Neuropsychologia, 1975, Vol. 13, pp. 353 to 364. PergamonPress.PrintedinEngland.
MEMORY FOR REMOTE EVENTS IN ANTEROGRADE
AMNESIA : RECOGNITION OF PUBLIC FIGURES
FROM NEWSPHOTOGRAPHS
WILLIAMD. MARSLEN-WILSON*and HANS-LUKASTEIJBER
Massachusetts lnstitute of Technology, Department of Psychology and Clinical Research Center,
Cambridge, Massachusetts 02139, U.S.A.
(Received 29 November 1974)
Abstract-Patients with anterograde amnesia, including the case H.M. and a group of alcoholic
Korsakov cases, were tested for their prompted and unprompted recognition of public figures
who had become famous at various points in time from the 1920’s to the 1960’s. The comparisons
between prompted and unprompted recognition for figures from before and after the
onsets of the patients’ amnesic syndromes were discussed in relation to competing theories
of anterograde amnesia. The results were interpreted as not favoring the strong versions of
either a faulty-storage or a faulty-retrieval theory.
INTRODUCTION
IN DISCUSSIONof human memory and its possible mechanisms, cases of abnormal forgetfulness
(anterograde amnesia) after brain injury or disease have played a special role. Yet,
as these discussions progressed, there has been increasing controversy about the proper
description of these conditions. Traditionally, anterograde amnesia has been defined as
an impairment in committing ongoing events to memory, in the face of considerable
preservation of memories for earlier (premorbid) events [l], and in the absence of general
intellectual deficiency. More recently, this description has been further specified by insisting
on essentially normal registration, and by emphasizing, either, a subsequent failure of
normal consolidation [e.g. 2, 31, inefficient encoding [e.g. 4, 51 or instead, an impairment
in the retrieval of apparently normally stored material [6], possibly because of abnormal
interference between relevant and irrelevant traces.
The possibility remains that these descriptions are not clear-cut alternatives being
applicable in various combinations to different kinds of amnesic conditions. Nevertheless,
the different views lead to somewhat different predictions about the relative sparing of
premorbid (as opposed to postmorbid) memories, and about the ways in which seemingly
forgotten material can be evoked with the aid of prompts. On a strong version of a faulty
retrieval theory, memory for premorbid events should be as defective, under conditions of
free recall or recognition, as memory for postmorbid events. Conversely, on this hypethesis,
appropriate prompting-by reducing the effects of interference-should improve the
performance for memories from any epoch in a patient’s life. On the strong version of the
view that anterograde amnesia is typically a failure to store ongoing events, one would
expect good recall for premorbid material, in sharp contrast to the failure to recall events
* W. Marslen-Wilson’s present address is :The University of Chicago, Department of Behavioral Sciences,
Committee on Cognition and Communication, Beecher Hall, 5848 S. University Avenue, Chicago, Illinois
60637, U.S.A.
353
354 WILLIAMD. MARSLEN-WILSONand HANS-LUKASTEUBER
that came after the onset of the illness; moreover, in so far as postmorbid events are in
fact not stored, the patient should derive no help from any kind of prompt. On a view
stressing primarily faulty encoding after the onset of an anterograde amnesia, there should
again be a contrast between early memories (well-preserved) and memory for postmorbid
events (defective), but, as on the faulty-retrieval notion, there should be the possibility of
demonstrating at least partial storage by recourse to particular kinds of prompts.
Anterograde amnesias arising from different causes may not be equally suitable for
testing these various predictions, and it will therefore be necessary, in the long run, to
investigate etiologically diverse forms of amnesia, in order to test the generality of the
various descriptions [e.g. 71. In particular, one would like to include some instances of
persistent anterograde memory disorders following damage to medial temporal lobe
structures [2, 81, as well as the often studied amnesia associated with long-standing alco-
holism.
Cases such as the justly famous patient H.M. of SCOVILLEand MILNER [9] afford the
advantage that the onset of the condition is sharply demarcated in time; his anterograde
amnesia began immediately after one-stage, bilateral resection of amygdala and large
portions of hippocampus and hippocampal gyrus, performed in 1953 in an attempt to
provide relief from non-focal epilepsy. Aside from a period of apparent retrograde amnesia
for one to two years immediately preceding the operation, memories for the period before
and after that date can be readily compared.
