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			{{Short description|American brain injury survivor (1823–1860)}}
	{{Use mdy dates|date=June 2013}}
			{{About|the survivor of an iron bar through the head|the UK musical band|Phinius Gage}}
	{{trunc|<!--Hack of all hacks: Each entry in the "Sources and further reading" section near the end of the article is "referenced" below. The "trunc" template just before this comment "truncates" the output of these references to zero length i.e. throws it away. However, since the reflist in the Sources section lists items in the order they are first used in the article, the list below precisely induces the order of the Sources section (in this case a General subsection, Specialist subsection, and Historical subsection -- within each of which items are sorted in the usual Author+Year order). A side-effect of this hack is that each Sources entry has a spurious "a" backlink to the (thrown-away) reference to that entry here. (If a Source entry is accidentally omitted from this list, then that entry will come out at the end of the reflist.) All of this could be avoided if there was some way to explicitly control the order of items in a reflist.-->
			{{Use American English|date=August 2020}}
	<!-- a/o July 2013 at most 9 ref names recognized in any one invocation of r template-->
			{{Use mdy dates|cs1-dates=ly|date=December 2016}}
	<!--general (Gage)-->
			{{Infobox person
	{{r| harlow1868 | pgip | okf | macm_unravelling }}
			|name = Phineas P. Gage
	{{r| macm_aggleton }}<!--the macmillan refs need to be checked for date order-->
			|image = Phineas Gage Cased Daguerreotype WilgusPhoto2008-12-19 EnhancedRetouched Color.jpg
	<!--general (portraits)-->
			|image_upright= 1.35
	{{r|lena_macm | macm_moreabout | twomey | wilgus2009 | wilgus_newimage |wilgus_meet }}<!--wilgus cites need to be checked for date order-->
			|caption = Gage and his "constant companion"{{mdashb}}his inscribed tamping iron{{mdashb}}sometime after 1849, seen in the portrait (identified in 2009){{NoteTag|name=dags}} that "exploded the common image of Gage as a dirty, {{nobr|disheveled misfit"{{hsp}}{{ran|K}} }}
	<!--middle-school students-->
			|birth_date = July 9, 1823 (date uncertain)<!--uncertain instead of circa because we have no confirmation this is even approximately the right date-->
	{{r| fleischman }}
			|birth_place = ],{{NoteTag|name=birth_name}}<!--<<cite covers birth date and place, and discusses uncertainty of birthdate--> U.S.
	<!--specialists-->
			|death_date = {{death date and age|1860|05|21|1823|07|09}}<!--1860 is correct despite Harlow reporting 1861; see Macmillan (2000) p. 108 -->
	{{r| barker | fuster | grafman | kihlstrom | kotowicz | macm_wonderful | macm_restoring }}
			|death_place = ], California, U.S.
	{{r| macm_obscure | macm_rehabilitating }}
			|death_cause = ]
	{{r|ratiu_nejm | ratiu_jneuro | tyler | vanderstoep | vanhorn }}
			|occupation = {{hlist | Railroad construction foreman | ] | ]&nbsp;driver}}
	<!--historical-->
			|spouse=None |children=None{{ran|M|p=39,319,327}}{{r|northstar}}<!--Please don't remove spouse, children even though values are None. It's frequently (though incorrectly) asserted that Gage had a wife and family, and since the correct info is easily highlighted here we may as well do that-->
	{{r| anonymous_bostonpost | ngray | anonymous_bmsj1869_1 | anonymous_bmsj1869_2 | austin | bigelow | bramwell }}
			|burial_place = ], California (skull in ], Boston)
	{{r| campbell | carlson | cobb1940|cobb1943}}
			|known_for = Personality change after brain&nbsp;injury
	{{r| damasioA1994 | damasioA1996 | damasioH1994 | dupuy }}<!--text and cites need rechecking re A vs H Damasio, both 1994-->
	{{r| folsom | fowler | ferrier1877_9 | ferrier1878 }}
	{{r| harlow1848 | harlow1849 | hockenbury | jackson1849 | jackson1870 }}
	{{r| nicholl | sacks | sizer | smith | stuss }}
	<ref group="Fig." name=lead_inset/><!--<<<Similarly, force numbering of figures-->
	<ref group="Fig." name=wilgus_dag/>
	<ref group="Fig." name=Cavendish_map/>
	<ref group="Fig." name=accident_site/>
	<ref group="Fig." name=post_notice/>
	<ref group="Fig." name=vanhorn_hinged/>
	<ref group="Fig." name=gage_face/>
	<ref group="Fig." name=wyman_imgs/>
	<ref group="Fig." name=burialrecord_imgs/>
	<ref group="Fig." name=frontal_diag/>
	<ref group="Fig." name=harlow1868_fig/>
	<ref group="Fig." name=dr_harlow/>
	<ref group="Fig." name=phrendiag/>
	<ref group="Fig." name=vanhorn_pathways/>
	<ref group="Fig." name=miller_img/>
	<ref group="Fig." name=inscription_detail/>
	<ref group="Fig." name=vanhorn_warren/>
	|0 }}<!--<< end truncate template, truncating output to "0" legth i.e. discard output from refs above -- we only want the side effects of the references i.e. the numbering of the citations/figures induced by the order they are invoked above--><!--must be no newline here, or you get unwanted whitespace in output-->{{Infobox person
	| name = Phineas P. Gage
	| image = Phineas Gage Cased Daguerreotype WilgusPhoto2008-12-19 Unretouched Color.jpg
	| image_size = 286px<!--size 286px = (220=default Preferences value for default img width) * (1.3="upright factor" used presently in imgs below) -- does not appear infobox has anything equivalent to "upright" in image syntax-->
	| caption = <span style="font-size:125%;"><sub><ref group="Fig." name=wilgus_dag><!--dummy to silence errmsg--></ref></sub></span>
	<br>The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"{{mdash}}{{zwsp}}his inscribed tamping iron{{zwsp}}{{efn-ua
	<!--BEGIN NOTE-->
	|Daguerreotype from the collection of Jack and Beverly Wilgus. The original, like almost all daguerreotypes,<!--cite technical details on dags--> shows its subject laterally (left-right) reversed, making it appear that Gage's right eye is injured; however, there is no question (Lena{{nbsp}}& Macmillan, 2010){{r|lena_macm}}<!--get pg#--> that all Gage's injuries, including to his eye, were on the left.<!--add cite and integrate notes on both photos --> Therefore, in presenting the image here a second, compensating reversal has been applied in order to show Gage as he appeared in life.
	See Harlow (1868){{r|harlow1868|page=340}} for "constant companion".
	}}<!--END NOTE-->
	| birth_date = July 9, 1823 <small>(date uncertain)</small>
	| birth_place = ]{{efn-ua|name="birth_name"}}<!--cite covers birth date, place-->
	| death_date = {{death date and age|1860|05|21|1823|07|09}}<!--1860 is correct despite Harlow 1868 reporting 1861; see Macmillan 2000 p108 -->
	| death_place = <small>In or near</small> ]{{efn-ua|name="death"}}<!--cite covers death date, place}--><!--chk covers "or near"-->
	| death_cause = ]
	| occupation = {{hlist | Railroad construc{{shy}}tion foreman | ]
	| {{nowrap|] driver}} }}
	<!--It is often reported that Gage mistreated wife and children. To emphasize that he actually had no wife/children, including the following two even though value = None-->
	| spouse=None
	| children=None{{r|okf}}{{rp|319,327}}<!--cite covers Spouse None, Children None-->
	| residence = {{hlist|] | ] | ] }}
	| home_town = ]{{efn-ua|name="birth_name"}}<!--cite covers home_town only-->
	| resting_place = {{plainlist|
	*{{hanging indent|text=], {{nowrap|Boston<small> (skull)</small>}} }}
	*{{hanging indent|text=], {{nowrap|California<small> (other remains)</small>}} }}
	}}
	| known_for = Personality change after ]
	}}		}}
	<!---=================================================================================================================--->
	'''Phineas P. Gage'''
	(1823{{ndash}}1860)<!--<<per MOS, giving only years (not month/day) of birth/death in lead because exact birthdate is uncertain; see Macmillan 2000 pp.6,11 (full dates and explanation in infobox and its notes)-->
	was an American railroad construc{{shy}}tion foreman remembered for his improba{{shy}}ble{{efn-ua|name="bemused"}} surviv{{shy}}al of an accident in which a large iron rod was driven completely through his head, destroy{{shy}}ing much of his brain's left ], and for that injury's reported effects on his personal{{shy}}i{{shy}}ty and behavior over the succeed{{shy}}ing twelve years{{mdash}}{{zwsp}}effects so profound that (for a time at least) friends saw him as "no longer Gage."
			'''Phineas P. Gage''' (1823{{ndash}}1860) was an American railroad ] remembered for his improbable{{ran|B1|p=19}} survival of an accident in which a large iron rod was driven completely through his head, ], and for that injury's reported effects on his personality and behavior over the remaining 12 years of his life{{mdashb}}effects sufficiently profound that friends saw him (for a time at least) as "no longer Gage".
	[[File:Phineas gage - 1868 skull diagram.jpg|thumb|upright=0.45|left<!--Please see Talk and discuss there before moving this img (e.g. based on MOS guidelines)-->
	|<span style="font-size:125%;"><sub><ref group="Fig." name=lead_inset><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>The "abrupt and intrusive visitor"<!--, per Harlow. Note partially detached bone flap above forehead.-->{{zwsp}}{{efn-ua|name="bemused"}}{{efn-ua
	<!--BEGIN NOTE-->
	|Harlow (1868): "Front and lateral view of the cranium, represent{{shy}}ing the direction in which the iron traversed its cavity; the present appearance of the line of fracture, and also the large anterior fragment of the frontal bone, which was wholly detached, replaced and partially re-united."{{thinsp}}{{r|harlow1868|page=347,fig.2}}
	}}<!--END NOTE-->
	]]
			{{stack|float=right|]}}
	Long known as "the American Crowbar Case"{{mdash}}{{zwsp}}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 ] doctrines"{{thinsp}}{{r|campbell}}{{mdash}}{{zwsp}}Phineas Gage influenced nineteenth-century discus{{shy}}sion about the mind and brain, particu{{shy}}lar{{shy}}ly debate on ], and was perhaps the first case to suggest that damage to specific parts of the brain might affect personality.{{zwsp}}{{r|okf|page1=ch7-9|barker}}<!--<<these cover cerebral localization-->
			Long known as the "American Crowbar Case"{{mdashb}}once termed "the case which more than all others is {{shy|cal|cu|lated}} to excite our wonder, impair the value of ], and even to subvert our ] doctrines"{{hsp}}{{r|campbell}}{{mdashb}}Phineas Gage influenced 19th-century discussion about the ] and brain, {{shy|par|tic|u|larly}} debate on ],{{wbo}}{{ran|M|p=ch7-9}}{{ran|B}} and was perhaps the first case to suggest the brain's role in {{shy|deter|min|ing per|son|al|ity}}, and that ] might induce specific mental changes.
	Gage is a fixture in the curricula of ], ] and ], and is frequently mentioned in books and academic papers; he even has a minor place in popular culture.{{efn-ua
	<!-----BEGIN NOTE----->
	|For scientific and academic discussions see Macmillan;{{r|okf|page=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?''{{thinsp}}"; investigators noted that, "The Phineas Gage video re-creates the famous tamping rod piercing Gage’s skull. Students{{nbsp}}... always react emotionally to this video clip."{{thinsp}}{{r|vanderstoep|page=89}}
	<p>
	For popular culture, see Macmillan (2000){{r|okf|page=ch13}} and
	Macmillan (2008){{r|macm_unravelling|page=830}};<!--chk pg # for offprint skew-->
	for example, several musical groups call themselves ''Phineas Gage'' (or some variation).
	}}<!--END NOTE-->
	Despite this celebrity<!--add cites here or just prior re examples of "celebrity"--> the body of established fact about Gage and what he was like (before or after his injury) is remark{{shy}}a{{shy}}bly small,{{efn-ua|name="accounts_reliablesources"}}
	which has allowed "the fitting of almost any theory to the small number of facts we have"{{thinsp}}{{efn-ua|name="fitting"}}{{mdash}}{{zwsp}}Gage having been cited, over the years, in support of various theories of the brain entirely inconsist{{shy}}ent with one another.
	A survey of published accounts, includ{{shy}}ing scientif{{shy}}ic ones, has found that they almost always severely distort Gage's behavior{{shy}}al changes, exaggerat{{shy}}ing the known facts when not directly contradict{{shy}}ing them.{{efn-ua|name="accounts_reliablesources"}}
			Gage is a fixture in the curricula of ], ], and ],{{wbo}}{{r|larner}}{{ran|M7|p=149}} one of "the great medical curiosities of all time"{{ran|M8}} and "a living part of the medical folklore"{{hsp}}{{ran|R|p=637}} frequently mentioned in books and scientific papers;{{ran|M|p=ch14}} he even has a minor place in popular culture.{{refn|], ch. 13; ], p. 830.}} Despite this celebrity, the body of established fact about Gage and what he was like (whether before or after his injury) is small,{{NoteTag|name=accounts_reliablesources}} which has allowed "the fitting of almost any theory to the small number of facts we have"{{hsp}}{{ran|M|p=290}}{{mdashb}}Gage acting as a "]"{{hsp}}{{r|mazzoni}} in which proponents of various conflicting theories of the brain all saw support for their views. Historically, published accounts of Gage (including scientific ones) have almost always severely exaggerated and distorted his behavioral changes, frequently contradicting the known facts.
	Two photographic portraits of Gage, and a physician's report of his physical and mental condition late in life, were announced 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 ] suggests that Gage's employment as a ] driver in Chile provided daily structure allowing him to relearn lost social and personal skills.
	{{clear left}}<!--at certain zooms something odd used to happen (don't ask what) without {{clear left}} before the TOC-->
	__TOC__{{clear}}<!-- similarly, a clear seems needed after TOC to stop various boxes from crashing into one another; since the TOC is normally triggered by the first section head, the only way to get a {{clear}} immediately after the TOC is to trigger the TOC explicitly, then clear-->
			A report of Gage's physical and mental condition shortly before his death implies that his most serious mental changes were temporary, so that in later life he was far more functional, and socially far better adapted, than in the years immediately following his accident. A social recovery hypothesis suggests that his work as a ] driver in Chile fostered this recovery by providing daily structure that allowed him to regain lost social and personal skills.
	==Background==<!---======================================= B A C K G R O U N D ========================================--->
	[[File:CavendishVermont 1869Map Beers AnnotatedPhineasGageLocations.jpg|thumb|upright=2.6
	|<span style="font-size:125%;"><sub><ref group="Fig." name=Cavendish_map><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>{{small|] about twenty years after Gage's accident. {{nowrap|''(A)''{{thinsp}}The}} two possible accident sites; {{nowrap|''(T)''{{thinsp}}Gage's}} lodgings, where he convalesced; {{nowrap|''(H)''}}{{thinsp}}Harlow's}} home and ].{{efn-ua|name=steps_setting}}
	]]
	{{Quote box | salign=right|align=center| bgcolor=#F5F6CE
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page=330}}
	|quote={{serif|The subject of it was Phin.{{thinsp}}P.{{thinsp}}Gage, a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temper{{shy}}a{{shy}}ment,{{efn-ua
	<!---BEGIN NOTE--->
	|Among ] various "temperaments", ''nervo-bilious'' denotes a rare combination of "excitable and active mental powers" with "energy and strength mind and body possible the endurance of great mental and physical labor"{{zwsp<!--patch linebreaking bug in IE-->}} (Macmillan 2000){{r|okf|page=346-7}}
	Fowler (1838) wrote that it "unites great power with great activity, and, although it seldom gives great brilliancy, it produces that kind of talent which will stand the test, and shine in proportion as it is brought into requisition."{{thinsp}}{{r|fowler}}<!--p.6 given in bibliog-->
	<p>
	Harlow's use of this term reflects his interest in phrenology.{{citation needed|date=July 2013}}<!--expand-->
	}}<!--END NOTE-->
	five feet six inches in height, average weight one hundred and fifty pounds, possess{{shy}}ing an iron will as well as an iron frame; muscular system unusually well dev{{shy}}el{{shy}}oped{{mdash}}{{zwsp}}having had scarcely a day's illness from his childhood to the date of this injury.
	}}<!--<<end serif-->}}<!--<<end quote box-->
	{{clear left}}
	Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage, of ].{{efn-ua
	|name=birth_name<!--BEGIN NOTE-->
	|Macmillan (2000){{r|okf|page=11,17,490-1}} discusses Gage's ancestry and what is and isn't known about his birth and early life.<!--okf p6 may also deal with birthdate uncertainty (check)-->
	Possible birthplaces are ], ], and ] (all in ]) though Harlow (1868) refers to Lebanon in particular as Gage's "native place" and as "his home"{{zwsp<!--patch linebreaking bug in IE-->}} (probably that of his parents) to which he returned ten weeks after the accident.
	<p>
	The vital records of neither Lebanon nor Enfield list Gage's birth. The birthdate July 9, 1823 (the only definite date given in any source) is from a comprehensive Gage genealogy, via Macmillan (2000),{{r|okf|page=16}} and is consist{{shy}}ent with agreement, among the numerous contemporary sources addres{{shy}}sing the point,<!-- cite--->
	that Gage was 25 years old at the time of the accident,
	as well as with Gage's age{{mdash}}{{zwsp}}36 years{{mdash}}{{zwsp}}as given in undertaker's records after his death on May 21, 1860.
	<p>
	There is no doubt Gage's middle initial was ''P''{{thinsp}}{{r|macm_unravelling|page=839fig.}}{{r|harlow1848}}{{r|harlow1868}}{{r|bigelow}}<!-- need page #s, add Macmillan 2000 appendix (also for "nothing to indicate"); add new document when available; particularly clarify re parents' home and JEG/uncle; link towns? -->
	but there is nothing to indicate what the ''P'' stood for (though his paternal grandfather was also named ''Phineas''). See also ]<!--improve this xref-->
	regarding the spelling of Gage's first name as inscribed on the tamping iron.
	<p>Gage's mother's maiden name is variously spelled Swetland, Sweatland, or Sweetland.
	}}<!--END NOTE-->
	Little is known about his upbringing and education, but he was almost certainly literate.{{zwsp}}{{r|okf|page=17,41}}
			==Life==
	He may have gained skill with explosives on the family's farms or in nearby mines and quarries,{{zwsp}}{{r|okf|page=17-18}}
	and by the time of his accident he was a ] foreman (possibly an independ{{shy}}ent contract{{shy}}or) on railway construc{{shy}}tion projects. His employers consider{{shy}}ed him (as his physician later put it) "the most effi­{{shy}}cient and capable foreman in their employ{{nbsp}}... a shrewd, smart business{{shy}}man, very energetic and persist{{shy}}ent in executing all his plans of operation",
	and he had even commis{{shy}}sioned a custom-made ]{{mdash}}{{zwsp}}an iron rod three feet seven inches long, and
	{{fraction|1|1|4}} inches (32{{nbsp}}mm)<!--use convert throughout-->
	in diameter{{mdash}}{{zwsp}}for use in setting charges.
	{{clear}}
			===Background===
	==Gage's injury==<!---======================================= G A G E ' S A C C I D E N T ==============================--->
	<!-- THE ORDER OF THE FOLLOWING 3 FLOATING ELEMENTS SEEMS TO MATTER. IF YOU CHANGE THEM BE SURE TO CHECK RESULTS AT VARIOUS ZOOM LEVELS/TEXT SIZES-->
	{{external media | float = left | width=18em<!--<<expressing width in ems allows controlled linewrap--> | video1 = {{anchor|ratiu_video_external_link}} (Ratiu et al. 2004){{zwsp}}{{efn-ua|name="ratiu_hinged"}}
	}}<!--end external media-->
	[[File:RailroadCutCavendishVermontPresumedToBePhineasGageAccidentSite cropped.jpg|thumb|upright=1.3
	|<span style="font-size:125%;"><sub><ref group="Fig." name=accident_site><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Line of the ] passing through ] in rock south of Caven{{shy}}dish. Gage met with his acci{{shy}}dent while setting explo{{shy}}sives to create either this cut or a similar one nearby.{{zwsp}}{{efn-ua|name=steps_setting}}
	]]
	[[File:PhineasGage BostonPostStory.jpg|thumb|upright=1.3
	|<span style="font-size:125%;"><sub><ref group="Fig." name=post_notice><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>The '']'' for Septem{{shy}}ber 21, 1848{{r|anonymous_bostonpost}} (understating the dimensions of Gage's tamp{{shy}}ing iron and over{{shy}}stat{{shy}}ing damage to the jaw).{{zwsp}}{{efn-ua
	|name= note_post<!--BEGIN NOTE-->
	|<sup>(See{{nbsp}}</sup><ref group="Fig." name=post_notice/><sup>)</sup>''],'' Septem{{shy}}ber 21, 1848,{{r|anonymous_bostonpost}} crediting an earlier report (unknown date) in the ''Ludlow Free Soil Union'' (Ludlow, Vermont). This early report misstates the length of the tamping iron, and confuses its circumference with its diameter.
	Also, despite its reference to the "shattering the upper jaw", that did not in fact happen. See Harlow (1868){{r|harlow1848|page=342}} for a description of the iron's path.<!--bring in others' path descriptions, also sequence of issues in brain damage determination i.e. path + location of brain + varied locus of functional regions + ... -->
	}}<!--END NOTE-->
	]]
	[[File:Simulated Connectivity Damage of Phineas Gage vanHorn ProbablePaths.jpg|thumb|upright=0.70
	|<span style="font-size:125%;"><sub><ref group="Fig." name=vanhorn_hinged><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span><!--Likely paths of iron center{{shy}}line per van Horn et{{nbsp}}al., with skull "hinging" open as suggested by Ratiu et{{nbsp}}al.-->Gage's skull "hinged" open as the iron passed through{{efn-ua|name=ratiu_hinged}}<!--though ratiu originated the hinging idea, this is vanhorn's img -- that needs to be made clear-->
	]]
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page=330}}
	|quote={{serif|1=The accident occurred in Cavendish, Vt., on the line of the Rutland{{nbsp}}& Burling{{shy}}ton Railroad, at that time being built, on the 13th of Septem{{shy}}ber, 1848, and was occa{{shy}}sioned by the premature explosion of a blast, when this iron, known to blasters as a tamping iron, and which I now show you, was shot through the face and head.}}
	}}<!--end quote box-->
	{{clear left}}
			], 20 years after Gage's accident: {{smallcaps|(a)}}&nbsp;Region of the accident site (exact location uncertain); {{smallcaps|(t)}}&nbsp;Gage's lodgings, to which he was taken after his injury; {{smallcaps|(h)}}&nbsp;Harlow's home and ].{{NoteTag|name=steps_setting}} ]]
	On September 13, 1848 Gage (aged 25){{efn-ua|name="birth_name"}} was directing a work gang blasting rock while preparing the roadbed for the ] outside the town of ].
	Setting a blast involved boring a hole deep into an outcropping of rock; adding ], a fuse, and sand; and then compact{{shy}}ing this charge into the hole using the tamping iron.{{efn-ua
	|name=steps_setting<!--BEGIN NOTE-->
	|See Macmillan (2000){{r|okf|page=25-27}} and Macmillan (PGIP){{r|pgip|page=A}} for the steps in setting a blast and the location and circumstances of the accident.
	The blast hole, about {{convert|1+3/4|in}} in diameter and up to twelve feet (1.8{{nbsp}}m) 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.<!--need additional Macmillan 2000 cite for labor relations-->
	}}<!--END NOTE-->
			Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage of ].{{NoteTag
	Gage was doing this around 4:30{{nbsp}}p.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 side of his face{{nbsp}}... passing back of the left eye, and out at the top of the head."{{thinsp}}{{efn-ua|name="note_post"}} {{nowrap|<sup>(See{{nbsp}}</sup><ref group="Fig." name=post_notice/><sup>)</sup>}}
			|name=birth_name
			|Macmillan{{ran|M|p=14-17,31n5,490-91}} discusses Gage's ancestry and early life. The birthdate July 9, 1823, is given by a Gage genealogy{{r|cv_gage}} without citation,{{ran|M|p=16}} but is consistent with agreement among contemporary sources{{r|anonymous_national_eagle}}{{r|background}} that Gage was 25 years old on the date of his accident, and with his age (36&nbsp;years) as given in undertaker's records after his death in May&nbsp;1860.{{ran|M|p=108-9}} Possible homes in childhood and youth are ] or nearby East Lebanon, ], and/or ] (all in ]), though Harlow refers to Lebanon in particular as Gage's "native place"{{hsp}}{{ran|H|p=10}} and "his home"{{hsp}}{{ran|H|p=12}} (likely that of his parents),{{ran|M|p=30}} to which Gage returned ten weeks{{ran|M2|p=C}} after his accident.
			{{paragraph break}}
			There is nothing to indicate what Gage's middle initial,{{thinsp}}''P'',{{hsp}}{{wbo}}{{r|background}}{{refn|], p. 490; ], p. 839 (fig.).}}{{ran|G1}}{{r|warren_index}} stood for.{{ran|M|p=490}} His mother's maiden name is variously given as ''Swetland, Sweatland,'' or ''Sweetland''.{{r|swetland}}
			<!--end efn>>-->}} Little is known about his upbringing and education beyond that he was literate.{{wbo}}{{ran|M|p=17,41,90}}{{ran|M10|p=643}}
			Physician ], who knew Gage before his accident, described him as "a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temperament, five feet six inches in height, average weight one hundred and fifty pounds , possessing an iron will as well as an iron frame; muscular system unusually well developed{{mdashb}}having had scarcely a day's illness from his childhood to the date of injury".{{ran|H|p=4}} (In the ], which was then just ending its vogue,{{r|cooter}} ''nervo-bilious'' denoted an unusual combination of "excitable and active mental powers" with "energy and strength mind and body possible the endurance of great mental and physical labor".){{wbo}}{{ran|M|p=346-47}}{{r|fowler|p=6}}
	Despite 19th-century references to Gage as "the American Crowbar Case"{{thinsp}}{{r|smith|page=54}}
	his tamping iron did not have the bend or claw sometimes associated with the term ''];''
	rather, it was simply a cylinder, "round and rendered comparatively smooth by use":{{zwsp}}{{r|harlow1848|page=331}}<!-- 1848 and 1868 page numbers need careful checking -->
	{{quote|The end which entered first is pointed; the taper being inches long{{nbsp}}... circumstances to which the patient perhaps owes his life. The iron is unlike any other, and was made by a <!--DO NOT AMERICANIZE THIS SPELLING>>>>-->neighbouring<!--<<<<DO NOT AMERICANIZE THIS SPELLING -- //neighbouring// is correct -- it follows the source quoted (Bigelow was educated in part in Paris and was perhaps a bit of a snob)--> blacksmith to please the fancy of its owner.{{efn-ua
	<!-----BEGIN NOTE----->
	|Bigelow describes the iron's taper as ''seven'' inches long, but the correct dimension is twelve (corrected in the quotation).{{zwsp}}{{r|harlow1848|page1=331|okf|page2=26}}<!--get direct cite from Warren catalog on taper length-->
	}}<!-----END NOTE----->
	}}<!--end quote-->
	Weighing {{frac|13|1|4}}{{nbsp}}pounds (6{{nbsp}}kg) this "abrupt and intrusive visitor"{{thinsp}}{{efn-ua
	|name=bemused<!------BEGIN NOTE------>
	|A tone of bemused wonderment was common in 19th-century medical writing about Gage (as well as about victims of other unlikely-sounding brain-injury accidents{{mdash}}{{zwsp}}see Macmillan 2000).{{r|okf|page=66-7}} Noting dryly that, "The leading feature of this case is its improbability{{nbsp}}... This is the sort of accident that happens in the pantomime at the theater, not elsewhere," Bigelow (1850){{r|bigelow|page=13,19}} emphasized that though "at first wholly skeptical, I have been personally convinced", calling the case "unparalled in the annals of surgery". This endorsement by Bigelow, Professor of Surgery at Harvard, helped end scoffing about Gage among physicians in general{{mdash}}{{zwsp}}one of whom, Harlow (1868) later recalled, had dismissed the matter as a "Yankee invention":
	<!--I have the pleasure of being able to present to you, to-day, the history and sequel of a case of severe injury of the head, followed by recovery, which, so far as I know, remains without parallel in the annals of surgery.-->
	"The case occurred nearly twenty years ago, in an obscure country town{{nbsp}}..., was attended and reported by an obscure country physician, and was received by the Metropolitan doctors with several grains of caution, insomuch that many utterly refused to believe that the man had risen, until they had thrust their fingers into the hole of<!--sic--> his head,"{{zwsp<!--patch linebreaking bug in IE-->}} (see ]) "and even then they required of the Country Doctor attested statements, from clergymen and lawyers, before they could or would believe{{mdash}}{{zwsp}}many eminent surgeons regarding such an occurrence as a physiological impossibility, the appearances presented by the subject being variously explained away."{{thinsp}}{{r|harlow1868|page=329,344}}
	<p>
	Indeed Jackson (1870){{r|jackson1870|page=v}} wrote that, "Unfortunately, and notwith{{shy}}stand{{shy}}ing the evidence that Dr.{{nbsp}}H. has furnished, the case seems, generally, to those who have not seen the skull, too much for human belief."
	But after Gage was joined by such later cases as a miner who survived traversal of his head by a gas pipe,{{citation needed|date=July 2013}}
	and a lumbermill foreman who returned to work soon after a circular saw cut three inches into his skull from just between the eyes to behind the top of his head (the surgeon removing from this incision "thirty-two pieces of bone, together with considerable sawdust"),{{r|folsom}}
	the ''Boston Medical{{nbsp}}& Surgical Journal'' (1869){{r|anonymous_bmsj1869_2}} pretended to wonder whether the brain has any function at all: "Since the antics of iron bars, gas pipes, and the like skepticism is discomfitted, and dares not utter itself. Brains do not seem to be of much account now-a-days." The ''Transactions of the Vermont Medical Society'' (Smith 1886){{r|smith|page=53-54}} was similarly facetious:
	{{"'}}The times have been,'<!-- /The times have been/ is given in the source, though line actually reads, /The time has been/-->
	says Macbeth {{bracket|]}}, 'that when the brains were out the man would die. But now they rise again.' Quite possibly we shall soon hear that some German professor is ] it."
	<p>
	The reference to Gage's iron as an "abrupt and intrusive visitor" appears in the ''Boston Medical{{nbsp}}& Surgical Jouurnal's'' review{{r|anonymous_bmsj1869_1}} of Harlow (1868).
	}}<!------END NOTE------>
	was found some 80{{nbsp}}feet (25{{nbsp}}m) away, "smeared with blood and brain."{{thinsp}}{{r|harlow1868|page=331}}
			Gage may have first worked with explosives on farms as a youth, or in nearby mines and quarries.{{ran|M|p=17-18}} In July 1848 he was employed on construction of the ] near ],{{r|heart}}{{ran|M10|p=643}} and by September he was a ] foreman (possibly an independent contractor) on railway construction projects.{{ran|M|p=18-22,32n9}} His employers' "most efficient and capable foreman&nbsp;... a shrewd, smart business man, very energetic and persistent in executing all his plans of operation",{{ran|H|p=13-14}} he had even commissioned a custom-made ]{{mdashb}}a large iron rod{{mdashb}}for use in setting explosive charges.{{wbo}}{{ran|B1|p=5}}{{ran|M|p=25}}
	;Initial treatment
	Gage "was thrown upon his back by the explosion, and gave a few convulsive motions of the extremities, but spoke in a few minutes,"{{thinsp}}{{r|harlow1868|page=331}} walked with little assistance, and sat upright in an oxcart for the {{frac||3|4}}-mile (1.2{{nbsp}}km) ride to his lodgings in town. Dr.{{nbsp}}] arrived some thirty minutes after the accident:
	{{quote|When I drove up he said, "Doctor, here is business enough for you." 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{{nbsp}}... as if some wedge-shaped body had passed from below upward. Mr.{{thinsp}}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.{{thinsp}}Gage's statement at that time, but thought he was deceived. Mr.{{thinsp}}Gage persisted in saying that the bar went through his head.{{nbsp}}... {{nowrap|Mr.{{thinsp}}G.}} got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.{{efn-ua
	|name=accident_excerpts<!--BEGIN NOTE-->
	|Excerpted from Williams' and Harlow's statements in: Harlow (1848);{{r|harlow1848|page=390,2}} Bigelow (1850);{{r|bigelow|page=16}} Harlow (1868).{{r|harlow1868|page=335-6}}<!--chk pg#s-->
	}}<!--END NOTE-->
	}}<!--end quote-->
	Dr. ] took charge of the case about 6{{nbsp}}p.m.:
	{{quote|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 ] of blood.{{efn-ua
	|name=accident_excerpts}}
	}}
			===Accident===
	;Convalescence
			] passing through "]" in rock south of Cavendish. Gage met with his accident while setting {{shy|ex|plo|sives}} to create either this cut or a similar one nearby.{{NoteTag|name=steps_setting}} ]]
	Despite Harlow's skillful care,{{efn-ua|name= skillful
	<!--BEGIN NOTE-->
	|As to his own contribution to Gage's survival, Harlow merely averred, "I can only say{{nbsp}}... with good old se Paré]], I dressed him, God healed him"{{thinsp}}{{r|harlow1868|page=346}}{{mdash}}{{zwsp}}an assessment
	Macmillan (2000) calls far too modest.{{r|okf|page=12,59-62,346-7}}
	See Macmillan (2008), Macmillan (2001) and Barker (1995) for further discussion of Harlow's management of the case.{{r|macm_unravelling|page=828-9}}{{r|macm_obscure<!--add specific pg #s-->}}{{r|barker|page=679-80}}
	}}<!--END NOTE-->
	Gage's recuperation was long and difficult. Pressure on the brain{{efn-ua
	|name= failingstrength<!------BEGIN NOTE------>
	|Harlow's notes for September 24: "Failing strength{{nbsp}}... During the three succeed{{shy}}ing days the coma deepened; the ] of the left eye became more protuberant, with fungus pushing out rapidly from the internal ]{{nbsp}}... also large fungi pushing up rapidly from the wounded brain, and coming out at the top of the head".{{r|harlow1868|page=335}}
	Here ''fungus'' does not mean an infecting ] but instead (Oxford English Dictionary) a "spongy morbid growth or excrescence, such as exuberant granulation in a wound"{{zwsp<!--patch linebreaking bug in IE-->}} (that is, part of the body's own reaction to the injury).{{r|okf|page=54,61-2}}
	}}<!------END NOTE------>
	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 expectan{{shy}}cy of his death, and have his coffin and clothes in readiness."<!--add surgery performed-->{{thinsp}}{{efn-ua|name=accident_excerpts}}
			]}} (sand or clay) directs blast into {{shy|sur|round|ing}} rock.]]
	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 ]," 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 "uncontrol{{shy}}la{{shy}}ble by his friends{{nbsp}}... got wet feet and a chill." He soon developed a fever, but by mid-November he was "feeling better in every respect{{nbsp}}... 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."{{thinsp}}{{r|harlow1848|page=392-3}}
			On September 13, 1848, Gage was {{shy|direct|ing a work gang blast|ing rock while pre|par|ing the road|bed}} for the ] south of the village of ]. Setting a blast entailed boring a hole deep into an {{shy|out|crop}} of rock; adding ] and a fuse; then using the tamping iron to pack ("tamp") sand, clay, or other inert material into the hole above the powder in order to contain the blast's energy and direct it into surrounding rock.{{NoteTag
	==Subsequent life and travels==<!---======================================= S U B S E Q U E N T L I F E ================================--->
			|name=steps_setting
	[[File:Phineas Gage Daguerreotype WilgusPhoto2008-12-19 CroppedHeadOnly Unretouched BW.jpg.jpg|right|thumb|upright=0.70
			|Macmillan gives background on the location and circumstances of the accident, and the steps in setting a blast.
	|<span style="font-size:125%;"><sub><ref group="Fig." name=gage_face><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>"Disfig{{shy}}ured yet still handsome"{{thinsp}}{{r|twomey}}]]
			The village of Cavendish (part of the ''town'' of Cavendish) was at the time called Duttonsville.
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
			The blast hole, about {{convert|1+3/4|inch|cm|round=0.5}} in diameter and up to {{convert|12|feet|m|sigfig=1}} 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 statements that Gage had been a "great favorite" with his men, and that his employers had considered him "the most efficient and capable foreman in their employ" prior to the accident.{{wbo}}{{ran|M|p=13,22-29}}{{wbo}}{{ran|M7|p=151-52}}{{wbo}}{{ran|M2|p=A}}
	|quote = {{serif|1=His mother, a most excellent lady, now seventy years age, informs me that Phineas was accust{{shy}}omed to entertain his little nephews and nieces with the most fabulous recita{{shy}}tions of his wonderful feats and hair-breadth escapes, without any found{{shy}}at{{shy}}ion except in his fancy. He conceived a great fondness for pets and souvenirs, especially for children, horses and dogs{{mdash}}{{zwsp}}only exceeded by his attachment for his tamping iron, which was his constant companion for the remainder of his life. He took to travelling{{nbsp}}...}}
			<!--end efn>>-->}}
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page1=340}}
			], p. 639{{ndash}}40; ], pp. 4{{ndash}}5, 17}} }}]]
			]
			As Gage was doing this around 4:30&nbsp;p.m., his attention was attracted by his men working behind him.
			Looking over his right shoulder, and {{shy|inad|vert|ent|ly}} bringing his head into line with the blast hole and tamping iron, Gage opened his mouth to speak; in that same instant the tamping iron sparked against the rock and (possibly because the sand had been omitted) the powder exploded. Rocketed from the hole, the tamping iron{{mdashb}}{{convert|1+1/4|inch|cm}} in diameter, {{convert|3|ft|7|in|1|spell=in}} long, and weighing {{convert|13+1/4|lb|kg}}{{mdashb}}entered the left side of Gage's face in an upward direction, just forward of the angle of the ]. Continuing upward outside the ] and possibly fracturing the ], it passed behind the left eye, through the left side of the brain, then completely out the top of the skull through the ].{{wbo}}{{ran|B1|p=13-14}}{{ran|H|p=5}}{{wbo}}{{ran|M|p=25-29}}{{wbo}}{{r|ratiu_vanhorn}}{{wbo}}{{r|anonymous_mercury}}
			Despite 19th-century references to Gage as the "American Crowbar Case",{{NoteTag
			|{{r|smithW|p=54}}{{ran|T2}} Barker: "Harlow always refers to the bar by its proper title, as a tamping iron. Bigelow's reference to a crowbar&nbsp;... gave the case its nickname, which is still encountered today."{{hsp}}{{wbo}}{{ran|B|p=678}}
			<!--end efn>>-->}} his tamping iron did not have the bend or claw {{shy|some|times asso|ci|at|ed}} with the term ''];'' rather, it was simply a pointed cylinder something like a ],{{ran|K}} round and fairly smooth:{{ran|H|p=5}}
			{{blockquote|The end which entered first is pointed; the taper being {{hsp}}{{nobr|{{ran|V|p=17}}...}} {{shy|cir|cum|stances}} to which the patient perhaps owes his life. The iron is unlike any other, and was made by a {{sic|{{shy|neigh|bo<!--<<DO NOT AMERICANISE THIS SPELLING. DON'T AMERICANIZE IT EITHER>>-->ur|ing}}|hide=y}} blacksmith to please the fancy of the owner.{{ran|B1|p=14}}
	}}		}}
	{{clear left}}
			The tamping iron landed point-first some {{convert|80|ft|m|round=5}} away,{{ran|M|p=29}}{{r|anonymous_mercury}}{{r|anonymous_national_eagle}} "smeared with blood and brain".{{ran|H|p=5}}
	;Injuries
	By November 25 Gage was strong enough to return to his parents' home in ],<!-- actually, check who was in Lebanon vs Enfield at this point; close carriage is at OKF p.{{nbsp}}29 --> 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 ]) of the left eye, a large scar on the forehead, and
			Gage was thrown onto his back and gave some brief ] of the arms and legs, but spoke within a few minutes, walked with little assistance, and sat upright in an oxcart for the {{convert|3/4|mi|km|adj=on}} ride to his lodgings in town.{{ran|H|p=5}}
	{{quote|upon the top of the head{{nbsp}}... a deep depression, two inches by one and one-half inches 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."{{thinsp}}{{r|harlow1868|page1=338-9|harlow1849}}<!--need page for harlow 1849-->
			(A possibly apocryphal contemporary newspaper report claimed that Gage, while en route, made an entry in his time-book{{mdashb}}the record of his crew's hours and wages.){{ran|L1|p=172}}
			About 30 minutes after the accident, physician ] found Gage sitting in a chair outside the hotel and was greeted with "one of the great understatements of medical history":{{wbo}}{{ran|M5|p=244}}
			{{blockquote|When I drove up he said, "Doctor, here is business enough for you." 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.&nbsp;G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain , which fell upon the floor.{{r|accident_excerpts}}
	}}		}}
			Harlow took charge of the case around 6 p.m.:
	;New England
	Harlow says that Gage, unable to return to his railroad work,{{r|harlow1868|page=339}} appeared for a time at ]{{efn-ua
	<!--BEGIN NOTE-->
	|Unlike ], his ] was not a traveling show but a station{{shy}}ary installa{{shy}}tion in New York City.
	There is no evidence Gage exhibit{{shy}}ed with a troupe or circus, or on a fair{{shy}}ground (Macmillan{{nbsp}}& Lena 2010).{{r|macm_rehabilitating|page=3-4}}
	}}<!--END NOTE-->
	in New York City (the curious paying to see, presum{{shy}}a{{shy}}bly, both Gage and the instrument which had injured him) although there is no independ­ent confirmation of this.{{citation needed|date=July 2013}}
	Recently, however, evidence has surfaced{{citation needed|date=July 2013}} support{{shy}}ing Harlow's statement that Gage made public appearances in "the larger New England towns".
	He subsequently worked in a livery stable <!-- add coach service when cite is available -->
	in ].{{zwsp}}{{r|harlow1868|page=340}}
			{{blockquote|You will excuse me for remarking here, that the picture presented was, to one unaccustomed to ], 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. His person, and the bed on which he was laid, were literally one ] of blood.{{r|accident_excerpts}}}}
	;Chile and California
	In August 1852 Gage was invited to Chile to work as a long-distance ] driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the ]{{ndash}}{{zwsp}}] route.
	After his health began to fail around 1859,{{efn-ua
	|name=death<!------BEGIN NOTE----->
	|Gage's death and (original) burial are discussed at Macmillan (2000).{{r|okf|page=108-9}}
	Harlow (1868){{r|harlow1868}}<!--page#--> gives the date of Gage's death as May 21, 1861, but undertaker's records{{r|ngray}} show conclusively that Gage was buried May 23, ''1860''. That Harlow (though in contact with Gage's mother as he was writing) was mistaken by exactly one year implies that certain other dates he gives for events late in Gage's life{{mdash}}{{zwsp}}his move from Chile to San Francisco and the onset of his convulsions{{mdash}}{{zwsp}}must also be mistaken, presum{{shy}}a{{shy}}bly by the same amount; this article follows Macmillan in correct{{shy}}ing those dates. (Each date so corrected carries this annotation).
	}}<!--END NOTE-->
	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 ].{{zwsp}}{{r|okf|harlow1868|page1=103-4<!--<<covers mother, sister move-->|page2=340-1<!--<<covers remainder-->}}
	{{clear}}
			Gage was also swallowing blood, ] every 15 or 20 minutes.{{r|accident_excerpts}}
	==Death and subsequent travels==<!---======================================= D E A T H A N D ========================================--->
