Traumatic brain injury (TBI) is a major public health problem, especially among male adolescents and young adults ages 15 to 24, and among elderly people of both sexes 75 years and older. Children aged 5 and younger are also at high risk for TBI.

Perhaps the most famous TBI patient in the history of medicine was Phineas Gage. In 1848, Gage was a 25-year-old railway construction foreman working on the Rutland and Burlington Railroad in Vermont.

In the 19th century, little was understood about the brain and even less was known about how to treat injury to it. Most serious injuries to the brain resulted in death due to bleeding or infection.

Gage was working with explosive powder and a packing rod, called a tamping iron, when a spark caused an explosion that propelled the 3-foot long, pointed rod through his head. It penetrated his skull at the top of his head, passed through his brain, and exited the skull by his temple. Amazingly, he survived the accident with the help of physician John Harlow who treated Gage for 73 days.

Before the accident Gage was a quiet, mild-mannered man; after his injuries he became an obscene, obstinate, self-absorbed man.  He continued to suffer personality and behavioral problems until his death in 1861.

tbi_1This computer-generated graphic shows how, in 1848, a 3-foot long, pointed rod penetrated the skull of Phineas Gage, a railway construction foreman. The rod entered at the top of his head, passed through his brain, and exited his skull by his temple. Gage survived the accident but suffered lasting personality and behavioral problems.

Today, we understand a great deal more about the healthy brain and its response to trauma, although science still has much to learn about how to reverse damage resulting from head injuries.

TBI costs the country more than $56 billion a year, and more than 5 million Americans alive today have had a TBI resulting in a permanent need for help in performing daily activities. Survivors of TBI are often left with significant cognitive, behavioral, and communicative disabilities, and some patients develop long-term medical complications, such as epilepsy.

Other statistics dramatically tell the story of head injury in the United States. Each year:

· approximately 1.4 million people experience a TBI,

· approximately 50,000 people die from head injury,

· approximately 1 million head-injured people are treated in hospital emergency rooms, and

· approximately 230,000 people are hospitalized for TBI and survive