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Phineas Gage: A Gruesome but True Story About Brain Science – An Award-Winning Medical History Book for Kids

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Phineas Gage was truly a man with a hole in his head. Phineas, a railroad construction foreman, was blasting rock near Cavendish, Vermont, in 1848 when a thirteen-pound iron rod was shot through his brain. Miraculously, he survived to live another eleven years and become a textbook case in brain science.

At the time, Phineas Gage seemed to completely recover from his accident. He could walk, talk, work, and travel, but he was changed. Gage "was no longer Gage," said his Vermont doctor, meaning that the old Phineas was dependable and well liked, and the new Phineas was crude and unpredictable.

His case astonished doctors in his day and still fascinates doctors today. What happened and what didn’t happen inside the brain of Phineas Gage will tell you a lot about how your brain works and how you act human.

96 pages, Paperback

First published February 25, 2009

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About the author

John Fleischman

8 books7 followers
John Fleischman, who is now the science writer for the American Society for Cell Biology and a magazine freelancer whose work appears in Discover, Muse, and Air & Space Smithsonian, was working in public affairs at Harvard Medical School when he wrote Phineas Gage: A Gruesome but True Story About Brain Science.

In addition to writing for science publications, Fleischman was a senior editor at Yankee and Ohio magazines. He lives in Cincinnati, Ohio with his wife and a greyhound named Psyche.

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5 stars
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Displaying 1 - 30 of 635 reviews
Profile Image for Leo.
4,984 reviews627 followers
February 10, 2022
One of the most peculiar kind of non fiction I've read. Never heard about the accident of Phineas Cage before and the fact that he survived having metal stick through his head that would most likely have killed anyone else. But he survived over 10 years after the accident although he was very much a different person. It was a tragic yet fascinating book about how much damage a brain injury can cause even if it on the outside looked like he came out "easy". I only wished the book was a couple 100s pages longer as I would have liked to learn more but maybe I can find a documentary somewhere. I finished the book a while ago so my memory might not been perfect at the moment of writing this
Profile Image for Joe.
98 reviews697 followers
February 5, 2009
In order to provide this book with a proper evaluation, my reciprocal ages must weigh in.

Phineas Gage: A Gruesome but True Story About Brain Science
A review by Joe Prince, Age 31

Grisly. Stomach-churning. Disgusting. These are adjectives that aptly describe the first chapter - nay! paragraphs - of John Fleischman's brief but explosive account of the freak accident that inspired deeper study of brain science.

Compelling. Engaging. Witty. These are adjectives that aptly describe the entire book. Fleischman deftly weaves scientific study and complicated medical explanations with sharp storytelling to create possibly the most compulsively readable piece of young adult non-fiction. Furthermore, his refusal to shy away from gruesome detail will attract even the most reluctant reader, male or female.

Most amusing, though, is the mixture of somber and irreverent observations sprinkled throughout the narrative. Fleischman treats scientific matter seriously, but often reflects on the accident with a charming tongue-in-cheek manner that will be enormously appealing to teenagers. This quality is best evident in his explanation of phrenology: "'The Organ of Veneration [respect:]' and 'The Organ of Benevolence [kindness:]', for example, are supposed to be just above the left eyebrow. Remember where Phineas was hit with the iron? Stay tuned." Sure enough, the accident turns Gage into a real son-of-a-gun.

Coupled with the archival photographs and disturbing illustrations, Gage's tale is one to be continually revisited with both reverence and jaw-dropping awe.

(4.5 out of 5 stars)

Phineas Gage: A Gruesome but True Story About Brain Science
A review by Joe Prince, Age 13

Good God, this is AWESOME!!

(5 out of 5 stars)
Profile Image for Lars Guthrie.
546 reviews192 followers
November 21, 2010
John Fleischman opens ‘Phineas Gage’ at full tilt, September 13, 1848, ‘a minute or two away’ from an accident that can only be described as freakish. Gage was working with gunpowder, blasting through solid rock as the foreman of a railroad construction gang in Vermont.

The tool of his trade was a tamping iron, three and a half feet long, a little less than two inches round, one end pointed like a spear to set a fuse, the blunt end used to tamp down earth over the gunpowder.

Something went wrong. The sharp end of the iron spear shot into Gage’s left cheek. Its entire length rocketed through the front of his brain and burst out of the top of his skull, clanking down thirty feet away.

Gage lived. During the half hour it took for a doctor to arrive, he sat down on the front porch of the hotel where he was boarding and talked about what had just happened.