	[[File:JacksonJBS A descriptive catalogue of the Warren Anatomical Museum 1870 frontispiece 623x1024.jpg|thumb|upright=1.0
			===Treatment and convalescence===
	|<span style="font-size:125%;"><sub><ref group="Fig." name=wyman_imgs><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Gage's skull (sawed to expose inte{{shy}}ri{{shy}}or) and iron, photo{{shy}}graphed for Harlow in 1868{{zwsp}}{{efn-ua
			] used as a bandage]]
	|name= skullphotos<!------BEGIN NOTE----->
	|Here reproduced from Jackson (1870),{{r|jackson1870<!--"Frontispiece" and specific catalog entry #s given in Sources list, not needed here-->}} these images were commissioned by Harlow from photographer Samuel Webster Wyman and were the basis for the woodcuts seen in Harlow (1868).{{zwsp}}{{r|harlow1868|page1=348|okf|page2=26,115,479-80<!--these pg ranges seem broad-->}}
			With Williams' assistance{{NoteTag
	}}<!---END NOTE----->
			|Williams family lore holds that Harlow did not appear on the scene until two days after Gage's accident, but nonetheless "sought eventually to take the whole glory of the successful outcome" of the case, even though Williams "was given full credit by all those who knew of his connection" to it. However, these stories conflict with every other account of the case, including Williams' own.{{wbo}}{{ran|M|p=279-84}}{{r|butler}}
	]]
			<!--end efn>>-->}} Harlow shaved the scalp around the region of the tamping iron's exit, then removed coagulated blood, small bone fragments, and "an ] or more" of protruding brain. After probing for foreign bodies and replacing two large detached pieces of bone, Harlow closed the wound with adhesive straps, leaving it partially open for drainage;{{ran|M|p=60-61}} the entrance wound in the cheek was ]d only loosely, for the same reason. A wet ] was applied, then a nightcap, then further bandaging to secure these dressings. Harlow also dressed Gage's hands and forearms (which along with his face had been deeply burned) and ordered that Gage's head be kept elevated.
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
	|quote = {{serif|1=It is regretted that an autopsy could not have been had, so that the precise condition of the ] at the time of his death might have been known. In considera{{shy}}tion of this important omission, the mother and friends, waiving the claims of personal and private affection, with a magnanim{{shy}}i{{shy}}ty more than praise{{shy}}wor{{shy}}thy, at my request have cheerful{{shy}}ly placed this skull (which I now show you) in my hands, for the benefit of science.
			Late that evening Harlow noted, "Mind clear. Constant agitation of his legs, being alternately retracted and extended{{nbsp}}... Says he 'does not care to see his friends, as he shall be at work in a few days.{{'"}}{{hsp}}{{r|accident_excerpts}}
	<p>I desire, here, to express gratefully my obligation, and those of the Profes{{shy}}sion, to D.{{thinsp}}D.{{nbsp}} Shattuck, Esq., brother-in-law of the deceased; to ], Mayor of San Francisco, and to Dr.{{nbsp}}], for their kind coopera{{shy}}tion in executing my plans for obtaining the head and tamping iron, and for their fidelity in personally superin{{shy}}tend{{shy}}ing the opening of the grave and forward{{shy}}ing what we so much desired to see.
	{{nowrap|<sup>(See </sup><ref group="Fig." name=wyman_imgs/><sup>)</sup>}}
			], p. 389; ], p. 21; ], p. 16; ], pp. 36{{ndash}}37.
	<!-- add Rehab (History?) material re delivery-->}}
			}} " fame is of the kind that is, and in his case literally so, thrust upon other|wise ordinary people", writes Malcolm Macmillan.{{ran|M|p=11}}
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page=342<!-- chk page #-->}}
			}} ]]
	}}<!--end quote box-->
	{{clear left}}
			Despite his own optimism, Gage's convalescence was long, difficult, and uneven. Though recognizing his mother and uncle{{mdash}}summoned from ], 30 miles (50{{nbsp}}km) away{{mdashb}}{{ran|H|p=12}}{{ran|M|p=30}} on the morning after the accident, on the second day, he "lost control of his mind, and became decidedly delirious". By the fourth day, he was again "rational&nbsp;... knows his friends", and after a week's further improvement Harlow entertained, for the first time, the thought "that it was ''possible'' for Gage to recover&nbsp;... This improvement, however, was of short duration."{{hsp}}{{r|accident_excerpts}}
	In February 1860{{efn-ua|name=death}}
	Gage had the first in a series of increasingly severe ]s. Apparently{{r|macm_rehabilitating|page=6-7}} quoting Gage's mother, Harlow{{r|harlow1868}} narrates that
			]
	{{quote|1=hile sitting at dinner, he fell in a fit, and soon after had two or three fits in succession.{{nbsp}}...<!--He had no premonition of these attacks, or of any subsequent ill feeling.-->"<!--Had--> been ploughing the day before he had the first attack; got better in a few days, and continued to work in various places<!--<<italics omitted-->;" could not do much, changing often<!--<<italics omitted-->, "and always finding something which did not suit him in every place he tried." On the 18th of May, {{efn-ua|name=death}} he left Santa Clara and went home to his mother. At 5 o'clock, A.{{thinsp}}M., on the 20th, he had a severe convul{{shy}}sion. The family physician was called in, and ] him. The convulsions were repeated frequently during the succeed{{shy}}ing day and night.
			] of the left eye and scar on forehead. ]]
			Beginning 12 days after the accident,{{ran|M|p=53}} Gage was semi-]tose, "seldom speaking unless spoken to, and then answering only in monosyllables", and on the 13th day Harlow noted, "Failing strength&nbsp;... coma deepened; the ] of the left eye became more protuberant, with ]]<!--<<while in Harlow's day there was debate about the nature of such "fungus", and the term could be (and even today sometimes is) used to refer to living tissue ("fungus cerebri"), Macmillan OKF p283 makes clear that the reference here is to infected tissue-->{{ran|M|p=61,283}} pushing out rapidly from the internal ] from the wounded brain, and coming out at the top of the head." By the 14th day, "the exhalations from the mouth and head horribly ]. Comatose, but will answer in monosyllables if aroused. Will not take nourishment unless strongly urged. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness. One of the attendants implored me not to do anything more for him, as it would only prolong his sufferings{{mdash}}that if I would only keep away and let him alone, he would die."{{hsp}}{{r|accident_excerpts}}
			Galvanized to action, Harlow "cut off the fungi which were sprouting out from the top of the brain and filling the opening, and made free application of caustic ]]{{ran|M|p=54}}{{ran|H1|p=392}} to them. With a scalpel I laid open the {{bracket|], from the exit wound down to the top of the nose}}{{ran|H1|p=392}} and immediately there were discharged eight ounces of ], with blood, and excessively fetid."{{hsp}}{{r|accident_excerpts}} ("Gage was lucky to encounter Dr. Harlow when he did", writes Barker. "Few doctors in 1848 would have had the experience with cerebral ] with which Harlow left {{bracket|]}} and which probably saved Gage's life."{{hsp}}{{ran|B|p=679-80}} ''See ], below.'')
			On the 24th day, 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 ]", 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&nbsp;... he went without an overcoat and with thin boots; got wet feet and a chill". He soon developed a fever, but by mid-November was "feeling better in every respect walking about the house again". Harlow's prognosis at this point: Gage "appears to be in a way of recovering, if he can be controlled".{{r|accident_excerpts}}
			By November 25 (10 weeks after his injury), Gage was strong enough to return to his parents' home in ], traveling there in a "close carriage" (an enclosed conveyance of the kind used for transporting the insane).{{ran|H|p = 12}}{{ran|M|p = 92}} Though "quite feeble and thin&nbsp;... weak and childish"{{r|jackson1849}}{{ran|M|p=93}}<!--"feeble and thin" is not quoted in Macmillan 2000, p. 93 (which gives only "weak and childish") but it's in the original JBS Jackson manuscript--> on arriving, by late December he was "riding out, improving both mentally and physically",{{ran|H2}} and by the following February he was "able to do a little work about the horses and barn, feeding the cattle etc. as the time for ploughing came he was able to do half a day's work after that and bore it well". In August his mother told an inquiring physician that his memory seemed somewhat impaired, though slightly enough that a stranger would not notice.{{NoteTag|
			{{r|jackson1849}}{{ran|M|p=ix,93-94}}
			Macmillan{{ran|M|p=378}} speculates that memory impairment may have been the interpretation placed by Gage's family on his difficulty, as reported by Harlow, in concentrating on tasks {{See below|1={{section link||Early observations (1849–1852)}}.}}
			<!--end efn>>-->}}
			===Injuries===
			In April 1849, Gage returned to Cavendish and visited Harlow, who noted at that time loss of vision, and ], of the left eye,{{NoteTag
			|Though the tamping iron's passage forced the left eye from its orbit by one-half its diameter, that eye retained "indistinct" vision until the tenth day after the accident, when vision was permanently lost.{{ran|H|p=6,8,13}} Ratiu et&nbsp;al. conclude that "the optic canal was spared&nbsp;... secondary to acute glaucoma or swelling of the optic nerve and compression against the rigid walls of the optic canal".{{ran|R|p=640}} Harlow added that Gage could "] and ] the globe, but move it in any other direction".
			<!--end efn>>-->}} a large scar on the forehead (from Harlow's draining of the abscess){{ran|H1|p=392}} and
			{{blockquote|upon the top of the head&nbsp;... <!--a large unequal depression and elevation{{mdashb}}-->a quadrangular fragment of bone<!--, which was entirely detached from the frontal, and extending low down upon the forehead, being still-->{{nbsp}}... raised and quite prominent. Behind this is a deep depression, two inches by one and one-half inches 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.{{ran|H|p=12-13}}}}
			Gage's rearmost left upper ], adjacent to the point of entry through the cheek, was also lost.{{NoteTag|
			] examination of the ] confirms that this tooth was lost before Gage died, though it is unknown when; presumably it was either knocked out during the accident, or loosened so that it fell out later.{{ran|V|p=17}}
			}}<!--<end efn-->
			Though a year later some weakness remained,{{ran|M|p=93}}{{r|ama_standing}} Harlow wrote that "physically, the recovery was quite complete during the four years immediately succeeding the injury".{{ran|H|p=19}}
			===New England and New York (1849{{ndash}}1852)===
			] in 1849. In this 1853 Society portrait, ] is seated second from left.]]
			] in New York City. ]]
			].{{wbo}}{{ran|L1|p=175}} }} ]]
			In November 1849 ], the Professor of Surgery at ],{{ran|M1|p=828}} brought Gage to Boston for several weeks and, after satisfying himself that the tamping iron had actually passed through Gage's head, presented him to a meeting of the ] and (possibly) to the medical school class.{{wbo}}{{ran|B1|p=20}}{{wbo}}{{ran|M|p=43,95}}{{wbo}}{{r|bsmi}}{{wbo}}{{NoteTag
			|name=firsts
			|Gage may have been one of the earliest examples of a patient entering a hospital primarily to further medical research rather than for treatment.{{r|yakovlev}} He also appears to have been one of the first patients exhibited in an entertainment venue, as opposed to in presentations before medical audiences.{{wbo}}{{r|hansen}}{{ran|M1|p=194n15}}
			}}<!--end efn-->
			Unable to reclaim his railroad job {{see below|1={{section link||Early observations (1849–1852)}}}} Gage was for a time "a kind of living museum exhibit"{{hsp}}{{r|raeburn}} at ] in New York City. (This was not the later ]; there is no evidence Gage ever exhibited with a troupe or circus, or on a fairground.){{refn| ]; ], p. 14; ], pp. 14,98{{ndash}}99; ], pp. 643{{ndash}}44.}}{{NoteTag|name=firsts}} Advertisements have also been found for public appearances by Gage{{mdashb}}which he may have arranged and promoted himself{{mdashb}}in New Hampshire and Vermont,{{ran|M10|p=643-44}} supporting Harlow's statement that Gage made public appearances in "most of the larger New England towns".{{ran|H|p=14}}{{ran|M1|p=829}} (Years later Bigelow wrote that Gage had been "a shrewd and intelligent man and quite disposed to do anything of that sort to turn an honest penny", but gave up such efforts because " sort of thing has not much interest for the general public".){{wbo}}{{ran|B2}}{{wbo}}{{r|bennett|p=28}}{{wbo}}{{ran|M10|p=643-44}}
			For about 18 months, he worked for the owner of a ] and coach service in ].{{wbo}}{{ran|H|p=14}}{{ran|M|p=101}}
			===Chile and California (1852{{ndash}}1860)===
			{{Quote box |salign=right|align=left|width=22em
			|quote = {{shy|Phineas was accustomed to entertain his little nephews and nieces with the most fabulous recit|als of his wonder|ful feats and hair-breadth escapes, without any found|at|ion except in his fancy. He con|ceived a great fondness for pets and souve|nirs, espe|cial|ly for children, horses and dogs{{mdashb}}only exceeded by his attach|ment for his tamping iron, which was his constant com|pan|ion during the remainder of his life.}}
			|author = ] (1868){{ran|H|page=340}}
	}}		}}
	Gage died '']''{{thinsp}}{{r|pgip|page=E}} in or near{{r|pgip|page=B}} San Francisco at 10 p.m. on May 21, just under twelve years after his injury. He was buried in San Francisco's ].{{efn-ua
	|name="death"}}<!--actually, is this cite specific to burial, or only death date etc? -->
	(Many accounts{{r|damasioH1994|damasioA1994|hockenbury}}
	assert that Gage's iron was buried with him, but there appears to be no evidence for this.){{efn-ua
	<!-----BEGIN NOTE----->
	|Macmillan{{nbsp}}& Lena: "Only Harlow 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{{nbsp}}... that Gage's tamping iron was recovered from the grave."{{thinsp}}{{r|macm_rehabilitating|page1=7|harlow1868|page2=342}}
	}}<!-----END NOTE----->
			In August 1852, Gage was invited to Chile to work as a long-distance ] driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the ]{{ndash}}] route.{{ran|M|p=103-4}}{{ran|H|p=14}} After his health began to fail in mid-1859,{{wbo}}{{ran|H|p=14-15}}{{NoteTag
	;Skull and iron
			|name=death
	In 1866 Harlow (who had "lost all trace of , and had well nigh abandoned all expecta{{shy}}tion of ever hearing from him again") somehow learned that Gage had died in California, and initiated a correspondence with Gage's family there.
			|Gage's death and original burial are discussed by Macmillan.{{wbo}}{{ran|M|p=108-9}}{{wbo}}{{ran|M2|p=D§corrections}}<!--SOURCE NOTE: Macmillan 2000 p. 108 says "the Interment Records of the Laurel Hill Cemetery give the date of death of 'Phineas B. Gage' as 20 May 1860 and the burial date as 23 May 1860"; however, in the "Phineas Gage Information Page -- Corrections to An Odd Kind of Fame" (https://www.uakron.edu/gage/book.dot) Macmillan corrected himself: "p. 108, para 2: The year of Gage's death is 1860, but the only other date on the records is 23rd. May for the funeral/interment".--> Harlow gives Gage's date of death as May&nbsp;21, 1861,{{ran|H|p=15}} but because bound, consecutive interment records{{r|anonymous_ngray}} show that Gage was buried May&nbsp;23, 1860,{{ran|M|p=122n17}} Macmillan concludes that May&nbsp;21, ''1860'' is the correct death date;{{wbo}}{{ran|M|p=122n15}}{{ran|M10|p=646}} this is confirmed by a contemporary obituary.{{r|deaths}} (Harlow's informant was Gage's mother;{{ran|H|p=15}}{{ran|M10|p=646}} Macmillan{{ran|M|p=376}} points out that the 1861 date, when combined with Gage's recorded age at death{{mdashb}}36 years plus an unspecified number of months{{mdashb}}obscures the fact that Gage was born just a few months after his parents' April&nbsp;27, 1823 marriage.) This implies that certain other dates Harlow gives for events late in Gage's life{{mdashb}}his move from Chile to San Francisco and the onset of his convulsions{{mdashb}}must also be mistaken, presumably by the same one year; this article follows Macmillan{{ran|M|p=122n15}} in correcting those dates, each of which carries this annotation.
	At Harlow's request they opened Gage's grave long enough to remove his skull, which the family then personally{{r|macm_rehabilitating|page=6}} delivered to Harlow back in New England.<!--add note re move to Woburn-->
			<!--end efn>>-->}} he left Chile for San Francisco, arriving (in his mother's words) "in a feeble condition, having failed very much since he left New Hampshire&nbsp;... Had many ill turns while in Valparaiso, especially during the last year, and suffered much from hardship and exposure." In San Francisco he recovered under the care of his mother and sister,{{ran|H|p=15}} who had relocated there from New Hampshire around the time he went to Chile.{{ran|M|p=103-4}} Then, "anxious to work", he found employment with a farmer in ].{{ran|H|p=15}}
			In February 1860,{{NoteTag|name=death}} Gage began to have ]s. He lost his job, and (wrote Harlow) as the seizures increased in frequency and severity he "continued to work in various places could not do much".{{wbo}}{{ran|M|p=14}}{{ran|H|p=16}}
	About a year after the accident, Gage had been persuaded by Bigelow<!--<<chk cite coming up covers this--> to deposit his tamping iron in Harvard Medical School's ], but he later reclaimed it{{r|bigelow|page1=22n|anonymous_bmsj1869_1|okf|page3=46-7}}
	and made what he called "my iron bar" his "constant companion during the remainder of his life";{{r|harlow1868|page=339}}
			===Death and exhumation===
	now it too was delivered to Harlow.{{nowrap|<sup>(See{{nbsp}}</sup><ref group="Fig." name=wyman_imgs/><sup>)</sup>}} After studying them for a triumphal retrospective paper on Gage{{r|harlow1868}}
	Harlow redeposited the iron{{mdash}}{{zwsp}}this time with Gage's skull{{mdash}}{{zwsp}}in the Warren Museum, where they remain on display today.{{efn-ua
			]
	|name=mostvaluable<!------BEGIN NOTE------>
	|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.{{thinsp}}John{{thinsp}}M.{{thinsp}}Harlow{{nbsp}}...<!--, of Woburn. It was the skull of the man through whose head a large iron bar passed, and who essentially recovered from the accident.--> For the professional zeal and the energy that Dr. H. showed, in getting possession of this remark{{shy}}a{{shy}}ble specimen, he deserves the warmest thanks of the profession, and still more, from the College ]"], for his donation."{{thinsp}}{{r|jackson1870|page=v}}
			On May 18, 1860, Gage "left Santa Clara and went home to his mother. At 5&nbsp;o'clock, A.M., on the 20th, he had a severe {{shy|con|vul|sion}}. The family physician was called in, and ] him. The {{shy|con|vul|sions}} were repeated frequently during the {{shy|suc|ceed|ing}} day and night,"{{hsp}}{{ran|H|p=15}} and he died in '']'',{{ran|M2|p=E}} in or near San Francisco,{{NoteTag
	}}<!------END NOTE------>
			|Where precisely Gage died is uncertain. Harlow states that Gage "went home to his mother" before he died, but the US census for June{{nbsp}}1, 1860 (seven days after Gage's death) lists as empty the San Francisco house shared by Hannah Gage, her daughter (Gage's sister) Phebe, Phebe's husband David Dustin Shattuck, and Phebe and David's young son Frank. Instead, Hannah, Phebe, and Frank (but not D.{{nbsp}}D. Shattuck, who sometimes traveled on business) were listed as living in the home of physician William Jackson Wentworth, across ] in what is now ]. The family's connection to Wentworth is uncertain, but it may be related to the fact that Frank was deaf; it is also possible Wentworth had met Gage when Gage visited Boston in 1849.{{wbo}}{{ran|M2|p=B}}{{ran|L1|p=194n16}}
	{{anchor|inscription}}
			<!--end efn-->}}
	The iron bears this inscription:{{efn-ua
			late on May&nbsp;21, 1860. He was buried in San Francisco's ].{{wbo}}{{NoteTag|name=death}}
	<!--BEGIN NOTE-->
	|Text of inscription from Macmillan (PGIP).{{r|pgip|page=D}}
			he mother and friends, waiving the claims of personal and private affec|tion, with a mag|na|nim|ity more than praise|worthy, at my request have cheer|fully placed this skull in my hands, for the benefit of science." Gage's skull (sawed to show inte|rior) and iron, photo|graphed for Harlow in 1868.}}{{wbo}}{{refn|], p. 21; ], pp. 26,115,479{{ndash}}80}} ]]
	{{anchor|name_Phinehas}}
	The inscription's date for the accident is one day off,
			]) and his {{shy|fam|i|ly per|son|al|ly de|liv|ered}} Gage's skull and iron to Harlow.{{wbo}}{{ran|M10|p=646}}{{r|departing}} ]]
	and ''Phinehas'' seems not to be how Gage spelled his name (Macmillan 2008).{{r|macm_unravelling|page=839fig.}}<!--again, check pg #; add cite to N. Gray record; consider Harlow 1868 "Phin."; tie/merge to note re middle initial -->
	The inscription was commissioned by Harvard's Dr. Bigelow{{Citation needed|date=March 2010}} 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. <!--need a cite for this; on reflection, it's not clear why Concord poster is more authoritative than inscription-->
			In 1866, Harlow (who had "lost all trace of , and had well nigh abandoned all {{shy|ex|pec|ta|tion}} of ever hearing from him again") somehow learned that Gage had died in California, and made contact with his family there. At Harlow's request the family had Gage's skull exhumed, then personally delivered it to Harlow,{{wbo}}{{ran|M|p=108-11}}{{ran|H|p=15-16}}{{ran|M10|p=646}} who was by then a prominent physician, {{shy|busi|ness|man,}} and civic leader in ].{{wbo}}{{ran|M|p=351-64}}{{ran|M7}}
	}}<!--END NOTE-->
	<sup>(See{{nbsp}}</sup><ref group="Fig." name=inscription_detail/><sup>)</sup>
			About a year after the accident, Gage had given his tamping iron to Harvard Medical School's ], but he later reclaimed it{{wbo}}{{ran|B1|p=22n}}{{r|anonymous_bmsj1869_1}}{{ran|M|p=46-47}} and made what he called "my iron bar"{{hsp}}{{ran|M10|p=644}}{{ran|G1}} his "constant companion during the remainder of his life";{{NoteTag
	{{quote|This is the bar that was shot through the head of M<sup>{{thinsp}}r</sup> Phinehas{{sup|}} P.{{nbsp}}Gage at Cavendish, Vermont, Sept.{{nbsp}}14,{{sup|}} 1848. He fully recovered from the injury{{nbsp}}& deposited this bar in the Museum of the Medical College of Harvard University. Phinehas{{sup|}} P.{{nbsp}}Gage Lebanon Grafton Cy {{nowrap|N{{ndash}}H}} Jan{{nbsp}}6 1850.}} <!-- fix typography of superscript r, chk Sept. 14COMMA Jan 6NOCOMMA (as given on Gagepage but chk directly in Warren)-->
			|name=memo
			|{{ran|H|p=13}} The tamping iron appears to have passed between the Warren Museum and Gage several times. Gage originally gave it to the Museum in early 1850, yet he had it with him when he briefly resumed exhibiting just before going to Chile in 1852. Two years later he was asking for it again: the Museum's files hold a note reading, "3106{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Mr. B.{{nbsp}}R. Sweatland{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Please deliver my iron bar to the bearer{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}P.{{nbsp}}P. Gage{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Aug 26th, 54". Benjamin Richards Sweetland (or Sweatland), a second cousin of Gage's mother, emigrated from New York to California in the 1850s. Presumably Gage either gave or sent this note to Sweetland, who used it to retrieve from the Museum the tamping iron, which he then took, or forwarded, to Gage in Valparaiso. The ''3106'', in a different hand, is the tamping iron's number in ]'s 1870 catalog of the Museum.{{wbo}}{{ran|L1|p=176}}{{ran|G1}}
			}}<!--<<end efn-->
			now it too was delivered by Gage's family to Harlow.{{ran|M10|p=646}} (Though some accounts assert that Gage's iron had been buried with him, there is no evidence for this.){{wbo}}{{ran|M10|p=647}}{{ran|L1|p=177}} After studying them for a triumphal{{ran|L1|p=178}} 1868 retrospective paper on Gage{{ran|H|p=3}} Harlow redeposited the iron{{mdashb}}this time with the skull{{mdashb}}in the Warren Museum, where they remain on display today.{{r|warren_phineas_gage}}
			The tamping iron bears the following inscription, commissioned by Bigelow in conjunction with the iron's original deposit in the Museum{{r|anonymous_bmsj1869_1}} (though the date given for the accident is one day off):
			{{blockquote|This is the bar that was shot through the head of Mr Phinehas{{sup|{{sic}}}} P.&nbsp;Gage at Cavendish Vermont Sept&nbsp;14,{{sup|{{sic}}}} 1848. He fully recovered from the injury&nbsp;& deposited this bar in the Museum of the Medical College of Harvard University.{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Phinehas P. Gage{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Lebanon Grafton&nbsp;Cy {{nowrap|N{{ndash}}H}}{{nbsp}}{{bullet}}{{thinsp}}{{thinsp}}Jan&nbsp;6 1850{{r|WAM03106}}<!--there's no period at the end of the inscription, so omitting that even though this is the end of the article sentence containing this quotation-->
			}}
			The date ''Jan 6 1850'' falls within the period during which Gage was in Boston under Bigelow's observation.{{wbo}}{{ran|B1|p=20}}{{ran|H|p=4n}}{{ran|M|p=43}}
	Much later Gage's headless remains were moved to ] as part of a systematic relocation of San Francisco's dead to new burial places outside city limits.{{r|okf|page=119-120}}
			In 1940 Gage's headless remains were moved to ] as part of a mandated relocation of San Francisco's cemeteries to outside city limits {{crossreference|(see ])}}.{{wbo}}{{ran|M|p=119-20}}{{r|proctor}}
	<imagemap>		<imagemap>
	File:PhineasGage BurialRecord GageEntry.jpg|center|thumb|upright=3.6|<span style="font-size:125%;"><sub><ref group="Fig." name=burialrecord_imgs><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Excerpt from record book for ], San Francisco, reflect{{shy}}ing the May 23, 1860 interment of {{nowrap|Gage by undertakers ]}}<!--<<end nowrap-->{{print version|web={{nowrap|{{small|'' (mouseover for transcription; ] for full page)''}}<!--<<end small-->}}{{thinsp}}{{efn-ua|name=death}}<!--<<end nowrap-->|print=It reads: ''Date of Burial:'' 1860 May 23; ''Name:'' Phineas B. Gage; ''Age (yrs mos ds):'' 36; ''Nativity:'' New Hampshire; ''Disease:'' Epilepsy; ''Place of Burial (tier grave plot):'' Vault; ''Undertaker:'' Gray.{{efn-ua|name=death}}}}<!--<<end {{print version}}-->		File:PhineasGage BurialRecord GageEntry.jpg|thumb|upright=3|center|alt=Refer to caption|Excerpt from record book, ], San Francisco, reflecting the May&nbsp;23, 1860 interment of {{nobr|''Phineas B.{{sup|}} Gage''}} by undertakers ]{{NoteTag|name=death}}<br />''(Position pointer over writing for transcription; click for full page.)''
	rect 0 0 290 387 ]		rect 0 0 290 387 ]
	rect 291 0 945 387 ]		rect 291 0 945 387 ]
Line 320:		Line 196:
	rect 2281 0 2400 387 ]		rect 2281 0 2400 387 ]
	</imagemap>		</imagemap>
	{{clear}}		{{Clear}}
	==Brain damage and mental changes==		==Mental changes and brain damage==
	===Extent of brain damage===<!---======================================= E X T E N T O F B R A I N D A M A G E ====================--->
	[[File:Frontal lobe animation.gif|thumb|upright=1.0
	|<span style="font-size:125%;"><sub><ref group="Fig." name=frontal_diag><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>The brain's left front{{shy}}al lobe ''(red)'', the forward portion of which was damag{{shy}}ed by Gage's injury, per Harlow's digit{{shy}}al exam{{shy}}i{{shy}}na{{shy}}tion and the digit{{shy}}al analy{{shy}}ses of Ratiu et{{nbsp}}al. and Van Horn et{{nbsp}}al.{{zwsp}}{{efn-ua|name="ratiu_hinged"}}
	]]<!--need to explain somewhere that red portion isn't meant to represent Gage's damage (beyond current "forward portion of which")-->
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
	|quote = {{serif|1=The favoring circumstances{{nbsp}}... I will name briefly:}}<!-- actually an excerpt-->
	*{{serif|1=1st. The subject was the man for the man for the case. His physique, will, and capacity of endurance could scarcely be excelled.}}
	*{{serif|1=2nd. The shape of the missle{{mdash}}{{zwsp}}being pointed, round, and comparatively smooth, not leaving behind it prolonged concussion or compression.<!--see bigelow p20, harlow somewhere re pulpification-->}}
	*{{serif|1=3rd. The point of entrance outside of the superior maxillary bone{{mdash}}{{zwsp}}<!--<<<need gloss; ] is not ideal-->the bolt<!--<<<need gloss--> did little injury until it reached the floor of the cranium, when, at the same time that it did irreparable mischief, it opened up its<!--"its"=this mischief's--> way of escape, as without this opening in the base of the skull, for drainage, recovery would have been impossible.}}
	*{{serif|1=4th. The portion of the brain traversed, was, for several reasons, the best fitted of any part of the cerebral substance to sustain the injury.}}{{efn-ua|name="skillful"}}
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page=344}}
	}}<!--end quote box-->
	{{clear left}}
	The amount of Gage's brain tissue destroyed must have been substant{{shy}}ial (consider{{shy}}ing 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.{{efn-ua
	<!--BEGIN NOTE-->
	|<!--need a cite for where this list comes from (OKF); also, could call out pp in some or all of these-->
	Early authors attempting to estimate the extent of damage include: Harlow (1848);{{r|harlow1848|page=389}} Bigelow (1850);{{r|bigelow|page=21-2}}<!--reread carefully--> Harlow (1868);{{r|harlow1868|page=343,5}} Dupuy (1877);{{r|dupuy}} Ferrier (1878).{{r|ferrier1878}}<!-- get pg #s-->
	See also Bramwell (1888);{{r|bramwell}} Tyler{{nbsp}}& Tyler (1982);{{r|tyler}} Cobb (1940, 1943).{{r|cobb1940|cobb1943}}<!--add note re discussed in OKF and poss other MBM papers-->
	}}<!--END NOTE-->
	The 1994 conclusion of H. Damasio et{{nbsp}}al.,{{r|damasioH1994}}
	that both frontal lobes were damaged, was drawn by modeling not Gage's skull but a "Gage-like" one.<!-- explain the similarity issue -->{{r|macm_unravelling|page1=829-30}}
	Ratiu et{{nbsp}}al. (2004, using ] scans of Gage's ''actual'' skull, and present{{shy}}ing a ] of the tamping iron passing through it){{r|ratiu_jneuro|ratiu_nejm}}
	confirm Harlow's conclusion (based on probing Gage's wounds with his finger){{efn-ua|
	<!--BEGIN NOTE-->
	See Macmillan{{nbsp}}& Lena (2010);{{r|macm_rehabilitating|page=9}} Harlow (1868);{{r|harlow1868|page=332,345}} Bigelow (1850);{{r|bigelow|page=16-17}} Harlow (1848);{{r|harlow1848|page=390}}<!--<<chk harlow 1848 p.390 pg ref--> Macmillan (2000).{{r|okf|page=86}}
	}}<!--END NOTE-->
	that the right hemisphere remained intact.{{efn-ua
	|name= ratiu_hinged<!------BEGIN NOTE------>
	|Ratiu et{{nbsp}}al.{{r|ratiu_nejm|ratiu_jneuro}} 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{{mdash}}{{zwsp}}hypothe{{shy}}siz{{shy}}ing (as seen in their ] of the iron passing through Gage's head) 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.{{r|macm_unravelling|page=830}}<!--BPS p# has the usual uncertainty; formalize cite and hyperlinks throughout-->
	<!-- This hypothesis has the further advantage that it helps explain Gage's very survival: the cranium's temporarily increased volume allowed the brain to move aside as the iron passed through, limiting the concussive effect to surrounding tissues.--><!-- check exact wording here; need cite on brain moved aside; integrate with Harlow quote elsewhere on shape of iron-->
	}}<!------END NOTE------->
	Van Horn et{{nbsp}}al. (2012){{r|vanhorn<!--get pg#-->}} agree that the right hemisphere was undamaged and make detailed estimates of the locus and extent of damage to Gage's ], suggest{{shy}}ing that this damage may have been more significant to Gage's mental changes than the ] (gray matter) damage.{{efn-ua
	<!--BEGIN NOTE-->
	|Specifically, Van Horn et{{nbsp}}al. 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"{{zwsp<!--patch linebreaking bug in IE-->}} (such as H. Damasio).<!--need cite here both to H Damasio and to van Horn's cite to it-->
	"Fiber pathway damage extended beyond the left frontal cortex to regions of the left temporal, parietal,<!--silently correcting /partial/ in VanHorn--> 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."{{zwsp<!--patch linebreak bug in IE-->}} (Quotations abridged to remove quantitative estimates of damage to each locus.)
	}}<!--END NOTE-->
	<sup>(See{{nbsp}}</sup><ref group="Fig." name=vanhorn_pathways/><sup>)</sup>
	{{clear}}
			] him, God healed him", wrote physician ], who attended Gage after the "rude missile had been shot through his brain"{{r|eliot}} and obtained his skull for study after his death. Shown here in later life, Harlow's interest in ] prepared him to accept that Gage's injury had changed his behavior.{{refn|], p. 20; ], p. 672}} ]]
	===First-hand reports of mental changes===<!---======================================= F I R S T - H A N D R E P O R T S =============================--->
	[[File:Recovery from the passage of an iron bar through the head p2 rotateRt0pt47 crop.jpg|thumb|right|upright=1.0
	|link=http://en.wikipedia.org/search/?title=File:Recovery_from_the_passage_of_an_iron_bar_through_the_head.djvu&page=2
	|<span style="font-size:125%;"><sub><ref group="Fig." name=harlow1868_fig><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Harlow's 1868 paper, pre{{shy}}sent{{shy}}ing Gage's skull and final history.{{r|harlow1868}}
	]]
	{{Quote box |align=center | bgcolor=#F5F6CE
	|quote = {{serif|1=It is due to science, that a case so grave, and succeeded by such remark{{shy}}a{{shy}}ble results, should not be lost sight of; that its subsequent history, termination, and pathological evidences, in detail, should have a permanent record. My desire to lay before the profession the sequel of this case, has not permitted me to remain altogether oblivious as to the whereabouts of my patient, and after tracing him in his wanderings over the greater part of this continent, I am able to present to you indubitable evidence that my report of the case, in the Boston Medical and Surgical Journal,{{r|harlow1848}} was no fiction.}}<!--end serif-->
	|salign=right|source = {{mdash}}{{thinsp}}{{serif|1="Recovery from the {{nowrap|Passage of an Iron Bar}} {{nowrap|Through the Head.{{pad|0.57em}} }}<!--<<end nowrap--> }}<!--<<end serif-->
	{{serif|1=By John M.{{thinsp}}Harlow, M.{{thinsp}}D., {{nowrap|of Woburn.{{efn-ua
	<!--BEGIN NOTE-->
	|Well before{{clarify|date=July 2013}}<!--give the timeline--> Harlow (1868) appeared, Harlow had left Cavendish, and after some travel in the United States, established a new practice in ], where he remained for the rest of his life.{{citation needed|date=June 2013}}
	}}<!--<<END NOTE--> (With a Plate.){{pad|2.66em}}<!--the padding may need to be adjusted according to whether the superscript note callout earlier in the line is one or two letters e.g. (2.77em) vs (2.25em) --> }}<!--<<end nowrap--> }}<!--<<end serif-->
	<br>{{serif|1=Read before the Massachusetts Medical Society, {{nowrap|June 3,{{thinsp}}1868."}}}}
	{{r|harlow1868|page=340}}{{nbsp}}<sup>(See{{nbsp}}</sup>{{serif|1=<ref group="Fig." name=harlow1868_fig/>}}</sup><sup>)</sup>
	}}<!--end quote box-->
	[[File:John-m-harlow cropped.jpg|thumb|upright=1.0
	|<span style="font-size:125%;"><sub><ref group="Fig." name=dr_harlow><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Physician John Martyn Harlow, who attended Gage after his accident and obtained his skull for study after his death, in later life{{r|macm_obscure}}<!--bring on Barker, Macmillan comments on tx-->
	]]
	{{clear left}}
	Gage certainly displayed some kind of change in behavior after his injury,{{r|macm_rehabilitating|page=12-15}}<!--likely other papers + Macmillan 2000 cited too -->
	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),{{efn-ua
	|name=accounts_reliablesources<!--BEGIN NOTE-------------------------->
	|Accounts of Gage are compared to one another, and against the known facts, at Macmillan (PGIP){{r|pgip|page=C}} and in Macmillan 2000.{{r|okf|page=esp.116-19,chs.13-14}}
	According to Macmillan{{nbsp}}& Lena (2010,<!--get page numbers-->
	and see also Macmillan 2000){{r|okf|page=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);{{r|harlow1848|harlow1849|harlow1868}} Bigelow (1850);{{r|bigelow}} Jackson (1870);{{r|jackson1870}}; Jackson (1849).{{r|jackson1849}}
	Macmillan{{nbsp}}& Lena (2010) presents previously unknown sources discovered post 2008.<!--get pg #s --><!-- mention Channing at OKF p95 -->
	<p>
	Macmillan (2001){{r|macm_obscure|page=161}}<!--dbl-check pg--> and Macmillan (2000){{r|okf|page=94}} discuss the high general reliability of Harlow (1868), and its primacy as a source.
	<p>
	The contrast between Gage's celebrity, and the small amount known about him, is discussed in Macmillan (2000):{{r|okf|page=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.{{nbsp}}... because Phineas Gage was said to be important in psychology, everyone would have been interested in him; because his survival was so remark{{shy}}a{{shy}}ble, someone must have made a major study of him. Neither was the case."
	}}<!--END NOTE--------------------------------->
	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.
			] (seen here in 1854). His anti-] training pre{{shy}}dis{{shy}}posed him to minimize Gage's behavioral changes.{{ran|B|p=672}}]]
	;Harlow's 1848 report
	In his 1848 report, as Gage was just completing his physical recovery, Harlow had only hinted at possible psycho{{shy}}log{{shy}}i{{shy}}cal symptoms:
	"The mental manifestations of the patient, I leave to a future communication. I think the case{{nbsp}}... is exceedingly interest{{shy}}ing to the enlightened physiologist and intellectual philosopher."{{thinsp}}{{r|harlow1848|page=393}}
	And after observing Gage for several weeks in late 1849, Harvard Professor of Surgery ] (in keeping with his anti-] training){{efn-ua
	|name= fitting<!--BEGIN NOTE-->
	|Quotations are from Ferrier (1877{{ndash}}9){{r|ferrier1877_9}}, Macmillan (2000){{r|okf|page=290}} and Smith (1886).{{r|smith}}<!--get pg#-->
	Other 19th-century exasperation was expressed by Dupuy (1877){{r|dupuy}} and Jackson (1870).{{r|jackson1870}}
	See Macmillan (2000){{r|okf|page='']''}}<!--certainly specific chapters can be called out-->
	and Macmillan (2008){{r|macm_unravelling|page=831}} for surveys and discussion of theoretical misuse of Gage, and Barker (1995){{r|barker|page=abstr.}}<!--don't know the proper fmt for cite to abstract-->
	for, specifically, the way in which nineteenth-century reports of Gage were colored by various writers' doctrinal leanings:
	"The educational backgrounds of Harlow and Bigelow<!--are examined to explain--> their differing attitudes toward the case. Harlow's interest in ] prepared him to accept the change in character as a significant clue to cerebral function which merited publication. Bigelow had <!--learned--> that damage to the cerebral hemispheres had no intellectual effect, and he was unwilling to consider Gage's deficit significant{{nbsp}}...
	The use of a single case to prove opposing views on phrenology was not uncommon."
	}}<!--END NOTE-->
	went so far as to say that Gage was "quite recovered in faculties of body and mind," there being only "inconsiderable disturbance of function".{{r|bigelow|page=13-14}}
			Gage may have been the first case to suggest the brain's role in determining personality and that damage to specific parts of the brain might induce specific personality changes,{{refn|{{ran|M|p=1,378}}{{ran|M2|p=C}}{{r|cobb1940|p=1347}}{{r|cobb1943|p=56}}{{ran|K2|p=abstr}}}} but the nature, extent, and duration of these changes have been difficult to establish.{{ran|M|p=89}}{{ran|M10|p=652-55}} Only a handful of sources give direct information on what Gage was like (either before or after the accident),{{NoteTag|name=accounts_reliablesources}} the mental changes published after his death were much more dramatic than anything reported while he was alive,{{ran|M|p=375-76}} and few sources are explicit about the periods of Gage's life to which their various descriptions of him (which vary widely in their implied level of functional impairment) are meant to apply.{{wbo}}{{ran|M10|p=646-47}}
	;Harlow's 1868 report
	Not until 1868 did Harlow (having obtained Gage's skull, tamping iron, and final 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 exaggera{{shy}}ted or distorted form{{mdash}}{{zwsp}}see next section).
	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":
	{{quote|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), manifest{{shy}}ing 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".{{r|harlow1868<!--get pg #, resolve pagination conflict betw harlow1868 and booklet; also Bigelow booklet version?-->}}
	}}<!--end quote-->
			===Early observations (1849–1852)<span id="Early observations"></span>===
	This oft-quoted<!--need a cite on this?--> description appears to draw on Harlow's own notes set down soon after the accident,{{zwsp}}{{r|okf|page=90,375}}
	but other behaviors he describes{{zwsp}}{{r|okf|harlow1868|page1=117-8|page2=340,345}}
	appear to draw on later communications from Gage's friends or family,{{efn-ua
	<!--BEGIN NOTE-->
	|Macmillan (2000){{r|okf|page=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{{r|okf|page=350-1}} that an 1850 communication calling Gage "gross, profane, coarse, and vulgar"<!--consider adding to source list -->
	was anonymously supplied by Harlow.{{cn|date=August 2013}}<!-- expand descr of phren piece; rewrite and relocate -->
	}}<!--END NOTE-->
	and it is difficult to match these various behaviors (which range widely in their implied level of functional impairment){{efn-ua
	<!--BEGIN NOTE-->
	|For example, the "fitful, irreverent{{nbsp}}... capricious and vacillating" Gage described in Harlow (1868){{r|harlow1868<!--get pg#-->}} is somewhat at variance with Gage's stagecoach work in Chile, which demanded that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers"{{zwsp<!--patch linebreaking bug in IE-->}} (Macmillan 2000,{{r|okf|page=106}} citing Austin 1977){{r|austin}}{{mdash}}{{zwsp}}and note Gage was hired by his employer ''in advance'', in New England, to be part of the new coaching enterprise in Chile.{{r|okf|page=376-7}}{{r|macm_unravelling|page=831}}<!--chk cites for coverage of hired-in-advance material-->
	}}<!--END NOTE-->
	to the particular period of Gage's post-accident life during which each described behavior was present.{{r|okf|page1=90-5}}
	This complicates reconstruction of how Gage's behavior changed over time, a critical task in light of evidence that his behavior at the end of his life was very different from his behavior (described by Harlow above) immediately post accident.{{r|macm_rehabilitating|page=6-9}}
	{{anchor|Distortion and misue of case}}<!--this anchor linked from ] -->
	{{clear}}
			Harlow ("virtually our only source of information" on Gage, according to psychologist Malcolm Macmillan){{ran|M|p=333}}{{NoteTag|name=accounts_reliablesources}} 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"; he also took pains to note that Gage's memory and general intelligence seemed unimpaired after the accident, outside of the delirium exhibited in the first few days.{{ran|M|p=30,91}} Nonetheless these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again":
