A HOLE IN THE HEAD

 

I suppose there are a hundred measures by which to assess the history of Phineas P. Gage. The most unlikely might be the field of phrenology, which held that just as a lifetime of muscular exertion leaves evidence on the leg and arm bones, mental endeavors - personality, intelligence and emotions - leave tell-tale imprints on the top of the skull; or so the theory went. 

Practitioners, like the American Orsen Squire Fowler (above), would run their fingers over the bumps on your head and divine your occupation, your character flaws, even why you were having trouble sleeping. 

But as profitable as the business was, even Fowler acknowledged, "....phrenology is either fundamentally true or else untrue..." - a statement which, standing alone,  is undoubtedly true. The ultimate disproof of phrenology would be provided by the words Pheneas P. Gage.

Phineas was originally an Egyptian title, meaning a dark or bronze skinned oracle. He first appears in the Old Testament  (Numbers 25, verses 7-8), as a priest's son who spies the Hebrew prince Zimri entering the Tabernacle with a Midianite woman. In a fit of offended religious passion, Phineas runs them both through with a spear. For this double murder, Moses rewards Phineas. His namesake may have paid the price for that excess of zeal.

His family name was English, which actually means it came from the French spoken in Normandy in 1066.  This Old French was mostly based on the everyday language spoken by Roman soldiers. In their Vulgate Latin a "jalle" was a measure of liquid, equal to our gallon, and a "jalgium" was the stick or rod inserted into the amphora to measure how much wine was left. Over centuries the pronunciation became a "gaunger" later shortened to "gauge". Thus a gauge is a standard of measurement. And by a happy coincidence, that describes Phineas Gage perfectly - an oracle of measurement.

In 1823 Phineas P. Gage was born in the southern New Hampshire village of Lebanon. He grew into a strikingly handsome young man, and a natural leader.  The doctor for the Burlington and Rutland Railroad, , physician John Martlyn Harlow, described Phineas as "...a perfectly healthy, strong active young man, 25 years of age...5 feet 6 inches tall...150 pounds...having had scarcely a day's illness...." 

Navies were members of the work teams - inland navigators -  who laid out the path of railroads crossing the land. The weak steam engines of the day could climb or descend no more than a 1 1/2 % grade, or rise 18 inches for every foot forward . Any obstacles to this would have to be blasted out of the way.  But it was worth the effort because of the money that could be made from transporting resources by rail.

In 1825 Englishman George Stephenson's locomotive "The Rocket" (above) took less than two hours to haul 36 wagons of loaded with coal, nine miles from the mine to the docks on the River Tees. His steam locomotive was not only a revolution in speed, but also reduced transportation costs by two thirds. 

Competitors literally followed in Stephenson's tracks. George had set his new rails four feet eight and one-half inches apart because that was the "gauge" of the old rails used when the wagons were pulled by horses. And by decree of the royal commission of 1845, that would be the "Standard Gauge" for Britain, and eventually most of the rest of the world.

Just three years later, on Wednesday, 13 September, 1848 a Rutland and Burlington Railroad construction crew, headed by the 25 year-old foreman Phineas P. Gage, was preparing a road bed outside of the little mill town of Cavendish, Vermont. Each member had a simple job, which is to say their collective task was a technically complicated jigsaw puzzle of mundane occupations, which when combined in a specific order, changed the world. 

In this case, an engineer would determine where rock was to be removed. Team members would then pound a drill into the rock, creating a hole.  As foreman, Phineas Gage would then pour a measure of black powder into the hole. Then he would pour a measure of sand on top of the powder. Then Phineas would insert a fuse through the sand into the powder. 

Then he would drop a 35 pound, three and a-half foot long iron tamping rod (above), sharpened at one end,  into the hole to compact the charge and sand. Finally, Phineas would light the fuse.

After the resulting explosion (above), other workers with shovels and carts would remove the broken rock while the foreman engineer would determine where the next charge should be placed.

Toward the end of a had day's work, the team had just about finished clearing a curved cut through a granite outcrop (above). At just about 4:30pm, Phineas ordered his weary drilling team to take cover yet again.  

Again Phineas poured black powder into the drill hole. But this time, in his haste,  he forgot to add enough sand. So when he shoved down the iron tamping rod down the hole, it sparked against the granite. And without the insulating sand, that set off the black powder.

There was a bright flash and a sharp loud crack. 

In something less than one second, the 35 pound rod was driven out of the hole, penetrating just below Gage's left cheek bone, destroying his left eye, plowing through his brain and blasting out the top of his skull. 

