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{{Infobox person
|name         = Phineas P. Gage
|image        = Phineas Gage Cased Daguerreotype WilgusPhoto2008-12-19 Unretouched Color.jpg
|image_size   = 150px
|caption      = The first identified (2009) portrait of Gage, here with his "constant companion for the remainder of his life"{{Citation needed|date=January 2014}}—his inscribed tamping iron.
|birth_date   = July 9, 1823 (date uncertain){{r|okf|page=491}}
|birth_place  = [[Grafton County, New Hampshire|Grafton Co., New Hampshire]] (uncertain){{r|okf|page=491}}
|death_date   = {{death date and age|1860|05|21|1823|07|09}}<!--1860 is correct despite Harlow (1868) reporting 1861; see Macmillan 2000 p108 -->
|death_place  = In or near [[San Francisco]]<!--cite covers death date, place}--><!--chk covers "or near"-->
|death_cause  = ''[[Status epilepticus]]''
|occupation   = {{hlist | Railroad construction foreman | [[Rock blasting|blaster]] | stagecoach driver }}
|spouse=None |children=None{{r|okf}}{{rp|319,327}}<!--Please don't remove spouse, children even though values are None-->
|residence    = {{hlist|[[New England]] | [[Chile]] | [[California]] }}
|home_town    = [[Lebanon, New Hampshire]]{{r|okf|page=491}}
|resting_place = {{plainlist|
*{{hanging indent|text=[[Warren Anatomical Museum]], Boston<small> ''(skull)''</small>}}
*{{hanging indent|text=[[Cypress Lawn Memorial Park]], California<small> ''(other remains)''</small>}}
}}<!--end resting_place plainlist-->
|known_for    = Personality change after [[brain injury]]
}}<!--<<END INFOBOX--> 

'''Phineas P. Gage''' (1823–1860)<!--<<as allowed by MOS, giving only years (not month, day) for birth/death in lead because exact birthdate is uncertain; see Macmillan 2000 pp.6,11 (full dates and explanation in infobox and its notes)--> was an American railroad 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 so profound that (for a time at least) friends saw him 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 [[physiology|physiological]] doctrines"{{r|campbell}} Phineas Gage influenced 19th-century discussion about the mind and brain, particularly debate on [[cerebral localization]], and was perhaps the first case to suggest that damage to specific parts of the brain might affect personality.{{r|okf|page1=ch7-9|barker}}<!--<<these cover cerebral localization-->

Gage is a fixture in the curricula of [[neurology]], [[psychology]] and [[Portal:neuroscience|related disciplines]], and is frequently mentioned in books and academic papers; he even has a minor place in popular culture. Despite this celebrity<!--add cites here or just prior re examples of "celebrity"--> the body of established fact about Gage and what he was like (before or after his injury) is small, which has allowed "the fitting of almost any theory [desired] to the small number of facts we have"{{r|okf|page=290}}—Gage having been cited, over the years, in support of various theories of the brain entirely inconsistent with one another. A survey of published accounts, including scientific ones, has found that they almost always severely distort Gage's behavioral changes, exaggerating the known facts when not directly contradicting them.

Two photographs of Gage, and a physician's report of his physical and mental condition late in life, were published in 2009 and 2010.
This new evidence indicates that Gage's most serious mental changes may have been temporary, so that in later life he was far more functional, and socially far better adjusted, than was previously assumed.
A [[#Social recovery|social recovery hypothesis]] suggests that Gage's employment as a [[stagecoach]] driver in Chile provided daily structure allowing him to relearn lost social and personal skills.

==Background==
[[File:RailroadCutCavendishVermontPresumedToBePhineasGageAccidentSite cropped.jpg|thumb|left|Line of the [[Rutland Railway|Rutland & Burlington Railroad]] passing through [[cut (earthmoving)|cut]] in rock south of Cavendish]]

The details and records on Gage's early life are few in number, but Phineas Gage was the first of five children born to Jesse Eaton Gage and Hannah Trussell Swetland Gage.{{r|okf|page=16-17}} According to C.V. Gage's genealogy, Gage's father, Jesse Gage, was born in Enfield, New Hampshire on April 1, 1798.{{r|okf|page=491}} His mother Hannah Swetland was born on December 27, 1797 in Lebanon, New Hampshire.{{r|okf|page=491}}{{efn-ua|Gage's mother's name has been variously spelled. The first name as "Hanna" or "Hannah", the second name as "Trusel" and "Trussel" and her maiden name as "Swetland", "Sweatland", or "Sweetland". Macmillan uses the spellings found in the 1907 Swetland genealogy.{{r|okf|page=490}}}} The two married on April 27, 1823 in Lebanon.{{r|okf|page=491}} No record gives location of Gage's birth or birthdate,{{r|okf|page=16}} but the genealogy states it was July 9, 1823 in Lebanon.{{r|okf|page=491}} Gage's second name is unknown, but it is most commonly listed as P, but has also been written as B.{{r|okf|page=490}}{{efn-ua|Macmillan notes that it was unlikely that "Phineas" would be his second name, and notes that his uncle, Dexter, had the second name of "Pritchard".{{r|okf|page=490}}}} There are no known surviving records for Gage's early life, but Macmillan assumes that Gage may have been raised in Lebanon and that Gage attended school and was literate.{{r|okf|page=16}} The schools in Grafton County at the time were criticized for their inadequacy, Macmillan wrote that if Gage grew up on his grandfather's farm, the nearest school would have been Grafton Pond school. Macmillan writes that Gage may have gained skill with explosives on the farms or from [[Mica#Isinglass|isinglass]] mines.{{r|okf|page=17-18}}