	===Distortion of mental changes===<!--this section head referenced elsewhere in article--><!---============= D I S T O R T I O N O F M E N T A L C H A N G E S ==========--->
	{{Quote box | salign=right|align=right
			{{blockquote|{{shy|The equi|lib|rium or balance, so to speak, between his intel|lec|tual fac|ul|ties and animal pro|pen|si|ties, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not pre|vi|ous|ly his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times per|ti|na|cious|ly obstinate, yet capricious and vac|il|lat|ing, 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 intel|lec|tu|al capacity and man|i|fes|ta|tions, 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 {{sic|hide=y|business <!--<<TWO WORDS, NOT "businessman">>-->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 acquaint|ances said he was "no longer Gage."}}{{ran|H|p=13-14}}}}
	|quote = <span style="font-size: 90%;">A moral man, Phineas Gage<br>Tamping powder down holes for his wage<br>Blew his special-made probe<br>Through his left frontal lobe<br>Now he drinks, swears, and flies in a rage.
	|source = {{mdash}}{{thinsp}}Anonymous<br>{{r|okf|page1=307}}</span>
			This description ("now routinely quoted", says Kotowicz){{ran|K2|p=125}} is from Harlow's observations set down soon after the accident,{{wbo}}{{ran|M|p=90,375}}{{ran|M10|p=646-49}} but Harlow{{mdashb}}perhaps hesitant to describe his patient negatively while he was still alive{{ran|M|p=375-76}}{{mdashb}}delayed publishing it until 1868, after Gage had died and his family had supplied "what we so much desired to see" (as Harlow termed Gage's skull).{{ran|H|p=16}}
			In the interim, Harlow's 1848 report, published just as Gage was emerging from his convalescence, merely hinted at psychological symptoms:{{ran|M|p=169}}
			{{blockquote|The mental manifestations of the patient, I reserve to a future communication. I think the case&nbsp;... is exceedingly interesting to the enlightened physiologist and intellectual philosopher.{{ran|H1|p=393}}}}
			]
			But after Bigelow termed Gage "quite recovered in faculties of body and mind" with only "inconsiderable disturbance of function",{{ran|B1|p=13-14}} a rejoinder in the ''American Phrenological Journal''{{mdashb}}
			{{blockquote|That there was no difference in his mental manifestations after the recovery ''not'' true&nbsp;... he was gross, profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people.{{r|amer_phren}}}}
			{{mdashb}}was apparently based on information anonymously supplied by Harlow.{{ran|M|p=350-51}} Pointing out that Bigelow gave extensive verbatim quotations from Harlow's 1848 papers, yet omitted Harlow's promise to follow up with details of Gage's "mental manifestations", Barker explains Bigelow's and Harlow's contradictory evaluations (less than a year apart) by differences in their educational backgrounds, in particular their attitudes toward ] (the idea that different regions of the brain are specialized for different functions) and ] (the nineteenth-century ] that held that talents and personality can be inferred from the shape of a person's skull):
			{{blockquote|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 that damage to the cerebral hemispheres had no intellectual effect, and he was unwilling to consider Gage's deficit significant&nbsp;... The use of a single case to prove opposing views on phrenology was not uncommon.{{ran|B|p=672,676,678,680}} }}
			A reluctance to ascribe a biological basis to "higher mental functions" (functions{{mdashb}}such as language, personality, and moral judgment{{mdashb}}beyond the merely ] and ]) may have been a further reason Bigelow discounted the behavioral changes in Gage which Harlow had noted.{{wbo}}{{ran|M|p=169-70}}{{ran|M1|p=838}} {{Crossreference|(See ].)}}
			===Later observations (1858{{ndash}}1859)===
			]
			In 1860, an American physician who had known Gage in Chile in 1858 and 1859 described him as still "engaged in stage driving in the enjoyment of good health, with no impairment whatever of his mental faculties".{{wbo}}{{r|hamilton}}{{ran|M10|p=648}} Together with the fact that Gage was hired by his employer in advance, in New England, to become part of the new coaching enterprise in Chile,{{wbo}}{{ran|H|p=15}}{{ran|M10|p=655}} this implies that Gage's most serious mental changes had been temporary, so that the "fitful, irreverent&nbsp;... capricious and vacillating" Gage described by Harlow immediately after the accident became, over time, far more functional and far better adapted socially.{{wbo}}{{ran|M1|p=831}}{{ran|M10|p=642,655}}
			Macmillan writes that this conclusion is reinforced by the responsibilities and challenges associated with stagecoach work such as that done by Gage in Chile, including the requirement that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers."{{hsp}}{{wbo}}{{r|austin|p=127-32}}{{ran|M|p=104-6}}{{ran|M10|p=644-45}} A day's work for Gage meant "a 13-hour journey over 100 miles of poor roads, often in times of political instability or frank revolution. All this{{mdashb}}in a land to whose language and customs Phineas arrived an utter stranger{{mdashb}}militates as much against permanent disinhibition as do the extremely complex sensory-motor and cognitive skills required of a coach driver."{{hsp}}{{wbo}}{{ran|M10|p=645}}{{ran|M1|p=831}}{{r|nyt_additional}} (An American visitor wrote: "The departure of the coach was always a great event at Valparaiso{{mdashb}}a crowd of ever-astonished Chilenos assembling every day to witness the phenomenon of one man driving six horses."){{r|merwin|p=73}}
			===Social recovery<span id="Social recovery hypothesis"></span>===
			], likely the type driven by Gage in Chile{{refn|], pp. 104, 121n13; ], p. 645}} ]]
			Macmillan writes that this contrast{{mdashb}}between Gage's early, versus later, post-accident behavior{{mdashb}}reflects his " from the commonly portrayed impulsive and uninhibited person into one who made a reasonable 'social recovery{{'"}},{{r|jarrett1}} citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills":{{ran|M1|p=831}}
			{{blockquote|{{shy|Phineas' survival and reha|bil|i|ta|tion dem|on|strated a theory of recovery which has influ|enced the treat|ment of frontal lobe damage today. In modern treat|ment, adding struc|ture to tasks by, for example, mentally vis|u|al|is|ing a written list, is con|sid|ered a key method in coping with frontal lobe damage.{{ran|M4}} }}}}
			According to contemporary accounts by visitors to Chile,{{wbo}}{{r|merwin}}{{r|nyt_additional}}{{ran|M1|p=831}}{{ran|M10|p=645}} Gage would have had to
			{{blockquote|rise early in the morning, prepare himself, and groom, feed, and harness the horses; he had to be at the departure point at a specified time, load the luggage, charge the fares and get the passengers settled; and then had to care for the passengers on the journey, unload their luggage at the destination, and look after the horses. The tasks formed a structure that required control of any impulsiveness he may have had.{{ran|M9}}}}
			En route (Macmillan continues):
			{{blockquote|much foresight was required. Drivers had to plan for turns well in advance, and sometimes react quickly to manoeuvre around other coaches, wagons, and '']'' travelling at various speeds{{nbsp}}... Adaptation had also to be made to the physical condition of the route: although some sections were well-made, others were dangerously steep and very rough.}}
			Thus Gage's stagecoach work{{mdashb}}"a highly structured environment in which clear sequences of tasks were required contingencies requiring foresight and planning arose daily"{{mdashb}}resembles rehabilitation regimens first developed by Soviet neuropsychologist ] for the reestablishment of self-regulation in World War&nbsp;II soldiers suffering frontal lobe injuries.{{wbo}}{{ran|M10|p=645,651-52,655}}{{ran|L2}}
			A neurological basis for such recoveries may be found in emerging evidence "that damaged tracts]] may re-establish their original connections or build alternative pathways as the brain recovers" from injury.{{r|jarrett1}} Macmillan adds that if Gage made such a recovery{{mdashb}}if he eventually "figured out how to live" (as Fleischman put it){{ran|F|p=75}} despite his injury{{mdashb}}then it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases";{{ran|M1|p=831}} and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"{{hsp}}{{ran|M9}} As author Sam Kean put it, "If even Phineas Gage bounced back{{mdashb}}that's a powerful message of hope."{{hsp}}{{ran|K}}
			===Exaggeration and distortion of mental changes===
			<!--above section header is linked from ] -->
			{{Quote box |salign=right|align=right|width=22em
			|quote = A moral man, Phineas Gage<br />Tamping powder down holes for his wage<br />{{nbsp|7}}Blew his special-made probe<br />{{nbsp|7}}Through his left frontal lobe<br />Now he drinks, swears, and flies in a rage.
			|author = Anonymous ]{{ran|L1|p=168}}
	}}		}}
	{{Quote box |salign=right|align=center | bgcolor=#F5F6CE
			Macmillan's analysis of scientific and popular accounts of Gage found that they almost always distort and exaggerate his behavioral changes well beyond anything described by anyone who had direct contact with him,{{NoteTag|name=accounts_reliablesources}} concluding that the known facts are "inconsistent with the common view of Gage as a boastful, brawling, foul-mouthed, dishonest useless drifter, unable to hold down a job, who died penniless in an institution".{{hsp}}{{r|macmillan_encyc}} In the words of Barker, "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis".{{ran|B|p=678}} Even today (writes Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a ]";{{ran|K2|p=125}} Grafman has written that "the details of social cognitive impairment have occasionally been inferred or even embellished to suit the enthusiasm of the story teller";{{ran|G|p=295}}
	|quote=
			and Goldenberg calls Gage "a (nearly) blank sheet upon which authors can write stories which illustrate their theories and entertain the public".{{hsp}}{{r|goldenberg}}
	The composite of modern writers has the accident transform{{shy}}ing into a rest{{shy}}less, moody, unpre{{shy}}dict{{shy}}a{{shy}}ble, untrust{{shy}}wor{{shy}}thy, depraved, sloven{{shy}}ly, violent{{shy}}ly quarrel{{shy}}some, aggres{{shy}}sive and boast{{shy}}ful dissi{{shy}}pat{{shy}}ed drunk{{shy}}en bully, display{{shy}}ing fits of temper, and with impaired sexual{{shy}}ity. He is a waster: unwilling to work and unable to settle down. He spends most of the rest of his life in travel{{shy}}ling circuses or drifting around fair{{shy}}grounds to exhibit himself as a human freak, and dies penni{{shy}}less. The facts about the real Phineas{{nbsp}}... can hardly be recognised in .
	|source={{mdash}}{{thinsp}}Malcolm Macmillan (2008)<br>{{r|macm_unravelling|page=830}}
			For example, Harlow's statement that Gage "continued to work in various places; could not do much, changing often, and always finding something that did not suit him in every place he tried"{{hsp}}{{ran|H|p=15}} refers only to Gage's final months, after convulsions had set in.{{ran|M|p=107}}{{ran|M10|p=646}} But it has been misinterpreted{{r|work}} as meaning that Gage ''never'' held a regular job after his accident,{{r|hockenbury}}{{r|employment}}{{r|mann}} "was prone to quit in a capricious fit or be let go because of poor discipline",{{r|damasioA_descartes|p=8-9}} "never returned to a fully independent existence",{{r|damasioH_return|p=1102}} "spent the rest of his life living miserably off the charity of others and traveling around the country as a sideshow freak",{{r|mann}} and ("dependent on his family"{{hsp}}{{r|ebenezer}} or "in the custody of his parents"){{r|bower}} died "in careless dissipation".{{r|damasioA_neuropsychology}} In fact, after his initial post-recovery months spent traveling and exhibiting, Gage supported himself{{mdashb}}at a total of just two different jobs{{mdashb}}from early 1851 until just before his death in 1860.{{wbo}}{{ran|M10|p=654-55}}{{ran|D|p=77}}
			Other behaviors ascribed, by various authors, to the post-accident Gage that are either unsupported by, or in contradiction to, the known facts include the following:
			{{columns-list|colwidth=32em|
			* mistreatment of wife and children (though Gage actually had neither);{{r|wife}}
			* inappropriate sexual behavior, promiscuity, or impaired sexuality;{{r|sexuality}}
			* lack of forethought, concern for the future, or capacity for embarrassment;{{r|forethought}}
			* parading his self-misery, and vainglory in showing his wounds;{{r|forethought}}
			* "gambling" himself into "emotional and reputational{{nbsp}}... bankruptcy";{{r|plante}}
			* irresponsibility, untrustworthiness,{{r|irresponsibility}} aggressiveness, violence;{{r|aggressiveness}}
			* vagrancy, begging,{{r|vagrancy}} drifting,{{r|drifting}} drinking;{{r|drinking}}
			* lying,{{r|lying}} brawling,{{r|brawling}} bullying;{{r|bullying}}
			* ],{{r|psychopathy|plante}} inability to make ethical decisions;{{r|idiot}}
			* " all respect for social conventions";{{r|idiot}}
			* acting like an "idiot"{{hsp}}{{r|idiot}} or a "lout";{{r|mann}}
			* living as a "layabout"{{hsp}}{{r|ahlstrom}} or a "boorish mess";{{r|boorish}}
			* " almost everyone who had ever cared about him";{{r|pelham}}
			* dying "due to a ]".{{r|northcarolina}}
	}}		}}
			None of these behaviors are mentioned by anyone who had met Gage or even his family,{{NoteTag
	{{clear left}}
			|name=accounts_reliablesources
	In the only book dedicated to the case, ''An Odd Kind of Fame:{{thinsp}}Stories of Phineas Gage'' (2000),{{r|okf}} psychologist Malcolm Macmillan surveys scores of accounts of Gage, both scientific and popular, finding that they almost always distort and exagger{{shy}}ate his behavioral changes well beyond anything described by those who had direct contact with him.{{efn-ua|name="accounts_reliablesources"}}
			|Macmillan{{ran|M|p=116-19,ch13-4}}{{ran|M2|p=C}}{{ran|M6}} compares accounts of Gage to one another and against the known facts, as well as contrasting Gage's celebrity{{mdashb}}he is mentioned in 91 percent of a sample of introductory psychology textbooks published 2012{{ndash}}2014{{r|griggs|p=198}}{{mdashb}}with what was, until comparatively recently, the lack of any major study of him and the dearth of papers solely or mainly about him.{{wbo}}{{ran|M|p=1-2,11}}
	In the words of Barker,{{r|barker}}
			{{paragraph break}}
	"As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis", and even today (writes historian Zbigniew Kotowicz)
			Until 2008{{ran|M10|p=642-43}}{{ran|M1|p=830}} the available primary sources offering significant information on Gage, and for which there is any evidence at all (even merely the source's own claim) of contact with Gage or his family, were limited to Harlow (1848, 1849, 1868);{{wbo}}{{ran|H1}}{{ran|H2}}{{ran|H}} Bigelow (1850);{{ran|B1}} and Jackson (1849, 1870).{{r|jackson1849|jackson1870}} Macmillan notes that descriptions of Gage's behavior{{mdashb}}the source of the perennial interest in the case{{mdashb}}total just 300 words{{ran|M|p=90}} and emphasizes the primacy of Harlow's three publications as sources.{{wbo}}{{ran|M|p=94,333,375}} (Harlow's original case notes have not been located.{{ran|M|p=90}} A Warren Museum curator referred to the "stately elegance" of Harlow's writings on Gage.){{r|yakovlev}} However, all of these sources were difficult to obtain prior to 2000{{r|griggs|p=196}}{{mdashb}}for example, Macmillan was able to identify something more than 21 copies of Harlow's 1868 paper{{ran|H}} worldwide{{ran|M|p=371-72}}{{mdashb}}and Macmillan believes this has helped allow distorted descriptions of Gage to flourish.{{ran|M1|p=831}}
	"Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a psychopath{{nbsp}}..."{{thinsp}}{{r|kotowicz}}<!--get pg#-->
			Macmillan&nbsp;& Lena{{ran|M10|p=643-46,648}} present previously unknown sources found since 2008.
	Attributes typically ascribed to the post-accident Gage which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children (of which Gage had neither), inappropriate sexual behavior,{{efn-ua
	<!--BEGIN NOTE-->		<!--end efn>>-->}}
			and as Kotowicz put it, "Harlow does not report a single act that Gage should have been ashamed of."{{hsp}}{{ran|K2|p=122-23}} Gage is "a great story for illustrating the need to go back to original sources", writes Macmillan,{{r|benderly}} most authors having been "content to summarize or paraphrase accounts that are already seriously in error".{{hsp}}{{ran|M|p=315}}
	|Though Macmillan (2000){{r|okf|page=327}} refers to the complete lack of information on Gage's sexual life, and Macmillan{{nbsp}}& Lena (2010){{r|macm_rehabilitating<!--need pg#-->}}
	discusses the continued absence of such information, curricular materials at one medical school{{r|nicholl}}
	go so far as to present Gage as having been "accused of sexually molesting young children".
	}}<!--END NOTE-->
	an "utter lack of foresight", "a vainglorious tendency to show off his wound",
	inability or refusal to hold a job, plus drinking, bragging, lying, gambling, brawling, bullying, thievery, and acting "like an idiot".
	Macmillan's detailed analysis shows that none of these behaviors is mentioned by anyone who had met Gage or even his family;{{efn-ua|name="accounts_reliablesources"}}
	as Kotowicz writes, "Harlow does not report a single act that Gage should have been ashamed of."{{thinsp}}{{r|kotowicz}}<!--get pg#-->{{efn-ua
	|name="notpsycho"<!--BEGIN NOTE-->
	|See also van Horn (2012):{{r|vanhorn<!--get pg#-->}} "Macmillan has noted that many reports on Gage's behavioral changes are anecdotal, largely in error, and that what we formally know of Mr.{{thinsp}}Gage's post-accident life comes largely from the follow-up report of Harlow according to which Gage, despite the description of him having some early difficulties, appeared to adjust moderately well for someone experi{{shy}}enc{{shy}}ing such a profound injury."
	}}<!--END NOTE-->
			Nonetheless (write Daffner and Searl) "the telling of story has increased interest in understanding the enigmatic role that the frontal lobes play in behavior and personality",{{r|daffner}} and Ratiu has said that in teaching about the frontal lobes, an anecdote about Gage is like an "ace your sleeve. It's just like whenever you talk about the French Revolution you talk about the ], because it's so cool."{{hsp}}{{ran|K}}
	For example, prominent modern discussions of Gage by ] and ]{{zwsp}}{{r|damasioH1994|damasioA1994|damasioA1996}}
			Benderly suggests that instructors use the Gage case to illustrate the importance of critical thinking.{{r|benderly}}
	misinterpret a passage by Harlow{{mdash}}{{zwsp}}{{"'}}...{{nbsp}}continued to work in various places;' could not do much, changing often, 'and always finding something that did not suit him in every place he tried{{'"}}{{thinsp}}{{r|harlow1868|page1=341}}<!--specific single pg likely can be called out-->{{mdash}}{{zwsp}}as implying Gage could not hold a job after his accident and "never returned to a fully independ{{shy}}ent existence".
	In fact Harlow's words refer not to Gage's post-accident life in general, but only to the months just before his death, after convulsions had set in;
	and until then Gage had supported himself throughout his adult life.{{efn-ua
	<!--BEGIN NOTE-->
	|For end-of-life employment difficulties see Macmillan (2000), p.{{nbsp}}107;
	for misinterpretation and self-support, see Macmillan{{nbsp}}& Lena (2010) '']'',<!--get specific pg#-->
	as well as Kotowicz (2007): "What Harlow is telling us is clear and unambiguous: Gage returns from South America to his mother to recuperate. As soon as he is fit, he goes back to work with horses, which is what he has been doing for years."
	}}<!--END NOTE-->
			===Extent of brain damage===
	===Theoretical use, misuse, and nonuse===<!-- linked from ] --><!---===================== T H E O R E T I C A L U S E A N D M I S U S E ===================--->
	] contended that destruc{{shy}}tion of the mental "organs"{{zwsp<!--patch linebreaking bug in IE-->}} of Benevolence and Veneration ''(top-right)'' caused Gage's behav{{shy}}ior{{shy}}al changes
			]
	]]
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
			{{Quote box |salign=right|align=right|width=22em
	|quote = {{serif|It is interesting to note the ingenuity with which advocates of various theories will explain away the evidence of their opponents.}}
			|quote = It is regretted that an autopsy could not have been had, so that the {{shy|pre|cise condi|tion}} of the ] at the time of his death might have been known.
	|source = {{serif|{{mdash}}{{thinsp}}William T. Smith (1886)}}{{efn-ua|name="fitting"}}
			|author = ] (1868){{ran|H|page=342}}
	}}		}}
	{{clear left}}
			{{external media |float=right|width=22em |video1= (Ratiu et&nbsp;al.){{ran|R1}} {{registration required}} }}
	Though Gage is considered the "] for personal{{shy}}ity change due to frontal lobe damage"{{thinsp}}{{r|barker}} (and more specifical{{shy}}ly, ] damage){{r|stuss|fuster}} the case's scientific value is severely under{{shy}}mined by the large and uncertain extent of the damage{{r|fuster}} and the small amount known about Gage's behavior{{shy}}al changes.{{citation needed|date=August 2013}}<!--include okf etc. on uncertainty-->
	Instead, Macmillan writes, "Phineas' story is worth remember{{shy}}ing because it illustrates how easily a small stock of facts becomes trans{{shy}}formed into popular and scientific myth," the paucity of evidence having allowed "the fitting of almost any theory to the small number of facts we have".{{efn-ua|name="fitting"}}
	This concern was expressed as far back as 1877, when British neurologist ] (writing to Harvard's ] in an attempt "to have this case definitely settled") complained that
	{{quote|In investi{{shy}}gat{{shy}}ing reports on diseases and injuries of the brain, I am constant{{shy}}ly amazed at the inexacti{{shy}}tude and distortion to which they are subject by men who have some pet theory to support. The facts suffer so frightful{{shy}}ly{{nbsp}}...{{efn-ua|name="fitting"}}
	}}		}}
	More recently Sacks{{r|sacks}} refers to the "interpretations and misinterpretations, from 1848 to the present," of Gage.
			{{shy|Debate about whether the trauma and sub|se|quent infect|ion had damaged Gage's left ''and'' right ], or only the left, began almost immedi|ate|ly after his accident.{{wbo}}{{NoteTag
	Thus in the nineteenth-century controversy over whether or not the various mental functions are ], both sides managed to enlist Gage in support of their theories;{{zwsp}}{{r|barker|okf|page2=ch9}}<!--emph okf p188 material-->
			|{{ran|M|p=3,71}} Early attempts to estimate the extent of damage include those by: Harlow (1848);{{ran|H1|p=389}} ] (1849);{{r|jackson1849}} Bigelow (1850);{{ran|B1|p=21-22}} Harlow (1868);{{ran|H|p=17-19}} Hammond (1871);{{r|hammond}} Dupuy (1873, 1877);{{r|dupuy1873}}{{r|dupuy1877}} Ferrier (1877{{ndash}}79);{{r|ferrier1877_9}}{{r|ferrier1878}} Bramwell (1888);{{r|bramwell}} Cobb (1840, 1843);{{wbo}}{{r|cobb1940|p=1349}}{{wbo}}{{r|cobb1943|p=54-56}} Tyler&nbsp;& Tyler (1982).{{ran|T2}} See ], Ch.{{nbsp}}5.
	for example, soon after ]{{r|dupuy}} wrote that Gage proved that the brain is not localized, Ferrier cited Gage as proof that it is.{{r|ferrier1878}}
			<!--end efn>>-->}} The 1994 con|clu|sion of ] et&nbsp;al., that the tamping iron did physical damage to both lobes, was drawn not from Gage's skull but from a cadaver skull dig|i|tal|ly deformed to match the dimen|sions of Gage's{{wbo}}{{ran|M1|p=829-30}}{{wbo}}{{r|damasioH_return|p=1103-4}}{{mdashb}}and made ''a{{nbsp}}priori'' assumptions about the location of Gage's internal injuries and the exit wound which in some cases contradict Harlow's observations.{{r|hayward}}{{ran|M|p=77-82}} Using ] of Gage's actual skull, Ratiu et&nbsp;al.{{ran|R|p=638}} and Van Horn et&nbsp;al.{{ran|V|p=4-5,22}} both rejected that conclusion, agreeing with Harlow's belief{{mdashb}}based on probing Gage's wounds with his fingers{{mdashb}}that only the left frontal lobe had been damaged.{{wbo}}{{r|fingers}}{{NoteTag
	<!--add frontal function / no function -->
			|In any event, any such analysis can estimate only the initial, direct damage done by the passage of the tamping iron itself; it cannot account for additional damage from concussion, from bone fragments pushed along by the iron after it broke through the base of the cranium, or from the extensive bleeding and severe infection.
	] made use of Gage as well, contend{{shy}}ing that his mental changes resulted from destruction of his "organ of Vener{{shy}}a{{shy}}tion" and/or the adjacent "organ of Benev{{shy}}o{{shy}}lence".{{r|sizer|page1=194}}
			Further uncertainty stems from individual variations in the position of the brain within the skull, and in the points at which various brain functions are localized.{{wbo}}{{ran|M|p=84-86}}
	<sup>(See{{nbsp}}</sup><ref group="Fig." name=phrendiag/><sup>)</sup>
			<!--end efn>>-->}}
			<!--end shy>>-->}}
			] pathways affected, per Van Horn et&nbsp;al.{{ran|V|p=3}} ]]
	Damasio, in presenting his "]"{{zwsp<!--patch linebreaking bug in IE-->}} (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he attributes to Gage and those of modern patients with damage to the orbitofrontal cortex and ].{{r|damasioA1994|damasioA1996}}
	However, Damasio's presentation of Gage has been criticized as
	{{quote|grotesque fabrication{{nbsp}}... the myth of Gage the psychopath.{{nbsp}}... Damasio changes narrative, omits facts, and adds freely to his story{{nbsp}}... It seems that the growing commitment to the frontal lobe doctrine of emotions brought Gage to the limelight and shapes how he is described.{{efn-ua
	<!--BEGIN NOTE-->
	|Kotowicz (2007),{{r|kotowicz}} which continues, " account of Gage's last months such a grotesque fabrication that it leaves one baffled," then quotes A. Damasio (1994){{r|damasioA1994|page=9}}:
	:<!--colon-indent instead of {{quote}} to get "one-sided indent" instead of two-sided, since space is tight in notes-->In my mind is a picture of 1860's San Francisco as a bustling place, full of adventurous entrepreneurs engaged in mining, farming, and shipping. That is where we can find Gage's mother and sister, the latter married to a prosperous San Francisco merchant {{nowrap|(D.{{thinsp}}D.}} Shattuck, Esquire), and that is where the old Phineas Gage might have belonged. But that is not where we would find him if we could travel back in time. We would probably find him drinking and brawling in a questionable district, not convers{{shy}}ing with the captains of commerce, as astonished as anybody when the fault would slip and the earth would shake threateningly. He had joined the tableau of dispirited people who, as ] would put it decades later, and a few hundred miles to the south, "had come to California to die".
	Kotowizc comments: "This little literary flourish is pure invention.{{nbsp}}... There is something callous in insinuat{{shy}}ing that Gage was some riff-raff who in his final days headed for California to drink and brawl himself to death."
	<p>
	Macmillan (2000){{r|okf|page=116-119,326,331}}<!--notes as well, and other Macmillan papers as well--> gives detailed criticism of Damasio's various presentations<!--specify which of AD's works--> of Gage (some of them in joint work with ] and others).
	}}<!--END NOTE-->
	}}<!--end quote "grotesque fabrication"-->
	Or as Kihlstrom put it,
	{{quote|any modern commentators exagger{{shy}}ate the extent of Gage's personality change, perhaps engaging in a kind of retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex in self-regulation.{{efn-ua|
	Kihlstrom (2010).{{r|kihlstrom}} See also Grafman:{{r|grafman|page=295}}:
	"Although the classic story of the nineteenth-century patient Gage who suffered a penetrat{{shy}}ing PFC {{bracket|]}} lesion has been used to exemplify the problems that patients with ventromedial PFC lesions have in obeying social rules, recogniz{{shy}}ing social cues, and making appropriate social decisions, the details of this social cognitive impairment have occasionally been inferred or even embellished to suit the enthusiasm of the story teller{{mdash}}{{zwsp}}at least regarding Gage" (citing Macmillan 2000).{{r|okf}}
	}}<!--END NOTE-->
	}}<!--end quote "Many modern commentators"-->
			In addition, Ratiu et&nbsp;al. noted that the hole in the base of the cranium (created as the tamping iron passed through the ] into the brain) has a diameter about half that of the iron itself; combining this with the hairline fracture beginning behind the exit region and running down the front of the skull, they concluded that the skull "hinged" open as the iron entered from below, then was pulled closed by the resilience of soft tissues once the iron had exited through the top of the head.{{wbo}}{{ran|R|p=640}}{{ran|M1|p=830}}
	It is frequently said{{efn-ua
	|<!--BEGIN NOTE-->
	See for example Carlson (1994);{{r|carlson|page=341}} additional examples and discussion are at Macmillan (2000).{{r|okf|page=246;252-3n9,10}}<!--extract some additional examples and list here, with some quotes; this note can likely be merged with other lobotomy note(s)-->
	}}<!--END NOTE-->
	that what happened to Gage played a part in the later development of various forms of ], particularly ]. Aside from the question of why the unpleasant changes usually (if erroneously) attributed to Gage would inspire surgical imitation,{{efn-ua
	<!--BEGIN NOTE-->
	|" argued that psychiatric patients would benefit from having disinhib{{shy}}it{{shy}}ed behaviors like deliberately induced in them"{{zwsp<!--patch linebreaking bug in IE-->}} (Macmillan 2000).{{r|okf|page=250}}
	}}<!--END NOTE-->
	careful inquiry turns up no such link, according to Macmillan:
	{{quote|here is no evidence that Gage's case contributed directly to psychosurgery.{{nbsp}}... As with surgery for the brain generally, what his case did show came solely from his surviving his accident: major operations could be performed on the brain without the outcome necessarily being fatal.{{r|okf|page1=250;ch10-11|pgip|page2=F }}}}
			Van Horn et&nbsp;al. concluded that damage to Gage's ] (of which they made detailed estimates) was as or more significant to Gage's mental changes than ] (gray matter) damage.{{ran|V|p=abstr}} Thiebaut de Schotten et&nbsp;al. estimated white-matter damage in Gage and two other case studies ("]" and "]"), concluding that these patients "suggest that social behavior, language, and memory depend on the coordinated activity of different regions rather than single areas in the frontal or temporal lobes."{{ran|T1|p=12}}
	===Social recovery===<!---======================================= S O C I A L R E C O V E R Y ===================================--->
	[[File:Simulated Connectivity Damage of Phineas Gage 4 vanHorn PathwaysDamaged.jpg|thumb|upright=1.3
			==<span id="Factors favoring"></span>Factors favoring Gage's survival==
	|<span style="font-size:125%;"><sub><ref group="Fig." name=vanhorn_pathways><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>False-color represen{{shy}}ta{{shy}}tion of cerebral fiber pathways affected, per Van Horn et{{nbsp}}al.{{zwsp}}{{r|vanhorn}}
	]]
			without parallel in the annals of surgery."{{hsp}}{{ran|H|p=3}} Harlow's 1868 presentation to the ]{{ran|H|p=tp}} of Gage's skull, tamping iron, and post-accident history.]]
	{{Quote box | salign=right|align=center | bgcolor=#F5F6CE
	|quote = {{serif|1=No attempt will be made by me to cite analogous cases, as after ransack{{shy}}ing the literature of surgery in quest of such, I learn that all, or nearly all soon came to a fatal result.<!--Hence I conclude to leave that task to those who have more taste for it.-->{{nbsp}}...
	This case is chiefly interest{{shy}}ing to me, as serving to show the wonderful resources of the system in enduing the shock and in in overcom{{shy}}ing the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature.}}		Harlow saw Gage's survival as demonstrating "the wonderful resources of the system in enduring the shock and in overcoming the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature", and listed what he saw as the circumstances favoring it:
			{{blockquote|
	|source = {{serif|{{mdash}}{{thinsp}}Harlow (1868)}}<br>{{r|harlow1868|page=419}}
			1st. The subject was the man for the case. His physique, will, and capacity of endurance, could scarcely be excelled.{{ran|H|p=18}}
	}}		}}
			For Harlow's description of the pre-accident Gage, see ], above.
			{{blockquote|
			2d. The shape of the missile{{mdashb}}being pointed, round and comparatively smooth, not leaving behind it prolonged concussion or compression.{{ran|H|p=18}}
			}}
			Despite its very large diameter and mass (compared to a weapon-fired projectile) the tamping iron's relatively low velocity drastically reduced the energy available to compressive and concussive "shock waves".{{wbo}}{{ran|M|p=56,68n3}}{{wbo}}{{r|ordia|mitchell}}
			Harlow continued:
			{{blockquote|
			3d. The point of entrance{{nbsp}}... did little injury until it reached the floor of the cranium, when, at the same time that it did irreparable damage, it opening in the base of the skull, for drainage, recovery would have been impossible.{{NoteTag|
			{{ran|H|p=18}} Harlow's full text, "The point of entrance outside of the ]{{mdashb}}the did little injury&nbsp;..." refers to the first point at which the tamping iron contacted bone; elsewhere he describes the initial penetration (i.e. of the tissue of the face) as "immediately anterior and external to the angle of the inferior maxillary bone",{{ran|H|p=16}} consistent with the analyses of Macmillan; Ratiu et al.; and Van Horn et al.{{wbo}}{{ran|B1|p=13-14}}{{ran|H|p=5}}{{ran|M|p=73-74}}{{r|ratiu_vanhorn}}
			<!--end efn-->}}
			}}
			Barker writes that " from falls, horse kicks, and gunfire, were well known in pre{{ndash}}Civil War America every contemporary course of lectures on surgery described the diagnosis and treatment" of such injuries. But to Gage's benefit, surgeon ] had performed "his most celebrated operation for head injury before Harlow's medical class, {{bracket|]}} to drain the pus, resulting in temporary recovery. Unfortunately, symptoms recurred and the patient died. At autopsy, reaccumulated pus was found: ] had blocked the opening in the ]." By keeping the exit wound open, and elevating Gage's head to encourage drainage from the cranium into the sinuses (through the hole made by the tamping iron), Harlow "had not repeated Professor Pancoast's mistake".{{wbo}}{{ran|B|p=675}}{{ran|M|p=58}}{{r|pancoast}}
			{{Quote box |salign=right|align=right|width=22.6em
			|quote = {{shy|No attempt will be made by me to cite analo|gous cases, as after ran|sack|ing the lit|er|a|ture of sur|gery in quest of such, I learn that all, or nearly all,<!--<<Pubs Mass Med Soc, and pamphlet, disagree on whether there's a comma here -- see https://en.wikisource.org/Page%3ARecovery_from_the_passage_of_an_iron_bar_through_the_head.djvu/18 -- including comma since it makes sense--> soon came to a fatal result.}}
			|author = ] (1868){{ran|H|p=344}}
			}}
			Finally,
			{{blockquote|
			4th. The portion of the brain traversed was, for several reasons, the best fitted of any part of the cerebral substance to sustain the injury.{{ran|H|p=18}}
			}}
			Precisely what Harlow's "several reasons" were is unclear, but he was likely referring, at least in part, to the understanding (slowly developing since ancient times) that injuries to the front of the brain are less dangerous than are those to the rear, because the latter frequently interrupt vital functions such as breathing and circulation.{{ran|M|p=126,142}} For example, surgeon ] wrote in 1790 that "a great part of the ] may be taken away without destroying the animal, or even depriving it of its faculties, whereas the ] will scarcely admit the smallest injury, without being followed by mortal symptoms."{{hsp}}{{wbo}}{{ran|M|p=128}}{{r|pott}}
			]
			Ratiu et&nbsp;al. and Van Horn et&nbsp;al. both concluded that the tamping iron passed left of the ] and left it intact, both because Harlow does not mention loss of ] through the nose, and because otherwise Gage would almost certainly have suffered fatal blood loss or ].{{wbo}}{{ran|R|p=640}}{{ran|V|p=17}}
			Harlow's moderate (in the context of medical practice of the time) use of ]s, ]s, and (in one instance) ]{{ran|M|p=59-60}} would have "produced dehydration with reduction of intracranial pressure may have favorably influenced the outcome of the case", according to Steegmann.{{r|steegmann|p=956}}
			As to his own role in Gage's survival, Harlow merely averred, "I can only say&nbsp;... with good old ], I ] him, God healed him",{{ran|H|p=20}} but Macmillan calls this self-assessment far too modest.{{refn| ], p. 12, ch. 4, pp. 355{{ndash}}59; ], pp. 28{{ndash}}29; ], pp. 151{{ndash}}53. }} Noting that Harlow had been a "relatively inexperienced local physician&nbsp;... graduated four and a half years earlier",{{ran|M|p=12}} Macmillan's discussion of Harlow's "skillful and imaginative adaptation conservative and progressive elements from the available therapies to the particular needs posed by Gage's injuries" emphasizes that Harlow "did not apply rigidly what he had learned", for example forgoing an exhaustive search for bone fragments (which risked hemorrhage and further brain injury) and applying ] to the "fungi" instead of excising them (which risked hemorrhage) or forcing them into the wound (which risked compressing the brain).{{ran|M|p=58-62}}
	{{clear left}}		{{clear left}}
	In 2008 an advertisement for a previously unknown public appearance by Gage was discovered, as well as a report of his physical and mental condition during his time in Chile, a description of what may well have been his daily work routine there as a stagecoach driver, and more recently an ad for a second public appearance.<!-- cite Unanswered Qs a/o Meet Gage / More about Gage -->
	This new evidence implies that the seriously maladapted Gage described by Harlow existed for only a limited time after the accident{{mdash}}{{zwsp}}that Gage eventually "figured out how to live" despite his injury,{{efn-ua
	<!--BEGIN NOTE-->
	|Fleischman (2002).{{r|fleischman|page=75}}
	See also Kotowicz (2007): "There is coherence and dignity in the way Gage dealt with his predicament. He deserves deep respect."{{thinsp}}{{r|kotowicz}}<!--get pg#-->
	}}<!--END NOTE-->
	and was in later life far more functional, and socially adapted, than previously thought.{{r|macm_unravelling|page1=831}}
			==Early medical attitudes==
	Macmillan hypothesizes that this change represents a social recovery undergone by Gage over time, citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills"{{zwsp<!--patch linebreaking bug in IE-->}} (in Gage's case, his highly structured employment in Chile).{{efn-ua
	<!--BEGIN NOTE-->
	|Macmillan{{nbsp}}& Aggleton (2011):{{r|macm_aggleton}} "Phineas' survival and rehabilitation demonstrated a theory of recovery which has influenced the treatment of frontal lobe damage today. 'There are something like 15 or 20 cases of people who've recovered from very serious frontal brain injury, of the kind that Phineas suffered from, without any professional assistance. In every case, what's common in the reports is that someone, or something, has taken over the lives of these people and given them structure.' In modern treatment, adding structure to tasks by, for example, mentally visual{{shy}}is{{shy}}ing a written list, is considered a key method in coping with frontal lobe damage. 'Phineas worked as a stage-coach driver,' continues Professor Macmillan. 'The job is one that has got an external structure. You've got to be here for this part, then there's that part, then there's something else. Just as with these cases who have recovered.{{'"}}
	}}<!--END NOTE-->
			===Skepticism===
	If this is so, he points out, then along with theoretical implications it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases"{{thinsp}}{{r|macm_unravelling|page1=831}}{{mdash}}{{zwsp}}and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"{{thinsp}}{{r|macm_moreabout}}
			{{Quote box |salign=right|align=right|width=24em
			|quote = {{shy|The very small amount of atten|tion that has been given to case can only be ex|plained by the fact that it far tran|scends any case of recov|ery from inju|ry of the head that can be found in the rec|ords of sur|gery. It was too mon|strous for belief&nbsp;...}}
			|author = ] (1870){{r|jackson1870|p=149}}
			}}
			]'', 1907]]
	==Portraits==<!---======================================= P O R T R A I T S ========================================--->
	[[File:Phineas Gage GageMillerPhoto2010-02-17 Unretouched Color Cropped.jpg|thumb|upright=1.0
	|<span style="font-size:125%;"><sub><ref group="Fig." name=miller_img><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>The second portrait of Gage to be identified (2010){{zwsp}}{{efn-ua|name="millerhartleyimage"}}
	]]
	In 2009 a ] portrait of Gage was discovered, the first likeness of him identified other than a life mask taken in late 1849.<!--chk this date-->{{zwsp}}{{r|bigelow|page1=22n|okf|page2=ii}}
	It shows "a disfigured yet still-handsome" Gage{{r|twomey}}
	with one eye closed and scars clearly visible, "well dressed and confident, even proud"{{thinsp}}{{r|wilgus2009}}{{efn-ua
	<!--BEGIN NOTE-->
	|"Indeed, the recent discovery of daguerreotype portraits of Mr.{{thinsp}}Gage show a 'handsome{{nbsp}}... well dressed and confident, even proud' man in the context of 19th century portraiture. That he was any form of vagrant following his injury is belied by these remark{{shy}}a{{shy}}ble images."{{zwsp<!--patch linebreaking bug in IE-->}} (van Horn 2012,{{r|vanhorn<!--get pg#-->}} quoting Wilgus 2009){{r|wilgus2009<!--get pg# from van horn cite, confirm this is wilgus journal paper 2009 not website-->}}
	}}<!--END NOTE-->
	and holding his iron, on which portions of the inscription (]) can be made out.
	{{anchor|not_harpoon}}(For decades the daguerreotype's owners had imagined that it showed an injured ] with his ].){{r|wilgus_meet}}
	Authenticity was confirmed in several ways, including photo-overlay{{shy}}ing the inscription visible in the portrait against that on the actual tamping iron in Harvard's ], and matching the injuries seen in the portrait against those preserved in the life mask.{{r|wilgus2009}}
			{{shy|Barker notes that Harlow's orig|i|nal 1848 report of Gage's sur|viv|al and recov|ery "was widely dis|be|lieved, for obvious reasons"{{hsp}}{{ran|B|p=676}} and Harlow, recall|ing this early skep|ti|cism in his 1868 ret|ro|spec|tive, invoked the biblical story of ]:{{ran|L1|p=178}} }}
	Macmillan cites the daguerreotype as consistent with the social recovery hypothesis already described.{{r|macm_moreabout}}
