What really happened to Phineas Gage after his accident?

Phineas Gage survived the tamping iron that passed through his head, recovered physically within months, and lived for about eleven and a half years. His doctor reported a marked change in his character, and he could not return to work as a foreman. But he later held demanding jobs, including driving stagecoaches in Chile, and died in May 1860 after a series of seizures. The popular picture of a drifting, violent man exhibited as a freak until he died penniless is not supported by the few primary sources. [1]

According to the Science History Institute, Dr John Harlow's care allowed Gage to pull through, and he went home to his family's farm. He lost his left eye, but his memory, language and motor skills remained intact. Malcolm Macmillan, writing in the British Psychological Society's magazine, says Harlow's management of a severe infection undoubtedly saved his life. Gage was well enough after three months to return to his parents' farm, and in November 1849 he travelled to Boston to be examined by Henry Jacob Bigelow at Harvard. [2] [1]

Probably in 1850 he appeared at Barnum's American Museum in New York and lectured and exhibited himself in New England. He then worked about 18 months for Jonathan Currier, who ran a livery stable and coach line in Hanover, New Hampshire, and afterwards went to Chile with a man planning a stagecoach line at Valparaiso. In June 1859 he rejoined his family in San Francisco, weakened by an illness, and later worked on farms. In February 1860 he had a fit at dinner; the seizures worsened and he died on 21 May 1860. [1]

Almost everything known about his personality comes from Harlow, who wrote in 1868 that the balance between Gage's intellectual faculties and animal propensities seemed destroyed. He described Gage as fitful, profane, impatient of restraint and obstinate, and said friends found him no longer Gage. Before the accident he had been regarded as an efficient and capable foreman with a well-balanced mind. Macmillan notes that there are only four primary sources: Harlow in 1848 and 1868, Bigelow in 1850, and J.B.S. Jackson in 1870. Even these are imperfect: Harlow gave the wrong year of death, and a relic found at Harvard suggests Gage went to Chile in 1854 rather than 1852. [1] [3]

The traditional view, found in many scientific and popular accounts, holds that Gage was impulsive and unreliable until his death. Macmillan argues that this is inconsistent with the record. Working for Currier and driving coaches in Chile required early rising, handling horses, dealing politely with passengers and managing a 13-hour, 100-mile route. In his view this points to a good long-term adaptation, helped by the structure that work provided, as in modern rehabilitation. His 2010 paper with Matthew Lena states that Gage eventually made a surprisingly good psychosocial adaptation. [1] [4]

Macmillan also cautions that the evidence is thin. No autopsy was done, Gage's brain was gone when his body was exhumed, and only the skull remains to guide estimates of damage. He writes that we will never know with certainty what Gage was like before or after, and the exact extent of the brain damage. The results here do not include a defender of the traditional view making a case in its strongest form. [1]