New research surfaces on famed Cavendish accident

New research on one of history’s most intriguing medical oddities has rekindled interest in the curious case of Phineas P. Gage.
http://www.eagletimes.com/news/2012-08-01/Front_Page/New_research_surfaces_on_famed_Cavendish_accident.html

New research surfaces on famed Cavendish accident Findings spark renewed interest in case By CHRIS GAROFOLO Staff Writer A memorial plaque in Cavendish commemorating Phineas Gage shows the direction of the 13-pound, 3.5-foot-long metal rod blown through his skull in September 1848. CHRIS GAROFOLO PHOTO A memorial plaque in Cavendish commemorating Phineas Gage shows the direction of the 13-pound, 3.5-foot-long metal rod blown through his skull in September 1848. CHRIS GAROFOLO PHOTO New research on one of history’s most intriguing medical oddities has rekindled interest in the curious case of Phineas P. Gage, the 25-year-old railroad worker who survived a massive brain injury after a tamping rod burst through the left side of his head more than 160 years ago in rural Cavendish. The latest round of Gage research from UCLA’s Laboratory of Neuro Imaging found his brain was more impaired then initially reported, estimating he lost small amounts of his cerebral cortex and more than 10 percent of his total white matter. The springtime study goes beyond previous work in the Gage case by looking closer at the light matter damage, providing more widespread insight to his injuries. “When we modeled the trajectory of the famous tamping iron, we discovered that he certainly did have damage to his cerebral cortex. In fact about 4 percent or so of his cerebral cortical value was lost, but we also noted that up to 11 percent of his white matter fibers had been effected by the tamping iron,” said Dr. Jack Van Horn, an assistant professor at UCLA and neurologist at the university’s laboratory. The increasing loss of white matter, which Van Horn called the “information superhighway of the brain,” could explain his significant personality change after the rod traveled through a portion of his skull, disrupting his neural connections. “We certainly think it was a significant contributor to some of the personality and behavioral changes he was believed to have experienced, that’s for sure,” he said. Considered the first distinguished brain injury patient, Gage survived his unbelievable injury in 1848 to live another 12 years, notwithstanding the complete changes in his personality from “an affable 25- year-old to one that was fitful, irreverent and profane,” according to the notes from his physician John M. Harlow. The young Cavendish doctor found his patient started showing “little deference for his fellows” and was so “impatient and obstinate, yet capricious and vacillating” that he was “no longer Gage.” Margo Caulfield, coordinator of the Cavendish Historical Society, said a renewed curiosity has come from the new knowledge stemming from UCLA traumatic brain study. The society will host a presentation later this month to discuss the latest research in Gage’s accident. “The reason that we’re doing it this year is we started getting phone calls. We did one last year for the 150th anniversary [of his death] and we’re doing it this year because we’ve had a number of inquires and phone calls based on the new research, so we said let’s address that,” she said. “It’s a curiosity for people ... people see it was right here in Cavendish and they come here.” Caulfield, who has an intensive history of working with traumatic brain injuries during her tenure at the Maryland Institute of Emergency Medical Services Systems, will host the presentation beginning at 2 p.m. on Aug. 12 at the Cavendish museum along Route 131. “People are fascinated by him simply because he was the first real documented case of brain injury and his significance is because Harlow did such a good job of documenting his behavior,” Caulfield said. “He’s a footnote to the work that’s really being done in brain injuries today and it is a fascinating piece of history.” Van Horn, who worked for seven years at Dartmouth College in Hanover, N.H., said his laboratory sampled 110 men similar to Gage (righthanded Caucasian males between the ages of 25-36) and mathematically combined a CAT scan of Gage’s skull with the database participants by using a new technique that modeled the tamping iron’s pathway through his head to detect and measure the damage. “It’s interesting in a historical context. Obviously for Mr. Gage’s case, it gives us some new insight into the extent of damage and how that might have effected his personality and behavioral changes, but Neuro-imaging technologies that we utilized would be very appropriate for looking at modern-day neurological traumatic brain injury patients,” Van Horn said. For decades, the Gage case remained part myth and part medical miracle. He has been the feature of online videos, excessively discussed within medical journals and a centerpiece for magazine and newspaper clippings. Most recently, the Los Angeles Times and Smithsonian magazine have penned fresh articles about a newfound Gage photograph or the medical studies at UCLA. Gage worked as a construction foreman for the Rutland & Burlington Railroad when, on Sept. 13, 1848, a miscue in handling the blasting powder shot a 13-pound iron rod cleanly through his skull. The rod was found an estimated 30 yards away with brain tissue remains still on the metal. Information passed down through the generations say he was taken on an ox cart to a nearby boarding house where Harlow and another doctor closed the wound with adhesive straps and a wet compass covering the opening. Gage remained there for 10 weeks before returning to his New Hampshire home. A marker in Cavendish depicts the accident and an ongoing timeline of his life. The historical society has mapped a self-guided tour that includes the alleged site of the accident. Within the museum is hundreds of articles, research pages and posters chronicling Gage’s journey, which took him from one odd job to the next. He worked as a stable hand at the Dartmouth Inn, drove coaches in the South American country of Chile and even exhibited himself at Barnum’s American Museum in New York. “We do have evidence that he did go around and promote himself as an oddity,” Caulfield said. Gage began to have epileptic seizures in February 1860 that led to his death on May 21 of that year, she added. Seven years later, his body was exhumed for study and eventually his skull and tamping iron were donated to the Harvard Medical School’s Warren Anatomical Museum, where they remain on display today. “It’s what people come to see. It is the most wellknown medical case in the museum and most people who come to the gallery come to see Phineas Gage’s skull and the tamping iron that caused the injury,” said Dominic Hall, curator of the Boston museum. “If you look at the iron, you really get an appreciation for just how large this projectile is and the fact that he survived and went on to live 12 years.” Gage allegedly carried the rod with him throughout the rest of his life. He proudly holds with both hands the iron that punctured his skull in the most famous daguerreotype taken of him. “He generates a lot of medical interest, but also generates a lot of public and popular interest as well,” Hall said. “It is such a remarkable story of survival.”