Fragments of Memory: The Case of H.

M and the Medial Temporal Lobes’ Role in Memory

Formation

Rohan Pandit

University of Massachusetts - Boston

PSYCH 250

Carolyn A Cohen

11/18/2024
 Fragments of Memory: The Case of H.M. and the Medial Temporal Lobes’ Role in

Memory Formation

Memory defines the essence of human experience, shaping our understanding of the

world and anchoring our sense of identity. Try to imagine a life where new memories cannot be

formed. Where every moment was lived in isolation from the past and anticipation for the future.

This was the unfortunate reality for Henry Molaison, widely recognized as H.M. His case

fundamentally transformed our understanding of the neurological foundations of memory. In

1953, H.M. underwent a radical surgical procedure to alleviate intractable epilepsy by removing

portions of his medial temporal lobes, including the hippocampus. While the operation achieved

its goal of reducing seizures, it resulted in severe anterograde amnesia, leaving H.M. unable to

form new declarative memories (Scoville & Milner, 1957). This case became a landmark in

cognitive neuroscience, transforming our understanding of how memories are encoded, stored,

and retrieved.

Before H. M’s case, most scholars believed that memory was diffusely distributed across

the brain, as theorized by Karl Lashley (Lashley, 1950). However, the problems that H.M had

with his memory challenged this idea, showing that the medial temporal lobes play an important

role in forming declarative memories, especially episodic and semantic ones (Milner, Corkin, &

Teuber, 1968). Even with the inability to form long-term memories, H.M still had his procedural

memory, such as learning to trace shapes in a mirror (Corkin, 1968). This dissociation

highlighted the specialized functions of brain regions and laid the foundation for the distinction

between declarative and nondeclarative memory systems (Squire, 1987).

This paper will explore the medial temporal lobes’ role in memory formation and

retrieval, using H.M’s case as the focal point. Through an analysis of primary research studies,
exploration of neurological mechanisms, and a home-based experiment which I conducted, I aim

to demonstrate how the medial temporal lobes enabled the encoding of episodic and semantic

memories while leaving other types of memory intact. Furthermore, this paper will also talk

about the ethical implications of experimental neurosurgery, as depicted in H.M’s experience.

Photo of Henry Gustav Molaison at home (Suzanne Corkin)

Theoretical Foundations: Memory Theories Before H.M

Prior the H.M’s case, prevailing theories about memory showed that it was distributed

across the brain in a diffuse manner. Karl Lashley’s studies on lesioning cortical region in rats in

search of the “engram” (the physical trace of memory) concluded that memory was not localized

to any specific area in the brain (Lashley, 1950). Lashley suggested the principles of mass action

and equipotentiality, claiming that memory impairment depended more on the total amount of

cortical tissue removed than on the specific location of the damage.

 Lesions marked by hatching, which destroyed the greater part of the so-called visual

associative areas in a monkey without affecting visual functions (Lashley, 1950).

While these ideas guided early memory research, H.M’s specific memory deficits directly

contradicted these claims. The discovery that damage to the medial temporal lobes disrupted

declarative memory formation but spared procedural memory challenged Lashley’s conclusions

and marked a paradigm shift in memory research (Scoville & Milner, 1957).

H.M’s contribution to understanding memory systems

H.M’s case was essentially direct evidence for the functional specialization of the medial

temporal lobes, particularly the hippocampus and surrounding structures, in memory formation.

Scoville and Milner (1957) first reported that bilateral removal of the medial temporal lobes

would result in severe anterograde amnesia. H.M could not form new declarative memories, such

as remembering people he had met or events that happened after his operation. However, he was

still able to perform tasks like drawing shapes in a mirror, which were all procedural memories

(Corkin, 1968). This differentiation created the foundation for distinguishing between declarative

and nondeclarative memory systems.

 There were even more studies showed the complexity of memory within these systems.

Milner et al. (1968) found that while H.M retained his personality and short-term memory his

inability to transform information from short-term to long-term memory highlighted the

hippocampus’s role in consolidation. H.M’s preserved semantic memory for knowledge acquired

before his surgery also indicated that the medial temporal lobes are not the storage area for long-

term memories, but are important for the formation of them.

Medial Temporal Lobes and Memory Consolidation

The transition from fleeting experiences to lasting memories is a complex process called

memory consolidation. H.M’s case brought this subtle mechanism into focus, revealing how

vulnerable new memories are before being stabilized into long-term storage. Research using

animal models like the electroconvulsive shock experiments in rodents showed that disrupting

the medial temporal lobes shortly after learning caused significant memory loss. On the other

hand, allowing more time for consolidation preserved these memories (Duncan, 1949). These

findings support the consolidation period model, which emphasizes the importance of this

critical transformation process (McGaugh, 2000).

