Patient H.M. (13 page)

As it turned out, Fulton was simultaneously offering the same tip to many other people, often using almost exactly the same words. In a letter he wrote to another former student the same week, he stated that he thought the lobotomy was “going to be a highly significant procedure” and that he “would like to see someone here in New Haven get in on the ground floor and do a group of such cases.” Then he added, “I feel certain that the procedure is justified.”

It is hard to overestimate the effect that the endorsement of John Fulton had on the spread of the lobotomy. He was the most famous physiologist of his era, and his words instantly imbued what was initially a fringe-dwelling procedure with a new respectability. Fulton's proselytizing might have owed something to the fact that his own work with chimpanzees had inspired the procedure and that the lobotomy's ascendance would inevitably raise his own stature, but it would be unfair to call his endorsement entirely self-serving. Fulton had an ego, but he was also a passionate scientist. He hungered to understand the brain, and everything he had done up to that point in his career, the hundreds of experiments involving thousands of apes, monkeys, rats, and mice, was in service to that fundamental pursuit. Now, suddenly, if it took hold, psychosurgery offered an entirely new way to pursue that line of research, one that would involve a very different sort of animal.

Bucy, like most of his peers, responded enthusiastically to Fulton's suggestion. “I have been very much interested in what you have to say regarding the operations in psychotic states,” he wrote a few days after receiving Fulton's letter. The fact that Freeman and Watts had begun performing lobotomies in the United States was news to Bucy, and he told Fulton that “it is not at all unlikely that we shall get going on something similar before long.” Bucy also made clear that he would approach the practice of psychosurgery in a manner that would please his mentor: “We will go at it, of course, primarily from the aspect of studying these people from a psychological and physiological standpoint and of finding out in what respect their condition has been altered by the operation. It seems to me that most that is to be gained here is from the standpoint of study, certainly at the present time.”

As his correspondence with Fulton continued, however, Bucy sounded several notes of caution.

To begin with, despite certain advantages humans had over other experimental test subjects, they had certain drawbacks, too. For instance, there was the fact that lobotomy patients were, well, patients.

“In animal experimentation,” Bucy wrote, “one presumably always starts with a normal organism. At least that is the basis of the greater part of our animal experimentation. In the human cases, at the present time at least, such is never true.” Bucy noted that there were historical exceptions, such as “in ancient Egypt where criminals were submitted to vivisection,” but that in the present day, “so far as the patient is concerned, any experiments which we may perform are incidental to the care and treatment of disease. It is only for that reason that he submits himself to the experimentation.”

Then there was the matter of the neurosurgeons themselves. Bucy was grateful to Fulton for inspiring a new generation to be interested in more than “mere mechanics,” but he also worried that some of these surgeons were overreaching. He fretted about ambitious but oblivious men who “have had no real experience with investigation. They have no idea what the real scientific method or approach is. They know nothing about controls.”

Finally, its experimental utility aside, the question of how to objectively evaluate the costs and benefits of the lobotomy as a treatment remained unanswered. In 1948, a respected Swedish neurosurgeon named Gosta Rylander took a subjective approach, publishing a critical paper based on extensive interviews with the families of patients he'd lobotomized. The interviews described, in chilling terms, the subtle but fundamental changes his patients had undergone. As one mother of a young woman put it, “She is my daughter but yet a different person. She is with me in body but her soul is in some way lost.” Rylander's paper generated lots of attention within the psychosurgical community and inspired another blunt, straight-talking letter from Bucy to Fulton. “Rylander's statements are so obviously correct,” Bucy wrote, “that no intelligent person who was not blinded by his own enthusiasm could doubt them. Frontal lobotomy is a worthwhile procedure in certain situations. But the procedure exacts a price.”

Fulton replied somewhat defensively. “As you say the improvement may come at a price,” he wrote, but “that is exactly what we are attempting to analyze through our Connecticut Lobotomy Committee. Bill Scoville has had a series of very striking responses to undercutting areas 9 and 10 and he feels that this less radical procedure does away with obsessions without causing intellectual impairment.”

Bucy's correspondence with Fulton provides a raw glimpse of the strange tensions in the neuroscientific community in the middle of the twentieth century. On the one hand, Fulton's initial laboratory research and subsequent advocacy had sparked the rise of psychosurgery, which allowed for an entirely new type of neurological exploration. Asylums were suddenly giving neurosurgeons and physiologists “unlimited access” to their patients, and people like Fulton and my grandfather seized on the opportunities for research that this access allowed. But even within the ranks of these experimentalists were men like Paul Bucy and Max Zehnder, who worried that things were moving too fast and going too far.

