“Horrible Accident” in Vermont – Chapter 1, Part 1 – Answer Key

1. Give a brief description of Phineas before the accident.

Answer: He’s 26, unmarried, about 5’6. He’s good with his hands and works well
with his crew, which means he can read people well and is liked by people.

2. Describe Phineas’s tamping iron and what it is used for.

Answer: A tamping iron is for the job of setting explosives. It’s a tapering iron rod
that is three feet, seven inches long and weighs thirteen and a half pounds. It looks
like an iron spear and is very smooth to the touch.

3. What caused Phineas’s accident? Explain the events that led to it.
Answer: The black powder is poured into the hole, but for some reason, the sand is
never poured down the hole. The powder and the fuse are exposed. He was either
sitting or standing over the hole and something distracted him. He turns his head to
glance over his right shoulder. The fat end of the tamping iron slips into the hole
and strikes the granite. A spark flies onto the powder and the hole acts as a gun
barrel. The rod fires straight upward and lands about thirty feet away.

4. Where did the rod enter and exit Phineas’s head?

Answer: The rod entered under his left cheekbone and exited in the middle of his
forehead.

5. List at least three things Phineas does immediately after the accident.
Answer: He’s speaking a minute after the accident. He talks about the explosion. He
rides a half-mile to Cavendish. He makes an entry in his call book as he heads for
town. He gets down from the cart without help.

6. What does Dr. Williams think about Phineas when he first speaks with him?
Answer: Dr. Williams doesn’t believe him. He thinks he was mistaken about his
injuries. Once he inspects them himself, he realizes that it is true.

7. List four medical conditions that could have killed Phineas due to his accident.
Answer: The piercing though the brain from the rod should have been enough to kill
him instantly. He could have died of shock. He could have bled to death. He could
have died of brain swelling. He could have died of a bacterial infection.

8. What can happen in a closed brain injury?

Answer: A hard blow to the head can make the brain rattle around in the skull. The
rattling bruises the brain and the bruised tissue swells. The brain swells, but the
skull stays the same size. The swollen brain can swell so tightly within the skull that
it cuts off its own blood supply. This can cause permanent damage or even death.

9. How can one prevent getting a concussion?

Answer: Wear a helmet when doing anything where you could hit your head.
10. How is Phineas lucky by having an open brain injury? What is a main risk of an open
brain injury other than the injury itself?
Answer: The hole in his head gives his brain swelling room. One of the main risks of
an open brain injury is the risk of bacterial infection.

“Horrible Accident” in Vermont – Chapter 1, Part 2 – Answer Key

1. Where did the term cell (as in the fundamental unit of life) come from?
Answer: Robert Hooke made a slide that held an extremely think slice of cork. When
it was placed under the microscope, he could see that it was made up of rows of tiny,
boxlike structures. The structures reminded him of the bare rooms used by monks
in a monastery, so he called them “cells.”

2. What did doctors in Phineas’s time call what we now know to be infection?
Answer: sepsis

3. What are two of the particularly dangerous families of bacteria?

Answer: Streptococci and staphylococci (strep and staph)

4. What were the three biological mysteries of Louis Pasteur’s time?

Answer: fermentation, decay, and infection

5. What precautions did Joseph Lister take? What was the result of these precautions?
Answer: Pasteur’s germ theory inspired Joseph Lister to try performing surgery in
sterile conditions that exclude or kill all microorganisms. He scrubbed his hands
almost raw before operating, he boiled surgical clothing and instruments, and he set
up a machine to spray carbolic acid in the operating room to kill germs in mid-air.
Lister’s first sterile operations in 1868 will cut the number of deaths from infection
after surgery by 90 percent.

6. Define pus.
Answer: Dead white blood cells, a sign that the body’s immune system is attacking
bacterial invaders.

7. Define lances.
Answer: Punctures

8. What saves Phineas when he develops an abscess just above his eye?
Answer: Dr. Harlow lances the abscess. He drains the pus and dresses his forehead
again. Phineas is saved by his youth, his iron constitution, and Dr. Harlow’s good
nursing.

9. Which bacteria has a distinctive beads-on-a-string appearance?

 Answer: streptococci

10. What are “humors”? What is the origin?

Answer: It goes back to the ancient Greek, which declared that health is maintained
by a balance of four liquids, or humors, in the body – blood, phlegm, yellow bile, and
black bile.

11. Explain the test Dr. Harlow gives Phineas before he leaves Cavendish.
Answer: The doctor offers Phineas $1,000.00 for the pocketful of pebbles that
Phineas has collected walking along the Black River near town. Dr. Harlow knows
that Phineas can add and subtract, yet Phinease angrily refuses the deal.

12. What were some of Phineas’s actions like after his accident?
Answer: The new Phineas is unreliable and, at times, downright nasty. He insults
old workmates and friends. He spouts vulgar language in the presence of women.
He changes his mind and his orders from minute to minute.

13. Why did Dr. Harlow keep his observations about Phineas to himself?
Answer: A doctor is bound by his oath not to reveal the details of a patient’s
condition without permission, so Dr. Harlow kept his observations to himself.

