Phineas Gage Information

You might like to compare your evaluation of An Odd Kind Of Fame: Stories of Phineas Gage with these extracts from the reviews of it that had appeared up to September 2012.  Alhough you may have seen the daguerreotype of Phineas, you might like to see how he is typically represented in textbooks and judge which of the images best represents him.

Reviews

John Marshall, Science, 2000, 290(5492), 718:
Macmillan sets [his] interpretations against a changing background of the development of sensory-motor psychology, the emergence of the practice of modern brain surgery, and a variety of theories of the localization of brain functions. Macmillan’s book provides one of those rare occasions on which one can truly say that further research is not necessary ... [It] is the definitive account … a welcome wake-up call … to read the original sources, and it will interest the more rational exponents of the social construction of science.

A. R. Davis, Johns Hopkins, Choice: Current Reviews for Academic Libraries, 2001, 38, January:
Evaluation of Gage’s physical, emotional, and psychologic behavior before and after the accident is a major focus ... Macmillan ... explored every related area: psychiatry, neuroscience, medicine, written records, and personal interviews to shed new light and provide an authentic account of Gage’s accident and subsequent life, a story unparalleled in medical history.  Highly recommended for physicians, medical historians, and students at all levels.

Randolf W. Evans, Journal of the American Medical Association, 2001, 285, 215-216:
[W]ell-written, entertaining … meticulous research … nicely reviews the history of cerebral localization … discusses value of Gage’s case in the origins of … neurosurgery … demonstrates that [it] did not contribute directly to … lobotomy … I highly recommend [it] to anyone interested in the history of neuroscience

Daniel Tranel, New England Journal of Medicine, 2001, 344, 312:
[A]xe-grinding style … lacks new insights … engaging as a history lesson … thinly disguised vendetta against other Gage experts and the frequent aspersions cast on their scholarship … [and] motives … make the narrative rather unsavory ….  The best parts of this book were written by Harlow and Bigelow.

Ian Glynn, Nature, 2001, 409, 561-562:
Macmillan’s enthusiasm is as infectious as his knowledge of detail is prodigious …. The book’s success lies in the combination of [his] skill as a writer, his familiarity with the labyrinthine development of nineteenth century ideas about brain and his passion for collecting and presenting evidence, whether scientific or historical … only rarely is one seriously worried about his conclusions.

Paul Crichton, The Lancet, 2001, 357, 566:
Some books encompass the whole of the universe (Hegel’s Phenomenology of Mind) or a whole society (Tolstoy’s War and Peace); others have a much narrower focus (in Ulysses James Joyce describes one day in the life of Leopold Bloom).  An Odd Kind of Fame combines both perspectives .... What Macmillan’s fastidious archaeological removal of the layers of legend surrounding Phineas Gage convincingly demonstrates is how the varying theories of brain function shaped the formation of this legend over time and vice versa.  Macmillan’s conclusions are refreshingly deflationary ...

John Pickard, British Journal of Neurosurgery, 2001, 15, 81:
Macmillan is to be congratulated on a comprehensive and scholarly account of Phineas Gage.  A detailed history of the location and circumstances of the accident are provided together with Dr. Harlow’s treatment .... most of the book is devoted to a general discussion of localization of function ... Overall, the book makes fascinating reading and the price is unusually reasonable.

Bruce Ammons, Psychological Reports, 2001, 88, 319:
[A] remarkable work of scholarship....much of what we've mistaken as trustworthy facts was actually...misquoting, imagination, misinterpretation, fame-seeking attempts to force precious few facts into ... Procrustean theoretical beds... This book should be in every history and systems psychology class and deserves reading by anyone interested in the workings of science and history, developing views of the localisation of brain function, the development of neurosurgical procedures, or a first rate example of carefully done historical work.  The CT scans ... are alone worth the price of admission.

Roy Porter, Times Literary Supplement, 18th. May, 2001:
[T]his giant book is ... something of a curiosity - do we really need six pages on the construction of the Rutland and Burlington Railroad? ... inordinate detail [on] the lives and work of scores of leading ... brain investigators, the great majority of whom never recorded a single thought about Gage .... Macmillan evidently hoped his would be a definitive story .... In reality, what he found was ... a dearth of truly solid, cast-iron historical facts ... as many "Gage’s” as there are neuroscientists who evoke him .... it is rather a relief that Gage retains his mystery ...