			{{blockquote|{{shy|The case occurred nearly twenty years ago, in an obscure country town&nbsp;..., was attended and reported by an obscure country phy|si|cian, and was received by the Met|ro|pol|i|tan Doctors with several grains of caution, insomuch that many utterly refused to believe that the man had risen, until they had thrust their fingers into the hole his head, and even then they required of the Country Doctor attested state|ments, from clergy|men and lawyers, before they could or would believe{{mdashb}}many eminent surgeons regarding such an occur|rence as a phys|i|o|log|i|cal impos|si|bil|i|ty, the appear|ances pre|sented by the subject being var|i|ous|ly explained away.}}
	To better understand the question, he and collaborators are actively seeking additional evidence on Gage's life and behavior,
			}}
	and describe certain kinds of historical material (see "Phineas Gage: Unanswered questions" in ], below)
	for which they hope readers will remain alert,
	such as letters or diaries by physicians whom their research indicates Gage may have met, or by persons in certain places Gage seems to have been.{{zwsp}}{{r|pgip|page=B|macm_unravelling|page2=831}}
			"A distinguished Professor of Surgery in a distant city", Harlow continued, had even dismissed Gage as a "] invention".{{ran|H|p=3,18}}
	In 2010 a second portrait of Gage was identified.
	This new image, copies of which are in the possession of at least two different branches of the Gage family, depicts the same subject seen in the Wilgus daguerreotype identified in 2009, according to Gage researchers consulted by the Smithsonian Institution.{{efn-ua
	|name= millerhartleyimage<!--BEGIN NOTE-->
	|Lena{{nbsp}}& Macmillan (2010),{{r|lena_macm}}<!--get pg#--> citing also {{nowrap|B.{{thinsp}}&{{thinsp}}J.}} Wilgus..<!--which specific paper?--> The image seen here is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey.
	(Gage had no known children{{mdash}}{{zwsp}}see Macmillan 2000;{{r|okf|page=319,327}} these are descendents of certain of his relatives{{mdash}}{{zwsp}}see Macmillan{{nbsp}}& Lena 2010.){{r|macm_rehabilitating|page=4}}
	Unlike the Wilgus portrait, which is itself a daguerreotype, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a daguerreotype or other laterally (left-right) reversing early-process photograph; a second, compen{{shy}}sat{{shy}}ing reversal has been applied here to show Gage as he appeared in life.
	The shirt and tie Gage is wearing in the {{nowrap|Miller{{ndash}}}}{{zwsp}}Hartley image are different from those seen in the Wilgus image, though he is wearing the same ] in both, and possibly the same jacket.{{r|wilgus_newimage}}
	}}<!--END NOTE-->
			According to the '']'' (1869) it was the 1850 report on Gage by Bigelow{{mdashb}}Harvard's Professor of Surgery and "a majestic and {{shy|author|i|ta|tive}} figure on the medical scene of those times"{{hsp}}{{r|yakovlev}}{{mdashb}}that "finally succeeded in forcing authenticity upon the credence of the {{shy|pro|fes|sion&nbsp;...}} as could hardly have been done by any one in whose sagacity and surgical knowledge his '']'' had any less confidence".{{r|anonymous_bmsj1869_1}} Noting that, "The leading feature of this case is its {{shy|improb|a|bil|i|ty&nbsp;...}} This is the sort of accident that happens in the pantomime at the theater, not elsewhere", Bigelow emphasized that though "at first wholly skeptical, I have been personally convinced".{{NoteTag
	==See also==<!---======================================= S E E A L S O ========================================--->
			|In addition to the "attested statements" mentioned by Harlow (which Harlow had gathered at Bigelow's request) and his own examination of Gage, Bigelow pointed out that the accident had occurred "in open day" with many witnesses, and that "in a thickly populated country neighbourhood, to which all the facts were matter of daily discussion at the time of their occurrence, there is no difference of belief, nor has there been at any time doubt that the iron was actually driven through the brain. A considerable number of medical gentlemen also visited the case at various times to satisfy their incredulity."{{hsp}}{{wbo}}{{ran|B1|p=13,19-20}}{{ran|M|p=42}}
	* ]{{mdash}}{{zwsp}}scientist through whose head a particle-accelerator proton beam accidentally passed
			<!--end efn>>-->}}
	* ]{{mdash}}{{zwsp}}another early case of head injury leading to mental changes
	{{clear}}
			Nonetheless (Bigelow wrote just before Harlow's 1868 presentation of Gage's skull) though "the nature of injury and its ''reality'' are now ''beyond doubt''&nbsp;... I{{nbsp}}have received a letter within a month to prove that&nbsp;... the accident ''could not have happened''."{{hsp}}{{ran|B2}}
	==Notes==<!---======================================= N O T E S ========================================--->
	[[File:Phineas Gage GageMillerPhoto2010-02-17 Unretouched Color 02.jpg|thumb|upright=0.5|right
	|<span style="font-size:125%;"><sub><ref group="Fig." name=inscription_detail><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Detail of in{{shy}}script{{shy}}ion from {{nowrap|Miller{{ndash}}}}{{zwsp}}Hartley image<!--link to this img-->
	]]
			===Standard for other brain injuries===
	{{Reflist |35em |group=upper-alpha}}
			have {{shy|at|tract|ed more vis|i|tors}} and spread farther the fame of the ]"{{wbo}}{{r|yakovlev}}
			than its "most {{shy|val|u|a|ble}} specimen"{{mdashb}}Gage's skull.{{wbo}}{{r|jackson1870|p=v}}]]
			As the reality of Gage's accident and survival gained credence, it became "the standard against which other injuries to the brain were judged", and it has retained that status despite competition from a growing list of other unlikely-sounding brain-injury accidents, including encounters with axes, bolts, low bridges, exploding firearms, a revolver shot to the nose, further tamping irons, and ].{{ran|M|p=62-67}}
			For example, after a miner survived traversal of his skull by a gas pipe {{convert|5/8|in|cm}} in diameter (extracted "not without considerable difficulty and force, owing to a bend in the portion of the rod in his skull"), his physician invoked Gage as the "only case comparable with this, in the amount of brain injury, that I have seen reported".{{NoteTag|
			{{ran|M|p=66}}{{r|anonymous_bmsj1868 }} Immediately after Harlow's presentation unveiling Gage's skull and iron, Bigelow ("in one of those ''coups dramatiques'' which were now and then incidents of his surgical communications without giving notice that he intended to do so"){{r|memoir_hjb|p=123}} actually produced this patient, Joel Lenn, together with "the gas pipe which had pierced his head from the right forehead to left ], and the hat he had been wearing (with entrance and exit holes)&nbsp;... This ''coup de théâtre'' must have been a painful coda for Harlow, eclipsing the pinnacle of his medical career."{{hsp}}{{ran|B|p=679}}
			Months after Lenn's accident his surgeon reported, "He seems to be perfectly rational, and will reply correctly in ''monosyllables'' to questions, but is entirely unable to ''connect words''. He succeeds best, when excited, in swearing in French."{{hsp}}{{r|jewett}}
			<!--end enf>>-->}}
			Often these comparisons carried hints of humor, competitiveness, or both.{{ran|M|p=66}} The ''Boston Medical and Surgical Journal'', for example, alluded to Gage's astonishing survival by referring to him as "the patient whose cerebral organism had been comparatively so little disturbed by its abrupt and intrusive visitor";{{r|anonymous_bmsj1869_1}} and a Kentucky doctor, reporting a patient's survival of a gunshot through the nose, bragged, "If you ] can send a tamping bar through a fellow's brain and not kill him, I guess there are not many can shoot a bullet between a man's mouth and his brains, stopping just short of the ], and not touch either."{{r|sutton}}
	==Sources and further reading==<!---======================================= S O U R C E S ========================================--->
			Similarly, when a lumbermill foreman returned to work soon after a saw cut {{convert|3|in|cm|spell=in|sigfig=1}} into his skull from just between the eyes to behind the top of his head, his surgeon (who had removed from this wound "thirty-two pieces of bone, together with considerable sawdust") termed the case "second to none reported, save the famous tamping-iron case of Dr. Harlow", though apologizing that "I cannot well gratify the desire of my professional brethren to possess skull, until he has no further use for it himself."{{r|folsom}}
	::::'''For general audiences (Gage)'''
	{{Reflist |33em |refs=
	<!-- The entries below need not be in any particular order -- the order in which they are listed is controlled by the fake "references" at the head of the article -- see comments there -->
			As these and other remarkable brain-injury survivals accumulated, the ''Boston Medical and Surgical Journal'' pretended to wonder whether the brain has any function at all: "Since the antics of iron bars, gas pipes, and the like skepticism is discomfitted, and dares not utter itself. Brains do not seem to be of much account now-a-days." The ''Transactions of the Vermont Medical Society'' was similarly facetious: {{"'}}The times have been,'<!-- /The times have been/ is given in the source, though Shakespeare's line actually reads, /The time has been/--> says Macbeth {{bracket|]}}, 'that when the brains were out the man would die. But now they rise again.' Quite possibly we shall soon hear that some German professor is ] it."{{hsp}}{{wbo}}{{ran|L1|p=183}}{{r|anonymous_bmsj1869_2}}{{r|smithW|p=53-54}}
	{{refn|name= fleischman |{{cite book |author = Fleischman,{{nbsp}}J. |year = 2002 |title = Phineas Gage: A Gruesome but True Story About Brain Science |isbn = 0-618-05252-6 |url=http://books.google.com/books?id=XXxtmdcj_04C&printsec=frontcover}}{{nbsp}}{{open access}}
	<br><br>
	::'''{{nbsp}}For specialists'''
	}}<!--end refn-->
			==Theoretical misuse==
	{{refn|name= harlow1868 |1=<br><!--linebreak after very long list of backlinks-->
	Harlow, John Martyn (1868). "." ''Publ Massachusetts Med Soc''<!--chk title abbr--> '''2''':327{{ndash}}347.{{nbsp}}{{open access}}}}<!--need to explain pagination diff between journal version and offprint pamphlet; some paper somewhere says this is #3 of vol 2-->
			{{Quote box |salign=right|align=right|width=24.7em
	{{refn|name= lena_macm |Lena,{{nbsp}}M.L. and M. Macmillan (2010). ""{{zwsp<!--patch linebreaking bug in IE-->}} (invited comment). '']''. March 2010. p.{{nbsp}}4<!--formal name is just Smithsonian--><!-- is it volume = 10 | issue = 4? -->{{nbsp}}{{open access}} }}
			|quote = The Gage who appears in contemporary psychology textbooks is simply a compound creature{{nbsp}}... a stunning example of the ideological uses of case histories and their mythological reconstruction.
			|author = Rhodri Hayward{{r|hayward}}
			}}
			Though Gage is considered the "] for personality change due to frontal lobe damage",{{hsp}}{{wbo}}{{ran|B|p=672}}{{r|stuss}}{{wbo}}{{r|hockenbury}}{{wbo}}{{ran|F1}}{{wbo}}{{ran|M|p=1}} the uncertain extent of his brain damage{{wbo}}{{ran|F1}}{{r|cobb1940|p=1349}}{{ran|M|p=11,ch5}} and the limited understanding of his behavioral changes{{NoteTag|name=accounts_reliablesources}} render him "of more historical than neurologic {{sic}}<!--<<"neurologic" is in the original, and apparently is correct -- see https://www.aan.com/globals/axon/assets/3078.pdf p.11--> interest".{{r|cobb1940|p=1348}} Thus, Macmillan writes, "Phineas' story is worth remembering because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth",{{refn| ], p. 831; ], chs. 5{{ndash}}6,9{{ndash}}14; ], pp. 251{{ndash}}59. }} the paucity of evidence having allowed "the fitting of almost any theory to the small number of facts we have".{{ran|M|p=290}} A similar concern was expressed as early as 1877, when British neurologist ] (writing to Harvard's ] in an attempt "to have this case definitely settled") complained that, "In investigating reports on diseases and injuries of the brain, I am constantly being amazed at the inexactitude and distortion to which they are subject by men who have some pet theory to support. The facts suffer so frightfully&nbsp;..."{{hsp}}{{wbo}}{{ran|M|p=1,75,197-79,464-65}}{{wbo}}{{r|ferrier1877_9}}
	{{refn|name= pgip |Macmillan, M. (PGIP). . The University of Akron. Retrieved July 22, 2013.{{nbsp}}{{open access}} Includes:
			More recently, neurologist ] refers to the "interpretations and misinterpretations from 1848<!--<<silently corrected from "1948" in the source, clearly a slip of the pen--> to the present",{{r|sacks}}
	{{small|
			and Jarrett discusses the use of Gage to promote "the myth, found in hundreds of psychology and neuroscience textbooks, plays, films, poems, and YouTube skits Personality is located in the frontal lobes{{nbsp}}... and once those are damaged, a person is changed forever."{{hsp}}{{r|jarrett2}}
	:A. {{cite web|url=http://www.uakron.edu/gage/sites-and-plaque.dot|title=Phineas Gage Sites in Cavendish}}{{nbsp}}{{open access}}
	:B. {{cite web|url=http://www.uakron.edu/gage/questions.dot|title=Phineas Gage: Unanswered questions}}{{nbsp}}{{open access}}
	:C. {{cite web|url=http://www.uakron.edu/gage/story.dot|title=Phineas Gage's Story}}{{nbsp}}{{open access}}
	:D. {{cite web|url=http://www.uakron.edu/gage/book.dot|title=Corrections to ''An Odd Kind of Fame''}}{{nbsp}}{{open access}}
	:E. {{cite web|url=http://www.uakron.edu/gage/adaptation.dot|title=Phineas Gage: Psychosocial Adaptation}}{{nbsp}}{{open access}}
	:F. {{cite web|url=http://www.uakron.edu/gage/lobotomy.dot | title=Phineas Gage and Frontal Lobotomies}}{{nbsp}}{{open access}}
	}}<!--<<end small--> }}<!--<<end refn-->
			===Cerebral localization===
	{{refn|name= macm_unravelling |<br><!--linebreak after very long list of backlinks-->
			] contended that destruction of the mental "organs" of Veneration and Benevolence caused Gage's behavioral changes. Harlow may have believed that the Organ of Comparison was damaged as well. ]]
	Macmillan, M. (2008). . ''The Psychologist'' '''21'''(9):828{{ndash}}831.<!-- There seems to be some problem with the page numbering here, online vs paper? -- check all cites to this --> ].{{nbsp}}{{open access}} }}
			In the 19th-century debate over whether the various mental functions are or are not localized in specific regions of the brain {{Crossreference|(see ])}}, both sides managed to enlist Gage in support of their theories.{{ran|B|p=678}}{{ran|M|p=ch9}} For example, after Eugene Dupuy wrote that Gage proved that the brain is not localized (characterizing him as a "striking case of destruction of the so-called ] without consequent ]") Ferrier replied by using Gage (along with the woodcuts of his skull and tamping iron from Harlow's 1868 paper) to support his thesis that the brain ''is'' localized.{{wbo}}{{r|dupuy1877}}{{r|ferrier1878}}{{ran|M|p=188}}{{wbo}}{{ran|M5|p=198,253}}
	{{refn|name= barker |Barker, F.G. II (1995) ''J{{nbsp}}Neurosurg'' '''82''':672{{ndash}}682{{nbsp}}{{closed access}} }}
			===Phrenology===<!--this section name referenced by links elsewhere in the article-->
	{{refn|name= fuster |{{cite book |author=Fuster, Joaquin M. |title=The prefrontal cortex |publisher=Elsevier/Academic Press |year=2008 |page=172 |isbn=0-12-373644-7 |oclc= |accessdate=}} }}
			] ]]
			Throughout the 19th century, adherents of ] contended that Gage's mental changes (his profanity, for example) stemmed from destruction of his mental "organ of ]"{{mdashb}}as phrenologists saw it, the part of the brain responsible for "goodness, benevolence, the gentle character&nbsp;... to dispose man to conduct himself in a manner conformed to the maintenance of social order"{{mdashb}}and/or the adjacent "organ of ]"{{mdashb}}related to religion and God, and respect for peers and those in authority.{{wbo}}{{ran|M|p=150-51,171n10}}{{wbo}}{{r|gall_sizer}}{{wbo}}{{r|northstar}}{{wbo}}{{r|amer_phren}} (Phrenology held that the organs of the "grosser and more animal passions are near the base of the brain; literally the lowest and nearest the animal man highest and farthest from the sensual are the moral and religions feelings, as if to be nearest heaven". Thus Veneration and Benevolence are at the apex of the skull{{mdashb}}the region of exit of Gage's tamping iron.){{r|apex}}
	{{refn|name=grafman | {{cite doi|10.1093/acprof:oso/9780195134971.003.0019 |noedit}} }}
			Harlow wrote that Gage, during his convalescence, did not "estimate size or money accurately would not take $1000 for a few pebbles"{{ran|H1|p=392}} and was not particular about prices when visiting a local store;{{ran|H|p=337}} by these examples Harlow may have been implying damage to phrenology's "Organ of Comparison".{{NoteTag|
	{{refn|name= kihlstrom |{{cite news|url=http://ist-socrates.berkeley.edu/~kihlstrm/SocialNeuroscience07.htm|author=Kihlstrom, J.F. |year=2010|title=Social neuroscience: The footprints of Phineas Gage|journal=Social Cognition
			{{ran|B|p=675-76}}{{ran|H|p=168-69}} However, this is somewhat contradicted by Harlow's statement that Gage paid "with his habitual accuracy" during the store visit.{{wbo}}{{ran|H|p=337}}{{ran|M|p=169}}
	|volume=28|pages=757{{ndash}}782}}{{nbsp}}{{open access}} }}
			<!--end efn>>-->}}
			===Psychosurgery and lobotomy===
	{{refn|name= okf |<br><!--linebreak after very long list of backlinks-->
	{{cite book| author = Macmillan, M. | year = 2000
	| title = An Odd Kind of Fame: Stories of Phineas Gage| publisher = ]
	| url=http://books.google.com/books?id=Qx4fMsTqGFYC&printsec=frontcover
	| id=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.{{nbsp}}{{open access}}<br>
	{{bullet}}See also .{{nbsp}}{{open access}} }}
			It is frequently asserted that what happened to Gage played a role in the later development of various forms of ]{{mdashb}}particularly ]{{r|lobotomy}}{{mdashb}}or even that Gage's accident constituted "the first lobotomy".{{r|vanderkloot}}{{r|rotarian}} Aside from the question of why the unpleasant changes usually (if hyperbolically) attributed to Gage would inspire surgical imitation,{{r|turner}} there is no such link, according to Macmillan:
	{{refn|name= macm_aggleton |{{cite interview |last= Macmillan, M.|last2 = Aggleton | first2 = John
	|interviewer = Claudia Hammond; Dave Lee |title = Phineas Gage: The man with a hole in his head
	|type = Audio interview |url = http://www.bbc.co.uk/news/health-12649555
	|program = Health Check |callsign = BBC World Service |date = March 6, 2011 }}{{nbsp}}{{open access}}
	<br><br>
	::'''{{nbsp}}For general audiences (portraits)''' }}
			{{blockquote|There is simply no evidence that any of these operations were deliberately designed to produce the kinds of changes in Gage that were caused by his accident, nor that knowledge of Gage's fate formed part of the rationale for them{{ran|M2|p=F}}{{zwj}}... hat his case did show came solely from his surviving his accident: major operations could be performed on the brain without the outcome necessarily being fatal.{{ran|M|p=250}}
	{{refn|name= twomey |{{cite journal
			}}
	|author=Twomey, S.| year = 2010| url=http://www.smithsonianmag.com/history-archaeology/78437017.html
	| title=Finding Phineas| pages=8{{ndash}}10 (January 2010)| volume = 40| issue=10| journal=] }}{{nbsp}}{{open access}} }}
			===Somatic marker hypothesis===
	{{refn|name= wilgus2009 |{{cite doi | 10.1080/09647040903018402 |noedit}}{{nbsp}}{{closed access}} }}
			], in support of his '']'' (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he ascribes to Gage and those of modern patients with damage to the ] and ].{{r|damasioA_descartes|p=ch3|damasioA_somatic}} But Damasio's depiction of Gage{{r|damasioA_descartes|p=ch1}} has been severely criticized, for example by Kotowicz:
	{{refn|name= wilgus_meet |{{cite web|url=http://161.58.72.244/phineasgage/index.html
	|title=Meet Phineas Gage|last=Wilgus|first={{nowrap|B.{{thinsp}}&{{thinsp}}J}}<!--template adds period here-->|accessdate=Oct 2, 2009}}{{nbsp}}{{open access}}{{full|date=July 2013}}<br><br>
	::{{nbsp}}'''For middle-school students''' }}
			{{blockquote|Damasio is the principal perpetrator of the myth of Gage the {{shy|psycho|path{{nbsp}}... Damasio changes nar|ra|tive, omits facts, and adds freely{{nbsp}}... His account of Gage's last months a gro|tesque fab|ri|ca|tion that Gage was some riff-raff who in his final days headed for Cal|i|for|nia to drink and brawl himself to death{{nbsp}}... It seems that the growing com|mit|ment to the frontal lobe doctrine of emotions brought Gage to the lime|light and shapes how he is described.{{ran|K2|p=125,130n6}}}} }}
	{{refn|name= wilgus_newimage |{{cite web |url=http://www.brightbytes.com/phineasgage/new_image.html|title=A New Image of Phineas Gage
	|last=Wilgus|first={{nowrap|B.{{thinsp}}&{{thinsp}}J}}|accessdate=March 10, 2010}}{{nbsp}}{{open access}} }}
			As Kihlstrom put it, "any modern commentators exaggerate the extent of Gage's personality change, perhaps engaging in a kind of retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex in self-regulation."{{ran|K1}}
	{{refn|name= kotowicz |<!--Kotowicz 2007-->{{cite doi| 10.1177/0952695106075178 |noedit}}{{nbsp}}{{closed access}} }}
			Macmillan{{wbo}}{{ran|M|p=116-19,326,331}} gives detailed criticism of Antonio Damasio's various presentations of Gage (some of which are joint work with Hannah Damasio and others).
			==Portraits==
	{{refn|name= macm_wonderful |<!--Macmillan 1986 wonderful-->{{cite doi | 10.1016/0278-2626(86)90062-X |noedit}}{{nbsp}}{{closed access}} }}
			has P. Gage at Cavendish, Vermont, Sept. 14, 1848. {{nobr|He fully{{nbsp}}...}}'']]
	{{refn|name= macm_restoring |<!--Macmillan 2000xxx Restoring PG-->{{cite doi | 10.1076/0964-704X(200004)9:1;1-2;FT046 |noedit}}{{nbsp}}{{closed access}} }}
			]
			Two ] portraits of Gage, identi{{shy}}fied in 2009 and 2010,{{NoteTag
	{{refn|name= macm_obscure |<!--Macmillan 2001 JMH Obscure-->{{cite doi | 10.1076/jhin.10.2.149.7254 |noedit}}{{nbsp}}{{closed access}} }}
			|name=dags
			|The 2009-identified image was, at the time, in the collection of Jack and Beverly Wilgus,{{wbo}}{{ran|T}}{{ran|W2}}{{wbo}}{{ran|W}}{{wbo}}{{ran|W1}} but in 2016 was donated to the Warren Anatomical Museum.{{r|silvestro}} Like almost all {{shy|da|guerre|o|types}} it shows its subject laterally (left{{ndash}}right) reversed, making it appear as if Gage's right eye is injured. However, all Gage's injuries, including to his eye, were on the left; therefore in presenting the image in this article a second, compensating reversal has been applied so as to show Gage as he appeared in life.{{wbo}}{{ran|L}}{{ran|W}}{{ran|W1}}
			{{paragraph break}}
			The 2010-identified image is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey.{{ran|L}} Unlike the Wilgus portrait, which is an original {{shy|da|guerre|o|type}}, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a {{shy|da|guerre|o|type}} or other laterally reversing ];{{ran|W1}} here again a compensating reversal has been applied.{{ran|L}}
			<!--end efn>>-->}} are the only {{shy|like|nes|ses}}{{wbo}}{{ran|W|p=343}}{{ran|T}}{{ran|W1|p=8}} of him known other than a plaster head cast taken for Bigelow in late 1849 (and now in the Warren Museum along with Gage's skull and tamping iron).{{NoteTag
			|name=mask
			|{{ran|B1|p=22n}}{{r|jackson1870|p=149}}{{ran|M|p=ii,42}} The head cast, taken from life, is often mistakenly referred to as a ].{{ran|M2|p=G}}
			}}
			The first portrait shows a "disfigured yet still-handsome" Gage{{ran|T}} with left eye closed and scars clearly visible, "well dressed and confident, even proud"{{hsp}}{{ran|W|p=343}} and holding his iron, on which portions of its inscription can be made out.{{ran|W2}} (For decades the portrait's owners had believed that it depicted an injured whaler with his ].){{ran|W2}}
			The second portrait, copies of which are in the possession of two branches of the Gage family, shows Gage in a somewhat different pose, wearing the same ] and possibly the same jacket, but with a different shirt and tie.{{ran|W3}}{{ran|L}}
			Authenticity of the portraits was confirmed by overlaying the inscription on the tamping iron, as seen in the portraits, against that on the actual tamping iron, and matching the subject's injuries to those preserved in the head cast.{{ran|W|p=342-43}}{{ran|L}} However, about when, where, and by whom the portraits were taken nothing is known, except that they were created no earlier than January 1850 (when the inscription was added to the tamping iron),{{ran|M10|p=644}} on different occasions, and are likely by different photographers.{{ran|W1|p=8}}
	{{refn|name= macm_rehabilitating |<br><!--linebreak after very long list of backlinks-->
	<!--Macmillan Lena Rehab 2010-->{{cite doi | 10.1080/09602011003760527 |noedit}}{{nbsp}}{{closed access}} }}
			The portraits support other evidence that Gage's most serious mental changes were temporary {{see above|{{section link||Social recovery}}}}.{{ran|M9}}{{r|smithS_carey}} "That was any form of vagrant following his injury is belied by these remarkable images", wrote Van Horn et&nbsp;al.{{ran|V|p=13}} "Although just one picture," Kean commented in reference to the first image discovered, "it exploded the common image of Gage as a dirty, disheveled misfit. This Phineas was proud, well-dressed, and disarmingly handsome."{{hsp}}{{ran|K}}
	{{refn|name= macm_moreabout |{{cite web|url=http://brightbytes.com/phineasgage/more.html|title=More About Phineas Gage, Especially After the Accident|last=Macmillan|first=M|date=July 2009|accessdate=July 27, 2013}}{{nbsp}}{{open access}} }}
			==See also==
	{{refn|name= ratiu_nejm |<!--Ratiu (2004, NEJM)-->{{cite doi | 10.1056/NEJMicm031024 |noedit }}{{nbsp}}{{open access}} }}
			{{columns-list|colwidth=40em|
	{{refn|name= ratiu_jneuro |<!--Ratiu J Neurotrauma-->{{cite doi | 10.1089/089771504774129964 |noedit }}{{nbsp}}{{closed access}} }}
			* ]{{snd}}scientist whose head was struck by a particle-accelerator ]
			* ]{{snd}}another early case of head injury leading to mental changes
			* ]{{snd}}man whose abdominal ] allowed pioneering studies of digestion
			* ]{{snd}}patient "H.M.", who developed severe ] after surgery for epilepsy
			* ]{{snd}}soldier who developed ] after a bullet pierced his ]-] area
			* ]{{snd}}known for his recovery from a gunshot injury that destroyed most of his right cerebral hemisphere
			}}
			{{columns-list|colwidth=20em|
			* ]
			* ]
			* ]
			* ]
			* ]
			* ]
			}}
			{{clear<!-- {clear} ensures images don't compromise horizontal space available to Notes -->}}
			==Notes==
	{{refn|name= tyler |Tyler, K.L. and Tyler, H.R. (1982) "A 'Yankee Invention': the celebrated American crowbar case". ''Neurology'' '''32''':A191. }}
			{{NoteFoot|30em}}
			==References==
	{{refn|name= vanhorn |<!--vanHorn-->{{cite doi|10.1371/journal.pone.0037454 |noedit}}{{nbsp}}{{open access}}<br><br>
			'''For general readers'''
	::'''{{nbsp}}Of historical interest''' }}
			{{Refbegin|30em}}<!-- In the following, the occasional |ref=none is to silence "Harv error" seen by editors with certain scripts installed -->
			{{rma| tag=K |reference= {{cite news
	{{refn|name= anonymous_bostonpost|{{cite news | year=1848|month=September|day=21| work=Boston Post|title=Horrible Accident}} }}<!--get pg#, mention is in okf-->
			|title=Phineas Gage, Neuroscience's Most Famous Patient |work=Slate |date=May 6, 2014 |last=Kean |first=Sam
			|url=http://www.slate.com/articles/health_and_science/science/2014/05/phineas_gage_neuroscience_case_true_story_of_famous_frontal_lobe_patient.html
			|ref=none
			}} Reprinted in {{cite book|editor-link=Rebecca Skloot|editor-last=Skloot|editor-first=Rebecca|year=2015|title=The Best American Science and Nature Writing 2015|publisher=Houghton Mifflin Harcourt|pages=143{{ndash}}48
			|ref=none
			}} }}
			{{rma| tag=M |reference= {{cite book
	{{refn|name=ngray | ''Volume 3: Lone Mountain register, 1850-1862'', Halsted N. Gray {{ndash}} Carew{{nbsp}}& English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285. }}
			|last=Macmillan |first=Malcolm B. |year=2000
			|title=An Odd Kind of Fame: Stories of Phineas Gage |publisher=]
			|url=https://books.google.com/books?id=Qx4fMsTqGFYC
			|id= (hbk, 2000) (pbk, 2002)
			|isbn=978-0-262-13363-0 |ref=none}} <!--limited preview--><br />{{bullet}}''See also'' .
			}}
			{{rma| tag=M1 |reference= {{cite journal |author-mask=2
	{{refn|name= anonymous_bmsj1869_1 |{{cite journal |year=1869 | title=Bibliographical Notice | work = Boston Medical{{nbsp}}& Surgical Journal| month =March |day=18|volume=3n.s.|number=7|pages=116{{ndash}}7}} }}
			|last=Macmillan |first=Malcolm B. |date=September 2008 |url=http://thepsychologist.bps.org.uk/volume-21/edition-9/phineas-gage-unravelling-myth
			|title=Phineas Gage – Unravelling the myth |journal=The Psychologist |volume=21 |number=9
			|pages=828{{ndash}}31.<!--Chk all cites for possible problem re pg #s in online vs print versions-->
			|ref=none
			}} }}
			{{rma| tag=M2 |reference= {{cite web |author-mask=2
	{{refn|name= anonymous_bmsj1869_2 |{{cite journal |year=1869 | title=Medical Intelligence. Extraordinary Recovery | work = Boston Medical{{nbsp}}& Surgical Journal| month =April |day=29|volume=3n.s.|number=13|pages=230{{ndash}}1}} }}
			|last=Macmillan |first=Malcolm B. |year=2012<!--2012 was latest update to site-->
			|url=http://www.uakron.edu/gage/index.dot
			|title=The Phineas Gage Information Page |publisher=The University of Akron |access-date=2016-05-16 |ref=none}} Includes:
			{{ordered list|list-style-type=none
			|A. {{cite web |url=http://www.uakron.edu/gage/sites-and-plaque.dot |title=Phineas Gage Sites in Cavendish}}
			|B. {{cite web |url=http://www.uakron.edu/gage/questions.dot |title=Phineas Gage: Unanswered questions}}
			|C. {{cite web |url=http://www.uakron.edu/gage/story.dot |title=Phineas Gage's Story}}
			|D. {{cite web |url=http://www.uakron.edu/gage/book.dot |title=''An Odd Kind of Fame''}}
			|E. {{cite web |url=http://www.uakron.edu/gage/adaptation.dot |title=Phineas Gage: Psychosocial Adaptation}}
			|F. {{cite web |url=http://www.uakron.edu/gage/lobotomy.dot |title=Phineas Gage and Frontal Lobotomies}}
			|G. {{cite web |url=http://www.uakron.edu/gage/reviews.dot |title=Reviews}}
			}} }}
			{{rma| tag=M3 |reference= {{cite interview
	{{refn|name=austin|{{cite book | author = K.A. Austin |year=1977 | title = A Pictorial History of Cobb and Co.: The Coaching Age in Australia, 1854{{ndash}}1924 | publisher = Rigby | location = Sydney | isbn = 0-7270-0316-X }} }}
			|interviewer= Jon Hamilton |title=Why Brain Scientists are Still Obsessed with the Curious Case of Phineas Gage
			|url=https://www.npr.org/sections/health-shots/2017/05/21/528966102/why-brain-scientists-are-still-obsessed-with-the-curious-case-of-phineas-gage
			|format=mp3 |work=Health Shots |publisher=National Public Radio |date=May 21, 2017
			|last=Macmillan |first=Malcolm |last2=Van Horn |first2=Jack |last3=Ropper |first3=Allan
			|ref=none
			}} }}
			{{rma| tag=M4 |reference= {{cite interview|author-mask=2
	{{refn|name= bigelow |<br><!--linebreak after very long list of backlinks-->
			|last1=Macmillan |first1=Malcolm B. |date=March 6, 2011 |last2=Aggleton |first2=John
	Bigelow, Henry Jacob (1850). "Dr. Harlow's case of Recovery from the passage of an Iron Bar through the Head." '']'' '''20''':13{{ndash}}22(July 1850)<!--July is per Harlow 1868-->. Reproduced in Macmillan (2000).{{r|okf}} }}
			|interviewer=Claudia Hammond |interviewer2=Dave Lee |type=Audio interview |work=Health Check |publisher=BBC World Service
			|title=Phineas Gage: The man with a hole in his head |url=https://www.bbc.co.uk/news/health-12649555
			|ref=none
			}} . }}
			{{rma| tag=T |reference= {{cite journal |last=Twomey |first=S. |date=January 2010 |volume=40 |issue=10 |journal=] |url=http://www.smithsonianmag.com/history-archaeology/78437017.html |title=Finding Phineas |pages=8{{ndash}}10 |ref=none |access-date=2009-12-24 |archive-date=2010-02-09 |archive-url=https://web.archive.org/web/20100209065825/http://www.smithsonianmag.com/history-archaeology/78437017.html |url-status=dead }} }}
	{{refn|name= bramwell |{{cite doi|10.1136/bmj.1.1425.835 |noedit}}{{nbsp}}{{open access}} }}
			{{Refend}}
	{{refn|name= campbell |Campbell,{{nbsp}}H.{{thinsp}}F. (1851) "Injuries of the Cranium{{mdash}}{{zwsp}}]". ''Ohio Med{{nbsp}}& Surg J'' '''4'''(1), {{nowrap|pp. 20{{ndash}}24,}} crediting the ''Southern Med{{nbsp}}& Surg J'' (unknown date) }}
			'''For younger readers'''
	{{refn|name= carlson |{{cite book |author=Carlson, N.R. |title=Physiology of Behavior |year = 1994 |page = 341 |isbn=0-205-07264-X}} }}
			{{Refbegin}}
			{{rma| tag=F |reference= {{cite book
	{{refn|name= cobb1940 |Cobb, S. (1940) "Review of neuropsychiatry for 1940". ''Arch Intern Med'' '''66''':1341{{ndash}}54 }}
			|title=Phineas Gage: A Gruesome but True Story About Brain Science |publisher=Houghton Mifflin Harcourt |year=2002 |isbn=978-0-618-05252-3
			|url=https://archive.org/details/phineasgagegrues00john |url-access=registration |last=Fleischman |first=J.
			|ref=none
			}} <!--limited preview-->
			}}
			{{Refend}}
	{{refn|name= cobb1943 |Cobb, S. (1943) ''Borderlands of psychiatry.'' Harvard Univ. Press.<!--need pg number--> }}
			'''For researchers and specialists'''
	{{refn|name= damasioA1994 |{{cite book | author = Damasio A.R. | year = 1994 | title = Descartes' Error: Emotion, Reason, and the Human Brain | isbn = 0-14-303622-X | authorlink = Antonio R. Damasio }} (2nd ed.:{{nbsp}}2005) }}
			{{Refbegin|35em}}
			{{rma| tag=B |reference= {{cite journal
	{{refn|name= damasioA1996 |<!--Damasio, A. 1996-->{{cite doi|10.1098/rstb.1996.0125 |noedit}}{{nbsp}}{{closed access}} }}
			|last=Barker |first=F. G. II |year=1995 |pmid=7897537 |url=http://mysois.uwm.edu/omeka/archive/files/b7cf786e3d97d4cf63ac3b7d14e1f88e.pdf |title=Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization |journal=Journal of Neurosurgery |volume=82 |pages=672{{ndash}}82 |doi=10.3171/jns.1995.82.4.0672 |issue=4 |url-status=dead |archive-url=https://web.archive.org/web/20141006074853/http://mysois.uwm.edu/omeka/archive/files/b7cf786e3d97d4cf63ac3b7d14e1f88e.pdf |archive-date=October 6, 2014 }}
			}}
			{{rma| tag=B1 |reference= {{cite journal
	{{refn|name= damasioH1994 |<!--Damasio, H. 1994-->{{cite doi|10.1126/science.8178168 |noedit}} }}
			|last=Bigelow |first=Henry Jacob |journal=]
			|title=Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head
			|url=https://books.google.com/books?id=pgMHAAAAcAAJ&pg=PA12-IA2
			|date=July 1850 |number=39 |volume=20 |series=New series |pages=13{{ndash}}22
			}}
			}}
			{{rma| tag=B2 |reference={{cite letter | author-mask=2 |first=Henry Jacob |last=Bigelow |recipient=M. Jewett |type=manuscript |subject=Your favor of April 29th is before me |date=May 12, 1868}} Records of the Warren Anatomical Museum, 1828{{ndash}}1892 (inclusive) (AA 192.5), Harvard Medical Library in the Francis A. Countway Library of Medicine.
	{{refn|name= dupuy |Dupuy, E. (1877) "A critical review of the prevailing theories concern{{shy}}ing the physiology and the pathology of the brain: localisation of functions, and mode of production of symptoms." Part II. ''Med Times{{nbsp}}& Gaz'' v.{{nbsp}}II pp.{{nbsp}}356{{ndash}}8. }}
			}}
			{{rma| tag=D |reference= {{cite book
	{{refn|name= ferrier1877_9 |Ferrier, D. (1877{{ndash}}9) ''Correspondence with Henry Pickering Bowditch.'' Countway Library (Harvard Univ.) Mss., H MS c 5.2 (transcribed in Macmillan 2000, pp.{{nbsp}}464{{ndash}}5). }}
			|last=Draaisma|first=Douwe |title=Disturbances of the Mind|chapter-url=https://books.google.com/books?id=KPpUAwAAQBAJ
			|year=2009|publisher=Cambridge University Press|isbn=978-1-139-93611-8
			|chapter=Phineas Gage's posthumous stroll: the Gage matrix
			}} {{closed access}} }}
			{{rma| tag=F1 |reference= {{cite book
	{{refn|name= ferrier1878 |Ferrier, D. (1878) "The Goulstonian lectures of the localisation of cerebral disease." Lecture I (concluded). ''Br Med J'' 1(900):443{{ndash}}7 }}
			|last=Fuster |first=Joaquin M. |title=The prefrontal cortex
			|publisher=Elsevier/Academic Press |year=2008 |page=172 |isbn=978-0-12-373644-4
			|url=https://books.google.com/books?id=zuZlvNICdhUC&pg=PA172
			}} {{closed access}}
			}}
			{{rma| tag=G |reference= {{cite book
	{{refn|name= folsom |{{cite news |author=Folsom, A.C.|work=Pacific Medical and Surgical Journal |title=Extraordinary Recovery from Extensive Saw-Wound of the Skull|year=1869|month=May |pages=550{{ndash}}555}} }}
			|chapter=The Structured Event Complex and the Human Prefrontal Cortex |doi=10.1093/acprof:oso/9780195134971.003.0019
			|title=Principles of Frontal Lobe Function |editor1=Stuss, D. T. |editor2=Knight, R. T.
			|pages=292{{ndash}}310 |year=2002 |isbn=978-0-19-513497-1 |last1=Grafman |first1=J.
			|publisher=Oxford University Press
			}} {{closed access}}
			}}
			{{rma| tag=G1 |reference= Gage, P. P. (1854). "Please deliver my iron bar to the bearer" (Note to unknown recipient). Records of the Warren Anatomical Museum, 1828{{ndash}}1892 (inclusive) (AA&nbsp;192.5), Box 1, Harvard Medical Library in the Francis A. Countway Library of Medicine.
	{{refn|name= fowler |{{cite book|author=Fowler, O.{{thinsp}}S.|title=Synopsis of phrenology: and the phrenological developments: together with the character and talents of ________ as given by ________: with references to those pages of "Phrenology proved, illustrated and applied," in which will be found a full and correct delineation of the intellectual and moral character and manifestations of the above-named individual
			}}
	|year=1838|url=http://pds.lib.harvard.edu/pds/view/2577557?n=6|page=6|location=New York|publisher=Fowler{{nbsp}}& Wells
	}}{{nbsp}}{{open access}} }}
			{{rma| tag=H |reference= {{cite journal
	{{refn|name= harlow1848 |1=<br><!--linebreak after very long list of backlinks-->
			|last=Harlow |first=John Martyn |year=1868
	Harlow, John Martyn (1848). "]". '']'' 39(20)<!--no. 20 is per Harlow 1868-->:389{{ndash}}393. Reproduced in Macmillan (2000).{{r|okf}}{{nbsp}}{{open access}} }}
			|title=Recovery from the Passage of an Iron Bar through the Head
			|journal=Publications of the Massachusetts Medical Society |volume=2|number=3
			|pages=327{{ndash}}47
			|url=https://en.wikisource.org/Recovery_from_the_passage_of_an_iron_bar_through_the_head
			}} Reprinted: David Clapp&nbsp;& Son (1869) <small><!--]]--></small>}}<!--article cites give pg#s in terms of 1869 reprint, so probably should reverse positions in this cite of 1868, 1869 versions, making 1869 primary-->
			{{rma| tag=H1 |reference= {{cite journal |last=Harlow |first=John Martyn |date=December 13, 1848 |volume=39 |title=Passage of an Iron Rod Through the Head |url=https://books.google.com/books?id=ArYEAAAAYAAJ&pg=PA389 |journal=] |number=20 |pages=389{{ndash}}93 |doi=10.1056/nejm184812130392001 |df=mdy-all }} (])
	{{refn|name= harlow1849 |Harlow, John Martyn (1849). Letter in "Medical Miscellany." '']'' '''39''':506{{ndash}}7. Reproduced in Macmillan (2000).{{r|okf}} }}
			}}
			{{rma| tag=H2 |reference= {{cite journal |author-mask=2
	{{refn|name= hockenbury |Hockenbury D.H. and Hockenbury S.E. (1997) ''Psychology.''{{full|date=June 2013}} }}
			|last=Harlow |first=John Martyn |date=January 17, 1849 |title=Medical Miscellany (letter dated January 3)
			|journal=] |volume=39 |number=25 |pages=506{{ndash}}7
			|url=https://books.google.com/books?id=ArYEAAAAYAAJ&pg=PA506
			}}
			}}
			{{rma| tag=K1 |reference= {{cite journal
	{{refn|name=jackson1849 | Jackson, J.{{thinsp}}B.{{thinsp}}S. (1849) ''Medical Cases'' (Vol.{{nbsp}}4, Case 1777) Countway Library (Harvard Univ.) Mss., H{{nbsp}}MS{{nbsp}}b{{nbsp}}72.4.<!--Get pg no & check case no--> }}
			|url=http://ist-socrates.berkeley.edu/~kihlstrm/SocialNeuroscience07.htm |last=Kihlstrom
			|first=J. F. |year=2010 |title=Social neuroscience: The footprints of Phineas Gage
			|journal=Social Cognition |volume=28 |pages=757{{ndash}}82 |doi=10.1521/soco.2010.28.6.757 |issue=6
			|archive-url = https://web.archive.org/web/20141006172659/http://ist-socrates.berkeley.edu/~kihlstrm/SocialNeuroscience07.htm | archive-date = 2014-10-06
			}}
			}}
			{{rma| tag=L |reference= {{cite news
	{{refn|name= jackson1870 |1=Jackson, J.{{thinsp}}B.{{thinsp}}S. (1870) '''' Frontis. and Nos. 949{{ndash}}51, 3106 (Republished in Macmillan 2000, in which see also p.{{nbsp}}107).{{nbsp}}{{open access}} }}
			|author=<!--anon-->|date=March 2010 |url=http://www.smithsonianmag.com/arts-culture/letters-41-7152623/
			|title=Letters: Readers Respond to the January Issue. Picturing Phineas Gage (Editor's note) |page=4
			|work=]
			}}
			* {{cite news
			|last1=Lena |first1=M. L. |last2=Macmillan |first2=Malcolm B.
			|date=March 2010 |url=http://www.smithsonianmag.com/arts-culture/letters-41-7152623/
			|title=Letters: Readers Respond to the January Issue. Picturing Phineas Gage (Invited comment) |page=4<!--chk vol, issue, pg-->
			|work=]
			}}
			}}
	{{refn|name=nicholl|1={{cite web		{{rma| tag=L1 |reference= {{cite journal
			|last=Lena |first= M. L. |date=Spring 2018 | volume=56 |number=1
	| url = http://tulane.edu/som/departments/psych_neuro/education/neuro_clerkship/neuroclerk-dementia-cases.cfm
			|title=The Navvy and the Navigator: Connecting Phineas Gage and Mark Twain's 'Mean Men'
	| title = Dementia Cases{{mdash}}{{zwsp}}Problem #1 | author = Nicholl, Jeffrey S., M.D. | year = 2009
			|journal=Mark Twain Journal | pages=166–200
	| work = Neurology Clerkship | publisher = Tulane Univ. School of Medicine| location = New Orleans
			}}
	| accessdate = November 1, 2009}}{{nbsp}}{{open access}} }}
			}}
			{{rma| tag=L2 |reference= {{cite book
	{{refn|name= sacks |{{cite book |author=Sacks, Oliver |title=An Anthropologist on Mars |year=1995 |pages=59{{ndash}}61 |isbn=0-679-43785-1 |oclc=30810706|accessdate=}} }}
			|last=Luria |first= A. R. |year=1963 |translator=O. L. Zangwill
			|title=Restoration of function after brain injury
			|location=New York |publisher=Pergamon Press, Macmillan
			}}
			* {{cite book | author-mask=2
			|last=Luria |first= A. R. |year=1973 |translator=Haigh Basil
			|title=The working brain: an introduction to neuropsychology
			|location=New York |publisher=Basic Books
			}}
			* {{cite book | author-mask=2
			|last=Luria |first= A. R. |year=1979
			|title=The making of mind: a personal account of Soviet psychology
			| url=https://archive.org/details/makingofmind00luri
			| url-access=registration
			|publisher=Harvard University Press
			|isbn=978-0-674-54326-3 |editor1=Michael Cole |editor2=Sheila Cole
			}}
			* {{cite book | author-mask=2
			|last=Luria |first= A. R. |year=1980 |edition=2nd |translator=Haigh Basil
			|title=Higher cortical functions in man
			|location=New York |publisher=Basic Books
			}}
			* {{cite book | author-mask=2
			|last=Luria |first= A. R. |year=1972 |translator=Lynn Solotaroff
			|title=The man with a shattered world: the history of a brain wound
			|publisher=Harvard University Press
			}}
			}}
			{{rma| tag=K2 |reference= {{cite journal
	{{refn|name=sizer|{{Cite book | last =Sizer |first =Nelson | year =1888 | title =Forty years in phrenology; embracing recol{{shy}}lec{{shy}}tions of history, anecdote, and experience | publisher =Fowler{{nbsp}}& Wells | location=New York|url =http://books.google.com/?id=xicZAAAAYAAJ&pg=PA313#PPA194}}{{nbsp}}{{open access}} }}
			|last1=Kotowicz |first1=Z. |doi=10.1177/0952695106075178 |pages=115{{ndash}}31 |year=2007
