32] 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 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.[6]: 830
^Here reproduced from Jackson (1870),[12] these images were commissioned by Harlow from photographer Samuel Webster Wyman and were the basis for the woodcuts seen in Harlow (1868).[1]: 348 [3]: 26, 115, 479–80
^Apparently[20]: 6–7 quoting Gage's mother, Harlow narrates that
while sitting at dinner, [Gage] fell in a fit, and soon after had two or three fits in succession... "[Phineas had] 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, [1860][B] 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.[1]
^Macmillan& Lena: "Only Harlow[1]: 342 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[s]... that Gage's tamping iron was recovered from the grave."[20]: 7
^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.JohnM.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 [i.e. the "Medical College of Harvard University"], for his donation."[12]: v
^Text of inscription from Macmillan (PGIP).[10]: D
The inscription's date for the accident is one day off,
and Phinehas seems not to be how Gage spelled his name (Macmillan 2008).[6]: 839fig.
The inscription was commissioned by Harvard's Dr. Bigelow[citation needed] 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.[citation needed]
^Early authors attempting to estimate the extent of damage include: Harlow (1848);[7]: 389 Bigelow (1850);[8]: 21–2 Harlow (1868);[1]: 343, 5 Dupuy (1877);[25] Ferrier (1878).[26]
See also Bramwell (1888);[27] Tyler& Tyler (1982);[28] Cobb (1940, 1943).[29][30]
^Specifically, Van Horn etal.[33] 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.)
^Macmillan (2000)[3]: 106–8, 375–6 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[3]: 350–1 that an 1850 communication calling Gage "gross, profane, coarse, and vulgar"
was anonymously supplied by Harlow.[citation needed]
^For example, the "fitful, irreverent... capricious and vacillating" Gage described in Harlow (1868)Cite error: The <ref> tag has too many names (see the help page).Phrenologists contended that destruction of the mental "organs" of Benevolence and Veneration (top-right) caused Gage's behavioral changes.
]]
[Fig. 7]False-color representation of cerebral fiber pathways affected, per Van Horn etal.[33]
Though Gage is considered the "index case for personality change due to frontal lobe damage"Cite error: The <ref> tag has too many names (see the help page).Excerpt from record book forLone Mountain Cemetery, San Francisco, reflecting the May23, 1860 interment of Gage by undertakers N. Gray& Co.[B]Template:Print version
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.
^Campbell,H.F. (1851) "Injuries of the Cranium—Trepanning". Ohio Med& Surg J4(1), pp. 20–24, crediting the Southern Med& Surg J (unknown date)
^ abAttention: 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.
^ abFolsom, 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)
^ abc"Bibliographical Notice". Boston Medical& Surgical Journal. 3n.s. (7): 116–7. March18, 1869. {{cite journal}}: Check date values in: |date= (help)
^ abcdAttention: 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.
^ abCite error: The named reference harlow1849 was invoked but never defined (see the help page).
^ abcdefgAttention: 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.
^ abVolume 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.
^ abc|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.
^Cite error: The named reference hockenbury was invoked but never defined (see the help page).
^ abcDupuy, 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.
^ abFerrier, D. (1878) "The Goulstonian lectures of the localisation of cerebral disease." Lecture I (concluded). Br Med J 1(900):443–7
^Cite error: The named reference bramwell was invoked but never defined (see the help page).
^ abTyler, K.L. and Tyler, H.R. (1982) "A 'Yankee Invention': the celebrated American crowbar case". Neurology32:A191.
^ abCobb, S. (1940) "Review of neuropsychiatry for 1940". Arch Intern Med66:1341–54
^ abCobb, S. (1943) Borderlands of psychiatry. Harvard Univ. Press.
^ abcAttention: 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.
^ abcAttention: 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.
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^ abJackson, J.B.S. (1849) Medical Cases (Vol.4, Case 1777) Countway Library (Harvard Univ.) Mss., HMSb72.4.
^ abFerrier, 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).
^{{cite book |author=Fuster, Joaquin M. |title=The prefrontal cortex |publisher=Elsevier/Academic Press |year=2008 />: 172
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^Macmillan, M.; Aggleton, John (March6, 2011). "Phineas Gage: The man with a hole in his head" (Audio interview). Interviewed by Claudia Hammond; Dave Lee. {{cite interview}}: Check date values in: |date= (help); Unknown parameter |callsign= ignored (help); Unknown parameter |program= ignored (help)CS1 maint: multiple names: interviewers list (link)
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^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)
Wikimedia Commons has media related to Phineas Gage.
Macmillan, M. "Phineas Gage: Unanswered questions".—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.
Template:Persondata Cite error: There are <ref group=note> tags on this page, but the references will not show without a {{reflist|group=note}} template (see the help page). Cite error: There are <ref group=Fig.> tags on this page, but the references will not show without a {{reflist|group=Fig.}} template (see the help page).
Video reconstruction of tamping iron passing through Gage's skull (Ratiu et al. 2004).[G]
