But the damage was already done.
During that first concussive impact and its immediate aftermath, as Henry’s brain twisted and compressed and rebounded, various things happened. Some of these things were physical and easy to understand. Neurons and glial cells—the stuff our brains are made of—were torn and ruptured. Other things that happened inside Henry’s brain, in that violent moment, were chemical and electrical and harder to explain. For reasons that are still poorly understood, when a brain experiences a combination of torsional forces and blunt-force impact, like Henry’s brain experienced, local clusters of neurons open up their floodgates in lockstep synchrony. Bursts of electricity surge down axons—the slender filaments that stretch out from each neuron—and trigger the release of neurotransmitters at their tips. These neurotransmitters bridge the synapses between the ends of the axons and the waiting dendrites of other nearby neurons, causing those neurons to trigger their own bursts of electricity. Eventually, the growing tsunami of neurotransmitters creates an overwhelming surge of brain activity. Whatever sensations and thoughts were inhabiting Henry’s brain prior to this moment—the fear, the pain, the confusion—were wiped out by this burst of activity. Which means that, much like a power surge knocks out a computer, it knocked Henry out.
For five minutes, nothing. Henry’s brain carried on with its usual autonomic, life-regulating tasks, but wherever his consciousness resided was temporarily shut down.
Then, slowly, he came back online.
He opened his eyes. The world came flooding in again, the bustle and noise of downtown Hartford, the voices of a gathering crowd, the pain from the gash in his forehead, the sticky warmth of the blood flowing down his face: The steady march of experience and sensation resumed.
He was back, but he was not the same.
—
The next day was the Fourth of July, and Henry went to a picnic with his family. It was perfect weather for it: warm, no rain. His forehead had been stitched up, and there was a bandage above his left eye. People joked with him about it, asking if he’d been playing with firecrackers.
“You must have been up early and got at it,” somebody said.
Henry laughed.
He seemed fine.
He felt fine.
Soon, though, the seizures began.
While the exact origins of Henry’s epilepsy can never be known for sure, many scientists believe that it was related to his fall. It could have been the direct physical damage: When brain injuries heal, the scars left behind have a tendency to become epileptogenic, meaning they can generate epileptic seizures. There’s also a theory known as the kindling effect, which holds that the sort of short-circuiting Henry’s brain underwent leaves a new circuit in its wake, a dangerously convulsive circuit, one that grows more active over time, kindling a fiercer and fiercer blaze.
The seizures were minor at first. Little instants of inattention. Dazed moments, small absences.
Still, the seed had been planted, and Henry’s transformation into Patient H.M., the most studied individual in the history of neuroscience, had begun.
—
That’s his real name: Henry.
I can even give it to you complete: Henry Gustave Molaison.
There was a time I couldn’t. It was a secret.
For almost six decades, the scientists who studied Henry kept his name hidden away. When they wrote about him they were always careful not to reveal too much, for fear that outsiders might find him, and they were successful. There wasn’t a single paper, out of the hundreds that chronicled in great detail the experiments performed on Henry during the fifty-five years between his operation and his death, that contained anything but the vaguest biographical information about Henry himself.
If you happened to read a lot of these papers, you could have pieced together a fragmentary portrait: One might have mentioned that he had relatives in Louisiana. Another that he was born in 1926. A third that his father’s name was Gustave. A fourth that he was an only child.
And so on.
But most of his story, starting with that most basic fact of his name, was a tightly guarded mystery to the outside world.
—
Henry Gustave Molaison was born in Manchester, Connecticut, on February 26, 1926.
Two twenty-six, twenty-six.
“ ’Least it’s easy enough to remember,” he often told the scientists with a smile.
They prodded him for his birth date over and over, sometimes five, six, seven times during a single session, and though he never remembered the previous time they’d asked him, the correct answer always came tumbling out intact: two twenty-six, twenty-six.
Other questions had less consistent answers.
“Henry,” a scientist asked him one afternoon, about fifteen years after the experiments began, “could you once more describe a little your earliest memory, very early in your life, when you were very small, the very first thing?”
“Well, gee,” Henry said. “There is a jumble right there.”
He paused. He was sitting in a laboratory at the Massachusetts Institute of Technology, though he didn’t know that, and when the scientists had earlier asked where he thought he was, he guessed that he might be in Canada.
“Sort of,” he continued, “to pinpoint, put them right down in a…”
Henry paused again. He was smoking a cigarette.
“Find the one that comes before or after,” he said. He had a soft, gentle voice with a thick New England accent. You could almost hear the thoughts whirring inside as he reached back, deep into his childhood. That time, his earliest memory was of a place. A little blue house the Molaison family once lived in.
Another time, during the same session, responding to the same question, he described a person.
“I can think of my grandfather,” he said. “Walking with him. I was very, very small. I think of, uh, well, right off I thought of a tall man, but he isn’t, wasn’t, tall. Medium-size. Not heavy-built. I always think of him in a gray suit….He looked entirely different than my father did, of course….He was, uh, I think of about five-eight.”