If Fulton shared any of Zehnder's misgivings about the scientific usefulness of the research being conducted at the asylums, he didn't express them. Instead, in a letter to my grandfather after Zehnder's resignation, he took a potshot at Zehnder. “I think Dr. Zehnder is sincerely interested in studying lobotomy patients from a scientific standpoint,” he wrote. “I also think he has ability, but he illustrates the futility of brains without technique.” He ended the letter on an optimistic note: “I believe that our lobotomy work has an important future, and I tremendously appreciate your interest and cooperation in our lobotomy venture.”

Fulton had reason to be optimistic. The press continued to describe lobotomies in effusive terms, running stories with headlines such as “Wizardry of Surgery Restores Sanity to Fifty Raving Maniacs” and “No Worse Than Removing Tooth.” The Veterans Administration was promoting the procedure to shell-shocked World War II veterans and sponsoring lobotomy research at a variety of institutions, Yale included. Of course, even the staunchest defenders of psychosurgery realized there was something inherently ghoulish about it. The invitations to a Christmas party at Fulton's lab in 1948 featured a cartoonish illustration of Fulton holding a brain without frontal lobes in one hand and a carving knife in the other, and the evening's entertainment consisted of a bunch of singing graduate students who'd dubbed themselves the Lobotomy Quartet.

In the fifteen years since John Fulton's laboratory work had inspired Egas Moniz to invent the leucotomy, the landscape of brain research had changed in profound ways. While the therapeutic value of the lobotomy remained murky, its scientific potential was clear: Human beings were no longer off-limits as test subjects in brain-lesioning experiments. This was a fundamental shift. Broken men like Phineas Gage and Monsieur Tan may have always illuminated the unbroken, but in the past they had always become broken by accident. No longer. By the middle of the twentieth century, the breaking of human brains was intentional, premeditated, clinical.

Even Paul Bucy, despite his notes of caution, realized that this presented researchers with unprecedented opportunities. In one of his letters to Fulton, written in 1938, shortly after he had begun performing lobotomies himself, he couldn't help but gush over the excitement he felt transitioning from laboratories full of macaques to asylums full of Homo sapiens.

“Man,” he wrote, “is certainly no poorer as an experimental animal merely because he can talk.”

E
XCERPT FROM A
M
AY 25, 1992, INTERVIEW BETWEEN
P
ATIENT
H
.
M
. AND A RESEARCHER AT THE
M
ASSACHUSETTS
I
NSTITUTE OF
T
ECHNOLOGY

It's unclear when that first meeting took place. I've gone through all of my grandfather's papers, at least the ones I've had access to, but records of that consultation do not seem to exist. I've read speculation that it probably happened sometime in 1943, but that doesn't make sense, because in 1943 my grandfather was still stationed at the military hospital in Walla Walla, Washington. More likely the consultation took place soon after the war, in 1945 or 1946.

Henry would have been in his late teens or, at most, twenty-one. A kid still. Maybe it was shortly after he graduated, three years late, from East Hartford High. Under his yearbook photo, Henry had placed a quote from Shakespeare's
Julius Caesar:
“There are no tricks in plain and simple faith.” He'd had to watch from the crowd as his classmates walked across the stage, since he was ordered to stay in his seat to prevent the possibility of a ceremony-disrupting seizure. Maybe he'd recently started his first job after high school, salvaging scrap metal at the junkyard. Or maybe he'd already moved on to his second job, at Ace Electric Motors, spending his days winding coils of copper. At home, he spent his time listening to Roy Rogers on the radio and watching television. His hobby was collecting guns, and he had several—from rifles to an old flintlock pistol—which he took out into the fields behind his house for target practice. He wanted to build a model railroad but never did. He did build model airplanes, model cars. He couldn't drive. He had few friends.

Henry's parents and Henry's primary care physician, Harvey Goddard, had done what they could to manage his epilepsy, but it was clear that things were only getting worse, the seizures increasing in intensity and frequency. Out of ideas, Goddard suggested they consult my grandfather, who despite not being an epilepsy specialist had training as a neurologist that gave him more insight than a general practitioner.

Henry's mother or father would have accompanied Henry to the consultation. There, in my grandfather's office, they would have exchanged handshakes and hellos. Maybe the Molaisons dressed up for the occasion. My grandfather was surely his usual immaculate self, his thick, graying hair parted to the right, slick with olive oil, his handsome blue eyes direct and inquisitive. Maybe Gustave the electrician and my grandfather the mechanic made small talk and found some common ground in their tinkering. Or maybe not. The Molaisons were a poor family, with humble jobs. My grandfather was a prominent brain surgeon. There was a clear divide between them, a chasm of wealth, position, education, power.