Was he okay? Not exactly. Phineas Gage was not the same man. He could walk and talk, but the even-tempered supervisor had now lost the ability to match his behavior to the situation at hand. He had no social skills.

Gage’s misfortune occurred as the medical establishment was on the verge of looking at the brain in an utterly new way. A decade and a half later, a surgeon in Paris showed, by conducting autopsies on stroke victims, that there was a specific region of the brain devoted to speech production. That place, located just above the left ear, is still known as Broca’s area, after the French doctor.

It has taken another century plus for neuroscientists, equipped with modern technologies such as magnetic resonance imaging and electroencephalography, to really begin to map out the brain. Today, when lay people are knowledgeable about ‘executive function,’ it’s far easier for us to understand how losing a chunk of your frontal lobe would affect your judgment, your planning, and the way you get along with others.

In the mid-nineteenth century, phrenologists were feeling the bumps and dents on people’s heads to determine cognitive strengths and weaknesses.

What doctors of the time were able to do was dig up poor old Phineas and preserve his skull, as well as the tamping iron that remained a constant companion until his death in 1860, at the age of thirty-six. This ensured that Gage would remain a subject of fascination, and become the protagonist of Fleischman’s unusual and compelling children’s book.

The only thing that bugged me about Fleischman’s otherwise riveting narration was his insistence on using present tense throughout the book. It worked for me in the initial passage, so forceful in its immediacy, but got hokier as he went through several time changes. But that never bothered me enough to lose interest. What a story, and thanks to Elizabeth Bird for bringing it to my attention.

Many of us are attracted, perhaps somewhat reluctantly, to the macabre and grotesque, including middle schoolers. Here’s a nifty book that plays into that draw, and then introduces readers to the exciting work being done in brain science.

Recommended for fifth graders on up.
Profile Image for Mary Ruth.
213 reviews
December 27, 2015
I really enjoyed this book and will have my children read it, but we will be discussing one aspect of it for sure.
The author said that "Humans have always argued about what makes us human." Then goes on to say, "The case of Phineas Gage suggests that we are human because our frontal lobes are set up so we can get along with other humans." I beg to differ.
Our frontal lobes are not what makes us human. Would we say a brain injured dog is something other than a dog? A brain injured horse is not a horse? A human is a human from conception to death because we are humans. Brain injury or abnormality does not make us any less human. No other deformity makes us any less human. We are created in the image of God. Every single human being is. That is why we need to treat every one with respect and give them the dignity that is due them. Any of us could be brain injured in an instant during our lives. Our humanity needs to be respected and protected at any age.
Profile Image for Christina DeVane.
432 reviews53 followers
October 9, 2022
Short book with interesting brain science information regarding Gage who survived a freak accident. A rod went through his head and he made a “full” recovery, but his personality was greatly altered.
When he died he was buried with the rod, but he was eventually dug up for examination of his skull. Doctors and scientists made many discoveries of the brain through Phineas Gage.
Profile Image for Mohammed omran.
1,839 reviews190 followers
February 4, 2018
“If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero.”

Unless you’re a neuroscientist, you’ve probably never heard of Phineas Gage (I hadn’t until a few days ago). He was born in 1823, and he gained a remarkable level of fame during his lifetime. He’s still famous in certain circles – not for having done anything particularly interesting or impressive, but for having something done to him.

Specifically, having a tamping iron (a long, metal rod) fly through his skull during an explosion.

Gage was 25 years old and working for the railroad, planting explosives in order to clear space for new tracks, when one of the charges went off unexpectedly. The metal tool that he used to pack sand around the explosives went through his head, starting at his left cheek and passing through his eye socket before emerging through the top of his skull.

Phineas remarkably survived the incident with all of his mental faculties intact, but even that’s not why his name is still commonly mentioned in neurology circles today. No. Gage’s fame began to spread not because of the ways in which he was the same after the accident, but because of the ways he was different.



According to his physician at the time, Gage’s personality was greatly altered after the iron was removed:

He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom.


Gage’s incident was the first definitive proof that the key to our personalities lay in our physical brains and not in some harder to define realm. Not only that, but because his injuries were to one specific area of the brain, there seemed to be an obvious connection between it and personality.

The fascination with Gage’s case didn’t die out with the people and science of his time. Researchers in the 40s, 80s, and then again in the 90s have all mapped the tamping iron’s trajectory in an attempt to understand just how the objects destructive path affected Gage’s personality.



Gage’s case is still relevant today in more ways than one (and for reasons other than morbid fascination, too). For one, people do still sustain serious injuries of this kind. For another, Gage lived a dozen years after his incident and recovered from the personality changes within two to three years. He held a skilled job during that time, as well.



