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This is a famous paper in which the scientists stumbled upon the tr...
William Beecher Scoville (January 13, 1906 – February 25, 1984) was...
Brenda Milner (Born July 15, 1918) is a British-Canadian neuropsych...
The medial temporal lobes are crucial to episodic memory. Amnesia p...
A lobotomy, or leucotomy, is a form of psychosurgery, a neurosurgic...
Lobotomies were traditionally performed on schizophrenia patients, ...
Research ethics and consent were a lot different in the 1950s. This...
"There has been one striking and totally unexpected behavioral resu...
Case #1, H.M. is one of the most famous patients in the history of ...
There is a book about Scoville and the patient he operated on, titl...
Henry Gustav Molaison (February 26, 1926 – December 2, 2008), known...
“In the early 1950s, the neurosurgeon William Scoville carried out ...
The Wechsler Memory Scale (WMS) is a neuropsychological test design...
"In summary, this patient appears to have a complete loss of memory...
Can someone explain this "of course" in "In all these hippocampal r...
"H.M.’s brain was kept at University of California, San Diego where...
Brenda Milner, coauthor of this study, noted in 2016, about the fut...
J.
Neurol.
Neurosurg.
Psychiat.,
1957,
20,
11.
LOSS
OF
RECENT
MEMORY
AFTER
BILATERAL
HIPPOCAMPAL
LESIONS
BY
WILLIAM
BEECHER
SCOVIILLE
and
BRENDA
MILNER
From
the
Department
of
Neurosurgery,
Hartford
Hospital,
and
the
Department
of
Neurology
and
Neurosurgery,
McGill
University,
and
the
Montreal
Neurological
Institute,
Canada
In
1954
Scoville
described
a
grave
loss
of
recent
memory
which
he
had
observed
as
a
sequel
to
bilateral
medial
temporal-lobe
resection
in
one
psychotic
patient
and
one
patient
with
intractable
seizures.
In
both
cases
the
operations
had
been
radical
ones,
undertaken
only
when
more
conserva-
tive
forms
of
treatment
had
failed.
The
removals
extended
posteriorly
along
the
mesial
surface
of
the
temporal
lobes
for
a
distance
of
approximately
8
cm.
from
the
temporal
tips
and
probably
destroyed
the
anterior
two-thirds
of
the
hippocampus
and
hippo-
campal
gyrus
bilaterally,
as
well
as
the
uncus
and
amygdala.
The
unexpected
and
persistent
memory
deficit
which
resulted
seemed
to
us
to
merit
further
investigation.
We
have
therefore
carried
out
formal
memory
and
intelligence
testing
of
these
two
patients
and
also
of
eight
other
patients
who
had
undergone
similar,
but
less
radical,
bilateral
medial
temporal-
lobe
resections.*
The
present
paper
gives
the
results
of
these
studies
which
point
to
the
importance
of
the
hippocampal
complex
for
normal
memory
func-
tion.
Whenever
the
hippocampus
and
hippocampal
gyrus
were
damaged
bilaterally
in
these
operations
some
memory
deficit
was
found,
but
not
otherwise.
We
have
chosen
to
report
these
findings
in
full,
partly
for
their
theoretical
significance,
and
partly
as
a
warning
to
others
of
the
risk
to
memory
involved
in
bilateral
surgical
lesions
of
the
hippocampal
region.
Operations
During
the
past
seven
years
in
an
effort
to
preserve
the
overall
personality
in
psychosurgery
some
300
fractional
lobotomies
have
been
performed,
largely
on
seriously
ill
schizophrenic
patients
who
had
failed
to
respond
to
other
forms
of
treatment.
The
aim
in
these
fractional
procedures
was
to
secure
as
far
as
possible
any
beneficial
effects
a
complete
frontal
lobotomy
might
have,
while
at
the
same
time
avoid-
ing
its
undesirable
side-effects.
And
it
was
in
fact
found
that
undercutting
limited
to
the
orbital
sur-
faces
of
both
frontal
lobes
has
an
appreciable
therapeutic
effect
in
psychosis
and
yet
does
not
cause
any
new
personality
deficit
to
appear
(Scoville,
Wilk,
and
Pepe,
1951).
In
view
of
the
known
close
relationship
between
the
posterior
orbital
and
mesial
temporal
cortices
(MacLean,
1952;
Pribram
and
Kruger,
1954),
it
was
hoped
that
still
greater
psychiatric
benefit
might
be
obtained
by
extending
the
orbital
undercutting
so
as
to
destroy
parts
of
the
mesial
temporal
cortex
bilaterally.
Accordingly,
in
30
severely
deteriorated
cases,
such
partial
temporal-
lobe
resections
were
carried
out,
either
with
or
with-
out
orbital
undercutting.
The
surgical
procedure
has
been
described
elsewhere
(Scoville,
Dunsmore,
Liberson,
Henry,
and
Pepe,
1953)
and
is
illustrated
anatomically
in
Figs.
1
to
4.
All
the
removals
have
been
bilateral,
extending
for
varying
distances
along
the
mesial
surface
of
the
temporal
lobes.
Five
were
limited
to
the
uncus
and
underlying
amygdaloid
nucleus;
all
others
encroached
also
upon
the
anterior
hippocampus,
the
excisions
being
carried
back
5
cm.
or
more
after
bisecting
the
tips
of
the
temporal
lobes,
with
the
temporal
horn
constituting
the
lateral
edge
of
resection.
In
one
case
only
in
this
psychotic
group
all
tissue
mesial
to
the
temporal
horns
for
a
distance
of
at
least
8
cm.
posterior
to
the
temporal
tips
was
destroyed,
a
removal
which
presumably
included
the
anterior
two-thirds
of
the
hippocampal
complex
bilaterally.
An
equally
radical
bilateral
medial
temporal-lobe
resection
was
carried
out
in
one
young
man
(H.
M.)
with
a
long
history
of
major
and
minor
seizures
uncontrollable
by
maximum
medication
of
various
forms,
and
showing
diffuse
electro-encephalographic
abnormality.
This
frankly
experimental
operation
was
considered
justifiable
because
the
patient
was
totally
incapacitated
by
his
seizures
and
these
had
proven
refractory
to
a
medical
approach.
It
was
suggested
because
of
the
known
epileptogenic
quali-
ties
of
the
uncus
and
hippocampal
complex
and
because
of
the
relative
absence
of
post-operative
*
These
further
psychological
examinations
by
one
of
the
authors,
B.
M.,
were
made
possible
through
the
interest
of
Dr.
Wilder
Penfield.
11
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WILLIAM
BEECHER
SCO
VILLE
AND
BRENDA
MILNER
..... +
..
* , ;, ... . .
..
. ............ .....
..
f.
:.i
i
.O ,.r . -
FiG.
1.-Area
removed
bilaterally
from
the
medial
temporal
lobes.demonstrating
5
cm.
as
well
as
8
cm.
removals
through
supra-orbital
trephines.
seizures
in
our
temporal-lobe
resections
as
com-
pared
with
fractional
lobotomies
in
other
areas.
The
operation
was
carried
out
with
the
understanding
and
approval
of
the
patient
and
his
family,
in
the
hope
of
lessening
his
seizures
to
some
extent.
At
operation
the
medial
surfaces
of
both
temporal
lobes
were
exposed
and
recordings
were
taken
from
both
surface
and
depth
electrodes
before
any
tissue
was
removed;
but
again
no
discrete
epileptogenic
focus
was
found.
Bilateral
resection
was
then
carried
out,
extending
posteriorly
for
a
distance
of
8
cm.
from
the
temporal
tips.
Results
The
psychiatric
findings
bearing
upon
the
treat-
ment
of
schizophrenia
have
already
been
reported
(Scoville
and
others,
1953).
Briefly,
it
was
found
that
bilateral
resections
limited
to
the
medial
portions
of
the
temporal
lobes
were
without
significant
thera-
peutic
effect
in
psychosis,
although
individual
patients
(including
the
one
with
the
most
radical
removal)
did
in
fact
show
some
improvement.
There
have
been
no
gross
changes
in
personality.
This
is
particularly
clear
in
the
case
of
the
epileptic,
non-
psychotic
patient
whose
present
cheerful
placidity
does
not
differ
appreciably
from
his
pre-operative
status
and
who,
in
the
opinion
of
his
family,
has
shown
no
personality
change.
Neurological
changes
in
the
group
have
also
been
minimal.
The
incidence
and
severity
of
seizures
in
the
epileptic
patient
were
sharply
reduced
for
the
first
year
after
operation,
and
although
he
is
once
again
having
both
major
and
minor
attacks,
these
attacks
no
longer
leave
him
stuporous,
as
they
formerly
did.
It
has
therefore
been
possible
to
reduce
his
medication
considerably.