Eventually my grandfather would have gotten down to business, methodically taking Henry's history, trying to find any clues that might explain his illness. He would have asked if there were any other cases of epilepsy in the Molaison family and learned that Henry's father had two cousins and a niece who all had some form of the disease, which hinted at a genetic component. He would have also asked if Henry had ever suffered any severe head injuries. Had he ever been knocked unconscious or received any violent blows that might have caused damage to his brain?

Henry would have told him about that distant day in July, about the bicycle he didn't see, about the fall, the blow to his head. Perhaps he leaned in to show the faint scar on his forehead.

If there was a record of this consultation it would consist of nothing more than my grandfather's clinical observations. A medical chart is no place for introspection, and he wouldn't have mentioned any personal memories Henry's story might have triggered. Even if Henry's bicycle accident reminded my grandfather of the first great loss in his own life, he wouldn't have written it down.

To understand that loss, it's necessary to step back about eight decades, to a courtroom in Brooklyn on February 24, 1875, when what was then the most scandalous trial in American history was nearing its end. The lead defense attorney, part of a formidable team that included a future secretary of state, paced the boards in front of the jury box and warned the twelve men sitting there that if they didn't acquit, they would be remembered as “actors in one of the greatest tragedies which has ever occupied the stage of human life.” The lead prosecutor, meanwhile, had already told the jurors that “upon the result of your verdict, to a very large extent, will depend the integrity of the Christian religion.”

The defendant was a preacher named Henry Ward Beecher. From the pulpit of Plymouth Church in Brooklyn Heights, Beecher had built a national following by railing eloquently against slavery, economic injustice, and inequality. He grabbed headlines with stunts like auctioning off a young slave at his church to raise enough money to buy her freedom, but it was his blunt, powerful oratory that earned him admirers like Oliver Wendell Holmes and Ulysses S. Grant. In 1863, after Beecher gave a series of speeches in England that helped persuade an ambivalent British public to side with the North in the Civil War, Abraham Lincoln said of Beecher that “there was not upon record, in ancient or modern biography, so productive a mind” and told his cabinet that if the North prevailed, “there would be but one man—Beecher—to raise the flag at Fort Sumter, for without Beecher in England there might have been no flag to raise.” (Lincoln held Beecher's sister,
Uncle Tom's Cabin
author Harriet Beecher Stowe, in similar esteem, once supposedly describing her as “the little woman who started this big war.”) By the beginning of the 1870s, Beecher was among the most famous and respected men in the country.

Then he was accused of adultery.

The accuser was a former friend, Theodore Tilton, who claimed that Beecher had seduced his wife, Elizabeth, and carried on an affair with her that lasted for years. Beecher denied everything and claimed that Tilton was just a desperate blackmailer. Tilton brought a civil suit in 1876, and the resulting trial was a sensation: The courtroom overflowed with journalists, witnesses, and curious onlookers, and
The New York Times
declared that “we can recall no one event since the death of Lincoln that has so moved the people as this question whether Henry Ward Beecher is the basest of men.” There were many fifteen-cent tabloids devoted exclusively to coverage of the trial. “Pictorial History of the Beecher-Tilton Scandal. Its Origin, Progress and Trial. Illustrated with Fifty Engravings from Accurate Sketches,” trumpeted the first page of one. Most of those sketches were of the courtroom proceedings—caricatures of witnesses becoming increasingly disheveled after hours of cross-examination—though some were re-creations of supposed events from the affair. One full-page drawing showed a woman in a billowing dress looking furtively over her shoulder as she knocked on the door of a Brooklyn brownstone, and bore the caption: “Mrs. Elizabeth R. Tilton Calling at the House of Her Pastor, The Rev. Henry Ward Beecher, on the 10th Day of October, 1868, When, as Alleged by Her Husband, She First Fell From Grace.”

