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The improbable story of Phineas Gage

By Thomas D’Agostino, www.tomdagostino.com

On September 13, 1848, an event stunned the medical field when the improbable happened in Cavendish, Vermont. 25-year-old Phineas Gage, a blasting foreman for the Rutland & Burlington Railroad, was using his three-foot tamping iron to set explosive charges for blasting when it prematurely exploded, sending the iron through his skull. Setting the blast entailed boring a hole in the rock, filling adding blasting powder and a fuse, then filling the rest of the hole with sand before tamping the whole mixture with the rod.

Around 4:30 p.m., Gage was distracted while filling one of the holes. He turned his head to speak to one of the workers and at the same time the rod accidentally hit the rock, sparking the powder. The 1-1/4-inch diameter, three-foot-seven-inch custom-made rod blew straight through Gage's upper jaw, passed behind the left eye and through the left side of the brain before exiting the skull. The rod landed eighty feet away, taking part of his brain with it. Gage, still conscious, was assisted as he walked and rode back to town. Physician Edward Williams was brought to the scene where Gage simply said, "Doctor, here is business enough for you."

Dr. John Harlow took charge of the case from there. Harlow, with the help of Williams, removed bone fragments and an ounce of protruding brain while cleaning the wound, replacing some of the bone and dressing it. Harlow also attended to the burns Gage suffered on his hands and arms from the blast.

Gage recovered but slowly and with ups and downs in regard to mental capacity. Further surgery was needed, but within a month Gage was walking and talking about. Ten weeks later, he returned to his parent’s home in Lebanon, New Hampshire.

News spread quickly of the man who had a three-foot iron rod blast through his skull and he soon became an attraction. People packed into theaters to see the man and his rod tell his story. He became somewhat of a celebrity, but his friends knew that something was different. He was now prone to fits of anger and began having epileptic seizures. The rod when it passed through his skull had taken his frontal lobe and sight in his left eye.

Gage later moved west where he found work as a stagecoach driver but illness began to take its toll on the once strong and industrious Gage. By February 1860, Gage was having regular epileptic seizures. His mother and sister moved west to care for him but on May 21, 1860, 36- year-old Gage died from one of his seizures and was buried in San Francisco's Lone Mountain Cemetery.

Gage had survived the accident for twelve years. In 1866, his body was disinterred and his skull and iron tamping bar were given to Dr. Harlow, the man who had cared for him after the accident. Dr. Harlow later gave the artifacts to Harvard Medical School’s Warren Anatomical Museum where they have been on display since. In 1940, Gage's headless remains were relocated to Cypress Lawn Cemetery when a law was passed for resting the dead outside of city limits. There is a monument in Cavendish telling the tale of the incident and a walking tour to go along with it. To this day, the story of Phineas Gage is an enigma to science but in New England as we have seen over and over again, truth is often stranger than fiction.