By the time of his accident he was a [[Rock blasting|blasting]] foreman on railway construction projects. He was not employed by Rutland and Burlington Railroad, but instead a construction firm, possibly Decker and Warner.{{r|okf|page=18}} It is unknown if he was a subcontractor or employed directly by his employer, but Macmillan writes that he may have been a subcontractor.{{r|okf|page=21}} His employers considered him as an efficient and capable foreman.{{r|okf|page=21}} Gage commissioned a custom-made tamping iron—an iron rod {{convert|43|in|cm}} long, and {{convert|1.25|in|cm}} in diameter—for use in setting charges.{{r|okf|page=25-26}}

==Gage's injury==
[[File:CavendishVermont 1869Map Beers AnnotatedPhineasGageLocations.jpg|thumb|[[Cavendish, Vermont]] about 20 years after Gage's accident:<!---explain re new map, old locations-->''(A)'' The two possible accident sites, ''(T)'' Gage's lodgings, ''(H)'' Harlow's home and surgery]]
On September 13, 1848, Gage (aged 25) was directing a work gang blasting rock while preparing the roadbed for the [[Rutland Railway|Rutland & Burlington Railroad]] outside [[Cavendish, Vermont]]. Setting a blast involved boring a hole deep into an outcropping of rock; adding [[blasting powder]], a fuse, and sand; then compacting this charge into the hole using the tamping iron. The blast holes, about {{fraction|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 nature of employer-employee relations on this type of job, all underscore the significance of Harlow's statement that Gage's employers had considered him "the most efficient and capable foreman in their employ" prior to the accident.{{r|pgip|page=A}}{{r|okf|page=25-7}} <!--need additional Macmillan 2000 cite for labor relations-->

Gage was doing this around 4:30&nbsp;p.m. when (possibly because the sand was omitted) the tamping iron struck a spark against the rock and the powder exploded.
<!--per feedback request, more on "how it happened" here: struck spark, powder exploded, rocketed. Gage had been sitting, head turned etc etc. (/Note/ for even more detail and Macmillan discussion of conflicting presentations on posture.) Iron entered etc. (also, perhaps, emph later that it passed completely through)-->
The tamping iron was fired out of the hole and "entered on the [left] side of his face... passing back of the left eye, and out at the top of the head."

Despite 19th-century references to Gage as "the American Crowbar Case"{{r|smith|barker<!--<<need pg#-->|page=54}}<!--add note re 'crowbar' show influence of Bigelow, per Barker--> his tamping iron did not have the bend or claw associated with a [[Crowbar (tool)|crowbar]]; rather, it was a cylinder, "round and rendered comparatively smooth by use":{{r|harlow1848|page=331}}<!-- 1848 and 1868 page numbers need careful checking -->
{{quote|The end which entered [Gage's cheek] first is pointed; the taper being [twelve] inches [30&nbsp;cm] long... circumstances to which the patient perhaps owes his life. The iron is unlike any other, and was made by a <!--DO NOT AMERICANISE THIS SPELLING>>>>-->neighbouring<!--<<<<DO NOT AMERICANISE THIS SPELLING --> blacksmith to please the fancy of its owner.{{efn-ua
<!--BEGIN NOTE-->
|Bigelow describes the iron's taper as ''seven'' inches long, but the correct dimension is twelve (corrected in the quotation).{{r|harlow1848|page1=331|okf|page2=26}}<!--get direct cite from Warren catalog on taper length-->
}}<!--<<END NOTE-->
}}<!--<<END QUOTE-->
Weighing {{frac|13|1|4}} pounds (6&nbsp;kg), this "abrupt and intrusive visitor"
was found 80&nbsp;feet (25&nbsp;m) away, "smeared with blood and brain."{{r|harlow1868|page=331}}

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 {{frac||3|4}}-mile (1.2-km) ride to his lodgings in town.{{r|harlow1868|page=331}}
Dr. [[Edward H. Williams]] arrived 30 minutes after the accident:
{{quote|<!--When I drove up he said, "Doctor, here is business enough for you." -->I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. The top of the head appeared somewhat like an inverted funnel, 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.
}}<!--<<END QUOTE-->
Harlow took charge of the case around 6p.m.:  
{{quote|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.}}

===Treatment and convalescence===
[[File:PhineasGage BostonPostStory.jpg|thumb|An early news report of Gage's accident, from the ''[[Boston Post]]'', September 21, 1848]]
With Williams' assistance Harlow shaved the scalp around the region of the tamping iron's exit, and 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 [[wikt:resin#English-plant secretion|resin]]-impregnated (i.e. adhesive) cloth strips,{{Citation needed|date=December 2013}} leaving it partially open for drainage; the entrance wound in the cheek was left loosely bandaged for the same reason. A wet [[wikt:compress#English-folded cloth|compress]] was applied, then a [[nightcap (garment)|nightcap]] and further bandaging added 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 be kept elevated. Later that evening Harlow wrote: "Mind clear. Says he 'does not care to see his friends, as he shall be at work in a few days.{{'"}}{{r|harlow1848|page1=390-1|harlow1868|page2=333|okf|page3=31-2,60-1}}

Despite Harlow's skillful care, Gage's recuperation was long and difficult. Pressure on the brain left him semi-comatose from September&nbsp;23 to October&nbsp;3, "seldom speaking unless spoken to, and then answering only in monosyllables. The friends and attendants are in hourly expectancy of his death, and have his coffin and clothes in readiness."<!--add surgery performed-->{{citation needed|date=December 2013}}<!-- Came from undisclosed excerpted notes --> Harlow's notes for September 24: "Failing strength... During the three succeeding days the coma deepened; the [[Globe (human eye)|globe]] of the left eye became more protuberant, with fungus pushing out rapidly from the internal [[canthus]]... also large fungi pushing up rapidly from the wounded brain, and coming out at the top of the head".{{r|harlow1868|page=335}} Here ''fungus'' does not mean an infecting [[mycosis]] but instead (Oxford English Dictionary) a "spongy morbid growth or excrescence, such as exuberant granulation in a wound"—that is, part of the body's own reaction to the injury.{{r|okf|page=54,61-2}}

