“Disfigured Yet Still Handsome”: The Story Of The Fantastic Phineas P. Gage


…the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. His person, and the bed on which he was laid, were literally one gore of blood.
–Dr. John Martyn Harlow

On September 13, 1848, railroad construction foreman Phineas P. Gage had a large iron rod shoved completely through his head in a freak accident.

**WARNING: This article has some images and descriptions not meant for those with delicate constitutions. Obviously.**

Gage had been coordinating the blasting of rock to make way for a new roadbed. Deep holes would be bored into the ground, filled with blasting powder; sand or clay would then be packed tight (“tamped”) above the powder using a large metal rod known as a tamping iron.


It was a routine task in the life of a railroad construction foreman. But as Gage was tamping the blast hole, he had gotten distracted and turned to look over his right shoulder. Just as he opened his mouth to speak, the iron accidentally sparked against the rock, setting the charge off and blowing the rod upward through his head.

The tamping iron was 1 14 inches in diameter, three feet seven inches long, and weighed 13 14 pounds. It entered in the lower left side of his face, near his cheek; then upward behind his left eye, through his brain (obliterating a bit of it along the way), exiting at the top of his head and eventually landing 80 feet away.


Despite initial convulsions, Gage reportedly (and there are a lot of “reportedlys” in this story) greeted the doctor while sitting upright, calmly telling him—in what has been described as “one of the great understatements of medical history”—”Doctor, here is business enough for you.”

Phineas Gage, just chillin’.

Exactly how bad was Gage’s condition? If you have the stomach for it, read on for physician Edward H. Williams’ eyewitness description:

I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. The top of the head appeared somewhat like an inverted funnel, as if some wedge-shaped body had passed from below upward. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage’s statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head. Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain [through the exit hole at the top of the skull], which fell upon the floor.


The main folkloric function of Gage in the collective imagination, even to this day, is the idea that traumatic brain injuries can cause personality changes.

The legend went that before the accident, Gage was an intelligent and polite upright citizen—but after, he was a foul-mouthed sex-crazed cretin with the intelligence of a child and yet possessing “adult impulses.”

Now, having reviewed all the Snopes-esque debunking of this legend…I tend to believe that the truth lies somewhere in the middle.

A note written by Gage, post-accident, himself; directing where to deliver his trusty tamping iron.

That Gage’s personality/health in his remaining 13 years of life was erratic seems to be obvious. But he also appeared to honestly want to get on with his life and live it as normally as possible despite his injuries.

Indeed, he was well enough in 1852 to be offered a stagecoach driver job in Chile, which he accepted and kept for about seven years (after which point his health unfortunately took a turn for the worse).

And if we have the two existing photos of him post-accident to gauge (sorry!) from, he not only “cleaned up” pretty well…but was quite a good-looking guy (thus prompting someone to famously describe him as “disfigured, but handsome”).


Except for the missing eye, you’d barely guess he was the survivor of such a horrific accident:


And as you can see, Gage—who had become somewhat of a celebrity—was quite proud of his tamping iron.

And wouldn’t you be?