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			{{Short description|American brain injury survivor (1823–1860)}}
			{{About|the survivor of an iron bar through the head|the UK musical band|Phinius Gage}}
			{{Use American English|date=August 2020}}
			{{Use mdy dates|cs1-dates=ly|date=December 2016}}
	{{Infobox person		{{Infobox person
	<!--CERTAIN FORMATTING ELEMENTS IN THIS INFOBOX (e.g. nbsp, box_width) CONTROL LINEBREAKS FOR ATTRACTIVE APPEARANCE. PLEASE TAKE CARE WHEN MODIFYING-->
	|name = Phineas P. Gage		|name = Phineas P. Gage
	|image = ]		|image = Phineas Gage Cased Daguerreotype WilgusPhoto2008-12-19 EnhancedRetouched Color.jpg
			|image_upright= 1.35
	|caption = The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"{{mdashb}}his inscribed tamping{{nbsp}}iron.{{efn-ua|name=dags}}
			|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}} }}
	|birth_date = July 9, 1823 (date uncertain)<!--<<see hidden note at beginning of lead re uncertain birthdate-->
			|birth_date = July 9, 1823 (date uncertain)<!--uncertain instead of circa because we have no confirmation this is even approximately the right date-->
	|birth_place = ]{{efn-ua|name="birth_name"}}<!--<<cite covers birth date and place, and discusses uncertainty of birthdate-->
			|birth_place = ],{{NoteTag|name=birth_name}}<!--<<cite covers birth date and place, and discusses uncertainty of birthdate--> U.S.
	|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_date = {{death date and age|1860|05|21|1823|07|09}}<!--1860 is correct despite Harlow reporting 1861; see Macmillan (2000) p. 108 -->
	|death_place = In or near ]
			|death_place = ], California, U.S.
	|death_cause = '']''
			|death_cause = ]
	|occupation = {{hlist | Railroad construction foreman | ] | ]{{nbsp}}driver}}
			|occupation = {{hlist | Railroad construction foreman | ] | ]&nbsp;driver}}
	|spouse=None |children=None{{r|okf}}{{rp|319,327}}<!--Please don't remove spouse, children even though values are None-->
			|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-->
	|residence = {{hlist|] | ] | ] }}
			|burial_place = ], California (skull in ], Boston)
	|home_town = ]{{efn-ua|name="birth_name"}}<!--cite covers home_town only-->
			|known_for = Personality change after brain&nbsp;injury
	|resting_place = {{plainlist|
			}}
	*{{hanging indent|text=], Boston<small>{{nbsp}}''(skull)''</small>}}
	*{{hanging indent|text=], California<small> ''(other{{nbsp}}remains)''</small>}}
	}}<!--end resting_place plainlist-->
	|known_for = Personality change after ]
	|box_width = 22em
	<!--CERTAIN FORMATTING ELEMENTS IN THIS INFOBOX (e.g. nbsp, box_width) CONTROL LINEBREAKS FOR ATTRACTIVE APPEARANCE. PLEASE TAKE CARE WHEN MODIFYING-->
	}}<!--<<END INFOBOX-->
			'''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".
	'''Phineas P. Gage''' (1823{{snd}}May{{nbsp}}21, 1860)<!--<<as allowed by MOS, giving only year for birth 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 construction foreman remembered for his improbable{{efn-ua|name="amused"}}
	survival of a ] accident in which a large iron rod was driven completely through his head, destroying much of his brain's left ], and for that injury's reported effects on his personality and behavior over the remaining twelve years of his life{{mdashb}}effects so profound that (for a time at least) friends saw him as "no longer Gage."
			{{stack|float=right|]}}
	Long known as "the American Crowbar Case"{{mdashb}}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"{{nowrap|{{r|campbell}}{{mdashb}}}}Phineas Gage influenced nineteenth{{hyp}}century discussion about the mind and brain, particularly debate on ],{{r|okf|page1=ch7{{hyp}}9|barker}}
	and was perhaps the first case to suggest that damage to specific parts of the brain might induce specific personality changes.{{r|okf|page1=1|pgip|page2=C}}
			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 related disciplines (see ]), and is frequently mentioned in books and academic papers; he even has a minor place in popular culture.{{efn-ua
	|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."{{px1}}{{r|vanderstoep|page=89}}
	<p>
	For popular culture, see Macmillan;{{r|okf|page1=ch13|macm_unravelling|page2=830}}
	for example, several musical groups call themselves ''Phineas Gage'' (or some variation).
	}}
	Despite this celebrity{{r|mcrae}}
	the body of established fact about Gage and what he was like (before or after his injury) is small,{{efn-ua|name="accounts_reliablesources"}}
	which has allowed "the fitting of almost any theory to the small number of facts we have"{{px1}}{{r|okf|page=290}}{{mdashb}}Gage having been cited, over the years, in support of various theories of the brain entirely contradictory to one another.
	Historically, published accounts (including scientific ones) have almost always severely distorted and exaggerated Gage's behavioral changes, frequently contradicting the known facts.{{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.
	A report of Gage's physical and mental condition shortly before his death implies that Gage's 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 after his accident. A social recovery hypothesis suggests that Gage's employment as a ] driver in Chile provided daily structure allowing him to relearn lost social and personal skills.
			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.
	] twenty years after Gage's acci{{shy}}dent:<!---explain re new map, old locations--> ''(A)''{{thinsp}}The two possi{{shy}}ble acci{{shy}}dent sites; ''(T)''{{thinsp}}Gage's lodg{{shy}}ings; ''(H)''{{thinsp}}Harlow's home and ]{{zwsp}}{{efn-ua|name=steps_setting}}]]
	==Background==		==Life==
			===Background===
	] 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}}]]
			], 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}} ]]
	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=14{{hyp}}17,31n5,490{{hyp}}1}}
	discusses Gage's ancestry and what is and isn't known about his birth and early life. His parents were married April{{nbsp}}27, 1823.
	<p>The birthdate July{{nbsp}}9, 1823 (the only definite date given in any source) is from a compre{{shy}}hen{{shy}}sive Gage genealogy via Macmillan (2000),{{r|okf|page=16}}
	which notes that while the genealogy gives no source for it, it is consistent with agreement, among contemporary sources addressing the point,{{r|harlow1848|page=389}}{{r|anonymous_C}}{{r|bigelow|page=13}}{{r|harlow1868|page=4}}
	that Gage was 25 years old on the date of his accident, as well as with Gage's age{{mdashb}}36 years{{mdashb}}as given in undertaker's records after his death on May{{nbsp}}21, 1860.
	<p>
	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"{{px1}}{{r|harlow1868|page=10}}
	and "his home"{{px1}}{{r|harlow1868|page=12}}
	(probably that of his parents), to which he returned ten weeks after his accident.
	<p>
	There is no doubt Gage's middle initial was ''P''{{thinsp}}{{r|harlow1848|page=389}}{{zwsp}}{{r|bigelow|page=13}}{{zwsp}}{{r|harlow1868|page=4}}{{zwsp}}{{r|okf|page=490}}{{zwsp}}{{r|macm_unravelling|page=839fig}}<!-- add new document when available; particularly clarify re parents' home and JEG/uncle -->
	but there is nothing to indicate what the ''P'' stood for (though his paternal grandfather was also a ''Phineas'' and brother Dexter's middle name was ''Pritchard'').{{r|okf|page=490}}
	Gage's mother's first and middle names are variously given as ''Hannah'' or ''Hanna'' and ''Trussell'', ''Trusel'', or ''Trussel''; her maiden name is variously spelled ''Swetland, Sweatland,'' or ''Sweetland''.{{r|okf|page=490}}
	}}<!--<<END NOTE-->
	Little is known about his upbringing and education, though he was almost certainly literate.{{r|okf|page=17,41,90}}
	He may have gained skill with explosives on his family's farms or in nearby mines and quarries,{{r|okf|page=17{{hyp}}18}}
	and by the time of his accident he was a ] foreman (possibly an independent contractor) on railway construction projects.{{r|okf|page=18,21,32n9}}
			Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell (Swetland) Gage of ].{{NoteTag
	Town doctor ] described Gage as "a perfectly healthy, strong and active young man, twenty-five years of age, nervo-bilious temperament,{{efn-ua
			|name=birth_name
	<!---BEGIN NOTE--->
			|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.
	|Harlow's reference to Gage's "temperament" reflects his interest in phrenology, which termed ''nervo-bilious'' a subject possessing 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}} (Macmillan 2000),{{r|okf|page=346-7}}
			{{paragraph break}}
	" 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" (Fowler 1838).{{r|fowler|page=6}}
			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 NOTE-->
			<!--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}}
	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 this injury."{{px1}}{{r|harlow1868|page=4}}
	His employers considered him "the most effi­cient and capable foreman in their employ{{nbsp}}... a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation",{{r|harlow1868|page=13}} and he had even commissioned a custom{{hyp}}made ]{{mdashb}}an iron rod three feet seven inches (1.1{{nbsp}}m) long and {{fraction|1|1|4}} inches (3.2{{nbsp}}cm) in diameter{{mdashb}}for use in setting charges.
			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}}
	==Gage's accident==
			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}}
	{{external media |float=left |width=18em<!--<<expressing width in ems allows controlled linewrap--> |video1= (Ratiu et{{nbsp}}al. 2004){{zwsp}}{{r|ratiu_nejm}}
			===Accident===
			] 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}} ]]
			]}} (sand or clay) directs blast into {{shy|sur|round|ing}} rock.]]
			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
			|name=steps_setting
			|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 {{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}}
			<!--end efn>>-->}}
			], 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}}
	}}		}}
			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}}
	On September 13, 1848, Gage was direct{{shy}}ing a work gang blast{{shy}}ing rock while prepar{{shy}}ing 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; then compacting this charge into the hole using the tamping iron.{{efn-ua
	|name=steps_setting<!--BEGIN NOTE-->
	|See Macmillan{{r|okf|page=23{{hyp}}9||pgip|page2=A}}
	for the steps in setting a blast and the location and circum{{shy}}stanc{{shy}}es of the accident.
	The blast hole, about {{frac|1|3|4}} inches (4.5{{nbsp}}cm) in diameter and up to 12 feet (4{{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{{hyp}}employee relations on this type of job, all underscore the significance of Harlow's statements that Gage has 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.{{r|okf|page=13,22-3,25}}
	}}<!--<<END NOTE-->
	Gage was doing this around 4:30{{nbsp}}p.m. when (possibly because the sand was omitted) the iron "struck fire" against the rock and the powder exploded.