As
far
as
general
intelligence
is
concerned,
the
epileptic
patient
has
actually
improved
slightly
since
operation,
possibly
because
he
is
less
drowsy
than
before.
The
psychotic
patients
were
for
the
most
part
too
disturbed
before
operation
for
finer
testing
of
higher
mental
functions
to
be
carried
out,
but
certainly
there
is
no
indication
of
any
general
intellectual
impairment
resulting
from
the
operation
in
those
patients
for
whom
the
appropriate
test
data
are
available.
There
has
been
one
striking
and
totally
unexpected
12
.:
.......
,.:i
,::
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LOSS
OF
RECENT
MEMORY
AFTER
BILATERAL
HIPPOCAMPAL
LESIONS
13
/
7e
\
FIG.
2.-Diagrammatic
cross-sections
of
i
A
.
-
}>i,/
\
human
brain
illustrating
extent
of
-
-
t
;
,57
^
\
attempted
bilateral
medial
temporal
-
-
-
----
--
lobe
resection
in
the
radical
operation.
.
I
-
f-
(For
diagrammatic
purposes
the
resection
has
been
shown
on
one
side
only.)
A
~
\
B
A
K,
A
C
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group.bmj.com on May 21, 2013 - Published by jnnp.bmj.comDownloaded from
WILLIAM
BEECHER
SCO
VILLE
AND
BRENDA
MILNER
FIG.
3.-Post-operative
skull
radiograph
with
silver
clip
markers
outlining
extent
of
bilateral
resections
limited
to
the
uncus
and
amygdala.
behavioural
result:
a
grave
loss
of
recent
memory
in
those
cases
in
which
the
medial
temporal-lobe
resection
was
so
extensive
as
to
involve
the
major
portion
of
the
hippocampal
complex
bilaterally.
The
psychotic
patient
having
the
most
radical
excision
(extending
8
cm.
from
the
tips
of
the
temporal
lobes
bilaterally)
has
shown
a
profound
post-operative
memory
disturbance,
but
unfortunately
this
was
not
recognized
at
the
time
because
of
her
disturbed
emotional
state.
In
the
non-psychotic
patient
the
loss
was
immediately
apparent.
After
operation
this
young
man
could
no
longer
recognize
the
hospital
staff
nor
find
his
way
to
the
bathroom,
and
he
seemed
to
recall
nothing
of
the
day-to-day
events
of
his
hospital
life.
There
was
also
a
partial
retrograde
amnesia,
inasmuch
as
he
did
not
remember
the
death
of
a
favourite
uncle
three
years
previously,
nor
anything
of
the
period
in
hospital,
yet
could
recall
some
trivial
events
that
had
occurred
just
before
his
admission
to
the
hospital.
His
early
memories
were
apparently
vivid
and
intact.
This
patient's
memory
defect
has
persisted
without
improvement
to
the
present
time,
and
numerous
illustrations
of
its
severity
could
be
given.
Ten
months
ago
the
family
moved
from
their
old
house
to
a
new
one
a
few
blocks
away
on
the
same
street;
he
still
has
not
learned
the
new
address,
though
remembering
the
old
one
perfectly,
nor
can
he
be
trusted
to
find
his
way
home
alone.
Moreover,
he
does
not
know
where
objects
in
continual
use
are
kept;
for
example,
his
mother,
still
has
to
tell
him
where
to
find
the
lawn
mower,
even
though
he
may
have
been
using
it
only
the
day
before.
She
also
states
that
he
will
do
the
same
jigsaw
puzzles
day
FIG.
4.-Post-operative
skull
radiograph
with
silver
clip
markers
outlining
the
extent
of
the
bilateral
resections
including
the
an-
terior
hippocampal
complex
(approximately
6
cm.
posterior
to
the
tip
of
the
anterior
temporal
fossa).
after
day
without
showing
any
practice
effect
and
that
he
will
read
the
same
magazines
over
and
over
again
without
finding
their
contents
familiar.
This
patient
has
even
eaten
luncheon
in
front
of
one
of
us
(B.
M.)
without
being
able
to
name,
a
mere
half-hour
later,
a
single
item of
food
he
had
eaten;
in
fact,
he
could
not
remember
having
eaten
luncheon
at
all.
Yet
to
a
casual
observer
this
man
seems
like
a
relatively
normal
individual,
since
his
understanding
and
reasoning
are
undiminished.
The
discovery
of
severe
memory
defect
in
these
two
patients
led
us
to
study
further
all
patients
in
the
temporal-lobe
series
who
were
sufficiently
co-
operative
to
permit
formal
psychological
testing.
The
operation
sample
included,
in
addition
to
the
two
radical
resections,
one
bilateral
removal
of
the
uncus,
extending
4
cm.
posterior
to
the
temporal
tips,
and
six
bilateral
medial
temporal-lobe
resections
in
which
the
removal
was
carried
back
5
or
6
cm.
to
include
also
a
portion
of
the
anterior
hippo-
campus;
in
three
of
these
six
cases
the
temporal-lobe
resection
was
combined
with
orbital
undercutting.
One
unilateral
case
was
also
studied
in
which
right
inferior
temporal
lobectomy
and
hippocampectomy
had
been
carried
out
for
the
relief
of
incisural
hemiation
due
to
malignant
oedema
(Fig.
5).
We
found
some
memory
impairment
in
all
the
bilateral
cases
in
which
the
removal
was
carried
far
enough
posteriorly
to
damage
the
hippocampus
and
hippo-
campal
gyrus,
but
in
only
one
of
these
six
additional
cases
(D.
C.)
did
the
memory
loss
equal
in
severity
that
seen
in
the
two
most
radical
excisions.
The
case
with
bilateral
excision
of
the
uncus
(in
which
the
removal
can
have
involved
only
the
amygdaloid
14
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LOSS
OF
RECENT
MEMORY
AFTER
BILATERAL
HIPPOCAMPAL
LESIONS
15
N3,.
\!T
\%
FIo.
5.-Unilateral
inferior
hori-
zontal
temporal
lobectomy
extending
a
distance
of
8
cm.
posterior
to
the
tip
of
the
anterior
temporal
fossa.
This
operation
is
performed
for
incisural
herniation
of
the
temporal
lobes
(Case
10).
and
peri-amygdaloid
areas)
showed
excellent
memory
function.
The
unilateral
operation,
extensive
as
it
was,
has
caused
no
lasting
memory
impairment,
though
some
disturbance
of
recent
memory
was
noted
in
the
early
post-operative
period
(Scoville,
1954);
we
now
attribute
this
deficit
to
temporary
interference
with
the
functioning
of
the
hippocampal
zone
of
the
opposite
hemisphere
by
contralateral
pressure.
The
histories
and
individual
test
results
for
these
10
cases
are
reported
below,
and
the
Table
sum-
marizes
the
principal
findings.
For
purposes
of
comparison
the
cases
have
been
divided
into
three
groups
representing
different
degrees
of
memory
impairment.
Group
I:
Severe
Memory
Defect
In
this
category
are
those
patients
who
since
operation
appear
to
forget
the
incidents
of
their
daily
life
as
fast
as
they
occur.
It
is
interesting
that
all
these
patients
were
able
to
retain
a
three-figure
number
or
a
pair
of
unrelated
words
for
several
minutes,
if
care
was
taken
not
to
distract
them
in
the
interval.
However,
they
forgot
the
instant
attention
was
diverted
to
a
new
topic.
Since
in
normal
life
the
focus
of
attention
is
constantly
a.
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16
WILLIAM
BEECHER
SCOVILLE
AND
BRENDA
MILNER
TABLE
CLASSIFICATION
OF
CASES
Approximate
Age
at
Bi-
Extent
of
Time
of
or
Removal
Time
Cases
Folow-
Sex
Diagnosis
Operation
Uni-
along
between
Wechsler
Scale
up
~~~~~~~~~~~lateral
Medial
Operation
(yr.)
~~~~~~~~~Temporal
and
(yr.)
~~~~~~
~~~~~~~~~
~~Lobes
Testing
Intelli-
(cm.)
(mth.)
gence
Memory
Quotient
Quotient
Group
1:
Severe
Memory
Defect
Case
1,
H.
M.
29
M
Epilepsy
Medial
temporal
B
8
20
112
67
Case
2,
D.
C.
47
M
Paranoid
Medial
temporal
and
B
5
5
21
122
70
schizophrenia
orbital
undercutting
Case
3,
M.
B.
55
F
Manic-depressive
Medial
temporal
B
8
28
78
60
psychosis
Group
II:
Moderate
Memory
Defect
Case
4,
A.
Z.
35
F
Paranoid
Medial
temporal
B
5
40
96
84
schizophrenia
Case
5,
M.
R.
