This Man Survived A Mind-Boggling Brain Injury, And The Case Still Baffles Experts 172 Years On

On a fall afternoon in 1848, a gang’s working on a railroad in rural Vermont. Its leader, a young man, is using a piece of metal to hammer powder into a small pit. Suddenly, though, there’s a huge explosion. The metal – a near 4-foot length of iron – flies through the air and through the man’s head.

The iron bar has passed through Phineas Gage’s head. It’s smashed through his cheek, gone clean through his brain and passed out to fly through the air for some tens of feet. It seems clear that Gage should have been killed by the accident. Yet not only is he alive, but he’s also able to talk to the doctor who rushes to attend him.

Before the accident, Gage had been a much-loved character. According to The Psychologist magazine, his doctor, John Martyn Harlow, would later describe him as having been “strong and active,” not just in his body but in his mind as well. By all accounts, he would’ve been a nice guy to be around: good-natured, easy to get along with, having what the doctor described as a “well-balanced mind.”

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But the passage of the tamping iron through his brain changed all that. Those who’d known him before the accident were stunned by the man whom they encountered afterwards. The alteration was so “radical” that, according to Harlow, people described him as “no longer Gage.” And this transformation would bring Gage notoriety.

Yes, Gage’s misfortune has since led to him becoming very well known among neuroscientists. This is largely due to the story of Gage’s transformation being the earliest indication that a switch in personality might follow damage to the brain. Altogether, University of Melbourne don Malcolm Macmillan has estimated that Gage features in two out of three psychology 101 guides.

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Over time, different teams of brain researchers have explored the story of Gage. These include Stanley Cobb, a neurologist who in the 1940s tried to figure out where precisely the iron had passed through Gage’s skull. And as technology improved, others did the same with new methods: CT scanning during the 1980s and 3-D modeling in the following decade.

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But who was Gage? Well, we don’t have that many details, bar that he came from New Hampshire farming stock. He later found work in railway building, and at the time of the accident he was with the Rutland and Burlington Railroad Company. This firm had received a state charter in the 1840s and was laying tracks in Vermont.

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Gage had grown into a hard-working, friendly man, at peace with the world and gentle of disposition. His employers found him, according to Harlow, “the most efficient and capable foreman” they had. As for the men in his gang, well, he was a “great favorite” of theirs, too. But all of that would change.

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The jobs Gage had included getting rid of stone in order to make the terrain level enough to lay down tracks. He did this by putting gunpowder into apertures that’d been created in the rocks. Once this task had been completed, the fissure would be covered with sand, so that he could safely pack it down with an iron crowbar.

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Gage oversaw the placement of the apertures and the amount of explosives to use. He also had the responsibility for pushing the gunpowder down into the hole, so there’d be a more contained detonation. To do that, he employed a tamping iron, which was a cylinder that tapered along its 3.5 feet or so.

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But for some reason, on an afternoon in September 1848 Gage allowed something to break his focus. And he then started to pound on the gunpowder prior to the sand being added. His tool scraped the tone, producing a spark that set off the explosives. To Gage’s horror, the iron was fired towards him by the ensuing blast.

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The spike of the iron plowed into Gage’s cheek near his left eye. It then carved through the bottom of his skull and, after shooting through his brain, exited from the tip of his head. The propulsion had been so fierce that the iron continued to travel 25 yards or so afterwards.

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Unsurprisingly, Gage possibly passed out at this point. But if he did, he wasn’t out for long. He was taken by cart to his nearby residence, where Gage was able to leave the vehicle without assistance. Once he’d gotten comfortable in a seat, he regaled bystanders with his tale. And when a medic turned up, he quipped, “Doctor, here is business enough for you.”

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It seems that Gage then made a decent recovery from his accident. So six months or so after the bar pierced his head, he was ready to go back to his job. But Gage had changed – so much so that his firm wasn’t interested in giving him back his previous position.

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Strangely, even though Gage had changed noticeably, nobody at the time made that much of it aside from his employer. His different psychology didn’t merit a mention from Harlow in the contemporary report of the accident. And a further account a couple years later also failed to reference it. Others only made passing note of a reduction in his mental capacities. It was as late as 1868, in fact, long after Gage had passed, that Harlow made a more substantial report that described the changes in psychology.

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Perhaps the scientists of the day just didn’t think to question whether having a spike go through Gage’s head had caused his personality to change. After all, they knew very little about the brain, with scant idea of how it operates. They had notions about nerves governing physical motion, but even these were limited.

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As far as the world of science was concerned, the brain remained an enigma for the most part. And they weren’t well informed about how personality is related to the brain, either. After all, this was the age of the phrenologist. Yes, the height of medical science was examining lumps on the head to figure out what your character was!

