"Phineas Gage: A Gruesome but True Story About Brain Science" by John Fleischman

Phineas is the foreman of a track construction gang that is in the process of blasting a railroad right-of-way through granite bedrock near the small town of Cavendish, Vermont.

A few yards behind Phineas, a group of his men are using a hand-cranked derrick crane to hoist a large piece of rock.

It exited his forehead between the two hemispheres of the cortex.

The two doctors confer, but Dr.

He develops a fever and begins to have delirious spells.

Oxygen and nutrients can cross the blood-brain barrier, but many dangerous substances like bacteria cannot.

They reminded him of the bare rooms used by monks in a monastery.

London society clamored to see more microscope images of things too fine for the human eye.

They call it "sepsis," and they know from bitter experience how quickly a "septic" wound can go from slight redness to gross swelling to a fatal condition called gangrene.

A cut or break in the skin lets staph and strep bacteria colonize the warm, wet, nutrient-rich cells inside.

The body's immune system tries to kill the invading bacteria with an array of special immune cells, while the bacteria try to protect themselves against immune cells by cranking out toxic chemicals.

Eventually, Pasteur will unravel the three great biological mysteries of his time—fermentation, decay, and infection.

Harlow follows the best medical advice of his time—keep the wound clean but covered and watch for inflammation.

A sign of infection is a fluid called "pus" (it's actually dead white blood cells, a sign that the body's immune system is attacking bacterial invaders) that collects in pockets to form abscesses.

The fever abates.

Harlow prescribes two powerful drugs—an "emetic" to make Phineas throw up and a "purgative," a powerful laxative, to evacuate his bowels.

Staphylococci bacteria are the other half of the deadly duo of opportunistic bacteria.

His left eye looks intact, but the vision has gradually faded away.

He spouts vulgar language in the presence of women.

Harlow, who is keeping confidential notes on Phineas, sadly writes, "His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again."

From a daguerreotype by Leon Foucault, Paris, 1841; courtesy of Countway Library of Medicine, Harvard Medical School

Harlow writes: "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."

Photographing anyone or anything moving is difficult because the light-sensitive plates are very slow, and a single exposure can take a fall minute.

Yet the year before Phineas's accident, a Boston photographer named Josiah Hawes sets up his camera in a surgical operating theater and takes a "daguerreotype" (a photograph on a metal plate) that he entitles, "Third Operation Using Ether Anesthesia at the Massachusetts General Hospital."

Bigelow's lectures to convince the assembled doctors that his case is neither an exaggeration nor a fraud.

"A physician who holds in his hand a crowbar, three and a half feet long, and more than thirteen pounds in weight, will not readily believe that it has been driven with a crash through the brain of a man who is still able to walk off, talking with composure and equanimity of the hole in his head. Yet there is every reason for supposing it in this case literally true."

Three hundred years ago, everybody "knew" that anger was controlled by the spleen.

They learn as students of gross (a term for "large-scale") anatomy by dissecting the cadavers of paupers, prisoners, and the unclaimed.

They learn as students of gross (a term for "large-scale") anatomy by dissecting the cadavers of paupers, prisoners, and the unclaimed.

The neck flap covers your cerebellum, which coordinates movement.

None of this vital activity is visible in gross anatomy.

A brain "address" can specify left or right hemisphere, the lobe, the nearest ridge or fold, and whether the location is on top or bottom, inside or out, and front or back.

Neurons never actually touch one another or splice together.

That means the 10 billion neurons in your brain and spinal cord have a possible 10 trillion synaptic choices to make.

They do know that cutting the spinal cord results in paralysis.

The Whole Brainers believe that thoughts and commands can originate anywhere in the brain jelly/cloud and flash into action.

Later in the nineteenth century, scientists will discover that a weak electrical current applied to the exposed brain of a laboratory animal will make certain muscles twitch involuntarily and certain senses sharpen or go dead.

The tamping iron has not killed him because the damage is limited to specific organs that are not critical to life.

Sizer tries to disguise the source of his report to the American Phrenological Journal in 1851, writing, "We have been informed by the best authority that after the man recovered, and while recovering, he was grossly profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people."

Sizer explains, "If we remember correctly, the iron passed through the regions of the organs of BENEVOLENCE and VENERATION, which left these organs without influence in his character, hence his profanity, and want of respect and kindness."

Bigelow tells the Boston doctors, "Taking all the circumstances into consideration, it may be doubted whether the present is not the most remarkable history of injury to the brain which has been recorded."

