Permanent Present Tense

by Suzanne Corkin

  In the 1920s, Otfrid Foerster in Breslau, Germany, operated on patients who had brain tumors or epilepsy resulting from head injuries sustained in World War I. Foerster conducted these operations under local anesthesia, using electrical stimulation to reproduce the patients’ seizures and then extirpating the offending brain area to achieve seizure control.

  Foerster was mentor to Wilder Penfield, founder and head of the Montreal Neurological Institute. After a six-month visit to Foerster’s hospital in 1928, Penfield returned to Montreal to expand his studies of cortical stimulation and mapping, allowing him to pinpoint and remove his patients’ epileptic focus. Starting in 1939, he developed a surgical procedure, temporal lobectomy—removal of part of the left or right temporal lobe—which has since been used extensively to control seizures originating in that part of the brain.5

  An important breakthrough at the Montreal Neurological Institute in the 1950s would profoundly affect Henry Molaison. Penfield and his colleague Herbert Jasper, a neurophysiologist, reviewed evidence from the surgical cases in which Penfield had carried out stimulation studies and from stimulation experiments in animals. They concluded that temporal-lobe seizures originated in the amygdala and hippocampus, structures deep in the temporal lobe. From then on, a standard left or right temporal lobectomy at Penfield’s institute included the amygdala and part of the hippocampus. Henry’s neurosurgeon, William Beecher Scoville, knew of Penfield’s good results after removal of the amygdala and hippocampus, and would cite that evidence as justification for Henry’s operation.

  We now know that all epileptic seizures are behavioral manifestations of excessive electrical activity in the brain. Researchers first came to understand this signature of epilepsy from Hans Berger’s momentous technical advance in the late 1920s. Berger, a German psychiatrist, dedicated his career to developing a model of brain function, the interaction between the mind and the brain. After disappointing efforts to link blood flow and temperature with behavior, he turned his attention to the electrical activity of the brain. In his early experiments, he inserted wires under a patient’s scalp and made the first recordings of electrical activity from the human brain. Berger christened his new method the electroencephalogram (EEG), and with it identified different kinds of brain rhythms, some fast and some slow. After a series of technical improvements, including the introduction of noninvasive scalp electrodes, Berger succeeded in recording abnormal electrical activity in several brain disorders, including epilepsy, dementia, and brain tumors. This new window on the human brain changed the practice of neurology, giving researchers clues to the brain’s underlying biology.6

  Word of Berger’s remarkable discovery reached Harvard Medical School in 1934, where it inspired a research project to study the brain’s electrical activity in epileptic patients. In 1935, technician and MIT graduate Albert Grass built three EEG machines, thereby founding the pioneering Grass Instrument Company. Grass, in collaboration with neurologists William Gordon Lennox and Frederic Gibbs, recorded EEGs on paper from individuals with petit mal epilepsy. The recordings showed a characteristic pattern of brainwaves in these subjects, and later studies in other patients with grand mal seizures revealed a different distinctive pattern.

  The amazing new tool, EEG, allowed doctors to identify the nature of the seizure and its location in the brain, a major advance in diagnosis and treatment. In the early days of epilepsy surgery, surgeons relied on patients’ seizure patterns to identify the brain area where the seizures originated, and then removed the dysfunctional tissue. Sometimes, however, when surgeons exposed the brain in the operating room, the area in question turned out to be normal and no tissue was removed. EEG greatly improved the preoperative evaluation of epilepsy patients and also provided a means of monitoring electrical activity during operations. In the late 1930s and 40s, Herbert Jasper’s laboratory devised methods to record EEG patterns and to localize seizure activity during the operation from a patient’s cortex and deeper structures. Scoville and his colleagues used similar physiological recording methods during Henry’s operation in an attempt to find the origin of his seizures, but to no avail. The availability of EEG machines to record seizure activity laid the groundwork for treatment with antiepileptic drugs, designed to correct the brain dysfunction evident in the EEG tracing and to prevent seizures from occurring. The use of drugs to treat epilepsy dates back at least to the fourth century BC, when practitioners administered a variety of ludicrous remedies. These treatments, some based on magical beliefs and others on observation, included camel’s hair, seal’s bile and stomach lining, crocodile feces, hare heart and genitals, sea-tortoise blood, and amulets made from such items as peony root. Although now considered superstitious, these remedies were said to be effective in many cases. The introduction of experimentally based anticonvulsant therapy came with the appearance of the drugs Luminal (phenobarbital) in 1912 and Dilantin (phenytoin) in 1938. In most patients, these drugs controlled seizures effectively, and became the backbone of epilepsy treatment. By Henry’s time, several other anticonvulsant medications had been added to the pharmaceutical armamentarium. These drugs could lessen the severity or frequency of seizures, but often had undesirable side effects, including drowsiness, nausea, loss of appetite, headache, irritability, fatigue, and constipation.7