40
F
Paranoid
Medial
temporal
and
B
5
39
123
81
schizophrenia
orbital
undercutting
Case
6,
A. R.
38
F
Hebephrenic
Medial
temporal
and
B
4-5
47
Incomplete
schizophrenia
orbital
undercutting
Case
7,
C.
G.
44
F
Schizophrenia
Medial
temporal
B
5-5
41
Incomplete
Case
8,
A.
L.
31
M
Schizophrenia
Medial
temporal
B
6
38
Incomplete
Group
III:
No
Memory
Defect
Case
9,
I.
S.
54
F
Paranoid
Uncectomy
B
4
53
122
125
schizophrenia
Case
10,
E.
G.
55
F
Incisural
Inferior
temporal
U-Rt.
9
16
93
90
herniation
lobectomy
changing,
such
individuals
show
an
apparently
complete
anterograde
amnesia.
This
severe
defect
was
observed
in
the
two
patients
having
the
most
radical
bilateral
medial
temporal-lobe
excisions
(with
the
posterior
limit
of
removal
approximately
8
cm.
from
the
temporal
tips)
and
in
one
other
case,
a
bilateral
5 5
cm.
medial
temporal
excision.
These
three
cases
will
now
be
described.
Case
1,
H.
M.-This
29-year-old
motor
winder,
a
high
school
graduate,
had
had
minor
seizures
since
the
age
of
10
and
major
seizures
since
the
age
of
16.
The
small
attacks
lasted
about
40
seconds,
during
which
he
would
be
unresponsive,
opening
his
mouth,
closing
his
eyes,
and
crossing
both
arms
and
legs;
but
he
believed
that
he
could
"
half
hear
what
was
going
on
".
The
major
seizures
occurred
without
warning
and
with
no
lateralizing
sign.
They
were
generalized
convulsions,
with
tongue-biting,
urinary
incontinence,
and
loss
of
consciousness
followed
by
prolonged
somnolence.
Despite
heavy
and
varied
anticonvulsant
medication
the
major
attacks
had
increased
in
frequency
and
severity
through
the
years
until
the
patient
was
quite
unable
to
work.
The
aetiology
of
this
patient's
attacks
is
not
clear.
He
was
knocked
down
by
a
bicycle
at
the
age
of
9
and
was
unconscious
for
five
minutes
afterwards,
sus-
taining
a
laceration
of
the
left
supra-orbital
region.
Later
radiological
studies,
however,
including
two
pneumo-
encephalograms,
have
been
completely
normal,
and
the
physical
examination
has
always
been
negative.
Electro-encephalographic
studies
have
consistently
failed
to
show
any
localized
epileptogenic
area.
In
the
examination
of
August
17,
1953,
Dr.
T.
W.
Liberson
described
diffuse
slow
activity
with
a
dominant
frequency
of
6
to
8
per
second.
A
short
clinical
attack
was
said
to
be
accompanied
by
generalized
2
to
3
per
second
spike-
and-wave
discharge
with
a
slight
asymmetry
in
the
central
leads
(flattening
on
the
left).
Despite
the
absence
of
any
localizing
sign,
operation
was
considered
justifiable
for
the
reasons
given
above.
On
September
1,
1953,
bilateral
medial
temporal-lobe
resection
was
carried
out,
extending
posteriorly
for
a
distance
of
8
cm.
from
the
midpoints
of
the
tips
of
the
temporal
lobes,
with
the
temporal
horns
constituting
the
lateral
edges
of
resection.
After
operation
the
patient
was
drowsy
for
a
few
days,
but
his
subsequent
recovery
was
uneventful
apart
from
the
grave
memory
loss
already
described.
There
has
been
no
neurological
deficit.
An
electro-encephalogram
taken
one
year
after
operation
showed
increased
spike-
and-wave
activity
which
was
maximal
over
the
frontal
areas
and
bilaterally
synchronous.
He
continues
to
have
seizures,
but
these
are
less
incapacitating
than
before.
Psychological
Examination.-This
was
performed
on
April
26,
1955.
The
memory
defect
was
immediately
apparent.
The
patient
gave
the
date
as
March,
1953,
and
his
age
as
27.
Just
before
coming
into
the
examining
room
he
had
been
talking
to
Dr.
Karl
Pribram,
yet
he
had
no
recollection
of
this
at
all
and
denied
that
anyone
had
spoken
to
him.
In
conversation,
he
reverted
con-
stantly
to
boyhood
events
and
seemed
scarcely
to
realize
that
he
had
had
an
operation.
On
formal
testing
the
contrast
between
his
good
general
intelligence
and
his
defective
memory
was
most
striking.
On
the
Wechsler-Bellevue
Intelligence
Scale
he
achieved
a
full-scale
I.Q.
rating
of
112,
which
compares
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RECENT
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AFTER
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HIPPOCAMPAL
LESIONS
17
favourably
with
the
pre-operative
rating
of
104
reported
by
Dr.
Liselotte
Fischer
in
August,
1953,
the
improvement
in
arithmetic
being
particularly
striking.
An
extensive
test
battery
failed
to
reveal
any
deficits
in
perception,
abstract
thinking,
or
reasoning
ability,
and
his
motivation
remained
excellent
throughout.
On
the
Wechsler
Memory
Scale
(Wechsler,
1945)
his
immediate
recall
of
stories
and
drawings
fell
far
below
the
average
level
and
on
the
"
associate
learning
"
subtest
of
this
scale
he
obtained
zero
scores
for
the
hard
word
associations,
low
scores
for
the
easy
associations,
and
failed
to
improve
with
repeated
practice.
These
findings
are
reflected
in
the
low
memory
quotient
of
67.
More-
over,
on
all
tests
we
found
that
once
he
had
turned
to
a
new
task
the
nature
of
the
preceding
one
could
no
longer
be
recalled,
nor
the
test
recognized
if
repeated.
In
summary,
this
patient
appears
to
have
a
complete
loss
of
memory
for
events
subsequent
to
bilateral
medial
temporal-lobe
resection
19
months
before,
together
with
a
partial
retrograde
amnesia
for
the
three
years
leading
up
to
his
operation;
but
early
memories
are
seemingly
normal
and
there
is
no
impairment
of
personality
or
general
intelligence.
Case
2,
D.
C.-This
47-year-old
doctor
was
a
paranoid
schizophrenic
with
a
four-year
history
of
violent,
com-
bative
behaviour.
Before
his
illness
he
had
been
prac-
tising
medicine
in
Chicago,
but
he
had
always
shown
paranoid
trends
and
for
this
reason
had
had
difficulty
completing
his
medical
training.
His
breakdown
followed
the
loss
of
a
lawsuit
in
1950,
at
which
time
he
made
a
homicidal
attack
on
his
wife
which
led
to
his
admission
to
hospital.
Since
then
both
insulin
and
electro-shock
therapy
had
been
tried
without
benefit
and
the
prognosis
was
considered
extremely
poor.
On
May
13,
1954,
at
the
request
of
Dr.
Frederick
Gibbs
and
Dr.
John
Kendrick,
a
bilateral
medial
temporal-lobe
resection
combined
with
orbital
undercutting
was
carried
out
at
Manteno
State
Hospital
(W.
B.
S.,
with
the
assistance
of
Dr.
John
Kendrick).
The
posterior
limit
of
the
removal
was
5
cm.
from
the
sphenoid
ridge,
or
roughly
5-5
cm.
from
the
tips
of
the
temporal
lobes,
with
the
inferior
horns
of
the
ventricles
forming
the
lateral
edges
of
resection.
Record-
ing
from
depth
electrodes
at
the
time
of
operation
showed
spiking
from
the
medial
temporal
regions
bilaterally
with
some
spread
to
the
orbital
surfaces
of
both
frontal
lobes,
but
after
the
removal
had
been
completed
a
normal
electro-encephalographic
record
was
obtained
from
the
borders
of
the
excision.
Post-operative
recovery
was
uneventful
and
there
has
been
no
neurological
deficit.
Since
operation
the
patient
has
been
outwardly
friendly
and
tractable
with
no
return
of
his
former
aggressive
behaviour,
although
the
para-
noid
thought
content
persists;
he
is
considered
markedly
improved.
But
he
too
shows
a
profound
memory
dis-
turbance.
At
Manteno
State
Hospital
he
was
described
as
"
confused
",
because
since
the
operation
he
had
been
unable
to
find
his
way
to
bed
and
seemed
no
longer
to
recognize
the
hospital
staff.
However,
no
psychological
examination
was
made
there,
and
on
November
29,
1955,
he
was
transferred
to
Galesburg
State
Research
Institute
where
he
was
interviewed
by
one
of
us
(B.
M.)
on
January
12,
1956.