Phrenology lost credibility as science found better ways to probe the brain.

Following Phineas Gage celerity
The story of Phineas Gage is famous, and when people repeat famous stories they have a tendency to improve them.

People have always gawked at strange and unusual things.

Barnum's "mermaid" is a total fake, a counterfeit fossil pasted together from bones, withered skins, and who knows what else.

The noise is deafening, with actors, jugglers, and glass blowers working the crowd.

...one-sheets depicted a husky young man smiling broadly in spite of a huge iron bar which stuck out of his head. Actually, of course, the iron bar no longer protruded from Gage's head but he had it with him, and another skull, also perforated. During his sideshow performances, he would shove the long iron through the holes in his...

...to be found in a pamphlet he sold, and by paying ten cents extra, skeptics could part Gage's hair and see his brain, what there was left of it, pulsating beneath the new, thin covering."

Did Phineas Gage, The Man with a Hole in His Head, fit in with the other human oddities and strange wonders that Barnum promoted here with hype and hoopla?

As far as Professor Macmillan can determine, Dr.

Jonathan Currier in his livery stable in the nearby town of Hanover.

According to his mother, Phineas drives for nearly seven years on a regular schedule over the primitive roads between Valparaiso and Santiago.

His decisions are quick and instinctive, based on long habit.

But an epileptic seizure is only a symptom; the cause can be anything from a tumor, to an inherited genetic disposition to seizures, to a blow to the head.

By the time a seasick Phineas Gage staggered ashore here in 1859, San Francisco was still a frontier town on the farthest edge of the continent.

It's outmoded treatment, even for 1860.

The immediate cause of death is probably hypothermia—his body can't control its internal temperature.

If you keep losing heat, the brain shuts down blood circulation over a larger and larger area of your skin.

The remains ofPhineas, his mother, his brother-in-law, and 35,000 other San Francisco pioneers were dug up by the city and moved to a mass grave in a suburban cemetery.

Other brain researchers soon learn to use low-voltage electricity to stimulate specific points on the brain.

They exchange cordial letters.

Harlow notes her description of how Phineas would entertain them "with the most fabulous recitals of his wonderful feats and hairbreadth escapes, without any foundation except in his fancy."

Harlow recalls how many scoffed at Phineas when Dr.

"This case has been cited as one of complete recovery ... without any impairment to the intellect," he says, but in truth, Phineas's personality changed drastically after the accident.

"Previous to his injury, though untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, 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.'"

"I think you have been shown that the subsequent history and progress of the case only warrant us in saying that physically, the recovery was quite complete," says Dr.

If there are exact locations in the brain that allow for the ability to hear or to breathe, is there a place that generates human social behavior?

The Damasios are renowned brain researchers at the University of Iowa Hospitals & Clinics in Iowa City and treat patients with the same kind of frontal lobe damage that afflicted Phineas.

The Damasios are renowned brain researchers at the University of Iowa Hospitals & Clinics in Iowa City and treat patients with the same kind of frontal lobe damage that afflicted Phineas.

This kind of brain surgery is strictly a last resort to save a patient's life, because even if the operation goes well, the risk of side effects is high.

All react with little empathy and seem to find emotion a foreign language.

When your emotions are "aroused," your skin (all over and not just your palms) gets slightly warmer and slightly sweatier.

Your sweat contains salts, which increase electrical conductivity.

Hooked to a skin response machine, the modern-day Phineases are shown a series of emotionally charged pictures—a tranquil landscape, a beautiful woman, a severed foot.

Hooked to a skin response machine, the modern-day Phineases are shown a series of emotionally charged pictures—a tranquil landscape, a beautiful woman, a severed foot.

The results are digitized so the specifics of Phineas's skull can be overlaid onto a three-dimensional computer image of a generic human skull.

A line is drawn between their center point to lay out a hypothetical path for the tamping iron.

Damasio turns to a computer program called Brainvox that is used to reassemble brain scan "slices" into a three-dimensional model.

These areas integrate your sensory input and muscle actions so you keep oriented in space and in motion.

If you want to see Phineas, you have to ask permission at the library's front desk, but generally they will send you straight up to the fifth floor, where Phineas resides in Harvard's collection of medical curiosities.

Psychologists, surgeons, and neurologists came from all over the world to present scientific papers on frontal cortex injuries.

The climax was the dedication of a memorial plaque explaining what had happened to Phineas and to brain science as a result.