	<!--Gage had been sitting, head turned etc etc. (/Note/ for even more detail and Macmillan discussion of conflicting presentations on posture.)-->
	Rocketing from the hole, the iron "entered on the side of face{{nbsp}}... passing back of the left eye, and out at the top of the head."{{px1}}{{efn-ua|name=note_post}}
			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}}
	]
			(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}}
	Despite nineteenth{{hyp}}century references to Gage as "the American Crowbar Case"{{px1}}{{r|smith|barker|page1=54|page2=678}}
			}}
	his tamping iron did not have the bend or claw sometimes associated with the term ''];''
	rather, it was a pointed cylinder something like a ],{{r|kean}}
	"round and rendered comparatively smooth by use":{{r|harlow1868|page=5}}
	{{quote|The end which entered first is pointed; the taper being inches long{{nbsp}}... circum{{shy}}stanc{{shy}}es to which the patient perhaps owes his life. The iron is unlike any other, and was made by a <!--DO NOT AMERICANISE THIS SPELLING>>>>-->{{sic|neighbouring|hide=y}}<!--<<<<DO NOT AMERICANISE THIS SPELLING --> blacksmith to please the fancy of its owner.{{efn-ua
	<!--BEGIN NOTE-->
	|{{r|bigelow|page=14}} Bigelow describes the iron's taper as ''seven'' inches (18{{nbsp}}cm) long, but the correct dimension is twelve (30{{nbsp}}cm).{{r|harlow1868|page1=5|okf|page2=25{{hyp}}6}}<!--from Warren catalog, maybe add re "smoothly blunt" point 1/4 inch diam-->
	}}<!--<<END NOTE-->}}<!--<<END QUOTE-->
			Harlow took charge of the case around 6 p.m.:
	Weighing {{frac|13|1|4}} pounds (6{{nbsp}}kg), this "abrupt and intrusive visitor"{{efn-ua
	|name=amused<!--BEGIN NOTE-->
	|A tone of amused wonderment was common in 19th{{hyp}}century medical writing about Gage (as well as about victims of other unlikely{{hyp}}sounding brain{{hyp}}injury accidents{{mdashb}}including encounters with axes, bolts, bridges, exploding firearms, a revolver shot to the nose,{{r|sutton}}and "even falling gum tree branches").{{r|okf|page=62,63{{hyp}}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) emphasized that though "at first wholly skeptical, I have been personally convinced", calling the case "unparalleled in the annals of surgery",{{r|bigelow|page=13,19}}
	and this endorsement by the Professor of Surgery at Harvard "finally succeeded in forcing authenticity upon the credence of the profession{{nbsp}}... as could hardly have been done by any one in whose sagacity and surgical knowledge his ''confr&egrave;res'' had any less confidence".{{r|anonymous_bmsj1869_1|page=116}}<!--add re Bigelow's influence led to nickname "crowbar case" -- see addl text in bmsj1869_1 re Bigelow vs. Harlow-->
	<p>
	Indeed, Harlow later recalled, "a distinguished Professor of Surgery in a distant city" had dismissed Gage as a "Yankee invention":{{r|harlow1868|page=18}}
	<!--I have the pleasure of being able to present to you, to{{hyp}}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 in<!--<<sic, source reads "of his head"--> his head, {{bracket|see ]}} and even then they required of the Country Doctor attested statements, from clergymen and lawyers, before they could or would believe{{mdashb}}many eminent surgeons regarding such an occurrence as a physiological impossibility, the appearances presented by the subject being variously explained away.{{r|harlow1868|page=3,18}}
	Even as late as 1870, Jackson was able to write that, "Unfortunately, and notwithstanding 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."{{px1}}{{r|jackson1870|page=v}}
	<p>
	But after Gage was joined by such later cases as a miner who survived traversal of his head by a gas pipe,{{r|okf|page=66}}{{r|jewett}}
	and a lumbermill foreman who returned to work soon after a circular saw cut three inches (8{{nbsp}}cm) into his skull from just between the eyes to behind the top of his head (the surgeon removing from this incision "thirty{{hyp}}two pieces of bone, together with considerable sawdust"),{{r|folsom}}
	the ''Boston Medical{{nbsp}}& Surgical Journal'' (1869) 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{{hyp}}a{{hyp}}days."{{px1}}{{r|anonymous_bmsj1869_2}}
	The ''Transactions of the Vermont Medical Society'' (Smith 1886) 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."{{px1}}{{r|smith|page=53{{hyp}}54}}
	<p>
	The reference to Gage's iron as an "abrupt and intrusive visitor" appears in the ''Boston Medical{{nbsp}}& Surgical Journal'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."{{px1}}{{r|harlow1868|page=5}}
			{{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}}}}
	Gage "was thrown upon his back by the explosion, and gave a few convulsive motions of the extremities, but spoke in a few minutes," walked with little assistance, and sat upright in an oxcart for the {{3/4}}-mile (1.2{{nbsp}}km) ride to his lodgings in town.{{r|harlow1868|page=5}}
	Dr. ] arrived about thirty minutes after the accident:
			Gage was also swallowing blood, ] every 15 or 20 minutes.{{r|accident_excerpts}}
	{{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, as if some wedge{{hyp}}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.{{efn-ua|name=accident_excerpts}}
	}}<!--<<END QUOTE-->
	Harlow took charge of the case around 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. His person, and the bed on which he was laid, were literally one ] of blood.{{efn-ua|name=accident_excerpts}}
	}}<!--<<END QUOTE-->
	===Treatment and convalescence===		===Treatment and convalescence===
			] used as a bandage]]
			With Williams' assistance{{NoteTag
			|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.
			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}}
	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 of protruding brain. After probing for foreign bodies and replacing two large detached pieces of bone, Harlow closed the wound with adhesive cloth strips, leaving it partially open for drainage;{{r|okf|page=60{{hyp}}1}}<!--bring in Harlow's comment re hole in roof of mouth-->
	the entrance wound in the cheek was bandaged only loosely, for the same reason. A wet ] was applied, then a ], then further bandag{{shy}}ing to secure these dressings. Harlow also dressed Gage's hands and forearms (which along with his face had been "deeply burned") and ordered that his head remain elevated. Late that evening Harlow noted: "Mind clear. Says he 'does not care to see his friends, as he shall be at work in a few days.{{'"}}{{px1}}{{efn-ua|name=accident_excerpts}}
	]'' for Sep.{{nbsp}}21, 1848 (under{{shy}}stat{{shy}}ing the diamet{{shy}}er of Gage's tamp{{shy}}ing iron and over{{shy}}stat{{shy}}ing dam{{shy}}age to his jaw){{zwsp}}{{efn-ua		], p. 389; ], p. 21; ], p. 16; ], pp. 36{{ndash}}37.
			}} " 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}}
	|name=note_post
	|{{r|anonymous_bostonpost}} The ''Boston Post'' credits an earlier report (of unknown date) in the ''Ludlow (Vermont) Free Soil Union'', which appears to have been the first printed report of Gage's accident anywhere;{{r|okf|page=11}} although reprinted by several New England papers,{{r|okf|page=35{{hyp}}36}} it is itself no longer extant.{{r|okf|page=70{{hyp}}1n1}}
	This report confuses the iron's circum{{shy}}fer{{shy}}ence with its diameter,{{r|okf|page=12}}
	and despite the reference to the "shattering the upper jaw", that did not in fact happen.{{r|harlow1848|page=389}}{{r|bigelow|page=21}}{{r|harlow1868|page=16}}{{r|okf|page=36{{hyp}}7}}<!--these may be duplicative, maybe use Bigelow re coronoid process; secondary source in layman's terms desirable, should be something in M2000-->
	}} ]]		}} ]]
			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}}
	Gage's convalescence was long and difficult.
	He was semi{{hyp}}comatose beginning Septem{{shy}}ber{{nbsp}}23, "seldom speaking unless spoken to, and then answering only in monosyllables."
	The next day Harlow noted, "Failing strength{{nbsp}}... coma deepened; the ] of the left eye became more protuberant, with ]", i.e. ]] pushing out rapidly from the internal ] <!--... also large fungi pushing up rapidly--> from the wounded brain, and coming out at the top of the head."{{px1}}{{efn-ua|name=accident_excerpts}}
			]
	By September{{nbsp}}27, "<!--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." Galvanized by this pessimism 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 ]]{{r|okf|page=54}} to them. With a scalpel I laid open the ], between the <!--opening and the roots of the nose,--> and immediately there were discharged eight ounces of ill{{hyp}}conditioned pus,{{efn-ua
			] of the left eye and scar on forehead. ]]
	|Before the advent of ], wrote surgeon ],
	:Practically all major wounds suppurated . Pus was the most common subject of converse, because it was the most prominent feature in the surgeon's work. It was classified according to degrees of vileness.{{r|nuland|page=347}}
	But pus was considered desirable if of the right kind.{{refn|{{cite journal
	|last=Van Hoosen |first=Bertha |id=UOM:39015006945235
	|title=A Woman's Medical Training in the Eighties |date=Autumn 1947
	|url=http://books.google.com/books?id=qhNYAAAAMAAJ&pg=PA80
	|publisher=University of Michigan Libraries|pages=77{{ndash}}81
	work=Quarterly Review of the Michigan Alumnus: A Journal of University Perspectives
	}} }}{{rp|80}}
	"If a patient was lucky{{nbsp}}... a thick cream-colored odorless fluid
	would appear within five or six days";
	such "laudable" pus was considered "a sure sign that the wound would
	heal"{{px1}}{{refn|name=nuland|{{cite book
	|last=Nuland |first=Sherwin B. |title=Doctors: The Biography of Medicine
	|url=http://books.google.com/books?id=hVePdRGsX2sC
	|year=2011 |publisher=Knopf Doubleday |isbn=978-0-307-80789-2
	}} }}{{rp|344}}
	because it meant "Nature has put up a bold fight against the invader".{{refn|name=scott|{{cite book
	|url=http://books.google.com/books?id=s5FIAQAAIAAJ&pg=PA603
	|title=An indexed system of veterinary treatment|year=1922|page=603
	|first=William |last=Scott|location=Chicago |publisher=Eger
	}} }}
	"On the other hand, if the pus gradually became watery, blood tinged and foul smelling, it was designated 'sanious'{{px1}}{{r|schneider}}
	{{px1}}{{refn|{{cite book
	|last=Williams |first=Charles J.{{nbsp}}B. |year=1848 |publisher=Churchill
	|title=Principles of Medicine: Comprising General Pathology and Therapeutics, and a Brief General View of Etiology, Nosology, Semeiology, Diagnosis, and Prognosis: With Additions and Notes by Meredith Clymer
	|url=http://books.google.com/books?id=mfcGAAAAcAAJ&pg=PA306 |page=306
	}} }}
	and the wound condition was considered unfavorable".{{refn|name=schneider|{{cite book
	|last=Schneider |first=Albert |title=Pharmaceutical bacteriology
	|url=http://books.google.com/books?id=jQPmAAAAIAAJ&pg=PA247
	|year=1920 |publisher=P. Blakiston |page=247 |edition=2nd
	}} }}
	(It later came to be understood that "laudable" pus generally stemmed from an invasion of relatively benign ], while what Harlow's contemporaries called "ill-conditioned" pus usually signaled that the more dangerous ] was present.){{r|nuland|schneider|page1=345|page2=247}}
	}}<!--<<END NOTE-->
	with blood, and excessively fetid."{{efn-ua
	|name=accident_excerpts<!--BEGIN NOTE-->
	|Excerpted from Williams' and Harlow's statements in: Harlow (1848);{{r|harlow1848|page=390{{hyphen}}2}} Bigelow (1850);{{r|bigelow|page=16}} Harlow (1868).{{zwsp}}{{r|harlow1868|page=7,9{{hyphen}}10}}<!--chk pg#s-->
	}}<!--<<END NOTE-->
	("Gage was lucky to encounter Dr. Harlow when he did," wrote Barker. "Few doctors in 1848 would have had the experience with cerebral ] with which Harlow left {{bracket|]}}
	and which probably saved Gage's life."){{efn-ua
	|name=skillful<!--BEGIN NOTE-->
	|{{r|barker|page=679{{hyp}}80}} Barker writes that " from falls, horse kicks, and gunfire, were well known in {{nobr|pre{{ndash}}Civil}} War America every contemporary course of lectures on surgery de{{shy}}scribed 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 school class<!--The patient presented with delayed cerebral symptoms from the accumulation of intracerebral pus after a head injury; Pancoast trephined-->, {{bracket|]}} 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 ]." By keeping the exit wound open and elevating Gage's head to encourage drainage from the cranium through the hole in the roof of the mouth, Harlow "had not repeated Professor Pancoast's mistake."{{px1}}{{r|barker|page=675}}
	<p>
	Noting that Harlow had been a "relatively inexperienced local physician{{nbsp}}... graduated four and a half years earlier", Macmillan's discussion of Harlow's "skillful and imaginative adaptation of traditional methods"{{r|okf|page=12}} additionally mentions the decision (in diverence from the teachings of one of his medical school instructors) to forego an exhaustive search for bone fragments, thus avoiding risk of hemorrhage and further brain injury; and treatment of the ] with caustic silver nitrate, thereby avoiding the risks of two more-usual treatments: excision (which risked hemorrhage) and forcing the tissue into the wound (which risked compressing the brain).{{r|okf|page=60{{hyp}}2}}
	<p>
	As to his own role in Gage's survival, Harlow merely averred, "I can only say{{nbsp}}... with good old se Par&egrave;]], I dressed him, God healed him"{{px1}}{{r|harlow1868|page=20}}{{mdashb}}an assessment Macmillan (2000){{r|okf|page=62}} calls far too modest.
	See Macmillan (2000),{{r|okf|page=12;ch4}} Macmillan (2008),{{r|macm_unravelling|page=828{{hyp}}9}}<!-- Macmillan (2001),{{r|macm_obscure--><!--add specific pg #s--><!--}} cite definition removed by another editor and will be replaced ASAP--> and Barker (1995){{r|barker|page=675,679{{hyp}}80}} for further discussion of Harlow's management of the case.
	}}<!--<<END NOTE-->
			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}}
	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 "uncontrollable by his friends{{nbsp}}... got wet feet and a chill." He soon developed a fever, but by mid{{hyp}}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."{{px1}}{{r|harlow1848|page=392{{hyp}}3}}
			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.'')
