A discussion on the statement:

The basic findings [based on patient HM] characterising amnesia as a selective deficit in
memory and identifying a key role for the medial temporal areas have stood the test of time
(Eichenbaum, 2013: 20).
By Ailbhe Owens.
5th December 2014.

Henry Molaison, more commonly known by his initials, H.M., is arguably the most famous
amnesiac patient ever. He was studied thoroughly for more than fifty years, from 1957, at the
age of 27 years old, until his death in 2008, at the age of 82. H.M. suffered a blow to his head
following a bicycle accident at age seven. He began to have minor epileptic seizures at age 10
and had major seizures from the age of 16 (Squire, 2009). At the time, scientists in Hartford
were unable to see inside his brain, due to a lack of technology and equipment, and had little
knowledge of how functions such as memory worked (Carey, B. 2008. H.M., An
Unforgettable Amnesiac Patient Dies, At 82. Retrieved December 1, 2014, from
http://www.nytimes.com/2008/12/05/us/05hm.html?pagewanted=all&_r=0).
H.M.s seizures were persistent and remained severe, despite a high dosage of anticonvulsant
medication. H.M. became incapacitated by his epilepsy and was no longer able to work or
live a normal life, and agreed to an experimental procedure in the hope of reducing the
frequency and severity of his seizures (Squire, 2009).
Wilder Penfield carried out two surgeries involving the unilateral removal of the medial
structures of the left temporal lobe on two patients who had suffered from severe epilepsy,
known as P.B. and F.C., in an attempt to treat their epilepsy and control their seizures. Both
patients suffered from amnesia following the surgery. Their amnesia was attributed to an
undetected, pre-existent atrophic lesion in the medial temporal lobe of the opposite
hemisphere, thus resulting to a bilateral lesion, which was later confirmed by autopsy in
patient F.B. (Squire, 2009). William Scoville, a neuroscientist, carried out a bilateral
resection of the uncys, amygala, anterior hippocampus and parahippocampal gyrus on H.M.,
in an attempt to eliminate his seizures when H.M. was 27 years old (Scoville & Milner, 1957,
cited by Squire, 2009). Metal tubes were inserted above the eyes, in order to remove parts of
the medial temporal lobe structures and two thirds of the hippocampus, through suction
(MacKay & James, 2009).

Scoville made contact with Penfield, as he observed a similar result of memory impairment in
H.M. following the surgery. From this, H.M. began to be studied intensively, by Milner and
up to 100 other psychologists (Squire, 2009).

Amnesia and impaired cognitive functions in patient H.M.

Patient H.M. is one of the most closely studied patients in the history of psychology. Before
H.M. was studied, memory was not often believed to be localised in the brain, nor was it
believed that memory was localised in one particular section of the brain. The effect of the
hippocampus specifically on memory was generally not believed to be significant, and the
hippocampus was seen as one section of the limbic emotional circuit. Many articles on
damage to particular sections of the cerebral cortex suggested that each area of the brain was
in control of a specific modality of the processing of knowledge and data, such as visual,
auditory and verbal information, and that memories relating to those specific modalities of
processing information were stored in those specific parts of the brain (Eichenbaum, 2012).
The studies conducted on H.M. changed the view of the hippocampus as a critical part of the
brain in relation to memory and cognitive functioning, and provided an insight into the
complex systems in the brain. Neurological examination showed that H.M. had ataxia of the
gait, polyneuropathy and a left ular neuropathy following his surgery (Hebben, Corkin,
Eichenbaum & Shedlack, 1985). H.M. suffered from severe anterograde amnesia. He was
unable to form new memories after the surgery (Retrieved December 2, 2014, from
bigpictureeducation.com/brain-case-study-patient-hm) and was incapable of transferring
newly acquired knowledge and information to his long term memory after the surgery
(McLeod, S. A., 2011). H.M. also suffered from retrograde amnesia, as he could not
remember events from the three years prior to his surgery (Squire, 2009).

