Bone and Blood – The tamping iron inside the head

Kim Le

Kim Le

A few weeks back I made an impromptu trip to Boston, and I chatted with a friend of mine about potential things to do. I mentioned a pilgrimage to the Harvard Medical Library to visit the skull of Phineas Gage.

“Who?”

“You know, the guy with the tamping iron through his head.”

It then occurred to me that not everyone in the world has taken Psych 101, or maintains a mental encyclopedia of medical freaks throughout history. Therefore, I thought I’d devote some of my column this week to neuroscience’s favorite railroad worker, though plenty of other resources abound on the Internet about this topic.

The story, in a nutshell, is this: on that fateful day in 1848, in the idyllic Vermont countryside, Phineas was hard at work blowing up rocks to make way for railroad. Before the existence of tunnel boring machines, this task was achieved through manually drilling holes into the rock, filling these holes with gunpowder, and jabbing at the gunpowder to compact it with a long stick called a tamping iron. This was a pretty routine task for Phineas, and likely he had been distracted at the time (probably in the middle of some breezy chit chat, as recent modeling of the impact site shows his jaw had been open). Whatever the reason, the tamping iron activated the gunpowder prematurely and it shot up right through Phineas’ face and skull.

Given the inherent dangers in such a task, this injury was perhaps not surprising. What was surprising was that Phineas, who would have perfectly well within his rights to drop dead after having a 13 lb. metal rod suddenly launched through his head, did not do so. He may not have even lost consciousness. Phineas hopped into the back of an oxcart and rode to town to see the nearest doctor, who observed:

“Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. He talked so rationally and was so willing to answer questions, that I directed my inquiries to him in preference to the men who were with him at the time of accident, and who were standing about at this time.”

(Ah, to be ruled comparatively dull, next to a man who has just had a metal rod blow through his skull.)

The account continues, grossly:

About this time, Mr. G. got up and vomited a large quantity of blood, together with some of his food; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor, together with the blood.

– from Bigelow’s Case of Injury of Head in the American Journal of Medical Sciences, July 1850

Later on, Phineas was attended by another doctor, who would have to perform emergency surgery to drain Phineas’ brain of fluid buildup as a result of a fungal infection:

Harlow shaved Gage’s scalp and peeled off the dried blood and brains. He then extracted skull fragments from the wound by sticking his fingers in from both ends, Chinese-finger-trap-style. Throughout this all, Gage was retching every 20 minutes, because blood and greasy bits of brain reportedly kept slipping down the back of his throat and gagging him. Incredibly, Gage never got ruffled, remaining conscious and rational throughout. He even claimed he’d be back blasting rocks in two days.

– from Sam Kean, “Phineas Gage: Neuroscience’s Most Famous Patient,” for Slate magazine

It wasn’t quite two days, but indeed he got up and was working back at the railroad within a month, for another go with the tamping iron. The doctors who attended him observed that he was able to speak, understood words, walked around and performed functions like an ordinary person, so declared him unscathed – a medical miracle.

Yet, there were reports of erratic and unstable behavior afterwards, which is why Phineas Gage continues to crop up in neuroscience textbooks as more than mere sideshow curiosity. The prefrontal cortex, through which the tamping iron passed, is considered to house areas of the brain that are responsible for decision making and emotional regulation. According to accounts of Phineas’ behavior in the subsequent years of his life, he was ill-tempered, foul-mouthed and prone to idiotic choices. His newly rude temper cost him his job at the railroad. He then traveled as a sideshow freak with the circus for some time; thereafter his life was characterized by instability, dissoluteness and misery. This was taught to me in college psychology as a way of highlighting the importance of the prefrontal cortex in regulatory activity and higher order functions. Since Gage’s prefrontal cortex was neatly punched out, leaving other functions intact, he made for a convenient real-life case study.

Yet real life outside of a lab is rarely so neat. Recent investigations into the complicated history of Phineas Gage’s life make that textbook story murkier. It turns out that we don’t have a solidly verifiable record of what Phineas was like prior to being tamped with an iron, so we lack a good baseline for what typical behavior would have been for him. Was Phineas already prone to temperamental outbursts and batty decisions? Also, according to historical researcher Malcolm Macmillan, later in life Gage apparently lived for some time as an expat in Chile, working as a stage coach driver. Living an expat life with a job demanding high precision would not be possible without higher level cognition – he not only had to drive a stage coach and make split-second decisions about where to steer horses carrying a two-ton frame, he also had to have learned passable Spanish. Sure, in the aftermath of the incident, he was not doing quite so well; but by these accounts Phineas Gage had to have improved his situation somewhat later in life. For a long time, it was thought that damage caused by brain trauma was permanent; lately researchers are discovering that the brain is more “plastic,” or adaptable to changes. Macmillan posits that the Phineas Gage story, far from being a story about the tragedy of suffering through life without a prefrontal cortex, is actually a redemption story – the story of the incredible resilience of the human brain.

