Gage's injury
Gage had complications from a fungal infection which left him in a "semi-comatose state" from 23 September - 3 October, "seldom speaking unless spoken to, and then only answering in monosyllables." From 4 October onwards, he began improving, and took his first step on 7 October.
According to Gage's doctor, Dr. J.M. Harlow, whereas previously he had been hard-working, responsible, and popular with the men in his charge, his personality seemed to have been radically altered after the accident. His doctor reported that:
Some months after the accident, probably in about the middle of 1849, Phineas felt strong enough to resume work. But because his personality had changed so much, the contractors who had employed him would not give him his place again.
When he was well enough again in or around 1850, he spent about a year as a sideshow attraction and at P. T. Barnum's New York museum, putting his injury, and the tamping iron which caused it, on display to anybody willing to pay for the show. He then worked as an assistant in New Hampshire and, for nearly seven years, as a coach driver in Chile. When his health started to fail in 1859, he returned to San Francisco, where he lived with his mother and, for some months before his death, was employed as a farm worker. In 1860, he began to have epileptic seizures and died a few months later.

Effect on Gage
Gage's case is cited as among the first evidence suggesting that damage to the frontal lobes could alter aspects of personality and affect socially appropriate interaction. Before this time the frontal lobes were largely thought to have little role in behavior. Neurologist Antonio Damasio has written extensively on Gage, as well as on various patients he has studied which, in his personal view, had similar brain injuries. In a theory he calls the somatic marker hypothesis, Damasio suggests a link between the frontal lobes, emotion and practical decision making. He sees Gage's case as playing a crucial role in the history of neuroscience, arguing that Gage's story "was the historical beginnings of the study of the biological basis of behavior".

Significance for neuroscience
There is no doubt that Gage suffered the accident, and that it had a dramatic impact on his life. However, in his book An Odd Kind of Fame: Stories of Phineas Gage, Australian psychologist Malcolm Macmillan casts serious doubts on the accuracy of the account that entered both scientific and popular discourse. First, very little is known about Gage's personality and habits before the accident; second, the post-traumatic psychological changes reported while Gage was still alive were much less dramatic than later reports assert.
Within twenty four hours of the accident, a first report was (anonymously) printed in the Ludlow, Vermont Free Soil Union. Having described the accident, the paper reports that "the most singular circumstance connected with this melancholy affair is, that he was alive at two o'clock this afternoon, and in full possession of his reason, and free from pain." Gage was popularly supposed to have later died in some way due to the damage in the frontal lobe, but the true cause of his death so many years later, remains unclear.
Harlow mentioned very few psychological changes in his initial report of 1848. Henry Bigelow, Professor of Surgery at Harvard University, wrote in 1850 that Gage was "quite recovered in faculties of body and mind." It was Harlow's account from 1868, eight years after Gage's death, that introduced the now-textbook changes.

Criticism of popular story
Gage kept the rod which damaged him as a souvenir throughout his life, and it was buried with him in death. In 1867, when his skeleton was exhumed, the original rod was thus available with it. There is an inscription on the rod that reads, "[t]his is the bar that was shot through the head of Mr. Phineas P. Gage at Cavendish, Vermont, Sept. 14, 1848. He fully recovered from the injury & deposited this bar in the Museum of the Medical College of Harvard University. Phineas P. Gage Lebanon Grafton Cy N-H Jan 6 1850. Gage's skull, as well as the rod that pierced it, is currently part of the permanent exhibition at Harvard Medical School's Warren Anatomical Museum in Boston, Massachusetts.

See also