This comparison is more difficult, though not impossible, in the memory disorders
associated with severe alcoholism or similar toxic or metabolic damage to the brain. These
disturbances often have an insidious onset, and even in cases of Korsakov’s syndrome,
where the beginning of the illness is marked by a florid confusional state, the effects of the
preceding alcoholism make it difficult to identify the exact date at which these memory
defects might have begun. Nonetheless, it is usually possible to define an earlier period in
such a patient’s life when he was presumably recording ongoing events in essentially normal
fashion.
Accordingly, in the present experiments, we have examined the performance of H.M.
and of a group of twelve patients with Korsakov’s syndrome, together with three different
control groups, on a test involving recognition of news photographs of public figures, who
had become famous at different times from the 1920’s to the late 1960’s, thereby enabling
us to compare the amnesic patients’ recognition of public figures famous from before and
after the onset of the patient’s illness. The task differed from one used by SANDERSand
WARRINGTON [lo], which appeared while this study was in progress, in a number of ways
which will be discussed later.
In order to probe, if only in preliminary fashion, for kinds and degrees of memory loss,
we introduced two types of prompts, letter prompts and circumstantial prompts, essentially
following the method first described by LOTMAR [ll, 121, who examined word-finding
difficulties in aphasic patients by giving them either letter prompts (N, Na, Nap, . . . , for
Napoleon), or circumstantial prompts (“the man who lost the battle of Waterloo”). This
approach is similar, though not identical, with the one advocated recently by BUTTERSand
CERMAK [4, 51, who have suggested that amnesics of the Korsakov variety fail to encode
the semantic aspects of material, relying instead on acoustic features with consequently
less efficient long-term storage.
The control groups for H.M. comprised 34 head-injured veterans of the Korean campaign
whose ages and time of injury matched H.M.‘s age and time of operation, as well as
MEMORY FOR REMOTE EVENTS IN ANTEROGRADE AMNESIA 355
15 non-injured veterans of that campaign of similar age and background. Since the possible
role of alcoholism as such, previous to the onset of the overt Korsakov syndrome, required
consideration, the control group for the Korsakov cases was composed of 12 patients with
histories of severe alcohol abuse but without history or symptoms of a Korsakov syndrome.
METHOD
Although the subjects of the study were briefly characterized in the introduction, a few additional details
will be necessary.
1. H.M.
This case has been described in a number of publications since 1957 [e.g., 3, 91. He had undergone a
bilateral mesial temporal-lobe removal including amygdala, hippocampus (back to about 8 cm) and hippocampal
gyrus, in 1953 when he was 27 yr old. The patient had then and continues to have above average
general intelligence, and a low-normal digit span (six digits forward); he impresses an interviewer as essentially
intact, but shows extraordinary forgetfulness for everyday events and necessities, as described, e.g.
in 1968 [3]. For the present study he was tested twice, eight months apart, in December, 1972 and July, 1973,
the first time without prompts, and the second time after the prompting procedure had been introduced.
The control group for H.M. consisted of 34 head-injured but non-amnesic patients whose injuries were
sustained, as already mentioned, in action during the Korean War (1950-1953). The mean age of this
group at the time of testing was 42.5 yr and thus not too far below H.M.‘s ages of 4647 at the time of
the two tests for recognition of famous faces. An additional control group of 15 combat veterans without
head injuries was later added since the first control group had been tested before the introduction of our
prompting procedures. The average age of that group was 40.2 yr and their background closely resembled
that of the head-injured men.
2. Korsakov cases
The second experimental group consisted of 12 male alcoholic patients bearing a diagnosis of Korsakov’s
disease, with amnesic syndromes ranging from 11 months to nearly 10 vr in duration (with a mean dura-- tion
of 4 yr and seven months). These onsets of their memory disorders-were dated from the first hospital
admission in which a diagnosis of Wernicke-Korsakoff syndrome was made. Thus all subjects
were well past the initial florid state tvpical of the onset of the syndrome and as their IQ scores (mean 103)
indicate they showed no signs of dementia at the time of testing (July and August, 1973)_According to their
medical histories, all of these natients had initiallv exhibited the combination of sums on which the diaenosis”
of Korsakov’s syndrome, in this particular group, was based: They had been deemed addictively alc:holic
for a number of years ranging from 15 to 34, prior to the onset of their amnesic syndrome. They all were
said to have presented, at one time, the signs of acute Wernicke-Korsakov encephalopathy, i.e. either
oculomotor disturbances, or ataxia, or both, combined with peripheral neuropathies. At the time of testing,
however, their oculomotor status was essentially normal, though some showed mild cerebellar signs, or
residual peripheral neuropathies. The mean age of this group of twelve patients, at the time of testing, was
54.7 yr, with a range of 45-64 yr.