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 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... got wet feet and a chill." He soon developed a fever, but by mid-November he was "feeling better in every respect... 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."{{r|harlow1848|page=392-3}}

==Subsequent life and travels==

===Injuries===
By November 25, Gage was strong enough to return to his parents' home in [[Lebanon, New Hampshire]],<!-- 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." In April 1849 he returned to Cavendish and paid a visit to Harlow, who noted at that time loss of vision (and [[ptosis (eyelid)|ptosis]]) of the left eye, a large scar on the forehead, and depression on the top of his head. Harlow reported that Gage was not in pain, "but says he has a queer feeling which he is not able to describe."{{r|harlow1868|page1=338-9|harlow1849}}<!--need page for harlow 1849-->

===New England===
Harlow says that Gage, unable to return to his railroad work,{{r|harlow1868|page=339}} appeared for a time at [[Barnum's American Museum]] in New York City (the curious paying to see, presumably, both Gage and the instrument which had injured him).
Recently, however, evidence has surfaced{{citation needed|date=July 2013}} supporting Harlow's statement that Gage made public appearances in "the larger New England towns".<!--add visit to Bigelow, presentation to Society-->
He subsequently worked in a livery stable <!-- add coach service when cite is available --> in [[Hanover, New Hampshire]].{{r|harlow1868|page=340}}

===Chile and California===
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 [[Valparaiso]]–[[Santiago, Chile|Santiago]] route. After his health began to fail around 1859,
he left Chile for San Francisco, where he recovered under the care of his mother and sister (who had gone there from New Hampshire around the time Gage went to Chile).
For the next few months, he did farm work in [[Santa Clara County, California|Santa Clara]].{{r|okf|harlow1868|page1=103-4<!--<<covers mother, sister move-->|page2=340-1<!--<<covers remainder-->}}
{{clear}}

==Death and subsequent travels==
[[File:JacksonJBS A descriptive catalogue of the Warren Anatomical Museum 1870 frontispiece 623x1024.jpg|thumb|upright|Gage's skull (sawed to show interior) and iron, photographed for Harlow in 1868]]

In February 1860, Gage had the first in a series of increasingly severe [[convulsion]]s;
he died ''[[status epilepticus]]''{{r|pgip|page=E}} in or near{{r|pgip|page=B}} San Francisco on May 21, just under twelve years after his injury, and was buried in San Francisco's [[Lone Mountain (California)|Lone Mountain Cemetery]].<!--actually, is this cite specific to burial, or only death date etc? -->
(Some accounts{{r|damasioH1994|damasioA1994|hockenbury}} assert that Gage's iron was buried with him, but there appears to be no evidence for this.) Macmillan & Lena: "Only Harlow{{r|harlow1868|page=342}} 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[s]... that Gage's tamping iron was recovered from the grave."{{r|macm_rehabilitating|page1=7}}

===Skull and iron===
In 1866, Harlow (who had "lost all trace of [Gage], 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-->

About a year after the accident, Gage had given his tamping iron to Harvard Medical School's [[Warren Anatomical Museum]],<!--<<chk cite coming up covers this--> but he later reclaimed it{{r|bigelow|page1=22n|anonymous_bmsj1869_1|okf|page3=46-7}} and made what he called "my iron bar" his "constant companion during the remainder of his life";{{r|harlow1868|page=339}} now it too was delivered to Harlow. After studying them for a triumphal retrospective paper on Gage,{{r|harlow1868}} Harlow redeposited the iron—this time with Gage's skull—in the Warren Museum, where they remain on display.{{r|jackson1870|page=v}}
{{anchor|inscription}}
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|[sic]}} P. Gage at Cavendish, Vermont, Sept. 14,{{sup|[sic]}} 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.<!--chk Sept. 14COMMA  Jan 6NOCOMMA (as given on Gagepage but chk directly in Warren)-->
}}<!--<<END QUOTE-->

Much later Gage's headless remains were moved to [[Cypress Lawn Memorial Park|Cypress Lawn Cemetery]] as part of a systematic relocation of San Francisco's dead to new burial places outside city limits.{{r|okf|page=119-20}}

==Brain damage and mental changes==
[[File:Henry Jacob Bigelow c1854 cropped.jpg|thumb|"The leading feature of this case is its improbability." Harvard's [[Henry Jacob Bigelow|Henry J. Bigelow]] in 1854. His training predisposed him to minimize Gage's behavioral changes.]]