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Nor did anyone have much to go on when theorizing about Gage. Harlow’s account of 1868 is the only good source of information, and even that remained little read. This meant stories spread about Gage that had relatively little basis in truth. And as we’ll see, even scientists helped amplify the myth.

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Harlow was well placed to know about the changes that Gage had undergone, given that he was responsible for Gage’s post-accident treatment. “He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom,” Harlow wrote of Gage’s character following the incident. And that wasn’t all that Harlow had to say.

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Once a model citizen, Gage had now apparently lost the balance of “intellectual faculties and animal propensities.” This was especially unfortunate, because he struck Harlow as a strong man but with the mind of a child. Gage would no longer listen to advice that didn’t suit his desires. Instead, he was “pertinaciously obstinate, capricious, and vacillating” when it came to making plans, which he’d readily abandon.

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Harlow’s character study hadn’t run to more than a couple hundred words, but later observers would have far more to say. Gage ballooned into a gross braggart, often drunk, plagued with sexual problems. Lazy and unmotivated, he couldn’t hold down jobs and ended up a drifter, showing himself off in circuses as a curio.

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But the descriptions that people indulged in aren’t wholly accurate. And some aspects are entirely made up. For instance, Harlow mentioned that Gage had toured some of New England’s bigger settlements and had been on show at a New York museum. But over time such modest travels had been exaggerated into the story of a feckless drifter.

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The museum that Gage had appeared in had been owned by PT Barnum, who’s better known today for owning a circus than a museum. This has led to fanciful tales that he appeared in Barnum’s circus, which have obscured the fact that Gage actually exhibited himself in the American Museum. And from a circus, then of course it’s a small step to being part of a freak-show.

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On top of that, Gage spent at most 12 months in New York and New England, since by the start of 1851 he was in steady employment again. So far from the waster that he’s often painted as, in truth he worked at a stable in the U.S. for 18 months before decamping to Chile, where he was employed as a stagecoach operator.

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After the accident, Gage had been in poor health, not even feeling strong enough to help out on the family farm. He journeyed as far as Boston in the winter of 1849, but even in 1850 he was still struggling physically. It’s certain that he wasn’t making a fortune as a circus freak, though, since he had legitimate work.

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So what else might’ve been exaggerated? Well, Harlow had it from Gage’s mom that he invented tales of what he’d been doing to keep his nieces and nephews amused. These stories may later have been mixed in with accounts of people who’d had brain operations to create a picture of a lying boaster who was quick to anger.

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Case studies of people who’d undergone lobotomies seem to be where ideas that Gage was feckless or lazy came from. Harlow didn’t write anything about alcohol consumption or Gage’s love life. But Gage somehow still became discussed as somebody lost in a haze of booze and obsessed with sex.

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Harlow did certainly describe a man who’d changed, though, even if it wasn’t in the ways that people would later claim. Professor Malcolm Macmillan, who wrote a book about Gage, told NPR in 2017, “He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality.”

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Neurologist Allan Ropper, from Brigham & Women’s Hospital and Harvard Medical School, sees in Gage the birth of neuroscience. He told NPR, “If you talk about hard-core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero.” The reason, Ropper explained, was that, “It’s one region [of the brain], it’s really obvious, and the changes in personality were stunning.”

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Even though Gage did recover to some extent, the accident remains the likely cause of the end of his life. In 1859 he returned from Chile a sick man and looked to recuperate with family in California. But it was to no avail: convulsions that resulted from epilepsy would carry him off in 1860.

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After Gage’s demise, an autopsy wasn’t held. And it wouldn’t be until 1867 that his remains were dug up for examination. The following year, Harlow received his skull, and that’s the only remnant of Gage that science can examine today. It isn’t clear what exact damage was done to his brain, since of course its position at the time of the accident can’t be determined for certain.

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During Gage’s lifetime, there’d been three attempts to find out what exact route the tamping iron had taken. But even those couldn’t reach a consensus. Harlow determined that it’d exited close to the bregma, in the midline of the skull. This would have caused severe damage to the brain’s middle-left and left-frontal lobes. The doctor believed that the right side of Gage’s brain had taken over as a result.

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With the advent of CT scanning, scientists could gain a new view of the iron’s passage. Richard Tyler and his son Ken took scans at Boston City Hospital that gave a two-dimensional view of the skull. This led them to conclude that while the left side of the brain had indeed been harmed, there’d also been some damage on the right.

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Hanna Damasio’s team didn’t agree a dozen years later, though. She recreated Gage’s skull in three dimensions using existing photos, measurements and X-rays of Gage. Damasio concluded that the harm was caused more on the right and to the front of the brain than had previously been thought.