He died when he was 36 from an epileptic seizure that was almost surely related to his injury. His skull is on display at the Warren Anatomical Museum in Boston, MA
Profile Image for Patrice Sartor.
885 reviews14 followers
August 23, 2010
GENRE: Non-fiction, biography, brain anatomy, science.

SUMMARY: Phineas Gage suffered a horrendous accident in 1848 when a tamping iron exploded through his skull. Amazingly, Phineas walked away from the accident, and lived for another eleven years. He was a changed man, however. His personality became harsher and less socially adept. He became prone to swearing and shortness of temper. After the incident Phineas was able to interact well with children and horses, and he worked with horses for many years.

EVALUATION: I remember seeing a video about Phineas Gage when I was in junior high, and how it fascinated me. Years later in college, as a psychology major, I studied Gage again, with more of a focus on his changed personality and brain function. This book is in-depth, and provides much information about Gage that I did not previously know.

WHY I WOULD INCLUDE IT: Phineas Gage's story is still a medical marvel, and still just as fascinating as it ever was. Tweens who enjoy gruesome true stories will be both entertained and educated, as the book offers a fair bit of discussion about the anatomy of the brain, including the different schools of thoughts about brain anatomy that were in effect during Gage's day.

READER'S ANNOTATION: An in-depth look at the accident that forever changed Phineas Gage, and gave the medical world new insight into how the brain works.

ITEMS WITH SIMILAR APPEAL:
• An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 by Jim Murphy.
• The Absolutely True Diary of a Part-Time Indian by Sherman Alexie.
• Shipwreck at the Bottom of the World: The Extraordinary True Story of Shackleton and the Endurance by Jennifer Armstrong.
• The Great Brain Book: An Inside Look at the Inside of Your Head by HP Newquist.
• Grossology by Sylvia Branzei and Jack Keely.

Profile Image for Lindsey Jones.
308 reviews14 followers
June 22, 2014
History, science, and psychology collide in this short, engaging read! The story of Phineas Gage is fascinating: not only the initial accident, but also the aftermath of the accident on Phineas's life and the developments in brain science and medicine. Fleischman does a great job of interweaving Gage's story with scientific explanations and historical medical developments. This writing style will enable young readers to make sense of technical content due to relevance. The inclusion of images are also crucial in making meaning of this text, and this book certainly delivers some gruesome images! What middle schooler wouldn't want to read this book? It would be my hopes that Gage's accident draws them in, but what they learn about brain science intrigues them and sets them on a path of inquiry. I would highly recommend this book for classroom use, particularly at the middle school level.
Profile Image for Dorian Becerra.
35 reviews1 follower
Read
March 3, 2016
This book is about Phineas Gage a survivor of a large Iron rod going through his head. This is his story of how this affected brain science forever and his. I liked this book because I've been amazed of how he could survive this accident and I wanted to know more about it. I would recommend this book to people who like brain science.
Profile Image for Barb.
1,318 reviews146 followers
August 5, 2016
I've always been fascinated by the story of Phineas Gage. I've had the book 'The Only Living Man with a Hole in His Head' by Todd Colby Pliss on my list of books to read for a while now. So, this book caught my eye. It's so short it was no trouble to work it into the reading rotation.

The story of Phineas Gage's brain injury is fascinating stuff, an accidental discharge of explosives sent a three foot long iron tamping rod through the man's skull. Minutes later he walked on his own into town to get medical attention and lived for over a decade with a hole in his head.

Everything about this story was interesting. I love how present day neurologist used state of the art medical technology to analyze his skull and narrow down the potential paths the tamping rod could have taken through Gage's brain.

The brain science of the time is given as a context to what the doctors would have known and what resources they would have had available to treat the injury. At the time of his injury doctors were unaware of the existence of germs!

All of the brain science and anatomy is given in very simple, understandable terms. This story is accessible to any level reader and I would recommend it to anyone who's ever heard of Phineas Gage. I could see this being a great book for teachers at the middle or high school level. It's just a crazy interesting story.
172 reviews
January 3, 2021
Unit planning for work.

Short, quick read. Very informative about how the brain works.

