Who was Phineas Gage?

On 13 September 1848, Gage was directing a work gang blasting rock to prepare a railroad bed near Cavendish, Vermont. The job required boring a hole into rock, adding blasting powder and a fuse, then tamping inert material down on top of the powder with an iron rod to direct the force of the blast into the surrounding stone. While Gage was tamping the charge, his attention was drawn to men working behind him. As he turned, bringing his head in line with the hole, the iron sparked against the rock and the powder exploded.

The tamping rod, over three feet long and weighing more than thirteen pounds, shot upward through the left side of Gage's face, behind his left eye, through the left side of his brain, and out through the top of his skull, landing some eighty feet away covered in blood and brain matter. Remarkably, Gage was thrown onto his back but regained speech within minutes, was able to walk with assistance, and sat upright for the ride into town. A doctor who examined him shortly afterward found him sitting in a chair, still conscious and describing his own injury to onlookers before vomiting up a portion of his brain tissue through the wound.

Harlow took over Gage's care that evening, cleaning the wound, removing bone fragments and damaged tissue, and closing it while leaving room for drainage. The following weeks were turbulent: Gage recognized family members early on, then became delirious, then improved, then relapsed into a near-comatose state as infection took hold. At one point his condition grew so dire that his attendants prepared his coffin, believing him close to death, but Harlow intervened with further treatment of the infected tissue and the crisis passed.

Gage's physical recovery, though slow, proved more complete than anyone might have expected. Within weeks he was walking, and within ten weeks of the accident he was strong enough to travel back to his parents' home in New Hampshire. Over the following months he regained enough strength to do farm work, and by the following year Harlow judged that physically, at least, Gage had recovered.

Harlow's most detailed account of Gage's mental state was not published until 1868, after Gage's death, and described a man transformed: impatient, profane, undisciplined, and unable to settle on plans, so different from his old self that friends said he was no longer Gage. This description, delayed by years and shaped by Harlow's interest in theories connecting brain structure to personality, became the dominant image of Gage for generations of readers, even though it applied specifically to the period soon after his injury rather than to his whole later life.

Evidence suggests that Gage's most severe mental disturbances faded with time. In the late 1850s he was working in Chile as a stagecoach driver on the demanding Valparaiso to Santiago route, a job requiring daily discipline, planning, and the ability to get along well with passengers and horses alike over long, difficult journeys. A physician who knew him there in 1858 and 1859 described him as being in good health with no apparent impairment of his mental faculties, suggesting that the structured, responsible nature of the work may have helped him regain social and personal skills that had been disrupted by his injury.

Gage's health declined after he left Chile in 1859, and in San Francisco he began having epileptic seizures in early 1860. These worsened over the following months, and he died in status epilepticus on 21 May 1860, following a severe convulsion two days earlier. He was buried in San Francisco. In 1866, after Harlow made contact with the family, Gage's skull and his beloved tamping iron, which he had kept as a constant companion for years, were exhumed and sent to Harlow, who eventually placed them in Harvard's Warren Anatomical Museum, where they remain on display.

Gage's survival became one of the most frequently cited cases in the history of brain science, used by nineteenth-century physicians to argue over whether mental functions are localized to specific brain regions, and later invoked in debates over phrenology, psychosurgery, and modern theories of decision-making and emotion. Yet historians studying the original sources have found that the body of verified fact about Gage is remarkably thin, which has allowed each generation of writers to project its own theories onto him, often exaggerating or inventing details of dissolute or violent behavior for which there is no actual evidence in the accounts of people who knew him.

Two confirmed photographic portraits of Gage, identified only in 2009 and 2010, show him well dressed, confident, and holding his tamping iron, undermining long-repeated claims that he spent his later years as a disheveled drifter or sideshow curiosity. Along with the account of his steady work in Chile, these images support the view that Gage, after a genuinely severe period of behavioral disturbance, found a way to rebuild a functional and socially capable life in the years before his death.