			|title=The strange case of Phineas Gage |journal=History of the Human Sciences |volume=20 |issue=1
			|s2cid=145698840 }} {{closed access}}
			}}
			{{rma| tag=M5 |reference= {{cite news
	{{refn|name= smith |1=Smith, William T. (1886) "". ''T Vermont Med Soc for the Year 1885.'' pp.{{nbsp}}46{{ndash}}58.{{nbsp}}{{open access}} }}
			|last=Macmillan |first=Malcolm B. |year=1996 |pages=243{{ndash}}62 |title=Phineas Gage: A Case for All Reasons
			|location=London |publisher=Erlbaum |work=Classic Cases in Neuropsychology
			|editor1-last=Code |editor1-first=C. |editor2-last=Wallesch |editor2-first=C. W.
			|editor3-last=Lecours |editor3-first=A. R. |editor4-last=Joanette |editor4-first=U.
			}} }}
			{{rma| tag=M6 |reference= {{cite journal |author-mask=2
	{{refn|name= stuss | {{cite doi|10.1037/0022-006X.60.3.349 }}{{nbsp}}{{closed access}} }}
			|last1=Macmillan |first1=Malcolm B.
			|title=Restoring Phineas Gage: A 150th Retrospective |doi=10.1076/0964-704X(200004)9:1;1-2;FT046
			|journal=Journal of the History of the Neurosciences |volume=9 |issue=1
			|pages=46{{ndash}}66 |year=2000 |pmid=11232349 |s2cid=2250377 }} {{closed access}}
			}}
			{{rma| tag=M7 |reference= {{cite journal |author-mask=2
	{{refn|name=vanderstoep| {{cite doi | 10.1207/S15328023TOP2702_02 | noedit }}{{nbsp}}{{open access}} }}
			|last1=Macmillan |first1=Malcolm B.
			|title=John Martyn Harlow: Obscure Country Physician? |doi=10.1076/jhin.10.2.149.7254 |year=2001
			|journal=Journal of the History of the Neurosciences |volume=10 |issue=2 |pages=149{{ndash}}62 |pmid=11512426
			|s2cid=341061 }} {{closed access}}
			}}
			{{rma| tag=M8 |reference= {{cite journal |author-mask=2
	}}<!--end reflist-->
			|last1=Macmillan |first1=Malcolm B.
			|title=Inhibition and Phineas Gage: Repression and Sigmund Freud |year=2004
			|journal=Neuropsychoanalysis |volume=6|number=2|pages=181{{ndash}}92 |doi=10.1080/15294145.2004.10773459
			|s2cid=145175407 }} {{closed access}}
			}}
			{{rma| tag=M9 |reference= {{cite web |author-mask=2
	==External links==<!---============================= E X T E R N A L L I N K S ===================================--->
			|url=http://brightbytes.com/phineasgage/more.html |last=Macmillan |first=Malcolm B. |date=July 2009
			|title=More About Phineas Gage, Especially After the Accident
			|access-date=2016-05-16|website=www.brightbytes.com
			}}}}
			{{rma| tag=M10 |reference= {{cite journal |author-mask=2
	[[File:Simulated Connectivity Damage of Phineas Gage SkullDisplayWarren.jpg|right|thumb|upright=0.60
			|last1=Macmillan |first1=Malcolm B. |last2=Lena |first2=M. L. |doi=10.1080/09602011003760527 |title=Rehabilitating Phineas Gage
	|<span style="font-size:125%;"><sub><ref group="Fig." name=vanhorn_warren><!--dummy to silence errmsg--></ref>{{thinsp}}</sub></span>Gage's skull, Warren Museum]]
			|journal=Neuropsychological Rehabilitation |volume=20 |issue=5 |pages=641{{ndash}}58 |year=2010 |pmid=20480430 |s2cid=205655881
	{{stack|{{Wikisource}}{{commons}}<!-- why is this a Commons "page" instead of (presumably broader) category?-->}}
			|df=mdy-all }}
	*{{cite web |url=http://www.uakron.edu/gage/questions.dot|title=Phineas Gage: Unanswered questions |last=Macmillan|first=M
			}}
	|accessdate=August 9, 2013}} Lists research questions related to Gage in localities throughout the United States and Chile, for which Gage researchers request assistance from the public.
	* , Center for the History of Medicine, Francis A. Countway Library of Medicine (Harvard Medical School){{mdash}}{{zwsp}}home of Gage's skull and iron.
	* {{mdash}}{{zwsp}}the story of how the owners of the 2009-identified daguerreotype learned it depicted Gage.
	* , Cavendish, Vermont
	{{trunc|{{reflist|group="Fig."}}|0}}<!--length = 0 discards output--><!--dummy reflist for figures must be present to silence complaints that group="Fig." references (so called) never output; it must come way down here in case the Ext Links contain a Fig. THERE MUST BE NO BLANK LINE BEFORE OR AFTER THIS ONE -- otherwise unwanted whitespace is output-->
			{{rma| tag=R |reference= {{cite journal
	{{Persondata
			|last1=Ratiu |first1=P. |last2=Talos |first2=I. F. |last3=Haker |first3=S. |last4=Lieberman |pages=637{{ndash}}43
	| NAME = Gage, Phineas | ALTERNATIVE NAMES = Gage, Phineas P.
			|first4=D. |last5=Everett |first5=P. |title=The Tale of Phineas Gage, Digitally Remastered |pmid=15165371
	| SHORT DESCRIPTION = | DATE OF BIRTH = July 9, 1823
			|doi=10.1089/089771504774129964 |journal=Journal of Neurotrauma |volume=21 |issue=5 |year=2004
	| PLACE OF BIRTH = ], N.H.
			}} {{closed access}}<!--confusing ratiu cites and page #s need checking-->
	| DATE OF DEATH = May 21, 1860<!--1860 is correct despite Harlow 1868 reporting 1861; see Macmillan 2000 p108 -->
	| PLACE OF DEATH = In or near San Francisco
	}}		}}
			{{rma| tag=R1 |reference= {{cite journal |author-mask=2
			|last1=Ratiu |first1=P. |last2=Talos |first2=I. F. |doi=10.1056/NEJMicm031024 |pmid=15575047
			|title=The Tale of Phineas Gage, Digitally Remastered |journal=New England Journal of Medicine
			|volume=351 |issue=23 |page=e21 |year=2004
			}}
			}}
			{{rma| tag=T1 |reference= {{cite journal
			|last1=Thiebaut de Schotten |first1=M. |last2=Dell'Acqua |first2=F. |last3=Ratiu |first3=P.
			|last4=Leslie |first4=A. |last5=Howells |first5=H. |last6=Cabanis |first6=E.
			|last7=Iba-Zizen |first7=M. T. |last8=Plaisant |first8=O. |last9=Simmons |first9=A.
			|last10=Dronkers |first10=N. F. |last11=Corkin |first11=S. |last12=Catani |first12=M.
			|year=2015 |pages=1{{ndash}}16
			|title=From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting Disconnection Syndromes
			|journal=Cerebral Cortex |doi=10.1093/cercor/bhv173 |pmid=26271113 |pmc=4635921 |volume=25
			|issue=12 }}
			}}
			{{rma| tag=T2 |reference= {{cite journal
			|last1=Tyler |first1=K. L. |last2=Tyler |first2=H. R. |year=1982 |volume=32 |page=A191
			|title=A 'Yankee Invention': the celebrated American crowbar case |journal=Neurology
			}} {{closed access}} Images reproduced in ], App. E.
			}}
			{{rma| tag=V |reference= {{cite journal
			|last1=Van Horn |first1=J. D. |last2=Irimia |first2=A. |last3=Torgerson |first3=C. M.
			|last4=Chambers |first4=M. C. |last5=Kikinis |first5=R. |last6=Toga |first6=A. W.
			|title=Mapping Connectivity Damage in the Case of Phineas Gage |doi=10.1371/journal.pone.0037454
			|journal=PLOS ONE |volume=7 |issue=5 |page=e37454 |year=2012 |pmid=22616011 |pmc=3353935
			|bibcode=2012PLoSO...737454V |doi-access=free }}
			}}
			{{rma| tag=W |reference= {{cite journal
			|last1=Wilgus |first1=J |last2=Wilgus |first2=B |year=2009 |title=Face to Face with Phineas Gage
			|pmid=20183215
			|journal=Journal of the History of the Neurosciences |volume=18 |issue=3 |pages=340{{ndash}}45 |doi=10.1080/09647040903018402
			|s2cid=19347145 }} {{closed access}}
			}}
			{{rma| tag=W1 |reference= {{cite journal |author-mask=2 |author-mask2=2
			|last1=Wilgus |first1=J |last2=Wilgus |first2=B |date=July{{ndash}}September 2009 |title=Phineas Gage{{snd}}Hiding in Plain Sight
			|journal=The Daguerreian Society Newsletter |volume=21 |issue=3 |pages=6{{ndash}}9
			}} }}
			{{rma| tag=W2 |reference= {{cite web |author-mask=2 |author-mask2=2
			|last1=Wilgus |first1=J |last2=Wilgus |first2=B |year=2009 |title=Meet Phineas Gage |website=www.brightbytes.com
			|url=http://www.brightbytes.com/phineasgage/index.html |access-date=2016-05-16
			}}
			}}
			{{rma| tag=W3 |reference= {{cite web |author-mask=2 |author-mask2=2
			|last1=Wilgus |first1=J |last2=Wilgus |first2=B |year=2010 |title=A New Image of Phineas Gage|website=www.brightbytes.com
			|url=http://www.brightbytes.com/phineasgage/new_image.html |access-date=2016-05-16
			}}
			}}
			{{Refend}}
			'''Other sources cited'''
			{{Reflist |30em |refs=
			{{refn |name=accident_excerpts
			|Excerpted from Williams's and Harlow's statements in: ], pp. 390{{ndash}}93; ], p. 16; ], pp. 7{{ndash}}10.
			}}
			{{refn |name=ahlstrom|{{cite news
			|title=Study finds blow to head may cause psychopathic behaviour
			|first=Dick|last= Ahlstrom |newspaper=The Irish Times|date= October 19, 1999|page=2
			}} }}
			{{refn |name=ama_standing|{{cite journal
			|author=American Medical Association |year=1850 |page=345
			|journal=The Transactions of the American Medical Association
			|title=Report of the Standing Committee on Surgery |location=Philadelphia |publisher=T.K. and P.G. Collins
			|volume=3 |url=https://archive.org/details/transactionsame45assogoog/page/n349
			}}}}
			{{refn |name=amer_phren |{{cite journal
			|author=<!--anon--> |journal=American Phrenological Journal and Repository of Science, Literature, and General Intelligence
			|title=A most remarkable case |volume=13 |number=4
			|url=https://books.google.com/books?id=Ao4eAQAAMAAJ&pg=PA89 |date=April 1851 |at=p. 89, col. 3
			}}}}
			{{refn |name=anonymous_ngray
			|author=<!--anon--> |''Volume 3: Lone Mountain register, 1850{{ndash}}1862'', Halsted N. Gray{{snd}}Carew & English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285.
			}}<!--chk exact cite/name of merged firm, and formalize cite-->
			{{refn |name=anonymous_bmsj1868 |{{cite journal
			|author=<!--anon--> |title=Reports of medical societies. Annual meeting of the Massachusetts Med. Society{{snd}}Second day|journal=] |date=June 11, 1868 |url=https://books.google.com/books?id=3P4TAAAAYAAJ&pg=PA301
			|volume=1 |series=New series |pages=301{{ndash}}6 |issue=19
			|doi=10.1056/NEJM186806110781906
			|s2cid=4747463}} }}
			{{refn |name=anonymous_bmsj1869_1 |{{cite journal
			|author=<!--anon--> |title=Bibliographical Notices |journal=] |date=March 18, 1869
			|volume=3 |series=New series |pages=116{{ndash}}17 |issue=7
			|url=https://books.google.com/books?id=T8QEAAAAYAAJ&pg=PA116
			}}}}
			{{refn |name=anonymous_bmsj1869_2 |{{cite journal
			|author=<!--anon--> |title=Medical Intelligence. Extraordinary Recovery |journal=] |date=April 29, 1869 |volume=3 |series=New series |pages=230{{ndash}}31 |issue=13 |url=https://books.google.com/books?id=T8QEAAAAYAAJ&pg=PA230
			}} }}
			{{refn |name=anonymous_bostonpost |{{cite news
			|author=<!--anon--> |date=September 21, 1848 |work=Boston Post |title=Horrible Accident|postscript=none
			}} (crediting ''Ludlow (Vermont) Free Soil Union'', unknown date).}}
			{{refn |name=anonymous_mercury|{{cite news
			|author=<!---anon-->|work=] |location=] |title=Wonderful Accident
			|at=p. 2 col. 3 |date=September 22, 1848
			}} Transcribed in ], pp. 36{{ndash}}7.
			}}
			{{refn |name=anonymous_national_eagle|{{cite news
			|author=<!--anon-->|date=March 29, 1849 |work=National Eagle |at=p. 2, col. 2
			|location=Claremont, New Hampshire |title=Incredible, But True Every Word
			}} Reprinted: ''True Democrat and Granite State Whig'' (Lebanon, New Hampshire), April 6, 1849, p.&nbsp;1, col.&nbsp;7. Transcribed in ], pp. 40{{ndash}}1.
			}}
			{{refn |name=austin |{{cite book
			|last=Austin |first=K. A. |year=1977
			|title=A Pictorial History of Cobb and Co.: The Coaching Age in Australia, 1854{{ndash}}1924
			|publisher=Rigby |location=Sydney |isbn=978-0-7270-0316-4
			}} }}
			{{refn |name=background |
			], p. 389; ], p. 13; ], p. 4.
			}}
			{{refn |name=benderly |{{cite journal
			|last=Benderly |first=Beryl Lieff | date=September 2012 |title=Psychology's tall tales
			|url=http://www.apa.org/gradpsych/2012/09/tall-tales.aspx|page=20
			|journal=GradPSYCH
			}}}}
			{{refn |name=bower |{{cite journal
			|title=The Social Brain: New Clues from Old Skull |first= B. |last= Bower |jstor=3978044
			|journal=Science News |volume=145 |number=21 |date=May 21, 1994 |pages=326{{ndash}}27 |doi=10.2307/3978044
			}} {{closed access}} }}
			{{refn | name=bring_me |{{cite magazine
			|title=Bring Me the Head of Phineas Gage|magazine=Boundless: A Science Comics Anthology
			|volume=1|year=2016|last1=Barnes |first1=E. J.|last2=Lee|first2=L. B.|isbn=978-0-9903433-5-6
			|url=http://boundlesscomics.tumblr.com/post/145332268645/meet-our-contributors-e-j-barnes-and-lb-lee-e
			}} {{closed access}} }}
			{{refn |name=wife |
			{{cite book|last=Moffatt|first=Gregory K.|title=A Violent Heart: Understanding Aggressive Individuals|page=6
			|url=https://books.google.com/books?id=d8lpAEI1mP0C&pg=PA6|year=2002|publisher=Greenwood Publishing Group|isbn=978-0-275-97336-0
			}}
			* ]; ], pp. 39, 319, 327.
			}}
			{{refn |name=sexuality|
			{{cite book
			|last1=Beaumont |first1=Graham |last2=Kenealy |first2=Pamela |last3=Rogers |first3=Marcus |date=1991 |publisher=Wiley
			|title=The Blackwell Dictionary of Neuropsychology |url=https://books.google.com/books?id=g5ijQgAACAAJ
			|isbn=978-0-631-17896-5 }} {{closed access}}
			* {{cite book
			|last1=Crider |first1=A. B. |last2=Goethals |first2=G. R. |last3=Kavanagh |first3=R. D.
			|last4=Solomon |first4=P. R. |year=1983 |title=Psychology |publisher=Scott, Foresman
			}}
			* {{cite book
			|last=Myers |first=David G. |url=https://archive.org/details/psychology00myer04|url-access=registration <!--get pg#-->
			|year=1995 |publisher=Worth Publishers |isbn=978-0-87901-644-9 |title=Psychology
			}} {{closed access}}
			* ], pp. 319, 327{{ndash}}28
			}}
			{{refn |name=forethought|
			], pp. 11, 51; ], pp. 119, 331.
			}}
			{{refn |name=employment|
			{{cite book |last=Altrocchi |first=John |year=1980 |title=Abnormal Behavior |publisher=Harcourt, Brace, Jovanovich |isbn=978-0-15-500370-5 |url=https://archive.org/details/abnormalbehavior0000altr }}
			* {{cite book
			|last1=Groves |first1=Philip M. |last2=Schlesinger |first2=K. |year=1982 |location=Dubuque, Iowa
			|title=Introduction to Biological Psychology |edition=2nd |publisher=Brown
			}}
			* {{cite book
			|last=Kalat |first=James W. |year=1981 |title=Biological Psychology |publisher=Wadsworth |location=Belmont, California
			}}
			* {{cite book
			|last=Lahey |first=B. B. |year=1992 |page=63 |title=Psychology: An Introduction |edition=4th |location=Dubuque, Iowa |publisher=Brown
			}}
			* {{cite book
			|last=Morris |first=C. G. |year=1996 |title=Psychology: An Introduction |url=https://archive.org/details/psychologyintrod00morr |url-access=registration |edition=9th |publisher=Prentice-Hall
			|isbn=978-0-13-432972-7 }}
			* {{cite book
			|last=Smith |first=A. |year=1985 |title=The Body |location=Harmondsworth, England |publisher=Penguin
			}}
			* ], pp. 107, 323.
			}}
			{{refn |name=irresponsibility|
			{{cite news |ref=blakeslee
			|last=Blakeslee |first=Sandra |date=May 24, 1994 |page=C1
			|title=Old Accident Points to Brain's Moral Center |work=]
			}}
			* ], p. 1102; ], p. 116.
			}}
			{{refn |name=aggressiveness|
			{{cite book
			|last=Dimond |first=Stuart J. |year=1980 |location=London |publisher=Butterworths
			|title=Neuropsychology: A Textbook of Systems and Psychological Functions of the Human Brain
			}}
			* ], pp. 321, 331.
			}}
			{{refn |name=vagrancy|
			{{cite book
			|last=Restak |first=Richard M. |title=The Brain |url=https://archive.org/details/brain00rest |url-access=registration |publisher=Bantam Books |year=1984
			|isbn=978-0-553-05047-9 }}
			* {{cite book
			|last=Tow |first=Peter Macdonald |year=1955 |location=London & New York |publisher=Oxford University Press
			|title=Personality changes following frontal leucotomy: a clinical and experimental study of the functions of the frontal lobes in man. With a foreword by Sir Russell Brain
			}}
			* ], p. 323.
			}}
			{{refn |name=drifting|
			{{cite book
			|last=Blakemore |first=Colin |title=Mechanics of the mind |url=https://archive.org/details/mechanicsofmind00blak |url-access=registration |publisher=Cambridge University Press |year=1977
			}}
			* {{cite book
			|last=Brown |first=H. |year=1976 |location=New York |publisher=Oxford University Press
			|title=Brain and Behavior: A Textbook of Physiological Psychology
			}}
			* {{cite book
			|last=Hart |first=Leslie A. |year=1975 |publisher=Basic Books
			|title=How the Brain Works: A New Understanding of Human Learning, Emotion, and Thinking
			|isbn=978-0-465-03102-3 |url=https://archive.org/details/howbrainworksn00hart |url-access=registration }}
			* ], pp. 316, 323.
			}}
			{{refn |name=drinking|
			{{cite journal
			|last=Hughes |first=C. D. |year=1897 |pages=315{{ndash}}23 |title=Neurological progress in America
			|journal=Journal of the American Medical Association |number=7 |volume=29 |doi=10.1001/jama.1897.02440330015001e
			|url=https://zenodo.org/record/1447257 }} {{closed access}}
			* {{cite book |last=Smith |first=A. |year=1984 |title=The Mind |location=London |publisher=Hodder and Stoughton
			}}
			* {{cite magazine
			|last=Wilson |first=Andrew |date=January 1879 |pages=68–85 |title=The old phrenology and the new
			|url=https://books.google.com/books?id=MRQJAAAAIAAJ&pg=PA68 |volume=CCXLIV |magazine=Gentleman's Magazine
			}}
			* ], pp. 118, 316, 321.
			}}
			{{refn |name=lying|
			]; ], pp. 119, 321.
			}}
			{{refn |name=brawling|
			], p. 9; ], p. 119.
			}}
			{{refn |name=bullying|
			{{cite book
			|last=Sdorow |first=Lester |year=1990 |title=Psychology |url=https://archive.org/details/psychology00sdor |url-access=registration |location=Dubuque, Iowa |publisher=Brown
			|isbn=978-0-697-07649-6 }}
			* ], p. 830; ], p. 321.
			}}
			{{refn |name=psychopathy|
			{{cite book
			|last=Changeux |first=Jean-Pierre |year=1985 |pages=158{{ndash}}59 |title=Neuronal Man: The Biology of the Mind
			|others=Tr. by Laurence Garey |publisher=Pantheon Books |edition=1st American
			}}
			* ], p. 321.
			}}
			{{refn |name=idiot|
			]; ], p. 39.
			}}
			{{refn|name=lobotomy|
			{{cite book
			|last=Carlson |first=N. R. |title=Physiology of Behavior |url=https://archive.org/details/physiologyofbeh000carl |url-access=registration |year=1994 |page= |publisher=Allyn and Bacon |isbn=978-0-205-07264-4
			}}
			* {{cite book
			|title=Cutting the mind: origins of psychosurgery |first1=Matheus |last1=Arts |first2= Philip |last2=Michielsen
			|location=Leuven |publisher=Acco |year=2012|isbn=978-9033486388 |page=40
			}}
			* ], pp. 246, 252{{ndash}}53nn9,10.
			}}
			{{refn |name=bennett |{{cite journal
			|last=Bennett |first=W. |date=July{{ndash}}August 1987 |pages=24{{ndash}}31
			|title=Dr. Warren's Possessions |journal=Harvard Magazine |volume=89 |number=6
			|pmid=11617033
			}} }}
			{{refn |name=bsmi |
			] (1849). ''Records'' '''6'''. November 10. pp. 103–4.<!--need full citation-->
			}}
			{{refn |name=bramwell |{{cite journal
			|last1=Bramwell |first1=B. |doi=10.1136/bmj.1.1425.835
			|title=The Process of Compensation and some of its Bearings on Prognosis and Treatment
			|journal=BMJ |volume=1 |issue=1425 |pages=835{{ndash}}40 |year=1888 |pmid=20752265 |pmc=2197878
			}}}}
			{{refn |name=campbell |{{cite journal |last=Campbell |first=H. F. |year=1851 |title=Injuries of the Cranium – Trepanning |journal=Ohio Medical & Surgical Journal |volume=4 |number=1 |pages=20{{ndash}}24
			|title-link=Trepanning }} (crediting the ''Southern Medical&nbsp;& Surgical Journal'', unknown date). }}
			{{refn |name=cobb1940 |{{cite journal
			|last=Cobb |first=Stanley |year=1940 |title=Review of neuropsychiatry for 1940
			|journal=Archives of Internal Medicine |volume=66 |issue=6 |pages=1341{{ndash}}54
			|doi=10.1001/archinte.1940.00190180153011
			}} {{closed access}} }}
			{{refn | name=cobb1943|{{cite book
			|last=Cobb |first=Stanley |year=1943 |title=Borderlands of psychiatry
			|url=https://archive.org/details/borderlandsofpsy0000cobb |url-access=registration |publisher=Harvard Univ. Press.<!--need pg number-->
			}} }}
			{{refn |name=cooter|{{cite book
			|last=Cooter |first=Roger |year=1984 |page=
			|title=The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-century Britain
			|publisher=Cambridge University Press |isbn=978-0-521-22743-8 |url=https://archive.org/details/culturalmeaningo00coot
			|url-access=registration }} }}
			{{refn |name=butler|{{cite web
			|url=http://www.cromwellbutlers.com/fam_tree/p_gage.htm
			|last=Macmillan|first=Malcolm|title=Phineas Gage: The claim of Williams' priority
			|website=Butler Family
			}}}}
			{{refn|name=daffner|{{cite book
			|series=Handbook of Clinical Neurology, 3rd series|volume=88|title=Neuropsychology and behavioral neurology|editor-first1= G.|editor-last1=Goldenberg|editor-first2=B. L. |editor-last2=Miller|year=2008 |publisher=Elsevier B.V.|chapter=The dysexecutive syndromes|last1=Daffner|first1=Kirk R.|last2=Searl|first2=Meghan M.
			}} }}
			{{refn |name=damasioA_somatic|{{cite journal
			|title=The Somatic Marker Hypothesis and the Possible Functions of the Prefrontal Cortex
			|first1=Antonio R. |last1=Damasio |first2=B. J. |last2=Everitt |first3=D. |last3=Bishop
			|journal=Philosophical Transactions: Biological Sciences |date=October 29, 1996 |pages=1413{{ndash}}20
			|volume=351 |number=1346 |series=Executive and Cognitive Functions of the Prefrontal Cortex
			|jstor=3069187 |doi=10.1098/rstb.1996.0125 |pmid=8941953|s2cid=1841280
			}} {{closed access}} }}
			{{refn |name=damasioA_neuropsychology |{{cite book
			|last1=Damasio |first1=A. R.|author-link1=Antonio Damasio |last2=Van Hoesen |first2=G. W.
			|chapter=Emotional disturbances associated with focal lesions of the limbic frontal lobe
			|url=https://books.google.com/books?id=Ia13QgAACAAJ |title=Neuropsychology of Human Emotion
			|year=1983 |publisher=Guilford Press|location=New York |isbn=978-0-89862-200-3
			|pages=85{{ndash}}110 |editor1=Paul Satz |editor2=Kenneth M. Heilman
			}} {{closed access}} }}
			{{refn |name=damasioA_descartes |{{cite book |ref=damasio1994
			|last=Damasio |first=Antonio R. |author-link=Antonio Damasio |publisher=Quill
			|title=Descartes' error: emotion, reason, and the human brain |year=1994
			|url=https://books.google.com/books?id=MocSdi6LXCkC|isbn=978-0-380-72647-9
			}} {{closed access}} }}
			{{refn |name=damasioH_return |{{cite journal|author-link4=Albert Galaburda
			|last1=Damasio |first1=H. |last2=Grabowski |first2=T. |last3=Frank |first3=R. |last4=Galaburda |first4=A. M. |last5=Damasio|first5=A. R.
			|title=The return of Phineas Gage: Clues about the brain from the skull of a famous patient
			|doi=10.1126/science.8178168 |journal=Science |volume=264 |issue=5162 |pages=1102{{ndash}}5 |year=1994 |pmid=8178168
			|bibcode=1994Sci...264.1102D |s2cid=206630865 }} {{closed access}} }}
			{{refn |name=apex|{{cite book
			|last=Burton |first=Warren |author-link=Warren Burton (1800{{ndash}}1866) |location=New York |page=
			|title=Uncle Sam's recommendation of phrenology to his millions of friends in the United States: In a series of not very dull letters
			|url=https://archive.org/details/unclesamsrecomm00burgoog |year=1842 |publisher=Harper and Brothers
			}}
			* {{cite news
			|last=Davidson |first=James Wood |author-link=James Wood Davidson
			|title=How We Read Each Other. Phrenology |publisher=J.J. Toon |location=Atlanta
			|url=https://books.google.com/books?id=U3RHAAAAYAAJ&pg=PA559 |volume=2 |date=July 1866 |number=2
			|pages=557{{ndash}}62 at 559 |work=Scott's Monthly Magazine
			}}
			* {{cite news
			|title=Phrenology for "Tim Bobbin" |number=624 |url=https://books.google.com/books?id=yQwAAAAAMAAJ&pg=PA302
			|volume=XXIV |page=302 |date=February 13, 1897
			|work=Fibre & Fabric: A Record of American Textile Industries in the Cotton and Woolen Trade
			}}}}
			{{refn |name=deaths|{{cite news
			|work=New Hampshire Statesman |date=July 21, 1860 |number=2042 |at=col. D |title=Deaths |location=Concord, New Hampshire
			}} }}
			{{refn |name=departing|{{cite news
			|work=Daily Alta California|date=December 25, 1867 |at=p. 2 col. 4 |title=A Departing Supervisor
			}} }}
			{{refn |name=dupuy1873|{{cite book
			|last=Dupuy |first=Eugene |year=1873
			|title=Examen de quelques points de la physiologie du cerveau
			|url=https://archive.org/details/b22353069 |location=Paris |publisher=Delahaye |language=fr
			}} }}
			{{refn |name=dupuy1877 |{{cite journal
			|last=Dupuy |first=Eugene |year=1877 |volume=II |pages=356{{ndash}}58
			|title=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
			|url=https://books.google.com/books?id=ppYEAAAAQAAJ&pg=PA356 |journal=Medical Times & Gazette
			}}}}
			{{refn|name=ebenezer |{{cite book
			|last=Ebenezer|first=Ivor|title=Neuropsychopharmacology and Therapeutics |isbn=978-1-118-38565-4|page=123
			|url=https://books.google.com/books?id=mRbWBgAAQBAJ&pg=PA123|year=2015|publisher=John Wiley & Sons
			}}}}
			{{refn |name=eliot |{{cite book
			|editor-last=Eliot |editor-first=Samuel Atkins |year=1911
			|title=Biographical History of Massachusetts: Biographies and Autobiographies of the Leading Men in the State
			|publisher=Massachusetts Biographical Society <!--book is unpaginated-->
			|volume=1 |chapter=John M. Harlow |chapter-url=https://books.google.com/books?id=1S0EAAAAYAAJ&pg=PT136
			}}}}
			{{refn |name=ferrier1877_9 |
			Ferrier, David (1877–79). ''Correspondence with Henry Pickering Bowditch''. H&nbsp;MS&nbsp;c5.2, Harvard Medical Library in the Francis A. Countway Library of Medicine. Transcribed in ], pp. 464–65.
			}}
			{{refn |name=ferrier1878 |{{cite journal |last=Ferrier |first=David |year=1878
			|title=The Goulstonian lectures on the Localisation of Cerebral Disease. Lecture I (concluded)
			|journal=British Medical Journal |volume=1 |number=900 |pages=443{{ndash}}47 |pmc=2220379 |pmid=20748815 |doi=10.1136/bmj.1.900.443
			}}}}
			{{refn |name=fingers
			|], p. 9; ], pp. 6, 19; ], pp. 16{{ndash}}17; ], p. 390; ], p. 86.
			}}
			{{refn |name=folsom |{{cite news |last=Folsom |first=A. C. |work=Pacific Medical and Surgical Journal |title=Extraordinary Recovery from Extensive Saw-Wound of the Skull |date=May 1869 |volume=2|pages=550{{ndash}}55
			}} }}
			{{refn |name=fowler |{{cite book
			|last=Fowler |first=O. S. |year=1838 |page=6
			|title=Synopsis of phrenology: and the phrenological developments: together with the character and talents of ________ as given by ________: with references to those pages of "Phrenology proved, illustrated and applied," in which will be found a full and correct delineation of the intellectual and moral character and manifestations of the above-named individual
			|url=http://pds.lib.harvard.edu/pds/view/2577557?n=6 |location=New York |publisher=Fowler & Wells
			}}}}
			{{refn |name=cv_gage |{{cite book
			|title=John Gage of Ipswich, Mass. and his descendants: an historical, genealogical and biographical record, as developed from sources explained herein
			|first=Clyde Van Tassel |last=Gage |location=Worcester, New York |publisher=C.V. Gage |year=1964
			}} }}
			{{refn|name=boorish|{{cite book|last=Dobbs|first=Bon|title=When Hope is Not Enough|page=101|edition=2nd
			|url=https://books.google.com/books?id=q515CgAAQBAJ|year=2015|publisher=Lulu.com|isbn=978-1-329-44409-6
			}}}}
			{{refn |name=gall_sizer |{{cite book
			|last=Gall |first=Franz Joseph |series=The phrenological library. |editor-first=Nahum |editor-last=Capen
			|title=On the functions of the brain and of each of its parts: with observations on the possibility of determining the instincts, propensities, and talents, or the moral and intellectual dispositions of men and animals, by the configuration of the brain and head<!--need pg#s-->
			|url=https://archive.org/details/onfunctionsbrai00gallgoog
			|others=Translated from the French by Winslow Lewis Jr. |location=Boston |publisher=Marsh, Capen & Lyon |year=1835
			}}
			* {{cite book
			|last=Sizer |first=Nelson |year=1888 |publisher=Fowler & Wells |page=194
			|title=Forty years in phrenology; embracing recollections of history, anecdote, and experience
			|location=New York |url=https://books.google.com/books?id=xicZAAAAYAAJ&pg=PA313
			}}
			}}
			{{refn|name=goldenberg|{{cite journal
			|last=Goldenberg | first=Georg |title=The life of Phineas Gage – Stories and Reality
			|journal=Cortex |volume=40 |issue=3 | pages=552–55 |date= December 2004 |doi=10.1016/S0010-9452(08)70147-3
			| s2cid=53168488 }} {{closed access}}
			}}
			{{refn |name=griggs |{{cite journal
			|first=Richard A. |last=Griggs |year=2015
			|title=Coverage of the Phineas Gage Story in Introductory Psychology Textbooks: Was Gage No Longer Gage?
			|journal=Teaching of Psychology |volume=42 |issue=3 |pages=195–202 |doi=10.1177/0098628315587614
			|s2cid=145438545 }} }}
			{{refn|name=hamilton |{{cite journal
			|last=Hamilton |first=J. W. |year=1860 |page=174 |journal=Ohio Medical and Surgical Journal |volume=13
			|title=Editorial and Miscellaneous. The Man Through Whose Head an Iron Rod Passed Is Still Living
			}} Reprinted: {{cite book |editor=Samuel Worcester Butler |editor2=D G. Brinton |date=November 17, 1860 |title=Medical and Surgical Reporter |volume=5 |publisher=Crissly & Markley |location=Philadelphia |page=183 |number=7 |url=https://books.google.com/books?id=lkWgAAAAMAAJ&pg=PA183}}}}
			{{refn |name=hammond|{{cite book
			|last=Hammond |first=W. A. |year=1871|title=A Treatise on the Diseases of the Nervous System
			|location=New York|publisher=Appleton
			}} }}
			{{refn |name=hansen|{{cite journal
			|last=Hansen |first=Bert |date=April 1998 |journal=American Historical Review
			|volume=103 |pages=373–418 |number=2 |title=America's first medical breakthrough: How popular excitement about a French rabies cure in 1885 raised new expectations for medical progress |doi=10.2307/2649773
			|jstor=2649773 |pmid=11620083 }} }}
			{{refn |name=hayward |{{cite journal
			|last=Hayward|first=Rhodri|title=''An Odd Kind of Fame: Stories of Phineas Gage'' by Malcolm Macmillan
			|journal=British Journal for the History of Science|date=December 2002
			|volume=35|issue=4|pages=479{{ndash}}81|jstor=4028281
			}} }}
			{{refn |name=heart |{{cite book
			|author=Rutland Railroad Company |year=1897 |title=Heart of the Green mountains. Souvenir edition. Season of 1897
			|chapter-url=https://books.google.com/books?id=ZC0TAAAAYAAJ&pg=PA41 |location=Boston
			|publisher=Rockwell and Churchill Press
			|pages=41{{ndash}}42 |chapter=The Summit. (Letter of Edward H. Williams)
			}}}}
			{{refn |name=warren_index|
			Catalog of the Museum, Index, undated. Series XXXIX. Miscellaneous specimens (page 179). Warren Anatomical Museum records, {{nobr|RG M-CL02.01}}, Box: 10, Folders: 6, 7. Center for the History of Medicine (Francis A. Countway Library of Medicine).
			}}
			{{refn |name=jackson1849 |
			] (1849). ''Medical Cases'' '''4'''. Case 1777. H&nbsp;MS&nbsp;b72.4 (v.&nbsp;11), Harvard Medical Library in the Francis A. Countway Library of Medicine, pp. 712 (cont'd 680).
			}}
			{{refn |name=jackson1870 |{{cite book
			|last=Jackson |first=J. B. S. |year=1870 |at=Frontis. and Nos. 949{{ndash}}51, 3106
			|url=https://books.google.com/books?id=F8UZAAAAIAAJ&pg=PA145|location=Boston|publisher=A. Williams & Co.
			|title=A Descriptive Catalog of the Warren Anatomical Museum|author-link = J. B. S. Jackson
			}}}}
			{{refn |name=jarrett1 |{{cite journal |first=Christian |last=Jarrett |title=Neuroscience still haunted by Phineas Gage |date=May 2012 |journal=PLOS ONE |volume=7 |issue=5 |page=e37454 |doi=10.1371/journal.pone.0037454 |pmid=22616011 |pmc=3353935 |bibcode=2012PLoSO...737454V |doi-access=free }}}}
			{{refn|name=jarrett2|{{cite book
			|last=Jarrett|first=Christian|title=Great Myths of the Brain
			|url=https://books.google.com/books?id=fBPyBQAAQBAJ&pg=PA38
			|year=2014|publisher=John Wiley & Sons|isbn=978-1-118-31271-1|pages=38–39
			}} }}
			{{refn |name=jewett |{{cite journal
			|last=Jewett |first=M. |year=1868 |title=Extraordinary Case of Recovery after Severe Injury to the Head
			|journal=Western Journal of Medicine |volume=3 |page=151{{ndash}}2
			}} Reprinted: {{cite journal |title=Extraordinary Case of Recovery after Severe Injury to the Head |journal=Boston Medical and Surgical Journal |date=April 23, 1868 |url=https://books.google.com/books?id=cAIHAAAAcAAJ&pg=PA188 |volume=1 |series=New series |number=12 |location=Boston |pages=188–89
			}}}}
			{{refn |name= larner |{{cite journal |url=http://www.acnr.co.uk/pdfs/volume2issue3/v2i3history.pdf |volume=2 |number=3 |date=July{{ndash}}August 2002 |page=26 |title=Phineas Gage and the beginnings of neuropsychology |first2=John Paul |last2=Leach |first1=Andrew |last1=Larner |journal=Advances in Clinical Neuroscience and Rehabilitation |access-date=2014-12-13 |archive-date=2016-04-09 |archive-url=https://web.archive.org/web/20160409034950/http://www.acnr.co.uk/pdfs/volume2issue3/v2i3history.pdf |url-status=dead }}}}
			{{refn |name=macmillan_encyc |{{cite book
			|title=Encyclopedia of the Neurological Sciences
			|chapter-url=https://books.google.com/books?id=hfjSVIWViRUC|year=2014
			|publisher=Academic Press|isbn=978-0-12-385158-1|page=383
			|last=Macmillan|first=Malcolm B.|chapter=Phineas Gage
			}}}}
			{{refn|name=mann|{{cite book
			|last=Mann|first=Mark H. |url=https://books.google.com/books?id=1fgbos7LTIAC
			|title=Perfecting Grace: Holiness, Human Being, and the Sciences |year=2006|publisher=A&C Black
			|isbn=978-0-567-02553-1|page=53
			}} {{closed access}}}}
			{{refn|name=mazzoni |{{cite book
			|last1=Mazzoni|first1=Giuliana|last2=Nelson|first2=Thomas O.
			|title=Metacognition and Cognitive Neuropsychology: Monitoring and Control Processes
			|url=https://books.google.com/books?id=RH2OAwAAQBAJ&pg=PA57|year=2014
			|publisher=Psychology Press|isbn=978-1-317-77843-1|pages=57–58
			}}}}
			{{refn |name=merwin |{{cite book
			|title=Three Years in {{sic|Chili|hide=y}}. By a Lady of Ohio |last=Merwin |first=Loretta L. Wood (Mrs. George B. Merwin)
			|year=1861|location=New York |publisher=Follett, Foster and Company
			|url=https://books.google.com/books?id=lzUgHAAACAAJ |pages=73{{ndash}}78
			}}}}
			{{refn |name=memoir_hjb |{{cite book
			|title=A Memoir of Henry Jacob Bigelow |year=1894 |publisher=Little, Brown |location=Boston
			|url=https://archive.org/details/amemoirhenryjac00unkngoog
			|page= }}}}
			{{refn |name=mitchell |{{cite journal
			|last1=Mitchell |first1= B. D. |first2=B. D. |last2=Fox |first3= W. E. |last3=Humphries
			|first4= A. |last4=Jalali |first5=S. |last5=Gopinath |year=2012
			|title=Phineas Gage revisited: Modern management of large-calibre penetrating brain injury
			|journal=Trauma |volume=14 |number=3 |pages=263{{ndash}}69 |doi=10.1177/1460408612442462
			|s2cid= 73103388 }} {{closed access}} }}
			{{refn |name=northcarolina |{{cite journal
			|editor-last=Wood |editor-first=Thomas F. |volume=1 |number=1 |journal=North Carolina Medical Journal| date=July 1882 |page=60{{ndash}}62
			|title=Notes. Lodgement of Foreign Bodies in the Brain
			|url=https://books.google.com/books?id=FWIsAAAAYAAJ&pg=RA1-PA62
			}} }}
			{{refn |name=northstar |{{cite news |ref=anonymous_northstar
			|author=<!--anon--> |work=North Star |location=] |date=November 6, 1848
			|title=Alive from the Dead, Almost |at=p. 1, col. 2
			}} Transcribed in ], pp. 39{{ndash}}40}}
			{{refn |name=nyt_additional |{{cite news
			|work=] |date=March 1, 1860 |page=11 |title=Additional from Chile
			|url=https://www.nytimes.com/1860/03/01/news/additional-chile-new-crops-commissions-authorized-valparaiso-chamber-commerce.html
			}} }}
			{{refn |name=ordia|{{cite journal
			|last=Ordia |first=J. I. |year=1989
			|title=Neurologic function seven years after crowbar impalement of the brain
			|journal=Surgical Neurology |volume=32 |issue=2 |pages=152{{ndash}}55 |doi=10.1016/0090-3019(89)90204-8
			|pmid=2665157 }} }}
			{{refn|name=pancoast|{{cite book
			|last=Pancoast |first=Joseph |year=1852 |page=
			|publisher=A. Hart |location=Philadelphia |edition=3rd
			|title=A Treatise on Operative Surgery: Comprising a Description of the Various Processes of the Art, Including All the New Operations; Exhibiting the State of Surgical Science in Its Present Advanced Condition
			|url=https://archive.org/details/66850910R.nlm.nih.gov
			}}}}
			{{refn|name=pelham|{{cite book
			|last1=Pelham|first1=Brett W.|last2=Blanton|first2=Hart
			|title=Conducting Research in Psychology: Measuring the Weight of Smoke|url=https://books.google.com/books?id=bbIJAAAAQBAJ&pg=PT184
			|year=2012|publisher=Cengage Learning|isbn=978-1-133-71038-7|page=184
			}}}}
			{{refn|name=plante|{{cite book
			|last=Plante|first=Thomas |url=https://books.google.com/books?id=7ZN3BgAAQBAJ&pg=PA18 |publisher=ABC-CLIO |isbn=978-1-4408-3270-3
			|title=The Psychology of Compassion and Cruelty: Understanding the Emotional, Spiritual, and Religious Influences |page=18 |year=2015
			}}}}
			{{refn|name=pott|{{cite book
			|author=Pott, Percivall
			|title=The chirurgical works of Percivall Pott, F.R.S. Surgeon to St. Bartholomew's Hospital. A new edition, with his last corrections. To which are added a short account of the life of the author ...
			|editor=] |url=https://books.google.com/books?id=0R0UAAAAQAAJ |year=1790 |page=184
			|location=London: printed for J. Johnson, G.G.J. and J. Robinson, T. Cadell, J. Murray, W. Fox, J. Bew, S. Hayes, and W. Lowndes
			|author-link=Percivall Pott
			}}}}
			{{refn|name=proctor|{{cite web
			|url=http://www.sfgenealogy.com/sf/history/hcmcpr.htm|year=1950
			|archive-url=https://web.archive.org/web/20120702064233/http://www.sfgenealogy.com/sf/history/hcmcpr.htm
			|archive-date=2012-07-02
			|title=Location, regulation, and removal of cemeteries in the City and County of San Francisco
			|last=Proctor|first=William A.|publisher=Department of City Planning, City and County of San Francisco
			}}}}
			{{refn|name=rotarian|{{cite magazine
			|url=https://books.google.com/books?id=kUYEAAAAMBAJ&pg=PA25|magazine=The Rotarian|publisher=Rotary International
			|date=March 1952|page=25|title=New Light on the Brain's Dark Mystery|first=Louis N. |last=Sarbach
			}} {{open access }} }}
			{{refn |name=warren_phineas_gage |{{cite web
			|url = http://www.countway.harvard.edu/menuNavigation/chom/warren/exhibits.html
			|title = The Phineas Gage Case
			|access-date = 2016-05-16
			|publisher = Francis A. Countway Library (Harvard Medical School). Center for the History of Medicine. Warren Anatomical Museum
			|archive-url = https://web.archive.org/web/20140814071815/https://www.countway.harvard.edu/menuNavigation/chom/warren/exhibits.html
			|archive-date = August 14, 2014
			|url-status = dead
			|df = mdy-all
			}}}}
			{{refn |name=raeburn | {{cite journal
			|title=Clinical Case Reports in mental health: the need for nuance and context
			|first1=Toby |last1= Raeburn |first2=Debra |last2=Jackson |first3=Garry |last3=Walter |first4=Phil |last4=Escott |first5=Michelle |last5=Cleary
			|doi=10.1002/ccr3.193|pmid = 25548621|pmc=4270701|journal=Clinical Case Reports
			|volume=2|issue=6|pages=241{{ndash}}42|date=December 2014
			}}}}
			{{refn |name=sacks |{{cite book
			|last=Sacks |first=Oliver |title=An Anthropologist on Mars |year=1995 |pages=59{{ndash}}61 |publisher=Knopf Doubleday Publishing |isbn=978-0-679-43785-7 |oclc=30810706 |url=https://books.google.com/books?id=9HQIHnREqhkC&pg=PT90
			}} {{closed access}} }}
			{{refn |name=silvestro |{{cite web
			|url=https://hms.harvard.edu/news/new-view-phineas-gage | website=Harvard Medical School News
			|title=A New View of Phineas Gage|last=Silvestro | first=Sara|date=June 24, 2016
			}} }}
			{{refn |name=smithS_carey |{{cite news
			|url=http://www.boston.com/news/local/massachusetts/articles/2009/07/22/newly_discovered_image_offers_fresh_insights_about_1848_medical_miracle/
			|last=Smith |first=Stephen |work=Boston Globe |date=July 22, 2009 <!--get pg#-->
			|title=Icon, revealed: Newly discovered image offers fresh insights about medical miracle
			}} {{closed access}}
			* {{cite news
			|url=http://tierneylab.blogs.nytimes.com/?s=phineas+gage |date=July 22, 2009
			|work=] |last=Carey |first=Benedict |title=The Curious Case of Phineas Gage, Refocused
			}} {{closed access}}
			}}
			{{refn |name=smithW |{{cite news
			|url=https://books.google.com/books?id=jcwDAAAAYAAJ&pg=PA54 |title=Lesions of the Cerebral Hemispheres |year=1886
			|work=Transactions of the Vermont Medical Society for the Year 1885 |pages=46{{ndash}}58 |last=Smith |first=William T.
			}}}}
			{{refn |name=stuss |{{cite journal
			|last1=Stuss |first1=D. T. |last2=Gow |first2=C. A. |last3=Hetherington |first3=C. R. |doi=10.1037/0022-006X.60.3.349
			|title='No longer Gage': Frontal lobe dysfunction and emotional changes
			|journal=Journal of Consulting and Clinical Psychology |volume=60 |issue=3 |pages=349{{ndash}}59 |year=1992 |pmid=1619089
			}} {{closed access}} }}
			{{refn|name=hockenbury |{{cite book
			|last1=Hockenbury |first1=Don H. |last2=Hockenbury |first2=Sandra E. |year=2008 |title=Psychology
			|page=74 |publisher=Macmillan |isbn=978-1-4292-0143-8
			}} {{closed access}} }}
			{{refn|name=steegmann|{{Cite journal
			|journal=Surgery |date=December 1962 |volume=52|number=6|page=952{{ndash}}58 |pmid=13983566
			|title=Dr. Harlow's famous case: the "impossible" accident of Phineas P. Gage|last=Steegmann|first=A. Theodore
			}} {{closed access}} }}
			{{refn |name=sutton |{{cite journal
			|last=Sutton |first=W. L. |title=A Cent<!--<<DO NOT AMERICANISE>>-->r<!--<<DO NOT AMERICANISE>>-->e<!--<<DO NOT AMERICANISE>>--> Shot
			|journal=] |volume=43 |number=12|page=241 |date=October 23, 1850
			|url=https://books.google.com/books?id=r8o9AQAAMAAJ&pg=PA241
			}}}}
			{{refn |name=swetland |{{cite book
			|title=A partial genealogy of the Swetland/Sweetland/Sweatland Family in America, 1560{{ndash}}2003
			|date=March 2003|editor1=B. S. Swetland|editor2=Doug Sweetland|pages=xxxiii, 15
			}} }}
			{{refn|name=turner |{{cite book|last=Turner|first=Eric Anderson|title=Surgery of the mind|url=https://books.google.com/books?id=oIpsAAAAMAAJ|year=1982|publisher=Carmen Press|location=Birmingham|isbn=978-0-946179-00-8|page=13
			}} {{closed access}} }}
			{{refn |name=vanderkloot|{{cite book
			|last=Van der Kloot |first=William G. |year=1974 |page=289
			|title=Readings in Behavior |publisher=Ardent Media |isbn=978-0-03-084077-7
			|url=https://books.google.com/books?id=Bsw12aCjmhYC&pg=PA289
			}}}}
			{{refn |name=WAM03106
			| An iron bar, that was driven through a man's head (Tamping iron of Phineas Gage). Warren Anatomical Museum (WAM&nbsp;03106), Harvard Medical Library in the Francis A. Countway Library of Medicine.
			}}
			{{refn |name=work
			| ], pp. 119, 316, 323; ], p. 830; ], p. 130n6; ], p. 77.
			}}
			{{refn |name=yakovlev |{{cite journal
			|title=The 'Crowbar Skull' and {{sic|hide=y|Mementoes}} of 'Phrenological Hours'
			|pages=19{{ndash}}24 |journal=Harvard Medical Alumni Bulletin
			|volume=33 |date=October 1958 |number=1 |last=Yakovlev |first=Paul I.
			|url=https://archive.org/stream/harvardmedicalal33harv/harvardmedicalal33harv_djvu.txt
			}}}}
			<!--<<end reflist-->}}
			==External links==
			{{Wikisource-author}}
			{{Commons}}
			* by the Center for the History of Psychology at the ]
			* at the ]
			* {{Webarchive|url=https://web.archive.org/web/20211205080138/https://countway.harvard.edu/center-history-medicine/collections/notable-holdings |date=2021-12-05 }} at the ] of the ]
			* at the ] 3D print exchange
			{{Authority control}}
	{{DEFAULTSORT:Gage, Phineas}}		{{DEFAULTSORT:Gage, Phineas}}
	]		]
	]		]
	]		]
	]
	]		]
			]
			]
			]
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			]