	==Subsequent life and travels==
			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===		===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
	] of the left eye.]]
			|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}}}}
	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.29 --> where by late December he was "riding out, improving both mentally and physically."{{px1}}{{r|harlow1849}}
	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
	{{quote|upon the top of the head{{nbsp}}... a deep depression, two inches by one and one{{hyp}}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."{{px1}}{{efn-ua|
	{{r|harlow1868|page=12{{hyp}}13}} Bigelow{{r|bigelow|page=20{{hyp}}1}} gives a more detailed and technical description of Gage's post-recovery appearance.
	}}<!--<<END NOTE--> }}<!--<<END QUOTE-->
			Gage's rearmost left upper ], adjacent to the point of entry through the cheek, was also lost.{{NoteTag|
	===New England===
			] 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)===
	Harlow says that Gage, unable to return to his railroad work,{{r|harlow1868|page=13}}
	appeared for a time at ] in New York City (not the later ]{{mdashb}}there is no evidence Gage ever exhibited with a troupe or circus){{r|macm_rehabilitating|page=3{{hyphen}}4}}
	though there is no confirmation of this.{{r|okf|page=498}}
	But advertisements for two public appearances by Gage, which he may have arranged and promoted himself,{{r|macm_rehabilitating|page=3<!--other potential cites are Meet, More About, Unanswered Qs-->}}
	support Harlow's statement that Gage made public appearances in "most of the larger New England towns".{{r|harlow1868|page=13}}
	(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 had given up such efforts because " sort of thing has not much interest for the general public".){{r|dr_warren|page=28}}
			] in 1849. In this 1853 Society portrait, ] is seated second from left.]]
	Gage subsequently worked for the owner of a livery and coach service in ].{{r|harlow1868|page=14}}{{r|okf|page=101}}
			] 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
	===Chile and California===
			|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}}
	In August 1852, Gage was invited to Chile to work as a long{{hyp}}distance ] driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the ]{{ndash}}] route. After his health began to fail around 1859,{{r|harlow1868|page=14{{hyp}}15}}{{efn-ua
			For about 18 months, he worked for the owner of a ] and coach service in ].{{wbo}}{{ran|H|p=14}}{{ran|M|p=101}}
	|name=death<!--BEGIN NOTE-->
	|Gage's death and (first) burial are discussed by Macmillan{{r|okf|page1=108{{hyp}}9}} (and see also "Corrections to ''An Odd Kind of Fame''").{{r|pgip|page2=D}} Harlow{{r|harlow1868|page=15}} gives the date of Gage's death as May{{nbsp}}21, 1861, but undertaker's records{{r|anonymous_ngray}}
	show that Gage was buried on May{{nbsp}}23, 1860.
	That Harlow (though he had likely discussed Gage's history, in person, with Gage's mother and sister in 1868){{r|macm_rehabilitating|page=6}} was mistaken by exactly one year implies that certain other dates he 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 amount; this article follows Macmillan in correcting those dates (each of which carries this annotation).
	}}<!--<<END NOTE-->
	he left Chile for San Francisco, where he recovered under the care of his mother and sister{{r|harlow1868|page=15}} (who had relocated there from New Hampshire around the time Gage went to Chile).{{r|okf|page=103{{hyp}}4}}
	For the next few months, he did farm work in ].{{r|harlow1868|page=340{{hyp}}1}}
	==Death and subsequent travels==		===Chile and California (1852{{ndash}}1860)===
			{{Quote box |salign=right|align=left|width=22em
	] at the time of his death might have been known. <!--In con{{shy}}sid{{shy}}er{{shy}}a{{shy}}­tion of this important omis{{shy}}sion, --> the mother and friends, waiv{{shy}}ing the claims of person{{shy}}al and pri{{shy}}vate af{{shy}}fec{{shy}}tion, with a magna{{shy}}nim{{shy}}­i{{shy}}­ty more than praise{{shy}}­wor­{{shy}}thy, at my request have cheer{{shy}}ful{{shy}}­ly placed this skull <!--(which I now show you)-->in my hands, for the benefit of science." Gage's skull (sawn to show inte{{shy}}rior) and iron, photo{{shy}}graphed in 1868.{{zwsp}}{{efn-ua
			|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.}}
	|name= skullphotos<!------BEGIN NOTE----->
			|author = ] (1868){{ran|H|page=340}}
	|{{r|harlow1868|page=16}} Here reproduced from Jackson's ''De{{shy}}scrip{{shy}}tive Catalog of the Warren Anatomical Museum,''{{r|jackson1870<!--"Frontispiece" and specific catalog entry #s given in Sources list, not needed here-->}} these images were commis{{shy}}sioned by Harlow from photo{{shy}}grapher Samuel Webster Wyman and were the basis for the wood{{shy}}cuts seen in Harlow (1868).{{zwsp}}{{r|harlow1868|page1=21|okf|page2=26,115,479-80<!--these pg ranges seem broad-->}}<!--mention woodcuts used by Ferrier-->
			}}
	}}<!---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
	In February 1860,{{efn-ua|name=death}}
			|name=death
	Gage had the first in a series of increas{{shy}}ingly severe ]s;{{efn-ua
			|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.
	<!--BEGIN NOTE-->
			<!--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}}
	|Apparently{{r|macm_rehabilitating|page=6-7}}
	quoting Gage's mother, Harlow narrates that,
	"while sitting at dinner, 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 May 18, 1860{{efn-ua|name=death}}
	he left Santa Clara and went home to his mother. At 5{{nbsp}}A.M. on May{{nbsp}}20, he had a severe convulsion. The family physician was called in, and ] him. The convulsions were repeated frequently during the succeeding day and night."{{px1}}{{r|harlow1868|page=15}}
	}}<!--<<END NOTE-->
	he died '']''"{{px1}}{{r|pgip|page=E}}
	in or near{{r|pgip|page=B}}
	San Francisco on May{{nbsp}}21,{{efn-ua|name=death}} just under twelve years after his injury, and was buried in San Francisco's ].{{efn-ua|name=death}}
	(Though some accounts{{r|damasioH1994|damasioA1994|hockenbury}}
	assert that Gage's iron was buried with him, there is no evidence for this.){{efn-ua
	<!--BEGIN NOTE-->
	|Macmillan{{nbsp}}& Lena: "Only Harlow{{r|harlow1868|page=16}}
	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."{{px1}}{{r|macm_rehabilitating|page=7}}
	}}<!--<<END NOTE-->
			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}}
	===Skull and iron===
	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 wrote to Gage's family there.
	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 in New England.<!--add note re move to Woburn-->
			===Death and exhumation===
	About a year after the accident, Gage had given his tamping iron to Harvard Medical School's ],<!--<<chk cite coming up covers this--> but he later reclaimed it{{r|bigelow|page=22n}}{{r|anonymous_bmsj1869_1}}{{r|okf|page=46{{hyp}}7}} and made what he called "my iron bar" his "constant companion during the remainder of his life";{{r|harlow1868|page=13}}
	now it too was delivered to Harlow. After studying them for a triumphal{{efn-ua|name=amused}}
	retrospective paper on Gage,{{r|harlow1868}}<!--<<maybe combine this cite with M2000 re "triumphal"-->
	Harlow redeposited the iron{{mdashb}}this time with Gage's skull{{mdashb}}in the Warren Museum, where they remain on display today.{{efn-ua
	|name=mostvaluable<!--BEGIN NOTE-->
	|{{r|remain_on_display}} 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. John M. 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.{{nbsp}}H. showed, in getting possession of this remarkable specimen, he deserves the warmest thanks of the profession, and still more, from the College ]"], for his donation."{{px1}}{{r|jackson1870|page=v}}
	}}<!--<<END NOTE-->
	The iron bears the following inscription (though the date it gives for the accident is one day off, and ''Phinehas'' is not the way Gage spelled his name):{{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 -->:
	{{quote|This is the bar that was shot through the head of M<sup>r</sup> Phinehas{{sup|}} P. 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 P. Gage Lebanon Grafton{{nbsp}}Cy N{{ndash}}H Jan{{nbsp}}6 1850.<!--chk Sept. 14COMMA Jan 6NOCOMMA (as given on Gagepage but chk directly in Warren)-->{{efn-ua|name=inscription
	<!--BEGIN NOTE-->
	|{{r|pgip|page=D}} The inscription was commissioned by Bigelow in preparation for the iron's deposit in the Warren Anatomical Museum.{{r|anonymous_bmsj1869_1|page=116}}
	The ''Jan 6 1850'' following Gage's "signature" corresponds to the period during which Gage was in Boston under Bigelow's observation.{{r|bigelow|page=20|harlow1868|page2=4n}}
	}}<!--<<END NOTE-->}}<!--<<END QUOTE-->
			]
	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{{hyp}}20}}
			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
	==Brain damage and mental changes==
			|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}}
			<!--end efn-->}}
			late on May&nbsp;21, 1860. He was buried in San Francisco's ].{{wbo}}{{NoteTag|name=death}}
			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}} ]]
	]
			]) 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}} ]]
			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}}
			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
			|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}}
			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>
			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 291 0 945 387 ]
			rect 946 0 1190 387 ]
			rect 1191 0 1500 387 ]
			rect 1500 0 1900 387 ]
			rect 1901 0 2280 387 ]
			rect 2281 0 2400 387 ]
			</imagemap>
			{{Clear}}
			==Mental changes and brain damage==
			] 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}} ]]
			] (seen here in 1854). His anti-] training pre{{shy}}dis{{shy}}posed him to minimize Gage's behavioral changes.{{ran|B|p=672}}]]
			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}}
			===Early observations (1849–1852)<span id="Early observations"></span>===
			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":
			{{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}}}}
			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}}
			}}
			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}}
			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}}
			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
			|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}}
			{{paragraph break}}
			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}}
			Macmillan&nbsp;& Lena{{ran|M10|p=643-46,648}} present previously unknown sources found since 2008.
			<!--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}}
			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}}
			Benderly suggests that instructors use the Gage case to illustrate the importance of critical thinking.{{r|benderly}}
	===Extent of brain damage===		===Extent of brain damage===
	]		]
	]
			{{Quote box |salign=right|align=right|width=22em
	Debate as to whether the trauma and subsequent infection had damaged both of Gage's ], or only the left, began almost immediately after his accident.{{efn-ua
			|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.
	<!--BEGIN NOTE-->
			|author = ] (1868){{ran|H|page=342}}
	|Early authors attempting to estimate the extent of damage include: Harlow;{{r|harlow1848|page=389}} Bigelow;{{r|bigelow|page=21{{hyphen}}2}} Harlow;{{r|harlow1868|page=343{{hyphen}}5}} Dupuy;{{r|dupuy}} Ferrier;{{r|ferrier1878}}
			}}
	Bramwell;{{r|bramwell}} Cobb;{{r|cobb1940|cobb1943}} Tyler{{nbsp}}& Tyler.{{r|tyler}}
	}}<!--<<END NOTE-->
	The 1994 conclusion of ] et{{nbsp}}al.,{{r|damasioH1994|page=1104}}
	that both of Gage's ]s (right as well as left) had been damaged, was drawn by modeling not Gage's skull but rather a "Gage{{hyp}}like" one.{{r|macm_unravelling|page=829{{hyp}}30}}
	Using ] of Gage's actual skull, Ratiu et{{nbsp}}al. (2004){{r|ratiu_nejm}} and Van Horn et{{nbsp}}al. (2012) rejected that conclusion, agreeing with Harlow's belief (based on probing Gage's wounds with his finger){{efn-ua
	<!--BEGIN NOTE-->
	|See Macmillan{{nbsp}}& Lena;{{r|macm_rehabilitating|page=9}} Harlow;{{r|harlow1868|page=332,345}} Bigelow;{{r|bigelow|page=16{{hyphen}}17}} Harlow;{{r|harlow1848|page=390}} Macmillan.{{r|okf|page=86}}
	}}<!--<<END NOTE-->
	that only the left frontal lobe had been damaged.{{r|harlow1868|page=19}}
			{{external media |float=right|width=22em |video1= (Ratiu et&nbsp;al.){{ran|R1}} {{registration required}} }}
	In addition, Ratiu et{{nbsp}}al. pointed out that the hole between the roof of the mouth and the base of the cranium (created as the iron passed through) has a diameter about half that of the iron itself;{{r|ratiu_nejm}}
			}}
	combining this with the hairline fracture running from behind the exit region down the front of the skull,
	they concluded that the skull "hinged" open as the iron entered the cranium, then (once the iron had exited at the top) were pulled closed by the resilience of soft tissues.{{r|ratiu_jneuro|page1=640|macm_unravelling|page2=830}}
	<!-- 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-->
			{{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
	Van Horn et{{nbsp}}al. concluded that damage to Gage's ] (of which they made detailed estimates) may have been more significant to Gage's mental changes than ] (gray matter) {{nobr|damage.{{r|vanhorn}} }}
			|{{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.
