One Wrong Glance
On September 13, 1848, a railroad foreman named Phineas Gage was twenty five years old and was preparing an explosion near Cavendish, Vermont. For this task he had to drill a hole into solid rock, put gunpowder plus a fuse inside and compress the materials with a personal iron rod. At 4:30 PM, a split-second distraction set off an event that would become significant to scientific history. Because he believed that his assistant had already covered the powder with sand, Gage looked behind him and hit the iron rod into the hole. The rod was thirteen pounds and three feet seven inches long. As metal touched rock, a spark started a fire and the hole functioned like the barrel of a cannon. By this force the heavy iron rod moved directly into his face.
The rod moved upward at a high velocity - the rod entered Gage's lower left cheek, moved behind his left eye, broke through his left prefrontal cortex, and exited through the top of his skull. The rod landed eighty feet away, covered in brain tissue and blood. Due to the explosion, Gage fell backward onto the ground but the events that followed are unexpected for the observers. He was not dead, and he was not even unconscious. Within minutes, Gage was sitting upright in an oxcart, speaking to others in a relaxed manner. When Dr. John Martyn Harlow reached the hotel room, Gage leaned toward him and said, "Doctor, here is business enough for you"
A Coffin, Just in Case
Popular retellings suggest Gage recovered within weeks, but his actual physical recovery was a difficult, month-long process. In this period Dr. Harlow cleaned the site of the injury, took out pieces of bone that were loose and moved tissue from the brain that was sticking out back inside the skull. During late September, a fungus grew rapidly in the brain of Gage where it was open to the air. By this time Gage was semi-comatose, and his condition was so serious that his family bought him a coffin. To prevent the death of his patient, Dr. Harlow operated quickly to remove fluid from a large pocket of infection while Gage was fully awake. As a result of this work, Gage returned to consciousness over time and started a slow process of physical healing that involved much pain.
The most famous part of the Phineas Gage story is his mental transformation. For medical science, this was the first solid proof that specific brain regions control personality. When the injury was new, Dr. Harlow wrote that Gage was "no longer Gage". Before the accident, Gage was a respectful, hard-working supervisor. After it, he became impulsive, disrespectful, foul-mouthed, and unable to stick to plans. This case changed neuroscience by showing that the prefrontal cortex is essential for impulse control, decision-making, and executive function.
What History Got Wrong
But modern historical research has debunked the idea that Gage remained an antisocial vagrant for the rest of his life. Records show he underwent a remarkable social recovery due to neuroplasticity, the brain's ability to rewire itself after damage. In 1852 Gage traveled to South America. For approximately seven years, he was a driver for a stagecoach that traveled long distances. The job demanded punctuality, composure, physical stamina, and customer service — proof that his self-control and planning had largely returned.
In 1859 the health of Gage was worse because of the injuries to his nervous system. When he moved to San Francisco to stay with his mother and sister, he began to have frequent and intense seizures. On May 21, 1860, he died nearly twelve years after the accident. At Dr. Harlow's request, Gage's body was exhumed many years after his burial. To this day his skull and the iron rod are located at the Warren Anatomical Museum at Harvard Medical School. They remain on display as a testament to one of the most astonishing survivals in medical history.