The American construction worker Phineas Gage (1823–1860) became famous as the victim of a horrible accident. While at work helping to lay the course for a railroad bed, an iron shaft was driven through Gage's skull by an accidental explosion. His survival was viewed as miraculous, especially considering his condition after the accident.
After Phineas Gage survived a horrific workplace accident in the fall of 1848, numerous questions arose regarding what happened that day as well as the accident's effects on his personality and on his future health. Regarding this medical mystery, popular accounts and scientific research have provided sharply diverging narratives. Gage's story is gripping in its details: he apparently remained conscious through most or all of his ordeal, and he quickly recovered to a point where he was able to work again. Accounts differ as to how much his personality changed in the years after the accident, and he has remained an object of fascination among scientists. Gage's case, still widely taught in university neuropsychology courses, was one of the first to focus attention on the relationships between specific parts of the brain and human personality traits.
Little is known about Gage's early life. He was probably born in 1823, perhaps on July 9; accounts of the 1848 incident give his age at the time as 25. He came from Grafton County, New Hampshire, reportedly from Lebanon, the city to which he would be sent to convalesce following his tragic mishap. As a young man, he likely worked on several railroad construction projects, gaining some experience in the use of explosives along the way. Contemporary reports on the 1848 accident described Gage as a crew foreman and noted that he was sought out by the Rutland & Burlington Railroad because of his expertise in difficult blasting situations.
On September 13, 1848, Gage and his crew were at work about a mile from the town of Cavendish, Vermont. It was near the end of a long workday spent carving a path for a new railroad bed through an outcropping of black rock. During the blasting process, a crew member poured gunpowder into a hole that had been drilled into the rock. Another crew member then poured sand or clay into the hole, covering the gunpowder and thereby protecting workers from the blast they were preparing. A straight iron shaft—which narrowed to a point at the grip end—was then used to tamp down the covering material over the power, and the materials were ignited after the crew moved a safe distance away. When Gage pushed the iron shaft to tamp down the materials in the hole, he somehow created a spark and the gunpowder exploded, driving the shaft directly toward his head.
At impact, Gage was knocked backward and fell to the ground. In his recollection of the event, he claimed that he had never lost consciousness. If he did, he quickly regained it and was able to climb into an oxcart and remain awake and aware during the mile-long trip to Cavendish. Arriving at his hotel, he sat down in a porch chair and waited for a doctor, chatting with passers-by. When one local doctor arrived and observed bones protruding from Gage's skull, he was reported by contemporary accounts to have quipped: “Here's business enough for you.” At around 6 p.m. a second physician, Dr. John Harlow, arrived and took charge of Gage's treatment, shaving his head and doing his best to remove skull fragments on the patient's head. Gage frequently vomited as fragments of brain tissue settled on the back of his throat, triggering a gag reflex. Yet he remained conscious and even upbeat, expressing a desire to return to work quickly.
After a few days of rest, Gage took a turn for the worse: an infection developed in his massive wound and he fell into a coma. Two weeks after the accident, Dr. Harlow performed a second round of surgery. Although the infection led to permanent blindness in Gage's left eye, the surgery likely saved his life: while in a coma, he had been measured for a coffin. In late November, Gage was discharged to his parents' home in Lebanon, where he rested for several months. Months into 1849, he was taken to Harvard Medical School in Cambridge, Massachusetts, where faculty performed several tests on him and declared his brain to be normal. With no previous knowledge of their celebrity patient, they had little basis for evaluating whether Gage had undergone substantial personality changes.
Although Gage's accident was widely reported at the time, detailed accounts of his activities and movements in the months after he left his parents' house are sparse. He earned money by traveling around New England, carrying the shaft and exhibiting himself as a kind of curiosity. Although he never, as has sometimes been reported, traveled with P.T. Barnum's famous circus, he visited the impresario's American Museum in New York City, where museum visitors could pay an extra ten cents to part his hair and see his pulsating brain through the hole in his head.
After he ended his tour of New England and the railroad declined to rehire him, Gage cast about for new ways to earn a living. He apparently worked as a coach driver and at a livery stable at the Dartmouth Hotel in Hanover, New Hampshire. The year 1852 found him in Valparaiso, Chile, where the discovery of gold had created work for stagecoach drivers and those with expertise in caring for horses. Gage's new job involved caring for horses and driving a six-horse team on a route between Valparaiso and the Chilean capital of Santiago. He remained in Chile for seven years, until 1859, when a new round of health problems prompted him to board a ship for San Francisco, where his family now lived. Once again, rest seemed to improve his health, and he then took a job working on a farm in Santa Clara, California.
In the years since Gage's accident, brain scientists have been fascinated by his case and what it might reveal about the structure of the brain and its relationship to human behavior. However, firm conclusions have been difficult to draw, partly because definitive accounts of exactly what happened to Gage's brain and of how he behaved afterward are spotty. The only careful accounts of his condition were made by Harvard physician Henry Bigelow, who pronounced him healthy, and from Harlow, who wrote of Gage that his intelligence and memory seemed undamaged but that (as quoted by Sam Kean in Slate) “the equilibrium or balance, so to speak, between his intellectual faculty and animal propensities” had been destroyed. Newspapers of the day often used the phrase “animal propensities” when describing Gage, combining it with unsubstantiated reports that the formerly polite accident victim now employed profanity with some frequency.
The day after a particularly hard day's work in early 1860, Gage suffered a seizure, and when he experienced several other severe seizures in the following days, he was dismissed from his farm job. Although he tried to gain stable employment elsewhere, continuing seizures forced him to return to his mother's house in San Francisco. Gage died there from what was described as epilepsy on May 21, 1860. Although buried, his body was exhumed at Harlow's request. Since 1868, his skull has been on display at the Warren Anatomical Museum at Harvard Medical School, where it attracts visitors from many parts of the world. Research has continued into exactly what parts of Gage's brain were damaged by the accident and how his personality was affected as a result.
Macmillan, Malcolm B., An Odd Kind of Fame: Stories of Phineas Gage, MIY, 2002.
Science, May 20, 1994, Hanna Demasio and others, “The Return of Phineas Gage: Clues about the Brain from the Skull of a Famous Patient,” p. 1102.
Big Picture Education, https://bigpictureeducation.com/brain-case-study-phineas-gage (September 22, 2017), “Brain Case Study: Phineas Gage.”
Phineas Gage Information (University of Akron), https://www.uakron.edu/gage/story.dot (September 22, 2017), “The Phineas Gage Story.”
Slate, http://www.slate.com/articles/health_and_science/science/2014/05/phineas_gage_neuroscience_case_true_story_of_famous_frontal_lobe_patient.html (May 1, 2015), Sam Kean, “Phineas Gage: Neuroscience's Most Famous Patient.”
Smithsonian, https://www.smithsonianmag.com/history/phineas-gage-neurosciences-most-famous-patient-11390067 (January 2010), Steve Twomey, “Phineas Gage: Neuroscience's Most Famous Patient.”□