The Curious ( and Striking ) Case of Phineas Gage

Traumatic brain injuries are older than the story of David and Goliath, but few people have heard of Phineas Gage. He remains the most famous patient in neuroscience and I’m sure you will find his case as remarkable as I do.

The Freak Accident

In 1848, Gage was using a 43 inch long tamping iron that was 1.25 inches in diameter to pack explosive powder into a railroad bed. The powder exploded from a spark, and it propelled the 13.25 pound tamping iron vertically through the left cheek and brain of Gage. It exited the top of his skull and came to rest dozens of feet away while taking a chunk of gray brain matter with it. This was quite a devastating traumatic brain injury as you can imagine. Although blinded in his left eye, Gage survived the explosion and harpooning. He visited a doctor that same day.

The New Phineas Gage

Prior to the accident, Gage was an affable and successful railroad construction foreman. As per the Harvard Gazette, a new Phineas Gage emerged from the explosion. He was suddenly “fitful, irreverent and grossly profane, showing little deference for his fellows.” His new and ill-mannered demeanor caused his employer to refuse to allow him to return to work. Certainly today Mr. Gage’s construction accident would have been the basis of a personal injury case, but such a thing did not exist in the 19th century.

The Famous Phineas Gage

Phineas Gage remains the most widely used name in the neuroscience of post-traumatic social disinhibition. His was the first recorded case when doctors could state within a reasonable degree of medical certainty that a traumatic brain injury could result in a change of personality. In Gage’s case, that change was dramatic. It was seminal in establishing brain science as a medical field. Gage died 12 years later from a series of seizures. It’s highly likely that the tamping rod accident was the cause of his seizures and death.

Phineas’s Place in TBI History

Before Gage’s traumatic brain injury, phrenologists were evaluating personalities by measuring the bumps on a person’s head. Generations of neuroscientists and doctors have examined and studied the curious skull of Phineas Gage and the tamping iron that made him famous. Both are at the Warren Anatomical Museum on the Harvard Medical School campus. In the context of neuroscience, the dynamics of structural damage to the brain and behavioral changes, the explosion resulting in Phineas Gage’s brain injury was the Eureka moment.