Phineas Gage: The man who lived after an iron bar went through his head

Phineas Gage led a quiet life with an unusual legacy. He’s referenced in nearly every psychology course, cited in hundreds of books and articles, and is still a centerpiece in discussing the brain and its functions, all because of a bad day at work. Phineas, a 25-year-old construction foreman, made an errant strike with a steel tamping rod that rocketed through his face and out the top of his head. The odd part was that this didn’t seem to affect him much.

Phineas Gage’s Accident

On September 13, 1848, Gage and his team were splitting through the mountainsides south of Cav en dish, Ver mont for the Rut land & Bur ling ton Railroad. The job involved drilling a hole in the rock, pouring in gunpowder and a long fuse, tamping it down, topping it off with sand, and then detonating it. Phineas tamped the gunpowder while turning to talk to his coworkers. That’s when the iron rod sparked against the sides of the hole, igniting the gunpowder and turning it into a crude missile. This unintended javelin shot up through his open mouth, entering under his left eye. The three-and-a-half-foot (1.16m) rod then passed entirely through his head.

The custom-made iron tamping rod was around a 1/4 inch (3.2 cm) in diameter and tapered. Some believe the tapering allowed the rod to slide through his head with less resistance, aiding his survival. Although not fully understood until more than 100 years later, the front of his skull fractured enough to split from the rest of his head. Luckily, his soft tissue kept everything together. The rod exited, arced through the air, and landed point down about eighty feet behind, covered with a notable quantity of blood and brain matter.

There have been a few variations in the retelling of what followed. But the basics are that Phineas Gage fell on the ground and convulsed but never lost consciousness. Standing up, he composed himself, was able to hold a conversation, and then got in a wagon to go to the doctor. When Dr. Edward H. Williams arrived at his office, “…he found Gage sitting on the lowest step with his feet in the road; with his elbows on his knees; holding his head between his hands and spitting blood. On being asked what was the matter, he did not speak but raised up his hat with one hand showing the hole in his skull.”

Abnormally Normal

Doctor Williams was initially suspicious that the accident even occurred due to Phineas Gage’s calm nature, “I did not believe Mr. Gage’s statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head. Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain [through the exit hole at the top of the skull], which fell upon the floor.” That’s when Dr. John Martyn Harlow, Gage’s primary physician and a man who had known him before the accident, was called in.

According to Harlow’s records, Phineas Gage recovered fairly quickly. The first two weeks were touch and go. But in as little as four weeks, he was considered well on the way to recovery. Phineas sustained no motor or speech impairments, and his memory remained intact. By six months, Dr. Harlow felt he had fully recovered. According to the doctor, his processes were slower but not worse. But not everyone agreed with Harlow’s assertions. Gage’s coworkers described him as more aggressive and belligerent after the accident. As this soon became a prominent case, stories started circulating about Gage becoming a monster. One paper even reported him attacking his wife and children – a wife and children he did not have.

Medical Curiosity

The story of the man who lost part of his brain spread through both academic and more sensational journals. Outside the wider press, friends, coworkers, and family attested that his personality had changed. He was labeled as less reliable, more impolite, and he used foul language where he hadn’t before. Gage also seemed to have an increased affinity for animals and children. He also had issues with money post-accident and was less apt to plan. Most of these changes align with modern-day understandings of frontal lobe damage, which controls skills like reasoning, planning, and self-control.

In this time when the brain was a near-total mystery, everything that Phineas Gage did was filtered through established and sometimes conflicting theories. For example, Dr. Harlow’s belief in phrenology (a pseudoscience) may have colored what data he focused on. Eventually, he would describe Gage as having “animal propensities” without defining what exactly that meant. So, as Phineas Gages’s life became more public and as more people studied him, the factual details of his life became much harder to pin down. What is known is that he eventually became a stagecoach driver and moved to Chile. While different from his previous work, one hypothesis suggested that this job fostered his recovery by providing the structure he needed to recover skills he seemed to lose in the accident.

The Unusual Legacy of Phineas Gage

The simple fact that Phineas Gage survived this accident showed that operations like removing brain tumors could be performed without assured fatality. He is still used as a case study in psychology and neuroscience courses. Gage passed away due to a seizure in 1860. For decades after, he shaped much of what people knew, or what they thought they knew, about the brain. After Gage passed, his skull was exhumed and became part of a collection at Harvard. It wasn’t until 2012 that his skull was more thoroughly examined and better understood. Through it all, his case has changed how humanity looked at the brain.

RELATED ARTICLE: The Life of Bass Reeves: Legendary Lawman