On the afternoon of 13 September 1848, a twenty-five-year-old railway construction foreman named Phineas Gage was blasting rock near Cavendish, Vermont, to clear a path for a new line. His job involved packing explosive powder into holes drilled in the stone and tamping it down with a long iron rod. Distracted for a moment, Gage brought his tamping iron down before an assistant had added the protective sand. The iron struck the rock, a spark ignited the powder, and the bar became a missile.
The tamping iron was over a metre long, more than three centimetres thick at its widest, and weighed some six kilograms, tapered to a point at one end. It entered under Gage's left cheekbone, passed behind his eye, tore through the front of his brain, and burst out through the top of his skull, landing point-first many metres away, smeared with blood and brain. By every expectation of the age, Gage should have been instantly dead.
The impossible survival
He was not. Within minutes Gage was talking. He was helped into an ox-cart and sat upright for the ride into the village, and when Dr Edward H. Williams, the first physician to reach him, arrived, Gage greeted him with the grim understatement that there was "business enough for you." Dr John Martyn Harlow took over his care soon after, and Gage remained conscious and lucid, able to recount what had happened even as a hole ran clean through his head.
The recovery that followed was long and grisly — infection, an abscess, weeks in a semi-comatose state — but Harlow's careful care pulled him through. Within a couple of months Gage was up and about, physically remarkably intact. He had lost the sight in his left eye, but he could walk, talk, work with his hands and reason. For medicine it was an astonishing demonstration that a person could survive massive destruction of the frontal lobes of the brain.
Yet those who knew him said he had not come through unchanged. Before the accident Gage had been a capable, well-balanced, responsible man, trusted as a foreman and liked by his crew. Afterwards, Harlow reported, he became fitful, irreverent, profane, impatient of restraint, unable to settle to a plan, lurching from one scheme to the next. His friends said he was "no longer Gage." The damage to the front of his brain seemed to have altered not his memory or his speech but his personality and self-control — the very faculties that make a person reliable.
The birth of a neuroscience legend
That observation is why Gage matters. In the mid-nineteenth century, scientists fiercely debated whether different mental functions were located in different parts of the brain, or whether the brain acted as a single undifferentiated whole. Gage became a living, and then much-studied, piece of evidence that the frontal lobes are bound up with personality, judgement and social behaviour — a foundation stone of the field that would become neuroscience. His case is still taught in psychology courses around the world.
It is also a cautionary tale about how facts decay into legend. Over the decades the story of Phineas Gage was told and retold, and the "no longer Gage" phase hardened into a permanent portrait of a ruined, drunken, drifting wretch. The historical record is thinner and more hopeful than the myth. Gage went on to work for years as a stagecoach driver in Chile, a demanding job requiring skill and responsibility, which suggests he recovered far more of his old self than the legend allows. Modern scholars argue that the popular image of a man wholly and permanently destroyed says more about the storytellers than about Gage. His personality changes may have been real but partial, and possibly eased with time.
Gage's later years were troubled by seizures, and in 1860, some twelve years after the accident, he died in San Francisco after a series of convulsions. His family kept the tamping iron after his death rather than burying it with him, and years later presented it to Harlow along with Gage's exhumed skull; today both are kept at the Warren Anatomical Museum at Harvard, where researchers have used them to model, with modern imaging, exactly which pathways the bar destroyed.
The image endures because it is so vivid and so strange: a bar of iron flying through a man's brain, and the man standing up to tell the tale. But the deeper reason it lasts is that Gage, without meaning to, answered one of the oldest questions about ourselves — where in the physical stuff of the head the person actually lives.
Quiz nuggets
- Phineas Gage was a railway construction foreman injured on 13 September 1848 near Cavendish, Vermont.
- A tamping iron over a metre long passed through his left cheek and out the top of his skull, damaging his frontal lobes.
- He survived, treated by Dr John Martyn Harlow, but reportedly underwent personality changes — friends said he was "no longer Gage."
- The case became foundational evidence that the frontal lobes govern personality and social behaviour.
- Gage's skull and the iron rod are preserved at Harvard's Warren Anatomical Museum; he died in 1860 in San Francisco.