What We Thought About How We Thought – Chapter 2 – Answer Key

1. What is a daguerreotype?
Answer: a photograph on a metal plate

2. What are two odd things about the photograph on page 25?
Answer: There are no females in the picture. There weren’t female nurses or
doctors. The second thing is that the doctors are wearing ordinary clothes. There
are no surgical scrubs, gloves, masks, or booties.

3. What are some of the steps Dr. Bigelow took to ensure that Phineas’s story would be
believable? List at least three examples of his evidence. Did everyone believe Dr. Bigelow’s
claim?
Answer: Dr. Bigelow made a three-dimensional version of Phineas’s face. Phineas
appears in person at Dr. Bigelow’s lectures, with his tamping iron in hand. Dr.
Bigelow reads out accounts from Dr. Williams and Dr. Harlow. He adds other
eyewitness statements from Cavendish people including the hotel owner and some
of the workmen. There were still doctors who thought that Phineas was a fake.

4. How much does the average human brain weigh?

Answer: about three pounds
5. What are two things your brain stem controls?
Answer: Your brain stem controls your breathing and heartbeat.

6. What does the cerebellum do?

Answer: The cerebellum coordinates movement.

7. What does the cerebral cortex do?

Answer: The cortex is where you think, remember, learn, imagine, read, speak,
listen, and dream. In the cortex, you feel your emotions and you make sense of what
your senses are telling you. The cortex is where you actually see what your eyes
transmit, smell what your nose senses, taste what your tongue samples, touch what
your nerves report, and hear what your ears pick up.

8. Where did the tamping iron pass through in Phineas’s brain?

Answer: The tamping iron passed through the frontal cortex.

9. What is the interhemispheric fissure?

Answer: It is a deep crack that separates the left and right hemispheres.

10. What is the corpus callosum?

Answer: It’s a thick mat of nerves that joins the left and right hemisphere. The
corpus is the switchboard for signals back and forth between the two halves.

11. True or False: Every human brain is folded in exactly the same way.
Answer: true

12. Define a cell.

Answer: The cell is the fundamental unit of life.

13. Define a neuron.

Answer: A neuron is a living, one-way wire with switches at both ends. A neuron is
a long, skinny cell with a tangle of receivers at one end called dendrites, a long
connector called an axon in between, and at the other end a smaller tangle of
transmitters called axon terminals.

14. Define a synapse.

Answer: A synapse is a tiny gap between the axon terminal of one neuron and the
dendrite of the next.

15. At the time of Phineas’s accident, list three things doctors knew about brain injuries.
Answer: They knew that cutting the spinal cord resulted in paralysis. They knew
that the higher the break in the spinal cord, the more complete the paralysis. They
knew that if the cord was cut at the base of the brain stem, the patient died.
16. At the time of Phineas’s accident, there was an argument over what the cortex does.
There were two sides to the argument. What did the book call these two groups? Briefly
explain what these groups believed.
Answer: The Whole Brainers thought the brain is a “whole intelligence,” that is, that
your brain is one interconnected “mind.” They think of the cortex as a chamber
holding a formless cloud or jelly driven by a mysterious “vital force.” Through this
force, every part of the brain is connected to every other part. The Whole Brainers
believed that thoughts and commands can originate anywhere in the brain
jelly/cloud and flash into action. If one part of the brain is injured, then the
functions or thoughts that came from there will flow to another part.
The Localizers or Phrenologists believed that the brain was divided into
specific areas that control specific things. They are followers of Dr. Gall, who started
the brain revolution by declaring that the brain was the seat of intelligence,
emotions, and will (phrenology). They believed that there were “organs” inside the
brain that controlled specific functions. They thought there were 37 organs by
feeling of the bumps on one’s head. They thought if you had a strong organ, it would
be big and project from your skull as a bump.

Following Phineas Gage – Chapter 3 – Answer Key

1. Where is it rumored that Phineas went after leaving the Boston medical school?
Answer: He ends up at P.T. Barnum’s American Museum on Broadway in New York
City.

2. What was Phineas’s mother’s name? List at least five facts that she gives Dr. Harlow
about Phineas after he leaves Boston.
Answer: Her name was Hannah Trusell Swetland Gage. She says Phineas returned
to New Hampshire and worked for Mr. Jonathan Currier in his livery stable in
Hanover. He got on well with the horses. He worked there for a year and a half. His
health was good. He seemed happiest with animals and children. In August 1852,
Phineas left New England forever, bound for Chile and a new life as a stagecoach
driver.

3. How long did Phineas drive the stagecoach according to his mother?
Answer: He drove for nearly seven years.

4. Where does Phineas go after leaving Chile?

Answer: He turns up on his family’s doorstep in San Francisco. (His mother had
moved to California to be with her youngest daughter, Phebe, and her new husband,
David Shattuck.

5. List three facts about seizures.

Answer: A seizure is an electrical storm in your brain’s nerve cells. It can begin in
one area of the brain and spread to other regions, sometimes sending your muscles
 into involuntary convulsions. Seizures are relatively common. About one person in
200 will experience a seizure at some time in life.