As additional control subjects for this group with Korsakov’s syndrome, a group of 12 alcoholics from
the Alcoholism Unit at the Brockton VA Hospital was also tested. They were matched with the Korsakov
cases for age, (mean 53.1 yr) and, as far as possible, for IQ (mean 106).
The purpose in testing this group, apart from controlling for age at time of testing, was to control for the
possible effects of alcoholism per se on memory for recent public figures. Even if an alcoholic’s memory is
not affected, his memory for recent events may be impaired because his alcohol intake might have interfered
with his original registration of such events. We needed to be able to distinguish such effects from those
produced by an anterograde amnesia.
STIMULUS MATERIALS
The materials for the test consisted of 65 8 x 10 in. black and white photographs portraying 85 famous
individuals. Eighteen of these were film stars or other entertainers, 17 were politicians and public servants,
15 were foreign leaders, 11 were sports figures, 9 were Presidents of the U.S., 5 were religious leaders, 3 were
scientists or inventors, and 7 fell into other categories. The public figures were assigned to that decade in
which they first became nationally famous. Twelve were assigned to the 1920’s, 17 to the 1930’s, 17 to the
1940’s, 19 to the 1950’s, and 20 to the 1960’s.
We did not attempt to select individuals who were famous only for a restricted period of time and then
faded into obscurity. To answer the questions we were asking, it was only necessary to establish the date
before which the subject could not have known about the person being shown to him.
356 WILLIAMD. MARSLEN-WILSONand HANS-LUKASTEUBER
EXPERIMENTAL PROCEDURE
The photographs were presented in a pseudo-random order, with the faces from each decade spread over
the whole series. The same order of presentation was used for all subjects. The subjects were tested individually.
They were first informed that they were goin,mto see a series of photographs of people who had
been famous for one reason or another at some point during the last 50 years. They were told that they
would be asked to answer up to 3 questions for each famous face: (1) whether the face was familiar or
unfamiliar; (2) if the face was familiar, whether they knew the name; (3) why and when the named person
was famous. It was stressed to the subjects that (1) and (2) were different questions, and that a face might
well seem familiar even if they could not place it. The subjects were given as much time as they needed
to respond to each photograph.
After the entire series of faces had been presented, the subjects were told that they had done very well
but that there were a few faces they had missed, either by misidentification or by failure to identify some
faces altogether. This had in fact happened in every case including the most proficient control subject. They
were further told that the faces they had missed would be shown again, and that, if necessary, they wcrc
to receive help in their identification.
If on this second presentation the subjects could not identify the face correctly they were then given either
a circumstantial or a letter prompt. An example of a circumstantial prompt (for Alfred Landon) is as
follows: “He was the Republican presidential nominee in 1936; he ran against Roosevelt and lost. He was
also governor of Kansas.” The letter prompts were graded systematically. The subject vvas first given the
initials, then the first syllable of the first name, then all of the first name, the first syllable of the last name,
and as far beyond that as possible letter by letter, without giving the full word. Thus for Alfred Landon the
letter prompt sequence was as follows: A.L.; Alf. L.; Alfred L.; Alfred Lan . . .; Alfred Land. . . If the
prompts had not elicited the full name by this time, the subject was given the rest of the last name and asked
if he had ever heard of the person in question.
We alternated between circumstantial and letter prompts throughout the series of faces which had not
been correctly named during the initial, unprompted presentation of the series. The letter prompts for a
given face were not followed by circumstantial prompts, but an unsuccessful circumstantial prompt was
always followed by a series of letter prompts for that face. No attempt was made to use misleading prompts,
nor were subjects left unaware of whether their performance after prompting was correct or not. In H.M.‘s
case, the first session (December, 1972) was done without prompting; the second (July, 1973), with the full
prompting sequence, as described. His sessions were tape-recorded, those with the other patients and control
subjects were recorded in writing during the tests. The full testing procedure lasted from l-1.5 hr, depending
on the amount of prompting required.
