Phineas Gage was a railroad construction foreman. On September 13, 1848, an explosion drove a tamping iron through his head while he was working near Cavendish, Vermont. Physician John Martyn Harlow recorded the accident and later returned to it in a longer account (Harlow’s retrospective report, pp. 3–5).
Gage was the person described in those records, not the author of a theory about the brain. It helps to keep the subject of an investigation separate from the people who interpreted it.
The tool and the work
Gage was a railroad construction foreman who supervised men excavating rock. Harlow described a tamping iron: a long metal tool used in preparing a blasting charge. He gave its length as three feet seven inches, with a pointed, tapering end (pp. 4–5).
That detail matters because the object was part of a particular kind of work. The account begins with a worker and a construction accident, before it becomes a discussion about the brain.
Harlow also separated parts of his narrative by where the information came from. His description of the accident drew on statements from Gage and others; his account of the examination described his own observations (pp. 5–7). These are different kinds of evidence, even when they appear in the same report.
Who wrote the reports?
The first report appeared on December 13, 1848, in the Boston Medical and Surgical Journal. Its title was Passage of an Iron Rod through the Head. The journal’s archive now sits on the New England Journal of Medicine website, but the modern website name should not replace the journal’s historical title (publication record).
Harlow identified that article as his report when he revisited the case. He also referred to a separate account by Henry Jacob Bigelow published in 1850 (p. 4).
A later address, Recovery from the Passage of an Iron Bar through the Head, was read to the Massachusetts Medical Society on June 3, 1868. The National Library of Medicine’s digitized offprint carries an 1869 publication date (title page and catalogue). The date of a presentation and the date on a printed copy need not match.
Reports are not a complete life
Harlow’s later narrative combined several sources. He included his own recollections, statements attributed to Gage’s acquaintances and information from relatives. He said he began corresponding with Gage’s mother and brother-in-law in 1866, after losing track of him (p. 15).
When Harlow described judgments about Gage’s character, those judgments came through this reporting process. They were not Gage’s account of his own inner life. A reader needs to ask who supplied a description, when they supplied it and what the writer actually observed.
The report also contains an account of Gage leaving New England in 1852 to work with a coach enterprise in Chile (p. 14). That is part of the documented narrative, not a basis for making a modern claim about his abilities or the course of an injury.
Checking an extraordinary report
Harlow’s later address opens by recalling skepticism about his first report. He says readers asked for attested statements from other people before accepting the account. He then identifies both his own publication and Bigelow’s later report (Harlow, pp. 3–4).
This is Harlow’s retrospective description of the report’s reception. It shows what he felt needed defending; it does not establish what every contemporary physician thought. Publication, corroboration and a writer’s recollection are different parts of the evidence.
What the surviving objects can show
Harvard’s Warren Anatomical Museum collection holds Gage’s skull and tamping iron. Its collection history records that Harlow gave them in 1868 (Harvard collection record). Harlow regretted the absence of an autopsy that could have established the brain’s condition at death (p. 16).
In 2012, John Darrell Van Horn and colleagues combined scans of the skull with brain imaging from 110 modern participants to model possible damage. Those participants supplied comparison anatomy; the researchers did not have a scan of Gage’s living brain (study methods and limitations).
The authors acknowledged assumptions about how a brain fitted inside the skull and about using other people’s anatomy. A reconstruction adds a way to investigate the evidence, while remaining a reconstruction.
How we know
What survives: Published reports, the skull and tamping iron, and later studies of those records and objects.
Whose voices are missing: The reports do not provide a sustained first-person account from Gage.
What is uncertain: The surviving material cannot supply a complete record of his daily experience or an exact scan of his brain.
Then vs. now
Keeping the person, the reports and the reconstructions separate helps us read this history carefully. Each can answer some questions; none supplies the whole story.