The Best American Science and Nature Writing 2011

by Mary Roach

  May 25, 1992:

  Researcher: How long have you had trouble remembering things?

  Henry: That I don't know myself. I can't tell you because I don't remember.

  R: Well, do you think it's days, or weeks, months, years?

  H: Well, see, I can't put it exactly on a day, week, or month, or year basis.

  R: But do you think it's been more than a year that you've had this problem?

  H: Well, I think it's about that. About a year. Or more. Because I believe I had an ... this is just a thought that I'm having myself, well, I possibly have had an operation or something.

  R: Uh-huh. Tell me about that.

  H: And uh, I remember, I don't remember just where it was done, in, uh...

  R: Do you remember your doctor's name?

  H: No, I don't.

  R: Does the name Dr. Scoville sound familiar?

  H: Yes! That does.

  R: Tell me about Dr. Scoville.

  H: Well, he, he would, he did some traveling around. He did, well, medical research on people. All kinds of people. In Europe, too! And the wealthy. And out on the movie stars, too.

  R: That's right. Did you ever meet him?

  H: Yes, I think I did. Several times...

  R: Was it in the hospital?

  H: No, the first time I met him was in his office. Before I went to a hospital. And there, well ... well, what he learned about me helped others, too. And I'm glad about that.

  My grandfather's home was full of curious artifacts, each with its own story. He traveled a lot, all over the world, and always came home with something new and strange. It was a lifelong occupation: in the mid-1920s, he took what was in those days a very unusual trip to China and ended up paying some of his college tuition by selling the exotic jewelry he brought back to the States. Many of the items in his home looked as if they belonged in a cabinet of curiosities. There was a carved wooden totem hanging on one wall of his dining room, some sort of pagan king or god. It was maybe three feet tall and had a soulful, mournful expression. One Thanksgiving, when I asked where it came from, I was told he'd received it during a trip to South America, perhaps in gratitude for some operation he'd performed there. The carving had apparently once been an object of worship, owing mainly to the fact that it would, at times unpredictable, weep, drops of water streaming from its eyes. Did seasonal moisture variations and the way the wood responded to them cause the tears? Probably. That or magic. My grandfather had appreciated the totem's beauty but was unsentimental about its emotions. When he brought it home, he had someone polish it before he hung it on the wall. It never cried again.

  Brain surgery is an ancient craft—there is a four-thousand-year-old hieroglyphic text describing successful operations—and among my grandfather's most interesting artifacts was a collection of premodern and tribal neurosurgical instruments. As a kid, I found those picks and blades fascinating and terrible to contemplate. It wasn't just the age of the tools, it was the acts they were intended for. Brain surgery, whatever the era, always requires at least two frightening qualities in its practitioners: the will to make forcible entry into another's skull and the hubris to believe you can fix the problems inside.

  He was always a risk taker. During medical school he'd climbed, on a dare, one of the suspension cables of the still-under-construction George Washington Bridge and had spent the night shivering in a crate up top, waiting for the dawn. Once, while attending a neurosurgical conference in Spain, he visited a small bullring where toreadors were practicing their craft, threw off his jacket, and stepped into the ring himself. He loved cars, loved driving them as fast as they'd go. He loved tinkering with them, too. He always told people he'd have been a mechanic if he hadn't become a brain surgeon.

  In 1939, a year after he completed a residency at Mass General, he cofounded the Department of Neurosurgery at Hartford Hospital. It was an interesting time for an ambitious young doctor to be entering his particular field, since a new kind of brain operation was on the verge of becoming a worldwide sensation. The operation had originated in Europe, pioneered by Egas Muniz, a Portuguese surgeon, who would go on to win a Nobel Prize for his efforts. Dr. Muniz called his operation leukotomy, but in the United States it came to be known by another name: lobotomy. The operation was crude—the surgeon would drive a skinny ice pick up through the thin bone behind his patient's eyeballs, then quickly swish the pick back and forth, cutting a messy swath through the frontal lobes—but it was inarguably effective at transforming otherwise difficult and uncontrollable individuals into placid, carefree creatures.

  My grandfather had no problem with the basic idea of treating psychiatric problems through brain surgery. He believed that psychosurgical procedures might eventually, as he once wrote, relegate "psychoanalysis to that scientific limbo where perhaps it belongs." But he didn't like the lobotomy. It was too blunt, too imprecise, knocked everything out, the good with the bad. It makes people "easy to control and easy to handle," he said, "but, God forbid, at what a cost!" There had to be a better way. Some way to achieve the lobotomy's beneficial effects—the calming, the reduction in anxiety—without the lobotomy's attendant insidious, zom-bielike stupor.

  So he tinkered. He began experimenting, at asylums in and around Hartford, with procedures he called "fractional lobotomies," attempting to target only the specific brain structures he believed were implicated in a particular patient's problems. Soon he was reporting a "most gratifying improvement in depressions, psycho-neuroses and tension states without any gross blunting of personality." And he mused about possible future advances and refinements to his approach, wondering whether his experiments in targeted brain lesioning might "bring us one blind step nearer" to the locations of the "fundamental mechanisms of mental disease and of epilepsy."

