John Harlow

Introduction

John Martyn Harlow (25 November 1819 – May 1907) was an American physician whose name survives for one reason: he was the doctor on the scene when an explosion drove an iron tamping bar through the head of the railway foreman Phineas Gage, and he is the reason anyone knows what happened next. Harlow published a short report in 1848, then tracked his former patient across two continents for another twenty years, obtained his skull, and in 1868 published a second account that turned a surgical curiosity into the founding case of frontal-lobe neuropsychology.

Everything we think we know about Gage's personality change comes from that 1868 paper. Harlow was a careful observer by the standards of his time, but he was also a country doctor writing twenty years after the fact from second-hand testimony, and his report has to be read with that in mind.

Early Life and Education

Harlow was born in Whitehall, New York, on 25 November 1819, the ninth of twelve children of Ransom and Annis Martyn Harlow. He prepared for college at the Methodist Collegiate Institute in West Poultney, Vermont, and at Ashby Academy in Massachusetts, and taught school while studying medicine — an experience that gave him the interest in public education he kept for life.

He began medical study at the Philadelphia School of Anatomy in 1840 and took his MD at Jefferson Medical College in Philadelphia in 1844. The following year he set up in practice in Cavendish, Vermont, a small town on the route of the Rutland and Burlington Railroad, which was then being cut through the rock of the Black River valley.

Academic and Professional Career

Cavendish

Harlow practised in Cavendish for around twelve to fifteen years, serving on the town school committee and building what his contemporaries described as an excellent reputation. The Gage accident happened on 13 September 1848, a few hundred yards from his door, and he managed the case through the infection, the fungus, the coma and the ten-week recovery.

His health failed in 1857 and he gave up the practice, spending the next three years travelling and studying — in Minnesota and back in Philadelphia.

Woburn

In the autumn of 1861 he settled in Woburn, Massachusetts, twelve miles north-west of Boston, and joined the Massachusetts Medical Society that December. The move is where the second half of his life begins, and it has almost nothing to do with the brain. Harlow became a substantial figure in the town and the state: school committee, selectman, library trustee, water and drainage committees, examining officer for army recruits during the Civil War, two terms as a state senator, a seat on the Governor's Council, a place on the state Board of Public Health, a trustee of Massachusetts General Hospital, president of the National Bank of Woburn, director of the local gas company. He held office in several county and state medical societies.

He married twice — Charlotte Davis of Acton, who died around 1887, and then Frances Kimball of Woburn — and had no children. He died at Woburn in May 1907, aged eighty-seven, described by The New York Times as the wealthiest man in town. His will endowed a ward for the poor at Massachusetts General Hospital and a book fund at Woburn Memorial High School, whose library is named for him.

Major Contributions to Psychology

The 1848 Report

Harlow's first publication on Gage, "Passage of an Iron Rod through the Head," appeared in the Boston Medical and Surgical Journal within weeks of the accident. It is essentially a surgical report: the dimensions of the bar, the track of the wound, the course of treatment, and the observation that the patient was conscious, talking and apparently intact. It says nothing about personality, because at that point there was nothing to say — Gage was, by all accounts, himself.

Two years later Henry Jacob Bigelow, professor of surgery at Harvard, wrote the case up in the American Journal of the Medical Sciences and declared Gage fully recovered, mentally as well as physically. Bigelow was an anti-localizationist who held that the brain worked as a whole, and he used Gage to argue that a large lesion in the frontal region could be survived without deficit. That paper, not Harlow's, was the one the profession read.

The 1868 Report

Harlow's second paper, "Recovery from the Passage of an Iron Bar through the Head," was published in the Publications of the Massachusetts Medical Society in 1868 — twenty years after the accident and eight after Gage's death, in 1860. It is a very different document. It assembles what Harlow could learn of Gage's later life by correspondence with the family: the years as an exhibit in Barnum's museum, the livery-stable work in New Hampshire, seven years driving a stagecoach in Chile, the move to San Francisco, the seizures, the death at thirty-six.

And it contains the passage that made the case famous, in which Gage's friends and family said he was "no longer Gage": fitful, irreverent, profane, obstinate yet capricious, unable to keep to a plan, with no regard for the social conventions he had once observed perfectly. Harlow concluded that the accident had damaged the balance between his "intellectual faculties" and his "animal propensities," and that the frontal lobes were therefore the organ of what he called the moral and intellectual faculties.

Read against Bigelow, the 1868 paper is a correction: the recovery had not been complete, and the deficit was not motor or linguistic or intellectual but social and executive. That dissociation — intelligence intact, judgement and conduct wrecked — is the observation that made Gage the founding case of frontal-lobe function.