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Latest revision as of 15:57, 16 December 2024

American brain injury survivor (1823–1860) This article is about the survivor of an iron bar through the head. For the UK musical band, see Phinius Gage.

Phineas P. Gage
Gage and his "constant companion"‍—‌his inscribed tamping iron‍—‌sometime after 1849, seen in the portrait (identified in 2009) that "exploded the common image of Gage as a dirty, disheveled misfit"
Born	July 9, 1823 (date uncertain) Grafton County, New Hampshire, U.S.
Died	May 21, 1860(1860-05-21) (aged 36) San Francisco Bay Area, California, U.S.
Cause of death	Status epilepticus
Burial place	Cypress Lawn Memorial Park, California (skull in Warren Anatomical Museum, Boston)
Occupations	Railroad construction foreman blaster stagecoach driver
Known for	Personality change after brain injury
Spouse	None
Children	None

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 remaining 12 years of his life‍—‌effects sufficiently profound that friends saw him (for a time at least) 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 phys­i­o­log­i­cal doctrines" ‍—‌Phineas Gage influenced 19th-century discussion about the mind and brain, par­tic­u­larly debate on cerebral local­i­za­tion,​ and was perhaps the first case to suggest the brain's role in deter­min­ing per­son­al­ity, and that damage to specific parts of the brain might induce specific mental changes.

