Phineas Gage survives a severe brain injury

Background. Phineas Gage (1823–1860) was an American railroad construction foreman remembered for his improbable survival of an accident in which a large tamping iron rod was driven completely through his head, destroying much of his brain's left frontal lobe. By September 1848 he was a blasting foreman, possibly an independent contractor, on railway construction projects, and he had commissioned a custom-made tamping iron for use in setting explosive charges.

The Accident. On September 13, 1848, Gage was directing a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad south of the village of Cavendish, Vermont. Harlow's original 1848 report of Gage's survival and recovery was widely disbelieved, for obvious reasons, as Harlow himself recalled in his 1868 retrospective.

Medical Verification. Henry Jacob Bigelow, Professor of Surgery at Harvard Medical School, brought Gage to Boston in November 1849 to verify that the tamping iron had actually passed through his head. Bigelow presented the case to the Boston Society for Medical Improvement, helping to force the case's authenticity upon the medical profession.

Clinical Observations. In April 1849, Gage returned to Cavendish and visited Harlow, who noted loss of vision and ptosis of the left eye, and a large scar on the forehead from the draining of an abscess. Harlow's 1848 discussion, published just as Gage was emerging from convalescence, had merely hinted at psychological symptoms. Barker explains Bigelow's and Harlow's contradictory evaluations by differences in their educational backgrounds, in particular their attitudes toward cerebral localization and phrenology.