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Counting The Cost Of Medical Advances In 'Patient H.M.'

"Every path that leads to new victories is lined with crosses of the dead," wrote one early practitioner of proto-lobotomies. Luke Dittrich's new book asks: How many lives does a medical breakthrough cost? "By the middle of the twentieth century," Dittrich writes, "the breaking of human brains was intentional, premeditated, clinical." But were "all those asylums, all those lesions, all those broken men and women," worth what we now know about the human brain?

In 1953, Dittrich's surgeon grandfather opened up Henry Gustav Molaison's head and removed much of his temporal lobes. Until then, lobotomies had mostly been performed on those who had perceived mental illnesses. But Patient H.M., as he's since become known, was having seizures, which the surgeon hoped to cure. Those "devastating and enlightening cuts" destroyed H.M.'s ability to form short-term memories — and subsequent studies of H.M. illuminated much of what we know about how memory works.

Patient H.M. is part pop science book, part family history, and part worrying essay about the ethics of medical research. Dittrich's grandfather William Scoville was an arrogant man who cut into H.M.'s brain with experimental recklessness. "From the perspective of the present, it can look as though the surgeons, the psychiatrists, the administrators, the whole lot of them, were trampling blithely, arrogantly, even insanely, through the delicate soil of other people's brains."

And yet, Dittrich works hard to be fair to Scoville, who wrote in a letter that he had spent "20 years in studying and operating on mental illness in the hopes of contributing for a cure for it" for the sake of his mentally ill wife.

'Patient H.M.' is part pop science book, part family history, and part worrying essay about the ethics of medical research.

The ability to write gracefully about something as abstruse as the brain, to clarify a complex idea with just the right metaphor, is a special skill. The question, as with all popular books that draw on academic research, is how faithful those graceful, arching metaphors are to the real facts. Are our neurons "promiscuous, always reaching out with their yearning axons to bond with other neurons?" Most readers won't be in a position to judge the science (I'm not), but the writing is satisfying and graceful, with a flair for dramatic emphasis that only occasionally veers into showiness (one whole paragraph is the world "Unless.").

But, in spite of his proclivity for dramatic chapter breaks, Dittrich has a gentle, charming self-awareness of the conventions of the pop nonfiction book even as he's using them: Explaining how many wires go into a cable, he writes, "If you unspooled the individual wires in all the cables, you would have a length of metal rope long enough to circle the earth four times or reach halfway to the moon, depending on your taste in superlatives."

The descriptions of the surgery itself are so grimly vivid as to be unforgettable: The doctor rolling forehead skin down "like a carpet" to expose the gleaming bone underneath. Then, the drill, and a "faintly visible plume of moist calcium," and the "musty smell of bone dust."

The person of H.M. remains necessarily hazy (after all, what is identity without accumulated memories?), but Dittrich writes a vivid and painful story of the dark tension between desire for knowledge and that most basic tenet: First, do no harm.

Annalisa Quinn is a freelance journalist and critic covering books and culture.

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Annalisa Quinn
Annalisa Quinn is a contributing writer, reporter, and literary critic for NPR. She created NPR's Book News column and covers literature and culture for NPR.