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On 13 September 1848, Phineas P. Gage, a 25-year-old construction foreman for the Rutland and Burlington Railroad in New England, became a victim of a bizarre accident. In order to lay new rail tracks across Vermont, it was necessary to level the uneven terrain by controlled blasting. Among other tasks, Gage was in charge of the detonations, which involved drilling holes in the stone, partially filling the holes with explosive powder, covering the powder with sand, and using a fuse and a tamping iron to trigger an explosion into the rock. On the fateful day, a momentary distraction let Gage begin tamping directly over the powder before his assistant had had a chance to cover it with sand. The result was a powerful explosion away from the rock and toward Gage. The fine-pointed, 3-cm-thick, 109-cm-long tamping iron was hurled, rocket-like, through his face, skull, brain, and then into the sky. Gage was momentarily stunned but regained full consciousness immediately thereafter. He was able to talk and even walk with the help of his men. The iron landed many yards away (1).
Phineas Gage not only survived the momentous injury, in itself enough to earn him a place in the annals of medicine, but he survived as a different man, and therein lies the greater significance of this case. Gage had been a responsible, intelligent, and socially well-adapted individual, a favorite with peers and elders. He had made progress and showed promise. The signs of a profound change in personality were already evident during the convalescence under the care of his physician, John Harlow. But as the months passed it became apparent that the transformation was not only radical but difficult to comprehend. In some respects, Gage was fully recovered. He remained as able-bodied and appeared to be as intelligent as before the accident; he had no impairment of movement or speech; new learning was intact, and neither memory nor intelligence in the conventional sense had been affected. On the other hand, he had become irreverent and capricious. His respect for the social conventions by which he once abided had vanished. His abundant profanity offended those around him. Perhaps most troubling, he had taken leave of his sense of responsibility. He could not be trusted to...