Barbara Wilson, Neuropsychological Rehabilitation, 2001, 11, 188-190:
[T]he author of this extraordinary book ... almost certainly knows more about Phineas Gage than anybody else.  There is passionate criticism about many of the accounts of Gage, including many from well-known neuropsychologists.  Most include errors of fact or interpretation.... The book concludes with a collection of papers and notes on Phineas Gage .... Given the difficulty of obtaining the original articles, these Appendices provide a useful resource.  I have never read a book quite like this before.  It is a passionate, scholarly, detailed, and fascinating account ... I thoroughly recommend it ...

Samuel Greenblatt, Journal of Neurosurgery, 94, 850-851:
An Odd Kind of Fame is a thorough antidote to its author’s problem of the paucity of material on Gage.  Macmillan’s ingenuity and energy in tracking down sources are truly awesome...  Some of [his] insights [into localization] are quite penetrating, but sometimes digress rather far from the main theme....   [A]ll efforts to localize the damage to Gage’s brain by reconstructing the path of the tamping iron from the localization of the skull defects are doomed to insufficiency.  Macmillan draws this important conclusion plainly and without emphasis, but it deserves to be emphasized.

Has Pols, Journal of the History of Medicine and Allied Sciences, 2001, 56, 192-194:
[The tamping iron exited] ... slightly to the right of center... Gage traveled around quite a bit and held a number of odd jobs before he died twelve years later .... Macmillan’s research is painstakingly thorough and accurate, and obviously driven by the desire to find out what actually happened to Gage and what role the Gage case played in the history of medicine, brain physiology, and psychology.... [h]e concludes that most accounts of Gage’s life are mistaken [and] that Gage played a neglible role.  These conclusions are interesting and convincingly supported ...[but leave] the reader feeling rather empty-handed.  The author’s attack on a social constructionist view of history that allegedly disregards facts seem misplaced and irrelevant.

John Hodges, Journal of Neurology, Neurosurgery, and Psychiatry, 2001, 71, 136-137:
[S]uperbly written ... fantastic reference source across a wide range of topics.  The first few chapters describe, in detail, the events surrounding the fateful afternoon... There are many revelations in this part of the book.  The second section is in many ways the most fascinating ... a scholarly account of the origins of the concept of cognitive localisation ... the contribution, or otherwise, of Gage’s story to psychosurgery ... a great deal of overlooked early literature ... on the surgical treatment of insanity .... I can thoroughly recommend this book to anyone interested in the history of neuroscience, neuropsychology, or neuropsychiatry.  It is also amazing value at just under Stg 25.

Sally-Ann Price, StudentBMJ, 2001, 9, 213:
While the choice of subject is laudable, the book itself is rather dry.  There is a great deal of historical detail...undoubtedly a fine piece of research clarifying precisely what we do and do not know about Gage’s story. .... difficult to see a niche for this book ...  Perhaps we have been spoilt by ... Sacks and Ramachandran and their easy to read style. ... other books (such as basic neuroanatomy texts) ... give you a greater understanding of functional anatomy.  Read it if you are fascinated by Gage or have an interest in historical detail, but for most people, the book gives far more detail than you require...

Tilli Tansey, Endeavour, 2001, 25, 83:
In this enormously detailed book (sometimes too detailed...) Macmillan tackles several themes, including...the biographies of the principal participants...the impact of the accident on...theories of localization... Macmillan explores both popular and scientific accounts ... provides facsimiles of the original case reports and concantenates a wide range of material ... [D]espite many efforts to elucidate, extend and enhance Harlow’s report, Gage’s genuine contributions to neurological knowledge remain a mystery..  Gage differs profoundly from Alexis St. Martin ... In contrast Gage’s ‘odd sort of fame’ remains just that.

James Beebe, August, 2001:
[A]n impressive achievement...the definitive history of one of the most widely discussed cases in the history of neuroscience and psychology. ....the first and only comprehensive study of Gage’s injury and its influence on the history of medicine, neuroscience and psychology. ... not light reading [it] is a remarkable piece of historical research .... Macmillan has cleared up much misinformation...  It will be recognized as an authoritative and valuable resource for many years to come.

Samuel Greenblatt, Bulletin of the History of Medicine, 2001, 75, 798-799:
Macmillan shows convincingly that all other reports either derive from Harlow , or are inaccurate to the extent that they do not. ...it is impossible to localize the extent of his frontal lobe damage by simply reconstructing the path of the tamping iron from the location of the skull defects.  Macmillan states this conclusion clearly but too modestly.  It invalidates all retrospective attempts at the precise localization ... even with modern imaging..  Macmillan has done a yeoman's job [and] has probably added to Gage’s fame, no matter how odd it may seem.