[[File:John-m-harlow cropped.jpg|thumb|Dr. [[John Martyn Harlow|John M. Harlow]], who attended Gage after the "rude missile had been shot through his brain",{{r|eliot}} and obtained his skull for study after his death, in later life. Harlow's interest in [[phrenology]] prepared him to accept that Gage's injury might change his behavior.{{r|barker|page=abstr}}]]

[[File:Recovery from the passage of an iron bar through the head p2 rotateRt0pt47 crop.jpg|thumb|right|upright|"I have the pleasure of being able to present to you<!--, to-day, the history and sequel of a case<!-- of severe injury of the head, followed by recovery, which, so far as I know, remains--> [a case] without parallel in the annals of surgery." Harlow's 1868 presentation, to the [[Massachusetts Medical Society]], of Gage's skull, iron, and late-life history.{{r|harlow1868}} ]]

===Extent of brain damage===
Debate as to whether the trauma and subsequent infection had damaged both of Gage's [[frontal lobes]], or only the left, began almost immediately after his accident.{{r|harlow1848|page=389}} The 1994 conclusion of H.Damasio et al.,{{r|damasioH1994}} that both frontal lobes were damaged, was drawn by modeling not Gage's skull but rather a "Gage-like" one.<!-- explain the similarity issue -->{{r|macm_unravelling|page1=829-30}} In 2004 Ratiu et al. used [[Computed tomography|CT scans]] of Gage's actual skull{{r|ratiu_jneuro|ratiu_nejm}} to confirm Harlow's conclusion (based on probing Gage's wounds with his finger){{r|macm_rehabilitating|page=9}} that the right hemisphere had remained intact. Ratiu et al. was the first study to account for the hairline fracture running from behind the exit region down the front of Gage's skull, as well as the fact 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—hypothesizing that the skull "hinged" open as the iron entered the base of the cranium, and was afterward pulled closed by the resilience of soft tissues once the iron had exited at the top.{{r|ratiu_nejm|ratiu_jneuro}}{{r|macm_unravelling|page=830}}<!--BPS p# has the usual uncertainty; formalize cite and hyperlinks throughout-->
<!-- This hypothesis has the further advantage that it helps explain Gage's very survival: the cranium's temporarily increased volume allowed the brain to move aside as the iron passed through, limiting the concussive effect to surrounding tissues.--><!-- check exact wording here; need cite on brain moved aside; integrate with Harlow quote elsewhere on shape of iron-->
Van Horn et al. (2012) agree that the right hemisphere was undamaged, and make detailed estimates of the locus and extent of damage to Gage's [[white matter]], suggesting that this damage may have been more significant to Gage's mental changes than the [[cerebral cortex]] (gray matter) damage. Specifically, Van Horn et al. estimated that although "extensive damage occurred to left frontal, left temporal polar, and insular cortex, the best fit rod trajectory did not result in the iron crossing the midline as has been suggested by some authors ... Fiber pathway damage extended beyond the left frontal cortex to regions of the left temporal, parietal,<!--silently correcting /partial/ in Van Horn--> and occipital cortices as well as to basal ganglia, brain stem, and cerebellum. Inter-hemispheric connections of the frontal and limbic lobes as well as basal ganglia were also affected."{{r|vanhorn<!--get pg#-->}} (Quotations abridged to remove quantitative estimates of damage to each locus.)

===First-hand reports of mental changes===
Gage certainly displayed some kind of change in behavior after his injury,{{r|macm_rehabilitating|page=12-15}}<!--likely other papers + Macmillan 2000 cited too -->
but the nature, extent, and duration of this change are very uncertain: little is reliably known about what Gage was like (either before or after the accident), the mental changes described after his death were much more dramatic than anything reported while he was alive, and the few descriptions which seem credible do not specify the period of his post-accident life to which they are meant to apply.

====Harlow's 1848 report====
In his 1848 report, as Gage was just completing his physical recovery, Harlow had only hinted at possible psychological symptoms:
"The mental manifestations of the patient, I leave to a future communication. I think the case... is exceedingly interesting to the enlightened physiologist and intellectual philosopher."{{r|harlow1848|page=393}}
And after observing Gage for several weeks in late 1849, Harvard Professor of Surgery [[Henry Jacob Bigelow]] (in keeping with his anti-[[cerebral localization|localizationist]] training) said that Gage was "quite recovered in faculties of body and mind," there being only "inconsiderable disturbance of function".{{r|bigelow|page=13-14}}

====Harlow's 1868 report====
In 1868 Harlow (having obtained Gage's skull, tamping iron, and late-life history) delivered the "future communication" he had promised 20 years earlier, detailing the mental changes found today in most presentations of the case (though usually in exaggerated or distorted form—see ''[[#Distortion of mental changes|Distortion of mental changes]],'' below).
He described the pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ". But these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again".{{citation needed|date=December 2013}}

The description that Gage was "no longer Gage" appears to draw on Harlow's own notes set down soon after the accident,{{r|okf|page=90,375}} but other behaviors he describes{{r|okf|harlow1868|page1=117-8|page2=340,345}} appear to draw on later communications from Gage's friends or family, to the particular period of Gage's post-accident life during which each described behavior was present.{{r|okf|page1=90-5}} Macmillan also discusses potential reluctance on the part of Gage's friends and family (and of Harlow himself) to describe Gage negatively, especially while he was still alive, and argues{{r|okf|page=350-1}} that an 1850 communication calling Gage "gross, profane, coarse, and vulgar"<!--consider adding to source list -->
was anonymously supplied by Harlow.{{citation needed|date=August 2013}}

The "fitful, irreverent... capricious and vacillating" Gage described in Harlow (1868){{r|harlow1868<!--get pg#-->}} is somewhat at variance with Gage's stagecoach work in Chile, which demanded that drivers "be reliable, resourceful, and possess great endurance. But above all, they had to have the kind of personality that enabled them to get on well with their passengers" (Macmillan 2000,{{r|okf|page=106}} citing Austin 1977){{r|austin}}—and note Gage was hired by his employer in advance, in New England, to be part of the new coaching enterprise in Chile.{{r|okf|page=376-7}} This complicates reconstruction of how Gage's behavior changed over time, a critical task in light of evidence that his behavior at the end of his life was very different from his behavior immediately after the accident.{{r|macm_rehabilitating|page=6-9}}

