Phineas Gage died in 1860, around twelve years after an iron rod was blasted through his skull and brain in a railroad accident. He is remembered less for how he died than for the dramatic change in his personality the injury caused.
Phineas Gage was a 25-year-old railroad construction foreman in Cavendish, Vermont, in 1848. His job was routine.
He used blasting powder to clear rock for the Rutland and Burlington Railroad. On September 13, 1848, a blast accidentally drove an iron rod through his brain.
Phineas Gage, a railroad construction foreman, survived a severe brain injury in 1848 when an iron rod pierced through his skull and brain. He lived for almost 12 years afterward. But his personality changed forever.
Gage died on May 21, 1860, after a series of seizures called status epilepticus, a condition marked by repeated convulsions without regaining consciousness between them. His case remains one of psychology’s most cited studies of brain function and personality.
Key Takeaways
- Cause of Death: Gage died in 1860, about twelve years after his accident, following a series of epileptic seizures.
- The Accident: In 1848, a work explosion drove an iron rod through Gage’s skull and left frontal lobe.
- Remarkable Survival: Gage stayed conscious, spoke within minutes, and recovered his physical health despite the severity of the injury.
- Personality Change: Acquaintances said Gage was “no longer Gage” afterward, though his memory and intelligence were unaffected.
- Disputed Lesion: Modern reconstructions disagree over whether the damage reached both sides of Gage’s brain or the left side only.
- A Complicated Legacy: Historians argue the popular “ruined man” story is exaggerated; Gage later held a demanding job in Chile.
How did Phineas Gage almost die?
Not knowing that a crucial step had been missed, Gage put an iron rod into a hole filled with gunpowder and tried to pack the contents.
The friction he created caused the powder to ignite and launch the rod directly into Gage’s upper cheek. The rod passed behind his left eye, through his left frontal lobe, and out through the top of his skull.
Miraculously, Gage did not die. Instead, he was able to speak a few minutes after the accident took place and even walked (with help) to an ox-cart to receive medical care.
Dr. John Martyn Harlow tended to Gage, and as a result, Gage ended up recovering from his physical injuries.
Why was Phineas Gage able to survive?
Researchers have tried to work out exactly where the rod passed through Gage’s frontal lobe, and why he survived such a catastrophic injury. Reconstructions of his skull disagree on the details.
Hanna Damasio and colleagues modelled the rod’s path and concluded the damage reached the ventromedial frontal lobe on both sides of Gage’s brain (Damasio et al., 1994).
Ratiu et al. (2004) and Van Horn et al. (2012) disagreed, concluding from CT scans that the injury was confined to the left frontal lobe alone.
This eliminated brain matter in the region. But the damage did not cross into the right hemisphere, so functioning elsewhere continued.
Ratiu et al. (2004) also found less damage to major blood vessels than earlier accounts assumed. This helps explain why Gage did not bleed to death.
Van Horn’s team went further, using diffusion imaging to model the white-matter pathways the rod had severed. This meant disconnected networks, not just a damaged patch.
How did Phineas Gage change after the accident?
Though he was able to heal, the 13-pound rod did severe damage to Gage’s frontal lobe. An infection from the wound site also caused Gage to have even more brain tissue removed.
After the surgeries, Gage’s observed behavior dramatically changed. Before his accident, Phineas Gage was described as a kind man who was considerate of others and extremely polite.
After, Gage’s personality was reported to have changed completely. Now, Gage was erratic, abusive, and rude.
He was incredibly stubborn when others did not agree with him and often acted without thinking. Those close to him said that Gage was no longer the person he once was.
The change unsettled everyone who knew him. As Harlow (1868) himself recorded, Gage had become “fitful, irreverent, indulging at times in the grossest profanity… pertinaciously obstinate, yet capricious and vacillating.” He devised “many plans of future operation, which are no sooner arranged than they are abandoned.”
The implication is broad. In Harlow’s own words, Gage was now “a child in his intellectual capacity and manifestations,” yet retained “the animal passions of a strong man.”
Curiously, Gage’s memory and cognitive understanding were not significantly impacted.
Dr. Harlow published articles on Gage’s brain during this time and documented some of the first insights into how damage to the frontal cortex impacted an individual.
Gage’s accident also led to an early influence on neuropsychiatry, the study of understanding how the interaction of neurobiology and psychology works to create behaviors.
When did Phineas Gage die?
After the accident, Gage was healthy and able to work as a stagecoach driver in Chile for seven years. Eventually, he became ill and moved to California to be with his family.
In 1860, about 12 years after his accident, he died of an epileptic seizure.
Gage’s body did not undergo an autopsy. However, it is assumed that the seizure was related to his brain injury.
Where is Phineas Gage’s skull now?
Years after his death, Dr. Harlow requested Phineas’s bones from the Gage family. Following exhumation, Gage’s skull and the iron rod that had entered Gage’s brain were in Dr. Harlow’s possession.
He secured them for scientific preservation and later donated them to Harvard University. To this day, they are still displayed in the Harvard Medical School’s Anatomical Museum.
Critical Evaluation
Gage’s case is one of psychology’s most famous, but it is also one of its most fragile as evidence. A fair reading has to weigh both its historical importance and its real limitations:
- A Single, Unreliable Record: Gage is one uncontrolled case, and the fullest account of his personality change was written twenty years later, partly from other people’s memories.
- A Disputed Lesion: As explained above, reconstructions of Gage’s skull disagree about whether the damage reached both sides of his brain or the left side only.
- A Story Built Up Over Time: Historians have shown that later writers exaggerated Gage’s personality change to make the case fit theory more neatly than the evidence allows.