James Stone, Journal of the History of the Neurosciences, 2001, 10, 353-355:
In a highly readable yet extraordinarily well-referenced fashion, we come to realize Gage’s influence on the development of biological thought including cerebral localization, neurosurgery, neurology, behavioral neurology, and neuropsychology ... to this reviewer, Harlow ’s surgical capability and intuition were extraordinary. .... Macmillan shows much originality in the manner in which he presents [the development of localization] .... gives a carefully measured analysis of pivotal models used ... in the past ... to explain behavior and the frontal lobe. ... [A] very well-written book which ... serves as a fairly extensive reference source on a number of areas relating to the development of neuroscience ... I would highly recommend this volume to anyone in the allied neurological fields seriously interested in the history of their discipline.

Jonathon Erlen, Quarterly Review of Biology, 2001, 76, 521:
The author presents at times excessive details of Gage’s accident, recovery, later life, and death....What emerges is a pattern of inaccurate facts and exaggerations that has seriously distorted the place of Gage’s health conditions in medical history....[W]hen Macmillan leaves Gage’s story to present an overview of brain localization theory [t]hese chapters add little.... Despite the unnecessary chapters and the author’s overuse of minute details, this is a significant contribution to the history of neuroscience.

Michael Saling, Australian and New Zealand Journal of Psychiatry, 2001, 35, 862:
The nature of [Gage’s] personality change has been elaborated possibly distorted) into a prototype par excellence of the frontal lobe syndrome. Yet the only link between us and the clinical reality of the post-injury Gage is a handful of scattered notes and recollections ... In Macmillan’s hands this becomes a study of the mutations that creep into the historicoclinical record in medicine, and an exercise in ‘recovering the truth’, not only about Gage, but about Harlow as well. ... Ultimately, the empirical status of Harlow ’s account is the issue that still needs to be resolved. After Macmillan’s exhaustive account one wonders if there is anything left to be uncovered.The book is immensely detailed, locating the case in a rich historical, social, and scientific context. It is certainly a major document in the field of neuropsychology and I think that time will tell that this is the definitive work on Phineas Gage.

Kieran O'Driscoll, Isis, 2002, 93, 138:
[T]he definitive work on this fascinating subject ... Having discharged his duty in relation to the sparse facts...and the lasting importance of the event, Macmillan could have left it there. We are fortunate that he didn’t ... [F]rom painstaking research [he] has taken us on a fascinating journey through nearly two hundred years of neuroscientific thinking on the functions of the frontal lobes ... I would strongly recommend this book to those interested in the history of medicine, to the clinical neuroscientist, and to the nonspecialist with an interest in the bizarre.

Rhodri Hayward, British Journal for the History of Science, 2002, 35, 479-481:
It is the transformation of Gage from ordinary foreman to neuropsychological exemplar which provides the structure and focus for Macmillan’s book. Over the course of four hundred pages of argument and a hundred pages of appendices, Macmillan provides an absolutely exhaustive interrogation of the historical bases of Gage’s story, his treatment, and its subsequent scientific reconstructions. As a piece of historical detective work it demonstrates a scholarly commitment which borders on the obsessional.
Despite the daunting amount of detail included .. the narrative is leavened by Macmillan’s lightness of touch and his genuine enthusiasm for the subject. Moreover the level of detail .. serves to emphasize (by way of contrast) just how little is known about Gage, his injury, or the subsequent personality change.
Although Macmillan is keen to distance himself from social constructivist arguments and makes extensive claims for a realist epistemology, it is difficult to see how his method conflicts with those employed by radical sociologists of knowledge ... It is the difficulty of disentangling the social from the neurological that makes Macmillan’s account .. so entertaining.  ... Gage .. does at least provide a stunning example of the ideological use of case histories and their mythological reconstruction.

Donlin M. Long, Neurosurgery Quarterly, 2002, 12, 87-88:
There is probably no patient case in medicine better known than that of Phineas Gage.  Every medical student hears some reference to him, and residents in neurosurgery, neurology and psychiatry are all led to believe that the observations on frontal lobe injuries sustained by Mr. Gage were basic for the development of psychosurgery a century later…It should come as a surprise for most readers to discover through this exquisitely detailed re-examination that much of what has been written and said about the Gage injury is incorrect.  Even some of the most prestigious academic researchers have disseminated erroneous information about this most important injury and its outcome….The author has done us a great service by clarifying the actual event and placing it in perspective.  There is another great service in warning us again to be careful of authority that is not supported direct reference….This is a superb book that every neurosurgeon will want to see.

