What Phineas Gage's Skull Actually Showed

At about 4:30 in the afternoon on September 13, 1848, a 25-year-old railroad foreman named Phineas Gage was setting a blasting charge for the Rutland & Burlington Railroad in Cavendish, Vermont. He pushed a tamping iron — a metre-long, 6-kilogram steel rod — into a borehole that had not yet been packed with sand. The friction lit the gunpowder. The rod was driven up through his cheekbone, behind his left eye, through the front of his brain, and clean out the top of his skull, landing roughly 25 metres away.

Gage was conscious, sitting up in the oxcart on the way to town. His physician John Martyn Harlow dressed the wound. Within months Gage was walking, talking, lucid. He lived another twelve years.

The famous part of the story is what came next. In an 1848 case report and a longer 1868 follow-up, Harlow described a personality shift: irreverent, profane, restless, "no longer Gage." For a century this became the textbook case for the prefrontal cortex's role in self-control and planning, and the basis of an entire framework in neuroscience.

The less-told part is the recovery. The personality changes Harlow recorded did not stay. By the early 1850s Gage was driving a stagecoach in Chile, on a route from Valparaíso to Santiago — work that takes constant planning, customer skills, and a steady head. Recent reanalyses suggest his behaviour stabilised within a few years of the accident.

He died in San Francisco in 1860, after a series of seizures. His skull and the tamping iron are on display at Harvard's Warren Anatomical Museum. The bar is engraved with a brief note about the accident, signed by Gage himself.