Gage is a fixture in the curricula of neurology, psychology, and neuroscience,​ one of "the great medical curiosities of all time" and "a living part of the medical folklore"  frequently mentioned in books and scientific papers; he even has a minor place in popular culture. Despite this celebrity, the body of established fact about Gage and what he was like (whether before or after his injury) is small, which has allowed "the fitting of almost any theory to the small number of facts we have" ‍—‌Gage acting as a "Rorschach inkblot"  in which proponents of various conflicting theories of the brain all saw support for their views. Historically, published accounts of Gage (including scientific ones) have almost always severely exaggerated and distorted his behavioral changes, frequently contradicting the known facts.

A report of Gage's physical and mental condition shortly before his death implies that his most serious mental changes were temporary, so that in later life he was far more functional, and socially far better adapted, than in the years immediately following his accident. A social recovery hypothesis suggests that his work as a stagecoach driver in Chile fostered this recovery by providing daily structure that allowed him to regain lost social and personal skills.

Life

Background

Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage of Grafton County, New Hampshire. Little is known about his upbringing and education beyond that he was literate.​

Physician John Martyn Harlow, who knew Gage before his accident, described him as "a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temperament, five feet six inches in height, average weight one hundred and fifty pounds , possessing an iron will as well as an iron frame; muscular system unusually well developed‍—‌having had scarcely a day's illness from his childhood to the date of injury". (In the pseudoscience of phrenology, which was then just ending its vogue, nervo-bilious denoted an unusual combination of "excitable and active mental powers" with "energy and strength mind and body possible the endurance of great mental and physical labor".)​

Gage may have first worked with explosives on farms as a youth, or in nearby mines and quarries. In July 1848 he was employed on construction of the Hudson River Railroad near Cortlandt Town, New York, and by September he was a blasting foreman (possibly an independent contractor) on railway construction projects. His employers' "most efficient and capable foreman ... a shrewd, smart business man, very energetic and persistent in executing all his plans of operation", he had even commissioned a custom-made tamping iron‍—‌a large iron rod‍—‌for use in setting explosive charges.​

Accident

On September 13, 1848, Gage was direct­ing a work gang blast­ing rock while pre­par­ing the road­bed for the Rut­land & Bur­ling­ton Rail­road south of the village of Cav­en­dish, Ver­mont. Setting a blast entailed boring a hole deep into an out­crop of rock; adding blast­ing pow­der and a fuse; then using the tamping iron to pack ("tamp") sand, clay, or other inert material into the hole above the powder in order to contain the blast's energy and direct it into surrounding rock.

As Gage was doing this around 4:30 p.m., his attention was attracted by his men working behind him. Looking over his right shoulder, and inad­vert­ent­ly bringing his head into line with the blast hole and tamping iron, Gage opened his mouth to speak; in that same instant the tamping iron sparked against the rock and (possibly because the sand had been omitted) the powder exploded. Rocketed from the hole, the 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)‍—‌entered the left side of Gage's face in an upward direction, just forward of the angle of the lower jaw. Continuing upward outside the upper jaw and possibly fracturing the cheekbone, it passed behind the left eye, through the left side of the brain, then completely out the top of the skull through the frontal bone.​​​​

Despite 19th-century references to Gage as the "American Crowbar Case", his tamping iron did not have the bend or claw some­times asso­ci­at­ed with the term crowbar; rather, it was simply a pointed cylinder something like a javelin, round and fairly smooth:

The end which entered first is pointed; the taper being  ... 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 the owner.

The tamping iron landed point-first some 80 feet (25 m) away, "smeared with blood and brain".

Gage was thrown onto his back and gave some brief convulsions of the arms and legs, but spoke within 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. (A possibly apocryphal contemporary newspaper report claimed that Gage, while en route, made an entry in his time-book‍—‌the record of his crew's hours and wages.) About 30 minutes after the accident, physician Edward H. Williams found Gage sitting in a chair outside the hotel and was greeted with "one of the great understatements of medical history":​

When I drove up he said, "Doctor, here is business enough for you." 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.

Harlow took charge of the case around 6 p.m.:

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. His person, and the bed on which he was laid, were literally one gore of blood.

Gage was also swallowing blood, which he regurgitated every 15 or 20 minutes.

Treatment and convalescence

With Williams' assistance Harlow shaved the scalp around the region of the tamping iron's exit, then removed coagulated blood, small bone fragments, and "an ounce or more" of protruding brain. After probing for foreign bodies and replacing two large detached pieces of bone, Harlow closed the wound with adhesive straps, leaving it partially open for drainage; the entrance wound in the cheek was bandaged only loosely, for the same reason. A wet compress was applied, then a nightcap, then further bandaging to secure these dressings. Harlow also dressed Gage's hands and forearms (which along with his face had been deeply burned) and ordered that Gage's head be kept elevated.

Late that evening Harlow noted, "Mind clear. Constant agitation of his legs, being alternately retracted and extended ... Says he 'does not care to see his friends, as he shall be at work in a few days.'" 

Despite his own optimism, Gage's convalescence was long, difficult, and uneven. Though recognizing his mother and uncle—summoned from Lebanon, New Hampshire, 30 miles (50 km) away‍—‌ on the morning after the accident, on the second day, he "lost control of his mind, and became decidedly delirious". By the fourth day, he was again "rational ... knows his friends", and after a week's further improvement Harlow entertained, for the first time, the thought "that it was possible for Gage to recover ... This improvement, however, was of short duration." 

Beginning 12 days after the accident, Gage was semi-comatose, "seldom speaking unless spoken to, and then answering only in monosyllables", and on the 13th day Harlow noted, "Failing strength ... coma deepened; the globe of the left eye became more protuberant, with pushing out rapidly from the internal canthus from the wounded brain, and coming out at the top of the head." By the 14th day, "the exhalations from the mouth and head horribly fetid. Comatose, but will answer in monosyllables if aroused. Will not take nourishment unless strongly urged. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness. One of the attendants implored me not to do anything more for him, as it would only prolong his sufferings—that if I would only keep away and let him alone, he would die." 

Galvanized to action, Harlow "cut off the fungi which were sprouting out from the top of the brain and filling the opening, and made free application of caustic to them. With a scalpel I laid open the [frontalis muscle, from the exit wound down to the top of the nose] and immediately there were discharged eight ounces of ill-conditioned pus, with blood, and excessively fetid."  ("Gage was lucky to encounter Dr. Harlow when he did", writes Barker. "Few doctors in 1848 would have had the experience with cerebral abscess with which Harlow left [Jefferson Medical College] and which probably saved Gage's life."  See § Factors favoring Gage's survival, below.)

On the 24th day, 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 ... he went without an overcoat and with thin boots; got wet feet and a chill". He soon developed a fever, but by mid-November was "feeling better in every respect walking about the house again". Harlow's prognosis at this point: Gage "appears to be in a way of recovering, if he can be controlled".

By November 25 (10 weeks after his injury), Gage was strong enough to return to his parents' home in Lebanon, New Hampshire, traveling there in a "close carriage" (an enclosed conveyance of the kind used for transporting the insane). Though "quite feeble and thin ... weak and childish" on arriving, by late December he was "riding out, improving both mentally and physically", and by the following February he was "able to do a little work about the horses and barn, feeding the cattle etc. as the time for ploughing came he was able to do half a day's work after that and bore it well". In August his mother told an inquiring physician that his memory seemed somewhat impaired, though slightly enough that a stranger would not notice.

Injuries

In April 1849, Gage returned to Cavendish and visited Harlow, who noted at that time loss of vision, and ptosis, of the left eye, a large scar on the forehead (from Harlow's draining of the abscess) and

upon the top of the head ... a quadrangular fragment of bone ... raised and quite prominent. Behind this is a deep depression, two inches by one and one-half inches 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.

Gage's rearmost left upper molar, adjacent to the point of entry through the cheek, was also lost. Though a year later some weakness remained, Harlow wrote that "physically, the recovery was quite complete during the four years immediately succeeding the injury".

New England and New York (1849–1852)

In November 1849 Henry Jacob Bigelow, the Professor of Surgery at Harvard Medical School, brought Gage to Boston for several weeks and, after satisfying himself that the tamping iron had actually passed through Gage's head, presented him to a meeting of the Boston Society for Medical Improvement and (possibly) to the medical school class.​​​​

Unable to reclaim his railroad job (see § Early observations (1849–1852)) Gage was for a time "a kind of living museum exhibit"  at Barnum's American Museum in New York City. (This was not the later Barnum's circus; there is no evidence Gage ever exhibited with a troupe or circus, or on a fairground.) Advertisements have also been found for public appearances by Gage‍—‌which he may have arranged and promoted himself‍—‌in New Hampshire and Vermont, supporting Harlow's statement that Gage made public appearances in "most of the larger New England towns". (Years later Bigelow wrote that Gage had been "a shrewd and intelligent man and quite disposed to do anything of that sort to turn an honest penny", but gave up such efforts because " sort of thing has not much interest for the general public".)​​​ For about 18 months, he worked for the owner of a stable and coach service in Hanover, New Hampshire.​

Chile and California (1852–1860)

Phineas was accustomed to entertain his little nephews and nieces with the most fabulous recit­als of his wonder­ful feats and hair-breadth escapes, without any found­at­ion except in his fancy. He con­ceived a great fondness for pets and souve­nirs, espe­cial­ly for children, horses and dogs‍—‌only exceeded by his attach­ment for his tamping iron, which was his constant com­pan­ion during the remainder of his life.

J. M. Harlow (1868)

In August 1852, Gage was invited to Chile to work as a long-distance stagecoach driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the Valparaíso–Santiago route. After his health began to fail in mid-1859,​ he left Chile for San Francisco, arriving (in his mother's words) "in a feeble condition, having failed very much since he left New Hampshire ... Had many ill turns while in Valparaiso, especially during the last year, and suffered much from hardship and exposure." In San Francisco he recovered under the care of his mother and sister, who had relocated there from New Hampshire around the time he went to Chile. Then, "anxious to work", he found employment with a farmer in Santa Clara.

In February 1860, Gage began to have epileptic seizures. He lost his job, and (wrote Harlow) as the seizures increased in frequency and severity he "continued to work in various places could not do much".​

Death and exhumation

On May 18, 1860, Gage "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,"  and he died in status epi­lep­ti­cus, in or near San Francisco, late on May 21, 1860. He was buried in San Francisco's Lone Mountain Cemetery.​

In 1866, Harlow (who had "lost all trace of , and had well nigh abandoned all ex­pec­ta­tion of ever hearing from him again") somehow learned that Gage had died in California, and made contact with his family there. At Harlow's request the family had Gage's skull exhumed, then personally delivered it to Harlow,​ who was by then a prominent physician, busi­ness­man, and civic leader in Woburn, Massachusetts.​

About a year after the accident, Gage had given his tamping iron to Harvard Medical School's Warren Anatomical Museum, but he later reclaimed it​ and made what he called "my iron bar"  his "constant companion during the remainder of his life"; now it too was delivered by Gage's family to Harlow. (Though some accounts assert that Gage's iron had been buried with him, there is no evidence for this.)​ After studying them for a triumphal 1868 retrospective paper on Gage Harlow redeposited the iron‍—‌this time with the skull‍—‌in the Warren Museum, where they remain on display today.

The tamping iron bears the following inscription, commissioned by Bigelow in conjunction with the iron's original deposit in the Museum (though the date given for the accident is one day off):

This is the bar that was shot through the head of Mr Phinehas P. Gage at Cavendish Vermont Sept 14, 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  •   Jan 6 1850

The date Jan 6 1850 falls within the period during which Gage was in Boston under Bigelow's observation.​

In 1940 Gage's headless remains were moved to Cypress Lawn Memorial Park as part of a mandated relocation of San Francisco's cemeteries to outside city limits (see San Francisco cemetery relocations).​

Mental changes and brain damage

Gage may have been the first case to suggest the brain's role in determining personality and that damage to specific parts of the brain might induce specific personality changes, but the nature, extent, and duration of these changes have been difficult to establish. Only a handful of sources give direct information on what Gage was like (either before or after the accident), the mental changes published after his death were much more dramatic than anything reported while he was alive, and few sources are explicit about the periods of Gage's life to which their various descriptions of him (which vary widely in their implied level of functional impairment) are meant to apply.​

Early observations (1849–1852)

Harlow ("virtually our only source of information" on Gage, according to psychologist Malcolm Macmillan) 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"; he also took pains to note that Gage's memory and general intelligence seemed unimpaired after the accident, outside of the delirium exhibited in the first few days. Nonetheless 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 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."

This description ("now routinely quoted", says Kotowicz) is from Harlow's observations set down soon after the accident,​ but Harlow‍—‌perhaps hesitant to describe his patient negatively while he was still alive‍—‌delayed publishing it until 1868, after Gage had died and his family had supplied "what we so much desired to see" (as Harlow termed Gage's skull).

In the interim, Harlow's 1848 report, published just as Gage was emerging from his convalescence, merely hinted at psychological symptoms:

The mental manifestations of the patient, I reserve to a future communication. I think the case ... is exceedingly interesting to the enlightened physiologist and intellectual philosopher.

But after Bigelow termed Gage "quite recovered in faculties of body and mind" with only "inconsiderable disturbance of function", a rejoinder in the American Phrenological Journal‍—‌

That there was no difference in his mental manifestations after the recovery not true ... he was gross, profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people.

‍—‌was apparently based on information anonymously supplied by Harlow. Pointing out that Bigelow gave extensive verbatim quotations from Harlow's 1848 papers, yet omitted Harlow's promise to follow up with details of Gage's "mental manifestations", Barker explains Bigelow's and Harlow's contradictory evaluations (less than a year apart) by differences in their educational backgrounds, in particular their attitudes toward cerebral localization (the idea that different regions of the brain are specialized for different functions) and phrenology (the nineteenth-century pseudoscience that held that talents and personality can be inferred from the shape of a person's skull):

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 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 to prove opposing views on phrenology was not uncommon.

A reluctance to ascribe a biological basis to "higher mental functions" (functions‍—‌such as language, personality, and moral judgment‍—‌beyond the merely sensory and motor) may have been a further reason Bigelow discounted the behavioral changes in Gage which Harlow had noted.​ (See Mind–body dualism.)

Later observations (1858–1859)

In 1860, an American physician who had known Gage in Chile in 1858 and 1859 described him as still "engaged in stage driving in the enjoyment of good health, with no impairment whatever of his mental faculties".​ Together with the fact that Gage was hired by his employer in advance, in New England, to become part of the new coaching enterprise in Chile,​ this implies that Gage's most serious mental changes had been temporary, so that the "fitful, irreverent ... capricious and vacillating" Gage described by Harlow immediately after the accident became, over time, far more functional and far better adapted socially.​

Macmillan writes that this conclusion is reinforced by the responsibilities and challenges associated with stagecoach work such as that done by Gage in Chile, including the requirement that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers." ​ A day's work for Gage meant "a 13-hour journey over 100 miles of poor roads, often in times of political instability or frank revolution. All this‍—‌in a land to whose language and customs Phineas arrived an utter stranger‍—‌militates as much against permanent disinhibition as do the extremely complex sensory-motor and cognitive skills required of a coach driver." ​ (An American visitor wrote: "The departure of the coach was always a great event at Valparaiso‍—‌a crowd of ever-astonished Chilenos assembling every day to witness the phenomenon of one man driving six horses.")

Social recovery

Macmillan writes that this contrast‍—‌between Gage's early, versus later, post-accident behavior‍—‌reflects his " from the commonly portrayed impulsive and uninhibited person into one who made a reasonable 'social recovery'", citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills":

Phineas' survival and reha­bil­i­ta­tion dem­on­strated a theory of recovery which has influ­enced the treat­ment of frontal lobe damage today. In modern treat­ment, adding struc­ture to tasks by, for example, mentally vis­u­al­is­ing a written list, is con­sid­ered a key method in coping with frontal lobe damage.

According to contemporary accounts by visitors to Chile,​ Gage would have had to

rise early in the morning, prepare himself, and groom, feed, and harness the horses; he had to be at the departure point at a specified time, load the luggage, charge the fares and get the passengers settled; and then had to care for the passengers on the journey, unload their luggage at the destination, and look after the horses. The tasks formed a structure that required control of any impulsiveness he may have had.

En route (Macmillan continues):

much foresight was required. Drivers had to plan for turns well in advance, and sometimes react quickly to manoeuvre around other coaches, wagons, and birlochos travelling at various speeds ... Adaptation had also to be made to the physical condition of the route: although some sections were well-made, others were dangerously steep and very rough.

Thus Gage's stagecoach work‍—‌"a highly structured environment in which clear sequences of tasks were required contingencies requiring foresight and planning arose daily"‍—‌resembles rehabilitation regimens first developed by Soviet neuropsychologist Alexander Luria for the reestablishment of self-regulation in World War II soldiers suffering frontal lobe injuries.​

A neurological basis for such recoveries may be found in emerging evidence "that damaged tracts may re-establish their original connections or build alternative pathways as the brain recovers" from injury. Macmillan adds that if Gage made such a recovery‍—‌if he eventually "figured out how to live" (as Fleischman put it) despite his injury‍—‌then it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases"; and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"  As author Sam Kean put it, "If even Phineas Gage bounced back‍—‌that's a powerful message of hope." 

Exaggeration and distortion of mental changes

A moral man, Phineas Gage
Tamping powder down holes for his wage
       Blew his special-made probe
       Through his left frontal lobe
Now he drinks, swears, and flies in a rage.

Anonymous limerick

Macmillan's analysis of scientific and popular accounts of Gage found that they almost always distort and exaggerate his behavioral changes well beyond anything described by anyone who had direct contact with him, concluding that the known facts are "inconsistent with the common view of Gage as a boastful, brawling, foul-mouthed, dishonest useless drifter, unable to hold down a job, who died penniless in an institution".  In the words of Barker, "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis". Even today (writes Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a psychopath"; Grafman has written that "the details of social cognitive impairment have occasionally been inferred or even embellished to suit the enthusiasm of the story teller"; and Goldenberg calls Gage "a (nearly) blank sheet upon which authors can write stories which illustrate their theories and entertain the public". 

For example, Harlow's statement that Gage "continued to work in various places; could not do much, changing often, and always finding something that did not suit him in every place he tried"  refers only to Gage's final months, after convulsions had set in. But it has been misinterpreted as meaning that Gage never held a regular job after his accident, "was prone to quit in a capricious fit or be let go because of poor discipline", "never returned to a fully independent existence", "spent the rest of his life living miserably off the charity of others and traveling around the country as a sideshow freak", and ("dependent on his family"  or "in the custody of his parents") died "in careless dissipation". In fact, after his initial post-recovery months spent traveling and exhibiting, Gage supported himself‍—‌at a total of just two different jobs‍—‌from early 1851 until just before his death in 1860.​

Other behaviors ascribed, by various authors, to the post-accident Gage that are either unsupported by, or in contradiction to, the known facts include the following:

• mistreatment of wife and children (though Gage actually had neither);
• inappropriate sexual behavior, promiscuity, or impaired sexuality;
• lack of forethought, concern for the future, or capacity for embarrassment;
• parading his self-misery, and vainglory in showing his wounds;
• "gambling" himself into "emotional and reputational ... bankruptcy";
• irresponsibility, untrustworthiness, aggressiveness, violence;
• vagrancy, begging, drifting, drinking;
• lying, brawling, bullying;
• psychopathy, inability to make ethical decisions;
• " all respect for social conventions";
• acting like an "idiot"  or a "lout";
• living as a "layabout"  or a "boorish mess";
• " almost everyone who had ever cared about him";
• dying "due to a debauch".

None of these behaviors are mentioned by anyone who had met Gage or even his family, and as Kotowicz put it, "Harlow does not report a single act that Gage should have been ashamed of."  Gage is "a great story for illustrating the need to go back to original sources", writes Macmillan, most authors having been "content to summarize or paraphrase accounts that are already seriously in error". 

Nonetheless (write Daffner and Searl) "the telling of story has increased interest in understanding the enigmatic role that the frontal lobes play in behavior and personality", and Ratiu has said that in teaching about the frontal lobes, an anecdote about Gage is like an "ace your sleeve. It's just like whenever you talk about the French Revolution you talk about the guillotine, because it's so cool."  Benderly suggests that instructors use the Gage case to illustrate the importance of critical thinking.

Extent of brain damage

It is regretted that an autopsy could not have been had, so that the pre­cise condi­tion of the en­ceph­a­lon at the time of his death might have been known.

J. M. Harlow (1868)

External videos
Video re­con­struc­tion of tamp­ing iron pass­ing through Gage's skull (Ratiu et al.) (registration required)

Debate about whether the trauma and sub­se­quent infect­ion had damaged Gage's left and right frontal lobes, or only the left, began almost immedi­ate­ly after his accident.​ The 1994 con­clu­sion of Hanna Damasio et al., that the tamping iron did physical damage to both lobes, was drawn not from Gage's skull but from a cadaver skull dig­i­tal­ly deformed to match the dimen­sions of Gage's​​‍—‌and made a priori assumptions about the location of Gage's internal injuries and the exit wound which in some cases contradict Harlow's observations. Using CT scans of Gage's actual skull, Ratiu et al. and Van Horn et al. both rejected that conclusion, agreeing with Harlow's belief‍—‌based on probing Gage's wounds with his fingers‍—‌that only the left frontal lobe had been damaged.​

In addition, Ratiu et al. noted that the hole in the base of the cranium (created as the tamping iron passed through the sphenoidal sinus into the brain) has a diameter about half that of the iron itself; combining this with the hairline fracture beginning behind the exit region and running down the front of the skull, they concluded that the skull "hinged" open as the iron entered from below, then was pulled closed by the resilience of soft tissues once the iron had exited through the top of the head.​

Van Horn et al. concluded that damage to Gage's white matter (of which they made detailed estimates) was as or more significant to Gage's mental changes than cerebral cortex (gray matter) damage. Thiebaut de Schotten et al. estimated white-matter damage in Gage and two other case studies ("Tan" and "H.M."), concluding that these patients "suggest that social behavior, language, and memory depend on the coordinated activity of different regions rather than single areas in the frontal or temporal lobes."

Factors favoring Gage's survival

Harlow saw Gage's survival as demonstrating "the wonderful resources of the system in enduring the shock and in overcoming the effects of so frightful a lesion, and as a beautiful display of the recuperative powers of nature", and listed what he saw as the circumstances favoring it:

1st. The subject was the man for the case. His physique, will, and capacity of endurance, could scarcely be excelled.

For Harlow's description of the pre-accident Gage, see § Background, above.

2d. The shape of the missile‍—‌being pointed, round and comparatively smooth, not leaving behind it prolonged concussion or compression.

Despite its very large diameter and mass (compared to a weapon-fired projectile) the tamping iron's relatively low velocity drastically reduced the energy available to compressive and concussive "shock waves".​​

Harlow continued:

3d. The point of entrance ... did little injury until it reached the floor of the cranium, when, at the same time that it did irreparable damage, it opening in the base of the skull, for drainage, recovery would have been impossible.

Barker writes that " from falls, horse kicks, and gunfire, were well known in pre–Civil War America every contemporary course of lectures on surgery described the diagnosis and treatment" of such injuries. But to Gage's benefit, surgeon Joseph Pancoast had performed "his most celebrated operation for head injury before Harlow's medical class, [trepanning] to drain the pus, resulting in temporary recovery. Unfortunately, symptoms recurred and the patient died. At autopsy, reaccumulated pus was found: granulation tissue had blocked the opening in the dura." By keeping the exit wound open, and elevating Gage's head to encourage drainage from the cranium into the sinuses (through the hole made by the tamping iron), Harlow "had not repeated Professor Pancoast's mistake".​

No attempt will be made by me to cite analo­gous cases, as after ran­sack­ing the lit­er­a­ture of sur­gery in quest of such, I learn that all, or nearly all, soon came to a fatal result.

J. M. Harlow (1868)

Finally,

4th. The portion of the brain traversed was, for several reasons, the best fitted of any part of the cerebral substance to sustain the injury.

Precisely what Harlow's "several reasons" were is unclear, but he was likely referring, at least in part, to the understanding (slowly developing since ancient times) that injuries to the front of the brain are less dangerous than are those to the rear, because the latter frequently interrupt vital functions such as breathing and circulation. For example, surgeon James Earle wrote in 1790 that "a great part of the cerebrum may be taken away without destroying the animal, or even depriving it of its faculties, whereas the cerebellum will scarcely admit the smallest injury, without being followed by mortal symptoms." ​

Ratiu et al. and Van Horn et al. both concluded that the tamping iron passed left of the superior sagittal sinus and left it intact, both because Harlow does not mention loss of cerebrospinal fluid through the nose, and because otherwise Gage would almost certainly have suffered fatal blood loss or air embolism.​ Harlow's moderate (in the context of medical practice of the time) use of emetics, purgatives, and (in one instance) bleeding would have "produced dehydration with reduction of intracranial pressure may have favorably influenced the outcome of the case", according to Steegmann.

As to his own role in Gage's survival, Harlow merely averred, "I can only say ... with good old Ambroise Paré, I dressed him, God healed him", but Macmillan calls this self-assessment far too modest. Noting that Harlow had been a "relatively inexperienced local physician ... graduated four and a half years earlier", Macmillan's discussion of Harlow's "skillful and imaginative adaptation conservative and progressive elements from the available therapies to the particular needs posed by Gage's injuries" emphasizes that Harlow "did not apply rigidly what he had learned", for example forgoing an exhaustive search for bone fragments (which risked hemorrhage and further brain injury) and applying caustic to the "fungi" instead of excising them (which risked hemorrhage) or forcing them into the wound (which risked compressing the brain).

Early medical attitudes

Skepticism

The very small amount of atten­tion that has been given to case can only be ex­plained by the fact that it far tran­scends any case of recov­ery from inju­ry of the head that can be found in the rec­ords of sur­gery. It was too mon­strous for belief ...

J. B. S. Jackson (1870)

Barker notes that Harlow's orig­i­nal 1848 report of Gage's sur­viv­al and recov­ery "was widely dis­be­lieved, for obvious reasons"  and Harlow, recall­ing this early skep­ti­cism in his 1868 ret­ro­spec­tive, invoked the biblical story of Doubting Thomas:

The case occurred nearly twenty years ago, in an obscure country town ..., was attended and reported by an obscure country phy­si­cian, and was received by the Met­ro­pol­i­tan Doctors with several grains of caution, insomuch that many utterly refused to believe that the man had risen, until they had thrust their fingers into the hole his head, and even then they required of the Country Doctor attested state­ments, from clergy­men and lawyers, before they could or would believe‍—‌many eminent surgeons regarding such an occur­rence as a phys­i­o­log­i­cal impos­si­bil­i­ty, the appear­ances pre­sented by the subject being var­i­ous­ly explained away.

"A distinguished Professor of Surgery in a distant city", Harlow continued, had even dismissed Gage as a "Yankee invention".

According to the Boston Medical and Surgical Journal (1869) it was the 1850 report on Gage by Bigelow‍—‌Harvard's Professor of Surgery and "a majestic and author­i­ta­tive figure on the medical scene of those times" ‍—‌that "finally succeeded in forcing authenticity upon the credence of the pro­fes­sion ... as could hardly have been done by any one in whose sagacity and surgical knowledge his confrères had any less confidence". Noting that, "The leading feature of this case is its improb­a­bil­i­ty ... This is the sort of accident that happens in the pantomime at the theater, not elsewhere", Bigelow emphasized that though "at first wholly skeptical, I have been personally convinced".

Nonetheless (Bigelow wrote just before Harlow's 1868 presentation of Gage's skull) though "the nature of injury and its reality are now beyond doubt ... I have received a letter within a month to prove that ... the accident could not have happened." 

Standard for other brain injuries

As the reality of Gage's accident and survival gained credence, it became "the standard against which other injuries to the brain were judged", and it has retained that status despite competition from a growing list of other unlikely-sounding brain-injury accidents, including encounters with axes, bolts, low bridges, exploding firearms, a revolver shot to the nose, further tamping irons, and falling Eucalyptus branches. For example, after a miner survived traversal of his skull by a gas pipe 5⁄8 inch (1.6 cm) in diameter (extracted "not without considerable difficulty and force, owing to a bend in the portion of the rod in his skull"), his physician invoked Gage as the "only case comparable with this, in the amount of brain injury, that I have seen reported".

Often these comparisons carried hints of humor, competitiveness, or both. The Boston Medical and Surgical Journal, for example, alluded to Gage's astonishing survival by referring to him as "the patient whose cerebral organism had been comparatively so little disturbed by its abrupt and intrusive visitor"; and a Kentucky doctor, reporting a patient's survival of a gunshot through the nose, bragged, "If you Yankees can send a tamping bar through a fellow's brain and not kill him, I guess there are not many can shoot a bullet between a man's mouth and his brains, stopping just short of the medulla oblongata, and not touch either." Similarly, when a lumbermill foreman returned to work soon after a saw cut three inches (8 cm) into his skull from just between the eyes to behind the top of his head, his surgeon (who had removed from this wound "thirty-two pieces of bone, together with considerable sawdust") termed the case "second to none reported, save the famous tamping-iron case of Dr. Harlow", though apologizing that "I cannot well gratify the desire of my professional brethren to possess skull, until he has no further use for it himself."

As these and other remarkable brain-injury survivals accumulated, the Boston Medical and Surgical Journal pretended to wonder whether the brain has any function at all: "Since the antics of iron bars, gas pipes, and the like skepticism is discomfitted, and dares not utter itself. Brains do not seem to be of much account now-a-days." The Transactions of the Vermont Medical Society was similarly facetious: "'The times have been,' says Macbeth [Act III], 'that when the brains were out the man would die. But now they rise again.' Quite possibly we shall soon hear that some German professor is exsecting it." ​

Theoretical misuse

The Gage who appears in contemporary psychology textbooks is simply a compound creature ... a stunning example of the ideological uses of case histories and their mythological reconstruction.

Rhodri Hayward

Though Gage is considered the "index case for personality change due to frontal lobe damage", ​​​​ the uncertain extent of his brain damage​ and the limited understanding of his behavioral changes render him "of more historical than neurologic [sic] interest". Thus, Macmillan writes, "Phineas' story is worth remembering because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth", the paucity of evidence having allowed "the fitting of almost any theory to the small number of facts we have". A similar concern was expressed as early as 1877, when British neurologist David Ferrier (writing to Harvard's Henry Pickering Bowditch in an attempt "to have this case definitely settled") complained that, "In investigating reports on diseases and injuries of the brain, I am constantly being amazed at the inexactitude and distortion to which they are subject by men who have some pet theory to support. The facts suffer so frightfully ..." ​​ More recently, neurologist Oliver Sacks refers to the "interpretations and misinterpretations from 1848 to the present", and Jarrett discusses the use of Gage to promote "the myth, found in hundreds of psychology and neuroscience textbooks, plays, films, poems, and YouTube skits Personality is located in the frontal lobes ... and once those are damaged, a person is changed forever." 

Cerebral localization

In the 19th-century debate over whether the various mental functions are or are not localized in specific regions of the brain (see Cerebral localization), both sides managed to enlist Gage in support of their theories. For example, after Eugene Dupuy wrote that Gage proved that the brain is not localized (characterizing him as a "striking case of destruction of the so-called speech centre without consequent aphasia") Ferrier replied by using Gage (along with the woodcuts of his skull and tamping iron from Harlow's 1868 paper) to support his thesis that the brain is localized.​​

Phrenology

Throughout the 19th century, adherents of phrenology contended that Gage's mental changes (his profanity, for example) stemmed from destruction of his mental "organ of Benevolence"‍—‌as phrenologists saw it, the part of the brain responsible for "goodness, benevolence, the gentle character ... to dispose man to conduct himself in a manner conformed to the maintenance of social order"‍—‌and/or the adjacent "organ of Veneration"‍—‌related to religion and God, and respect for peers and those in authority.​​​​ (Phrenology held that the organs of the "grosser and more animal passions are near the base of the brain; literally the lowest and nearest the animal man highest and farthest from the sensual are the moral and religions feelings, as if to be nearest heaven". Thus Veneration and Benevolence are at the apex of the skull‍—‌the region of exit of Gage's tamping iron.)

Harlow wrote that Gage, during his convalescence, did not "estimate size or money accurately would not take $1000 for a few pebbles" and was not particular about prices when visiting a local store; by these examples Harlow may have been implying damage to phrenology's "Organ of Comparison".

Psychosurgery and lobotomy

It is frequently asserted that what happened to Gage played a role in the later development of various forms of psychosurgery‍—‌particularly lobotomy‍—‌or even that Gage's accident constituted "the first lobotomy". Aside from the question of why the unpleasant changes usually (if hyperbolically) attributed to Gage would inspire surgical imitation, there is no such link, according to Macmillan:

There is simply no evidence that any of these operations were deliberately designed to produce the kinds of changes in Gage that were caused by his accident, nor that knowledge of Gage's fate formed part of the rationale for them‍... hat his case did show came solely from his surviving his accident: major operations could be performed on the brain without the outcome necessarily being fatal.

Somatic marker hypothesis

Antonio Damasio, in support of his somatic marker hypothesis (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he ascribes to Gage and those of modern patients with damage to the orbitofrontal cortex and amygdala. But Damasio's depiction of Gage has been severely criticized, for example by Kotowicz:

Damasio is the principal perpetrator of the myth of Gage the psycho­path ... Damasio changes nar­ra­tive, omits facts, and adds freely ... His account of Gage's last months a gro­tesque fab­ri­ca­tion that Gage was some riff-raff who in his final days headed for Cal­i­for­nia to drink and brawl himself to death ... It seems that the growing com­mit­ment to the frontal lobe doctrine of emotions brought Gage to the lime­light and shapes how he is described.

As Kihlstrom put it, "any modern commentators exaggerate the extent of Gage's personality change, perhaps engaging in a kind of retrospective reconstruction based on what we now know, or think we do, about the role of the frontal cortex in self-regulation." Macmillan​ gives detailed criticism of Antonio Damasio's various presentations of Gage (some of which are joint work with Hannah Damasio and others).

Portraits

Two daguerreotype portraits of Gage, identi­fied in 2009 and 2010, are the only like­nes­ses​ of him known other than a plaster head cast taken for Bigelow in late 1849 (and now in the Warren Museum along with Gage's skull and tamping iron). The first portrait shows a "disfigured yet still-handsome" Gage with left eye closed and scars clearly visible, "well dressed and confident, even proud"  and holding his iron, on which portions of its inscription can be made out. (For decades the portrait's owners had believed that it depicted an injured whaler with his harpoon.) The second portrait, copies of which are in the possession of two branches of the Gage family, shows Gage in a somewhat different pose, wearing the same waistcoat and possibly the same jacket, but with a different shirt and tie.

Authenticity of the portraits was confirmed by overlaying the inscription on the tamping iron, as seen in the portraits, against that on the actual tamping iron, and matching the subject's injuries to those preserved in the head cast. However, about when, where, and by whom the portraits were taken nothing is known, except that they were created no earlier than January 1850 (when the inscription was added to the tamping iron), on different occasions, and are likely by different photographers.

The portraits support other evidence that Gage's most serious mental changes were temporary (see § Social recovery). "That was any form of vagrant following his injury is belied by these remarkable images", wrote Van Horn et al. "Although just one picture," Kean commented in reference to the first image discovered, "it exploded the common image of Gage as a dirty, disheveled misfit. This Phineas was proud, well-dressed, and disarmingly handsome." 

See also

• Anatoli Bugorski – scientist whose head was struck by a particle-accelerator proton beam
• Eadweard Muybridge – another early case of head injury leading to mental changes
• Alexis St. Martin – man whose abdominal fistula allowed pioneering studies of digestion
• Henry Molaison – patient "H.M.", who developed severe anterograde amnesia after surgery for epilepsy
• Lev Zasetsky – soldier who developed agnosia after a bullet pierced his parieto-occipital area
• Ahad Israfil – known for his recovery from a gunshot injury that destroyed most of his right cerebral hemisphere

• Cognitive neuropsychology
• Cognitive rehabilitation therapy
• Neuroplasticity
• Neurorehabilitation
• Occupational therapy
• Rehabilitation (neuropsychology)

Notes

1. ^ The 2009-identified image was, at the time, in the collection of Jack and Beverly Wilgus,​​​ but in 2016 was donated to the Warren Anatomical Museum. Like almost all da­guerre­o­types it shows its subject laterally (left–right) reversed, making it appear as if Gage's right eye is injured. However, all Gage's injuries, including to his eye, were on the left; therefore in presenting the image in this article a second, compensating reversal has been applied so as to show Gage as he appeared in life.​

   The 2010-identified image is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey. Unlike the Wilgus portrait, which is an original da­guerre­o­type, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a da­guerre­o­type or other laterally reversing early-process photograph; here again a compensating reversal has been applied.

2. ^ Macmillan discusses Gage's ancestry and early life. The birthdate July 9, 1823, is given by a Gage genealogy without citation, but is consistent with agreement among contemporary sources that Gage was 25 years old on the date of his accident, and with his age (36 years) as given in undertaker's records after his death in May 1860. Possible homes in childhood and youth are Lebanon or nearby East Lebanon, Enfield, and/or Grafton (all in Grafton County, New Hampshire), though Harlow refers to Lebanon in particular as Gage's "native place"  and "his home"  (likely that of his parents), to which Gage returned ten weeks after his accident.

   There is nothing to indicate what Gage's middle initial, P, ​ stood for. His mother's maiden name is variously given as Swetland, Sweatland, or Sweetland.

3. ^ Macmillan compares accounts of Gage to one another and against the known facts, as well as contrasting Gage's celebrity‍—‌he is mentioned in 91 percent of a sample of introductory psychology textbooks published 2012–2014‍—‌with what was, until comparatively recently, the lack of any major study of him and the dearth of papers solely or mainly about him.​

   Until 2008 the available primary sources offering significant information on Gage, and for which there is any evidence at all (even merely the source's own claim) of contact with Gage or his family, were limited to Harlow (1848, 1849, 1868);​ Bigelow (1850); and Jackson (1849, 1870). Macmillan notes that descriptions of Gage's behavior‍—‌the source of the perennial interest in the case‍—‌total just 300 words and emphasizes the primacy of Harlow's three publications as sources.​ (Harlow's original case notes have not been located. A Warren Museum curator referred to the "stately elegance" of Harlow's writings on Gage.) However, all of these sources were difficult to obtain prior to 2000‍—‌for example, Macmillan was able to identify something more than 21 copies of Harlow's 1868 paper worldwide‍—‌and Macmillan believes this has helped allow distorted descriptions of Gage to flourish.

   Macmillan & Lena present previously unknown sources found since 2008.