The tamping rod landed 80 feet away, smeared in blood and brain matter..

As the smoke cleared, the startled crew rushed to Phineas' assistance. They found him awake and alert, but in great pain. 

With assistance Phineas was loaded aboard an ox cart, and suffered a jarring forty-five minute long, three quarters of a mile ride back to the Adams Hotel in Cavendish, where he was placed in a chair on the front porch.

An hour local doctor Edward Williams  arrived. "I first noticed the wound," wrote the good doctor, "before I alighted from my carriage, the pulsations of the brain being very distinct."

The doctor recorded that his patient had a pulse of 60, was breathing regularly and his pupils were reactive. He reported no pain. "Mr. Gage...was relating the manner in which he was injured to the bystanders," wrote Dr. Williams, ".(and then) got up and vomited; the effort...pressed out about half a teacup full of the brain, which fell upon the floor."

The tamping rod had performed a frontal lobotomy on Phineas Gage's brain, disconnecting that part of his mind which dealt with "....future consequences... chooses between good and bad actions... (and) override(s) and suppress unacceptable social responses..." (Wikapedia - "Frontal Lobe"). 

Severing the neural connections with the frontal lobe causes patients to  "...not respond to imaginary situations, rules, or plans for the future..." and who tend to be  "...unusually aggressive ".  And in the case of Phineas Gage, he tended to ".. use puns a lot." In other words, Phineas Gage was a new gauge. About 6:00 pm the company man, Doctor Harlow (above) arrived and took over treatment of the unusual young patient.

http://www.psywww.com/intropsych/ch02_human_nervous_system/lobotomy_effects.html

To no one's surprise, the company doctor decided the young man with the hole in his head could be quickly released from care. And despite several setbacks, Dr. Harlow deemed Phineas able to travel the thirty miles to his mother's home, in Lebanon, New Hampshire for Christmas in 1848.  

He returned to Cavendish in April of 1849, and Dr. John Harlow noted "his physical health is good, and I am inclined to say he has recovered. Has no pain in (his) head, but says it has a queer feeling which he is not able to describe."

Phineas never worked as a "navvie" again. Briefly he tried selling his story via public speaking engagements, and displaying the very rod (above) which had passed through his brain. 

But handsome though he still was, that career never suited him. Despite rumors that he appeared in P.T. Barnum's museum in New York, there is no evidence he ever did. Instead, in 1851, he found a job at the Hannover Inn in Dartmouth, New Hampshire, as a stable hand and coach driver.  Perhaps he found animals a better gauge of Gage than humans. 

Then in 1854 he moved to driving for another stage line , this time in Valparaiso, Chile (above). He took with him his "constant companion", that iron tamping rod. 

Phineas held down his new job for seven years, driving the 70 miles up and down the steep mountain roads (above) between Valparaiso, and Santiago. That would seem to me to be a far longer than you would expect from an unpredictable violent man, as Phineas was described in later medical texts. But I suspect those are just rumors. But one of the occasional side effects of a frontal lobotomy are seizures caused by scar tissue within the brain. And those now began to plague Phineas. 

In 1859 Phineas rejoined his mother, sister and her husband, who were now living in California. He got a job as a farm hand in Santa Clara County (above), at the southern end of San Francisco Bay. But the seizures got worse, and on 21 May, 1860,  Phineas Gauge died of what the doctors called complications of epilepsy, six months short of twelve years after he forgot to load enough sand atop the black powder.

Phineas Gage died just as the American Civil War was exploding. Over the next four years the number of survivors with similar brain injuries multiplied. 

Doctors now had patients and skulls aplenty to examine, and upon reflection they reached several conclusions. First, it was clear that the bumps on the top of the head had no connection to anything going on inside the skull. Phrenology was bunk. But the disabilities of various head wound survivors (above) was proof that different sections of the brain did perform different functions.

And third, the old adage that medicine is the search for profit after death, was confirmed when in 1866, the ex-company Doctor John Harlow convinced (paid?) Phineas' sister and brother-in-law to disinter Phineas just long enough to chop off his head and ship the skull and the infamous tamping rod back to Boston. 

There Doctor Harlow used the skull as an exhibit in his second (and more colorful) paper on his most famous patient.  It was this paper which enlarged on the stories of his post accident temper and use of profanities. But there can also be no doubt that even after his death Phineas reset the gauge for our understanding of brain injuries.

A 2012 study by Harvard University determined the iron rode had "...destroyed approximately 11% of the white matter in Gage's frontal lobe and 4% of his cerebral cortex".  The story of Phineas P. Gage can thus serve as a warning sign about the dangers in being in the forefront of medical science.