I do wonder why the author writes in present tense though this also an historical account. Also, I know that a major part of the remainder of Gage's life was spent in Chile. However, to truly answer the question "is Phineas lucky," I felt as though I needed a bit more information about his social life. His family supported him but it was clear that other areas of his life faltered. Just how much did they falter? Are there accounts of him being belligerent and getting into fights? What were the conversations like with the farmers he couldn't get along with? Why did he come back form Chile? I know the answers to these questions may not be answerable, but without them, to answer the question, is he lucky, is too difficult to answer.
Profile Image for Brianna Preston.
69 reviews
February 7, 2017
A short but engaging read in simple terms about what we've learned over the years about the brain. How did Phineas Gage survive, and what altered him so dramatically?
Profile Image for Bruno Souza.
12 reviews4 followers
November 12, 2022
Bem ilustrado, esse livro conta a história do caso mais famoso da história da neurociência. Bem escrito, é gostoso de ler, inclusive para o público leigo. Porém não é um livro completo e detalhado .
Profile Image for J.
511 reviews58 followers
March 26, 2023
I’ve been reading quite a bit on science of the adolescent brain. I remembered this book from seven years ago when I taught English. Interestingly. Phineas Gage is referenced by a writer on teenage Borderline Personality Disorder (BPD). Since it was mentioned, part of my repertoire for reading is to explore whatever is referenced. To that end, I usually have 12-20 books going at a time. It’s kind of a six-degrees-of-separation approach for books.

“Phineas Gage” turns out to be an excellent resource for my students, and because it is created for a teenage reading level, I have landed upon a nugget that describes how brain function is related to emotions.

So, the book holds two values that are critical in helping students understand how their brains actually works, thereby serving to explain how brain disorders have a very real medically-based rationale.

Phineas Gage is an excellent read that will empower my students reading skills, their capacity for empathy and deeper awareness of how scientific methodology works.

My suggestion is that teachers consider purchasing a classroom set. I loved this book!
Profile Image for Grace RS.
207 reviews5 followers
February 20, 2025
The fascinating story of the man who survived a major brain accident (a tamping iron crashed through his cheekbone and exited his frontal lobe). Although he seemed to recover quickly, his emotional/social behavior was completely altered, resulting in his being crude, unfriendly, and unable to process social cues.

This book is a crash course in brain science. Fleischman introduces the science and medicinal practices of the 1850s so that readers grasp the controversy that his brain accident caused; toward the end of the book, he delves into a modern understanding of the brain, and how his accident led to further studies of the cerebral cortex.
Profile Image for Sarah Coller.
Author 2 books46 followers
September 13, 2022
A couple of my kids have read this so I wanted to, as well. It was super interesting, for sure! The following quote provided interesting food for thought, though I'm not sure of the answer:

"If there are exact locations in the brain that allow for the ability to hear or to breathe, is there a place that generates human social behavior? If that place is damaged, do you stop acting human?"
63 reviews5 followers
October 19, 2018
This book is a nonfiction book about a man who had a big accident which affected his brain. If you don't like nonfiction books, you should start with this book because it is interesting and informational at the same time. I would highly recommend this book to really everybody!
Profile Image for Xenia Blanco.
9 reviews1 follower
May 22, 2019
Sin palabras. Un libro maravilloso que profundiza en el Síndrome Frontal a través del caso de Phineas Gage. Además, aporta numerosos datos e información bastante difíciles de encontrar. Muy buen libro.
Profile Image for Kali Burks-Mosier.
327 reviews
October 5, 2020
Non fiction books are a little harder for me to engage with, and the abundance of text features made it hard to stay to the plot. However, this would be a great book for emerging readers, reluctant readers, and science enthusiasts!
Profile Image for Tina.
10 reviews
October 8, 2022
My non-sciency 14 yr old loved this book. Just the right amount of gory story to keep him interested and we had some awesome discussions regarding Phineas's changes in behavior after the accident.
Profile Image for Miguel Rodriguez.
40 reviews53 followers
January 4, 2023
What’s not to like? The audiobook was the perfect length for a single 6 mile hike.
Profile Image for That Guy.
10 reviews
March 25, 2024
one thtarr. he wouldn't stop with the yaping about sceince and crap like that it was not w boook it was oposite i
Profile Image for Katie.
323 reviews7 followers
October 23, 2023
I bought this because of its placement on a few “living books about science” lists and what a treat. I am not science-y by nature or nurture, but I do like to have a breadth of knowledge (for when jeopardy! comes calling, as one does) so I do have some experience in reading science books for laypeople. But even tho I was sometimes grossed out, I thought this was a great story with just the right amount of brain science and the history of said science. I can’t wait to share with my middle/high schoolers.
19 reviews1 follower
April 21, 2025
Super interesting true story of a brain injury survivor from the 1800s
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