“Your father?” the scientist asked.
“Grand,” Henry corrected. “Grandfather. Because my father was almost exactly six foot, just had, oh, a quarter part of an inch or so to go, and he’d be six foot.”
“How tall are you?” the scientist asked.
“I think of six-two right off.”
“Pretty tall,” the scientist said.
“Yes, I know I’m taller than my father,” Henry said.
“Is your father still alive?” the scientist asked.
Henry thought about the question for a few moments before answering. “There I have an argument with myself. Right off, I think that he is. And then I have the argument, of course, that I think that he has been called.”
“You’re not sure?” the scientist said.
“I’m not sure,” Henry said. “Can’t put my finger, well, definitely on it.” He paused again before continuing. “He is and he isn’t.”
The scientist made a note of this—Henry’s father had died three years before—and then asked once again for his earliest memory.
“Now, Henry, I want you to go back as far as you can, and I want you to try to tell me what you think is your very first, earliest childhood memory, the memory which you think comes before any other.”
“Well, I can go back to, uh, taking a sleigh ride for the first time….”
He described being on Spruce Street, in Manchester, Connecticut, midwinter. He remembered the sleigh being pulled by a single horse. He thought the sleigh and horse belonged to the father of playmates of his, two brothers, Frankie and Jimmie. As he told the story, he picked up the pace, added more details, lost himself in the memory. The horse was on its way to a stable to be reshod. Frankie and Jimmie and Henry were nestled warmly in the back. Some other local kids, seeing them go by, threw snowballs, but the walls of the sleigh kept them safe.
Henry chuckled.
“It was good,” he said. “I liked that.”
The scientist nodded.
“You remember things from before the operation quite well, don’t you?”
Later, when a graduate student transcribed the tape of this session, she noted in parentheses that Henry’s response to this last question arrived in a hushed voice, and that he was almost in tears.
“Yes,” Henry whispered. “Before that, yes. I do remember.”
TWO
CRUMPLED LEAD AND RIPPLED COPPER
I remember midway through one Christmas dinner, when I was about eight, my grandfather pushing himself up from his chair at the head of the table, wandering off to his study, and returning a few minutes later with something in his hand. He placed the object beside his plate: It was a crumpled wad of dark metal, not much bigger than a pencil eraser. I looked at it, wondering what it was. Then he sat back down and told us a story.
Stamford, Connecticut, turn of the century. A burglar broke into the home of a young bachelor, and the bachelor woke up. He reached for the pistol he kept in his nightstand, aimed it at the intruder, but the pistol jammed. The burglar’s didn’t. A bullet entered the bachelor’s chest, where it encountered a rib, deflecting it away from his heart. The bachelor survived and kept the bullet as a memento. He eventually passed it down to his son, my grandfather.
The bullet sat there for the rest of the dinner, and I found it both fascinating and terrible to contemplate. Had it found its target, had its aim been true, then my grandfather, his children, his children’s children, most of the people sitting around the table, would have never existed. It was a matter of centimeters—a fluke of aim, bone, ballistics—and it had made all the difference, its repercussions rippling down through generations.
There were other artifacts in my grandfather’s home, many equally fascinating—like the bleached human skull that sat on a shelf in his study—and some equally terrible. Each had its own story.
A carved wooden totem hung on one wall of the dining room, a representation of some sort of pagan king or god. It was maybe three feet tall, with a mournful look on its face. He’d received it during a trip to South America, an expression of gratitude for an operation he’d performed. The carving had apparently once been an object of worship, owing mainly to the fact that it would sometimes cry, drops of water trickling from the corners of 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 shellac it before he hung it on the wall. It never cried again.
Hanging on a wall near the front door was something that at first glance looked like another piece of tribal art. It was made of metal, had a green patina, was about eight inches tall. Its top and bottom both had similar half-moon shapes, though the top had a face carved into it, and the bottom, which was sharpened to a razor’s edge, did not. It was part of my grandfather’s collection of ancient Inca neurosurgical instruments. The top was a handle, the bottom a blade. It used to mesmerize me. It wasn’t just its age, it was its purpose. Somewhere, hundreds of years in the past and thousands of miles to the south, in a time and place incredibly far from my grandfather’s warm New England home, this relic had been used to do the same sort of work he did. I would imagine that half-moon sweep of metal slicing through flesh, exposing the bone beneath, then cutting even deeper. I used to wonder if it was still flecked with old blood.
Neurosurgery, whatever the era, always requires at least two frightening qualities in its practitioners: the will to make forcible entry into another human’s brain, and the hubris to believe you can fix the problems inside.
—
The early history of neurosurgery is written in skulls, not words.
Hundreds of skulls, thousands of skulls, all over the world. In Europe, Africa, South America, Asia. Skulls from different races, different societies, different millennia. All these different skulls, all telling variants of the same story.