Fatah B. Nahab, Journal of Neurosurgery, 2003, 99, 1109:
Macmillan has done an excellent job of writing a multifaceted scholarly work to satisfy different readers in different ways...Although the medical jargon is limited to allow a broader readership, the depth of neuroanatomical localization is highly accurate and descriptive, and the author does not dilute the essence of this medical case report and its ramifications.  At a list price of $24.95, this book is a highly recommended addition to any library.

T. R. Morley, Canadian Bulletin of Medical History, 2003, 20, 195-197:
...a thoroughly readable treatise not only on all aspects of the Gage legend, but much more. The author uses Gage as the peg from which he hangs the history of the evolving understanding of brain function...Chapter 14 reviews the case reports that appeared in the medical journals; the authors sometimes got it right but as often got it wrong-a happy note to bring up the rear of a stunningly researched, ordered, and written history.

Paul Eling, Contemporary Psychology, 2003, 48, 289-291:
In essence more than an analysis of the Phineas Gage case, Macmillan’s study is a colorful picture of how scientists (and subsequently all kinds of people in society) used a particular case to convince others of their own theories. [A]t this point [of Gages’s recovery and subsequent activities] that [Macmillan’s] enterprise becomes relevant to current scientists. That is not to say that his unprecedented detective work...brought nothing new.  On the contrary: fact and fancy can now be separated clearly.
Macmillan...reveals how other authors picked up bits and pieces [of Harlow’s 1868 paper] and reformulated them into a code that best fit their own purposes ... In Chapter 6, Macmillan presents a sobering overview of the "post-Harlow fables” as well as their echoes in the recent accounts...
Macmillan collected practically every piece of information about Gage...Moreover, he analyzed all that material almost on a word-by-word basis. The reader might think that this would result in a rather boring report. In fact, the book is a real pleasure to read, thanks to the author’s writing style. He is very precise, careful in his wording, and modest in his conclusions....
What can we learn...with respect to case studies in general?...Gage might be considered an interesting case study for the philosophy of science, or for the history of science. Macmillan, however, does not give much attention to these aspects.

Georg Goldenberg, Cortex, 2004, 40, 552-555:
The main theme of the book is the confrontation between the many stories of Gage and the limited evidence of his real life. As to the evidence, Macmillan has obstinately searched all possible sources. It seems very unlikely that anyone else could find a relevant piece not considered. ...Macmillan’s writing style is not one of easy going story telling. Sometimes this makes reading a bit hard for readers who are not familiar with history of neurosciences, but the occasional use of rather bulky sentences...is compensated by the tongue in cheek humour of Macmillan’s comments... Macmillan’s book...does not strain the reader’s credulity. It is a sober and meticulous inquiry of facts and circumstances, but it is at least as exciting as any of the stories of Phineas Gage.

Representations

You know what Phineas looked like because you will have seen the photograph of his daguerreotype on this website.  Below are various representations of him some of which are still used in textbooks and on websites, despite their incorrectness being mentioned from 1999 in An Odd Kind of Fame and the earlier version of this website, or after 2009, when the photo of the daguerreotype was publicised.  Which representation of Phineas do you think is the most accurate?  Try to identify where each comes from.  The answers are at the bottom of the page.

(a) (b) (c)
(d) (e) (f)

Answers:

(a) Very, very wrong.  True, it is a skull with a tamping iron in it, but it is not even Gage’s.  It is the ‘common’ skull Henry Jacob Bigelow drilled in 1849 or 1850 to show that the tamping iron could have passed through Gage’s.  Nevertheless it is described as Gage’s skull in many textbooks of psychology, medicine, and the neurosciences.

(b) Reasonable but wrong.  Although this is the woodcut of Gage’s skull made for John Martyn Harlow in 1868, the regrowth of bone in the 11 1/2 years after Gage’s accident would have prevented the tamping iron being passed through it as shown.

(c) Good.  This is Gage’s actual skull, photographed for Harlow in Woburn in 1868.

(d) Plausible but very wrong.  This is a drawing made in 1921 by Russell Windsor for her husband’s book on phrenology.  Not only is it not known who the model was -- he probably does not resemble Gage -- but no one could have lived with the iron so embedded in their skull and brain.

(e) Very good.  This is Phineas Gage’s life mask and was made for Henry Jacob Bigelow in 1849 or 1850.  Add bonus points if you said ‘life mask’ – in textbooks it is often described as Gage’s death mask.

(f) Very wrong.  This is a right to left reversal printing of (b), also often found in textbooks. 

 

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