Psychological
Findings.-This
patient
presented
exactly
the
same
pattern
of
memory
loss
as
H.
M.
He
was
cour-
teous
and
cooperative
throughout
the
examination,
and
the
full-scale
Wechsler
I.Q.
rating
of
122
showed
him
to
be
still
of
superior
intellect.
Yet
he
had
no
idea
where
he
was,
explaining
that
naturally
the
surroundings
were
quite
unfamiliar
because
he
had
only
arrived
there
for
the
first
time
the
night
before.
(In
fact,
he
had
been
there
six
weeks.)
He
was
unable
to
learn
either
the
name
of
the
hospital
or
the
name
of
the
examiner,
despite
being
told
them
repeatedly.
Each
time
he
received
the
information
as
something
new,
and
a
moment
later
would
deny
having
heard
it.
At
the
examiner's
request
he
drew
a
dog
and
an
elephant,
yet
half
an
hour
later
did
not
even
recognize
them
as
his
own
drawings.
On
the
formal
tests
of
the
Wechsler
Memory
Scale
his
immediate
recall
of
stories
and
drawings
was
poor,
and
the
memory
quotient
of
70
is
in
sharp
contrast
to
the
high
I.Q.
level.
As
with
H.
M.,
once
a
new
task
was
introduced
there
was
total
amnesia
for
the
preceding
one;
in
his
own
words,
the
change
of
topic
confused
him.
This
man
did
not
know
that
he
had had
a
brain
operation
and
did
not
recall
being
at
Manteno
State
Hospital,
although
he
had
spent
six
months
there
before
the
operation
as
well
as
six
months
post-operatively.
Yet
he
could
give
minute
details
of
his
early
life
and
medical
training
(accurately,
as
far
as
we
could
tell).
Case
3,
M.
B.-This
55-year-old
manic
depressive
woman,
a
former
clerical
worker,
was
admitted
to
Connecticut
State
Hospital
on
December
27,
1951,
at
which
time
she
was
described
as
anxious,
irritable,
argu-
mentative,
and
restless,
but
well-orientated
in
all
spheres.
Her
recent
memory
was
normal,
in
that
she
knew
how
long
she
had
been
living
in
Connecticut
and
could
give
the
date
of
her
hospital
admission
and
the
exact
times
of
various
clinic
appointments.
On
December
18,
1952,
a
radical
bilateral
medial
temporal-lobe
resection
was
carried
out,
with
the
posterior
limit
of
removal
8
cm.
from
the
temporal
tips.
Post-operatively
she
was
stupor-
ous
and
confused
for
one
week,
but
then
recovered
rapidly
and
without
neurological
deficit.
She
has
become
neater
and
more
even-tempered
and
is
held
to
be
greatly
improved.
However,
psychological
testing
by
Mr.
1.
Borganz
in
November,
1953,
revealed
a
grave
impair-
ment
of
recent
memory;
she
gave
the
year
as
1950
and
appeared
to
recall
nothing
of
the
events
of
the
last
three
years.
Yet
her
verbal
intelligence
proved
to
be
normal.
She
was
examined
briefly
by
B.
M.
in
April,
1955,
at
which
time
she
showed
a
global
loss
of
recent
memory
similar
to
that
of
H.
M.
and
D.
C.
She
had
been
brought
to
the
examining
room
from
another
building,
but
had
already
forgotten
this;
nor
could
she
describe
any
other
part
of
the
hospital
although
she
had
been
living
there
continuously
for
nearly
three
and
a
half
years.
On
the
Wechsler
Memory
Scale
her
immediate
recall
of
stories
and
drawings
was
inaccurate
and
fragmentary,
and
delayed
recall
was
impossible
for
her
even
with
prompt-
ing;
when
the
material
was
presented
again
she
failed
to
recognize
it.
Her
conversation
centred
around
her
early
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life
and
she
was
unable
to
give
any
information
about
the
years
of
her
hospital
stay.
Vocabulary,
attention
span,
and
comprehension
were
normal,
thus
confirming
Mr.
Borganz'
findings.
Group
II:
Moderately
Severe
Memory
Defect
In
this
second
category
are
those
patients
who
can
be
shown
to
re-
some
impression
of
new
places
and
events,
alth.
.gi
they
are
unable
to
learn
such
arbitrary
new
associations
as
people's
names
and
cannot
be
depended
upon
to
carry
out
commissions.
Subjectively,
these
patients
complain
of
memory
difficulty,
and
objectively,
on
formal
tests,
they
do
very
poorly
irrespective
of
the
type
of
material
to
be
memorized.
'The
five
remaining
patients
with
bilateral
medial
temporal-lobe
removals
extending
5
or
6
cm.
posteriorly
from
the
temporal
tips
make
up
this
group.
Only
two
of
these
patients
were
well
enough
to
permit
thorough
testing,
but
in
all
five
cases
enough
data
were
obtained
to
establish
that
the
patient
did
have
a
memory
defect
and
that
it
was
not
of
the
gross
type
seen
in
Group
I.
The
individual
cases
are
reported
below.
Case
4,
A.
Z.-This
35-year-old
woman,
a
paranoid
schizophrenic,
had
been
in
Cor
<
icut
State
Hospital
for
three
years
and
extensiv
o-shock
therapy
had
been
tried
without
lasting
be
''-'She
was
described
as
tense,
assaultative,
and
se
Ay
preoccupied.
On
November
29,
1951,
bilatc
A
medial
temporal-lobe
resection
was
carried
out
under
local
anaesthesia,
the
posterior
limit
of
the
removal
being
approximately
5
cm.
from
the
tips
of
the
temporal
robes.
During
subpial
resection
of
the
right
hippocanv-al
cortex
the
surgeon
inadvertently
went
through
the
arachnoid
and
injured
by
suction
a
portion
of
the
right
peduncle,
geniculate,
or
hypothalamic
region
with
immediate
development
of
deep
coma.
The
injury
was
visualized
by
extra-arachnoid
inspection.
Post-operatively
the
patient
remained
in
stupor
for
72
hours
and
exhibited
a
left
spastic
hemi-
plegia,
contracted
fixed
pupils,
strabismus,
and
lateral
nystagmus
of
the
right
eye;
vital
signs
remained
constant
and
within
normal
limits.
She
slowly
recovered
the
use
of
the
left
arm
and
leg
and
her
lethargy
gradually
dis-
appeared.
By
the
seventh
post-operative
day
she
could
walk
without
support
and
pupillary
responses
had
returned
to
normal.
The
only
residual
neurological
deficit
has
been
a
left
homonymous
hemianopia.
Of
particular
interest
was
the
dramatic
post-operative
im-
provement
in
her
psychotic
state
with
an
early
complete
remission
of
her
delusions,
anxiety,
and
paranoid
be-
haviour.
At
the
same
time
she
showed
a
retrograde
amnesia
for
the
entire
period
of
her
illness.
This
patient
was
discharged
from
the
hospital
nine
months
after
operation
and
is
now
able
to
earn
her
living
as
a
domestic
worker.
However,
she
complains
that
her
memory
is
poor,
and
psychological
examination
(April
27,
1955)
three
and
a
half
years
post-operatively
confirms
this.
But
the
deficit
is
less
striking
than
in
the
three
cases
reported
above.
This
patient,
for
example,
was
able
to
give
the
address
of
the
house
where
she
worked
although
she
had
been
there
only
two
days,
and
she
could
even
describe
the
furnishings
in
some
detail
although
she
had
not
yet
learned
the
name
of
her
employer.
She
was
also
able
to
give
an
accurate,
though
sketchy,
description
of
a
doctor
who
had
spoken
to
her
briefly
that
morning
and
whom
she
had
never
seen
before.
However,
she
could
recall
very
little
of
the
conversation.
Formal
testing
at
this
time
showed
her
intelligence
to
lie
within
the
average
range
with
no
impairment
of
atten-
tion
or
concentration.
The
Wechsler-Bellevue
I.Q.
rating
was
96.
On
the
Wechsler
Memory
Scale
her
immediate
recall
of
stories
was
normal,
but
passing
from
one
story
to
the
next
was
enough
to
make
her
unable
to
recall
the
first
one,
though
a
few
fragments
could
be
recovered
with
judicious
prompting.
She
showed
the
same
rapid
forget-
ting
on
the
"
visual
retention"
subtest,
indicating
that
the
memory
impairment
was
not
specific
to
verbal
material.
Finally,
she
was
conspicuously
unsuccessful
on
the
"associate
learning
"
subtest,
failing
to
master
a
single
unfamiliar
word
association.
This
examination
as
a
whole
provides
clear
evidence
of
an
impairment
of
recent
memory.
Case
5,
M.
R.-This
40-year-old
woman,
a
paranoid
schizophrenic
with
superimposed
alcoholism,
had
been
a
patient
at
Norwich
State
Hospital
for
11
years,
receiving
extensive
electro-shock
therapy.