RESULTS AND DATA ANALYSIS
1. H.M. unprompted
Table la lists the unprompted mean scores for H.M. and for the two control groups,
head injured and normal veterans of the Korean campaign. The scores are given as per cent
correct per decade in Fig. 1. Since H.M.‘s performance on the two test sessions (done 8
months apart) is so stable, we took the mean of these two scores as his unprompted score.
H.M.‘s recognition rate was above average for the 1920’s and the 1930’s, fell off slightly
foi the 1940’s and dropped dramatically for the 1950’s and the 1960’s. He managed to
recognize some faces, for example, John Glenn, Elvis Presley, and Krushchev, which he
could only have encountered after 1953. Yet in general, his performance indicated a severe
deterioration of unprompted memory for faces from the last two decades. The slight and
non-significant fall-off for the 1940’s may reflect a mild retrograde amnesia; he was quite
confused when questioned about events in the mid- and late 1940’s.
The normal control subjects did better than the head-injured control subjects throughout,
but the response pattern for the two groups across decades was qualitatively similar. All
the control subjects individually did better on the more recent faces. The peak in the curves
for the 1940’s may be due to an idiosyncrasy of this particular series of faces, or to the
greater salience of war-time figures.
2. H.M. prompted
The prompting procedures were very effective for both the normal control subjects and
MEMORY FOR REMOTE EVENTS IN ANTEROGRADE AMNESIA 357
Tableslaand lb. Unprompted correct identification
Number correct by decade
20's jO's 40'e 50'S 60’s Total--
Maximum Possible: 12 17 17 19 20 85
la
H.M. Test I 6 12 11 4 2 35
Test II 6 12 12 3 1 34
Mean: 6 12 11.5 3.5 1.5 34.5
Head-injuredControls: 3.0 7.5 10.1 9.1 11.3 41.0
(n=34) Range: O-8 l-13 2-17 2-16 3-17 14-65
No-1 Controls: 4.6 9.7 1493 13.1 14.9 56.6
(n=15) Range: l-y 3-14 8-16 9-18 11-17 34-70
2
AlcoholicControls: 5*7 9.8 11.8 8.5 9.8 45.7
(n-12) Range: j-10 5-13 6-55 3-14 4-13 21-62
Korsakovs: 5.4 8.1 9.3 6.1 4.4 33.4
(n=12) Range: 1.11 4-13 2-14 o-11 1-y Y-51
MeanDifference: 0.3 1.7 2.5 2.4 5.4 12.3
forH.M. (see Table 2a and Fig. 2). The prompted scores of the controls were throughout
above 90 per cent of the total possible, and reached 99 per cent in the 1940’s and 1960’s.
H.M.‘s performance was indistinguishable from the controls for all decades, except for the
1960’s where his prompted total of 16 (out of 20) was somewhat below the average of 19.8
reached by the controls.
3. Korsakov cases unprompted
The unprompted scores for the Korsakov cases and their alcoholic controls are given
in Table lb and (as percentages) in Fig. 3.
The Korsakov cases did worse than the alcoholics for all decades, but the pattern of
their results across decades was very similar until the 1960’s, when their recognition rate
fell off sharply. The difference between the two groups, Korsakov cases vs alcoholic controls,
is negligible for the 1920’s (t = O-428, df = 22, non-significant), and increases to a constant,
marginally significant level for the 1930’s, the 1940’s, and the 1950’s. The difference for the
1960’s is twice as large and highly significant (t = 5.002, df = 22, P < OWl).
358 WILLIAM D. MARSLEN-WILSON and HANS-LUKAS TEIJBER
tl M unoromoted score
Decode
FIG. 1. Per cent correct identifications of faces (unprompted) in each decade, for H.M.,
head-injured controls, and normal controls.
H M :prompted and unprcmpted SCOWS
IVL A-....... ‘5
A.....
..a.
... ....* ,....I ..‘.‘.
--.._ l
90
.&-’
/
..
l\.
.
\
80
.
a-,_
/
/’ ‘‘\
1’
\
\
6’
\
\
c-•:H.M.-unprompted \
+a :H M. -prompted
b-6 .Normals-prompted
lt\
\
\
‘.