The Skull

Harlow did something no one had done before in a case of this kind. Having traced Gage, as he put it, "in his wanderings over the greater part of this continent," he arranged for the body to be exhumed some six years after death and obtained the skull and the tamping iron, which he deposited in the Warren Anatomical Museum at the Harvard Medical School, where both remain. He wanted anatomy to check the clinical inference, and he was right to: every modern reconstruction of Gage's lesion, including the three-dimensional ones, is built on that skull.

Major Publications

  • Harlow, J. M. (1848). "Passage of an iron rod through the head." Boston Medical and Surgical Journal, 39(20), 389–393.
  • Harlow, J. M. (1868). "Recovery from the passage of an iron bar through the head." Publications of the Massachusetts Medical Society, 2(3), 327–347 (reprinted by David Clapp & Son, 1869).

These are the only two publications of Harlow's that are securely documented. He described himself in the second as "an obscure country physician," and for most of his life that is exactly what he was.

Impact and Legacy

The 1868 paper is the origin of three things that outlasted it: the idea that the frontal lobes govern social judgement and conduct; the frontal-lobe syndrome, now described as dysexecutive and pseudopsychopathic; and the model of long-term outcome follow-up in brain injury, which Harlow invented out of stubbornness rather than method.

What Harlow actually established is less than what is usually claimed. The "no longer Gage" evidence is a single quotation, from relatives, recalled after twenty years, in a report written by a doctor who had not seen the patient for most of that period. There was no pre-injury assessment of Gage, no control, no way to separate what the lesion did from what the celebrity, the loss of his trade, the drinking and the epilepsy did. Gage's own mother told Harlow he was unchanged in some respects. Harlow's account is the whole basis of the standard story, and it is testimony rather than measurement.

The record has since been searched systematically, and what turned up cuts in both directions. In 2026 Manon Auffret published a reconstruction of the case from digitised nineteenth-century newspapers (Journal of the History of the Neurosciences, 35(2), 186–206), screening Newspapers.com, Google News Archives and Chronicling America for the years 1848 to 1899 and retrieving 831 reports. Three of the findings bear directly on Harlow. Most of the coverage — 72.44 per cent — appeared after Gage's death, which means the case was not prominent during his lifetime and that a good deal of what reads like contemporary testimony is retrospective. The search also surfaced previously unknown primary sources: new evidence of Gage's functional recovery, records of occasional exhibitions in New England, early notices in European journals, and unpublished photographs and drawings of the skull and the tamping iron. And the reports from 1848 and 1849, written while Gage was alive and before anyone had a localisationist argument to make, contain nothing of the transformation that the 1868 paper made famous.

That is the awkward part for Harlow, and it is a matter of arithmetic as much as of interpretation. His total discussion of Gage's character runs to a little over three hundred words; he never quotes Gage and never asked him, because Gage had been dead for eight years when he wrote it. A review of the recent clinical literature found that about half of the papers examined attributed negative traits to Gage that the primary sources do not support — the embellishment did not stop with the nineteenth-century press. What Auffret's archive adds is not a refutation of Harlow's observation but a sharper statement of its status: the earliest and least theory-laden sources describe a man who recovered, and the famous description comes twenty years later, from a single physician, at third hand.

Harlow was not a modern localizationist. He had phrenological sympathies, and his reading of the case draws on them — he noted that Gage's powers of calculation had suffered, attributed to damage to the organ of Calculation, and he argued that the faculties were represented in both hemispheres, so that the undamaged right side could carry on "feebly" alone. He also offered no mechanism of his own for Gage's disinhibition.

Later reconstructions have partly corrected him. Antonio Damasio's 1994 reconstruction of the skull found bilateral ventromedial prefrontal damage, which fitted the story of a social and emotional deficit. But the two subsequent imaging studies — Ratiu and Talos in 2004 and Van Horn and colleagues in 2012 — both concluded the lesion was confined to the left hemisphere, with Van Horn's estimate putting the loss at about four per cent of cerebral grey matter but roughly eleven per cent of white matter, making Gage as much a disconnection case as a loss-of-tissue one.

And the case was misused. Harlow's report was cited through the 1930s and 1940s as evidence that destruction of the frontal lobes produced improvement rather than impairment in some patients, and it formed part of the case for prefrontal leucotomy. That reading inverted what Harlow had said, but it had his authority behind it.

In Woburn he is remembered for the library. In neuroscience he is remembered for two papers written twenty years apart about one man, and for refusing to let the story end when the patient walked out of town.

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References

  • Harlow, J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39, 389-393.

Last updated: 2026-10-20

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