Bilateral
medial
tem-
poral-lobe
resection
combined
with
orbital
undercutting
was
carried
out
on
January
17,
1952,
the
posterior
extent
of
removal
being
roughly
5
cm.
from
the
temporal
tips.
The
patient
has
shown
complete
remission
of
psychotic
symptoms
and
was
discharged
from
the
hospital
on
September
16,
1954,
to
the
care
of
her
family.
Psychological
Examination.-This
was
performed
on
April
29,
1955.
Tests
showed
this
woman
to
be
of
superior
intelligence,
with
a
full-scale
I.Q.
rating
of
123
on
the
Wechsler
Scale.
However,
she
complained
of
poor
memory,
adding
that
she
could
remember
faces
and
"
the
things
that
are
important
",
but
that,
to
her
great
em-
barrassment,
she
forgot
many
ordinary
daily
happenings.
Upon
questioning
she
gave
the
year
correctly
but
did
not
know
the
month
or
the
day.
She
knew
that
she
had
had
an
operation
in
1952
but
did
not
recognize
the
surgeon
(W.
B.
S.)
nor
recall
his
name.
Formal
testing
revealed
the
same
pattern
of
memory
disturbance
as
A.
Z.
had
shown,
and
the
memory
quotient
of
81
com-
pares
most
unfavourably
with
the
high
I.Q.
rating.
In
conversation,
she
reverted
constantly
to
discussion
of
her
work
during
the
years
of
depression
and
showed
little
knowledge
of
recent
events.
Case
6,
A.
R.-This
38-year-old
woman
had
been
in
hospital
for
five
years
with
a
diagnosis
of
hebephrenic
schizophrenia.
Before
operation
she
was
said
to
be
noisy,
combative,
and
suspicious,
and
electro-shock
therapy
had
caused
only
transient
improvement
in
this
condition.
On
May
31,
1951,bilateral
medial
temporal-lobe
resection
combined
with
orbital
undercutting
was
carried
out,
the
posterior
limit
of
removal
being
slightly
less
than
5
cm.
from
the
bisected
tips
of
the
temporal
lobes.
After
operation
the
patient
gradually
became
quieter
and
more
18
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LOSS
OF
RECENT
MEMORY
AFTER
BILATERAL
HIPPOCAMPAL
LESIONS
19
cooperative
and
on
September
29,
1952,
she
was
dis-
charged
to
her
home.
There
have
been
no
neurological
sequelae.
Psychological
Examination.-This
was
performed
in
April,
1955.
Examination
revealed
a
hyperactive
woman,
too
excited
and
talkative
for
prolonged
testing.
She
showed
a
restricted
span
of
attention
but
scores
on
verbal
intelligence
tests
were
within
the
dull
normal
range.
Moreover,
she
appeared
to
recall
some
recent
happenings
quite
well.
Thus,
she
knew
that
her
daughter
had
caught
a
7
o'clock
train
to
New
York
City
that
morning
to
buy
a
dress
for
a
wedding
the
following
Saturday.
She
could
also
describe
the
clothes
worn
by
the
secretary
who
had
shown
her
into
the
office.
However,
on
formal
testing
some
impairment
of
recent
memory
was
seen,
although
unlike
the
other
patients
in
this
group
she
did
succeed
on
some
of
the
difficult
items
of
the
"
associate
learning
"
test.
As
with
A.
Z.
and
M.
R.,
the
deficit
appeared
most
clearly
on
tests
of
delayed
recall
after
a
brief
interval
filled
with
some
other
activity.
Thus,
on
the
"
logical
memory
"
test
she
gave
an
adequate
version
of
each
story
immediately
after
hearing
it,
but
passing
from
one
story
to
the
next
caused
her
to
forget
the
first
almost
com-
pletely;
similar
results
were
obtained
for
the
recall
of
drawings.
We
conclude
that
this
patient
has
a
memory
impairment
identical
in
type
to
that
of
the
other
patients
in
this
group,
but
somewhat
milder.
It
is
interesting
that
she
had
a
relatively
small
excision.
Case
7,
C.
G.-This
44-year-old
schizophrenic
woman
had
been
in
the
hospital
for
20
years
without
showing
any
improvement
in
her
psychosis.
On
November
19,
1951,
bilateral
medial
temporal-lobe
resection
was
carried
out
under
local
anaesthesia,
the
posterior
limit
of
removal
being
5-5
cm.
from
the
tips
of
the
temporal
lobes.
There
was
temporary
loss
of
consciousness
during
the
resection
but
the
patient
was
fully
conscious
at
the
end
of
the
procedure
and
post-operative
recovery
was
uneventful.
There
has
been
no
neurological
deficit.
She
is
considered
to
be
in
better
contact
than
before
but
more
forgetful.
This
patient
was
examined
at
Norwich
State
Hospital
in
April,
1955,
and
although
she
was
too
distractible
for
prolonged
testing,
it
was
possible to
show
that
she
re-
membered
some
recent
events.
For
example,
she
knew
that
she
had
been
working
in
the
hospital
beauty
parlour
for
the
past
week
and
that
she
had
been
washing
towels
that
morning.
Yet
formal
memory
testing
revealed
the
same
deficit
as
that
shown
by
A.
Z.
and
M.
R.,
though
less
extensive
data
were
obtained
in
this
case.
Case
8,
A.
L.-This
31-year-old
schizophrenic
man
had
been
a
patient
at
Norwich
State
Hospital
since
October,
1950.
He
had
first
become
ill
in
August,
1950,
demonstrating
a
catatonic
type
of
schizophrenia
with
auditory
and
visual
hallucinations.
On
January
31,
1952,
bilateral
medial
temporal-lobe
resection
combined
with
orbital
undercutting
was
carried
out,
the
removal
extend-
ing
posteriorly
for
a
distance
of
6
cm.
along
the
mesial
surface
of
the
temporal
lobes.
Recovery
was
uneventful
and
no
neurological
deficit
ensued.
The
patient
has
been
more
tractable
since
the
operation
but
he
is
still
subject
to
delusions
and
hallucinations.
He
is
said
to
have
a
memory
defect.
When
interviewed
by
B.
M.
in
April,
1955,
he
was
found
to
be
too
out
of
contact
for
extensive
formal
testing.
However,
he
was
able
to
recall
the
exami-
ner'
s
name
and
place
of
origin
10
minutes
after
hearing
them
for
the
first
time,
and
this
despite
the
fact
that
the
interval
had
been
occupied
with
other
tasks.
He
could
also
recognize
objects
which
had
been
shown
to
him
earlier
in
the
interview,
selecting'
,-m
correctly
from
others
which
he
had
not
seen
befc
But
his
immediate
recall
of
drawings
and
stories
was
"aulty
and
these
were
forgotten
completely
once
his
attention
was
directed
to
a
new
topic.
In
this
patient
we
stress
the
negative
findings:
despite
his
evident
psychosis
he
did
not
show
the
severe
memory
loss
typical
of
the
patients
in
Group
1.
Yet
the
brief
psychological
examination
and
the
hospital
record
both
indicate
some
impairment
of
recent
memory,
though
no
reliable
quantitative
studies
could
be
made.
Group
III:
No
Persistent
Memory
Defect
Case
9,
I.
S.-This
54-year-old
woman
had
a
20-year
history
of
paranoid
schizophrenia,
with
auditory
hallu-
cinations
and
marked
emotional
lability.
She
had
attempted
suicide
on
several
occasions.
On
November
16,
1950,
six
months
after
admission
to
a
state
hospital,
a
bilateral
medial
temporal
lobectomy
was
carried
out
under
local
anaesth
.ia
with
sectioning
of
the
tips
of
the
temporal
lobes
and
suction
removal
of
the
medial
portion,
extending
)
cm.
to
include
the
uncus
and
amygdala.
Thus
thiu
a
conservative
bilateral
re-
moval,
sparing
the
hipj.
ampal
region.
The
operation
was
complicated
by
acciJ1ental
damage
to
the
midbrain
from
the
electrocautery,
causing
the
patient
to
give
a
convulsive
twitch
wi.:ch
was
followed
by
coma
and
extensive
rigidity.
After
operation
she
was
somnolent
for
a
time
with
continuing
rigidity,
more
marked
on
the
left
side
than
on
the
right.
Vital
signs
were
normal.
She
required
traction
to
prevent
flexure
spasm
contractures.
There
was
slow
improvement
over
the
ensuing
two
months,
with
some
residual
clumsiness
and
spasticity
of
gait.
For
a
time
the
patient's
mental
state
was
worse
than
before
operation,
but
within
three
months
she
had
improved
markedly,
with
increased
gentleness,
diminished
auditory
hallucinations,
and
no
depression.