0 I I I I
1920’s 1930’5 1940’S 1950’5 1960’s
Decade
FIG. 2. Per cent correct identifications of faces (prompted and unprompted) in each decade
for H. M. and (prompted scores only) for normal controls.
MEMORY FOR REMOTE EVENTS IN ANTEROGRADE AMNESIA 359
Tables 2a and 2b. Prompted correct identification
Number correct by decade
-=40’s20’S 50’S 60’s Total- Maximum
Possible: 12 17 17 19 20 85
z!!
H.M.: 10 16 16 17 16 75
Normal Controls: 11.5 15.5 16.9 18.3 19.8 82.0
(n=15) Range : 10-12 13-17 16-17 17-19 19-20 77-85
2b
Alcoholic Controls: 11.4 15.7 16.7 17.4 17.5 78.7
(n-12) Range: 10-12 14-17 16-17 14-19 14-20 74-85
Korsakovs: 11.2 15.4 16.3 17.2 16.4 76.5
(n-11) Range : 9-12 13.17 13-17 15-19 10-20 66-82
Mean DiUerence: 0.2 0.3 0.4 0.2 1.1 2.3
Korsokovs unprompted stores
9O__ l--*:Korsokovs
M:Alcoholic controls
1920's 1930’S 1940’S 1950’s 1960’5
Decade
FIG. 3. Per cent correct identification of faces (unprompted) in each decade, for Korsakov
cases and alcoholic controls.
4. Korsakov cases prompted
One of the Korsakov subjects was excluded from the prompted groups because a severe
hearing loss made it difficult for him to hear the prompts.
360 WILLIAM D. MARSLEN-WILSON and HANS-LUKAS TEUBER
As Table 2b and Fig. 4 demonstrate, the effect of prompting is to make the scores of
the Korsakov cases and their alcoholic controls indistinguishable from each other for all
decades. The largest difference for the 1960’s, does not approach significance (t = 0.948,
L/J1 21, non-significant), and cannot account for the 5.4 points difference in their unprompted
scores.
FIG;.4. Per cent correct identifications of faces (prompted and unprompted) in each decade
for Korsakov cases and (prompted scores only) for alcoholic controls.
5. Analysis of prompts
Number of prompts required for correct identification of a given face was, as expected,
greater for H.M. than for normal subjects, but this was not differential for pre- and postmorbid
material. The same was true for the Korsakov cases: although they tended to be
less efficient than the alcoholic controls in using prompts, this effect was not specific to the
most recent material and in fact diminished over the last two decades. Even on using a
more refined measure of utilization of prompts, essentially the same picture was obtained.
(This measure was based on the per cent increase produced by prompting, divided by the
mean number of prompts required.)
Furthermore, we looked into the possibility that the two types of prompts, i.e. circumstantial
and letter prompts, might have had differential effects. Table 3 shows the results of
such an analysis. Evidently there were no differences between Korsakov cases and alcoholics,
and no systematic decrease across decades. Although the levels of the two groups
dropped for the 1950’s, the proportion of successful circumstantial prompts for the 1960’s
was as high as for the 1920’s and 1930’s, and higher than the normal scores for the 1960’s.
Overall, the Korsakov cases and the alcoholics had a slightly higher percentage of successful
circum.;tantial prompts than the normals. Generally, the Korsakov cases did not show a
specific impairment on the more “semantic” prompts for either pre- or post-onset material.
MEMORY FOR REMOTE EVENTS IN ANTEROGRADE AMMSIA 361
H.M., nevertheless, did show a differential trend in the direction suggested by BUTTERS
and CERMAK [4, 51, in that he seemed unable to use circumstantial prompts for the postmorbid
material. It should be noted, however, that the number of observations involved
(ten) was small.
Table 3. Percentage of successful circumstantial prompts
Number correct by decade
20’S 30’8 40’s 50’S 60’s Total
Normal Centrals: 55.8” 48.5 63.2 55.6 42.3 53.0
Alconolic Controls: 65.7 58.6 52.2 37.9 65.2 56.1
Korsakovs: 61.9 65.5 59.1 35.7 66.7 56.8
*The figures represent the percentage of the successful initial letter and circumstantial prompts added
together that were circumstantial prompts.