===Social recovery===
In 2008 a report was discovered calling Gage mentally unimpaired during his last years in Chile (from a physician who had known him "well" there), and since then a description of what may have been his daily work routine there as a stagecoach driver, and advertisements for two previously unknown public appearances.<!-- cite Unanswered Qs a/o Meet Gage / More about Gage -->
This new evidence implies that the seriously maladapted Gage described by Harlow existed for only a limited time after the accident—that Gage eventually "figured out how to live" despite his injury,{{zwnbsp}}{{r|fleischman|page=75}} and was in later life far more functional, and socially far better adapted, than previously assumed.{{r|macm_unravelling|page1=831}}

Psychologist Malcolm Macmillan hypothesizes that this change 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"{{r|macm_unravelling}}—in Gage's case, his highly structured employment in Chile. "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-coach driver provided that external structure to aid in his recovery.{{r|macm_aggleton}} If this is so, Macmillan points out, then along with theoretical implications it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases"{{r|macm_unravelling|page1=831}}—and asks, if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"{{r|macm_moreabout}}

{{anchor|Distortion and misue of case}}<!--this anchor linked from [[Cognitive Neuropsychology]] -->

===Distortion of mental changes===
{{Quote box |salign=left|align=left
|quote  = A moral man, Phineas Gage<br>Tamping powder down holes for his wage<br>Blew his special-made probe<br>Through his left frontal lobe<br>Now he drinks, swears, and flies in a rage.
|source = —Anonymous{{r|okf|page1=307}}
}}
Macmillan carries out a comprehensive analysis of accounts of Gage (scientific and popular), finding that they almost always distort and exaggerate his behavioral changes well beyond anything described by anyone who had contact with him. 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 psychopath..."{{r|kotowicz}}<!--get pg#-->

Attributes typically ascribed to the post-accident Gage which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children (of which Gage had neither), inappropriate sexual behavior, 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; as Kotowicz writes, "Harlow does not report a single act that Gage should have been ashamed of."{{r|kotowicz}}<!--get pg#-->

===Theoretical use, misuse, and nonuse===<!-- linked from [[History_of_neurology]] -->
[[File:PhrenologyPix CroppedUpperFront.jpg|thumb|[[Phrenology|Phrenologists]] contended that destruction of Gage's mental "organs" of veneration and benevolence ''(upper&nbsp;right)'' caused his behavioral changes. ]]

[[File:Simulated Connectivity Damage of Phineas Gage 4 vanHorn PathwaysDamaged.jpg|thumb|False-color representation of cerebral fiber pathways affected, per Van Horn et al.{{r|vanhorn}}]]

Though Gage is considered the "[[index case]] for personality change due to frontal lobe damage"{{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)--> combined with 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 [primarily] 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 [desired] 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 [[David Ferrier]] (writing to Harvard's [[Henry Pickering Bowditch]] 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...{{r|ferrier1877_9}}}}
More recently Sacks refers to the "interpretations and misinterpretations, from 1848 to the present," of Gage.{{r|sacks}}

Thus in the 19th century controversy over whether or not the various mental functions are [[cerebral localization|localized in specific regions of the brain]], 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 [[Eugene Dupuy|Dupuy]]{{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 -->
[[phrenology|Phrenologists]] made use of Gage as well, contending that his mental changes resulted from destruction of his "organ of Veneration" and/or the adjacent "organ of Benevolence".{{r|sizer|page1=194}}
Antonio Damasio, in support of his ''[[somatic marker hypothesis]]'' (relating decision-making to emotions and their biological underpinnings), draws parallels between behaviors he attributes to Gage and those of modern patients with damage to the [[orbitofrontal cortex]] and [[amygdala]].{{r|damasioA1994}} Damasio's depiction of Gage has been criticized as changing the narrative and the last months of Gage being labeled a "grotesque fabrication" by Kotowicz. {{r|kotowicz}} 

Or as Kihlstrom put it:
{{quote|[M]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.{{r|kihlstrom}}}}

According to Grafman, Gage's case has been used to exemplify the social problems arising from patients with ventromedial PFC {{bracket|[[prefrontal cortex]]}} lesions, but the impairment could be the subject of embellishment by storytellers. {{r|grafman|page=295}}

====Psychosurgery and lobotomy====
It is frequently said that what happened to Gage played a part in the later development of various forms of [[psychosurgery]], particularly [[lobotomy]].{{r|carlson|page=341}} Aside from the question of why the unpleasant changes usually (if hyperbolically) attributed to Gage would inspire surgical imitation, Macmillan states there is no such link.{{r|okf|page=250}}

==Portraits==
[[File:Phineas Gage GageMillerPhoto2010-02-17 Unretouched Color Cropped.jpg|thumb|upright|The second portrait of Gage to be identified (2010). A compensating reversal has been applied in order to show Gage as he appeared in life.]]

In 2009, a [[daguerreotype]] portrait of Gage was discovered. It was the first likeness of Gage identified since the [[life mask#lifemask|life mask]] taken by Bigelow in late 1849.<!--chk this date and that cites cover "by Bigelow"-->{{r|bigelow|page1=22n|okf|page2=ii}}
It shows "a disfigured yet still-handsome" Gage{{r|twomey}}
with one eye closed and scars clearly visible, "well dressed and confident, even proud" and holding his iron, on which portions of the inscription can be made out.{{r|wilgus_meet}}
Authenticity was confirmed in several ways, including photo-overlaying the inscription visible in the portraits against that on the tamping iron in Harvard's [[Warren Anatomical Museum]], and matching the injuries seen in the portraits against those preserved in the life mask.{{r|wilgus2009}}

