Doctor's Review: Medicine on the Move

October 1, 2014
Bookmark and Share

Forever young

Neurology’s most noteworthy patient “died” when he was 27 though he would go on to live another 55 years

Just over a year ago, an 82-year-old man named Henry Gustav Molaison died of respiratory failure at a nursing home in Hartford, CT. To a casual observer, he might have been any sweet, senile old chap suffering from dementia. Indeed he was, but he was also so much more.

Arguably the most famous case study in the history of neuroscience, psychiatry and psychology, the mind of H.M. — as he was known in both literature and the press — provided researchers with a rare glimpse into the formation and functioning of memory. The series of tragedies H.M. experienced, at the hands of both fate and his well-intentioned physicians, opened up the mysteries of the human mind and lay them out for the entire world to see.

A bicycle’s path

Henry Molaison was born near Hartford, CT, on February 26, 1926. In a sense, he died 27 years later on September 1, 1953 though he would go on to live another 55 years. When Henry was nine, he was playing outside near his home when he was hit hard by a child riding a bike. He fell down and knocked his head on the pavement. He regained consciousness after about five minutes, apparently fine, but he would never be the same again.

The seizures started soon after. At first, they were mild and infrequent, but they gradually increased in intensity and duration. The day he turned 16, Henry experienced his first grand-mal. It was the beginning of the end. By 27, his epilepsy was so severe that he couldn’t function. Most attributed his condition to the bike accident, though epilepsy did run in his father’s family; in fact, three of Henry’s first cousins suffered from the disease.

At the time, Henry was experiencing major seizures and blackouts once or twice a day, and his drugs were barely taking the edge off. His parents brought him to see a neurosurgeon at Hartford Hospital, Dr William Beecher Scoville. Dr Scoville believed he knew exactly where Henry’s seizures were originating and an experimental brain surgery, it was agreed, was his only chance for a normal life.

In the burgeoning field of neurosurgery, it was the best of times and worst of times. Huge advances were being made — Wilder Penfield was blazing a trail in brain mapping and epilepsy research at McGill — but not all psychosurgery patients made it through their procedures unscathed. On September 1, 1953, Dr Scoville performed a highly experimental bilateral medial temporal-lobe resection on his patient. When Henry awoke, his amygdala, entorhinal cortex, perirhinal cortex and two thirds of his hippocampus were gone… as was his ability to form new memories. He was about to become the most famous amnesiac in the annals of medicine.

Good news, bad news

The only good news was that Henry’s epilepsy was all but cured; he would experience just one or two seizures a year from that point on. But it was immediately apparent that he was left with debilitating memory loss, too. Henry’s profound anterograde amnesia meant he could no longer commit new events to long-term memory, unable to hold on to anything for more than a minute or two. He was also suffering from partial retrograde amnesia: the two years before the surgery were gone forever as was much of the decade leading up to it. His life as he knew it was over.

A panicky Dr Scoville looked north to Dr Penfield for advice. The professor sent one of his graduate students, neuropsychologist Dr Brenda Milner of the Montreal Neurological Institute, to assess the situation. Their meeting turned into a life-long collaboration between the researcher and patient, and quite literally revolutionized the field of memory research. Prior to Dr Milner’s investigations, scientists had been largely unable to physically account for the process of memory or pinpoint the neurological structures responsible for it, and so believed it to be a philosophical or psychoanalytical issue rather than one with its roots in cold, hard anatomy.

Dr Milner and Dr Scoville researched what happened and published a paper on the subject in 1957 in the Journal of Neurology, Neurosurgery and Psychiatry. In addition to H.M.’s case, they examined the effects of similar surgeries Dr Scoville had performed. Nine cases were explored; all experienced some degree of memory loss, though none so grave as H.M.’s.

H.M.’s condition, Milner found, was most likely as severe as amnesia can get. Upon awaking from surgery, he would never again recognize a new face or find his way through unfamiliar territory. For him, Harry Truman would be president forever and he would be endlessly shocked to learn that his father had died. Amazingly, Henry’s character remained intact and he was regarded as a pleasant fellow who enjoyed socializing with his caregivers. Indeed, he met with Dr Milner countless times over the course of their 30-year friendship and each day it was as if he was meeting her for the first time.

Forgetful fate

As for Henry, he did have an idea something was wrong. When asked how he was feeling, he once replied: “Right now, I’m wondering, have I done or said anything amiss? You see, at this moment everything looks clear to me, but what happened just before? That’s what worries me. It’s like waking from a dream. I just don’t remember.” Sadly, the nightmare would never end. He would remain forever trapped between childhood memories and contemporary confusion.

When his mother could no longer care for him after his dad passed away, they moved in with family, but eventually, he ended up at a nursing home. In a testament to his character, he was always a willing participant in the endless studies in which he was involved. His linguistic skills, grammar and most of his speech remained unaffected. He enjoyed crossword puzzles, TV shows (particularly All in the Family), always laughed at a good joke and even retained his above-average IQ of 118. Interestingly, H.M.’s procedural memory was undamaged — he could be taught new motor skills, though he would have no memory of the lessons themselves.

The tragic loss H.M. lived with every day was not lost on those who researched his case and cared for him. An ageing Henry was continually surprised by the old man staring him back in the mirror; he thought he was in his early twenties. Out of kindness, they kept him away from mirrors and fibbed if he inquired as to the whereabouts of loved ones long since gone.

A beautiful mind

In death, as in life, the mind behind the man has proved to be equally fascinating. Immediately after he passed away on December 2, 2008, H.M.’s brain was removed and transported to the Brain Observatory at the University of California, San Diego, for a groundbreaking anatomical study. Over the course of 53 hours, his brain was first frozen, then 2401 histological sections sliced a mere 70 microns thick were stained, digitized and uploaded in real time onto the Web as 400,000 curious onlookers from both lay and scientific communities waited with baited breath. To date, millions have logged on to the website (http://thebrainobservatory.ucsd.edu/index.php) to take a peak at what the mysterious mind of H.M. might yet reveal.

The role he played in teaching the scientific community how memories are formed cannot be overstated and it is with great respect that H.M. is remembered. Through the losses he suffered, scientists were able to conclusively determine much of the exact nature and structure of memory function, encoding and retrieval, as well as accomplish huge leaps forward in general neuropathology. Henry Molaison’s obituary, which appeared in The New York Times on December 3, 2008, perhaps stated it best when they lauded H.M. as an “unforgettable amnesiac.”

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

Comments

Post a comment