She
ulti-
mately
showed
the
best
result
of
all
the
cases
in
this
series
and
was
discharged
from
the
hospital
five
months
after
operation.
This
patient
was
re-examined
on
May
11,
1956.
She
shows
a
complete
remission
of
her
former
psychotic
behaviour
and
is
living
at
home
with
her
husband
and
leading
a
normal
social
life.
Her
hallucinations
have
ceased.
Upon
neurological
examination
she
shows
some
25%
residual
deficit,
manifested
chiefly
by
spastic
in-
coordination
of
gait
and
similar
but
less
marked
inco-
ordination
of
the
arms.
The
deep
leg
reflexes
are
increased
to
near
clonus,
but
there
is
no
Babinski
sign.
Arm
reflexes
are
moderately
increased
and
abdominal
reflexes
absent.
Smell
is
completely
lost
but
all
other
sense
modalities
are
intact
and
other
cranial
nerves
normal.
Psychological
Findings.-The
patient
was
examined
psychologically
in
April,
1955.
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the
standpoint
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WILLIAM
BEECHER
SCOVILLE
AND
BRENDA
MILNER
memory,
this
patient
presents
a
complete
contrast
to
the
cases
reported
above,
obtaining
excellent
scores
for
both
immediate
and
delayed
recall
of
stories,
drawings,
and
word
associations,
and
describing
accurately
episodes
from
the
relatively
early
post-operative
period.
The
memory
quotient
of
125
is
consistent
with
the
I.Q.
level
of
122,
and
both
would
be
classed
as
superior.
This
is
so
despite
prolonged
psychosis,
intensive
electro-shock
therapy,
and
brain-stem
damage
of
undetermined
extent.
Case
10,
E.
G.-This
55-year-old
woman
developed
malignant
oedema
after
removal
of
a
huge,
saddle-type
meningioma
from
the
right
sphenoid
ridge;
the
pupils
were
dilated,
she
lost
consciousness,
and
vital
signs
began
to
fail.
A
diagnosis
of
incisural
hippocampal
herniation
was
made,
and,
as
a
life-saving
measure,
unilateral
non-
dominant
inferior
temporal
lobectomy
was
carried
out,
with
deliberate
resection
of
the
hippocampus
and
hippo-
campal
gyrus
to
a
distance
of 9
cm.
from
the
tip
of
the
temporal
lobe.
(The
operative
procedure
is
illustrated
in
Fig.
5.)
Vital
signs
improved
immediately
and
con-
sciousness
gradually
returned,
but
for
a
few
weeks
the
patient
showed
a
disturbance
of
recent
memory
resembling
that
seen
in
our
bilateral
cases.
However,
follow-up
studies
in
April,
1955,
16
months
after
operation,
showed
no
residual
memory
loss.
Both
immediate
and
delayed
recall
were
normal
and
the
memory
quotient
of
90
was
completely
consistent
with
the
I.Q.
level
of
93.
Neuro-
logical
examination
at
this
time
showed
a
left
homony-
mous
visual
field
defect
with
macular
sparing
but
no
other
deficit.
Discussion
The
findings
in
these
10
cases
point
to
the
impor-
tance
of
the
hippocampal
region
for
normal
memory
function.
All
patients
in
this
series
having
bilateral
medial
temporal-lobe
resections
extensive
enough
to
damage
portions
of
the
hippocampus
and
hippo-
campal
gyrus
bilaterally
have
shown
a
clear
and
persistent
disturbance
of
recent
memory,
and
in
the
two
most
radical
excisions
(in
which
the
posterior
limit
of
removal
was
at
least
8
cm.
from
the
temporal
tips)
the
deficit
has
been
particularly
severe,
with
no
improvement
in
the
two
or
more
years
which
have
elapsed
since
operation.
These
observations
suggest
a
positive
relationship
between
the
extent
of
destruc-
tion
to
the
hippocampal
complex
specifically
and
the
degree
of
memory
impairment.
The
correlation
is
not
perfect,
since
D.
C.,
who
had
only
a
5-5
cm.
removal,
showed
as
much
deficit
as
did
the
two
cases
of
most
radical
excision.
Moreover,
in
the
absence
of
necropsy
material
we
cannot
be
sure
of
the
exact
area
removed.
In
all
these
hippocampal
resections
the
uncus
and
amygdala
have
also
of
course
been
destroyed.
Never-
theless
the
importance
of
the
amygdaloid
and
peri-
amygdaloid
region
for
memory
mechanisms
is
open
to
question,
considering
the
total
lack
of
memory
impairment
in
the
bilateral
uncectomy
case
(I.
S.),
in
which
a
4
cm.
medial-temporal
lobe
removal
was
made.
But
not
enough
is
known
of
the
effects
of
lesions
restricted
to
the
hippocampal
area
itself
to
permit
assessment
of
the
relative
contributions
of
these
two
regions.
This
is
a
question
on
which
selective
ablation
studies
in
animals
could
well
shed
important
light,
but
unfortunately
the
crucial
ex-
periments
have
yet
to
be
done
(Jasper,
Gloor,
and
Milner,
1956).
The
role
of
the
hippocampus
specifically
has
been
discussed
in
some
clinical
studies.
Glees
and
Griffith
(1952)
put
forward
the
view
that
bilateral
destruction
of
the
hippocampus
in
man
causes
recent-
memory
loss
and
mental
confusion,
citing
in
support
of
this
a
somewhat
unconvincing
case
of
Grunthal
(1947)
and
also
a
case
of
their
own
in
which
the
hippocampus,
the
hippocampal
and
fusiform
gyri,
and
75%
of
the
fornix
fibres
had
been
destroyed
bilaterally
by
vascular
lesion,
but
in
which
the
rest
of
the
brain
appeared
normal
at
necropsy.
In-
terestingly
enough,
the
amygdaloid
nuclei
were
found
to
be
intact
as
were
the
mamillary
bodies.
This
patient
showed
marked
anterograde
and
retrograde
amnesia.
More
recently
Milner
and
Penfield
(1955)
have
described
a
memory
loss
similar
in
all
respects
to
that
shown
by
our
patients,
in
two
cases
of
unilateral
partial
temporal
lobectomy
in
the
dominant
hemi-
sphere.
In
one
case
the
removal
was
carried
out
in
two
stages
separated
by
a
five-year
interval,
and
the
memory
loss
followed
the
second
operation
only,
at
which
time
the
uncus,
hippocampus,
and
hippo-
campal
gyrus
alone
were
excised.
Although
these
authors
had
carried
out
careful
psychological
testing
in
over
90
other
cases
of
similar
unilateral
operation,
only
in
these
two
cases
was
a
general
memory
loss
found.
To
account
for
the
unusual
deficit,
they
have
assumed
that there
was
in
each
case
a
pre-operatively
unsuspected,
but
more
or
less
completely
destructive
lesion
of
the
hippocampal
area
of
the
opposite
hemi-
sphere.
The
unilateral
operation
would
then
deprive
the
patient
of
hippocampal
function
bilaterally,
thus
causing
memory
loss.
The
present
study
provides
strong
support
for
this
interpretation.
Memory
loss
after
partial
bilateral
temporal
lobectomy
has
been
reported
by
Petit-Dutaillis,
Christophe,
Pertuiset,
Dreyfus-Brisac,
and
Blanc
(1954)
but
in
their
patient
the
deficit
was
a
transient
one,
a
finding
which
led
these
authors
to
question
the
primary
importance
of
the
temporal
lobes
for
memory
function.
However,
their
temporal
lobe
removals
were
complementary
to
ours
in
that
they
destroyed
the
lateral
neocortex
bilaterally
but
spared
the
hippocampal
gyrus
on
the
right
and
the
uncus
and
hippocampus
on
the
left.
It
therefore
seems
likely
that
the
memory
loss
was
due
to
temporary
20
group.bmj.com on May 21, 2013 - Published by jnnp.bmj.comDownloaded from
LOSS
OF
RECENT
MEMORY
AFTER
BILATERAL
HIPPOCAMPAL
LESIONS
21
interference
with
the
functioning
of
the
hippocampal
system,
which
later
recovered.
We
have
stated
that
the
loss
seen
in
patients
with
bilateral
hippocampal
lesions
is
curiously
specific
to
the
domain
of
recent
memory;
neither
in
our
cases
nor
in
those
of
Milner
and
Penfield
was
there
any
deterioration
in
intellect
or
personality
as
a
result
of
hippocampal
resection.
It
appears
important
to
emphasize
this,
since
Terzian
and
Dalle
Orc
(1955)
have
described
gross
behavioural
changes
(affecting
memory,
perception,
and
sexual
behaviour)
after
bilateral
temporal
lobectomy
in
man;
they
consider
these
changes
comparable
to
Kluver
and
Bucy's
(1939)
findings
after
radical
bilateral
temporal
lobec-
tomy
in
the
monkey.
