On September 13, 1848, a three-foot-seven-inch iron rod weighing thirteen pounds shot through Phineas Gage’s skull at the speed of a cannonball.

It entered below his left cheekbone, passed behind his left eye, tore through the front part of his brain, and exploded out through the top of his head, landing about 80 feet away, covered in blood and brain matter.

Gage was packing explosives into a rock using a tamping iron when a spark ignited the powder charge prematurely. The rod became a projectile, and Gage became the most famous patient in the history of neuroscience.

Here’s what makes this impossible to comprehend: Gage never lost consciousness.

He was thrown onto his back by the force. Then he sat up. Spoke. Got up and walked. Rode in an oxcart sitting upright for three-quarters of a mile to a hotel in Cavendish, Vermont.

When the doctor arrived, Gage greeted him: “Doctor, here is business enough for you.”

He then calmly described what happened while the doctor stared at a hole in his skull large enough to fit a fist.

The Medical Impossibility

Dr. John Martyn Harlow, the physician who treated Gage, later wrote a detailed account that still reads like fiction:

The iron rod had destroyed most of Gage’s left frontal lobe. A wound that size, in that location, should have killed him instantly. At minimum, it should have left him in a coma, paralyzed, unable to speak.

Instead, Gage walked, talked, and remained lucid.

He lost enormous amounts of blood. Pieces of his brain were scattered along the accident site. Bone fragments were embedded in his skull. Yet within minutes, he was rational and conversational.

The initial prognosis: he would die within hours from infection or brain swelling.

He didn’t die. He survived.

But was it really Phineas Gage who survived?

The Transformation

Before the accident, Phineas Gage was 25 years old and considered one of the most capable foremen working for the Rutland & Burlington Railroad. His supervisors described him as:

  • Efficient and capable
  • Well-balanced and shrewd
  • A sharp businessman
  • Energetic and persistent
  • Respectful and reliable

The kind of man you’d trust with responsibility and money.

After his physical recovery—which took about two months—something was wrong.

Dr. Harlow observed the change immediately, though it took years for him to fully document it. Other workers and friends noticed it too. This was not the same Phineas Gage.

The railroad company that valued him refused to rehire him.

Dr. Harlow’s clinical notes, written years later, provide the most detailed description:

“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible.”

Read that description again. That’s not describing brain damage affecting motor skills or speech or memory.

That’s describing a completely different person.

The Questions That Haunt

Here’s what makes Gage’s case an enduring mystery:

The damage was localized. Gage could still walk, speak clearly, see (with his remaining eye), use his hands, and recall memories. His intelligence seemed intact. He could reason through problems.

But the person reasoning was no longer the person who existed before September 13, 1848.

Was the “new” Gage always there, suppressed by the parts of his brain that were destroyed?

Did the accident reveal his “true nature”—impulsive, unreliable, profane—by removing the neurological constraints of civilized behavior?

Or did the accident create someone entirely new, someone who had never existed before?

Think about what this implies:

If the old Gage was the “real” one, then the accident was a kind of murder—Phineas Gage died that day, even though a body with his memories kept walking around.

If the new Gage was the “real” one, then what does that say about personality? That we’re all just one brain injury away from becoming fundamentally different people?

Or maybe both versions were equally real. Maybe personality isn’t a single, stable thing. Maybe it’s an emergent property of intact neural architecture, and when you change the architecture, you change the person.

Where Does Personality Actually Live?

Gage’s case forced neuroscience to confront an uncomfortable truth: personality has a physical location in the brain.

Before Gage, many scientists and philosophers believed the mind was somehow separate from the brain—a soul that used the brain as a tool but wasn’t dependent on it.

Gage proved that wrong. Damage specific brain regions, and you don’t just impair function. You change who someone is.

The region destroyed in Gage’s accident—the prefrontal cortex—is now known to be crucial for:

  • Impulse control and self-regulation
  • Social behavior and interpersonal awareness
  • Planning and decision-making
  • Emotional regulation
  • Moral reasoning

Lose it, and you lose the ability to be the “responsible foreman” version of yourself.

But here’s the deeper mystery: if personality lives in brain structure, and brain structure can change, then who are we, really?

Are we our intentions? Our memories? Our behavior? Our capacity for self-control?

Gage had his memories. He knew who he’d been. But he couldn’t act like that person anymore. Friends said he was “no longer Gage.”

So which one was Gage—the memories, or the behavior?

The Rest of His Life

After the accident, Gage’s life became a series of fresh starts that never worked out.