4. ^ Macmillan gives background on the location and circumstances of the accident, and the steps in setting a blast. The village of Cavendish (part of the town of Cavendish) was at the time called Duttonsville. The blast hole, about 1+3⁄4 inches (4.5 cm) in diameter and up to 12 feet (4 m) 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 statements that Gage had been a "great favorite" with his men, and that his employers had considered him "the most efficient and capable foreman in their employ" prior to the accident.​​​
5. Barker: "Harlow always refers to the bar by its proper title, as a tamping iron. Bigelow's reference to a crowbar ... gave the case its nickname, which is still encountered today." ​
6. Williams family lore holds that Harlow did not appear on the scene until two days after Gage's accident, but nonetheless "sought eventually to take the whole glory of the successful outcome" of the case, even though Williams "was given full credit by all those who knew of his connection" to it. However, these stories conflict with every other account of the case, including Williams' own.​
7. ^ The head cast, taken from life, is often mistakenly referred to as a death mask.
8. Macmillan speculates that memory impairment may have been the interpretation placed by Gage's family on his difficulty, as reported by Harlow, in concentrating on tasks (see § Early observations (1849–1852).)
9. Though the tamping iron's passage forced the left eye from its orbit by one-half its diameter, that eye retained "indistinct" vision until the tenth day after the accident, when vision was permanently lost. Ratiu et al. conclude that "the optic canal was spared ... secondary to acute glaucoma or swelling of the optic nerve and compression against the rigid walls of the optic canal". Harlow added that Gage could "adduct and depress the globe, but move it in any other direction".
10. Osteological examination of the tooth socket confirms that this tooth was lost before Gage died, though it is unknown when; presumably it was either knocked out during the accident, or loosened so that it fell out later.
11. ^ Gage may have been one of the earliest examples of a patient entering a hospital primarily to further medical research rather than for treatment. He also appears to have been one of the first patients exhibited in an entertainment venue, as opposed to in presentations before medical audiences.​
12. ^ Gage's death and original burial are discussed by Macmillan.​​ Harlow gives Gage's date of death as May 21, 1861, but because bound, consecutive interment records show that Gage was buried May 23, 1860, Macmillan concludes that May 21, 1860 is the correct death date;​ this is confirmed by a contemporary obituary. (Harlow's informant was Gage's mother; Macmillan points out that the 1861 date, when combined with Gage's recorded age at death‍—‌36 years plus an unspecified number of months‍—‌obscures the fact that Gage was born just a few months after his parents' April 27, 1823 marriage.) This implies that certain other dates Harlow gives for events late in Gage's life‍—‌his move from Chile to San Francisco and the onset of his convulsions‍—‌must also be mistaken, presumably by the same one year; this article follows Macmillan in correcting those dates, each of which carries this annotation.
13. Where precisely Gage died is uncertain. Harlow states that Gage "went home to his mother" before he died, but the US census for June 1, 1860 (seven days after Gage's death) lists as empty the San Francisco house shared by Hannah Gage, her daughter (Gage's sister) Phebe, Phebe's husband David Dustin Shattuck, and Phebe and David's young son Frank. Instead, Hannah, Phebe, and Frank (but not D. D. Shattuck, who sometimes traveled on business) were listed as living in the home of physician William Jackson Wentworth, across San Francisco Bay in what is now Oakland. The family's connection to Wentworth is uncertain, but it may be related to the fact that Frank was deaf; it is also possible Wentworth had met Gage when Gage visited Boston in 1849.​
14. ^ The tamping iron appears to have passed between the Warren Museum and Gage several times. Gage originally gave it to the Museum in early 1850, yet he had it with him when he briefly resumed exhibiting just before going to Chile in 1852. Two years later he was asking for it again: the Museum's files hold a note reading, "3106  •   Mr. B. R. Sweatland  •   Please deliver my iron bar to the bearer  •   P. P. Gage  •   Aug 26th, 54". Benjamin Richards Sweetland (or Sweatland), a second cousin of Gage's mother, emigrated from New York to California in the 1850s. Presumably Gage either gave or sent this note to Sweetland, who used it to retrieve from the Museum the tamping iron, which he then took, or forwarded, to Gage in Valparaiso. The 3106, in a different hand, is the tamping iron's number in J.B.S. Jackson's 1870 catalog of the Museum.​
15. Early attempts to estimate the extent of damage include those by: Harlow (1848); Edward Elisha Phelps (1849); Bigelow (1850); Harlow (1868); Hammond (1871); Dupuy (1873, 1877); Ferrier (1877–79); Bramwell (1888); Cobb (1840, 1843);​​ Tyler & Tyler (1982). See Macmillan (2000), Ch. 5.
16. In any event, any such analysis can estimate only the initial, direct damage done by the passage of the tamping iron itself; it cannot account for additional damage from concussion, from bone fragments pushed along by the iron after it broke through the base of the cranium, or from the extensive bleeding and severe infection. Further uncertainty stems from individual variations in the position of the brain within the skull, and in the points at which various brain functions are localized.​
17. Harlow's full text, "The point of entrance outside of the superior maxillary‍—‌the did little injury ..." refers to the first point at which the tamping iron contacted bone; elsewhere he describes the initial penetration (i.e. of the tissue of the face) as "immediately anterior and external to the angle of the inferior maxillary bone", consistent with the analyses of Macmillan; Ratiu et al.; and Van Horn et al.​
18. In addition to the "attested statements" mentioned by Harlow (which Harlow had gathered at Bigelow's request) and his own examination of Gage, Bigelow pointed out that the accident had occurred "in open day" with many witnesses, and that "in a thickly populated country neighbourhood, to which all the facts were matter of daily discussion at the time of their occurrence, there is no difference of belief, nor has there been at any time doubt that the iron was actually driven through the brain. A considerable number of medical gentlemen also visited the case at various times to satisfy their incredulity." ​
19. Immediately after Harlow's presentation unveiling Gage's skull and iron, Bigelow ("in one of those coups dramatiques which were now and then incidents of his surgical communications without giving notice that he intended to do so") actually produced this patient, Joel Lenn, together with "the gas pipe which had pierced his head from the right forehead to left occiput, and the hat he had been wearing (with entrance and exit holes) ... This coup de théâtre must have been a painful coda for Harlow, eclipsing the pinnacle of his medical career."  Months after Lenn's accident his surgeon reported, "He seems to be perfectly rational, and will reply correctly in monosyllables to questions, but is entirely unable to connect words. He succeeds best, when excited, in swearing in French." 
20. However, this is somewhat contradicted by Harlow's statement that Gage paid "with his habitual accuracy" during the store visit.​

References

For general readers

K.	Kean, Sam (May 6, 2014). "Phineas Gage, Neuroscience's Most Famous Patient". Slate. Reprinted in Skloot, Rebecca, ed. (2015). The Best American Science and Nature Writing 2015. Houghton Mifflin Harcourt. pp. 143–48.

M.	Macmillan, Malcolm B. (2000). An Odd Kind of Fame: Stories of Phineas Gage. MIT Press. ISBN 978-0-262-13363-0. (hbk, 2000) (pbk, 2002).  • See also "An Odd Kind of Fame § Corrections".

M1.	—— (September 2008). "Phineas Gage – Unravelling the myth". The Psychologist. 21 (9): 828–31.

M2.

—— (2012). "The Phineas Gage Information Page". The University of Akron. Retrieved 2016-05-16. Includes: A. "Phineas Gage Sites in Cavendish". B. "Phineas Gage: Unanswered questions". C. "Phineas Gage's Story". D. "An Odd Kind of Fame". E. "Phineas Gage: Psychosocial Adaptation". F. "Phineas Gage and Frontal Lobotomies". G. "Reviews".

M3.	Macmillan, Malcolm; Van Horn, Jack; Ropper, Allan (May 21, 2017). "Why Brain Scientists are Still Obsessed with the Curious Case of Phineas Gage" (mp3). Health Shots (Interview). Interviewed by Jon Hamilton. National Public Radio.

M4.	——; Aggleton, John (March 6, 2011). "Phineas Gage: The man with a hole in his head". Health Check (Audio interview). Interviewed by Claudia Hammond; Dave Lee. BBC World Service. Originally broadcast December 7, 2008.

T.	Twomey, S. (January 2010). "Finding Phineas". Smithsonian. 40 (10): 8–10. Archived from the original on 2010-02-09. Retrieved 2009-12-24.

For younger readers

F.	Fleischman, J. (2002). Phineas Gage: A Gruesome but True Story About Brain Science. Houghton Mifflin Harcourt. ISBN 978-0-618-05252-3.

For researchers and specialists

B.	Barker, F. G. II (1995). "Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization" (PDF). Journal of Neurosurgery. 82 (4): 672–82. doi:10.3171/jns.1995.82.4.0672. PMID 7897537. Archived from the original (PDF) on 2014-10-06.

B1.	Bigelow, Henry Jacob (July 1850). "Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head". American Journal of the Medical Sciences. New series. 20 (39): 13–22.

B2.	—— (May 12, 1868). "Your favor of April 29th is before me" (manuscript). Letter to M. Jewett. Records of the Warren Anatomical Museum, 1828–1892 (inclusive) (AA 192.5), Harvard Medical Library in the Francis A. Countway Library of Medicine.

D.	Draaisma, Douwe (2009). "Phineas Gage's posthumous stroll: the Gage matrix". Disturbances of the Mind. Cambridge University Press. ISBN 978-1-139-93611-8.

F1.	Fuster, Joaquin M. (2008). The prefrontal cortex. Elsevier/Academic Press. p. 172. ISBN 978-0-12-373644-4.

G.	Grafman, J. (2002). "The Structured Event Complex and the Human Prefrontal Cortex". In Stuss, D. T.; Knight, R. T. (eds.). Principles of Frontal Lobe Function. Oxford University Press. pp. 292–310. doi:10.1093/acprof:oso/9780195134971.003.0019. ISBN 978-0-19-513497-1.

G1.	Gage, P. P. (1854). "Please deliver my iron bar to the bearer" (Note to unknown recipient). Records of the Warren Anatomical Museum, 1828–1892 (inclusive) (AA 192.5), Box 1, Harvard Medical Library in the Francis A. Countway Library of Medicine.

H.	Harlow, John Martyn (1868). "Recovery from the Passage of an Iron Bar through the Head". Publications of the Massachusetts Medical Society. 2 (3): 327–47. Reprinted: David Clapp & Son (1869) [scan]

H1.	Harlow, John Martyn (December 13, 1848). "Passage of an Iron Rod Through the Head". Boston Medical and Surgical Journal. 39 (20): 389–93. doi:10.1056/nejm184812130392001. (Transcription)

H2.	—— (January 17, 1849). "Medical Miscellany (letter dated January 3)". Boston Medical and Surgical Journal. 39 (25): 506–7.

K1.	Kihlstrom, J. F. (2010). "Social neuroscience: The footprints of Phineas Gage". Social Cognition. 28 (6): 757–82. doi:10.1521/soco.2010.28.6.757. Archived from the original on 2014-10-06.

L.	"Letters: Readers Respond to the January Issue. Picturing Phineas Gage (Editor's note)". Smithsonian. March 2010. p. 4. Lena, M. L.; Macmillan, Malcolm B. (March 2010). "Letters: Readers Respond to the January Issue. Picturing Phineas Gage (Invited comment)". Smithsonian. p. 4.

L1.	Lena, M. L. (Spring 2018). "The Navvy and the Navigator: Connecting Phineas Gage and Mark Twain's 'Mean Men'". Mark Twain Journal. 56 (1): 166–200.

L2.

Luria, A. R. (1963). Restoration of function after brain injury. Translated by O. L. Zangwill. New York: Pergamon Press, Macmillan. —— (1973). The working brain: an introduction to neuropsychology. Translated by Haigh Basil. New York: Basic Books. —— (1979). Michael Cole; Sheila Cole (eds.). The making of mind: a personal account of Soviet psychology. Harvard University Press. ISBN 978-0-674-54326-3. —— (1980). Higher cortical functions in man. Translated by Haigh Basil (2nd ed.). New York: Basic Books. —— (1972). The man with a shattered world: the history of a brain wound. Translated by Lynn Solotaroff. Harvard University Press.

K2.	Kotowicz, Z. (2007). "The strange case of Phineas Gage". History of the Human Sciences. 20 (1): 115–31. doi:10.1177/0952695106075178. S2CID 145698840.

M5.	Macmillan, Malcolm B. (1996). Code, C.; Wallesch, C. W.; Lecours, A. R.; Joanette, U. (eds.). "Phineas Gage: A Case for All Reasons". Classic Cases in Neuropsychology. London: Erlbaum. pp. 243–62.

M6.	—— (2000). "Restoring Phineas Gage: A 150th Retrospective". Journal of the History of the Neurosciences. 9 (1): 46–66. doi:10.1076/0964-704X(200004)9:1;1-2;FT046. PMID 11232349. S2CID 2250377.

M7.	—— (2001). "John Martyn Harlow: Obscure Country Physician?". Journal of the History of the Neurosciences. 10 (2): 149–62. doi:10.1076/jhin.10.2.149.7254. PMID 11512426. S2CID 341061.

M8.	—— (2004). "Inhibition and Phineas Gage: Repression and Sigmund Freud". Neuropsychoanalysis. 6 (2): 181–92. doi:10.1080/15294145.2004.10773459. S2CID 145175407.

M9.	—— (July 2009). "More About Phineas Gage, Especially After the Accident". www.brightbytes.com. Retrieved 2016-05-16.

M10.	——; Lena, M. L. (2010). "Rehabilitating Phineas Gage". Neuropsychological Rehabilitation. 20 (5): 641–58. doi:10.1080/09602011003760527. PMID 20480430. S2CID 205655881.

R.	Ratiu, P.; Talos, I. F.; Haker, S.; Lieberman, D.; Everett, P. (2004). "The Tale of Phineas Gage, Digitally Remastered". Journal of Neurotrauma. 21 (5): 637–43. doi:10.1089/089771504774129964. PMID 15165371.

R1.	——; Talos, I. F. (2004). "The Tale of Phineas Gage, Digitally Remastered". New England Journal of Medicine. 351 (23): e21. doi:10.1056/NEJMicm031024. PMID 15575047.

T1.

Thiebaut de Schotten, M.; Dell'Acqua, F.; Ratiu, P.; Leslie, A.; Howells, H.; Cabanis, E.; Iba-Zizen, M. T.; Plaisant, O.; Simmons, A.; Dronkers, N. F.; Corkin, S.; Catani, M. (2015). "From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting Disconnection Syndromes". Cerebral Cortex. 25 (12): 1–16. doi:10.1093/cercor/bhv173. PMC 4635921. PMID 26271113.

T2.	Tyler, K. L.; Tyler, H. R. (1982). "A 'Yankee Invention': the celebrated American crowbar case". Neurology. 32: A191. Images reproduced in Macmillan (2000), App. E.

V.	Van Horn, J. D.; Irimia, A.; Torgerson, C. M.; Chambers, M. C.; Kikinis, R.; Toga, A. W. (2012). "Mapping Connectivity Damage in the Case of Phineas Gage". PLOS ONE. 7 (5): e37454. Bibcode:2012PLoSO...737454V. doi:10.1371/journal.pone.0037454. PMC 3353935. PMID 22616011.

W.	Wilgus, J; Wilgus, B (2009). "Face to Face with Phineas Gage". Journal of the History of the Neurosciences. 18 (3): 340–45. doi:10.1080/09647040903018402. PMID 20183215. S2CID 19347145.

W1.	——; —— (July–September 2009). "Phineas Gage – Hiding in Plain Sight". The Daguerreian Society Newsletter. 21 (3): 6–9.

W2.	——; —— (2009). "Meet Phineas Gage". www.brightbytes.com. Retrieved 2016-05-16.

W3.	——; —— (2010). "A New Image of Phineas Gage". www.brightbytes.com. Retrieved 2016-05-16.

Other sources cited

1. ^ "Alive from the Dead, Almost". North Star. Danville, Vermont. November 6, 1848. p. 1, col. 2. Transcribed in Macmillan (2000), pp. 39–40
2. Campbell, H. F. (1851). "Injuries of the Cranium – Trepanning". Ohio Medical & Surgical Journal. 4 (1): 20–24. (crediting the Southern Medical & Surgical Journal, unknown date).
3. Larner, Andrew; Leach, John Paul (July–August 2002). "Phineas Gage and the beginnings of neuropsychology" (PDF). Advances in Clinical Neuroscience and Rehabilitation. 2 (3): 26. Archived from the original (PDF) on 2016-04-09. Retrieved 2014-12-13.
4. Macmillan (2000), ch. 13; Macmillan (2008), p. 830.
5. Mazzoni, Giuliana; Nelson, Thomas O. (2014). Metacognition and Cognitive Neuropsychology: Monitoring and Control Processes. Psychology Press. pp. 57–58. ISBN 978-1-317-77843-1.
6. Gage, Clyde Van Tassel (1964). John Gage of Ipswich, Mass. and his descendants: an historical, genealogical and biographical record, as developed from sources explained herein. Worcester, New York: C.V. Gage.
7. ^ "Incredible, But True Every Word". National Eagle. Claremont, New Hampshire. March 29, 1849. p. 2, col. 2. Reprinted: True Democrat and Granite State Whig (Lebanon, New Hampshire), April 6, 1849, p. 1, col. 7. Transcribed in Macmillan (2000), pp. 40–1.
8. ^ Harlow (1848), p. 389; Bigelow (1850), p. 13; Harlow (1868), p. 4.
9. Macmillan (2000), p. 490; Macmillan (2008), p. 839 (fig.).
10. "An iron bar that had been driven through a man's head." Catalog of the Museum, Index, undated. Series XXXIX. Miscellaneous specimens (page 179). Warren Anatomical Museum records, RG M-CL02.01, Box: 10, Folders: 6, 7. Center for the History of Medicine (Francis A. Countway Library of Medicine).
11. B. S. Swetland; Doug Sweetland, eds. (March 2003). A partial genealogy of the Swetland/Sweetland/Sweatland Family in America, 1560–2003. pp. xxxiii, 15.
12. Cooter, Roger (1984). The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-century Britain. Cambridge University Press. p. 20. ISBN 978-0-521-22743-8.
13. Fowler, O. S. (1838). Synopsis of phrenology: and the phrenological developments: together with the character and talents of ________ as given by ________: with references to those pages of "Phrenology proved, illustrated and applied," in which will be found a full and correct delineation of the intellectual and moral character and manifestations of the above-named individual. New York: Fowler & Wells. p. 6.
14. Rutland Railroad Company (1897). "The Summit. (Letter of Edward H. Williams)". Heart of the Green mountains. Souvenir edition. Season of 1897. Boston: Rockwell and Churchill Press. pp. 41–42.
15. ^ Ratiu et al., p. 639–40; Van Horn et al., pp. 4–5, 17
16. Barnes, E. J.; Lee, L. B. (2016). "Bring Me the Head of Phineas Gage". Boundless: A Science Comics Anthology. Vol. 1. ISBN 978-0-9903433-5-6.
17. ^ "Wonderful Accident". Vermont Mercury. Woodstock, Vermont. September 22, 1848. p. 2 col. 3. Transcribed in Macmillan (2000), pp. 36–7.
18. ^ Smith, William T. (1886). "Lesions of the Cerebral Hemispheres". Transactions of the Vermont Medical Society for the Year 1885. pp. 46–58.
19. ^ Excerpted from Williams's and Harlow's statements in: Harlow (1848), pp. 390–93; Bigelow (1850), p. 16; Harlow (1868), pp. 7–10.
20. Macmillan, Malcolm. "Phineas Gage: The claim of Williams' priority". Butler Family.
21. "Horrible Accident". Boston Post. September 21, 1848 (crediting Ludlow (Vermont) Free Soil Union, unknown date).
22. Harlow (1848), p. 389; Bigelow (1850), p. 21; Harlow (1868), p. 16; Macmillan (2000), pp. 36–37.
23. ^ Jackson, J.B.S. (1849). Medical Cases 4. Case 1777. H MS b72.4 (v. 11), Harvard Medical Library in the Francis A. Countway Library of Medicine, pp. 712 (cont'd 680).
24. American Medical Association (1850). "Report of the Standing Committee on Surgery". The Transactions of the American Medical Association. 3. Philadelphia: T.K. and P.G. Collins: 345.
25. 1634–1699: McCusker, J. J. (1997). How Much Is That in Real Money? A Historical Price Index for Use as a Deflator of Money Values in the Economy of the United States: Addenda et Corrigenda (PDF). American Antiquarian Society. 1700–1799: McCusker, J. J. (1992). How Much Is That in Real Money? A Historical Price Index for Use as a Deflator of Money Values in the Economy of the United States (PDF). American Antiquarian Society. 1800–present: Federal Reserve Bank of Minneapolis. "Consumer Price Index (estimate) 1800–". Retrieved 2024-02-29.
26. Boston Society for Medical Improvement (1849). Records 6. November 10. pp. 103–4.
27. ^ Yakovlev, Paul I. (October 1958). "The 'Crowbar Skull' and Mementoes of 'Phrenological Hours'". Harvard Medical Alumni Bulletin. 33 (1): 19–24.
28. Hansen, Bert (April 1998). "America's first medical breakthrough: How popular excitement about a French rabies cure in 1885 raised new expectations for medical progress". American Historical Review. 103 (2): 373–418. doi:10.2307/2649773. JSTOR 2649773. PMID 11620083.
29. Raeburn, Toby; Jackson, Debra; Walter, Garry; Escott, Phil; Cleary, Michelle (December 2014). "Clinical Case Reports in mental health: the need for nuance and context". Clinical Case Reports. 2 (6): 241–42. doi:10.1002/ccr3.193. PMC 4270701. PMID 25548621.
30. Bigelow (1868); Harlow (1868), p. 14; Macmillan (2000), pp. 14,98–99; Macmillan & Lena, pp. 643–44.
31. Bennett, W. (July–August 1987). "Dr. Warren's Possessions". Harvard Magazine. 89 (6): 24–31. PMID 11617033.
32. Volume 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.
33. ^ "Deaths". New Hampshire Statesman. No. 2042. Concord, New Hampshire. July 21, 1860. col. D.
34. Harlow (1868), p. 21; Macmillan (2000), pp. 26,115,479–80
35. "A Departing Supervisor". Daily Alta California. December 25, 1867. p. 2 col. 4.
36. ^ "Bibliographical Notices". Boston Medical and Surgical Journal. New series. 3 (7): 116–17. March 18, 1869.
37. "The Phineas Gage Case". Francis A. Countway Library (Harvard Medical School). Center for the History of Medicine. Warren Anatomical Museum. Archived from the original on August 14, 2014. Retrieved May 16, 2016.
38. An iron bar, that was driven through a man's head (Tamping iron of Phineas Gage). Warren Anatomical Museum (WAM 03106), Harvard Medical Library in the Francis A. Countway Library of Medicine.
39. Proctor, William A. (1950). "Location, regulation, and removal of cemeteries in the City and County of San Francisco". Department of City Planning, City and County of San Francisco. Archived from the original on 2012-07-02.
40. Eliot, Samuel Atkins, ed. (1911). "John M. Harlow". Biographical History of Massachusetts: Biographies and Autobiographies of the Leading Men in the State. Vol. 1. Massachusetts Biographical Society.
41. Harlow (1868), p. 20; Barker, p. 672
42. ^ Cobb, Stanley (1940). "Review of neuropsychiatry for 1940". Archives of Internal Medicine. 66 (6): 1341–54. doi:10.1001/archinte.1940.00190180153011.
43. ^ Cobb, Stanley (1943). Borderlands of psychiatry. Harvard Univ. Press.
45. ^ "A most remarkable case". American Phrenological Journal and Repository of Science, Literature, and General Intelligence. 13 (4). p. 89, col. 3. April 1851.
46. Hamilton, J. W. (1860). "Editorial and Miscellaneous. The Man Through Whose Head an Iron Rod Passed Is Still Living". Ohio Medical and Surgical Journal. 13: 174. Reprinted: Samuel Worcester Butler; D G. Brinton, eds. (November 17, 1860). Medical and Surgical Reporter. Vol. 5. Philadelphia: Crissly & Markley. p. 183.
47. Austin, K. A. (1977). A Pictorial History of Cobb and Co.: The Coaching Age in Australia, 1854–1924. Sydney: Rigby. ISBN 978-0-7270-0316-4.
48. ^ "Additional from Chile". The New York Times. March 1, 1860. p. 11.
49. ^ Merwin, Loretta L. Wood (Mrs. George B. Merwin) (1861). Three Years in Chili. By a Lady of Ohio. New York: Follett, Foster and Company. pp. 73–78.
50. Macmillan (2000), pp. 104, 121n13; Macmillan & Lena, p. 645
51. ^ Jarrett, Christian (May 2012). "Neuroscience still haunted by Phineas Gage". PLOS ONE. 7 (5): e37454. Bibcode:2012PLoSO...737454V. doi:10.1371/journal.pone.0037454. PMC 3353935. PMID 22616011.
52. Macmillan, Malcolm B. (2014). "Phineas Gage". Encyclopedia of the Neurological Sciences. Academic Press. p. 383. ISBN 978-0-12-385158-1.
53. Goldenberg, Georg (December 2004). "The life of Phineas Gage – Stories and Reality". Cortex. 40 (3): 552–55. doi:10.1016/S0010-9452(08)70147-3. S2CID 53168488.
54. Macmillan (2000), pp. 119, 316, 323; Macmillan (2008), p. 830; Kotowicz, p. 130n6; Draaisma, p. 77.
55. ^ Hockenbury, Don H.; Hockenbury, Sandra E. (2008). Psychology. Macmillan. p. 74. ISBN 978-1-4292-0143-8.
56. Altrocchi, John (1980). Abnormal Behavior. Harcourt, Brace, Jovanovich. ISBN 978-0-15-500370-5.
    • Groves, Philip M.; Schlesinger, K. (1982). Introduction to Biological Psychology (2nd ed.). Dubuque, Iowa: Brown.
    • Kalat, James W. (1981). Biological Psychology. Belmont, California: Wadsworth.
    • Lahey, B. B. (1992). Psychology: An Introduction (4th ed.). Dubuque, Iowa: Brown. p. 63.
    • Morris, C. G. (1996). Psychology: An Introduction (9th ed.). Prentice-Hall. ISBN 978-0-13-432972-7.
    • Smith, A. (1985). The Body. Harmondsworth, England: Penguin.
    • Macmillan (2000), pp. 107, 323.
57. ^ Mann, Mark H. (2006). Perfecting Grace: Holiness, Human Being, and the Sciences. A&C Black. p. 53. ISBN 978-0-567-02553-1.
58. ^ Damasio, Antonio R. (1994). Descartes' error: emotion, reason, and the human brain. Quill. ISBN 978-0-380-72647-9.
59. ^ Damasio, H.; Grabowski, T.; Frank, R.; Galaburda, A. M.; Damasio, A. R. (1994). "The return of Phineas Gage: Clues about the brain from the skull of a famous patient". Science. 264 (5162): 1102–5. Bibcode:1994Sci...264.1102D. doi:10.1126/science.8178168. PMID 8178168. S2CID 206630865.
60. Ebenezer, Ivor (2015). Neuropsychopharmacology and Therapeutics. John Wiley & Sons. p. 123. ISBN 978-1-118-38565-4.
61. Bower, B. (May 21, 1994). "The Social Brain: New Clues from Old Skull". Science News. 145 (21): 326–27. doi:10.2307/3978044. JSTOR 3978044.
62. Damasio, A. R.; Van Hoesen, G. W. (1983). "Emotional disturbances associated with focal lesions of the limbic frontal lobe". In Paul Satz; Kenneth M. Heilman (eds.). Neuropsychology of Human Emotion. New York: Guilford Press. pp. 85–110. ISBN 978-0-89862-200-3.
63. Moffatt, Gregory K. (2002). A Violent Heart: Understanding Aggressive Individuals. Greenwood Publishing Group. p. 6. ISBN 978-0-275-97336-0.
    • Anonymous (1848); Macmillan (2000), pp. 39, 319, 327.
64. Beaumont, Graham; Kenealy, Pamela; Rogers, Marcus (1991). The Blackwell Dictionary of Neuropsychology. Wiley. ISBN 978-0-631-17896-5.
    • Crider, A. B.; Goethals, G. R.; Kavanagh, R. D.; Solomon, P. R. (1983). Psychology. Scott, Foresman.
    • Myers, David G. (1995). Psychology. Worth Publishers. ISBN 978-0-87901-644-9.
    • Macmillan (2000), pp. 319, 327–28
65. ^ Damasio (1994), pp. 11, 51; Macmillan (2000), pp. 119, 331.
66. ^ Plante, Thomas (2015). The Psychology of Compassion and Cruelty: Understanding the Emotional, Spiritual, and Religious Influences. ABC-CLIO. p. 18. ISBN 978-1-4408-3270-3.
67. Blakeslee, Sandra (May 24, 1994). "Old Accident Points to Brain's Moral Center". The New York Times. p. C1.
    • Damasio et al. (1994), p. 1102; Macmillan (2000), p. 116.
68. Dimond, Stuart J. (1980). Neuropsychology: A Textbook of Systems and Psychological Functions of the Human Brain. London: Butterworths.
    • Macmillan (2000), pp. 321, 331.
69. Restak, Richard M. (1984). The Brain. Bantam Books. ISBN 978-0-553-05047-9.
    • Tow, Peter Macdonald (1955). Personality changes following frontal leucotomy: a clinical and experimental study of the functions of the frontal lobes in man. With a foreword by Sir Russell Brain. London & New York: Oxford University Press.
    • Macmillan (2000), p. 323.
70. Blakemore, Colin (1977). Mechanics of the mind. Cambridge University Press.
    • Brown, H. (1976). Brain and Behavior: A Textbook of Physiological Psychology. New York: Oxford University Press.
    • Hart, Leslie A. (1975). How the Brain Works: A New Understanding of Human Learning, Emotion, and Thinking. Basic Books. ISBN 978-0-465-03102-3.
    • Macmillan (2000), pp. 316, 323.
71. Hughes, C. D. (1897). "Neurological progress in America". Journal of the American Medical Association. 29 (7): 315–23. doi:10.1001/jama.1897.02440330015001e.
    • Smith, A. (1984). The Mind. London: Hodder and Stoughton.
    • Wilson, Andrew (January 1879). "The old phrenology and the new". Gentleman's Magazine. Vol. CCXLIV. pp. 68–85.
    • Macmillan (2000), pp. 118, 316, 321.
72. Blakeslee (1994); Macmillan (2000), pp. 119, 321.
73. Damasio (1994), p. 9; Macmillan (2000), p. 119.
74. Sdorow, Lester (1990). Psychology. Dubuque, Iowa: Brown. ISBN 978-0-697-07649-6.
    • Macmillan (2008), p. 830; Macmillan (2000), p. 321.
75. Changeux, Jean-Pierre (1985). Neuronal Man: The Biology of the Mind. Tr. by Laurence Garey (1st American ed.). Pantheon Books. pp. 158–59.
    • Macmillan (2000), p. 321.
76. ^ Blakeslee (1994); Macmillan (2000), p. 39.
77. Ahlstrom, Dick (October 19, 1999). "Study finds blow to head may cause psychopathic behaviour". The Irish Times. p. 2.
78. Dobbs, Bon (2015). When Hope is Not Enough (2nd ed.). Lulu.com. p. 101. ISBN 978-1-329-44409-6.
79. Pelham, Brett W.; Blanton, Hart (2012). Conducting Research in Psychology: Measuring the Weight of Smoke. Cengage Learning. p. 184. ISBN 978-1-133-71038-7.
80. Wood, Thomas F., ed. (July 1882). "Notes. Lodgement of Foreign Bodies in the Brain". North Carolina Medical Journal. 1 (1): 60–62.
81. ^ Griggs, Richard A. (2015). "Coverage of the Phineas Gage Story in Introductory Psychology Textbooks: Was Gage No Longer Gage?". Teaching of Psychology. 42 (3): 195–202. doi:10.1177/0098628315587614. S2CID 145438545.
82. ^ Jackson, J. B. S. (1870). A Descriptive Catalog of the Warren Anatomical Museum. Boston: A. Williams & Co. Frontis. and Nos. 949–51, 3106.
83. ^ Benderly, Beryl Lieff (September 2012). "Psychology's tall tales". GradPSYCH: 20.
84. Daffner, Kirk R.; Searl, Meghan M. (2008). "The dysexecutive syndromes". In Goldenberg, G.; Miller, B. L. (eds.). Neuropsychology and behavioral neurology. Handbook of Clinical Neurology, 3rd series. Vol. 88. Elsevier B.V.
85. Hammond, W. A. (1871). A Treatise on the Diseases of the Nervous System. New York: Appleton.
86. Dupuy, Eugene (1873). Examen de quelques points de la physiologie du cerveau (in French). Paris: Delahaye.
87. ^ Dupuy, Eugene (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". Medical Times & Gazette. II: 356–58.
88. ^ Ferrier, David (1877–79). Correspondence with Henry Pickering Bowditch. H MS c5.2, Harvard Medical Library in the Francis A. Countway Library of Medicine. Transcribed in Macmillan (2000), pp. 464–65.
89. ^ Ferrier, David (1878). "The Goulstonian lectures on the Localisation of Cerebral Disease. Lecture I (concluded)". British Medical Journal. 1 (900): 443–47. doi:10.1136/bmj.1.900.443. PMC 2220379. PMID 20748815.
90. Bramwell, B. (1888). "The Process of Compensation and some of its Bearings on Prognosis and Treatment". BMJ. 1 (1425): 835–40. doi:10.1136/bmj.1.1425.835. PMC 2197878. PMID 20752265.
91. ^ Hayward, Rhodri (December 2002). "An Odd Kind of Fame: Stories of Phineas Gage by Malcolm Macmillan". British Journal for the History of Science. 35 (4): 479–81. JSTOR 4028281.
92. Lena & Macmillan, p. 9; Harlow (1868), pp. 6, 19; Bigelow (1850), pp. 16–17; Harlow (1848), p. 390; Macmillan (2000), p. 86.
93. Ordia, J. I. (1989). "Neurologic function seven years after crowbar impalement of the brain". Surgical Neurology. 32 (2): 152–55. doi:10.1016/0090-3019(89)90204-8. PMID 2665157.
94. Mitchell, B. D.; Fox, B. D.; Humphries, W. E.; Jalali, A.; Gopinath, S. (2012). "Phineas Gage revisited: Modern management of large-calibre penetrating brain injury". Trauma. 14 (3): 263–69. doi:10.1177/1460408612442462. S2CID 73103388.
95. Pancoast, Joseph (1852). A Treatise on Operative Surgery: Comprising a Description of the Various Processes of the Art, Including All the New Operations; Exhibiting the State of Surgical Science in Its Present Advanced Condition (3rd ed.). Philadelphia: A. Hart. p. 106.
96. Pott, Percivall (1790). James Earle (ed.). The chirurgical works of Percivall Pott, F.R.S. Surgeon to St. Bartholomew's Hospital. A new edition, with his last corrections. To which are added a short account of the life of the author ... London: printed for J. Johnson, G.G.J. and J. Robinson, T. Cadell, J. Murray, W. Fox, J. Bew, S. Hayes, and W. Lowndes. p. 184.
97. Steegmann, A. Theodore (December 1962). "Dr. Harlow's famous case: the "impossible" accident of Phineas P. Gage". Surgery. 52 (6): 952–58. PMID 13983566.
98. Macmillan (2000), p. 12, ch. 4, pp. 355–59; Macmillan (2008), pp. 28–29; Macmillan (2001), pp. 151–53.
99. "Reports of medical societies. Annual meeting of the Massachusetts Med. Society – Second day". Boston Medical and Surgical Journal. New series. 1 (19): 301–6. June 11, 1868. doi:10.1056/NEJM186806110781906. S2CID 4747463.
100. A Memoir of Henry Jacob Bigelow. Boston: Little, Brown. 1894. p. 119.
101. Jewett, M. (1868). "Extraordinary Case of Recovery after Severe Injury to the Head". Western Journal of Medicine. 3: 151–2. Reprinted: "Extraordinary Case of Recovery after Severe Injury to the Head". Boston Medical and Surgical Journal. New series. 1 (12). Boston: 188–89. April 23, 1868.
102. Sutton, W. L. (October 23, 1850). "A Centre Shot". Boston Medical and Surgical Journal. 43 (12): 241.
103. Folsom, A. C. (May 1869). "Extraordinary Recovery from Extensive Saw-Wound of the Skull". Pacific Medical and Surgical Journal. Vol. 2. pp. 550–55.
104. "Medical Intelligence. Extraordinary Recovery". Boston Medical and Surgical Journal. New series. 3 (13): 230–31. April 29, 1869.
105. Stuss, D. T.; Gow, C. A.; Hetherington, C. R. (1992). "'No longer Gage': Frontal lobe dysfunction and emotional changes". Journal of Consulting and Clinical Psychology. 60 (3): 349–59. doi:10.1037/0022-006X.60.3.349. PMID 1619089.
106. Macmillan (2008), p. 831; Macmillan (2000), chs. 5–6,9–14; Macmillan (1996), pp. 251–59.
107. Sacks, Oliver (1995). An Anthropologist on Mars. Knopf Doubleday Publishing. pp. 59–61. ISBN 978-0-679-43785-7. OCLC 30810706.
108. Jarrett, Christian (2014). Great Myths of the Brain. John Wiley & Sons. pp. 38–39. ISBN 978-1-118-31271-1.
109. Gall, Franz Joseph (1835). Capen, Nahum (ed.). On the functions of the brain and of each of its parts: with observations on the possibility of determining the instincts, propensities, and talents, or the moral and intellectual dispositions of men and animals, by the configuration of the brain and head. The phrenological library. Translated from the French by Winslow Lewis Jr. Boston: Marsh, Capen & Lyon.
     • Sizer, Nelson (1888). Forty years in phrenology; embracing recollections of history, anecdote, and experience. New York: Fowler & Wells. p. 194.
110. Burton, Warren (1842). Uncle Sam's recommendation of phrenology to his millions of friends in the United States: In a series of not very dull letters. New York: Harper and Brothers. p. 217.
     • Davidson, James Wood (July 1866). "How We Read Each Other. Phrenology". Scott's Monthly Magazine. Vol. 2, no. 2. Atlanta: J.J. Toon. pp. 557–62 at 559.
     • "Phrenology for "Tim Bobbin"". Fibre & Fabric: A Record of American Textile Industries in the Cotton and Woolen Trade. Vol. XXIV, no. 624. February 13, 1897. p. 302.
111. Carlson, N. R. (1994). Physiology of Behavior. Allyn and Bacon. p. 341. ISBN 978-0-205-07264-4.
     • Arts, Matheus; Michielsen, Philip (2012). Cutting the mind: origins of psychosurgery. Leuven: Acco. p. 40. ISBN 978-9033486388.
     • Macmillan (2000), pp. 246, 252–53nn9,10.
112. Van der Kloot, William G. (1974). Readings in Behavior. Ardent Media. p. 289. ISBN 978-0-03-084077-7.
113. Sarbach, Louis N. (March 1952). "New Light on the Brain's Dark Mystery". The Rotarian. Rotary International. p. 25.
114. Turner, Eric Anderson (1982). Surgery of the mind. Birmingham: Carmen Press. p. 13. ISBN 978-0-946179-00-8.
115. Damasio, Antonio R.; Everitt, B. J.; Bishop, D. (October 29, 1996). "The Somatic Marker Hypothesis and the Possible Functions of the Prefrontal Cortex ". Philosophical Transactions: Biological Sciences. Executive and Cognitive Functions of the Prefrontal Cortex. 351 (1346): 1413–20. doi:10.1098/rstb.1996.0125. JSTOR 3069187. PMID 8941953. S2CID 1841280.
116. Silvestro, Sara (June 24, 2016). "A New View of Phineas Gage". Harvard Medical School News.
117. Smith, Stephen (July 22, 2009). "Icon, revealed: Newly discovered image offers fresh insights about medical miracle". Boston Globe.
     • Carey, Benedict (July 22, 2009). "The Curious Case of Phineas Gage, Refocused". The New York Times.

External links

• Phineas Gage information page by the Center for the History of Psychology at the University of Akron
• Case of Phineas Gage at the Center for the History of Medicine
• Skull, life cast, and tamping iron of Phineas Gage Archived 2021-12-05 at the Wayback Machine at the Warren Anatomical Museum of the Harvard Medical School
• Skull of Phineas Gage at the National Institutes of Health 3D print exchange

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