A Single, Unreliable Record
Gage’s case has no control group and no experimental manipulation. It is a one-off natural experiment, not a designed study, so it cannot show what would happen to a different person with a similar injury.
Individual brains vary enough in their organisation that one patient cannot settle a general claim about how the brain works.
The behavioural record is also worryingly thin. Dr. Harlow published his fullest account of Gage’s changed personality in 1868, twenty years after the accident and eight years after Gage had died.
He drew partly on Gage’s family’s recollections. There was no contemporaneous, systematic record of his day-to-day behaviour, and no neuroimaging or formal psychological testing was possible during his lifetime.
Later infection may also have destroyed additional brain tissue, further complicating the picture.
A Story Built Up Over Time
Historian Malcolm Macmillan (2002) has shown that the popular version of Gage’s story goes well beyond what Harlow actually documented. Later writers polished Gage’s “before” into an idealised, mild-mannered citizen.
They also darkened his “after” into a dissolute, aimless wreck, a contrast that fit localisation theory more neatly than the record supports.
The popular image of Gage as a psychopathic drifter, reduced to exhibiting himself at fairgrounds, is especially poorly supported. Harlow’s own account records that Gage held a demanding job as a long-distance stagecoach driver in Chile for around seven years.
That image does not hold up.
The job demanded punctuality and planning. It also meant managing horses and passengers day after day. Surviving photographs, identified only decades later, show him well-dressed and composed rather than dishevelled (Macmillan, 2002).
None of this erases why Gage matters. His case still offers striking, if imperfect, evidence that frontal-lobe damage can change personality and social judgement while leaving intellect and memory intact. It also helped launch neuropsychology as a discipline.
Contemporary Research
Since 2015, the picture has moved on two fronts. Sharper anatomical modelling and more systematic reviews have refined the Gage story further.
Aim: Thiebaut de Schotten et al. (2015) set out to model exactly which white-matter fibre tracts Gage’s injury would have severed, not just which grey-matter regions it struck.
Method: The team went further. They combined a CT scan of Gage’s skull with a 3D model of the iron’s path. This was overlaid on a white-matter connectivity map built from 129 healthy adults’ diffusion scans.
Results: Beyond the directly damaged frontal cortex, the model showed substantial disruption to long-range tracts reaching the frontal pole, cingulate cortex, precuneus and amygdala, structures nowhere near the rod’s path.
Conclusion: The implication is broad. The breadth of Gage’s reported personality change is better explained by this widespread disconnection than by the local cortical damage alone.
This tractography model does not settle how necessary the damaged region actually was for decision-making. A 2023 systematic review of ventromedial prefrontal cortex lesion studies found the region’s role in decision-making to be moderate and context-specific, not an indispensable switch (Messimeris et al., 2023).
This is the evidence Gage’s case often introduces. The picture is more complicated now.
This tempers, without discarding, the classic reading of Gage: the frontal lobes clearly matter for social and emotional judgement, but the modern evidence no longer supports an all-or-nothing story.
A content analysis of 23 introductory psychology textbooks found that most cover Gage’s accident accurately (Griggs, 2015). But only around half discuss his recovery, and few mention the newer lesion reconstructions. That gap helps explain why the myth persists.
References
Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M., & Damasio, A. R. (1994). The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science, 264(5162), 1102–1105.
Gearhart, S. (2022, June 27). Phineas Gage. Encyclopedia Britannica. https://www.britannica.com/biography/Phineas-Gage
Griggs, R. A. (2015). Coverage of the Phineas Gage story in introductory psychology textbooks: Was Gage no longer Gage? Teaching of Psychology, 42(3), 195–202. https://doi.org/10.1177/0098628315587614
Harlow, J. M. (1868). Recovery from the passage of an iron bar through the head. Publications of the Massachusetts Medical Society, 2(3), 327–347.
Macmillan, M. (2002). An odd kind of fame: Stories of Phineas Gage. MIT Press.
Messimeris, D., Levy, R., & Le Bouc, R. (2023). Economic and social values in the brain: Evidence from lesions to the human ventromedial prefrontal cortex. Frontiers in Neurology, 14, Article 1198262. https://doi.org/10.3389/fneur.2023.1198262
Ratiu, Talos, I.-F., Haker, S., Lieberman, D., & Everett, P. (2004). The Tale of Phineas Gage, Digitally Remastered. Journal of Neurotrauma, 21(5), 637–643. https://doi.org/10.1089/089771504774129964
Sevmez, Adanir, S. S., & Ince, R. (2022). Legendary name of neuroscience: Phineas Gage (1823–1860). Child’s Nervous System, 38(5), 855–856. https://doi.org/10.1007/s00381-020-04595-6
Teles. (2020). Phineas Gage’s great legacy. Dementia & Neuropsychologia, 14(4), 419–421. https://doi.org/10.1590/1980-57642020dn14-040013
Thiebaut de Schotten, M., Dell’Acqua, F., Ratiu, P., Leslie, A., Howells, H., Cabanis, E., Iba-Zizen, M. T., Plaisant, O., Simmons, A., Dronkers, N. F., Corkin, S., & Catani, M. (2015). From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting disconnection syndromes. Cerebral Cortex, 25(12), 4812–4827. https://doi.org/10.1093/cercor/bhv173
Van Horn, Irimia, A., Torgerson, C. M., Chambers, M. C., Kikinis, R., & Toga, A. W. (2012). Mapping Connectivity Damage in the Case of Phineas Gage. PloS One, 7(5), e37454–e37454. https://doi.org/10.1371/journal.pone.0037454