Whatever kind of story it is, the story of Phineas Gage continues to fascinate. When my niece was five, she read about Phineas in a brain book presumably written for children. She became obsessed and asked endless questions about it, very loudly, in restaurants with lots of people within earshot trying to eat dinner. She had even penned her own “book” about the incident. Since I would be in the area, I felt that I owed it to her to make the pilgrimage to the skull. And the tamping iron.

Both are housed at the Warren Anatomical Museum on the Harvard campus in Cambridge, MA. I had a bit of confusion because the Atlas Obscura entry mentions the museum as being open Monday through Friday, whereas Yelp page lists it as being closed on Fridays. This was distressing to me, as I had planned my visit so that I would be able to come that Friday. I tried calling and eventually just emailed the museum to ask their hours; I got a reply back saying that my inquiry had been entered into a ticketing system and would be responded to within 24 hours. I decided to just show up at the Harvard campus and hope for the best.

For those who do plan a pilgrimage to this site (and you should, because it’s awesome): it turns out it is open on Fridays, until 5 pm. The security guards around campus will give you blank looks if you ask for the Warren Anatomical Museum, or ask for the whereabouts of a broken skull and a tamping iron – ask instead for the whereabouts of the Harvard Medical Library. You do not need to be a student or faculty, but be sure to bring a picture ID with you. The “museum” itself is really a handful of long glass cases lining the walls of the top floor of the library, with an eclectic assortment of writings, medical devices, specimens and oddities collected by John Collins Warren, the first dean of the Harvard Medical School.

The tamping iron is much larger than I had expected. I had also not expected it to be engraved with writing (obviously post-tampening):

This is the bar that was shot through the head of Mr Phinehas[sic] P. Gage at Cavendish, Vermont, Sept 14,[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.

Gage carried this thing around for the rest of his life, complete with butchering of his own name, considering it to be a good luck charm of sorts. Both the skull and iron were unearthed from his resting place in the ground, toured around for awhile, eventually ending up here.

(Another traveler’s note: photography is not allowed in this area. Ahem.)

The collection is small, especially compared to that of the International Museum of Surgical Science. But it is filled with lots of gems. Near the tamping iron and Gage’s skull, there is the skull of another patient, along with a giant bone tumor that had been extracted from this skull’s face using an “amputating saw chisel.” The tumor is roughly the size of my closed fist. The patient survived the initial procedure, but – as with most early surgeries – he died of sepsis, nearly a month later.

There’s the skeleton of an anencephalous fetus, which looks a bit like a tiny frog man. There are forceps and other obstetrical instruments designed by the unfortunately named William Smellie. He reportedly attended deliveries wearing a woman’s nightcap and gown, concealing the instruments underneath this gown, so as not to frighten the patients. There’s a contraption called a carbolic acid atomizer, which was utilized on the battlefront as one of the only viable techniques of combating infection during surgery. It would spray a thin layer of acid over the patient, the physician’s instruments and bandages.

There are reminiscences by Alfred Worcester about his time at HMS, including accounts of students procuring black-market skeletons from janitors and the overwhelming stench of the dissection room pre-formaldehyde. A lead ball is displayed next to its victim: the patient had improvised a lint plug and stuffed it in the hole created by the ball. Twenty-five years later, the patient “was made to remove” the lint plug; he died of acute meningitis three days later. Randomly, there is also a bust of Samuel Coleridge Taylor.

The sepia-toned daguerrotype of Phineas Gage, which was only recently discovered in 2008, shows a defiant man with a spark in his pale, uninjured eye. He could easily pass for a modern-day superhero (or supervillain, depending). He not only survived the initial blast (and the iatrogenic surgeries and treatment thereafter), he continued walking the earth for another dozen years after the great tampening. I suspect he’ll live on long after those of us with intact prefrontal cortices, inspiring, terrifying and fascinating people with his origin story.

Kim Le is a writer and shiftless gadabout who hails from the distant wheat fields of Kansas. Obsessions include sustainability, yurts and extreme DIY. Also, she makes sculptures out of food, mostly potatoes. She never updates her blog at http://badmetaphor.net.

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