			<!--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
			|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.{{wbo}}{{ran|M|p=84-86}}
			<!--end efn>>-->}}
			<!--end shy>>-->}}
			] pathways affected, per Van Horn et&nbsp;al.{{ran|V|p=3}} ]]
	===First{{hyp}}hand reports of mental changes===
	Gage certainly displayed some kind of change in behavior after his injury,{{r|macm_rehabilitating|page=12{{hyp}}15}}<!--likely other papers + Macmillan 2000 cited too -->
	but the nature, extent, and duration of this change have been difficult to establish.
	Only a handful of sources give direct information on what Gage was like (either before or after the accident),{{efn-ua|name="accounts_reliablesources"}}
	the mental changes described after his death were much more dramatic than anything reported while he was alive,{{r|okf|page=375{{hyp}}6}} and few of the sources are explicit about the period of Gage's life to which their descriptions of him (which vary widely in their implied level of functional impairment) are meant to apply.{{r|macm_rehabilitating|page=6-7}}
			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}}
	====Early observations (1849{{ndash}}1851)====
			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}}
	] in 1854. His train{{shy}}ing pre{{shy}}dis{{shy}}posed him to min{{shy}}i{{shy}}mize Gage's behav{{shy}}ioral changes.{{zwsp}}{{r|barker|page=abstr}}]]
			==<span id="Factors favoring"></span>Factors favoring Gage's survival==
	], who attend{{shy}}ed Gage after the "rude mis{{shy}}sile had been shot through his brain",{{r|eliot}} and ob{{shy}}tained his skull for study after his death, in later life. Harlow's interest in ] pre{{shy}}pared him to accept that Gage's injury might have changed his behavior.{{zwsp}}{{r|barker|page=abstr}}]]
	without parallel in the annals of surgery."{{r|harlow1868|page=3}} Harlow's 1868 pres{{shy}}en{{shy}}ta{{shy}}tion, to the ],<!--need cite for reading of paper--> of Gage's skull, iron, and later history.]]		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.]]
			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:
	Harlow described the pre{{hyp}}accident Gage as hard{{hyp}}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":
			{{blockquote|
	{{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), 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{{hyp}}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|page=13{{hyp}}14}}
			1st. The subject was the man for the case. His physique, will, and capacity of endurance, could scarcely be excelled.{{ran|H|p=18}}
	}}		}}
	This oft-quoted{{r|kotowicz|page=125}} description
	is from Harlow's notes set down soon after the accident,{{r|okf|page=90,375|macm_rehabilitating|page2=6{{hyphen}}9}}
	but Harlow{{mdashb}}perhaps hesitant to describe his patient negatively while he was still alive{{r|okf|page=375{{hyp}}6}}{{mdashb}}left them unpublished until 1868 (after Gage had died and his family had forwarded "what we so much desired to see", as Harlow termed Gage's skull and iron).{{r|harlow1868|page=16}}
			For Harlow's description of the pre-accident Gage, see ], above.
	In the interim, Harlow's 1848 report (published just as Gage was emerging from his convalescence) only hinted at psychological symptoms:
	{{quote|The mental manifestations of the patient, I leave to a future communication. I think the case{{nbsp}}... is exceedingly interesting to the enlightened physiologist and intellectual philosopher.{{r|harlow1848|page=393}}
	}}<!--<<END QUOTE-->
	But after Harvard Professor of Surgery ] (who had brought Gage to Boston for observation in late 1849){{r|bigelow|page=20}}{{r|harlow1868|page=4n}}{{r|okf|page=43}}
	termed Gage "quite recovered in faculties of body and mind", with only "inconsid{{shy}}er{{shy}}a{{shy}}ble disturbance of function",{{r|bigelow|page=13{{hyphen}}14}}
	a rejoinder in the ''American ] Journal''{{r|amer_phren}}{{mdash}}
	{{blockquote|That there was no difference in his mental manifestations after the recovery is{{nbsp}}''not'' true{{nbsp}}... The man was gross, profane, coarse, and vulgar, to such a degree that his society was intolerable to decent people.}}
	{{mdash}}was apparently based on information anonymously supplied by Harlow.{{r|okf|page=350{{hyp}}1}}
			{{blockquote|
	Barker explains these contradictory evaluations (only six months apart) by differences in Bigelow's and Harlow's educational backgrounds:
			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}}
	{{block quote|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 <!--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.{{r|barker|page=abstr}}{{efn-ua
			}}
	|name=fitting<!--BEGIN NOTE-->
	|See Macmillan{{r|okf|page='']''}}<!--certainly specific chapters can be called out-->
	and Macmillan{{r|macm_unravelling|page=831}}
	for surveys and discussion of theoretical misuse of Gage.
	Smith noted "<!--It is interesting to note -->the ingenuity with which the advocates of various theories will explain away the evidence of their opponents."{{px1}}{{r|smith|page=51
	}} }}<!--<<END NOTE--> }}<!--<<END BLOCK QUOTE--><!--other aspects include Harlow knew Gage before accident, and class-based expectatipons about behavior-->
			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}}
	====Later observations (1852{{ndash}}1858)====<!--explain where these specific dates come from-->
			Harlow continued:
	In 1860, an American physician returned from Chile reported that he had known Gage "well" there,{{clarify|date=May 2014}} and "that he is in the enjoyment of good health, with no impairment whatever of his mental faculties."{{px1}}{{r|kean}}<!--substitute direct cite, and check quote-->
			{{blockquote|
	Together with the fact that 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{{hyp}}7}}{{r|macm_unravelling|page=831}}<!--chk cites for coverage of hired-in-advance material-->
			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|
	this implies that Gage's most serious mental changes were temporary, so that the "fitful, irreverent{{nbsp}}... capricious and vacillating" Gage de{{shy}}scribed by Harlow (who last saw Gage less than a year after the accident) became, over time, far more functional, and socially far better adapted.{{r|macm_unravelling|page1=831|macm_unravelling|page2='']''}}
			{{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}}
	This conclusion is reinforced by the responsibilities and challenges faced by drivers on the stagecoach route worked by Gage in Chile,{{r|okf|page=104-6|macm_rehabilitating|page2=4-5}} including the general 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."{{r|austin}}<!--get pg# Austin-->
	Gage had also (writes Macmillan) "to deal with political upheavals that frequently spilled into everyday life{{nbsp}}...
	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."{{r|macm_rehabilitating|page=5|macm_unravelling|page2=831}}
	(A visitor wrote that "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."){{px1}}{{r|merwin|page=73}}
			{{Quote box |salign=right|align=right|width=22.6em
	===Social recovery===
			|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,
	Psychologist Malcolm Macmillan hypothesizes that this change in Gage over time represents a social recovery by Gage over time, citing people with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills"{{px1}}{{r|macm_unravelling}}{{mdashb}}in Gage's case, his highly structured employment in Chile:
			{{blockquote|
	{{block quote|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. Phineas job as a stage{{hyp}}coach driver provided that external structure to aid in his recovery.{{r|macm_aggleton}} }}
			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}}
	Macmillan writes that if Gage made such a recovery{{mdashb}}if he eventually "figured out how to live" (as Fleischman put it){{r|fleischman|page=75}}
	despite his injury{{mdashb}}then it "would add to current evidence that rehabilitation can be effective even in difficult and long{{hyp}}standing cases";{{r|macm_unravelling|page=831}}
	and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"{{px1}}{{r|macm_moreabout}}
	As Kean put it, "If even Phineas Gage bounced back{{mdashb}}that's a powerful message of hope."{{px1}}{{r|kean}}
	{{anchor|Distortion and misue of case}}<!--this anchor linked from ] -->
			]
	{{Quote box |salign=right|align=left
	|quote = A moral man, Phineas Gage<br>Tamping powder down holes for his wage<br>Blew his special{{hyp}}made probe<br>Through his left frontal lobe<br>Now he drinks, swears, and flies in a rage.
			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}}
	|source = {{mdashb}}{{thinsp}}Anonymous{{r|okf|page=307}}
			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}}
			==Early medical attitudes==
			===Skepticism===
			{{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]]
	===Distortion of mental changes===
	Macmillan's comprehensive{{efn-ua|
			{{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's book provides one of those rare occasions on which one can truly say that further research is not necessary{{nbsp}}... the definitive account{{nbsp}}..."{{r|marshall}}
			{{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.}}
	}}		}}
	survey of accounts of Gage (scientific and popular)
	found that they almost always distort and exaggerate his behavioral changes well beyond anything de{{shy}}scribed by anyone who had contact with him.{{efn-ua|name="accounts_reliablesources"}}
	In the words of Barker,{{r|barker}}
	"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)
	"Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a ]{{nbsp}}..."{{px1}}{{r|kotowicz}}<!--get pg#-->
			"A distinguished Professor of Surgery in a distant city", Harlow continued, had even dismissed Gage as a "] invention".{{ran|H|p=3,18}}
	Attributes typically ascribed to the post{{hyp}}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, 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".<!--cite each of these-->
	Macmillan shows that none of these behaviors is mentioned by anyone who had met Gage or even his family;{{efn-ua
			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
	|name=accounts_reliablesources
			|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}}
	|Macmillan{{r|okf|page1=116{{hyphen}}19,ch13{{hyphen}}14|pgip|page2=C}} compares accounts of Gage to one another and to the known facts.
			<!--end efn>>-->}}
	Along with a handful of lesser sources,{{r|okf|page=11,89,93,95,116,120n4}}
	until 2008{{r|macm_rehabilitating|page=2-3}} the available sources offering detailed information on Gage, and for which there is evidence (even merely the source's own claim) of contact with him or with his family, were limited to Harlow,{{r|harlow1848|harlow1849|harlow1868}} Bigelow,{{r|bigelow}} and Jackson;{{r|jackson1849|jackson1870}}
			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}}
	Macmillan{{r|macm_obscure|page=161|okf|page2=94}} emphasizes the primacy of Harlow's 1868 paper.
	Macmillan{{nbsp}}& Lena{{r|macm_rehabilitating|page=3-6,8}} present previously unknown sources found since 2008.
			===Standard for other brain injuries===
	<p>The contrast between Gage's celebrity and the small amount known about him, is discussed by Macmillan:{{r|okf|page=1{{hyphen}}2,11}}
			have {{shy|at|tract|ed more vis|i|tors}} and spread farther the fame of the ]"{{wbo}}{{r|yakovlev}}
	"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 remarkable, someone must have made a major study of him. Neither was the case."
			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}}
			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}}
			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}}
			==Theoretical misuse==
			{{Quote box |salign=right|align=right|width=24.7em
			|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}}
	}}		}}
	as Kotowicz writes, "Harlow does not report a single act that Gage should have been ashamed of."{{px1}}{{r|kotowicz|page=122{{hyp}}3}}
			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}}
	For example, H.{{nbsp}}Damasio et{{nbsp}}al.{{r|damasioH1994}} and ]{{r|damasioA1994}}
			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}}
	misinterpret a passage by Harlow{{mdashb}}{{px1}}{{"'}}...{{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{{'"}}{{px1}}{{r|harlow1868|page=15}}{{mdashb}}as implying Gage could not hold a job after his accident and "never returned to a fully independent existence".
