Cavendish Historical Society News: Phineas Gage: Handout from 173rd Anniversary Walk & Talk

Monday, September 13, 2021

Phineas Gage: Handout from 173rd Anniversary Walk & Talk

Today, Sept. 13, is the 173rd anniversary of the Phineas Gage accident. Below is the handout from yesterday's Walk & Talk.

TIMELINE

Life in 1848: California Gold Rush begins; Seneca Falls Convention (first women’s rights group); Cholera epidemic in New York kills 5,000; French Revolution; The Communist Minifesto is published; Boston Public Library is founded; Wisconsin becomes the 30^th state; James Polk is president; the first medical school for women opens in Boston; the Great Famine continues in Ireland; injuries very common from falls, horse kicks and gunfire; doctors were not required to be licensed.

1844: John Martyn Harlow graduates from Jefferson Medical College in Philadelphia. While there learns about trepanning to drain pus from a head injury, a technique he would use on Gage. He kept the exit wound open at the base of the skull for drainage

1844-1857: Harlow practiced medicine in Cavendish. Left due to poor health

1846 Dr. Jacob Bigelow publishes "Insensibility during Surgical Operations Produced by Inhalation". Boston Med Surg J. 35 (16): 309–317. detailing the discovery of ether anesthesia. 200 years later his article is voted the most important article in NEJM.

1848, Sept. 13: Phineas Gage accident

1848, Nov. 25: Approximately 10 weeks after his accident, Gage returns to his parents home in Lebanon, NH

Dec. 1848 Harlow authors: "Passage of an iron rod through the head". Boston Medical and Surgical Journal. 39 (20): 389–393. Follow up note appears the early part of 1849

Feb. 1949: "Able to do a little work about the horses and barn, feeding the cattle etc. [and] as the time for ploughing came [i.e. about May or June] 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.

April 1849: Returns to Cavendish and visits Harlow who notes loss of vision in the left eye. “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 [51 by 38 mm] 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.”

Nov. 1849: Bigelow, Professor of Surgery at Harvard, brings 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

1850: Bigelow brought the Phineas Gage case out of complete obscurity into merely relative obscurity, and largely neutralized remaining scepticism about the case."Dr. Harlow's case of Recovery from the passage of an Iron Bar through the Head". American Journal of the Medical Sciences. 20 (14): 13–22. Note that the Boston Medical and Surgical Journal becomes the New England Journal of Medicine

Aug. 1852: Gage goes to work as a long distance stage coach driver on the Valpariso -Santiago route in Chile.

1859: Due to ill health, Gage goes to San Francisco to be with his family, aarriving (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." Recovers sufficiently to work for a farmer in Santa Clara

May 21 1860 Phineas Gage dies in San Francisco from epilepsy

1868: Harlow authors "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)

INJURY & RECOVERY

Gage’s Injury: When the tamping rod entered under the left check bone and exited his head, the left frontal lobe was damaged. Gage’s behavior post accident was described as impulsive, bad-tempered ne'er-do-well whose "friends and acquaintances said he was 'no longer Gage.'"

Research from UCLA Laboratory of Neuro Imaging: Part of the Human Connectome Project.

• Gage’s brain damage was far more profound and widespread than previously thought

• Estimated he lost small amounts of his cerebral cortex (4%) and more than 10% of his total white matter (the information superhighway of the brain). Some white matter was wiped out completely, others partially severed

• Brain damaged between frontal cortex and limbic system (emotions)

Neuroplasticity/Neuorgenesis: The human brain is a highly dynamic and constantly reorganizing system capable of being shaped and reshaped across an entire lifespan. Experience and environment alters the brain’s organization at some level. The key words in this new approach to the brain are neuroplasticity and neurogenesis.. Neuroplasticity is the ability of the brain to form new connections and pathways and change how its circuits are wired in response to the stimulation of learning and experience. Neurogenesis is the ability of the brain to grow new neurons. Fred “Rusty” Gage, a cousin of Phineas Gage, discovered that the human brain continues to produce new nerve cells into adulthood.

TRAUMATIC BRAIN INJURY RESOURCES

• Brain Injury Association of VT 877-856-1772

• Brain Injury Assoc of NH 800-773-8400 (Family Helpline; 800-444-6443 (Information and Resources only) Can download “NH Resource Directory Brain Injury & Stroke 10^th Edition,” lots of good information

• National Toll Free Brain Injury Resource Line 800-444-6443

• Cavendish Health & Senior Resources: Includes “Getting What You Need: A Checklist” that helps with planning and understanding resource availability locally.

• My Stroke of Insight by Dr. Jill Bolte Taylor: Includes Forty Things I Needed Most. TED Talk