This article is about the man who survived an iron bar passing through his head. For the UK musical band, see Phinius Gage. Grafton County, New Hampshire [note 1]. In or near San Francisco.
New England Chile California. The Gage who appears in contemporary psychology textbooks is simply a compound creature Anatoli Bugorski —scientist whose head was struck by a particle-accelerator proton beam Eadweard Muybridge —another early case of head injury leading to mental changes Alexis St. Martin —man whose abdominal fistula allowed pioneering studies of digestion Henry Molaison —patient "H.
Cognitive neuropsychology Cognitive rehabilitation therapy Neuroplasticity Neurorehabilitation Occupational therapy Rehabilitation neuropsychology. The birthdate July 9, , is given by a Gage genealogy [6] without citation, [M]: C after his accident. Kean, Sam May 6, Reprinted in Skloot, Rebecca , ed. An Odd Kind of Fame: Stories of Phineas Gage. The University of Akron. Interviewed by Jon Hamilton. The man with a hole in his head". Health Check Audio interview. Interviewed by Claudia Hammond; Dave Lee.
Originally broadcast December 7, Archived from the original PDF on October 6, Bigelow, Henry Jacob July American Journal of the Medical Sciences. Countway Library of Medicine. Disturbances of the Mind. Principles of Frontal Lobe Function. Uses editors parameter link G1.
Harlow, John Martyn Publications of the Massachusetts Medical Society. Harlow, John Martyn December 13, Archived from the original PDF on May 23, Retrieved May 12, Reproduced in Macmillan , p.
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The footprints of Phineas Gage". Archived from the original on Readers Respond to the January Issue. Picturing Phineas Gage Editor's note ". Picturing Phineas Gage Invited comment ". Restoration of function after brain injury. Translated by Haigh Basil. Michael Cole; Sheila Cole, eds. The making of mind: Higher cortical functions in man. Translated by Haigh Basil 2nd ed. The man with a shattered world: Translated by Lynn Solotaroff. History of the Human Sciences.
A Case for All Reasons". Classic Cases in Neuropsychology. Journal of the History of the Neurosciences. Repression and Sigmund Freud". New England Journal of Medicine. Thiebaut de Schotten, M. Images reproduced in Macmillan , App. The Daguerreian Society Newsletter. Transcribed in Macmillan , pp. Advances in Clinical Neuroscience and Rehabilitation. Metacognition and Cognitive Neuropsychology: Monitoring and Control Processes. John Gage of Ipswich, Mass. Miscellaneous specimens page Folders 6 and 7. Swetland; Doug Sweetland, eds. The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-century Britain.
Letter of Edward H. Heart of the Green mountains. Rockwell and Churchill Press. A Science Comics Anthology. Transactions of the Vermont Medical Society for the Year Harlow , pp.
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The claim of Williams' priority". Countway Library of Medicine, pp. Report of the Standing Committee on Surgery. The Transactions of the American Medical Association. Harvard Medical Alumni Bulletin. How popular excitement about a French rabies cure in raised new expectations for medical progress".
Federal Reserve Bank of Minneapolis. Retrieved January 2, Lone Mountain register, — , Halsted N.
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Archives of Internal Medicine. Ohio Medical and Surgical Journal. Samuel Worcester Butler; D G. Medical and Surgical Reporter. A Pictorial History of Cobb and Co.: The Coaching Age in Australia, — Three Years in Chili. By a Lady of Ohio. Hypoperfusion, ischaemia and infection impair healing by decreasing fibroblast proliferation, collagen production and angiogenesis. Diabetic wounds are associated with peripheral neuropathy, vascular disease and impaired local immunity.
Chemotaxis, phagocytosis, bacterial killing and lymphocytic function are reduced, impairing inflammation and healing. Morbidity and mortality are high, and improved healing and limb salvage have been shown with HBO. Bakker recognized the potential of adjunctive HBO in diabetic wounds, 57 but emphasized the need for a multidisciplinary prospective randomized controlled trial. A double-blind randomized controlled trial in demonstrated improved healing and cost-benefits with adjunctive HBO in diabetic ulcers, compared to a placebo group receiving hyperbaric air, although the sample was small.