  By the early 1950s, epilepsy treatment had advanced on three fronts: seizure localization, drug remedies, and surgery. Most patients achieved seizure control with personalized medication regimes. Those who required surgical intervention enjoyed satisfactory outcomes after the surgeon removed the specific area in the cortex where the seizures originated. The removals varied in extent, often restricted to part of the frontal, temporal, or parietal lobe on one side of the brain, but occasionally they included the entire cortex on the left or right. In neurosurgical centers worldwide, researchers conducted EEG studies and cognitive testing before and after operations to document treatment efficacy and to guide new approaches.8

  At school, Henry’s epilepsy kept him from fitting in. He enrolled in Willimantic High School, but dropped out for several years when he could no longer bear the teasing of other boys. In 1943, at seventeen, Henry enrolled as a freshman in East Hartford High. He was tall and quiet, with thick glasses, and he kept to himself; other than a brief stint in the Science Club, he never took part in any extracurricular activities. Few of his high-school classmates knew him; those who did commented that he was very polite.

  Henry’s embarrassment over his epilepsy may have kept him from being more active in school—participating would increase the likelihood that he would have seizures in front of his classmates. We can only speculate how different Henry would have been without his epilepsy, and how much of his withdrawal came from natural shyness rather than embarrassment about his disease. At that time, social attitudes toward epilepsy were still fueled by fear and misinformation, and Henry was singled out for his condition. A teacher once pulled aside one of Henry’s male classmates and told him, “You’re big and strong. We have a problem here: one of your classmates, Henry, has epilepsy. If he takes a fit, I want you to hold him down while I get the nurse.” The student was fortunately never called into action.

  An East Hartford High classmate, Lucille Taylor Blasko, remembers that the first time she noticed Henry was when she saw him on the floor of the hallway in high school, shaking and writhing. From a distance, it looked to her as if he was overcome with laughter. The next day, the school superintendent called a school-wide student assembly in the auditorium to explain Henry’s situation. Although his intention was to educate the students, this assembly also singled Henry out and further publicized his condition.

  Two of Henry’s neighborhood friends, Jack Quinlan and Duncan Johnson, went to serve in World War II while Henry was still in school. He exchanged letters with them, and their colorful prose offers glimpses into Henry’s social life. Henry was undoubtedly interested in women and went out on dates. In 1946, he seems to have admitted to Quinlan that he had a cru
sh on an older woman. Quinlan wrote back from Chefoo, China, apparently in response to Henry’s revelation: “Mi Amigo! It grieves me to find you are, beyond a doubt, a psicopathic [sic] case. Dames twenty-eight years old are too smart for guys like you especially the sweet married ones.”9

  Henry seems to have enjoyed other simple pleasures as well. At home, he liked listening to radio programs: he was a fan of Roy Rogers, Dale Evans, and Gabby Hayes and the family sitcom The Adventures of Ozzie and Harriet. He would play records on an upright Victrola, sometimes listening to popular songs with friends. Henry loved the sweetly harmonizing trio the McGuire Sisters, as well as the big bands of the 1930s and ’40s, and popular hits—“My Blue Heaven,” “The Prisoner’s Song,” “Tennessee Waltz,” “On Top of Old Smoky,” and “Young at Heart.”

