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“No longer Gage”: an iron bar through the head

BMJ 1998; 317 doi: (Published 19 December 1998) Cite this as: BMJ 1998;317:1673

Early observations of personality change after injury to the prefrontal cortex

  1. Kieran O'Driscoll, Consultant neuropsychiatrist.,
  2. John Paul Leach, Specialist registrar in neurology
  1. Department of Neuroscience, Walton Centre for Neurology and Neurosurgery, Fazakerley Hospital, Liverpool, L9 7LJ

    In September 1848, in Cavendish, Vermont, an incident occurred which was to change our understanding of the relation between mind and brain. Phineas P Gage, a 25 year old railroad foreman, was excavating rock. In preparation for blasting he was tamping powder into a drill hole when a premature explosion drove the tamping iron —.1.1  m long, 6 mm in diameter, and weighing 6 kg — through his left cheek and out of the vault of his skull with such force that it threw him on his back and fell several rods behind, “smeared with brain.”1 Despite his injuries he remained conscious and only a few minutes later was sitting in an ox cart writing in his work book. He recognised and reassured Dr Harlow, who had been summoned to the scene. The wound continued to bleed for two days; then followed a virulent infection that rendered Gage semiconscious for a month. His condition was so poor that a coffin had been prepared. Nevertheless, Dr Harlow continued treatment, and by the fifth week the infection had resolved and Gage had regained …

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