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AN OLD TUMMYACHE

 

I hate to tell you this, but America's midsection has a big tummy ache. It's probably not keeping you up nights, but maybe it should. The testimonials of our last intestinal uprising are striking. “The roar I thought would leave us deaf...It was the worst thing that I have ever witnessed.” It was an historic case of indigestion. And that was what you would expect, considering what we swallowed.

About a billion years ago the earth had cooled enough for surface rocks to be strong enough to support the first great mountain range. The worn down nubs of these ancient Himalayas (above, across the center of the landmass)  still stretch across Quebec and Northern New York State, now called the Laurentide mountains and gave that name to this particular toddler continent. 

But as the mountains were word down the ancient bedrock, the igneous granite and quartz of  was first broken and cracked, and then buried under a few billion tons of sedimentary sandstone and limestone washed down from the same Laurentide mountains.

For most of the next three quarters of a billion years, Laurentia slowly drifted, her west flank adding new terrains in more collisions, until she reached young adulthood as the North American tectonic plate. And then, like a Mexican omelet that brings up last night's sweet and sour pork, about a million years ago a lump of ice brought back up that lump of broken rock in our belly.

It was the glacier melt that realigned North America's rivers from north to south. The Mississippi now carried the weight of the Rocky Mountains to America's abdomen, depositing billions of tons silt at low water right on top of the ancient undigested meal. The piling weight caused the broken bedrock to occasionally shift. We know it shifted 2,500 years ago, again 1,800 years ago, and again 600 years ago. And then, one more time, 200 years ago. That last time, it happened to people who wrote the experience down.

In 1777, on the outer bank of a great westward bend of the half mile wide Mississippi river (above), 175 river miles south of St. Louis (and 70 air miles south of the mouth of the Ohio River) , the Spanish established a fort they named after their capital - New Madrid. One year later Azor Rees, a farmer from Pennsylvania arrived with his wife and 3 year old daughter Eliza. The Rees willing swore allegiance to the Charles III of Spain, and adopted Roman Catholicism. They were successful in the community, even after Azor died in 1796. Then in 1803, with the Louisiana Purchase, they became Americans again.

Seven years later, the town of New "MAD-rid" had 400 residents, including the now 31 year old Eliza Rees Bryan – married a second time to a United States Army surgeon. Having a government job, Dr. Bryan received a regular paycheck, and Eliza's mother also operated a boarding house, making them a very important family in this small frontier town. So it was natural that Eliza, in a time and a place where an educated woman was still a rarity, would be asked by a visiting evangelist to record what she had experienced. This is what Eliza wrote.

“On the 16 of December, 1811, about two o'clock, A.M., we were visited by a violent shock of an earthquake, accompanied by a very awful noise resembling loud but distant thunder, but more hoarse and vibrating...The screams of the affrighted inhabitants running to and fro....the cries of the fowls and beasts of every species - the cracking of trees falling, and the roaring of the Mississippi - the current of which was retro-gade for a few minutes....formed a scene truly horrible.” The town's graveyard even disappeared into the river.

Fifteen miles to the south, and closer to the epicenter, stood the 27 houses of the river town of Little Prairie. Here 16 year old Ben Chartier and his mother were standing in the cabin doorway overlooking their orchards though the crisp 40 degree air. Abruptly, "The ground burst wide open and peach and apple trees were knocked down and then blowed up.” The leading citizen of Little Prairie was George Roddell. As swamps next to his property “rose up and became dry land”, he watched his home and grain mill swallowed by adjacent collapsing earth. Within fifteen minutes the residents were waist deep in the cold roiling Mississippi. Stumbling in the dark water, without lights, Roddell led his 100 neighbors in search of dry land. They did not find any until the village of Hayti, eight miles to the northwest.

As the riverbed below the New Madrid Bend rose up, the river was sent rushing backward, swamping 30 flatboats tied up for the night. Their crews were heard calling in terror as the darkness and the mad river swallowed them. On one of those boats which survived, Scotchman John Bradbury was awakened by “a most tremendous noise. All nature seemed running into chaos, as wild fowl fled, trees snapped and river banks tumbled into the water.”

Below the bend another earthen block was thrown up, creating a waterfall that continued for days. Eliza Bryan observed that small shocks continued , “...until about sunrise...(when) one still more violent than the first took place... The inhabitants fled in every direction...In one person, a female, the alarm was so great that she fainted, and could not be recovered. In all four died in New Madrid.