In 2010, a second portrait of Gage was identified. This new image, copies of which are in the possession of at least two different branches of the Gage family, depicts the same subject seen in the Wilgus daguerreotype identified in 2009, according to Gage researchers consulted by the Smithsonian Institution.{{r|lena_macm}} The 2009-identified image is from the collection of Jack and Beverly Wilgus. The original, like almost all daguerreotypes,<!--cite technical details on dags--> shows its subject laterally (left-right) reversed, making it appear that Gage's right eye is injured.{{r|lena_macm}}<!--get pg#--><!--integrate notes on both photos --> 

Unlike the Wilgus portrait, which is a daguerreotype, the Miller and Hartley images are 19th-century photographic reproductions of a common original which remains undiscovered, itself a daguerreotype or other laterally (left-right) reversing early-process photograph; here again a second, compensating reversal has been applied.
The shirt and tie Gage is wearing in the Miller–Hartley image are different from those seen in the Wilgus image, though he is wearing the same [[waistcoat]] in both, and possibly the same jacket.{{r|wilgus_newimage}}

== Analysis of sources ==
Macmillan compares differing accounts of Gage's life to draw his conclusions.{{r|pgip|page=C}}{{r|okf|page=esp.116-19,}}{{sup|ch13-14}} For over a century, the available sources on Gage's life are few and only included Harlow (1848, 1849, 1868);{{r|harlow1848|harlow1849|harlow1868}} Bigelow (1850);{{r|bigelow}} Jackson (1870);{{r|jackson1870}}; Jackson (1849).{{r|jackson1849}} 

Macmillan's work contradicts Harlow's stated date of Gage's death.{{r|okf|page=108-9}} Harlow (1868){{r|harlow1868}}<!--page#--> gives the date of Gage's death as May 21, 1861, but undertaker's records{{r|anonymous_ngray}} show that Gage was buried on May 23, 1860. Macmillan alters certain other dates for events late in Gage's life, his move from Chile to San Francisco and the onset of his convulsions, to account for this discrepancy.

==See also==
* [[Anatoli Bugorski]]—scientist through whose head a particle-accelerator proton beam accidentally passed
* [[Eadweard Muybridge]]—another early case of head injury leading to mental changes
* [[Prefrontal cortex]]
{{clear}}

==Notes==
{{Reflist |group=upper-alpha}}

==Sources and further reading==
{{Reflist |33em |refs=

{{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}} }}

{{refn|name=harlow1868 |1=<br><!--linebreak after long list of backlinks-->
{{cite journal |last=Harlow |first=John Martyn |year=1868 |title=Recovery from the Passage of an Iron Bar through the Head
|url=http://commons.wikimedia.org/enwiki/w/index.php?title=File:Recovery_from_the_passage_of_an_iron_bar_through_the_head.djvu&page=2
|work=Publ Massachusetts Med Soc<!--chk title abbr-->|volume=2 |pages=327–347 }} {{open access}} }}
<!--need to explain pagination diff between journal and offprint; some paper somewhere says this is #3 of vol 2-->

{{refn|name=lena_macm |{{cite news |last1=Lena |first1=M.L. |last2=Macmillan |first2=Malcolm B.
|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=[[Smithsonian Magazine|Smithsonian]]<!--<<formal name is "Smithsonian"-->}} {{open access}} }}

{{refn|name=pgip |<br>{{cite web|last=Macmillan |first=Malcolm B. |year=PGIP |url=http://www.uakron.edu/gage/index.dot
|title=The Phineas Gage Information Page |publisher=The University of Akron |accessdate=July 22, 2013 }} Includes:
:A. {{cite web|url=http://www.uakron.edu/gage/sites-and-plaque.dot|title=Phineas Gage Sites in Cavendish}} {{open access}}
: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|author-mask=3
|last=Macmillan |first=Malcolm B. |year=2008 |publisher=[[British Psychological Society]]
|url=http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_21-editionID_164-ArticleID_1399-getfile_getPDF/thepsychologist%5C0908look.pdf 
|title=Phineas Gage—Unravelling the myth |work=The Psychologist |volume=21 |number=9
|pages=828–831.<!--Possible problem re pg#s, online vs paper?--check all cites to this-->}} {{open access}} }}

{{refn|name=barker |{{cite journal |last=Barker |first=F.G.II |year=1995
|pmid=7897537 |title=Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization
|work=JNeurosurg |volume=82 |pages=672–682 }} {{closed access}} }}

{{refn|name=fuster |{{cite book |author=Fuster, Joaquin M. |title=The prefrontal cortex 
|publisher=Elsevier/Academic Press |year=2008 |page=172  |isbn=0-12-373644-7
|url=http://books.google.com/books?id=zuZlvNICdhUC&lpg=PA172 }} {{closed access}} }}

{{refn|name=grafman |{{cite book |last1=Grafman |first1=J. 
|chapter=The Structured Event Complex and the Human Prefrontal Cortex |doi=10.1093/acprof:oso/9780195134971.003.0019 
|work=Principles of Frontal Lobe Function |editors=Stuss, D.T.; Knight, R.T.
|pages=292–310|year=2002 |isbn=978-0-195-13497-1 }} {{closed access}} }}

{{refn|name=kihlstrom |{{cite journal|url=http://ist-socrates.berkeley.edu/~kihlstrm/SocialNeuroscience07.htm |author=Kihlstrom, J.F. |year=2010 |title=Social neuroscience: The footprints of Phineas Gage |journal=Social Cognition
|volume=28 |pages=757–782 |doi=10.1521/soco.2010.28.6.757 |issue=6}} {{open access}} }}