  Guns fascinated Henry. With the help of his father, he amassed a collection of hunting rifles and pistols, including an old flintlock pistol, a gun popular in the eighteenth and early nineteenth centuries. Henry kept these in his bedroom, and a favorite pastime was target shooting in the countryside. He was a proud member of the National Rifle Association and loved to show off the gun collection to interested friends and relatives.

  In 1947, when Henry was twenty-one, he graduated from East Hartford High. According to Mrs. Molaison, the superintendent would not let him participate in the graduation ceremony, for fear that he would have a “bad spell.” Instead, Henry sat with his parents, and was “all broken up about it.” In 1968, he had no recollection of the event. More than sixty of his classmates signed his yearbook, a surprising number considering his relative social isolation. It is possible that during a yearbook signing session, the books were passed around from person to person, and everybody signed everybody else’s. His friend Bob Murray wrote: “A fellow roommate who lightens up the gloom.” Another classmate: “To a swell fellow and a perfect friend. Love & luck always, Loris.” Henry chose a quote from Shakespeare’s Julius Caesar to accompany his handsome yearbook picture: “There are no tricks in plain and simple faith.”

  In high school, Henry had chosen to take the Practical Course rather than the Commercial or College Course. His classes focused on job skills over pure academics and prepared him for a technical career. At sixteen, he had a summer job as an usher in a movie theater. After graduating from high school, he first worked at a junkyard outside Willimantic rewinding electric motors. Next, he worked at Ace Electric Motor Company, also in Willimantic, where he assisted the two owners. Henry was a methodical worker, and made careful notes and diagrams about his work in a small black diary. His notes included equations for calculating voltage and power in an electrical circuit, and a diagram of two resistors in parallel. His diary also contained plans for building a model railroad. Later, Henry left the electric-motor company and worked on an assembly line at the Underwood Typewriter Company in Hartford.

  Henry rode to and from work with a neighbor every day. He was unable to drive himself, as he still experienced many petit mal seizures every day and intermittent grand mal seizures. The seizures made it hard for Henry to do his job, and he often missed days. He took large doses of antiepilepsy drugs, but they could not quell his attacks.

  By this time, Henry was twenty-four and had come under William Beecher Scoville’s care. A prominent physician, Scoville had established the Department of Neurosurgery at the Hartford Hospital in 1939 and had a teaching position at Yale University Medical School. He held a BA from Yale University and MD from the University of Pennsylvania, and before arriving at Hartford had trained in some of the nation’s top medical centers—New York Cornell Hospital and Bellevue Hospital in New York City, and Mass General and Lahey Clinic in Boston—where he was mentored by some of the most prominent figures in twentieth-century neurosurgery. Bright, energetic, and ambitious, Scoville spoke with a glint of humor but often seemed reserved to his colleagues. Regarded as an independent thinker and a nonconformist, he rode motorcycles and had a passion for old cars. In 1975, he wrote, “I prefer action to thought, which is why I am a surgeon. I like to see results. I am an auto mechanic at heart and love perfection in machinery and so I chose neurosurgery.”10

  When it was clear that the available medications were not adequate to control Henry’s symptoms, his family doctor, Harvey Burton Goddard, suggested that Henry and his parents consult Scoville. Henry probably had his first appointment with Scoville in 1943, when he was seventeen, and began taking Dilantin at that time, giving him some relief from the grand mal seizures.

  Sometime between 1942 and 1953, Henry’s parents took him to the renowned Lahey Clinic in Boston, a trip that Henry could recount after his operation. No records describing that consultation are available. He continued under Scoville’s care, so the Lahey doctors probably told the Molaisons that they could not provide any treatments not already available in Hartford, and emphasized the importance of being cared for by a local doctor. Scoville admitted Henry to the Hartford Hospital on three occasions before September 1946, but medical records from those admissions were not in Scoville’s office files.