In St. Louis, two hundred miles north of the epicenter, a reporter for the Louisiana Gazette noted he had been “roused from sleep by the clamor of windows, doors and furniture in tremulous motion, with a distant rumbling noise, resembling a number of carriages passing over pavement – in a few seconds the motion and subterranean thunder increased....The agitation...lasted about one and three fourth minutes....At forty seven minutes past two, another shock was felt...much less violent than the first...At thirty four minutes past three, a third shock...(lasted) about fifty seconds...About 8 o'clock, a fifth shock was felt; this was almost as violent as the first, accompanied with the usual noise, it lasted about half a minute...”.

In South Carolina wells went dry and people were shaken awake from their sleep. In Washington, D.C., chairs slid about wooden floors and chandeliers were sent vibrating. Church bells were sent swinging and rang in Philadelphia and as far north as Boston. Two hundred thirty miles from the epicenter, at the falls of the Ohio River, in Louisville, Kentucky, future president Zachary Taylor recorded, “The sight was truly awful: houses cracking, chimneys falling, men, women and children running in all directions in their shirts for safety, and a friend of mine was so much alarmed as to jump off a window and was very much hurt.”

By current scientific figuring it was at least a seven on the Mercalli scale, and maybe an eight. If the larger, that meant at least two aftershocks in the seven range, four above six and at least eight above five. But superimposed over this was a pattern, On 13 January, 1812, in St Louis, the Governor of Louisiana Territory, sent an urgent request to Washington, arguing “provisions ought to be made by law for or cashiered to the said inhabitants relief, either out of the public fund or in some other way”. But “the Supreme Being of the Universe” as Governor Clark called him, was not yet finished with the residents of New Madrid.

On 23 January, 1812, there was a second major quake measuring between a seven and an eight, this time centered even closer to New Madrid. Artist James Audubon, on a boat trip to paint the birds in the new country, wrote in his journal, “ I heard what I imagined to be the distant rumbling of a violent tornado…at that instant all the shrubs and trees began to move...The ground rose and fell in successive furrows like the ruffled waters of a lake.” Godfrey Lessieur saw the ground, “rolling in waves of a few feet in height... These swells burst, throwing up large volumes of water (and) sand...(Leaving) large, wide and long fissures...I have seen some four or five miles in length, four and one-half feet deep on an average about ten feet wide.” George Crist, a farmer in Kentucky, confided to his diary, “We lost our Amandy Jane in this one – a log fell on her...A lot of people thinks that the devil has come here. Some thinks that this is the beginning of the world coming to an end.”

Then, as Eliza Rees Bryan noted, on 7 February, “..about 4 o'clock A.M., a concussion took place so much more violent...At first the Mississippi seemed to recede...leaving for the moment many boats, ...on bare sand...It then rising fifteen to twenty feet....the banks were overflowed with the retro-gade current, rapid as a torrent - the boats....were now torn from their moorings, and suddenly driven up a little creek...nearly a quarter of a mile. The river falling immediately...with such violence, that...whole groves of young cotton-wood trees...were broken off....A great many fish were left on the banks...The river was literally covered with the wrecks of boats, and 'tis said that one was wrecked in which there was a lady and six children, all of whom were lost.” There was now not a house undamaged nor a chimney standing within 250 miles of New Madrid.

At the headwaters of the Tennessee River, in the village of Knoxville, “the river rose several feet, the trees on the shore shook...hundreds of old trees that had lain perhaps half a century at the bottom of the river, appeared...” Six hundred miles from the epicenter, in Charleston, South Carolina there was, “Another severe shock....Books and other articles were thrown from shelves, and chairs and other furniture standing against walls, made a rattling noise...”.

Back in New Madrid, membership in the Methodist Church went from 17 in 1811 to 165 in 1812. Eliza Rees Bryan noted, “The site of this town...(has) settled down at least fifteen feet, and not more than a half a mile below the town...numerous large ponds or lakes....are elevated...fifteen to twenty feet....And lately it has been discovered that a lake was formed on the opposite side of the Mississippi (above)...upwards of one hundred miles in length, and from one to six miles in width,.” This came to be called Reelfoot Lake, and it is now, in the 21st century,  a Tennessee Recreation Area

Responding with typical government efficiency, in 1815 congress voted to offer the December 1811 survivors of New Madrid, 640 free acres of land each, anywhere else in Missouri they wanted. Land speculators beat the government communications to the riverfront town, and bought up most of the claims for $40 to $60 each. Now we can only wait for the next shaker on this old fault to prove that like earthquakes, mountains and continents, human greed is a repetitive story.

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