			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}}
	In fact Harlow's words refer not to Gage's post{{hyp}}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 post-accident life.{{efn-ua
	<!--BEGIN NOTE-->
	|For end-of-life employment difficulties see Macmillan;{{r|okf|page=107}}
	for misinterpretation see Macmillan{{r|okf|page=323}}
	for self-support see Macmillan{{nbsp}}& Lena{{r|macm_rehabilitating|page=14-15}}
	as well as Kotowicz:{{r|kotowicz}} "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-->
			===Cerebral localization===
	===Theoretical use, misuse, and nonuse===<!-- linked from ] -->
			] 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. ]]
	[[File:PhrenologyPix CroppedUpperFront.jpg|thumb|right|upright=1.2|link=http://upload.wikimedia.org/wikipedia/commons/e/ec/PhrenologyPix.jpg
	|] contended that destruc{{shy}}tion of the men{{shy}}tal "organs" of Ven{{shy}}er{{shy}}a{{shy}}tion and Ben{{shy}}ev{{shy}}o{{shy}}lence ''(top)'' caused Gage's behav{{shy}}ioral changes. ]]
			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}}
	Though Gage is considered the "] for personality change due to frontal lobe damage"{{px1}}{{r|barker|stuss|fuster|hockenbury}}
	his scientific value is undermined by the uncertain extent of his brain damage{{r|fuster}}<!-- add Macmillan re chain of brain damage uncertainties (path, position of brain, individual locations of regions)--> and the lack of information about his behavioral changes.{{r|okf|page=290}}<!--find addl Macmillan refs re lack of info-->
	Instead, 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".{{r|okf|page=290}}
	A similar concern had been 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 investigating reports on diseases and injuries of the brain, I am constantly 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}}...{{r|ferrier1877_9}}}}
	More recently ] refers to the "interpretations and misinterpretations, from 1848 to the present," of Gage.{{r|sacks}}
			===Phrenology===<!--this section name referenced by links elsewhere in the article-->
	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;{{r|barker<!--<<need pg#-->|okf|page2=ch9}}<!--emph okf p188 material-->
			] ]]
	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}}
	<!--add frontal function / no function --><!--add re Gulstonian and its effect on opinion-->
	Phrenologists made use of Gage as well, contending that his mental changes resulted from destruction of his "organ of ]" and/or the adjacent "organ of ]".{{r|sizer|page=194}}
			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}}
	In a more recent example A.{{nbsp}}Damasio, in support of his '']'' (relating decision{{hyp}}making to emotions and their biological underpinnings), draws parallels between behaviors he attributes to Gage and those of modern patients with damage to the ] and ].{{r|damasioA1994}}
	But A.{{nbsp}}Damasio's depiction of Gage has been criticized by Kotowicz as "grotesque fabrication{{nbsp}}... the myth of Gage the psychopath{{nbsp}}... 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-->
	|{{r|kotowicz}} Kotowicz continues, " account of Gage's last months such a grotesque fabrication that it leaves one baffled," then quotes á passage from A.{{nbsp}}Damasio:{{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 conversing 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 insinuating that Gage was some riff{{hyp}}raff who in his final days headed for California to drink and brawl himself to death."
	<p>
	Macmillan{{r|okf|page=116{{hyp}}19,326,331}}<!--notes as well, and other Macmillan papers as well--> gives detailed criticism of A.{{nbsp}}Damasio's various presentations<!--specify which of AD's works--> of Gage (some of them in joint work with H.{{nbsp}}Damasio and others).
	}}<!--<<END NOTE-->
			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|
	As Kihlstrom put it:
			{{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}}
	{{quote|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{{hyp}}regulation.{{efn-ua|
			<!--end efn>>-->}}
	{{r|kihlstrom}} See also Grafman:{{r|grafman|page=295}}
	"Although <!--the classic story of the nineteenth-century patient Gage who suffered a penetrating PFC lesion--> has been used to exemplify the problems that patients with ventromedial PFC {{bracket|]}} lesions have in obeying social rules, recognizing 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{{mdashb}}at least regarding Gage" (citing Macmillan 2000).{{r|okf}}
	}}<!--<<END NOTE-->}}<!--<<END QUOTE-->
	====Psychosurgery and lobotomy====		===Psychosurgery and lobotomy===
	It is frequently said that what happened to Gage played a part in the later development of various forms of ], particularly ].{{efn-ua		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:
	<!--BEGIN NOTE-->
			{{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}}
	|See for example Carlson (1994);{{r|carlson|page=341}}
			}}
	additional examples and discussion are at Macmillan (2000).{{r|okf|page=246;252{{hyp}}3n9,10}}<!--extract some additional examples and list here, with some quotes-->
	}}<!--<<END NOTE-->
			===Somatic marker hypothesis===
	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:
	{{quote|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{{r|pgip|page=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.{{r|okf|page=250}}
			], 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:
	}}<!-- add note re Freeman's use of Gage story as delaying tactic-->
			{{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}}}} }}
			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}}
			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==		==Portraits==
	]		has P. Gage at Cavendish, Vermont, Sept. 14, 1848. {{nobr|He fully{{nbsp}}...}}'']]
			]
	Two ] portraits of Gage, identified in 2009 and 2010,{{efn-ua		Two ] portraits of Gage, identi{{shy}}fied in 2009 and 2010,{{NoteTag
	|name=dags<!--BEGIN NOTE-->		|name=dags
	|The 2009{{hyp}}identified image is from the collection of Jack and Beverly Wilgus. The original, like almost all daguerre{{shy}}otypes,<!--cite technical details on dags--> shows its subject laterally (left{{hyp}}right) reversed, making it appear that Gage's right eye is injured; however, all Gage's injuries, including to his eye, were on the left.{{r|lena_macm}}<!--get pg#-->		|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}}
	Therefore in presenting the image here a second, compensating reversal has been applied in order 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.{{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}}
	<p>
			<!--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
	The 2010{{hyp}}identified image is in the possession of Tara Gage Miller of Texas; an identical image belongs to Phyllis Gage Hartley of New Jersey.
			|name=mask
	(Gage had no known children;{{r|okf|page=319,327}}
			|{{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}}
	these are descendents of certain of his relatives.){{r|macm_rehabilitating|page=4}}
			}}
	Unlike the Wilgus portrait, which is itself a daguerre{{shy}}otype, the Miller and Hartley images are 19th{{hyp}}century photographic reproductions of a common original which remains undiscovered, itself a daguerre{{shy}}otype or other laterally reversing ]; here again a second, compensating reversal has been applied.
			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}}
	}}<!--<<END NOTE-->
			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}}
	are the only known likenesses{{r|wilgus2009a|page1=343|twomey|wilgus2009b|page3=8}} of him other than a ] taken for Bigelow in late 1849.<!--chk this date and that cites cover "by Bigelow"; img of lifemask would be good-->{{r|bigelow|page1=22n|okf|page2=ii,42}}
	The first shows "a disfigured yet still{{hyp}}handsome" Gage{{r|twomey}}
	with one eye closed and scars clearly visible, "well dressed and confident, even proud"{{px1}}{{r|wilgus2009a}}
	and holding his iron, on which portions of its inscription can be made out.{{r|wilgus_meet}}
	(For decades the portrait's owners had imagined it showed an injured whaler with his ].){{px1}}{{r|wilgus_meet}}
			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}}
	The second, found in the possession of two different branches of the Gage family, shows Gage in a somewhat different pose, wearing a different shirt and different tie, but the same ] and possibly the same jacket.{{r|wilgus_newimage}}
	The portraits' authenticity was confirmed in several ways (including photo{{hyp}}overlaying the inscriptions seen in the portraits against that on the actual tamping iron, and matching the subject's injuries against those preserved in the life mask){{r|wilgus2009a}}<!--mention mask in museum-->
	but about when and where they were taken nothing is known, except that they were likely taken by different photographers.{{r|wilgus2009b|page=8}}
			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}}
	The portraits reinforce the social recovery hypothesis already de{{shy}}scribed.{{r|macm_moreabout}}
	"Although just one picture," Kean wrote in reference to the first image, "it exploded the common image of Gage as a dirty, disheveled misfit. This Phineas was proud, well{{hyp}}dressed, and disarmingly handsome."{{efn-ua
	<!--BEGIN NOTE-->
	|{{r|kean}} Van Horn: "That was any form of vagrant following his injury is belied by these remarkable images."{{px1}}{{r|vanhorn<!--get pg#-->}}
	}}<!--<<END NOTE-->
	==See also==		==See also==
	* ]{{mdashb}}scientist through whose head a particle{{hyp}}accelerator proton beam accidentally passed
			{{columns-list|colwidth=40em|
	* ]—another early case of head injury leading to mental changes
			* ]{{snd}}scientist whose head was struck by a particle-accelerator ]
	{{clear}}
			* ]{{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==		==Notes==
			{{NoteFoot|30em}}
	{{Reflist |33em |group=upper-alpha }}
			==References==
	==Sources and further reading==
			'''For general readers'''
			{{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
	{{Reflist |33em |refs=
			|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
			}} }}
	{{refn|name=dr_warren|{{cite journal		{{rma| tag=M |reference= {{cite book
			|last=Macmillan |first=Malcolm B. |year=2000
	|title=Dr. Warren's Possessions|work=Harvard Magazine|volume=89 |page=28ff<!--get end pg#, author-->|year=1986
			|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'' .
			}}
	{{refn| name=marshall| {{cite journal |		{{rma| tag=M1 |reference= {{cite journal |author-mask=2
			|last=Macmillan |first=Malcolm B. |date=September 2008 |url=http://thepsychologist.bps.org.uk/volume-21/edition-9/phineas-gage-unravelling-myth
	|first=John C.|last= Marshall|journal= ] |year= 2000
			|title=Phineas Gage – Unravelling the myth |journal=The Psychologist |volume=21 |number=9
	|volume= 290|number=5492|page= 718
			|pages=828{{ndash}}31.<!--Chk all cites for possible problem re pg #s in online vs print versions-->
	|title=Books. Iron in the Soul. An Odd Kind of Fame Stories of Phineas Gage.
			|ref=none
	}} }}		}} }}
			{{rma| tag=M2 |reference= {{cite web |author-mask=2
	{{refn |name=mcrae |{{cite book | title=Tribal Science: Brains, Beliefs and Bad Ideas
			|last=Macmillan |first=Malcolm B. |year=2012<!--2012 was latest update to site-->
	| last = McRae |first=Mike | publisher = ]
			|url=http://www.uakron.edu/gage/index.dot
	| year = 2011 | isbn = 0702247340 | pages = 9{{hyp}}11
			|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=kean |{{citation|title=Phineas Gage, Neuroscience's Most Famous Patient
			|interviewer= Jon Hamilton |title=Why Brain Scientists are Still Obsessed with the Curious Case of Phineas Gage
	|work=Slate|date= May 6, 2014|last=Kean|first=Sam
			|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
	|url=http://www.slate.com/articles/health_and_science/science/2014/05/phineas_gage_neuroscience_case_true_story_of_famous_frontal_lobe_patient.html
			|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=merwin |{{cite book| title=Three Years in {{sic|Chili|hide=y}} |last=Merwin |first=Mrs. George B.
			|last1=Macmillan |first1=Malcolm B. |date=March 6, 2011 |last2=Aggleton |first2=John
	| year=1863<!--check earlier ed-->|location=New York|publisher=Follett, Foster and Company}} }}
			|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=remain_on_display| {{cite web
	| url=http://www.countway.harvard.edu/menuNavigation/chom/warren/exhibits.html <!--<<upload to commons-->
	| title=The Phineas Gage Case | publisher = Warren Museum | accessdate = 2013-01-10 }}}}<!--cite needs expansion-->
			{{Refend}}
	{{refn|name=fleischman |{{cite book |last=Fleischman |first=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}} {{open access}} }}
			'''For younger readers'''
	{{refn|name=harlow1868 |1=<br><!--linebreak after long list of backlinks-->
			{{Refbegin}}
	{{cite journal |last=Harlow |first=John Martyn |year=1868
			{{rma| tag=F |reference= {{cite book
			|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}}
			'''For researchers and specialists'''
			{{Refbegin|35em}}
			{{rma| tag=B |reference= {{cite journal
			|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
			|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.
			}}
			{{rma| tag=D |reference= {{cite book
			|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
			|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
			|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.
			}}
			{{rma| tag=H |reference= {{cite journal
			|last=Harlow |first=John Martyn |year=1868
	|title=Recovery from the Passage of an Iron Bar through the Head		|title=Recovery from the Passage of an Iron Bar through the Head
			|journal=Publications of the Massachusetts Medical Society |volume=2|number=3
	|url=http://books.google.com/books?id=WgE2AQAAMAAJ
			|pages=327{{ndash}}47
	}} {{open access}} (].)
			|url=https://en.wikisource.org/Recovery_from_the_passage_of_an_iron_bar_through_the_head
	Originally published in
			}} 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 }} (])
			}}
			{{rma| tag=H2 |reference= {{cite journal |author-mask=2
			|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
			|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
			|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=]
			}}
			}}
			{{rma| tag=L1 |reference= {{cite journal
			|last=Lena |first= M. L. |date=Spring 2018 | volume=56 |number=1
			|title=The Navvy and the Navigator: Connecting Phineas Gage and Mark Twain's 'Mean Men'
			|journal=Mark Twain Journal | pages=166–200
			}}
			}}
			{{rma| tag=L2 |reference= {{cite book
			|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
			|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
			|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
			|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
			|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
			|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
			|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
			|last1=Macmillan |first1=Malcolm B. |last2=Lena |first2=M. L. |doi=10.1080/09602011003760527 |title=Rehabilitating Phineas Gage
			|journal=Neuropsychological Rehabilitation |volume=20 |issue=5 |pages=641{{ndash}}58 |year=2010 |pmid=20480430 |s2cid=205655881
			|df=mdy-all }}
			}}
			{{rma| tag=R |reference= {{cite journal
			|last1=Ratiu |first1=P. |last2=Talos |first2=I. F. |last3=Haker |first3=S. |last4=Lieberman |pages=637{{ndash}}43
			|first4=D. |last5=Everett |first5=P. |title=The Tale of Phineas Gage, Digitally Remastered |pmid=15165371
			|doi=10.1089/089771504774129964 |journal=Journal of Neurotrauma |volume=21 |issue=5 |year=2004
			}} {{closed access}}<!--confusing ratiu cites and page #s need checking-->
			}}
			{{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
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			], p. 389; ], p. 13; ], p. 4.
