Phineas Gage the man who survived a metal bar being blown through his head

YOUNG railway foreman, Phineas Gage, became famous for surviving an horrific brain injury.

Portrait of brain-injury survivor Phineas P. Gage, who lost an eye after an iron rod was blasted through his cheek and into his head in 1848.

THE young, energetic railway foreman Phineas Gage was watching some of his workers tamping down explosives into a hole. They were blasting out a railway cutting in Cavendish, Vermont, by drilling holes, filling them with blasting powder then detonating them using a long fuse that would allow the men the time to get to safety first.

According to witnesses Gage was using a long pointy iron bar to tamp down the explosives into one of the holes. He was momentarily distracted by workers behind him dumping a load of rock into a cart. While still looking over his right shoulder, Gage thrust the bar downwards, it struck rock, made a spark and set off the explosives.

The bar was blown upwards through Gage’s left cheek and out through the top of his head, ending up about 25m away. The 25-year-old foreman was thrown to the ground, his legs and arms convulsed briefly, but he was soon able to sit up and talk.

It took witnesses some time to realise what happened and some even refused to believe it, but Gage had survived the horrific accident. While there were some temporary changes to his personality and temperament, Gage largely recovered from the damage to his brain and lived another 12 years, even becoming a medical oddity.

The accident happened on September 13, 1848, 170 years ago today. It was at a time when medical science about the human brain was in its infancy and his case provided important clues about how the brain functioned.

Studio portrait of brain-injury survivor Phineas P. Gage holding the tamping iron which injured him. Picture: Warren Anatomical Museum, Harvard Medical School

Gage was born on July 9, 1823, the son of Jesse Eaton Gage in the farming community of Enfield, Grafton County in New Hampshire. Little is known about his upbringing, or education, except that he could read and write and had a range of farm skills, including being able to wrangle cattle and control horse teams.

After learning some valuable farming skills, possibly in local mines and on other engineering projects, he went to work for the Rutland and Burlington Railroad, which in 1843 had started building a railway between the towns of Rutland and Burlington. Rail companies generally recruited locals, who knew the lay of the land, including the different types of rock in given areas.

Gage rose to the level of foreman, responsible for overseeing teams of workers assigning them tasks and organising their pay.

He was described as being a “shrewd, smart, business man” and was well liked by his fellow workers for his fairness and even temper.

However, it may have been a moment of impatience that caused him to try to tamp down the explosive on that fateful afternoon, causing the metal bar to fly through his skull.

After the confusion of the moment had passed and Gage explained to disbelieving colleagues what had happened, he was put on a cart and taken to the local doctor, Edward H. Williams, to attend him.

Although bleeding, dazed and feeling unwell, he greeted the doctor saying “here is business enough for you”. He then vomited and a piece of brain squeezed out of the wound on top of his head.

The doctor at first didn’t believe the story, but the wound was consistent with Gage’s own account. Fortunately for Gage, another physician John Martyn Harlow was on hand to take over the case. Harlow had graduated from Jefferson Medical College, Philadelphia in 1844 where he had experience with treating cerebral abscesses.

Harlow and Williams treated Gage, whose recovery took time. He lost an eye to infection and slipped into a coma for a period but, after 10 weeks, was able to go home to visit his parents.

Despite his recovery, people noticed marked changes in his behaviour. He caught a chill because he seemed to not feel the cold. Martyn, who published several medical papers on the case observed: “He is fitful, irreverent, indulging at times in the grossest profanity” which was not at all how he had been before the accident. It was believed that the brain damage he sustained had impaired some of mental functions including his social skills.

Phineas T. Barnum, circa 1860.

He was also still weak for several months and unable to return to his job. He earnt money as an exhibit at P.T. Barnum’s American Museum in New York and toured elsewhere, carrying the metal bar with him. He also offered himself for doctors to examine him.

Many of the personality changes he exhibited were not permanent or his brain was able to adapt, because he lived a fairly normal life for several years after. Falling back on his farm skills he found work looking after stables in New Hampshire and in 1852 took a job in Chile driving stage coaches.

But in 1859 his health began to fail so he returned to live with relatives in San Francisco. He suffered a series of epileptic seizures and died in May 1860.