6. Incidence of ntisidentiJcations
Neither H.M. or the patients with Korsakov syndrome differed from the various control
groups with respect to the selective incidence of “false positive” responses, i.e., misidentifications
as compared with their statement that a given face could not be identified.
DISCUSSION
The outcome of this study is not compatible with the strong versions of either a faultystorage
or a generalized poor-retrieval hypothesis about anterograde amnesia. The patient
H.M. as well as the 12 patients with Korsakov’s syndrome patently did better, in the
unprompted condition, for faces to which they had been exposed for some years before
the onset of their amnesia, and performed quite badly when asked to identify public figures
who had more recently become famous. This was particularly striking in the case of H.M.,
where the date of the operation that provoked the amnestic syndrome is exactly known.
A non-differential difficulty with retrieval should have affected performance for pre- and
post-onset material alike.
At the same time, any strong claims for a failure to store events after the onset of an
amnestic syndrome has to be tempered by the remarkable effectiveness of prompting in
eliciting successful identification of faces to which the patients could only have been exposed
after the onset of their memory disorder. That some recent material is getting stored, and
occasionally retrieved, either spontaneously or under the influence of appropriate hints,
has of course been noted by a number of observers, irrespective of their theoretical views
about the nature of amnestic states. Nevertheless, the findings of our present study may
serve to underscore the extent to which, even in an amnesia as severe as H.M.‘s, such an
uncovering of seemingly lost memory traces is possible.
On the other hand, it would be unwise not to stress that the number of prompts required
in H.M.‘s case, for the recognition of public figures whose fame began only after 1953
(the date of H.M.‘s operation) was 50 per cent above the normal mean, indicating that
362 WILLIAMD. MARSLEN-WILSONand HANS-LUKASTEUBER
even under conditions of extensive cueing, his memories are not as readily brought out as
in normal subjects.
The patterns of prompted and unprompted scores, for the cases of Korsakov’s syndrome,
was essentially as BUTTERSand CERMAK might have predicted, except that we did not find
the expected advantage of letter prompts over circumstantial prompts (i.e., prompts that
BUTTERSand CERMAKwould have called “semantic”). Our prompting procedure, however,
was far from a direct test of their hypothesis, since it is not clear whether our two classes of
prompts really correspond to theirs.
Nor is it possible to compare our findings, in the unprompted condition, with the strikingly
different results of SANDERS and WARRINGTON [IO], whose amnesic patients did
equally badly on both pre- and postmorbid material. Aside from probable differences in
the kinds of patients tested in their study and in ours, there are major differences in the test
materials. As we pointed out, we did not attempt to find public figures whose fame might
have faded after a particular period; our concern was to identify the approximate date
when their fame began. By contrast, SANDERSand WARRINGTON took pains to concentrate
their choices of test photographs on those public figures whose fame had come and gone.
They were explicitly concerned with what they called the “fate of old memories” which
we could not, strictly speaking, evaluate with our procedures.
Nonetheless, the fact remains that, without prompting, there is a clear difference between
the success of our Korsakov patients with faces from the 1920’s to the 1950’s, and their
relative failure with those from the 1960’s (except in H.M.‘s case where a precipitous
decline sets in already for the 19.50’s, in line with the abrupt onset of his disorder in 1953).
Such a result would, of course, have been expected on the traditional view of anterograde
amnesia, which has always assumed a relative sparing of older memories, aside from the
puzzling facts of retrograde loss for a period immediately preceding the onset of the trouble.
A similar conclusion has recently been reached by SELTZERand BENSON[13] on the basis
of a questionnaire probing memory for public events across different decades. There, too,
events falling into a premorbid period (for essentially the same group of Korsakov cases)
were better recalled than more recent postmorbid events, just as traditional assumptions
would have predicted. Similarly, a very extended series of biographical interviews with
H.M. [14] yielded rich recollections for the first two decades-and-a-half of his life, in
contrast to a virtual absence of such recollections for the two decades since his operation.
This near-total failure of free recall for his postmorbid autobiography must be weighed
against the fact that he has produced, at times, evidence of unprompted recognition or recall
of figures or events to which he can only have been exposed post-operatively, ranging from
his recognition of President Kennedy on a half dollar [3] to some of his more intriguing
misrecognitions on our test for famous faces: for example, on being shown a picture of
Einstein, he called him Pompidou, adding that he meant a French statesman. This was
doubly surprising, since Pompidou was not a particularly well-known figure in the U.S.,
and must have been unknown to H.M. until sometime in the 1960’s.