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			|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
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			{{cite book|last=Moffatt|first=Gregory K.|title=A Violent Heart: Understanding Aggressive Individuals|page=6
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			* ]; ], pp. 39, 319, 327.
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			|isbn=978-0-631-17896-5 }} {{closed access}}
			* {{cite book
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			|last4=Solomon |first4=P. R. |year=1983 |title=Psychology |publisher=Scott, Foresman
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			* {{cite book
			|last=Myers |first=David G. |url=https://archive.org/details/psychology00myer04|url-access=registration <!--get pg#-->
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			* ], pp. 319, 327{{ndash}}28
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			], pp. 11, 51; ], pp. 119, 331.
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			{{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
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			* {{cite book
			|last=Kalat |first=James W. |year=1981 |title=Biological Psychology |publisher=Wadsworth |location=Belmont, California
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			|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
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			* ], p. 1102; ], p. 116.
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			{{cite book
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			* {{cite book
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			* ], p. 323.
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			}}
			* {{cite book
			|last=Brown |first=H. |year=1976 |location=New York |publisher=Oxford University Press
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			* {{cite book
			|last=Hart |first=Leslie A. |year=1975 |publisher=Basic Books
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			* ], pp. 316, 323.
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			{{refn |name=drinking|
	{{cite journal		{{cite journal
			|last=Hughes |first=C. D. |year=1897 |pages=315{{ndash}}23 |title=Neurological progress in America
	|work=Publications of the Massa{{shy}}chu{{shy}}setts Medical Society|volume=2 |pages=327{{ndash}}347<!--something somewhere says n3 of v2-->
			|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
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			* ], pp. 118, 316, 321.
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			{{refn |name=lying|
			]; ], pp. 119, 321.
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			], p. 9; ], p. 119.
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			{{refn |name=bullying|
			{{cite book
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			|isbn=978-0-697-07649-6 }}
			* ], p. 830; ], p. 321.
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			{{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
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			* ], p. 321.
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			{{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 |
	{{refn|name=lena_macm |{{cite news |last1=Lena |first1=M.{{thinsp}}L. |last2=Macmillan |first2=Malcolm B.
			] (1849). ''Records'' '''6'''. November 10. pp. 103–4.<!--need full citation-->
	|date=March 2010 |url=http://www.smithsonianmag.com/arts-culture/Letters-201003.html#article-text
	|title=Picturing Phineas Gage (Invited comment) |page=4<!-- is it volume=10 |issue=4? -->
	|work=]}} {{open access}}
	}}		}}
			{{refn |name=bramwell |{{cite journal
	{{refn|name=pgip |<br>{{cite web|last=Macmillan |first=Malcolm B. |year=PGIP |url=http://www.uakron.edu/gage/index.dot
			|last1=Bramwell |first1=B. |doi=10.1136/bmj.1.1425.835
	|title=The Phineas Gage Information Page |publisher=The University of Akron |accessdate=July 22, 2013 }} Includes:
			|title=The Process of Compensation and some of its Bearings on Prognosis and Treatment
	:A. {{cite web|url=http://www.uakron.edu/gage/sites-and-plaque.dot|title=Phineas Gage Sites in Cavendish}} {{open access}}
			|journal=BMJ |volume=1 |issue=1425 |pages=835{{ndash}}40 |year=1888 |pmid=20752265 |pmc=2197878
	:B. {{cite web|url=http://www.uakron.edu/gage/questions.dot|title=Phineas Gage: Unanswered questions}} {{open access}}
			}}}}
	:C. {{cite web|url=http://www.uakron.edu/gage/story.dot|title=Phineas Gage's Story}} {{open access}}
	:D. {{cite web|url=http://www.uakron.edu/gage/book.dot|title=Corrections to ''An Odd Kind of Fame''}} {{open access}}
	:E. {{cite web|url=http://www.uakron.edu/gage/adaptation.dot|title=Phineas Gage: Psychosocial Adaptation}} {{open access}}
	:F. {{cite web|url=http://www.uakron.edu/gage/lobotomy.dot|title=Phineas Gage and Frontal Lobotomies}} {{open access}}
	}}<!--<<end refn-->
	{{refn|name=macm_unravelling |<br><!--linebreak after long list of backlinks-->{{cite journal |last=Macmillan |first=Malcolm B. |year=2008 |publisher=]		{{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). }}
	|url=http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_21-editionID_164-ArticleID_1399-getfile_getPDF/thepsychologist%5C0908look.pdf
	|title=Phineas Gage{{mdashb}}Unravelling the myth |work=The Psychologist |volume=21 |number=9
	|pages=828{{ndash}}831.<!--Possible problem re pg#s, online vs paper?--check all cites to this-->}} {{open access}} }}
	{{refn|name=barker |{{cite journal |last=Barker |first=F.{{thinsp}}G.{{thinsp}}II |year=1995		{{refn |name=cobb1940 |{{cite journal
			|last=Cobb |first=Stanley |year=1940 |title=Review of neuropsychiatry for 1940
	|pmid=7897537 |title=Phineas among the phre{{shy}}nol{{shy}}o{{shy}}gists: the American crowbar case and nineteenth{{hyp}}century theories of cerebral localization
			|journal=Archives of Internal Medicine |volume=66 |issue=6 |pages=1341{{ndash}}54
	|work=Journal of Neurosurgery |volume=82 |pages=672{{ndash}}682 |doi=10.3171/jns.1995.82.4.0672 |issue=4}} {{closed access}} }}
			|doi=10.1001/archinte.1940.00190180153011
			}} {{closed access}} }}
	{{refn|name=fuster |{{cite book |last=Fuster |first= Joaquin M. |title=The prefrontal cortex		{{refn | name=cobb1943|{{cite book
			|last=Cobb |first=Stanley |year=1943 |title=Borderlands of psychiatry
	|publisher=Elsevier/{{zwsp}}Academic Press |year=2008 |page=172 |isbn=0-12-373644-7
			|url=https://archive.org/details/borderlandsofpsy0000cobb |url-access=registration |publisher=Harvard Univ. Press.<!--need pg number-->
	|url=http://books.google.com/books?id=zuZlvNICdhUC&lpg=PA172 }} {{closed access}} }}
			}} }}
	{{refn|name=grafman |{{cite book |last1=Grafman |first1=J.		{{refn |name=cooter|{{cite book
			|last=Cooter |first=Roger |year=1984 |page=
	|chapter=The Structured Event Complex and the Human Prefrontal Cortex |doi=10.1093/acprof:oso/9780195134971.003.0019
			|title=The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-century Britain
	|work=Principles of Frontal Lobe Function |editors=Stuss, D.{{thinsp}}T.; Knight, R.{{thinsp}}T.
			|publisher=Cambridge University Press |isbn=978-0-521-22743-8 |url=https://archive.org/details/culturalmeaningo00coot
	|pages=292{{ndash}}310|year=2002 |isbn=978-0-195-13497-1 }} {{closed access}} }}
			|url-access=registration }} }}
			{{refn |name=butler|{{cite web
	{{refn|name=kihlstrom |{{cite journal|url=http://ist-socrates.berkeley.edu/~kihlstrm/SocialNeuroscience07.htm |last=Kihlstrom |first=J.{{thinsp}}F. |year=2010 |title=Social neuroscience: The footprints of Phineas Gage |journal=Social Cognition
			|url=http://www.cromwellbutlers.com/fam_tree/p_gage.htm
	|volume=28 |pages=757{{ndash}}782 |doi=10.1521/soco.2010.28.6.757 |issue=6}} {{open access}} }}
			|last=Macmillan|first=Malcolm|title=Phineas Gage: The claim of Williams' priority
			|website=Butler Family
			}}}}
	{{refn|name=okf |<br><!--linebreak after long list of backlinks-->		{{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.
	{{cite book |last=Macmillan |first=Malcolm B. |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)}} {{open access}}<br>
	{{bullet}}See also . {{open access}} }}
	{{refn|name=cobb1940 |{{cite journal|last=Cobb |first=S |year=1940 |title=Review of neuropsychiatry for 1940		{{refn |name=damasioA_somatic|{{cite journal
			|title=The Somatic Marker Hypothesis and the Possible Functions of the Prefrontal Cortex
	|work=Arch Intern Med |volume=66 |pages=1341–54 }} }}
			|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
	{{refn|name=cobb1943 |{{cite book |author-mask=3 |last=Cobb |first=S |year=1943 |title=Borderlands of psychiatry
			|last1=Damasio |first1=A. R.|author-link1=Antonio Damasio |last2=Van Hoesen |first2=G. W.
	|publisher=Harvard Univ. Press.<!--need pg number--> }} }}
			|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=tyler |{{cite journal |last1=Tyler |first1=K.L. |last2=Tyler |first2=H.R.		{{refn |name=damasioA_descartes |{{cite book |ref=damasio1994
			|last=Damasio |first=Antonio R. |author-link=Antonio Damasio |publisher=Quill
	|year=1982 |title=A 'Yankee Invention': the celebrated American crowbar case
			|title=Descartes' error: emotion, reason, and the human brain |year=1994
	|work=Neurology |volume=32 |page=A191 }} {{closed access}} }}
			|url=https://books.google.com/books?id=MocSdi6LXCkC|isbn=978-0-380-72647-9
			}} {{closed access}} }}
	{{refn|name=bramwell |{{cite journal |last1=Bramwell |first1=B. |doi=10.1136/bmj.1.1425.835		{{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.