Learning curves for the 4 groups of animals shocked through the legs after each trial.

Results chart from Duncan’s electroconvulsive experiments. (Duncan, 1949).

 Modern neuroimaging techniques have revealed the importance of this process in

humans. Functional MRI scans show heightened hippocampal activity during episodic memory

tasks, showing its important role in encoding and stabilizing autobiographical information

(Squire, Stark, & Clark, 2004). My extrapolation from these findings is that H.M’s memory

problems were not caused by an inability to store memories permanently but by the removal of

brain regions essential for the consolidation process.

Declarative vs. Nondeclarative memory

The distinction between declarative and nondeclarative memory stemmed from H.M’s

dissociation of abilities. Declarative memory refers to semantic and episodic memories that can

be consciously accessed, while nondeclarative memory encompasses implicit skills and

conditioned behaviors that operate outside conscious awareness (Squire, 1987). H.M’s ability to

acquire procedural skills, like learning to trace shapes in a mirror, despite being unable to recall

the training itself, served as one of the first clear demonstrations of this distinction (Gabrieli,

Corkin, Mickel, & Crowden, 1993).

Similar patterns have been observed in other individuals with medial temporal lobe

damage. For example, patients with amnesia due to encephalitis often show significant

impairments in declarative memory while retaining the ability to learn and perform procedural

tasks (Squire & Zola, 1996). These examples show that the medial temporal lobes are necessary

for forming declarative memories, whereas nondeclarative memory relies in other neural

structures like the basal ganglia and cerebellum.

Challenges to H.M -Derived Theories

Although H.M’s case was honestly groundbreaking, subsequent research has revealed

nuances in the medial temporal lobes’ role. For instance, studies on patients with unilateral
hippocampal damage suggest that the degree of impairment depends on the extent of the lesion

and the affected hemisphere. Right hippocampal damage tends to impair spatial memory, while

left hippocampal damage affects verbal memory (Smith & Milner, 1981). Also, debates about the

relationship between episodic and semantic memory have emerged. In 2002, Tulving (2002)

argued that episodic memory builds upon semantic memory, while others contend that episodic

memory is foundational, enabling the development of generalized knowledge.

Ethical Implications

H.M’s case definitely raise a couple red flags when it comes to experimental surgeries.

While his family did consent to the procedure in hopes of alleviating his suffering, the

unanticipated consequences show the need for rigorous ethical standards in medical research.

The lack of alternative treatments for epilepsy at the time might have justified the risk, but

modern protocols prioritize the non-invasive and comprehensive patient counselling first.

Reconciling the Complexity of H.M’s memory systems

The case of H.M. presents an intriguing complexity that extends beyond a simple

narrative of medial temporal lobe dysfunction and anterograde amnesia. A careful analysis

reveals sophisticated interactions among memory systems and their corresponding neural

substrates. Although his ability to form declarative memories was severely compromised, H.M.

retained his capacity for procedural learning, indicating that distinct neural pathways can

function with relative autonomy. This observation prompts us to consider fundamental questions

about the nature of these systems' interactions and their implications for understanding memory

organization in the brain.

Consider the possibility that procedural and declarative memory systems, despite their

anatomical separation, participate in shared encoding processes within larger cortical networks.
Research utilizing fMRI with neurologically intact subjects has demonstrated that procedural

learning tasks, including motor sequence acquisition, temporarily activate medial temporal lobe

structures during initial learning phases (Albouy et al., 2008). This finding suggests that H.M.'s

preserved procedural memory capabilities may not indicate a complete absence of medial

temporal lobe involvement, but rather illustrate a neural adaptation wherein subcortical

structures, particularly the basal ganglia and cerebellum, assume primary responsibility for

learning. His experience demonstrates how the brain's inherent redundancy enables alternative

learning pathways when primary systems are compromised.

The Role of the Medial Temporal Lobes in Memory Contextualization

Another layer of depth lies in the medial temporal lobes’ role in contextualizing

memories. Aside from merely encoding events, it connects various elements of experiences such

as time, place, and emotions to create complete episodic memories (Eichenbaum, 2004). In

H.M., this ability was entirely lost, though he could still recall individual pieces of semantic

knowledge he had learned before his surgery. For example, he could remember facts about the

world but could not place those facts into the context of his personal experiences.

