Writer Jim Horne, the Director of the Sleep Research Centre at Loughborough University, says that there were other people who suffered similar injuries as Gage and not only survived but also didn’t sustain significant damage. Many of these cases, he explains, were soldiers, who’d either been hit by their own muskets backfiring or by musket balls from others’ weapons.
The iron bar did not lodge in Mr. Gage’s skull – it passed through – and the person staring out of the photograph looks far from seriously disabled. He looks like the actor Christopher Reeve in his prime, minus an eye. In an article accompanying the image in the Journal of the History of Neuroscience, Malcolm Macmillan, a psychologist at the University of Melbourne, describes the process and raises the question, Who was Phineas Gage after the accident? No one really knows, as Dr. Macmillan has pointed out in a series of papers.
Talos and Dr. Peter Ratiu took sophisticated medical scans of Gage's skull and the tamping iron to create a three-dimensional computer model. It showed the tool entering beneath Gage's left cheekbone before passing through the brain's left frontal lobe and exiting the left side of his head.
The researchers concluded that as the tapered end of the tamping iron burrowed into Gage's head, it caused the left side of his face and forehead to hinge outward. Gage's face snapped back into place as the bar departed, landing about 25 yards away.
Scholars have disagreed, and continue to disagree, about where the rod entered and left the skull, about how much brain was thereby destroyed and where, and about how Gage's personality and cognitive abilities were (or were not) changed by his injuries. Secondary sources describe an upright, responsible, and hard-working young man who, after his accident, changed into a psychopath without foresight, moral sense, or concern for social conventions despite intact intelligence, learning, and memory.
Gage's frontal lobes were injured in the accident. They sit directly behind the forehead and eyes. Gage's accident provided evidence that the area might serve as kind of internal police force, controlling impulses for swearing, rude behaviour and risky ventures.
But the holes in his head healed, and Gage eventually recovered from his physical injuries. However, the brain injury had changed his personality. His former employers wouldn't take him back.
"The equilibrium or balance, so to speak, betweenhis intellectual faculties and animal propensities, seems to have been destroyed," Harlow told the Massachusetts Medical Society on June 3, 1868. "He is 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 operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible."
Gage lived for a dozen more years. He wasn't able to return to his old job. For a while, he drove coaches in Chile. He is said to have once exhibited himself as a curiosity at Barnum's Museum in New York. After the accident Gage often made up tales about imagined adventures to entertain young nephews and nieces.
Gage mended physically, his intelligence was unimpaired and he retained full control over movement and speech.
His amazing survival earned him a place in the annals of medicine, but he lived as a different man.
He sat upright in the ox cart that carried him to an inn, a half-mile away. He was met there by Dr. John Martyn Harlow, who performed one of the first neurosurgeries ever. Gage recovered in a matter of months, though he lost his left eye.
That tamping iron now hangs in the Warren Anatomical Museum at Harvard Medical School. Most visitors to the museum come to see the giant spike and a life mask of Gage's head, complete with gaping scar.
On the fateful day, a momentary distraction let Gage begin tamping directly over the powder before his assistant had had a chance to cover it with sand. The result was a powerful explosion away from the rock and toward Gage. The fine-pointed, 3-cm-thick, 109-cm-long tamping iron was hurled, rocket-like, through his face, skull, brain, and then into the sky. Gage was momentarily stunned but regained full consciousness immediately thereafter. He was able to talk and even walk with the help of his men. The iron landed many yards away (1).