But
Terzian
and
Ore
included
not
only
the
uncal
and
hippocampal
areas,
but
also
the
lateral
temporal
cortex
in
their
bilateral
removal.
In
contrast
to
the
grossly
deteriorated
picture
they
describe,
we
find
that
bilateral
resections
limited
to
the
mesial
temporal
region
cause
no
perceptual
dis-
turbance,
even
on
visual
tests
known
to
be
sensitive
to
unilateral
lesions
of
the
temporal
neocortex
(Milner,
1954).
The
findings
reported
herein
have
led
us
to
attribute
a
special
importance
to
the
anterior
hippo-
campus
and
hippocampal
gyrus
in
the
retention
of
new
experience.
But
the
hippocampus
has
a
strong
and
orderly
projection
to
the
mamillary
bodies
(Simpson,
1952),
and
as
early
as
1928
Gamper
claimed
that
lesions
of
the
mamillary
bodies
were
commonly
found
in
amnesic
states
of
the
Korsakoff
type.
Moreover,
Williams
and
Pennybacker
(1954)
have
carried
out
careful
psychological
studies
of
180
patients
with
verified
intracranial
lesions
and
find
that
a
specific
deficit
in
recent
memory
is
most
likely
to
occur
when
the
lesion
involves
the
ma-
millary
region.
It
is
possible,
then,
that
when
we
have
two
interrelated
structures
(hippocampus
and
ma-
millary
bodies)
damage
to
either
can
cause
memory
loss,
a
point
which
has
been
emphasized
by
Jasper
and
others
(1956).
In
view
of
these
findings
it
is
interesting
that
sectioning
the
fornix
bilaterally,
and
thereby
interrupting
the
descending
fibres
from
the
hippocampus,
appears
to
have
little
effect
on
be-
haviour
(Dott,
1938;
Garcia
Bengochea,
De
la
Torre,
Esquivel,
Vieta,
and
Fernandez,
1954),
though
a
transient
memory
deficit
is
sometimes
seen
(Garcia
Bengochea,
1955).
To
conclude,
the
observations
reported
herein
demonstrate
the
deleterious
effect
of
bilateral
sur-
gical
lesions
of
the
hippocampus
and
hippocampal
gyrus
on
recent
memory.
The
relationship
between
this
region
and
the
overlying
neocortex
in
the
tem-
poral
lobe
needs
further
elucidation,
as
does
its
relationship
to
deeper-lying
structures.
Summary
Bilateral
medial
temporal-lobe
resection
in
man
results
in
a
persistent
impairment
of
recent
memory
whenever
the
removal
is
carried
far
enough
pos-
teriorly
to
damage
portions
of
the
anterior
hippo-
campus
and
hippocampal
gyrus.
This
conclusion
is
based
on
formal
psychological
testing
of
nine
cases
(eight
psychotic
and
one
epileptic)
carried
out
from
one
and
one-half
to
four
years
after
operation.
The
degree
of
memory
loss
appears
to
depend
on
the
extent
of
hippocampal
removal.
In
two
cases
in
which
bilateral
resection
was
carried
to
a
distance
of
8
cm.
posterior
to
the
temporal
tips
the
loss
was
particularly
severe.
Removal
of
only
the
uncus
and
amygdala
bilater-
ally
does
not
appear
to
cause
memory
impairment.
A
case
of
unilateral
inferior
temporal
lobectomy
with
radical
posterior
extension
to
include
the
major
portion
of
the
hippocampus
and
hippocampal
gyrus
showed
no
lasting
memory
loss.
This
is
consistent
with
Milner
and
Penfield's
negative
findings
in
a
long
series
of
unilateral
removals
for
temporal-lobe
epilepsy.
The
memory
loss
in
these
cases
of
medial
tem-
poral-lobe
excision
involved
both
anterograde
and
some
retrograde
amnesia,
but
left
early
memories
and
technical
skills
intact.
There
was
no
deteriora-
tion
in
personality
or
general
intelligence,
and
no
complex
perceptual
disturbance
such
as
is
seen
after
a
more
complete
bilateral
temporal
lobectomy.
It
is
concluded
that
the
anterior
hippocampus
and
hippocampal
gyrus,
either
separately
or
together,
are
critically
concerned
in
the
retention
of
current
experience.
It
is
not
known
whether
the
amygdala
plays
any
part
in
this
mechanism,
since
the
hippo-
campal
complex
has
not
been
removed
alone,
but
always
together
with
uncus
and
amygdala.
REFERENCES
Dott,
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Clark,
W.
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Dott,
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The
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Dtsch.
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122.
Garcia
Bengochea,
F.
(1955).
Personal
Communication.
De
La
Torre,
O.,
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and
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C.
(1954).
Trans.
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Pepe,
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doi: 10.1136/jnnp.20.1.11
1957 20: 11-21J Neurol Neurosurg Psychiatry
William Beecher Scoville and Brenda Milner
HIPPOCAMPAL LESIONS
AFTER BILATERAL
LOSS OF RECENT MEMORY
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Discussion

Can someone explain this "of course" in "In all these hippocampal resections the uncus and amygdala have also of course been destroyed"? Lobotomies were traditionally performed on schizophrenia patients, not epileptic patients. This surgery was an experimental surgery both because of the patient (epileptic), and because of the different techniques/approach that Scoville employed. "There has been one striking and totally unexpected behavioral result: a grave loss of recent memory in those cases in which the medial temporal-lobe resection was so extensive as to involve the major portion of thee hippocampal complex bilaterally.” Case #1, H.M. is one of the most famous patients in the history of neuroscience. The Wechsler Memory Scale (WMS) is a neuropsychological test designed to measure different memory functions in a person. Anyone ages 16 to 90 is eligible to take this test.  There is clear evidence that the WMS differentiates clinical groups (such as those with dementias or neurological disorders) from those with normal memory functioning and that the primary index scores can distinguish among the memory-impaired clinical groups The Wechhsler Memory Scale was published by Wechsler in 1945 and revised in 1987, 1997, and again in 2009. Source: https://en.wikipedia.org/wiki/Wechsler_Memory_Scale The medial temporal lobes are crucial to episodic memory. Amnesia patients with bilateral damage to the medial temporal lobes are unable to remember specific past episodes or to learn new ones. Source: https://www.sciencedirect.com/topics/medicine-and-dentistry/medial-temporal-lobe "In summary, this patient appears to have a complete loss of memory for events subsequent to bilateral medial temporal-lobe resection 19 months before, together with a partial retrograde amnesia for the three years leading up to his operation; but early memories are seemingly normal and there is no impairment of personality or general intelligence." "H.M.’s brain was kept at University of California, San Diego where it was sliced into histological sections on December 4, 2009. It was later moved to The M.I.N.D. Institute at UC Davis. The brain atlas constructed was made publicly available in 2014. Imaging of Molaison's brain in the late 1990s revealed the extent of damage was more widespread than previous theories had accounted for, making it very hard to identify any one particular region or even isolated set of regions that were responsible for HM's deficits. In January 2014, researchers found, to their surprise, that half of H.M.'s hippocampus had survived the 1953 surgery, which has deep implications on past and future interpretations of H.M.'s neurobehavioral profile and of the previous literature describing H.M. as a 'pure' hippocampus lesion patient.” Source: https://en.wikipedia.org/wiki/Henry_Molaison A lobotomy, or leucotomy, is a form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex. Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed. The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the "discovery of the therapeutic value of leucotomy in certain psychoses",although the awarding of the prize has been subject to controversy. The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States and proportionally more in the United Kingdom. The majority of lobotomies were performed on women; a 1951 study of American hospitals found nearly 60% of lobotomy patients were women; limited data shows 74% of lobotomies in Ontario from 1948–1952 were performed on women.From the 1950s onward lobotomy began to be abandoned, first in the Soviet Union and Europe. The term is derived from Greek: λοβός lobos "lobe" and τομή tomē "cut, slice". ![Imgur](https://imgur.com/L4zBe8L.png) Source: https://en.wikipedia.org/wiki/Lobotomy “In the early 1950s, the neurosurgeon William Scoville carried out a “frankly experimental” operation on a young, severely epileptic man known as HM. The operation, known as temporal lobectomy, involved removing parts of both the left and right temporal lobe responsible for the patient's continuing epileptic seizures. At one level, the operation was a great success in that HM's condition could now be managed by drugs, but at another level it had a catastrophic result —  HM became densely amnesic. HM is still alive today, and it is known that he has retained only a handful of facts since his operation. Thus, he knows little of world events or discoveries that have taken place over the last 30 years or so. His language is ‘frozen’ in the 1950s, so that words such as ‘CD player’, introduced after his operation, mean nothing to him. HM suffers from the amnesic syndrome, and it has been known since the beginning of this century that damage to the temporal lobes can produce this severe loss of memory. In the amnesic syndrome, loss of memory can take two forms: anterograde amnesia, which involves an inability to remember new information, and retrograde amnesia, where the patient fails to remember information that they possessed before the brain injury that led them to become amnesic. As well as severe anterograde amnesia, HM also has retrograde amnesia for the eleven year period immediately preceding his operation. This illustrates an intriguing aspect of retrograde amnesia, in that it always exhibits a temporal gradient with the memories most vulnerable to disruption being those formed in the more recent past, a relationship that is known as Ribot's Law after the