Boston : A. Williams and company, 1870.
Description : [1 l ] pl., -xii p., -759 p. ; ill.: 1 phot., figs. ; 23 cm.
Photograph : mounted albumen, montage of four images.
Photographer : S. Webster Wyman.
Subject : Human anatomy — Anatomical museums; catalogs.
Nor would the profession forgive me if I forgot to mention the admirable museum of pathological anatomy, created almost entirely by the hands of Dr. John Barnard Swett Jackson, and illustrated by his own printed descriptive catalogue, justly spoken of by a distinguished professor in the University of Pennsylvania as the most important contribution which had ever been made in this country to the branch to which it relates. — O. W. Holmes. 1
The most valuable specimen that has ever been added to the Museum, and probably ever will be, was given two years ago by Dr. John M. Harlow, of Woburn. It was the skull of the man through whose head a large iron bar passed, and who essentially recovered from the accident. For the professional zeal and the energy that Dr. H. showed, in getting possession of this remarkable specimen, he deserves the warmest thanks of the profession, and still more, from the College, for his donation. Unfortunately, and notwithstanding the evidence that Dr. H. has furnished, the case seems, generally, to those who have not seen the skull, too much for human belief. — preface.
The very small amount of attention that has been given to the above wonderful case, by the profession in this country, as well as in Europe, can only be explained by the fact that it far transcends any case of recovery from injury of the head that can be found in the records of surgery. It was too monstrous for belief, and yet Dr. Harlow has at last furnished evidence that leaves no question in regard to it. — page 149.
The frontispiece is a photomontage showing four views of the skull of Phineas Gage. The fourth view shows his skull placed next to the 3 ½ foot custom-forged iron bar he used in highway construction to tamp down explosive packing in holes drilled into rock escarpments. One of these charges detonated prematurely and the bar passed through his head, but Gage survived and lived another 12 ½ years. His attending physician was Dr. John Martyn Harlow (1819-1907) of Woburn, Vermont, who wrote two papers on this extraordinary case, the first one appearing in the Boston Medical and Surgical Journal, three months after the accident.2
Recognizing the injury for its importance in the study of brain function, Dr. Henry Jacob Bigelow (1818-1890) of Harvard paid Phineas Gage to travel to Boston so that he could make a cast of his head and write his own paper on the case, published in the American Journal of Medical Sciences.3 The Bigelow and Harlow papers were in opposition over the conclusions they drew from Gage's injury. Bigelow found Gage to be wholly recovered and this was proof enough to refute Franz Joseph Gall's (1758-1828) theory of localisation in brain function. Harlow was not so sure and he continued to study Gage, compiling evidence of behavioral changes and a permanent loss of Gage's faculty to plan for the future. Harlow was pioneering in the enigmatic science of mapping brain function and his monumental second report, published in 1868, remains cogent for contemporary neurobiologists.4 In 1994, Dr. Hanna Damasio led a team of scientists to trace the exact injury caused by the trajectory of Gage's tamping iron and her lab at the University of Iowa ran computer analysis of Gage's skull, demonstrating probable injury to his prefrontal cortices. A fascinating account of her work can be found in Descartes' Error, written by her husband and partner, Dr. Antonio Damasio, who augmented her work with clinical descriptions of patients suffering from the complex of symptoms now recognized as "Phineas Gage disorder." 5
Harlow donated Gage's skull to the Warren anatomical cabinet, and it should be noted that he chose this repository over that of the Mütter cabinet associated with Jefferson Medical College where he took his degree in 1844. Harlow trained under Thomas Dent Mütter (1811-1859) who assumed the chair of surgery in 1841 and although little can be surmised of what Mütter thought about Gall and the science of phrenology, Jefferson College did provide courses on the subject and it was at Jefferson that Harlow learned the discipline. However, John Collins Warren also practiced phrenology and his pathological cabinet inaugurated with the purchase of the Johann Gaspar Spurzheim (1776-1832) collection of skulls. Both the Warren and Mütter cabinets were established in 1847 but it was not until 1874, with the purchase of Hyrtl's collection of skulls, that the Mütter had a phrenological collection of any worth. Harlow chose the Warren because of the authenticity of its phrenological collection and its connection with Spurzheim who assumed the mantle of Gall, the founder of phrenology. Moreover, it was Dr. Warren who had arranged for Spurzheim's sensational lecture tour to America in 1832, who then introduced him to Boston's medical elite, and who — upon Spurzheim's death a few months after his arrival in Boston — arranged for Spurzheim's skull to be bequeathed and vested in the Warren cabinet. Lastly, it was probably significant for Harlow that the Warren cabinet held several other specimens of head injuries which were important for the study of cerebral function, including a remarkably similar case of a man who recovered after a length of pipe pierced his skull in a gas explosion. The iron pipe and a cast of the man's skull (specimens 952 and 3107 ) were presented to the museum by Dr. Bigelow in 1868, the same year that saw the publication of Harlow's second treatise on Phineas Gage and the year he donated this most famous of skulls to the Warren Museum.
The following link will bring up Jackson's transcription of Harlow's notes on the Phineas Gage case including a description of Gage's skull which Harlow donated to the museum and is listed as specimen #949 »». There are also descriptions of the iron bar (specimen #3106), a plaster cast of Gage's head made by Dr. Bigelow (specimen #960) and a skull model Bigelow made to demonstrate the angle of the path taken by the iron bar (specimen #951).
The next link will bring up Jackson's transcription of Bigelow's notes to another case remarkably similar to that of Phineas Gage — a man whose head was pierced by a gas pipe not that dimensionally different than Gage's tamping iron: Specimens #952 and 3107 »». Bigelow comments on the aphasia he found in his subject, but he makes no mention of damage to Broca's region of the brain which could have caused this debility. A brilliant surgeon, Bigelow would have known of Pierre Paul Broca's 1861 work which placed the speech function to the inferior side of the left frontal lobe.6, 7 By omitting this reference Bigelow seems to be making a point of his skepticism of regional brain function, a point he emphasizes by observing that his patient suffered no paralysis — Broca's subject did suffer a hemiparalysis from brain lesion. To be fair to Bigelow, the gas-pipe probably missed Broca's region and damaged instead both the motor and auditory cortices although bone fragment could have been pushed into the left prefrontal lobe. Unfortunately a chance for an important autopsy was missed when Bigelow's patient returned to Ohio and presumably died there.
1. Holmes, Oliver Wendell, 1809-1894. Medical essays, 1842-1882 ;
Boston, Houghton, Mifflin, 1883.
2. Harlow, John Martyn, Passage of an iron rod through the head ; Boston Medical and Surgical Journal, 39, pp 389-393 (also issued as an offprint, vide Cordasco, 60-0808), 1848.
3. H. J. Bigelow, Dr. Harlow’s case of recovery from the passage of an iron bar through the head ; American Journal of the Medical Sciences, 19, pp 13-22, 1850.
4. Harlow, John Martyn, Recovery from the passage of an iron bar through the head. (Paper read before the Massachusetts Medical Society) ; Publications of the Massachusetts Medical Society, 2, pp. 327-347, 1868.
5. Damasio, Antonio R., Descartes’ error : emotion, reason, and the human brain ; New York : G.P. Putnam, 1994.
6. Broca M. P., Perte de la parole, ramollissement chronique et desstruction partielle du lob antérieur gauche de cerveau ; Bulletins de la Société d'Antrhopologie, 62:235-238, 1861.
7. Broca M. P., Remarques sur le siége de la faculté du langage articulé, suivies d'une observation d'aphemie (Perte de la Parole) ; Bulletins et memoires de la Societe Anatomique de Paris 36:330-357, 1861.