The Phineas Gage Story

Recently, the journal History of Psychiatry reprinted the original presentation of the case study of Phineas P. Gage, noteworthy in psychology for surviving having an iron tamping rod driven through his skull and brain. The case notes, by physician John M. Harlow, reveal aspects of the event that provide greater detail about Gage and his unfortunate accident.

Phineas Gage stood five feet six inches tall, weighed 150 pounds, and was 25 years old at the time of the incident. By all accounts this muscular foreman of the Rutland and Burlington Railroad excavating crew was well-liked and respected by his workers, due in part to "an iron will" that matched "his iron frame." He had scarcely known illness until his accident on September 13, 1848, in Cavendish, Vermont. Here is an account of the incident, in Harlow's own words:

"He was engaged in charging a hold (sic) drilled in the rock, for the purpose of blasting, sitting at the time upon a shelf of rock above the hole. His men were engaged in the pit, a few feet behind him... The powder and fuse had been adjusted in the hole, and he was in the act of ‘tamping it in', as it is called...While doing this, his attention was attracted by his men in the pit behind him. Averting his head and looking over his right shoulder, at the same instant dropping the iron upon the charge, it struck fire upon the rock, and the explosion followed, which projected the iron obliquely upwards...passing completely through his head, and high into the air, falling to the ground several rods behind him, where it was afterwards picked up by his men, smeared with blood and brain."

The tamping rod itself was three feet seven inches in length, with a diameter of 1_ inches at its base and a weight of 13_ pounds. The bar was round and smooth from continued use, and it tapered to a point 12 inches from the end; the point itself was approximately _ inch in diameter.

The accounts of Phineas' frontal lobe damage and personality change are well-known, and are corroborated by Harlow's presentation. Details of Phineas' subsequent life (he lived 12 years after the accident) are less known. Phineas apparently tried to regain his job as a railroad foreman, but his erratic behavior and altered personality made it impossible to do so. He took to traveling, visiting Boston and most major New England cities, and New York, where he did a brief stint at Barnum's sideshow. He eventually returned to work in a livery stable in New Hampshire, but in August, 1852, he turned his back on New England forever. Gage lived in Chile until June of 1860, then left to join his mother and sister in San Francisco. In February, 1861, he suffered a series of epileptic seizures, leading to a rather severe convulsion at 5 a.m. on February 20. The family physician unfortunately chose bloodletting as the course of treatment. At 10 p.m., May 21, 1861, Phineas eventually died, having suffered several more seizures. Although an autopsy was not performed, Phineas' relatives agreed to donate his skull and the iron rod (which Phineas carried with him almost daily after the accident) to the Museum of the Medical Department of Harvard University.

Miller (1993) also briefly notes that John Martyn Harlow himself had a rather pedestrian career, save for his association with the Gage case. Born in 1819, qualifying for medical practice in 1844, and dying in 1907, he practiced medicine in Vermont and later in Woburn, Massachusetts, where he engaged in civic affairs and apparently amassed a respectable fortune as an investor. Like Gage himself, Harlow was an unremarkable person brought into the annals of psychology by one remarkable event.

Harlow, J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39, 389-393.

Harlow, J. M. (1868). Recovery from the passage of an iron bar through the head. Paper read before the Massachusetts Medical Society.

Miller, E. (1993). Recovery from the passage of an iron bar through the head. History of Psychiatry, 4, 271-281.