September 13, 1848, marked the day in history when a young railroad foreman named Phineas Gage survived one of the most extraordinary accidents in medical history. While preparing a blasting site for the Rutland & Burlington Railroad near Cavendish, Vermont, an iron tamping rod shot through his skull—entering his cheek and exiting the top of his head—yet he lived for nearly 12 more years.
The Accident
At about 4:30 p.m., Gage was tamping blasting powder into a drilled hole when a spark ignited the charge. The iron rod, 3.2 cm in diameter and over a meter long, rocketed upward with explosive force. It passed through the left side of his face, behind his eye, and out the top of his skull, landing some 80 feet away, “smeared with blood and brain.”
Amazingly, Gage did not die instantly. Reports say he spoke moments later, walked with little assistance, and even sat upright during the wagon ride into town. Local physician Edward H. Williams found him sitting in a chair, calmly telling bystanders about the accident.
Treatment and Survival
Dr. John Martyn Harlow soon took charge of his care. The injury left a gaping wound, with brain tissue visibly pulsating. Harlow cleaned the area, removed bone fragments, and left the wound partially open to drain—a rare decision that likely saved Gage from fatal infection.
Although he slipped in and out of delirium in the following days and nearly died from infection, Gage gradually recovered. By November, he was able to walk and resume light work. He ultimately lived another 12 years, a medical marvel in an era before the advent of antiseptics or antibiotics.
Personality Changes
The true significance of Gage’s case was not only his survival but also the profound changes observed in his behavior. Before the accident, he was considered a capable, responsible foreman, admired by his men and employers. Afterward, however, accounts described him as irreverent, impatient, and profane. Dr. Harlow wrote that his personality had changed so drastically that those who knew him said he was “no longer Gage.”
Modern interpretations suggest that the damage to his frontal lobe disrupted emotional regulation and decision-making, highlighting the brain’s role in shaping personality.
Gage’s case became one of the earliest and most famous pieces of evidence linking brain injury to changes in behavior.
Later Life
Unable to return to his railroad job, Gage spent time making public appearances and later worked as a stagecoach driver in Chile, which some scholars believe helped him regain social functioning and stability.
In his final years, he lived with family in California but suffered from seizures. He died in 1860, at the age of 36.
His skull and tamping iron were preserved and are now displayed at Harvard’s Warren Anatomical Museum, serving as enduring symbols of medical curiosity and resilience.
Over 175 years later, his story remains a cornerstone in the study of brain function, illustrating both the fragility and resilience of the human mind.