{{refn|name=okf |<br><!--linebreak after long list of backlinks-->
{{cite book |author-mask=3 |author=Macmillan |first=Malcolm B. |year=2000
|title=An Odd Kind of Fame: Stories of Phineas Gage |publisher=[[MIT Press]]
|url=http://books.google.com/books?id=Qx4fMsTqGFYC&printsec=frontcover
|ISBN=0-262-13363-6 (hbk, 2000) {{ISBN|0-262-63259-4}} (pbk, 2002)}} Appendices reproduce Harlow (1848, 1849, and 1868) and Bigelow (1850){{open access}}<br>
{{bullet}}See also [http://www.uakron.edu/gage/book.dot "Corrections to ''An Odd Kind of Fame''"]. {{open access}} }}

{{refn|name=macm_aggleton|<br>{{cite interview |author-mask=3 |last1=Macmillan |first1=Malcolm B.
|last2=Aggleton |first2=John |interviewer=Claudia Hammond; Dave Lee |type=Audio interview 
|title=Phineas Gage: The man with a hole in his head |url=http://www.bbc.co.uk/news/health-12649555
|program=Health Check |callsign=BBC World Service |date=March 6, 2011 }} {{open access}} }}

{{refn|name=twomey |{{cite journal |author=Twomey, S. |date=January 2010
|url=http://www.smithsonianmag.com/history-archaeology/78437017.html |title=Finding Phineas |pages=8–10
|volume=40 |issue=10 |journal=[[Smithsonian Magazine|Smithsonian]] }} {{open access}} }}

{{refn|name=wilgus2009 |{{cite journal |last=Wilgus |first=B.&J
|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=340–345 
|year=2009 |pmid=20183215}} {{closed access}} }}

{{refn|name=wilgus_meet |{{cite web |author-mask=3 |url=http://www.brightbytes.com/phineasgage/index.html
|title=Meet Phineas Gage |last=Wilgus |first=B.&J.|accessdate=October 2, 2009}} {{open access}}{{full|date=July 2013}} }}

{{refn|name=wilgus_newimage |{{cite web |author-mask=3 |url=http://www.brightbytes.com/phineasgage/new_image.html |title=A New Image of Phineas Gage |last=Wilgus |first=B.&J |accessdate=March 10, 2010}} {{open access}} }}

{{refn|name=kotowicz |{{cite journal |last1=Kotowicz |first1=Z. |doi=10.1177/0952695106075178
|title=The strange case of Phineas Gage |journal=History of the Human Sciences
|volume=20 |issue=1 |pages=115–131 |year=2007 }} {{closed access}} }}

{{refn|name=macm_rehabilitating |<br><!--linebreak after long list of backlinks-->
{{cite journal |author-mask=3 |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=641–658 |year=2010 |pmid=20480430 }} {{closed access}} }}

{{refn|name=macm_moreabout |<br><!--linebreak for consistency with other Macmillan cites nearby-->{{cite web |author-mask=3 |url=http://brightbytes.com/phineasgage/more.html
|title=More About Phineas Gage, Especially After the Accident |last=Macmillan |first=Malcolm B. 
|date=July 2009 |accessdate=July 27, 2013}} {{open access}} }}

{{refn|name=ratiu_jneuro |{{cite journal |last1=Ratiu |first1=P. |last2=Talos |first2=I.F. 
|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=637–643 |year=2004 |pmid=15165371 }} {{closed access}} }}

{{refn|name=ratiu_nejm |{{cite journal |author-mask=3 |last1=Ratiu |first1=P. |last2=Talos |first2=I.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.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 |pages=e37454 |year=2012 |pmid=22616011 |pmc=3353935}} {{open access}} }}

<!--not sure whether to add author=anonymous to these following-->

{{refn|name=anonymous_ngray |''Volume 3: Lone Mountain register, 1850-1862'', Halsted N.Gray – Carew& English Funeral Home Records (SFH 38), San Francisco History Center, San Francisco Public Library. p. 285. }}<!--chk exact cite/name of merged firm-->

{{refn|name=anonymous_bmsj1869_1 |{{cite journal |title=Bibliographical Notice |work=Boston Medical& Surgical Journal |date=March 18, 1869 |volume=3n.s. |pages=116–7 |issue=7}} }}

{{refn|name=anonymous_bmsj1869_2 |{{cite journal |title=Medical Intelligence. Extraordinary Recovery |work=Boston Medical& Surgical Journal |date=April 29, 1869 |volume=3n.s. |pages=230–1 |issue=13}} }}

{{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, 1854–1924 |publisher=Rigby |location=Sydney |isbn=0-7270-0316-X }} }}

{{refn|name=bigelow |<br><!--linebreak after long list of backlinks-->{{cite journal |last=Bigelow |first=Henry Jacob
|work=[[American Journal of the Medical Sciences|Am J Med Sci]] |volume=20 |pages=13–22
|title=Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head
|date=July 1850<!--<<July is per Harlow 1868-->}} Reproduced in Macmillan (2000).{{r|okf}}<!--page#--> }}

{{refn|name=campbell |{{cite journal|last=Campbell |first=H.F. |year=1851 |title=Injuries of the Cranium—[[Trepanning]] |work=Ohio Med& Surg J |volume=4 |number=1 |pages=20–24 |postscript=}} (crediting the ''Southern Med& Surg J'' (unknown date). }}

{{refn|name=carlson |{{cite book |author=Carlson, N.R. |title=Physiology of Behavior |year=1994 |page=341 |isbn=0-205-07264-X}} }}

{{refn|name=damasioA1994 |{{cite book |author=Damasio A.R. |year=1994 |title=Descartes' Error: Emotion, Reason, and the Human Brain |isbn=0-14-303622-X |authorlink=Antonio R. Damasio }} (2nd ed.:2005) }}