Other non-diabetic problem wounds include venous stasis ulcers, for which Hammarlund 60 found improved healing with HBO. In summary, some wounds fail to heal even with appropriate cleansing, debridement, closure and antibiotics. HBO is a relatively safe, non-invasive means of improving healing by enhancing oxygenation, decreasing oedema, and modifying healing and immune responses. Limb preservation and speedier healing make this a cost-effective method of wound care, and recent reviews have concluded that HBO is very useful in the management of problem wounds.
Without replacement of red blood cells in major blood loss or haemolysis, tissue hypoxia and ischaemia will soon occur. Where whole blood transfusion is not possible, for religious or practical reasons, HBO may compensate for such a haemoglobin deficiency by increasing levels of plasma-dissolved oxygen to enable oxygenation while erythrocyte regeneration occurs.
This is useful as a short-term measure, but is inconvenient and expensive, and the risk of oxygen toxicity limits treatment duration. Mortality has decreased in conditions such as cerebral abscess, subdural empyema and epidural empyema, due to improved diagnosis, minimally invasive CT-guided aspiration, and improved antibiotic therapy, enabling more conservative and less radical management. In patients with severe infection or immune compromise, who may be unresponsive to standard aspiration and antibiotic treatment, adjunctive HBO inhibits the predominantly anaerobic micro-organisms, reduces cerebral oedema, and modifies the immune response.
Clinical evidence is limited, but the UHMS recommends HBO for multiple, deep or dominantly-located abscesses, or in patients with immune compromise, poor surgical risk, or resistance to conventional treatment. Necrotising fasciitis is a rapidly-progressive and usually traumatic bacterial infection of the deep fascia with secondary subcutaneous and cutaneous involvement. Haemolytic streptococci are typical pathogens, but polymicrobial infection, host diabetes and vascular disease are all common. Local hypoxia occurs, with up-regulation of endothelial adherence molecules, resulting in leukocyte adhesion and endothelial cytotoxicity.
Leukocytes may become sequestered in vessels, impairing local immunity, and incomplete substrate oxidation results in hydrogen and methane accumulation in the tissues. In animal studies, HBO has a direct antibiotic effect, improving tissue oxygen tension, leukocyte function and bacterial clearance.
These chronic, unresponsive bone infections are caused by bacteria that may remain dormant for years. Combined with antibiotics, debridement, and removal of foreign material, HBO is recommended in localized and diffuse osteomyelitis, particularly with vascular or immune compromise. HBO was first used in refractory osteomyelitis by Slack in , 70 and its efficacy has been confirmed in controlled animal studies. Radiation therapy impairs cellular proliferation, causing a progressive, obliterative endarteritis, which results in hypocellular, hypovascular and hypoxic tissue.
This is seen clinically as oedema, ulceration, bony necrosis and poor wound healing that can persist for years after the initial insult. High radiation doses may result in spontaneous radionecrosis. HBO increases vascular density and oxygenation in radiation-damaged tissue.
Oxygen tension is increased to normal levels, enabling fibroblast proliferation, collagen formation and angiogenesis at the wound edges, further improving oxygenation and re-epithelialization. In , Mainous 74 reported improved mandibular healing with HBO after radiotherapy for head and neck tumours. Marx reported in that prophylactic HBO before tooth extractions in heavily irradiated mandibles prevented mandibular osteoradionecrosis more effectively than penicillin. HBO may reduce the incidence and progression of soft tissue radionecrosis, such as laryngeal radionecrosis, 68 although there is less support for this in the literature than for osteoradionecrosis.
Successful treatment with HBO is also documented in other post-radiation damage, including chest wall necrosis, radiation-induced haemorrhagic cystitis, and central nervous system radiation damage. In summary, there is extensive, but not conclusive, evidence for HBO in radiation injury, particularly in mandibular osteoradionecrosis, though randomized controlled trials are lacking.
One particularly detailed economic analysis in osteoradionecrosis found that it was six times more expensive not to use HBO! A number of animal studies have established improved survival of skin flaps and grafts with HBO. In , Marx reported enhanced angiogenesis, healing and flap survival, 81 and in , Nemiroff reported significantly increased microvasculature in animals treated with HBO.
Clinically, significant improvements with HBO in skin grafts and flaps have been reported since The UHMS recommends twice-daily treatment at 2. Severe burns have a central area of coagulation that is subject to rapid deterioration, due to insufficient oxygen and nutrient supply from the surrounding tissues. Burn therapy comprises respiratory care, antibiotics, debridement, and parenteral nutrition, with the aims of reducing oedema, preserving borderline tissue and enhancing host defences. There is evidence that HBO reduces haemoconcentration, coagulability and vascular damage in thermal burns.