The skulls have holes in them. Man-made holes. More than ten thousand years ago, people began cutting holes into the skulls of other people.
Medical historians have noted that ancient Inca skulls in Peru, when they had holes in them, almost always had those holes on the upper left side, the so-called left frontoparietal area. The Incans were a martial culture, fought hard at close quarters with maces and clubs. They were also, like modern humans, predominantly right-handed. When a right-handed man swings a club at the head of an adversary, it tends to land on the left frontoparietal area. So, the theory goes, these surgical holes in the Inca skulls were probably part of the treatment for head wounds they’d received in battle. Perhaps they were made to relieve intracranial pressure or were cut around smaller, brute-force holes and cracks made by the impact of the weapons to better reach and remove the bony shrapnel inside.
In other parts of the world—more specifically, in a trove of skulls discovered at a seven-thousand-year-old grave site in Ensisheim, France—the holes seemed to be evenly divided between the left and the right sides of the head. This was taken as evidence that not all the skull openings had been made to treat war wounds. But if not, then what were they for? To release evil spirits? To cure headaches? To accelerate enlightenment? Nobody knows for sure.
One thing we do know: Having a hole cut in your skull, even seven thousand years ago, didn’t necessarily kill you. A close examination of the edges of the holes in those ancient skulls revealed that in most of them, stretching inward from the serrated or punched or smooth edge where surgeons made their marks, new bone had grown, the beginning of an attempt by the skull to reseal itself. The bones in our heads grow slowly, and stop growing as soon as we die. Which means that the owners of those skulls, with their indications of postoperative growth, had survived their surgeries.
In some skulls, in some cultures, the holes weren’t so much cut as they were scraped away by surgeons wielding tools more like Brillo pads or sanders than scalpels or drills. Paul Broca, a pioneering French nineteenth-century neuroanatomist, was fascinated by these scraped skulls. He noted that they predated anesthesia—which originated in its crudest form around 400 B.C.E., when Assyrian surgeons would induce unconsciousness by compressing the carotid arteries of their patients—by at least 3,500 years, and speculated that the surgeries must have been performed when the patients were young children, because a child’s thinner skull wouldn’t take so agonizingly long to rub through. To prove his point, Broca obtained a number of corpses of all ages and demonstrated that while it took him almost an hour to rub through the skull of an adult, he could do the same to a two-year-old child’s in less than five minutes. Others took exception to Broca’s theory, noting that although dying from these operations was evidently rare—see again: the evidence of postoperative bone growth—it did sometimes happen, and if ancient brain surgeons had been scraping holes in ancient infants, you would expect to find at least a few ancient infant skulls with holes in them, victims of unsuccessful operations. No such skulls had been found.
These sorts of debates will go on and on. People continue to study these silent skulls, trying to read the stories their preliterate former owners couldn’t document.
Eventually, of course, humans did gain the ability to record their own lives. We began to write. And among the first things we wrote about?
Brain injuries and how to treat them.
—
In 1862, an American collector of antiquities named Edwin Smith bought a scroll of papyrus from a dealer in Luxor, Egypt. The papyrus was fifteen feet long, and an unknown ancient had used a reed brush and inks derived from clay and burnt oils to cover it in a thicket of hieratic script. Hieratic was the less formal and ornate descendant of the Egyptian hieroglyphs, their version of shorthand. For almost all of the thousand years prior to Smith’s purchase, both forms of writing—hieroglyphs and hieratic—had been relics of a de
ad language, unused and untranslatable. The Egyptians themselves debated whether the two scripts even represented a language at all or whether their ancestors had just enjoyed covering scrolls and tombs with meaningless decorative symbols. In one often-repeated tale, an Italian merchant visiting the Giza pyramids in the 1700s was offered a wooden chest containing forty ancient papyrus rolls. He purchased only one of them, and the villagers supposedly “burned the rest in order to enjoy the smell they gave off.”
But by 1862, things had changed. The 1822 translation of the Rosetta Stone—which contains versions of the same text in hieroglyphs, hieratic, and Greek—provided sudden access to an entire epoch of the ancient world that had been previously sealed off. For people interested in history, or in profiting from it, this was the equivalent of the gold rush: Egypt swarmed with tomb raiders and treasure hunters, such as Edwin Smith, who gathered up as many of these formerly inscrutable documents as they could.
Smith took the scroll home to Connecticut and spent much of the rest of his life trying to make sense of it. Even the best linguist might spend years translating a single passage of hieratic. Edwin Smith was not the best linguist. He’d obtained an objectively beautiful piece of writing—the papyrus was incredibly well preserved, and its ink changed intriguingly from a deep black to, for certain words and lines, a crimson made out of ground ochre—but it refused to give up its secrets. When Smith died in 1906, his daughter donated the scroll to the New-York Historical Society, where it was found by James Henry Breasted, a professor of Egyptology at the University of Chicago.
Patient H.M. Page 2