6. Phineas has a seizure in February. What happens immediately after the seizure?
Answer: He recovers almost immediately with no memory of the fit or any ill effects
from it. Within hours, though, he has two more seizures. In the morning, he seems
fine and insists that he has to get back to work.

7. What did Phineas die from? Make sure you explain fully.
Answer: Phineas begins to have seizure after seizure with very little time in between
them. The seizures are probably caused by slow changes in brain tissue damaged in
the original accident. We don’t know why the damage worsened as Phineas grew
older. The seizures leave him weaker and weaker. The immediate cause of death is
probably hypothermia – his body can’t control its internal temperature. His brain
shuts down circulation to his feet and hands, then his skin, and then organ by organ
until his brain must choose between blood for itself and blood for the heart. His
heart stops.

8. Explain how someone dies from hypothermia.

Answer: You shiver (or convulse) but still sweat as your muscles throw off heat.
Eventually the muscles expel heat faster than it can be replaced. Your blood
temperature starts to fall. Your internal organs, especially the brain and heart, need
a constant core temperature to function. As the brain detects a fall in blood
temperature, it automatically protects itself by shutting down the blood supply to
the hands and feet. You lose feeling. If you keep losing heat, the brain shuts down
blood circulation over a larger and larger area of your skin.

9. Define stroke.
Answer: A stroke is an interruption of the blood supply to the brain that causes
localized damage and often leaves stroke patients without the ability to speak.

10. If you lose the ability to speak, what area of your brain is damaged? Why is it called
that? What is the name of the disorder if you lose the ability to speak?
Answer: If one’s Broca’s area is damaged, he or she will have lost the ability to
speak. That disorder is called aphasia. The Broca’s area is called this because
French surgeon Paul Broca showed how damage to one very small spot in the brain
causes one very specific kind of damage by studying autopsies of stroke patients
who had lost the power to speak.

11. What is the area on the left temporal lobe that controls the ability to understand speech
called? Why is it called that? What is the name of the disorder if you lose the ability to
understand what is said to you?
Answer: It’s called Wernicke’s area because a German Carl Wernicke identified it.
The disorder is called receptive aphasia if you lose the ability to understand what
people say to you.
12. What happened to Phineas’s grave in 1940? Do you think this would have been allowed
to happen today? Why or why not?
Answer: San Francisco needed the land, so the remains of Phineas, his mother, his
brother-in-law, and 35,000 other San Francisco pioneers were dug up by the city
and moved to a mass grave in a suburban cemetery. Their headstones and tombs
were trucked away for landfill. A strong coastal storm uncovered the missing
tombstones under a highway in 1944.

13. What does Dr. Harlow learn about Phineas after his death, and how does he learn it?
Answer: Phineas’s mother describes his last illness and fills in the details of his life
after he left Boston. He concludes that Phineas had “a great fondness for children,
horses, and dogs – only exceeded by his attachment for his tamping iron, which was
his constant companion during the remainder of his life.”

14. Dr. Harlow makes a rather unusual request of Phineas’s mother. What was the request,
and why did he want to do it?
Answer: Dr. Harlow knows how important Phineas’s case is to science and knows
that many people did not believe his story. He asked Phineas’s mother if she would
allow Phineas to be dug up from his grave and have his skull shipped to
Massachusetts.

15. Dr. Harlow appeared before the Massachusetts Medical Society in 1868 and disclosed
all the events of Phineas’s case. What did he tell them?
Answer: “This case has been cited as one of complete recovery…without any
impairment to the intellect,” he said, but in truth Phineas’s personality changed
drastically after the accident. “Previous to his injury, though untrained the schools,
he possessed a well-balanced mind, and was looked upon by those who knew him as
a shrewd, smart business man, very energetic and persistent in executing all his
plans of operation. In this regard, his mind was drastically changed, so decidedly
that his friends and acquaintances said he was ‘no longer Gage.’”

16. Do you think it was right for Dr. Harlow to wait until after Phineas died to announce all
the facts of his case? What were some consequences of this decision?

Putting Phineas Together Again – Chapter 4 – Answer Key

1. People with front lobe damage have difficulties because of their injury. What are some of
these difficulties? List at least three.
Answer: Patients with front lobe damage have trouble making decisions. They
perform well on logic and math tests but make strange choices in trading situations.
Their emotional responses are unpredictable. They seem out of step emotionally
 with the rest of the world. They have little empathy and find emotions to be
something they cannot comprehend.

2. According to information from Phineas’s case, what makes us human?

Answer: The case of Phineas Gage suggest that we are human because our frontal
lobes are set up so we can get along with other humans. We are “hard wired” to be
sociable.

3. Where did Phineas and his tamping iron find their final resting place?
Answer: They are at the Harvard Medical School in Boston. After 150 years on
display just outside the dean’s office in the medical school, they were cleaned up and
moved in 2000 to a new exhibit case in the Countway Library of Medicine.

4. How might people who study serial killers find Phineas’s case interesting?