He tried working on his family’s farm. He couldn’t stick with it.

He traveled to Boston and New York, where he was briefly exhibited at Barnum’s American Museum alongside other “curiosities.” He stood on stage with the iron rod that had pierced his skull, telling his story for money.

He worked in stables. He drove coaches in Chile for several years—work that required skill and focus, suggesting his abilities weren’t entirely destroyed.

He had seizures. He drifted. In 1860, twelve years after the accident, he died at age 36, likely from epileptic complications related to his injury.

Dr. Harlow, who’d lost touch with Gage, heard about his death years later and contacted Gage’s family. They agreed to exhume the body so Harlow could retrieve the skull for medical study.

Today, Phineas Gage’s skull and the iron tamping rod are displayed together at Harvard Medical School’s Warren Anatomical Museum.

You can visit them. Stare at the trajectory of the damage. See the entry and exit holes in the bone.

And you can wonder: when that rod passed through his brain, did it destroy Phineas Gage, or reveal him?

The Medical Legacy

Gage became one of the foundational cases in neuroscience, though his story was often exaggerated or misunderstood.

Early accounts claimed he became violent or savage. The evidence doesn’t support that. He became unreliable and impulsive, not dangerous.

Some retellings said he lost all cognitive function. Also false. He remained intelligent and articulate.

What he lost was harder to define: he lost the ability to be the kind of person he’d been before.

Modern neuroscience has examined Gage’s skull with CT scans and computer modeling to map exactly which brain regions were destroyed. The damage was extensive but specific—primarily to the left frontal lobe, especially the ventromedial prefrontal cortex and anterior cingulate cortex.

We now know these regions are crucial for emotional regulation, social cognition, and decision-making in complex, real-world situations.

Antonio Damasio, a prominent neuroscientist, studied Gage’s case extensively and argued that Gage’s transformation revealed how emotion and reason are inseparable. The brain regions Gage lost don’t just regulate emotion—they integrate emotional information into decision-making.

Without them, Gage could still think logically, but he couldn’t apply that logic to real life in a way that accounted for consequences, social relationships, or long-term planning.

He could solve a math problem, but he couldn’t hold a job.

The Wondering

Most neuroscience textbooks present Gage’s case as settled science: frontal lobe damage causes personality changes and executive function deficits.

But that clinical summary misses the existential weight of the case.

Phineas Gage forces us to ask:

  • If I suffered the same injury, would “I” still exist?
  • Is there a version of me that would emerge if you removed the right (or wrong) part of my brain?
  • Are we all just one accident away from becoming strangers to ourselves?
  • When we talk about “who someone really is,” what do we mean?

Friends said Gage was “no longer Gage.” But he had Gage’s memories. He knew his own name. He could tell you his life story.

He just couldn’t live it the same way.

So was he Gage or not?

There’s no clean answer. And maybe that’s the point.

Maybe personality isn’t a thing you have. Maybe it’s a process your brain performs when it’s intact. Damage the hardware, and the process changes.

Gage lived for twelve more years after the accident. Twelve years of people looking at him and seeing someone who used to be someone else.

Twelve years of being a living question mark.

The Iron Rod

The tamping iron is unremarkable. It’s a metal bar—heavy, tapered to a point, stained with age.

But it’s the most famous weapon in neuroscience. Not because of what it destroyed, but because of what it revealed.

Before Gage, the brain was a black box. We knew damage to it caused problems, but we didn’t know it had specialized regions for different aspects of being human.

Gage showed us that who you are has an address in your skull.

Change the structure, change the person.

It’s both terrifying and illuminating.

And it leaves us with the question that’s haunted neuroscience since 1848:

When the iron rod passed through Phineas Gage’s brain, did it reveal who he really was, or create someone entirely new?

The medical records can’t tell us. Dr. Harlow couldn’t answer. Modern neuroscience can map the damage but can’t resolve the mystery.

We can only wonder.

Medical Sources:

  • Harlow, J. M. (1868). “Recovery from the Passage of an Iron Bar through the Head.” Publications of the Massachusetts Medical Society
  • 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.
  • Macmillan, M. (2000). An Odd Kind of Fame: Stories of Phineas Gage. MIT Press.
  • Ratiu, P., Talos, I. F., Haker, S., Lieberman, D., & Everett, P. (2004). “The tale of Phineas Gage, digitally remastered.” Journal of Neurotrauma, 21(5), 637-643.

Next in the series: The Cotard Delusion Patients - When people become convinced they’re dead, even while walking and talking.