  Around this time, Henry showed up in his office for a consultation.

  When Henry Molaison is seven, a bicyclist collides with him, knocking him out cold for five minutes, leaving him with a deep gash in the left side of his forehead.

  After that, the seizures begin.

  They are minor at first but gradually increase in severity. At the age of sixteen, he experiences the first seizure of the type that used to be called grand mal and is now called tonic-clonic. He attends Windham High School in Willimantic, Connecticut, is smart, sharper than most. But the other students—watching him seize up ten or more times a day—tease him without mercy. Henry drops out of high school for a while but eventually goes back, struggles his way through to a diploma.

  The seizures keep getting worse. He is in his early twenties, foggy-headed, living at home with his parents, no social life, barely holding down a job as a motor winder, when he has his first appointment with my grandfather.

  My grandfather prescribes him Dilantin, phenobarbital, Tridione, Mesantoin, the best anticonvulsants of the day, in maximal doses. They don't work.

  Henry's epilepsy is severe, horrible, intractable.

  My grandfather suggests they try something else. Henry and his parents agree.

  They are willing to try anything.

  August 25, 1953. Henry lies on his back on an operating table in the Hartford Hospital neurosurgery suite. At the head of the table, flanked by scrub nurses and assistants, my grandfather leans over Henry with a trepan in his hand. Henry has been sedated and given a local anesthetic, and the flesh has been peeled down from his forehead, but he is conscious. A trepan is a sort of wide-mouthed serrated drill. The particular trepan he's using, like a lot of his surgical instruments, and like the operation itself, is of his own invention. To make this trepan, he bought a hole saw from a local autosupply or machine shop for about a dollar, then attached it to a standard Hudson drill handle, the kind you crank by hand. Now he places the trepan down on Henry's exposed skull, just above one of his eye sockets, and bears down. It grinds through, extracting a button of bone roughly the size of a poker chip. He moves the trepan over a few inches, to the same spot above the other eye socket, and repeats the proc
ess. Scrub nurses flush the holes, exposing Henry's pale frontal lobes to the harsh light of my grandfather's headlamp. He puts the trepan aside, picks up a slightly curved metal retractor, inserts it into one of the holes, then levers Henry's frontal lobe up and out of the way, so he can reach the hidden structures deeper in the recesses of Henry's brain.

  Once he finds what he's looking for, the sea horse–shaped hippocampus and its adjacent organs—the hook-shaped uncus, the almond-shaped amygdala—he proceeds with the extraction. He has performed variations of this operation on a number of asylum residents but never on an epileptic. Still, he knows that the hippocampus—an organ whose precise function is a mystery to him, as it is to everyone else in 1953—has been implicated in some forms of epilepsy, and other surgeons have had success reducing seizures by removing one half of it, performing a so-called unilateral resection. With Henry, however, he decides to see what happens if he takes out both sides, not just one. He uses an electric cautery to cut the tissue and a skinny vacuum to suck it out, leaving behind just a negligible stump. Then he repeats the procedure on the other side. In all, taking both hemispheres into account, he removes several tablespoons of neuronal tissue.

  Before he plugs the holes, he uses another tool to snap a few tiny metal clips onto the frayed far frontier of the fresh lesion. The operation is, as he will later write, a "frankly experimental" one, and these clips, visible in X-rays, will help him document its parameters.

  Researcher: Do you know what you did yesterday?

  Henry: No, I don't.

  R: How about this morning?

  H: I don't even remember that.

  R: Could you tell me what you had for lunch today?

  H: I don't know, to tell you the truth.

  April 25, 1955, the night train from Montreal to Hartford. Brenda Milner, a young Cambridge-educated neuroscientist from McGill University, tries to sleep in the hurtling darkness. She's on her way to investigate a curious case of amnesia. Over the last year or so, she's begun to explore the mystery of how memory works. She knows that the scientific consensus is that memory is a diffuse phenomenon, one that can't be tracked to any particular part of the brain, but she's noticed that people with damage to their hippocampus sometimes have a particularly hard time remembering things. She has a hunch that the hippocampus plays some role in memory formation, and the patient she's going to see now will allow her to explore this hunch as never before: his hippocampus isn'tjust damaged, it's gone. From what she's been told, a surgeon, in a novel procedure, essentially removed it.

  The next morning, in my grandfather's office, Milner meets Henry for the first time. He's a good-looking kid with hazel eyes, cordial, polite, quick with a joke, easygoing. They chat for a little while, and it strikes her that you might never know, after just a short conversation, that there was anything wrong with him. And then Milner steps out of the office for a cup of coffee, comes back a few minutes later, and meets Henry for the first time all over again.

  Later my grandfather explains to Milner about the thirty or so other patients who've received variations of the operation he performed on Henry. These "severely deteriorated cases" were mostly schizophrenics and are scattered at various asylums around the state. He hasn't done much follow-up work on them and isn't sure if they've suffered the same sorts of memory deficits as Henry. He arranges a car and driver for Milner, so she can visit some of them. For the next few days, she descends into the back wards of one state institution after another. She has never been to an asylum before. She takes careful notes.

