The Only Living Man with a Hole in His Head

September 13, 1848, was a lovely autumn day in Cavendish, Vermont. Phineas Gage, a sturdy 25-year-old man, led a crew in the dangerous task of blasting through boulders and rock ledges to clear the path for the construction of the Rutland-to-Burlington railroad in Vermont.

The crew worked as a team. One man drilled holes in the bedrock at a specific angle and depth. Gage’s assistant then placed coarse-grained gunpowder in each hole, one at a time. Gage used the tapered end of a tamping iron to stick a rope fuse into the powder. The assistant filled the rest of the hole with sand, and Gage pressed or tamped the sand down tightly with the blunt end of the tamping iron. The idea was to direct the explosion of the gunpowder down into the rock, blasting it to bits. Finally, men would come in and manually dig to remove the rubble.

Gage and his team had done these tasks thousands of times. They would set up for the blast, warn everyone, light the fuse, and run for cover. It sounds like a dangerous job, and it was, but Gage was so skilled that his men trusted him and followed his orders.


But on this day, something went terribly wrong. Somehow, sand was never poured down one of the holes. Gage turned his head to glance over his right shoulder, and the blunt end of his tamping iron slipped into the hole, sparking when it hit the rock. The spark lit the blasting powder and sent the tamping rod shooting into the air like a rocket. It landed with a loud clatter more than 100 feet away.

An examination of the rod revealed a gruesome detail about its flight—the rod was covered with blood and brain. Looking away from where the rod had landed and through a haze of smoke, the men saw Gage lying on the ground, his arms and legs twitching. The tamping iron had shot through Phineas Gage’s head, up into the air, and back down to earth, all in less than a second.

Everyone on the crew rushed over, and then an even more unexpected thing occurred. Gage sat up and began talking. When Gage’s men brought him to town for medical care, he was able to walk, with minimal assistance, and to carry on normal conversation.

Gage’s wounds were initially treated by Dr. John Harrow with the assistance of Dr. Edward H. Williams. The damage they observed was considerable. The tamping iron that shot through Gage’s head was 3 feet, 7 inches long and weighed 13¼ lbs. Although the rod was 1½ inches in diameter, the exit hole through the top of his head was 3½ inches wide. The rod entered Gage’s head just under his left cheekbone. It passed behind his left eye and through the front of his brain. It exited just above the hairline toward the middle of the forehead (Figure 13.2).

figure_13.2Harlow cared for Gage over the next two months. Harlow repositioned large pieces of Gage’s skull and pulled the scalp over the hole to cover the unprotected brain. He kept the wound clean and drained infections as they occurred. Gage’s strong constitution and good health enabled him to fight off infections that would have killed most men. Harlow declared Gage “healed” physically, and Gage eventually resumed his duties working for the railroad. However, Harlow and Gage’s coworkers and friends soon suspected that something was not quite right.

Before the accident, Gage had been a responsible, hard-working, dependable man. He was well respected, a great favorite of his coworkers and considered by his employers their “most efficient and capable foreman.” Now there was a “new” Gage who was unreliable and sometimes nasty. He was stubborn and foul-mouthed. He also couldn’t make up his mind about what to do; he would make big plans but fail to follow through. He could no longer work effectively, and his employer had to let him go. Even his friends gave up on him, remarking that “Gage is no longer Gage.”

What exactly happened to Phineas Gage? He survived his dreadful accident and retained his hearing and vision. He had no paralysis. He walked normally and could use his hands to do fine motor tasks. Gage also had no difficulty with speech or language. But his disposition, likes and dislikes, goals, and even dreams for his future had all changed dramatically. Why?


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