{{refn|name=damasioH1994 |{{cite journal |last1=Damasio |first1=H. |last2=Grabowski |first2=T.
|last3=Frank |first3=R. |last4=Galaburda |first4=A.M. |last5=Damasio |first5=A.R.
|title=The return of Phineas Gage: Clues about the brain from the skull of a famous patient 
|doi=10.1126/science.8178168 |journal=Science |volume=264 |issue=5162 |pages=1102–1105 |year=1994 
|pmid=8178168 }} {{closed access}} }}

{{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. PartII. |url=http://books.google.com/books?id=ppYEAAAAQAAJ&pg=PA356 |work=Med Times& Gaz. |volume=II |pages=356–8}} {{open access}} }}

{{refn|name=eliot|{{cite book|editor-last=Eliot |editor-first=Samuel Atkins|year=1911
|chapter=JohnM. Harlow |chapter-url=http://books.google.com/books?id=1S0EAAAAYAAJ&pg=PT136 
|work=Biographical History of Massachusetts: Biographies and Autobiographies of the Leading Men in the State
|volume=1 |publisher=Massachusetts Biographical Society  <!--book is unpaginated-->}} {{open access}} }}

{{refn|name=ferrier1877_9 |{{cite journal|last=Ferrier |first=David |year=1877–79
|title=Correspondence with Henry Pickering Bowditch}}<!--<<end cite template-->
Countway Library (Harvard Univ.) Mss., HMSc5.2. Transcribed in Macmillan (2000).{{r|okf|page=464-5}}<!--chk final fmt incl detailed punct against Countway catalog cite--> }}

{{refn|name=ferrier1878 |{{cite journal |author-mask=3 |last=Ferrier |first=David |year=1878
|title=The Goulstonian lectures of the localisation of cerebral disease. LectureI (concluded)
|work=Br Med J |volume=1 |number=900 |pages=443–7 }} }}

{{refn|name=folsom |{{cite news |author=Folsom, A.C.|work=Pacific Medical and Surgical Journal |title=Extraordinary Recovery from Extensive Saw-Wound of the Skull |year=1869 |month=May |pages=550–555}} }}

{{refn|name=harlow1848 |<br><!--linebreak after long list of backlinks-->{{cite journal |last=Harlow |first=John Martyn
|year=1848 |volume=39 |number=20<!--no. 20 is per Harlow 1868--> |pages=389–393
|title=[[:File:Harlow BMSJ1848 Passage of an Iron Rod through the Head.pdf|Passage of an Iron Rod through the Head]]
|work=[[Boston Medical and Surgical Journal|Boston Med& Surg J]]
}} {{open access}} ([[s:Passage of an iron rod through the head|Transcription]].)}}

{{refn|name=harlow1849 |{{cite journal |author-mask=3 |last=Harlow |first=John Martyn
|year=1849<!--get specific date--> |title=Medical Miscellany (letter) 
|work=[[Boston Medical and Surgical Journal|Boston Med& Surg J]]
|volume=39 |pages=506–7 }} Reproduced in Macmillan (2000).{{r|okf<!--page# also full text at commons? (or just 1868?)-->}} }}

{{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}} }}

{{refn|name=jackson1849 |{{cite journal |last=Jackson |first=J.B.S. |year=1849 |work=Medical Cases |volume=4 |number=Case 1777 }}<!--<<end cite template-->
Countway Library (Harvard Univ.) Mss., HMSb72.4.<!--isn't this imaged/transcribed in OKF? chk from OKF for all img/transcribes-->
<!--Get pg no & check case no--><!--chk final fmt incl detailed punct against Countway catalog cite--> }}

{{refn|name=jackson1870 |{{cite journal |author-mask=3 |last=Jackson |first=J.B.S.
|chapter=Frontis. and Nos. 949–51,3106 |url=http://books.google.com/books?id=F8UZAAAAIAAJ
|title=A Descriptive Catalog of the Warren Anatomical Museum }} Reproduced in Macmillan (2000),{{r|okf}}<!--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}} }}

{{refn|name=sacks |{{cite book |author=Sacks, Oliver |title=An Anthropologist on Mars |year=1995 |pages=59–61 |isbn=0-679-43785-1 |oclc=30810706 |url=http://books.google.com/books?id=9HQIHnREqhkC&lpg=PT90&pg=PT90 }} {{closed access}} }}

{{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& Wells |location=New York |url=http://books.google.com/?id=xicZAAAAYAAJ&pg=PA313#PPA194}} {{open access}} }}

{{refn|name=smith |{{cite news |last=Smith |first=William T |year=1886
|url=http://books.google.com/books?id=jcwDAAAAYAAJ&pg=PA46 |title=Lesions of the Cerebral Hemispheres]
|work=TVermont Med Soc for the Year 1885 |pages=46–58 }} {{open access}} }}

{{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=349–359 |year=1992 |pmid=1619089 }} {{closed access}} }}


}}<!--end reflist-->

==External links==
{{stack|{{Wikisource-author}}{{commons}}<!-- why is this a Commons "page" instead of (presumably broader) category?-->}}
* [http://brightbytes.com/phineasgage/index.html Meet Phineas Gage]—The story of how the owners of the 2009-identified daguerreotype learned it depicted Gage.
* [http://www.roadsideamerica.com/attract/VTCAVgage.html Phineas Gage roadside memorial], Cavendish, Vermont

{{DEFAULTSORT:Gage, Phineas}}
[[:Category:1823 births]]
[[:Category:1860 deaths]]
[[:Category:History of neuroscience]]
[[:Category:American people in rail transportation]]
[[:Category:American expatriates in Chile]]
[[:Category:People from Grafton County, New Hampshire]]
[[:Category:People from Windsor County, Vermont]]
[[:Category:Burials in California]]
[[:Category:People with brain injuries]]