  Patient A. Z.: "35-year-old woman, a paranoid schizophrenic ... tense, assaultative, and sexually preoccupied..."

  Patient I. S.: "54-year-old woman ... auditory hallucinations and marked emotional lability..."

  Patient A. L.: "31-year-old schizophrenic man ... auditory and visual hallucinations..."

  Patient M. B.: "55-year-old manic depressive woman ... anxious, irritable, argumentative, and restless..."

  And on and on, quick sketches of profound damage. Many of these cases interest Milner—particularly Patient D. C., a brilliant and psychotic medical doctor who attempted to kill his wife—but she returns from her asylum odyssey convinced of Henry's singular importance. Though some of the asylum patients clearly suffer from a similar amnesia to Henry's, Henry uniquely combines a near-complete resection of both hemispheres of the hippocampus with a mind not otherwise muddied by mental illness. The only other patient who received an operation identical to Henry's—a "radical bilateral medial temporal lobe excision (with the posterior limit of removal 8 cm from the temporal tips)"—is so deeply disturbed that nobody even noticed her inability to create new memories until nearly a year after her surgery.

  Henry is the one.

  The testing begins.

  In 1848 an explosion drives a steel tamping bar through the skull of a twenty-five-year-old railroad foreman named Phineas Gage, obliterating a portion of his frontal lobes. He recovers and seems to possess all his earlier faculties, with one exception: the formerly mild-mannered Gage is now something of a hellion, an impulsive shit-starter. Ipso facto, the frontal lobes must play some function in regulating and restraining our more animalistic instincts.

  In 1861 a French neurosurgeon named Pierre-Paul Broca announces that he has found the root of speech articulation in the brain. He bases his discovery on a patient of his, a man with damage to the left hemisphere of his inferior frontal lobe. The man comes to be known as Monsieur Tan, because, though he can understand what people say, "tan" is the only syllable he is capable of pronouncing.

  Thirteen years later, Carl Wernicke, a German neurologist, describes a patient with damage to his posterior left temporal lobe, a man who speaks fluently but completely nonsensically, unable to form a logical sentence or understand the sentences of others. If Broca's area, as the damaged part of Monsieur Tan's brain came to be known, is responsible for speech articulation, then Wernicke's area must be responsible for language comprehension.

  And so it goes. The broken illuminate the unbroken.

  There is a word neuroscientists use to describe Henry. They call him pure. The purity in question doesn't have anything to do with morals or hygiene. It is entirely anatomical. My grandfather's resection produced a living, breathing test subject, Patient H. M., who will allow scientists to study how memory works with, as Brenda Milner will write, "the exactness of a planned experiment." And it is unlikely that a patient like Henry could arise without the willful act of a surgical procedure. Another scientist who later studies Henry discounts the possibility, for example, that a soldier might wind up with a brain similar to Henry's by being shot in the head: "To get a pure one would be rare. Because think about what it would take to blow out both hippocampi. You'd be dead. I think it would be most compatible with not being alive."

  Henry is the purest, and his purity makes him valuable.

  Shortly after Milner's first visit with Henry, she and my grandfather begin coauthoring a paper, "Loss of Recent Memory After Bilateral Hippocampal Lesions," which appears in 1957 in the Journal of Neurology, Neurosurgery and Psychiatry. The paper, which formally introduces the scientific world to Patient H. M., reaches a deceptively straightforward conclusion: since my grandfather removed Henry's hippocampus and Henry no longer seems capable of creating new memories, the hippocampus must play an essential role in creating new memories.

  That paper—which for the first time convincingly localizes memory function to a specific part of the brain—becomes the founding text of modern memory science.

  But Milner continues riding the night train down to Hartford, spending days at a time with Henry. Her initial focus is on probing the depths of his memory dysfunction, the way experiences seem to slip away from him, leaving no trace. Then she begins investigating whether there are any experiences at all that he can remember.

  One afternoon she sits Henry down at a desk and puts a piece of paper in front of him. The paper has a large drawing of a five-pointed star on it. There i
s a mirror angled at the star and a curtain over the paper so that Henry can no longer see the star directly but can see only its reflection in the mirror. She asks him to trace the star. It's a hard task for anyone, with any sort of brain, though after a while, with practice, people with normal brains tend to improve their results, mastering the necessary counterintuitive muscle movements. The first time Henry tries it, he performs poorly. But the funny thing is, the next time he tries, he does it a little better. And the next time better still. With each new attempt, he never remembers ever having attempted it before, but soon he's completing the task as well as anyone. Even Henry recognizes the strangeness of this.

  "I thought this would be difficult," he says to Milner after tracing the star almost perfectly, "but I seem to have done this well."

  In 1962 Milner publishes her account of the star-tracing experiment. That article arrives at another simple but revolutionary conclusion: since Henry is incapable of consciously remembering the events he's living through but seems to be able to unconsciously remember how to perform certain physical tasks, the human mind must contain at least two separate and independent memory systems. The world of memory science is upended again.

  Less than a decade after his surgery, the study of Henry's incomplete brain has already spawned the century's two pivotal insights into how memory works. Milner has revealed him to be a sort of human Rosetta stone, an incarnate key to ancient mysteries.