French neurologist who first documented it.” Source: https://www.sciencedirect.com/science/article/pii/S0960982202707781 This is a famous paper in which the scientists stumbled upon the truth, and their discovery was accidental. A brain surgery and its effect on a patient opened up our understanding of the hippocampus and memory. Revisiting the paper in 2016 (59 years after it was published), Brenda Milner wrote: “Reflecting back, the paper takes an important place in history by demonstrating a clear relationship between the location and extent of the lesion and the memory loss in young individuals with no previous memory impairment. This early emphasis on the role of the medial temporal lobes in memory remains central to all interpretations of the amnestic syndrome and highlights the important role that neuropsychological testing plays in providing a window into the brain. This was the case in 1957, long before the advent of brain-imaging tools, and is still the case today.” Source: https://jnnp.bmj.com/content/87/3/230 Brenda Milner (Born July 15, 1918) is a British-Canadian neuropsychologist who has contributed extensively to the research literature on various topics in the field of clinical neuropsychology, sometimes referred to as "the founder of neuropsychology". As of 2010, Milner is a professor in the Department of Neurology and Neurosurgery at McGill University and a professor of Psychology at the Montreal Neurological Institute. “Milner was a pioneer in the field of neuropsychology and in the study of memory and other cognitive functions in humankind. She studied the effects of damage to the medial temporal lobe on memory and systematically described the deficits in the most famous patient in cognitive neuroscience, Henry Molaison, formerly known as patient H.M. Though he was not able to remember new events he was able to learn new motor skills. Milner was invited to Hartford to study H.M., "who had undergone a bilateral temporal lobectomy that included removal of major portions of the hippocampus." In the early stages of her work with H.M., Milner wanted to completely understand his memory impairments. Dr. Milner showed that the medial temporal lobe amnestic syndrome is characterized by an inability to acquire new memories and an inability to recall established memories from a few years immediately before damage, while memories from the more remote past and other cognitive abilities, including language, perception and reasoning were intact. For example, Milner spent three days with H.M. as he learned a new perceptual-motor task in order to determine what type of learning and memory were intact in him. This task involved reproducing the drawing of a star by looking at it in a mirror. His performance improved over those three days. However, he retained absolutely no memory of any events that took place during those three days. This led Milner to speculate that there are different types of learning and memory, each dependent on a separate system of the brain . She was able to demonstrate two different memory systems- episodic memory and procedural memory.” ![Imgur](https://imgur.com/ZLlIUQA.png) Source: https://en.wikipedia.org/wiki/Brenda_Milner Henry Gustav Molaison (February 26, 1926 – December 2, 2008), known widely as H.M., was an American man who had a bilateral medial temporal lobectomy to surgically resect the anterior two thirds of his hippocampi, parahippocampal cortices, entorhinal cortices, piriform cortices, and amygdalae in an attempt to cure his epilepsy. The surgery took place in 1953 and H.M. was widely studied from late 1957 until his death in 2008. “Molaison was influential not only for the knowledge he provided about memory impairment and amnesia, but also because it was thought his exact brain surgery allowed a good understanding of how particular areas of the brain may be linked to specific processes hypothesized to occur in memory formation. In this way, his case was taken to provide information about brain pathology, and helped to form theories of normal memory function. In particular, his apparent ability to complete tasks that require recall from short-term memory and procedural memory but not long-term episodic memory suggests that recall from these memory systems may be mediated, at least in part, by different areas of the brain. Similarly, his ability to recall long-term memories that existed well before his surgery, but inability to create new long-term memories, suggests that encoding and retrieval of long-term memory information may also be mediated by distinct systems." ![Imgur](https://imgur.com/mp7STPw.png) Source: https://en.wikipedia.org/wiki/Henry_Molaison Brenda Milner, coauthor of this study, noted in 2016, about the future of neuroscience research and how their are now technical tools to study and probe the brain that do not involve the sacrifice of human life or dangerous procedures: “Looking forward, it is now possible to use functional neuroimaging techniques to observe the normal brain in action during the performance of cognitive tasks and to use structural brain imaging to explore the contribution of different medial temporal- lobe structures to memory processes. Before brain imaging, clearly we had less information, but brain imaging tools are complex and sifting through the data can yield too much, making it difficult to disambiguate the role of different brain regions. The challenge now is to link the lesion work and imaging to understand the brain in health and in disease. The task for the future is to understand the brain connections that help us to remember our past and make the memories that we bring to our future.” Source: https://jnnp.bmj.com/content/87/3/230 There is a book about Scoville and the patient he operated on, titled Patient H.M, and written by Scoville’s grandson. Quotes from his grandson’s interview with Wired: “He hoped the lobotomies he developed would be far, far less blunting and more precise than the icepick transorbital lobotomies that were pioneered by Walter Freeman. He viewed it as messy and crude. One of the evocative scenes I uncovered was in that asylum, Institute of the Living, finding out there there had been that surgical showdown between my grandfather and Freeman. One afternoon, they lobotomized four different women—two by Freeman’s method, two by my grandfather’s method. Then they went off to the university club to have cocktails and discuss. There was something very chilling to me about the whole scene. I don’t want to engage in too much presentism. They were operating during very desperate times. To be mentally ill at that time was to not have a very promising future period. Many surgeons passionately believed they would be able to find the magic bullet for mental illness by operating. I don’t think that entirely excuses everything that they did, but I do try to bear in mind the context.” “It became increasingly clear in this odd way that my grandmother’s mental illness inspired my grandfather to be this passionate lobotomist, to pursue psychosurgery with a fervor and an energy that he probably wouldn't have otherwise. That passion for psychosurgery ultimately lead to that surgery that he performed on HM. There were these weird connections. Somehow my grandmother’s mental illness was relevant to memory science.” Source: https://www.wired.com/2016/08/untold-story-neurosciences-famous-brain/ Research ethics and consent were a lot different in the 1950s. This kind of experiment on a human being would not be permitted in today's research environment (for both regulatory and ethical reasons). There is a book about Scoville and the patient he operated on, titled Patient H.M, and written by Scoville’s grandson. Quotes from his grandson’s interview with Wired: “The textbook story of patient HM is in a lot of ways half the story. He’s clearly somebody who is illuminating in terms of understanding how our memory works, but his case is also illuminating when it comes to questions of research ethics. I think it’s very poorly understood how much the operation that my grandfather performed on HM—even though it wasn’t strictly a psychosurgery procedure because HM didn’t suffer from any sort of psychiatric disorder—that still grew out of that whole era. It was in some ways this culmination of a whole period human experimentation.” Source: https://www.wired.com/2016/08/untold-story-neurosciences-famous-brain/ William Beecher Scoville (January 13, 1906 – February 25, 1984) was a neurosurgeon at Hartford Hospital. This paper was inspired by his surgery of Henry Gustav Molaison in 1953 (intended to relieve epileps) that led to damage of Molaison's hippocampus and a memory disorder. “In 1953 Scoville offered Henry Gustav Molaison (better known as H. M.) the chance to cure Molaison's epilepsy through a pioneered experimental procedure. With the approval of the patient and his family, Scoville was to perform an experimental resection of several portions of the temporal lobes, a procedure which had previously performed in psychotic patients. Scoville had a "hunch" that the hippocampus was responsible, and based on this erroneous guess, removed Molaison's hippocampus - sucking it out using a medical tool which comprises a cauterizing blade and suction vacuum, while the anesthetized but conscious Molaison sat in the operating chair. Later, the hippocampus became known to be crucial in the formation of memories - which is why Molaison was rendered unable to form new memories for the rest of his life. Scoville consulted with a leading Canadian surgeon, Wilder Penfield at McGill University in Montreal, who, with psychologist Brenda Milner, had previously reported on two other patients’ memory deficits. As a result of this work (her PhD thesis) Milner has become one of the most famous neuropsychologists in the world.” ![Imgur](https://imgur.com/OaMovth.png) Source: https://en.wikipedia.org/wiki/William_Beecher_Scoville
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