H.M.‘s behavior thus underscores the perplexing quality of severe amnesia: it is not all
or none, even in such a grave case as H.M.‘s, and it does not readily lend itself to those
interpretations of amnesia which speak of generalized failure either of storage or retrieval.
A good deal more postmorbid material is stored than can be retrieved without considerable
prompting, but if a general failure of retrieval were the basis of the trouble, it should have
extended to the early premorbid material as well. The fact that it did not, under our conditions
of testing, brings us back to the classical view that there is something amiss in the
MEhlORYI:ORREMOTEEVENTSIN ANTEROGRADEAMNESIA 363
way in which ongoing events, after the onset of the amnesic syndrome, are stored. Unfortunately,
there is little in our data that could shed further light on the nature of this disturbance
of storage.
A promising tack one might take is to look further into the question of whether items
that do get into long-term storage, despite severe anterograde amnesia, are indeed stored
in an abnormal fashion, and hence are rendered less accessible for retrieval. Our present
observations are not incompatible with those recent approaches that invoke some inefficiency
of encoding as one major factor. Other work [15] suggests, in addition, that H.M.
performs abnormally on verbal learning tasks involving an extended-span paradigm [16].
H.M., when asked to repeat an unrelated word string exceeding his normal span, will
produce large numbers of “recombination” errors; for example, he will substitute the
response “waste” for the list words “wake” and “taste”. Similar responses were noted
for the cases of Korsakov’s syndrome. Although we do not wish to imply that other tasks
might not demonstrate some differences between H.M. and the Korsakov cases, this
abnormality in immediate recall may be indicative of a more long-lasting disturbance of
storage shared by both groups.
Acknowledgements-This research was supported in part by grants to H.-L.T. and W.M.-W. from the
Sloan and Spencer Foundations, and from the National Institute of Health, under their grant 24433-02.
We wish to thank Dr. S. CORKINfor her help with the Normal and Head-injured control subjects, Dr. B.
MILNERfor her valuable advice and for the permission to test H.M., and Dr. N. BUTTERSof the Boston
V.A. Hospital and Drs. C. GOODENOUGHand E. ROTHSTEINof the Brockton V.A. Hospital for their help
in making available the Korsakov and the Alcoholic cases. We are also deeply appreciative of the patience
and courtesy with which H.M. and his mother treated us during our visits to their home.
1.
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11.
12.
13.
14.
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On a examin; ohes des maladee aveo emn&ie ant&grade, oomprenant
le oaa KM. et un groupe de malades atteints de Korsakoff d’origine alcoolique,
la reconnaissance, aveo ou aane aide, de visages de personnalit& devenues
c’&bres & des e’poques variant entre l92O et 1960. On discute les comparaisons
faites entre les reconnaissances avec ou ~811~aide, des visages selon que
leur cklibriti date d’avant ou d’aprbs le debut des syndromes amnisiques, en
tenant ccmpte des thTories qui aont en compitition 8ur l’annesie snterograde.
L’interpretation de oes resultrats n’est pas en faveur dw aspects “forts”
aussi bien de la thsorie d’un difioit de l’emmagaeinement que d’un deficit
du rappel.
Eatientsn mit anterograder Am.esi~, darwnter such der Fail H. K.
und ein,. Grtippe van alkohulischen Korsekowkranken wurd?n auf
ihr sofortiges oder verzfigertes Erkennen van bekannten PersGnlichkeiten
getestet, die in verschiedener Hinsicht in der Leit
zh'ischen den zwanziger linC den sechziger Jahren bertihnt geworden
waren. Die Veri;leiche mischen sofortigem und verzBgertem
Erkenner, van Pers6nlichkeiten aus der Zeit van vor und nach
dem Auftreten der ennestischen Syndrome der Patienten wurden
hinsichtlich konkurriercnder Theorien Uber die anterograde
Amnesic diskutiert. Die Resultate wurden dahingehend lnterpretiert,
da? sic keine der einseitigen Versionen favorisieren,
weder die Theorie fehlerhnit er Speichemng nochdiejenige eines
fehlerhaften Abrufes.