The Case of Phineas Gage

On September 13, 1848, a railroad construction foreman named Phineas Gage was tamping explosive powder into a rock near Cavendish, Vermont, when the powder detonated prematurely, driving a thirteen-pound, more than three-foot iron tamping rod up through his left cheek, behind his left eye, through the front of his brain and out through the top of his skull. Remarkably, Gage survived the injury, was reportedly able to speak within minutes, and in the following months recovered his physical strength, motor coordination and speech with no apparent loss of basic intellectual function. What changed, according to his physician John Martyn Harlow and those who had known him before the accident, was his personality and behavior: the previously capable, reliable and even-tempered foreman became, by their accounts, impulsive, irreverent, profane and unable to stick to plans, prompting acquaintances to say he was simply no longer Gage. Because the rod's path destroyed a substantial portion of Gage's left frontal lobe while sparing his basic motor, sensory and language faculties, his case became one of the earliest and most influential pieces of evidence that specific regions of the frontal cortex, particularly areas now associated with the ventromedial prefrontal cortex, are centrally involved in personality, planning, judgment and social behavior, a connection that later brain-imaging reconstructions of his injury have helped to refine.