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Two years later, advancements in science led to a new view. Ion-Florin Talos and Peter Ratiu were able to deploy thin CT scans to look at Gage’s actual skull and reconstruct it. They found that the entry hole for the tamping iron was too narrow for it to have passed through. So the skull must have lifted off to allow passage and then come back together after it was through.

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Because of the hinge mechanism that this involved, and the fracture that was left behind, Ratiu and Talos could pinpoint the exit spot. It was left of the central line of the skull. They concluded that the damage to the brain would’ve been to the frontal and left lobes. In other words, they agreed with Harlow. So after decades of scientific investigation, they’d returned to square one!

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Gage has a lasting fame, then, and students still hear about him to this day. Neurology professor Jack van Horn told NPR that similar cases crop up constantly. “Every six months or so you’ll see something like that, where somebody has been shot in the head with an arrow, or falls off a ladder and lands on a piece of rebar,” he said. “So you do have these modern kind of Phineas Gage-like cases.”

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Yet Gage’s unique story continues to fascinate. To this day, visitors to Harvard Medical School’s Warren Anatomical Museum seek out items that – despite their slightly grisly nature – help tell that tale. There you can find not just the man’s skull and a mask of his face, but also the very tool that caused his personality to change.

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But as we’ve seen, and Macmillan confirmed to NPR, the alteration of Gage’s personality probably was far from permanent. Macmillan told the broadcaster, “That personality change, which undoubtedly occurred, did not last much longer than about two to three years.” So this is good news for those who suffer brain injury today. He added, “Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible.”

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The importance of Gage’s case today doesn’t lie in a description of his behavior. We still aren’t all that clear on exactly what he was like before and after the accident. And we still don’t know enough to say what piece of damage caused which change in personality. But what is important is that Gage adapted and learned to live with it.

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Sadly, though, Phineas Gage isn’t the only person to have sustained a devastating injury and lived to tell the tale. In July 1978 a Soviet scientist made the fateful decision to place his head inside a particle accelerator – a hi-tech piece of hardware used for moving subatomic particles at incredible speeds. But before he knew what was happening, a charged proton stream struck his skull at around 670 million miles per hour. And with that single blinding flash, everything changed.

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It might be said that nothing has arguably done more to advance humanity than science. Indeed, thanks to those working in the field, many people today enjoy never-before-seen levels of comfort and mobility. And in essence, science’s spirit of inquiry can be summed up by the 18th-century Latin motto “Sapere aude” – or “Dare to know.”

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But daring to know is not quite enough; we must, after all, also glean clear evidence. With this in mind, normal scientific method is what separates professional researchers from hapless Marvel comic book heroes. Unfortunately, however, such rigor was lacking in one Soviet scientist’s close-up encounter with a particle accelerator.

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Particle accelerators were first engineered in the 1930s in order to learn more about the structure of matter. Put simply, these machines use magnetism to move particles at very high speed. When those particles then crash into one another, they leave observable traces from which scientists can extract information. Ultimately, the results of the collisions can help to prove or disprove theories concerning the mysteries of the universe.

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Nowadays, the largest particle accelerator on the planet is the Large Hadron Collider (LHC), which incorporates a 16.7-mile loop that particles zoom around. It’s located below ground at depths of between 164 and 574 feet, straddling the Swiss-French border close to the city of Geneva. The circular 12-foot wide concrete tunnel took five years to build.

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And in 2012 LHC experiments seemed to confirm the existence of the Higgs boson – a particle that has helped explain how others obtain mass. This discovery subsequently earned Nobel Prizes for two of the scientists concerned, Peter Higgs and Francois Englert, and their work could very well ultimately lead us to a better understanding of the universe.

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Back in the 1970s, though, the Soviet Union was a leading light in particle physics research. In fact, the award-winning U-70 synchrotron collider – constructed in 1967 – was the most powerful particle accelerator in the world at the time. Even today, the U-70 remains the most energetic synchrotron of its kind in Russia.

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Now, if it’s been a while since you attended school, here’s the science behind some aspects of a particle accelerator. A proton is a positively charged subatomic particle and an essential ingredient in the nucleus of an atom. Protons were once thought to be the smallest and final pieces of an atom, but they’re now known to each contain three even smaller particles called quarks.

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Furthermore, a quark cannot be observed on its own but rather only when it’s a part of a composite particle called a hadron – hence the name of the Large Hadron Collider. And quarks are unique in that, as far as the Standard Model of particle physics goes, they – and no other – elementary particles are subjected to the four fundamental forces of strong interaction, weak interaction, electromagnetism and gravitation.

