On 13 September 1848, near the Vermont town of Cavendish, a 25-year-old railway construction foreman named Phineas Gage was preparing a blast. His job was to bore holes into rock, add explosive powder and a fuse, cover it with sand, and tamp the charge down with a long iron rod. Distracted for a moment, he brought the rod down before the sand had been added. The friction sparked the powder, and the tamping iron, over a metre long, three centimetres thick, and weighing around six kilograms, shot upward like and hit his face beneath his left cheekbone, passed behind his left eye, tore through the front of his brain, and burst out through the top of his skull, landing many metres away, smeared with blood and tissue.
By every reasonable expectation, Gage should have been killed instantly - but he was not. Witnesses reported that he spoke within minutes and, with a little help, walked to a cart and sat upright for the ride back to town. When the local physician, John Martyn Harlow, arrived, Gage reportedly greeted him and reported that the iron had gone through his head. Over the following weeks he experienced infection and delirium, but under Harlow’s care he pulled through, keeping his speech, memory, movement, and the sight in his uninjured eye.
What he may not have kept, at least for a time, was himself. Harlow’s later report described a disturbing transformation: the once capable, reliable, well-balanced foreman had become impulsive, profane, capricious, and unable to stick to plans, “no longer Gage,” to those who knew him. Gage, it seemed, was living proof that the frontal lobes are the seat of personality, judgement, and social restraint, that the self has a physical home in the brain, and that damaging the tissue can alter the person. Of course, this all depends upon the definition of self.
Most descriptions of Gage’s changed character are second-hand and close to the accident. There is good evidence that he recovered a great deal over the following years, enough to hold down demanding, socially complex work as a long-distance stagecoach driver in Chile, a job requiring skill, reliability, and the daily management of horses and passengers. However, the popular myth makes a better story. He lived roughly twelve more years, dying in California in 1860 after a series of seizures, likely a delayed consequence of his injury.
His skull and the tamping iron survive in a Harvard museum, and researchers have used them, together with modern imaging techniques, to reconstruct the rod’s probable path and estimate which brain regions were destroyed. it is likely that there was damage in the ventro-medial prefrontal cortex, an area now linked to emotional regulation and decision-making. The debate goes on.