Phagocytic bacterial killing is also improved, and white cell endothelial adherence is inhibited, preventing capillary damage. HBO is a relatively safe treatment, but does carry some risks, due to the increased pressure and hyperoxia. The commonest effect of oxygen toxicity is a progressive, reversible myopia, thought to be due to physical lens deformation. Middle ear and sinus barotraumas are preventable by equalization techniques or tympanostomy tubes, 11 and otitis media can be prevented with pseudoephidrine.
Pulmonary barotrauma and pneumothorax are extremely rare, particularly without pre-existing lung disease. Dental barotrauma may rarely cause pain under a dental filling. There have been some concerns that HBO could stimulate malignant growth by increasing tumour oxygenation. This was not supported by Feldmeier in his report of , 90 or his review in , 91 and he concluded that a history of malignancy should not be a contra-indication for HBO therapy. Clinical and experimental evidence does not support claims that HBO during pregnancy can cause a range of foetal complications, including spina bifida and limb defects.
Accidents are a risk due to the enriched oxygen and inaccessibility, with over 50 reported deaths due to fire in the last 20 years. The only absolute contraindication to HBO is an untreated tension pneumothorax, and this must be excluded before treatment. HBO has been recommended and used for a wide range of medical conditions, with a varying evidence base. Evidence for its widespread use in decompression sickness and air embolism is strong, and the UHMS recommends the use of HBO in these and eleven other conditions.
There is extensive anecdotal literature suggesting its use in a range of other conditions Table 4 , including ischaemic stroke, multiple sclerosis and sports injuries.
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Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation. History of hyperbaric medicine. Physiological basis of hyperbaric oxygen therapy. Indications and uses for hyperbaric oxygen therapy.
Address correspondence to Dr C. Introduction Hyperbaric oxygen therapy HBO is increasingly used in a number of areas of medical practice. Physiological basis of hyperbaric oxygen therapy The effects of HBO are based on the gas laws, and the physiological and biochemical effects of hyperoxia. Indications and uses for hyperbaric oxygen therapy In hypoxic conditions, whether due to ischaemia or other factors, HBO reduces infection and cell death and maintains tissue viability while healing occurs.
Oxygen therapy by means of compressed air.
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The pathological effects due to increase of oxygen tension in the air breathed. Treatment of compressed air illness utilizing oxygen. J Indust Hyg Toxicol. High pressure oxygen and radiotherapy. High atmospheric pressure as an aid to cardiac surgery. Treatment of anaerobic infections clostridial myostitis by drenching the tissue with oxygen under high atmospheric pressure. Smith G, Sharp GR. Treatment of coal gas poisoning with oxygen at two atmospheres pressure. Short-term tympanostomy in conjunction with hyperbaric oxygen therapy.
N Engl J Med. Gabb G, Robin ED. Hyperbaric oxygen—a therapy in search of diseases. Oxygen as an antibiotic: Potentiation of tobramycin by hyperbaric oxygen in experimental Pseudomonas aeruginosa. The physiology of wound healing. Regulation of wound-healing angiogenesis—effect of oxygen gradients and inspired oxygen concentration. Tissue destruction by neutrophils. With the introduction of the Live Battle PVP mode, it was important for us - in addition to our current efforts on the leaderboards cleaning - to develop a fair competitive experience to all players.
To do so, the dev team has been working on an update of the vehicle collision model see below for more information , which includes an important focus on the impact of obstacles to your vehicle speed and behavior. Indeed, where it was sometimes more effective to bounce head-on off a wall or slide along it thanks to limited friction, the game will now encourage players to use the best trajectories to get the best results. We will continue to improve this model through further updates.
With this improved collision model, we also reworked the behavior of vehicles when bumping into static elements or traffic. Our objective is to offer a more realistic behavior that would offer a coherent reaction based on the impact source and strength. Vehicles will automatically repair over time when not being hit or whenever you join an event. In our will to continuously improve the driving sensations of the game, we are introducing a reworked version of the Rally Raid vehicles handling.
Vehicles are no longer being forced back on the track, especially when being on air, leading to longer jump times and potentially rocky landings.