How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever

Wyatt Redd - April 15, 2018

The afternoon of September 13, 1848, probably seemed like any other to Phineas Gage. Gage worked for the Rutland & Burlington Railroad company, and that morning he was helping to lay tracks for a new route that ran just south of Cavendish, Vermont. Gage directed his crew through the process of clearing rocks from the path of the railroad. It was a job that could be dangerous, of course. The workers had to drill holes down into the rocks, push explosive powder into the holes, and then stand clear as the blast pulverized the rocks. As one might imagine, deadly accidents were tragically common among railroad workers who worked with explosives.

But what was about to happen to Gage was anything but common. At about 4:30 PM, Gage was using a tamping iron, an iron bar that weighed about 13 pounds, to push sand over the blasting powder in one of the holes drilled into the rock. At the same time, he was distracted by some men working behind him and turned to say something to them. As he did so, he moved his head directly over the hole. And in a freak accident, his tamping iron struck the rock at that exact moment. The iron created a spark as it hit the rock and the blasting powder immediately exploded.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
A crew of railroad workers. Wikimedia Commons.

The explosion shot the tamping iron out of the hole in the rock like a bullet. The iron hit Gage just in front of his jawbone, and the force of the explosion drove it into his head. The iron passed through the mouth and traveled just behind his left eye. And as it continued moving upward, the iron punctured the bottom of his skull and traveled through his brain before finally punching out of the top of his skull. Gage was knocked onto his back as his arms and legs began to twitch rapidly.

Other railroad workers rushed to the scene, sure that Gage was already dead. But Gage was still alive. Within a few minutes, he was even able to speak, or at least speak as well as anyone who has just had an iron rod fired through his skull can. A few minutes later, Gage was on his feet and walked to a waiting cart with little help. As the cart carried Gage back to town, one of the railroad workers found the tamping rod. It had come to rest 80 ft from the explosion. Parts of Gage’s brain still clung to the metal.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
The modern day site of Gage’s accident. Wikimedia Commons.

In the nearby town, Gage waited for the arrival of Dr. Edward Williams. When Williams arrived Gage greeted him with a joke, saying, “Doctor, here is business enough for you.” Williams began his examination, noting that he could see the brain pulsing through the hole in Gage’s skull. Gage continued to speak to bystanders about how he was injured. The only sign that something was wrong came when Gage suddenly stood up and vomited, and the force actually pushed some of Gage’s brain out of the top of his skull. “About a teacup’s worth” of brain tissue dropped onto the deck. Things were about to get much worse for Gage before they got any better.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
A 3-D reconstruction of the path the iron took through Gage’s skull. Wikimedia Commons.

By 6:00 PM that night, Gage was starting to show the effects of his injury. He had, after all, lost a lot of blood and a significant amount of brain tissue. Williams turned the case over to a local surgeon, John Martyn Harlow, who noted that the bed sheet Gage lay on was now completely covered in gore. Gage was still awake and said that he expected to be back at work in a few days. But he was growing weaker. And his legs seemed to move by themselves, a clear sign that something was wrong with his brain.

Harlow began cutting away bone fragments and clearing the congealed blood out of the wound. He also had to remove another ounce of Gage’s brain that was sticking out of the skull. Finally, Harlow bandaged the wound, allowing a space for it to drain. Ultimately, there was little else he could do, and Gage’s condition began to rapidly grow worse. By the next morning, he was completely delirious. Within two weeks, he was close to falling into a coma. The tissue around his brain began to grow infected, and visible fungus collected on the open wound.

Gage’s family began making preparations for his funeral, even purchasing his coffin. But Harlow wasn’t ready to give up. Instead, applied medication to fungus to stop it from growing back. Then, he made a large incision in Gage’s forehead. It left a scar that Gage would have for the rest of his life, but the cut worked. Immediately, a large amount of extremely foul-smelling pus drained out of the wound. Gage had been suffering from what doctors now call a cerebral abscess. By draining it, Harlow had saved his life.

Almost a month after the accident, Gage was able to get out of bed and take a few shaky steps. Eventually, Gage was able to return to New Hampshire to stay with his family. And by the time summer rolled around, he was strong enough to help out around the farm. In April of 1849, Gage returned to Cavendish to meet with Dr. Harlow. Harlow noted that Gage seemed to have made a full recovery. The only lasting signs of the accident was a drooping of his left eyelid and a depression in the skin over the injury. Harlow was even able to feel the brain pulsing through it.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
Dr. Harlow. Wikimedia Commons.

Gage reported that the injury no longer hurt but still gave him a “queer feeling which he is not able to describe.” But while Gage seemed like he had recovered physically, there were signs that something strange was happening in his mind. His family first noticed that he had trouble remembering things. More disturbingly, his personality had changed as well. Gage was no longer the man he used to be. Something strange had happened to Gage. And his unique case was beginning to change everything doctors knew about the brain.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
Gage’s skull showing the damage from the accident. Wikimedia Commons.

Harlow first described Gage’s case in a medical journal shortly after the accident. According to Harlow, Gage was a hardworking and sensible supervisor at the railroad before the accident. But after he recovered, his employers thought he had changed so much that they couldn’t give him his job back. Gage was now quick to anger and refused to follow directions. And anyone who upset him was subjected to a string of swear words. This begged an important question. Can damage to the brain actually change the way someone acts?

The question became a subject of fierce debate in the scientific community. Some doctors argued that Gage’s changes were not the result of the accident. Or that he had always been that way, and the extra scrutiny was the only reason anyone noticed. Today, we know that the damage to Gage’s brain could have affected the way his nervous system made connections, changing his personality. But at a time when the brain was less understood, the idea that someone’s entire personality, perhaps even essentially their “soul,” could be changed physically was considered by many to be deeply disturbing.

But while there’s little doubt that Gage changed after his accident, the good news for Gage was that the change doesn’t seem to have been permanent. After losing his job at the railroad, Gage was hired by a company to drive stagecoaches in Chile. The fact that Gage was able to do the job suggests that his injuries had no impact on his ability to handle complex tasks, like driving a team of horses. And according to people who met Gage in Chile, he seems to have more or less gone back to being the man he was before the accident.

It’s hard to say now if Gage’s brain had changed, or if he had just managed to learn to live in polite society again. But either way, living in Chile was ultimately not a good experience for Gage. His health began to fail, and he returned to New Hampshire in poor shape. He soon recovered enough to find work as a farmhand in California, but there he began to suffer from bouts of epilepsy. One night in 1860, Gage fell into a seizure that lasted on and off for several days. He finally died on May 21, 1860. A few years later, Harlow heard what had happened to his most famous patient and wrote to Gage’s family.

How This Man Survived Having A Metal Bar Shot Through His Skull… And Changed Medicine Forever
Phineas Gage and his tamping iron. Wikimedia Commons.

He asked that Gage’s skull be exhumed so that it could be studied. Gage’s family agreed and sent him the skull, along with the tamping rod that Gage had carried for years as a keepsake. His skull remains today in a museum in Boston. Gage’s case also remains as a valuable research tool for scientists. It’s a real-life example of how damage to the frontal lobe can change someone’s personality. And the best-known photo of Gage, discovered in 2010, serves as a powerful example of how people can survive life-changing injuries. It shows Gage, holding his tamping iron, proud and strong in spite of everything. And in many ways, it changes Gage’s story from a medical oddity to one of hope.


Where did we find this stuff? Here are our sources:

“Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage”. Jon Hamilton, NPR. May 2017.

“Phineas Gage: Neuroscience’s Most Famous Patient”. Steve Twomey, Smithsonian Magazine. January 2010.

“The Phineas Gage Story”. The University of Akron.