This separation between factual knowledge and the ability to give it context raises

important questions about how memories are stored over time. There is some research that shows

that episodic memory relies on the hippocampus at first to organize and connect contextual

details, but over time, these memories are transferred to cortical regions for long-term storage

(Winocur & Moscovitch, 2011). H.M’s inability to form new episodic memories is probably

because of a failure in this initial linking process, while his preserved semantic memory shows

the stability of the cortical networks that store knowledge already learned.
 Memory Consolidation as a Dynamic Process

Traditionally, consolidation was viewed as a one-time event, where memories transition

from a fragile to a stable state. However, more recent studies are showing that memory retrieval

itself can trigger reconsolidation, a process by which previously stable memories become

temporarily malleable and subject to modifications (Dudai, 2004). In H.M., this process was

likely impaired, as the medial temporal lobes are necessary for reconsolidating episodic

memories after retrieval.

This blockage may explain some of H.M.’s behavioral patterns like his repeated inability

to update his understanding of recurring events (e.g., the death of his uncle). Each time he found

out about the death, the memory failed to stabilize due to the loss of reconsolidation

mechanisms. This phenomenon not only sheds light on his personal experience but also

emphasizes the vulnerability of memory systems when key neural structures are compromised.

Implications for Neuroplasticity and Compensation

Even though H.M’s medial temporal lobes were removed, he retained his ability to learn

new procedural tasks and showed improvements with practice, such as the rotary pursuit task

where he had to keep a stylus on a rotating disk through repeated practice. This task

demonstrated his capacity to acquire and refine motor skills over time, despite having no

conscious recollection of the training sessions (Corkin, 1968). I extrapolated that procedural

memory systems can adapt to compensate for declarative memory loss, albeit within certain

limitations.

Interestingly, neuroplasticity may not have been confined to procedural learning alone.

There are other studies on individuals with similar lesions which provided some evidence of

partial declarative memory recovery through recruitment of adjacent cortical areas (Steinvorth,
Levine, & Corkin, 2005). Although H.M.’s damage was quite rough, his preserved intelligence

and problem-solving abilities suggest that his remaining brain structures adapted to support his

overall cognition. I believe that this highlights a potential avenue for therapeutic strategies,

where residual neural networks could be trained to compensate for damaged regions.

Reevaluating the Ethical Legacy of H.M’s surgery

The experimental nature of his surgery reflects a time when the long-term consequences

of such procedures were poorly understood. Today, his case serves as a reminder of the ethical

obligations inherent in experimental treatments. The removal of his medial temporal lobes

achieved the primary goal of reducing his seizures but came at the cost of a profound personal

loss, stripping him of the ability to form new memories.

This ethical dilemma extends to modern neuroscience, particularly in experimental

interventions like deep brain stimulation or optogenetics. H.M.’s experience underscores the

importance of rigorous preclinical research, thorough patient counseling, and long-term follow-

up to mitigate unforeseen consequences. It also highlights the value of balancing scientific

advancement with the preservation of human dignity.

Conclusion

H.M.’s story is one of the most fascinating I have encountered in neuroscience. After

H.M’s surgery to treat epilepsy, whatever I thought I knew about memory was completely

redefined. Watching him persevere and get better at new skills while not being able to form new,

lasting memories had to be the most shocking thing yet. Tasks like mirror tracing and rotary

pursuit showed that parts of his brain were still working in ways we did not fully understand.

This raised a question for me. How does the brain decide which abilities to preserve and which to
lose after an injury like his? I hope that in the future there will be more studies and experiments

to shed light on this.

The more research I did for this paper, I realized just how complex memory systems

really are. The medial temporal lobes do more than store memories. They link details like time,

place, and emotions, creating full experiences we can recall later. H.M.’s case revealed how

much we rely on these processes. Yet, his ability to improve at physical tasks without

remembering to practice them surprised me even more. It showed me how adaptable the brain

can be. Other areas, like the basal ganglia and cerebellum, seemed to take over in ways I had not

considered before. This left me wondering if the brain can be trained to compensate even more

after injury or surgery.

I also found myself thinking about the ethics of his surgery. Sure, it might have reduced

his seizures, but it literally took away his independence and changed his life forever. My goal is

to become a cardiologist, and the ethics of it all scares me more than any other aspect of being a

doctor. I could not help but question the decisions made at that time. How do we ensure that

advancements in science do not come at such a great personal cost? H.M’s case really reinforced

the idea that behind every scientific breakthrough is a person who lives with the consequences of

that progress in my head.

H.M.’s life taught me so much about the fragility and resilience of the human brain. It

helped me understand how memory works and how much we still have to learn. It also left me

with questions about where we go from here. What other systems in the brain might help us

recover lost functions? How can we ensure that ethical decisions guide future discoveries? For

me, H.M.’s legacy is not just about memory. It is about understanding what makes us human and

finding a way to advance science without losing sight of that humanity.

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