Phineas Gage

Phineas Gage: A Gruesome but True Story About Brain Science is a children’s nonfiction book by John Fleischman. First published in 2004 by HMH Books for Young Readers, the book tells the story of the infamous railroad construction worker who survived a hole in the head and became the subject of intense brain study. The book won the 2003 Society of Midland Authors Award for Children’s Nonfiction. Fleischman’s debut work, he wrote it while working in the public affairs department at Harvard Medical School. He is now a freelance science writer for a host of popular magazines.

The book opens in the moments just before Phineas Gage, a railroad construction foreman has an accident that will change his life forever. He is twenty-six years old and without family. A popular foreman, his authority is well-respected on site. Although foremen generally take on a supervisory role, Phineas is never shy about doing the dirtier work.

It is almost 4:30 p.m. on September 13, 1848. In a moment, Phineas’s team will blast a tunnel through granite in Cavendish, Vermont. They’re creating a tunnel so the railroad track, the Rutland & Burlington Railroad, can pass through the stone of the Green Mountains. As Phineas is particularly good at blasting, he is on the front line for this job. Although this is a job he has done many times before, accidents can happen; the blast is catastrophic for him.



During the explosion, a thirteen-pound iron rod dislodges from its position, firing straight into Phineas’s skull through his chin. Everyone around him expects him to die from the injury, but somehow, Phineas survives. Fleischman spends the rest of the book discussing Phineas’s injuries and what he taught the medical world about neurology and brain trauma.

Describing the injuries in a manner appropriate for the age range, Fleischman provides a diagram of what the injury would have looked like. The rod goes through a cheek, behind one eye, and through a part of his frontal lobe. Phineas, however, doesn’t just survive—he seems to be, to most people, the exact same as he was before the accident. Phineas walks on his own into town for medical advice, to the disbelief of stunned workers and onlookers. The doctors have never seen anything like this, and they don’t know how to treat his injuries. He is suffering a terrible concussion, which he only survives because the hole in his head alleviates the pressure; doctors struggle to pack the wounds. He has lost brain matter, but he doesn’t appear to be in shock.

Within months, Phineas is walking, talking, and working as normal. The changes he has experienced are subtle; these changes teach doctors which parts of our brains control the different things we can do and our personality traits. Phineas goes from being a gentle and friendly man to a rude and aggressive character. He has, as we would say, “no filter,” and no inhibitions. He is unreliable, never showing up for work on time.



At the time of the injury, brain science is underdeveloped. Doctors measure heads and skulls, and they feel for lumps and dents to determine injuries and weaknesses. This is how they predict factors such as intelligence, personality, and cognition. Phineas’s injury flies in the face of this science, which isn’t advanced enough to handle it.

Medics scramble to work out what happened in Phineas’s brain, how he survived, and why he is so changed. It will take more than ten years before a Parisian doctor can show that one area of the brain controls speech function—Broca’s area. The blast damaged this part of Phineas’s brain. While it seems obvious to us now that frontal lobe damage will affect one’s personality, at the time, it was revolutionary knowledge.

Phineas is only thirty-six when he dies in 1860 from seizures. He had suffered epileptic fits for many years, leaving him unable to work in the construction industry. However, although medicine and brain science move forward, no one forgets poor dear Phineas, and scientists continue to study him.



Now that he is dead, scientists preserve his skull and the rod that is still locked in place behind his eye socket. They look at the position of the rod in detail to build a picture of the injuries he sustained and how these injuries correlate to the roles played by different parts of the brain.

Thanks to Phineas, we now know that our brains control our personalities and which part of the brain controls everything from reasoning to inhibitions. Although it took many years to make the connections, it is arguable that scientists would have taken much longer to discover these truths had it not been for Phineas. The book doesn’t go into the science in too much detail, given the age range, but it serves to teach children about a hugely important historical figure whom they might otherwise know nothing about.