Frontal Lobe Injury due to a Railroad Construction Blasting Accident
The dangers of 19th century railroad construction using black powder to blast rock are illustrated by one of the most famous cases in neurology and psychiatry:
"One of the most famous brain injuries on record is the fascinating case of the 'crowbar incident,' which occurred in [Vermont, where his group was preparing the bed for the Rutland and Burlington Rail Road] on September 13, 1848. A 24-year-old railroad worker, Phineas P. Gage, was caught in a powerful explosion during a construction accident. A steel rod, [a 13.5 lb., 3 foot 7 inch long and 1.5 inch thick tamping iron] ... became airborne and pierced the skull of Phineas Gage. The iron entered the top of his head, passed through the brain and exited through the lower portion of the left cheek, leaving a gaping hole. Gage never lost consciousness and spoke with his co-workers several minutes after the event. He was taken to a hotel where he walked unassisted up stairs. 'He bore his sufferings with firmness,' Dr. J. M. Harlow, the treating physician, later wrote, 'and directed my attention to the hole in his cheek, saying, ‘the iron entered there and passed through my head!'
Gage survived. But his personality had undergone a dramatic change. Whereas before he was the capable and efficient foreman on the job, Phineas Gage became sloppy, careless and argumentative. 'The equilibrium or balance between his intellectual faculties and his animal propensities seemed to have been destroyed,' said the doctor. Gage was later dismissed from his job and became somewhat of a reclusive figure. 'His mind is radically changed,' wrote Dr. Harlow, 'so decidedly that his friends said he was no longer Gage!' But because of his fantastic injury, Gage became famous. He even appeared in P.T. Barnum’s American Museum in New York City. His skull and the iron bar that pierced it are on display at Harvard University."
Phineas Gage from Wikipedia:
"Gage was fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was 'no longer Gage.' "
—Harlow, J.M. (1848). "Passage of an iron rod through the head." Boston Medical and Surgical Journal 39: 389-393.