H.M.s ability to recall memories and identify faces was tested by Marslen-Wilson and
Teuber in 1975. H.M. was asked to recognize faces of famous people from different decades
from 1920 to 1970. H.M. was severely impaired at identifying and naming faces from the
years following his surgery, but performed as well or better than other people of the same age
at recognising people that were famous in the years prior to his surgery. These findings by
Marslen-Wilsen and Teuber were critical in suggesting that the medial temporal lobe is not
where previously acquired information is stored.
Research also tested H.M.s somatosensory capacities, and investigated the effect of an
impairment of memory ability in relation to the ability to understand and report internal
states. Experiments examining his ability to report and feel hunger, thirst, pain and thermal
pain perception were conducted when H.M. was 54 years old (Hebben et al., 1985). H.M.
was compared to nineteen normal controls and five other subjects that also suffered from
global amnesia. H.M. reported feeling no more or less hungry or thirsty after consuming a
meal and drinking water than he had before eating and drinking. He was also unable to
appreciate thermal pain. The research provided evidence to support the claim that H.M. was
incapable of responding appropriately to normal homeostatic stress. This research, and
similar experimental studies conducted on animals (Bagshaw & Pribram et al., 1968, cited by
Hebben et al., 1985) have supported the theory that internal states are attributable to
amygdaloid lesions.

Long Term Memory

The severity of H.M.s memory has been thoroughly examined through his performance on
neuropsychological tests. Despite his severe retrograde amnesia, certain areas or memory
function were preserved. The amount of time it took for H.M. to complete a mirror tracing

test decreased over three days of practice, although he could not recall ever doing the test
before (Milner, 1962, cited by Corkin, 2002). H.M. demonstrated his ability to learn new
perceptual skills and cognitive skills, such as those needed to complete the Tower of Hanoi
puzzle (Corkin, 2002). H.M. was also able to demonstrate the biasing effect with words,
though he could not remember the experiencing the bias (Gabrieli, Cohn & Corkin,
unpublished data). He could also retain non-declarative learning skills for one year (Corkin,
2002).
The tests conducted on H.M. provided evidence to support the claim that declarative
knowledge (knowing that) needs bilateral medial temporal lobe structures, and procedural
knowledge (knowing how) is not dependant on that system, but rather substrates outside of
the medial temporal lobe area (Corkin, 1984, 2002). Research conducted on H.M. has lead to
the conclusion that other types of learning are independent of the medial temporal lobe such
as perceptual learning, which was tested by H.M.s ability to improve at reading mirrorreversed words, and most skills that were repeatedly practiced. Recent studies have attributed
more importance to structures within the parahippocampal, as oppose to the hippocampus
itself. H.M. demonstrated an accurate drawing of the floor plan of the house that he lived in,
during the years after his surgery. This suggested that H.M.s topographical memory was
intact. Corkin (2002) suggested that H.M. was able to draw an accurate floor plan as a result
of long term repetition of locomotion through his house. The implication of this finding is
quite important H.M., despite having severe anterograde amnesia, was able to draw from
long term memories formed after the onset of his amnesia.
Many hypothesis have been drawn in an attempt to explain the data on H.M.. One such
hypothesis is the Internal Representation Hypothesis. This hypothesis proposes that H.M.s
poor result when completing the Whats-Wrong-Here and Hidden-Figure tasks were
attributable to an impediment in forming a precise internal representation for the unfamiliar

aspects of the visual objects which were presented to him during these tasks, as well as
objects that he had not encountered prior to his surgery (McKay & James, 2009).

Conclusion
Research conducted on H.M. has had many findings, such as suggesting that amnesia is an
impairment of both declarative and episodic memory, establishing the hippocampus as an
important area of the brain for memory and in showing that amnesia can leave short term and
working memory unharmed (Eichenbaum, 2009).
It has also provided data to support the suggestion that amygdaloid lesions are responsible for
the interpretation and reporting of internal states (Hebben et al. 1985), and has given
psychologists an insight into how retrograde amnesia and anterograde amnesia works.
It has also provided evidence that long term memories can be formed after the onset of severe
amnesia, and that motor learning skills can be preserved in amnesiac patients (Corkin, 2002).
Also, research on H.M. has lead the way in proposing that memory functions under multiple
memory systems (Squire, 2009).
The research done on H.M. has had a lasting effect on how we understand cognition in
humans, long term memory, retrograde and anterograde amnesia, that remains relevant today.

References
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bigpictureeducation.com/brain-case-study-patient-hm
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1, 2014, from http://www.nytimes.com/2008/12/05/us/05hm.html?pagewanted=all&_r=0).
Corkin, S. (2002). Whats new with the amnesiac patient H.M.?. Nature Reviews:
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interpret and report internal states after bilateral medial temporal resection: Case H.M..
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MacKay, D. G., James, L.E. (2009). Visual Cognition in amnesiac H.M.: Selective deficits
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Neuropsychology, 31 (7), 769 789.
McLeod, S. A. (2011). Retrieved from http://www.simplypsychology.org/anterogradeamnesia.html
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amnesia: Recognition of public figures from newsphotographs. Neuropsychologia, 13,
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