  On September 3, 1946, at age twenty, Henry was admitted a fourth time, and underwent a pneumoencephalogram (brain X-ray) to rule out other abnormalities, such as a brain tumor, as the cause of the seizures. This unpleasant, invasive test was the closest that doctors could come in those days to visualizing living brain tissue without opening up the skull to peer inside. A physician inserted a needle into Henry’s spine, extracted some cerebrospinal fluid, and injected oxygen that traveled up his spinal canal to his brain. The doctor then took an X-ray, which revealed the location and size of the spaces in the brain where the cerebrospinal fluid normally traveled. From those pictures, the doctor could determine whether Henry’s brain had shrunk due to a disease, or whether structures had shifted to one side or the other because of an abnormal growth, such as a tumor. Patients loathed this procedure because it left them with a terrible headache and nausea. Despite these side effects, Henry left the hospital two days later with good news—his pneumoencephalogram was normal, and his physical and neurological examinations showed no problems. Although the diagnostic workup excluded some possible causes of Henry’s epilepsy, such as brain tumor or stroke, it fell short of revealing exactly where his seizures originated. The Hartford Hospital discharge summary dated September 1946 read, “to continue on Dilantin indefinitely.” Henry still awaited the medical breakthrough that would normalize his life.

  On December 22, 1952, when Henry was twenty-six, Scoville noted that Henry had had at most one seizure within the past month. He wrote that he was “on massive medication, Dilantin five times a day, phenobarbital twice a day, Tridione three times a day, and Mesantoin three times a day.” Scoville ordered precautionary, monthly blood work for Henry to be sure that the drugs did not reach toxic levels, and asked a Hartford Hospital colleague, Howard Buckley Haylett, to see Henry in his office. According to Scoville’s office notes, he saw Henry again three months later, in March 1953.

  Henry also endured repeated EEG studies in an attempt to find the area in his brain where the seizures originated. If his doctors had found such a focus, then they might have proposed surgically removing that area with the hope of eliminating his spells. As it turned out, however, an EEG study carried out on August 17, 1953, eight days before his operation, found only scattered, slow activity. Henry actually had an attack during the recording, which was potentially helpful, but still the EEG did not point to a specific locus of abnormality. Two days later, he had another pneumoencephalogram, and it showed no abnormalities. His vision and hearing were also deemed normal. In short, the tests available in 1953 revealed no evidence of a discrete abnormality in Henry’s brain. In a repeated attempt to unmask an epileptic focus, another EEG study was carried out the day before his operation, when he was no longer taking heavy medication. The abnormal waves were still diffuse rather than in one particular area. During the two weeks before his operation, he had had two grand mal attacks and daily petit mal attacks.
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  Knowing that Henry’s seizures had been progressing for a decade, Scoville had suggested an experimental operation that he hoped would control the attacks and improve Henry’s quality of life. He saw this operation as part of a series of investigative surgeries that could further understanding of psychiatric disease and offer solutions for certain brain disorders that seemed intractable. The operation would entail removing several inches of brain tissue from structures deep in Henry’s brain, first from one side and then from the other. Scoville had performed similar operations before, but only in patients with severe psychiatric disorders, mainly schizophrenia. The psychiatric results were mixed: Scoville, in consultation with hospital staff and family members, ranked each patient’s psychiatric symptoms after the operation from minus one (worse) to four (markedly improved with discharge to home). One patient was rated as minus one, and two were rated as four, with the others falling in between. Cognitive testing was not carried out. Henry would be the first patient to undergo this procedure for intractable epilepsy. In 1991 when Henry was sixty-five, a caregiver heard him say that he remembered signing forms long ago but did not remember when or what they entailed. “I think they were about my surgery on my head.” No record exists of the conversations that Henry had with his parents after their meetings with Scoville, but after a decade of failed treatment, everyone agreed that the operation would be Henry’s best chance for relief.11

  On Monday, August 24, 1953, he and his parents left their home on Burnside Avenue and crossed the Connecticut River from East Hartford, driving a tense five miles to the Hartford Hospital. After being admitted, Henry met with a psychologist, Liselotte Fischer, for testing. She wrote in her report: “He admits to being ‘somewhat nervous’ because of the impending operation, but expresses the hope that it will help him, or at least others, to have it performed. His attitude was cooperative and friendly throughout, and he expressed a pleasant type of sense of humor.”12