	|journal=BMJ |volume=1 |issue=1425 |pages=835–840 |year=1888 |pmid=20752265 |pmc=2197878
			|title=The return of Phineas Gage: Clues about the brain from the skull of a famous patient
	}} {{open access}} }}
			|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=macm_aggleton|<br>{{cite interview |last1=Macmillan |first1=Malcolm B.		{{refn |name=apex|{{cite book
			|last=Burton |first=Warren |author-link=Warren Burton (1800{{ndash}}1866) |location=New York |page=
	|last2=Aggleton |first2=John |interviewer=Claudia Hammond; Dave Lee |type=Audio interview
			|title=Uncle Sam's recommendation of phrenology to his millions of friends in the United States: In a series of not very dull letters
	|title=Phineas Gage: The man with a hole in his head |url=http://www.bbc.co.uk/news/health-12649555
			|url=https://archive.org/details/unclesamsrecomm00burgoog |year=1842 |publisher=Harper and Brothers
	|program=Health Check |callsign=BBC World Service |date=March 6, 2011 }} {{open access}} }}
			}}
			* {{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=twomey |{{cite journal |last=Twomey |first= S. |date=January 2010		{{refn |name=deaths|{{cite news
			|work=New Hampshire Statesman |date=July 21, 1860 |number=2042 |at=col. D |title=Deaths |location=Concord, New Hampshire
	|url=http://www.smithsonianmag.com/history-archaeology/78437017.html |title=Finding Phineas |pages=8{{ndash}}10
			}} }}
	|volume=40 |issue=10 |journal=] }} {{open access}} }}
	{{refn|name=wilgus2009a |{{cite journal |last=Wilgus |first=B.{{thinsp}}&{{thinsp}}J.		{{refn |name=departing|{{cite news
			|work=Daily Alta California|date=December 25, 1867 |at=p. 2 col. 4 |title=A Departing Supervisor
	|doi=10.1080/09647040903018402 |title=Face to Face with Phineas Gage
			}} }}
	|url=http://www.tandfonline.com/doi/full/10.1080/09647040903018402#preview
	|journal=Journal of the History of the Neurosciences |volume=18 |issue=3 |pages=340{{ndash}}345
	|year=2009 |pmid=20183215}} {{closed access}} }}
	{{refn|name=wilgus2009b |{{cite journal |last=Wilgus |first=B.{{thinsp}}&{{thinsp}}J.		{{refn |name=dupuy1873|{{cite book
			|last=Dupuy |first=Eugene |year=1873
	|title=Phineas Gage{{snd}}Hiding in Plain Sight <!--derre.o/soc'y-->
			|title=Examen de quelques points de la physiologie du cerveau
	|journal=The Daguerre{{shy}}i{{shy}}an Soci{{shy}}ety News{{shy}}let{{shy}}ter |volume=21 |issue=3 |pages=6{{ndash}}9 |date=
			|url=https://archive.org/details/b22353069 |location=Paris |publisher=Delahaye |language=fr
	July{{ndash}}September 2009}} }}
			}} }}
	{{refn|name=wilgus_meet |{{cite web |url=http://www.brightbytes.com/phineasgage/index.html		{{refn |name=dupuy1877 |{{cite journal
			|last=Dupuy |first=Eugene |year=1877 |volume=II |pages=356{{ndash}}58
	|title=Meet Phineas Gage |last=Wilgus |first=B.{{thinsp}}&{{thinsp}}J.|accessdate=October 2, 2009}} {{open access}} }}
			|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=wilgus_newimage |{{cite web |url=http://www.brightbytes.com/phineasgage/new_image.html		{{refn|name=ebenezer |{{cite book
			|last=Ebenezer|first=Ivor|title=Neuropsychopharmacology and Therapeutics |isbn=978-1-118-38565-4|page=123
	|title=A New Image of Phineas Gage |last=Wilgus |first=B.{{thinsp}}&{{thinsp}}J
			|url=https://books.google.com/books?id=mRbWBgAAQBAJ&pg=PA123|year=2015|publisher=John Wiley & Sons
	|accessdate=March 10, 2010}} {{open access}} }}
			}}}}
	{{refn|name=kotowicz |{{cite journal |last1=Kotowicz |first1=Z. |doi=10.1177/0952695106075178		{{refn |name=eliot |{{cite book
			|editor-last=Eliot |editor-first=Samuel Atkins |year=1911
	|title=The strange case of Phineas Gage |journal=History of the Human Sciences
			|title=Biographical History of Massachusetts: Biographies and Autobiographies of the Leading Men in the State
	|volume=20 |issue=1 |pages=115{{ndash}}131 |year=2007 }} {{closed access}} }}
			|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 |
	{{refn|name=macm_rehabilitating |<br><!--linebreak after long list of backlinks-->
			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.
	{{cite journal |last1=Macmillan |first1=Malcolm B. |last2=Lena |first2=M.{{thinsp}}L. |doi=10.1080/09602011003760527
			}}
	|title=Rehabilitating Phineas Gage |journal=Neuropsychological Rehabilitation |volume=20 |issue=5
	|pages=641{{ndash}}658 |year=2010 |pmid=20480430 }} {{closed access}} }}
			{{refn |name=ferrier1878 |{{cite journal |last=Ferrier |first=David |year=1878
	{{refn|name=macm_moreabout |<br><!--linebreak for consistency with other Macmillan cites nearby-->{{cite web |url=http://brightbytes.com/phineasgage/more.html
			|title=The Goulstonian lectures on the Localisation of Cerebral Disease. Lecture I (concluded)
	|title=More About Phineas Gage, Especially After the Accident |last=Macmillan |first=Malcolm B.
			|journal=British Medical Journal |volume=1 |number=900 |pages=443{{ndash}}47 |pmc=2220379 |pmid=20748815 |doi=10.1136/bmj.1.900.443
	|date=July 2009 |accessdate=July 27, 2013}} {{open access}} }}
			}}}}
			{{refn |name=fingers
	{{refn|name=ratiu_jneuro |{{cite journal |last1=Ratiu |first1=P. |last2=Talos |first2=I.{{thinsp}}F.
			|], p. 9; ], pp. 6, 19; ], pp. 16{{ndash}}17; ], p. 390; ], p. 86.
	|last3=Haker |first3=S. |last4=Lieberman |first4=D. |last5=Everett |first5=P.
			}}
	|title=The Tale of Phineas Gage, Digitally Remastered |doi=10.1089/089771504774129964
	|journal=Journal of Neurotrauma |volume=21 |issue=5 |pages=637{{ndash}}643 |year=2004 |pmid=15165371 }} {{closed access}} }}
			{{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=ratiu_nejm |{{cite journal |last1=Ratiu |first1=P. |last2=Talos |first2=I.{{thinsp}}F. |doi=10.1056/NEJMicm031024
			}} }}
	|title=The Tale of Phineas Gage, Digitally Remastered |journal=New England Journal of Medicine
	|volume=351 |issue=23 |pages=e21 |url=http://www.nejm.org/doi/full/10.1056/NEJMicm031024|year=2004
	|pmid=15575047 }} {{open access}} }}
	{{refn|name=vanhorn |{{cite journal |last1=Van Horn |first1=J.{{thinsp}}D. |last2=Irimia |first2=A.		{{refn |name=fowler |{{cite book
			|last=Fowler |first=O. S. |year=1838 |page=6
	|last3=Torgerson |first3=C.{{thinsp}}M. |last4=Chambers |first4=M.{{thinsp}}C.
			|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
	|last5=Kikinis |first5=R. |last6=Toga |first6=A.{{thinsp}}W.
			|url=http://pds.lib.harvard.edu/pds/view/2577557?n=6 |location=New York |publisher=Fowler & Wells
	|title=Mapping Connectivity Damage in the Case of Phineas Gage |doi=10.1371/journal.pone.0037454
			}}}}
	|journal=PLoS ONE|volume=7 |issue=5 |pages=e37454 |year=2012 |pmid=22616011 |pmc=3353935}} {{open access}} }}
			{{refn |name=cv_gage |{{cite book
	<!--not sure whether to add author=anonymous to these following-->
			|title=John Gage of Ipswich, Mass. and his descendants: an historical, genealogical and biographical record, as developed from sources explained herein
	{{refn|name=anonymous_bostonpost|{{cite news |date=Septem{{shy}}ber 21, 1848 |work=Boston Post
			|first=Clyde Van Tassel |last=Gage |location=Worcester, New York |publisher=C.V. Gage |year=1964
	|title=Horrible Accident}}<!--refer to Fig. #--> }}
			}} }}
	{{refn|name=amer_phren|{{cite journal |work=American Phrenological Journal |title=A most remarkable case |year=1851		{{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
	|volume=13|page=89<!--anonymous--><!--col. 3--><!--cite needs check see Macmillan 2000 p.349, check for online copy/link-->}} }}
			}}}}
	{{refn|name=anonymous_C|{{cite news |date=March 29, 1849 |work=National Eagle |page=2		{{refn |name=gall_sizer |{{cite book
			|last=Gall |first=Franz Joseph |series=The phrenological library. |editor-first=Nahum |editor-last=Capen
	|place=Claremont, New Hamp{{shy}}shire |title=Incredible, But True Every Word
			|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-->
	}}<!--<<end cite template-->
			|url=https://archive.org/details/onfunctionsbrai00gallgoog
	Transcribed in Macmillan (2000), pp. 40{{ndash}}1 <!--OKF p40n7 also gives reprint info-->}}
			|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
	{{refn|name=anonymous_ngray |''Volume 3: Lone Mountain register, 1850{{ndash}}1862'', Halsted N.{{nbsp}}Gray{{snd}}Carew{{nbsp}}&{{nbsp}}{{zwsp}}English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285. }}<!--chk exact cite/name of merged firm-->
			|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
	{{refn|name=anonymous_bmsj1869_1 |{{cite journal |title=Bibliographical Notice |work=Boston Medical{{nbsp}}& Surgical Journal |date=March 18, 1869 |volume=3{{thinsp}}n.s. |pages=116{{ndash}}7 |issue=7}} }}
			|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
	{{refn|name=anonymous_bmsj1869_2 |{{cite journal |title=Medical Intelligence. Extraordinary Recovery |work=Boston Medical{{nbsp}}& Surgical Journal |date=April 29, 1869 |volume=3{{thinsp}}n.s. |pages=230{{ndash}}1 |issue=13}} }}
			|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
	{{refn|name=austin|{{cite book |last=Austin |first=K.{{thinsp}}A. |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 }} }}
			|last=Hammond |first=W. A. |year=1871|title=A Treatise on the Diseases of the Nervous System
			|location=New York|publisher=Appleton
			}} }}
	{{refn|name=bigelow |<br><!--linebreak after long list of backlinks-->{{cite journal |last=Bigelow |first=Henry Jacob		{{refn |name=hansen|{{cite journal
			|last=Hansen |first=Bert |date=April 1998 |journal=American Historical Review
	|work=] |volume=20 |pages=13{{ndash}}22
			|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
	|title=Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head
			|jstor=2649773 |pmid=11620083 }} }}
	|url=http://books.google.com/books?id=pgMHAAAAcAAJ&pg=PA12-IA2 <!--https://archive.org/stream/orthopedicsurge00bige#page/172/mode/2up may have(?) ocr usable at Wikisource-->
	|date=July 1850<!--<<July is per Harlow 1868-->}} }}
			{{refn |name=hayward |{{cite journal
	{{refn|name=macm_obscure |<br><!--linebreak for consistency with other Macmillan cites before and after-->{{cite journal |author-mask=3 |last1=Macmillan |first1=Malcolm B.
			|last=Hayward|first=Rhodri|title=''An Odd Kind of Fame: Stories of Phineas Gage'' by Malcolm Macmillan
	|title=John Martyn Harlow: Obscure Country Physician? |doi=10.1076/jhin.10.2.149.7254
	|journal=Journal of the History of the Neurosciences |volume=10 |issue=2		|journal=British Journal for the History of Science|date=December 2002
			|volume=35|issue=4|pages=479{{ndash}}81|jstor=4028281
	|pages=149–162 |year=2001 |pmid=11512426 }} {{closed access}} }}
			}} }}
			{{refn |name=heart |{{cite book
	{{refn|name=campbell |{{cite journal|last=Campbell |first=H.{{thinsp}}F. |year=1851 |title=Injuries of the Cranium{{mdashb}}] |work=Ohio Medical{{nbsp}}& Surgical Journal |volume=4 |number=1 |pages=20{{ndash}}24 |postscript=}} (crediting the ''Southern Medical{{nbsp}}& Surgical Journal'' (unknown date). }}
			|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|
	{{refn|name=carlson |{{cite book |last=Carlson|first= N.{{thinsp}}R. |title=Physiology of Behavior |year=1994 |page=341 |isbn=0-205-07264-X}} }}
			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 |
	{{refn|name=damasioA1994 |{{cite book |last=Damasio |first=A.{{thinsp}}R. |year=1994
			] (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).
	|title=Descartes' Error: Emotion, Reason, and the Human Brain |isbn=0-14-303622-X |authorlink=Antonio R. Damasio }} (2nd ed.:2005) }}
			}}
	{{refn|name=damasioH1994 |{{cite journal |last1=Damasio |first1=H. |last2=Grabowski |first2=T.		{{refn |name=jackson1870 |{{cite book
			|last=Jackson |first=J. B. S. |year=1870 |at=Frontis. and Nos. 949{{ndash}}51, 3106
	|last3=Frank |first3=R. |last4=Galaburda |first4=A.{{thinsp}}M. |last5=Damasio |first5=A.{{thinsp}}R.
			|url=https://books.google.com/books?id=F8UZAAAAIAAJ&pg=PA145|location=Boston|publisher=A. Williams & Co.
