Phineas Gage: A Gruesome but True Story About Brain Science shows how an unusual case can become evidence in the scientific community. Gage’s case isn’t just important because of its nature but because of how people interpreted it. After the tamping rod went through his head and he miraculously survived, medical professionals quickly began asking what Gage’s survival indicated about the brain. In Boston, Gage became “Dr. Bigelow’s guest but also his prize specimen” (24), as he was examined, measured, and exhibited to other medical professionals. Gage’s survival was so unlikely that many medical professionals thought that he or someone else may have been involved in a hoax. Others believed that Gage provided evidence for their own competing ideas.

Fleischman emphasizes that evidence does not interpret itself. An identical occurrence could provide proof for two opposing conclusions. The “whole brainers” argued that since Gage survived after sustaining massive damage to a substantial portion of his cortex, then all parts of the brain work together as a unit with one area capable of replacing another. Conversely, the “localizers” (including phrenologists) argued the exact opposite: that Gage survived due to limited localized areas of the brain being damaged and that those damaged localizations are unnecessary for basic functions of life. Each group used Gage’s case for their own purposes, and neither had sufficient solid evidence. As Fleischman points out, “the Whole Brainers ha[d] no hard evidence for their theory” (35), and the phrenologists identified supposed brain “organs” through skull bumps rather than direct observation. Each group of scientists tried to fill gaps in knowledge.

This theme continues throughout subsequent chapters as Fleischman describes Gage’s immediate aftermath of his injury and his subsequent ascension to legend status in stories, scholarship, and modern neuroscience. The author states that well-known stories are often altered as they’re retold. He questions numerous sensationalized accounts of Gage performing for crowds at P. T. Barnum’s museum. He contrasts these stories with much more precise scholarly study, specifically Malcolm MacMillan’s efforts to distinguish between verifiable documentation and mere repetition. Thus, Fleischman views evidence as an ongoing process of evaluating sources, assessing claims, and dismissing exaggerations.

In the final chapter, Fleischman discusses how modern technology allows researchers like Hanna Damasio to use scans and computers to reevaluate Gage’s injury. Brainvox software narrowed several possible paths of penetration by the tamping rod down to the single path most consistent with the skull and remaining physical evidence.

The book argues that science develops not through worshiping great tales but by reassessing them. What makes Gage important is that his case has kept producing new questions for successive generations and that each succeeding generation has attempted to answer them more thoroughly than the preceding one.