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In addition, quarks come in six different varieties – top, bottom, up, down, charm and strange – that physicists call flavors, with each of these flavors possessing a corresponding antiquark. But before we’re overwhelmed by the complexities of these tiny particles, let’s return to the Soviet U-70 synchotron.

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On July 13, 1978, the U-70 wasn’t functioning as it should. Research scientist Anatoli Bugorski happened to be working that day, though, and perhaps in an attempt to discover what was up, he inserted his head inside the machine. Then, at a critical moment, something went wrong. Somehow, the beam fired – and it headed towards the unfortunate researcher.

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In that single life-changing moment, the U-70 had fired a highly charged beam of protons straight through the scientist’s head. The experience was seemingly brief and painless, although Bugorski later reported having seen a burst of light. Yet the physical impact of receiving such a high-powered dose of proton radiation was, at that time, unknown.

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Indeed, proton radiation appears relatively rarely in nature. One known source is solar wind – a beam of particles that radiate from the Sun. Cosmic rays coming from deep space are another. But in both cases, the Earth’s atmosphere stops the radiation reaching us. It wasn’t until 1970 that scientists detected proton radiation in radioactive decay.

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Proton radiation damages DNA, destroys cells and may even cause cancer. Its relative scarcity, therefore, is certainly a good thing for biological life. Such radiation can also disrupt the making of red and white blood cells in bone marrow, which is why high doses often lead to anemia and infections.

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That said, proton beams can have positive effects as well – specifically in the treatment of some forms of cancer. Cancerous cells divide at a rapid rate and are therefore susceptible to the kind of DNA damage caused by proton radiation. This treatment has several advantages over other forms of radiotherapy because it can be specifically directed at particular tumors.

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The beam that went through Bugorski’s head in 1978, however, was far more powerful than those used in conventional radiotherapy. In fact, its electron voltage was approximately 76 billion, compared to the 250 million used in proton therapy. And the beam’s radiation level – which is measured in units called “grays” – was approximately 2,000 to 3,000. To put that in perspective, generally speaking, exposure to over five grays typically results in death.

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Consequently, following his accident, Bugorski was placed under observation at a Moscow clinic. And there was little hope that the scientist would still be alive even a week later. After all, the proton beam had struck the back of his skull, passed through his brain and come out close to his nostril. Indeed, the doctors were basically waiting for him to die.

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In the following minutes and hours, one of the first visible effects of the accident was the heavy swelling of Bugorski’s face. The proton beam had actually scorched parts of his brain and skull, leaving him deaf in one ear. And after the initial swelling, the skin around the beam’s entry and exit points began to peel.

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But because the work Bugorski had been involved in was part of the Soviet nuclear program, it was unsurprisingly highly clandestine. After all, when the scientist had had his mishap, the Cold War was still under way – meaning anything to do with nuclear physics was not for public consumption.

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In fact, it would be over a decade before anyone in the Western world heard about Bugorski’s extraordinary accident. And the Soviets were especially cagey about admitting to any blunders in their nuclear program – whether these concerned civil nuclear power or military weapons. The Chernobyl disaster was a good example of this secrecy.

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Famously, in April 1986 a nuclear reactor at the Chernobyl Nuclear Power Plant in the Ukrainian Soviet Socialist Republic went into meltdown. Then, in the immediate wake of the incident, the Soviet authorities attempted to play down its seriousness. In truth, though, it was – and remains to this day – the worst nuclear accident ever to have occurred.

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Initially, the Soviets told the world that there had only been a small incident. The first admission that something had gone wrong, then, came in a Soviet television news announcement a whole two days after the calamity. And even at the time, the report was no more than cursory. It explained, “There has been an accident at the Chernobyl Nuclear Power Plant. One of the nuclear reactors was damaged. The effects of the accident are being remedied. Assistance has been provided for any affected people.”

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Of course, this terse news bulletin was very far from revealing the truth of the matter. Nevertheless, the wholesale removal of 100,000 people from the area surrounding Chernobyl wasn’t something that the Soviets could entirely conceal. And it soon became obvious to observers around the world that this accident had been anything but minor.

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So, given the attempted downplay of the Chernobyl disaster, it’s hardly a surprise that Bugorski’s 1978 accident at the Institute for High Energy Physics in Protvino wasn’t initially announced. Indeed, more than ten years would pass – until roughly the time when the Cold War ended – before the circumstances of the mishap became known to the world.