	|title=The return of Phineas Gage: Clues about the brain from the skull of a famous patient
			|title=A Descriptive Catalog of the Warren Anatomical Museum|author-link = J. B. S. Jackson
	|doi=10.1126/science.8178168 |journal=Science |volume=264 |issue=5162 |pages=1102{{ndash}}1105 |year=1994
			}}}}
	|pmid=8178168 }} {{closed access}} }}
			{{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=dupuy |{{cite journal |last=Dupuy |first=Eugene |year=1877 |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{{nbsp}}II. |url=http://books.google.com/books?id=ppYEAAAAQAAJ&pg=PA356 |work=Med Times{{nbsp}}& Gaz. |volume=II |pages=356{{ndash}}8}} {{open access}} }}
	{{refn|name=eliot|{{cite book|editor-last=Eliot |editor-first=Samuel Atkins|year=1911		{{refn|name=jarrett2|{{cite book
			|last=Jarrett|first=Christian|title=Great Myths of the Brain
	|chapter=John M. Harlow |chapter-url=http://books.google.com/books?id=1S0EAAAAYAAJ&pg=PT136
			|url=https://books.google.com/books?id=fBPyBQAAQBAJ&pg=PA38
	|work=Biographical History of Massa{{shy}}chu{{shy}}setts: Biographies and Autobiographies of the Leading Men in the State
			|year=2014|publisher=John Wiley & Sons|isbn=978-1-118-31271-1|pages=38–39
	|volume=1 |publisher=Massa{{shy}}chu{{shy}}setts Biographical Society <!--book is unpaginated-->}} {{open access}} }}
			}} }}
	{{refn|name=ferrier1877_9 |{{cite journal|last=Ferrier |first=David |year=1877{{ndash}}79		{{refn |name=jewett |{{cite journal
			|last=Jewett |first=M. |year=1868 |title=Extraordinary Case of Recovery after Severe Injury to the Head
	|title=Correspondence with Henry Pickering Bowditch}}<!--<<end cite template-->
			|journal=Western Journal of Medicine |volume=3 |page=151{{ndash}}2
	Countway Library (Harvard Univ.) Mss., HMSc5.2. Transcribed in Macmillan (2000).{{r|okf|page=464{{hyp}}5}}<!--chk final fmt incl detailed punct against Countway catalog cite--> }}
			}} 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=ferrier1878 |{{cite journal |last=Ferrier |first=David |year=1878
	|title=The Goulstonian lectures of the localisation of cerebral disease. Lecture{{nbsp}}I (concluded)
	|work=Br Med J |volume=1 |number=900 |pages=443{{ndash}}7 }} }}
			{{refn |name=macmillan_encyc |{{cite book
	{{refn|name=folsom |{{cite news |last=Folsom |first= A.{{thinsp}}C.|work=Pacific Medical and Surgical Journal |title=Extraordinary Recovery from Extensive Saw{{hyp}}Wound of the Skull |date=May 1869 |pages=550{{ndash}}555}} }}
			|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
	{{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
			|last=Mann|first=Mark H. |url=https://books.google.com/books?id=1fgbos7LTIAC
	|year=1838|url=http://pds.lib.harvard.edu/pds/view/2577557?n=6|page=6|location=New York|publisher=Fowler{{nbsp}}& Wells
			|title=Perfecting Grace: Holiness, Human Being, and the Sciences |year=2006|publisher=A&C Black
	}}{{nbsp}}{{open access}} }}
			|isbn=978-0-567-02553-1|page=53
			}} {{closed access}}}}
	{{refn|name=harlow1848 |<br><!--linebreak after long list of backlinks-->{{cite journal		{{refn|name=mazzoni |{{cite book
			|last1=Mazzoni|first1=Giuliana|last2=Nelson|first2=Thomas O.
	|last=Harlow |first=John Martyn |year=1848 |volume=39 |title=Passage of an Iron Rod Through the Head
			|title=Metacognition and Cognitive Neuropsychology: Monitoring and Control Processes
	|number=20<!--no. 20 is per Harlow 1868--> |pages=389{{ndash}}393
			|url=https://books.google.com/books?id=RH2OAwAAQBAJ&pg=PA57|year=2014
	|url=https://www.countway.harvard.edu/menuNavigation/chom/warren/exhibits/HarlowBMSJ1848.pdf
			|publisher=Psychology Press|isbn=978-1-317-77843-1|pages=57–58
	|work=]
	}} {{open access}}		}}}}
	(].)}}
	{{refn|name=harlow1849 |{{cite journal |last=Harlow |first=John Martyn		{{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=1849<!--get specific date--> |title=Medical Miscellany (letter)
			|year=1861|location=New York |publisher=Follett, Foster and Company
	|work=]
			|url=https://books.google.com/books?id=lzUgHAAACAAJ |pages=73{{ndash}}78
	|volume=39 |page=507 }} Reproduced in Macmillan (2000).{{r|okf<!--page# also full text at commons? (or just 1868?)-->}} }}
			}}}}
			{{refn |name=memoir_hjb |{{cite book
	{{refn|name=hockenbury |{{cite book|last1=Hockenbury |first1=Don H. |last2=Hockenbury |first2=Sandra E. |year=2008 |title=Psychology |page=74 |isbn=978-1-429-20143-8 }} {{closed access}} }}
			|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
	{{refn|name=jackson1849 |{{cite journal |last=Jackson |first=J.B.S. |year=1849 |work=Medical Cases |volume=4 |number=Case 1777 }}<!--<<end cite template-->
			|last1=Mitchell |first1= B. D. |first2=B. D. |last2=Fox |first3= W. E. |last3=Humphries
	Countway Library (Harvard Univ.) Mss., HMSb72.4.<!--isn't this imaged/transcribed in OKF? chk from OKF for all img/transcribes-->
			|first4= A. |last4=Jalali |first5=S. |last5=Gopinath |year=2012
	<!--Get pg no & check case no--><!--chk final fmt incl detailed punct against Countway catalog cite--> }}
			|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=jackson1870 |{{cite journal |last=Jackson |first=J.{{thinsp}}B.{{thinsp}}S.		{{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
	|chapter=Frontis. and Nos. 949{{ndash}}51,3106 |url=http://books.google.com/books?id=F8UZAAAAIAAJ
			|title=Notes. Lodgement of Foreign Bodies in the Brain
	|title=A De{{shy}}scrip{{shy}}tive Catalog of the Warren Anatomical Museum }} Reproduced in Macmillan (2000),<!--get pg#s and integrate "in which see also"; review fmt of "chapter" vs catalog #, fronis. ref--> in which see also p.107.<!--<<um, what is this?--> {{open access}} }}
			|url=https://books.google.com/books?id=FWIsAAAAYAAJ&pg=RA1-PA62
			}} }}
			{{refn |name=northstar |{{cite news |ref=anonymous_northstar
	{{refn|name=jewett |{{cite journal |last=Jewett |first=M. |title=Extraordinary Recovery after Severe Injury to the Head
			|author=<!--anon--> |work=North Star |location=] |date=November 6, 1848
	|work=Western Journal of Medicine |volume=43 |pages=241 |year=1868
			|title=Alive from the Dead, Almost |at=p. 1, col. 2
	|url=http://books.google.com/books?id=yd5XAAAAMAAJ }} {{closed access}} }}
			}} Transcribed in ], pp. 39{{ndash}}40}}
			{{refn |name=nyt_additional |{{cite news
	{{refn|name=vanderstoep|{{cite journal |last1=Vanderstoep |first1=S.{{thinsp}}W. |last2=Fagerlin |first2=A.
			|work=] |date=March 1, 1860 |page=11 |title=Additional from Chile
	|last3=Feenstra |first3=J.{{thinsp}}S. |doi=10.1207/S15328023TOP2702_02 |volume=27 |issue=2 |pages=89 |year=2000
			|url=https://www.nytimes.com/1860/03/01/news/additional-chile-new-crops-commissions-authorized-valparaiso-chamber-commerce.html
	|title=What Do Students Remember from Introductory Psychology? |journal=Teaching of Psychology
			}} }}
	|url=http://faculty.weber.edu/eamsel/Classes/Practicum/TA%20Practicum/papers/VandersStoep%20et%20al%20(2000).pdf
	}} {{open access}} }}
			{{refn |name=ordia|{{cite journal
	{{refn|name=jackson1849 |{{cite journal |last=Jackson |first=J.B.S. |year=1849 |work=Medical Cases |volume=4 |number=Case 1777 }}<!--<<end cite template-->
			|last=Ordia |first=J. I. |year=1989
	Countway Library (Harvard Univ.) Mss., HMSb72.4.
			|title=Neurologic function seven years after crowbar impalement of the brain
	<!--Get pg no & check case no--><!--chk final fmt incl detailed punct against Countway catalog cite--> }}
			|journal=Surgical Neurology |volume=32 |issue=2 |pages=152{{ndash}}55 |doi=10.1016/0090-3019(89)90204-8
			|pmid=2665157 }} }}
	{{refn|name=sutton |{{cite journal |last=Sutton |first=W.{{thinsp}}L.		{{refn|name=pancoast|{{cite book
			|last=Pancoast |first=Joseph |year=1852 |page=
	|title=A {{sic|Centre<!--<<do not Americanise!-->|hide=y}} Shot
			|publisher=A. Hart |location=Philadelphia |edition=3rd
	|work=Boston Medical{{nbsp}}& Surgical Journal |volume=3 |pages=151{{ndash}}2 |year=1850
			|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=http://books.google.com/books?id=r8o9AQAAMAAJ&pg=PA241 }} {{open access}} }}
			|url=https://archive.org/details/66850910R.nlm.nih.gov
			}}}}
			{{refn|name=pelham|{{cite book
	{{refn|name=sacks |{{cite book |last=Sacks |first= Oliver |title=An Anthropologist on Mars |year=1995 |pages=59{{ndash}}61 |isbn=0-679-43785-1 |oclc=30810706 |url=http://books.google.com/books?id=9HQIHnREqhkC&lpg=PT90&pg=PT90 }} {{closed access}} }}
			|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
	{{refn|name=sizer|{{cite book |last=Sizer |first=Nelson |year=1888 |title=Forty years in phrenology; embracing recollections of history, anecdote, and experience |publisher=Fowler{{nbsp}}& Wells |location=New York |url=http://books.google.com/?id=xicZAAAAYAAJ&pg=PA313#PPA194}} {{open access}} }}
			|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=smith |{{cite news |last=Smith |first=William T. |year=1886		{{refn|name=pott|{{cite book
			|author=Pott, Percivall
	|url=http://books.google.com/books?id=jcwDAAAAYAAJ&pg=PA46 |title=Lesions of the Cerebral Hemi{{shy}}spheres
			|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 ...
	|work=Transactions of the Vermont Medical Society for the Year 1885 |pages=46{{ndash}}58 }} {{open access}} }}
			|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
	{{refn|name=stuss |{{cite journal |last1=Stuss |first1=D.{{thinsp}}T.|last2=Gow |first2=C.{{thinsp}}A. |last3=Hetherington |first3=C.{{thinsp}}R. |doi=10.1037/0022-006X.60.3.349
			|url=http://www.sfgenealogy.com/sf/history/hcmcpr.htm|year=1950
	|title={{thinsp}}<!--<<thinsp separates ' at start of title from " automatically added by template-->
			|archive-url=https://web.archive.org/web/20120702064233/http://www.sfgenealogy.com/sf/history/hcmcpr.htm
	'No longer Gage': Frontal lobe dysfunction and emotional changes |journal=Journal of Consulting and Clinical Psychology |volume=60 |issue=3 |pages=349{{ndash}}359 |year=1992 |pmid=1619089 }} {{closed access}} }}
			|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
	}}<!--<<end reflist-->
			|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
	==External links==
			|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
	]<!--<<this img is in External Links section because it relates to the Warren Museum link, below-->
			|title=Clinical Case Reports in mental health: the need for nuance and context
	{{stack|{{Wikisource-author}}{{commons}}<!-- why is this a Commons "page" instead of (presumably broader) category?-->}}
			|first1=Toby |last1= Raeburn |first2=Debra |last2=Jackson |first3=Garry |last3=Walter |first4=Phil |last4=Escott |first5=Michelle |last5=Cleary
	* , Center for the History of Medicine, Francis A. Countway Library of Medicine (Harvard Medical School){{mdashb}}Home of Gage's skull and iron.
			|doi=10.1002/ccr3.193|pmid = 25548621|pmc=4270701|journal=Clinical Case Reports
	* {{mdashb}}How the owners of the 2009{{hyp}}identified daguerre{{shy}}otype learned it depicted Gage.
			|volume=2|issue=6|pages=241{{ndash}}42|date=December 2014
	* , Cavendish, Vermont
			}}}}
			{{refn |name=sacks |{{cite book
	{{Persondata
			|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
	| NAME = Gage, Phineas
			}} {{closed access}} }}
	| ALTERNATIVE NAMES = Gage, Phineas P.
	| SHORT DESCRIPTION = Landmark medical case (brain injury)
			{{refn |name=silvestro |{{cite web
	| DATE OF BIRTH = July 9, 1823
			|url=https://hms.harvard.edu/news/new-view-phineas-gage | website=Harvard Medical School News
	| PLACE OF BIRTH = ], N.H.
			|title=A New View of Phineas Gage|last=Silvestro | first=Sara|date=June 24, 2016
	| 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
			{{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}}
	]		]
	]		]
	]		]
	]
	]		]
			]
			]
			]
			]
			]
			]
	]		]
	]		]
	]		]
	]		]
			]
			]

---

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).
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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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