The Accident
On September 13, 1848, 25-year-old Phineas Gage was working as a railroad construction foreman in Cavendish, Vermont. His job required blasting rock to clear the path for the Rutland and Burlington Railroad. The process involved drilling holes in rock, adding blasting powder and a fuse, then tamping the powder down with a long iron rod — the tamping iron — before covering it with sand. At approximately 4:30 PM, Gage was preparing a blast when the powder ignited prematurely. The tamping iron — 3 feet 7 inches long, 1.25 inches in diameter, and 13.25 pounds — was launched upward with tremendous force.
The Iron Rod's Path
The iron rod entered Gage's skull below his left cheekbone, passed behind his left eye, traveled through his frontal lobe, and exited through the top of his skull. It was found 80 feet away, covered in blood and brain tissue. Gage was thrown onto his back. Witnesses reported that he had a brief convulsion but was then able to speak. A physician named John Harlow arrived and treated Gage's wounds. Harlow described the entry and exit wounds and noted that the rod appeared to have passed through the anterior part of the frontal lobe. He was skeptical of his own notes.
The Recovery
Gage survived. Within minutes of the accident, he was conscious and speaking. He was transported to his boarding house, where Harlow treated his injuries over the following weeks. There was significant infection and near-death periods. But Gage recovered physically. He was back on his feet within two months and lived another twelve years. The physical recovery was, by any measure of 1848 medicine, miraculous.
The Personality Change
This is where Phineas Gage's case became historically significant. Before the accident, Gage was described by his employers and colleagues as an efficient, responsible, socially able foreman — someone they had come to rely on. After the accident, Gage was described as markedly different. He was fitful, irreverent, impatient, obstinate, and unable to maintain the social conventions he had previously navigated easily. His physician wrote that 'the equilibrium or balance between his intellectual faculties and animal propensities seems to have been destroyed.' Gage's employers found him changed enough that they would not give him his job back.
What Gage's Case Proved
Before Gage, the dominant medical understanding held that the brain operated as a relatively unified organ — that personality and behavior were not specifically localized to particular regions. Gage's case — showing a specific, targeted injury to the frontal lobe producing specific, targeted personality changes while leaving other cognitive functions intact — was among the first strong evidence that the frontal lobe was specifically involved in social behavior, planning, and personality. This insight, derived from a railroad accident in Vermont in 1848, became one of the foundational pieces of modern neuroscience.
Gage's Later Life
After losing his railroad job, Gage worked at the Barnum Museum in New York, exhibited himself and his tamping iron, then worked as a stagecoach driver in Chile for several years. He eventually moved to San Francisco to live with his family. He died on May 21, 1860, approximately twelve years after the accident, from a series of epileptic seizures. His skull and the tamping iron are on display at Harvard Medical School. He has been cited in virtually every introductory neuroscience textbook published in the past century.