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Miraculously, Bugorski’s exposure to the high-powered proton beam didn’t kill him. Indeed, he’s still alive today. You see, although the beam had subjected Bugorski to extremely high levels of radiation, its path had been incredibly thin and its aim precise. In fact, the radiation seemingly had no impact on any surrounding organs. Yes, Bugorski’s bone marrow and other susceptible tissues were apparently relatively unscathed.

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Nonetheless, the incident left Bugorski with several long-term health problems. For one thing, the left side of his face suffered severe nerve damage, leaving it paralyzed. For another, the scientist’s hearing never returned properly to his left ear. This organ was also affected by tinnitus – a state in which the brain registers a noise for which there’s no external source.

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But there’s also a strong indication that Bugorski may have suffered permanent brain damage. Be that as it may, Bugorski – as we’ve mentioned – is alive today and well into his 70s. What’s more, even if there is brain damage, it appears that the scientist’s intellectual abilities are unimpaired. For one thing, he went on to complete his Ph.D. after that massive dose of radiation.

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Bugorski even continued his career as a nuclear scientist following the accident. It seems, in fact, that the only difference he noticed in his mental capabilities was that he tended to tire more quickly than he had before. However, along with the tinnitus that affected his hearing, the scientist would suffer other distressing physical symptoms.

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For instance, Bugorski suffered grand mal seizures after his injury. Marked out by powerful convulsions and bouts of unconsciousness, these fits are also called generalized tonic-clonic seizures. Such episodes are prompted by irregular electrical impulses in the brain and are generally associated with epilepsy.

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To keep a check on how Bugorski’s health was progressing, then, doctors gave the scientist physical exams. These occurred for a period at a medical facility in Moscow on a couple of occasions each year. But perhaps the most incredible part of Bugorski’s brush with a proton beam is the fact that – as far as we know – he hasn’t yet developed cancer.

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Still, over the years, Bugorski’s physical symptoms have gradually worsened. In the first 12 or so years after the accident, his epilepsy resulted in only mild fits; after that and up to 1997, however, he suffered six major grand mal seizures. Yet Bugorski is not exactly the only person to fall victim to a nuclear accident in the Soviet Union.

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Indeed, in 1997 Bugorski spoke to Wired about the unfortunate kinship he shares with others who have been at the receiving end of nuclear injuries. “Like former inmates, we are always aware of one another,” he said. “There aren’t that many of us, and we know one another’s life stories. Generally, these are sad tales.”

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And there’s been one decidedly peculiar side effect of that proton stream: in essence, it looks as though a line has been drawn down the center of Bugorski’s face. You see, while the side that escaped the effects of the beam has aged as normal, the one side that took the impact from the synchotron looks much as it did back in 1978.

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Meanwhile, as Bugorski alluded to in his interview with Wired, there have been many others who have first-hand experience of nuclear science’s destructive potential. Some perished as the result of the Chernobyl disaster, while others succumbed to similarly tragic fates back in 1945. That year, the U.S. dropped two nuclear bombs on the Japanese cities of Hiroshima and Nagasaki.

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In fact, somewhere between 129,000 and 226,000 individuals died in those two cities as a result of the nuclear bombs dropped. About half of these fatalities occurred in the immediate aftermath of the blasts, while the rest died in the weeks and months afterwards – in large part due to the effects of radiation sickness.

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And the effects of radiation exposure can also be seen in Bugorski, as he himself has pointed out. “This is, in effect, an unintended test of proton warfare,” he told Wired. “I am being tested. The human capacity for survival is being tested.” And Bugorski is not the first scientist to unwittingly experience the dangers of radioactivity, either.

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Probably the best known of all scientists to make great sacrifice in the quest for knowledge about nuclear power is Marie Curie. Born in 1867 in Poland, Curie later took French citizenship. And in 1903 the pioneering scientist won the Nobel Prize for Physics for her groundbreaking work on radioactivity. A second Nobel – this time for chemistry – came in 1911.

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Perhaps Curie’s main scientific achievement, though, was the finding of two radioactive elements: polonium and radium. Yet when she made her breakthroughs, no one was aware of the dangers posed by radioactivity. Indeed, bizarre as it may seem to us today, radioactive drinks and skin creams were marketed as beneficial to health during the first few decades of the 20th century.

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And, tragically, the massive amount of exposure to radiation that Curie had subjected herself to proved consequential. During her work, you see, she had carried unshielded radioactive material in her pockets as well as keeping it in her desk. Perhaps owing to the effects of these practices, then, the blood disorder aplastic anemia killed Curie in 1934.

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Meanwhile, although physicists may remember Bugorski for his years of scientific service, everyone else is more likely to know of him thanks to his accident with a particle accelerator. And since Bugorski put himself in the way of danger for science, he’s even something of a hero – just not quite the kind you may find in comic books.

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