There was little hard evidence. The principal exhibits introduced during the trial were a series of letters Beecher had written to Elizabeth, her husband, and various mutual acquaintances. None of the letters were explicit confessions, but many hinted at some terrible secret Beecher was holding. One such letter, to a confidant named Frank Moulton, came to be known as the Ragged Edge Letter, and in it Beecher described his inner turmoil. “Nothing can possibly be so bad as the horror of great darkness in which I spend much of my time,” he wrote. “I look upon death as sweeter faced than any friend I have in the world. Life would be pleasant if I could see that rebuilt which is shattered. But to live on the sharp and ragged edge of despair, and yet put on the appearance of serenity and happiness, cannot be endured much longer….To keep serene as if I was not alarmed or disturbed, to be cheerful at home and among friends when I was suffering the torments of the damned; to pass sleepless nights often, and yet to come up fresh and full for Sunday—all this may be talked about, but the real thing cannot be understood from the outside, nor its wearing and grinding on the nervous system.” The prosecutors described Beecher's agonizing introspection as the product of a guilt-stricken conscience, while the defense argued that the letters were simply the outpourings of an innocent but overly sensitive man. The letters were damning to some, exculpatory to others. It was a matter of interpretation, one that would be left up to the jury to decide.

Toward the end of the day, Beecher's lead counsel implored the jurors to consider the historical ramifications of their decision: “Gentlemen,” he said, “by the judgment which you here pronounce you will yourselves be judged at the tribunal of the ages. What you do here will never die. When these scenes shall have passed away; when he who presides over this trial shall rest in the silent chambers of the dead; when the seats you occupy shall be filled by your children, or your children's children, strangers from distant climes will come to view the place from which was given back to the world, freed from cloud or passing shadow, the name of Henry Ward Beecher.”

The jurors chose to acquit.

Beecher's name was never quite freed from passing shadow, however. Some suspicions are hard to shake, and the once unimpeachable reputation of the great preacher was forever tainted by doubt. Still, the Beecher clan remained fiercely proud of its lineage. My grandfather's father was Beecher's grandson, and he named his third son Henry Ward Beecher Scoville.

Henry was born in 1909, two years after my grandfather. The brothers had an idyllic childhood, close to each other and close to nature: Growing up, they often went on camping trips in the Connecticut woods or near their summer home on the coast of Maine. Their father would teach them the names of all the trees and the birds and his beloved snakes, and he gave the boys themselves goofy nicknames to mark these adventures—the eldest, Gurdon, became First Lieutenant Trottie, my grandfather became Second Lieutenant Honey Bee, and young Henry was simply Henny Penny. Honey Bee and Henny Penny had a particularly tight bond. They were brothers and best friends.

My grandfather went away to college in August 1924, and a few months later terrible news came from home. There'd been an accident. Henry had been riding a bicycle, was hit by another vehicle. A fall, a blow to the head.

His brother Henry was gone.

Henry was there.

There in my grandfather's office, during their initial consultation. When Henry told him of his own accident—the bicycle, the fall, the blow to the head—was my grandfather reminded of his lost brother? Our brains do tend to make connections like that, crossing years in a heartbeat. Memory scientists have a word to describe those sorts of moments, when something in the immediate present triggers the recollection of something in the distant past:
ecphory.

Here's what is known for sure: He prescribed Henry an antiepilepsy medication called Dilantin. Dilantin works by dampening the electrical activity in the brain, thereby reducing the frequency and severity of seizures. It only treats the symptoms, though; it's not a cure. He also made an appointment for Henry to return to Hartford Hospital for a pneumoencephalogram, which was then the state of the art in brain-imaging technologies. This would allow my grandfather to see if there was, for example, a tumor pressing upon some portion of Henry's cortex, causing his seizures. Something tangible, something targetable.

Records do exist for that next visit. On September 4, 1946, after checking in to the hospital, Henry changed into a surgical smock and was led to a room on an upper floor. The room contained a chair resembling something astronauts might train in, full of belts and restraints, capable of rotation in almost any direction, including upside down. Henry sat in the chair, and a technician strapped him in, fixing his arms to the armrests and using a harness under his chin to immobilize his head against a backrest. There was an opening in the rear of the chair, and a needle was inserted into Henry's lower back, into the base of his spinal column. This so-called lumbar puncture allowed the technician to do two things: First he extracted all of Henry's cerebrospinal fluid, drawing it out like blood into a syringe. (Although CSF is an essential part of the body's nervous system, protecting and cushioning the brain and spinal cord, there is actually less of it than you might think: The average adult has only about 150 milliliters—10 tablespoons—at any given moment.) Second, after the technician completed suctioning out Henry's CSF, he pumped oxygen in to replace it. In order for the technician to ensure that the oxygen diffused completely, not just into the areas surrounding Henry's brain but through all his brain's ventricles—the cavernous spaces usually filled with CSF—the chair was then lifted and spun slowly into a variety of positions, allowing the oxygen to bubble up and fill all the crevices. This hurt. A splitting headache was an inevitable side effect of pneumoencephalography. One woman who went through the procedure gave a typical account: “It was the most painful experience of my life…it would make an excellent torture program for the military.”