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Phineas P Gage was a railway construction workman who, in 1848, received a devastating penetrating head injury. A 4 ft long tamping iron was fired by accident through his skull destroying both frontal lobes. He survived the accident through luck, the care he received from colleagues at the scene and through medical care received from doctors. This article examines closely the injury pattern, prehospital care, trauma care and medical and psychiatric sequelae Gage received.

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