Bryan Jennett, CBE, M.D., FRCS,
died on Saturday, 16 February 2008. He was a neurosurgeon who
revolutionized head-injury care, and was expert at identifying important
but soluble questions, thereby improving the care of brain-injured
patients. In the 1960s, understanding of issues such as brain
swelling, late deterioration, impaired consciousness, prognosis and brain
death was rudimentary.
Born in England in 1926, Jennett was evacuated from Twickenham, Middlesex
during the Second World War to rural Scotland and then to Southport and
King George V School. He attended Liverpool University Medical School,
where he met his future wife. Professor Jennett trained at Oxford where
his lifelong devotion to the treatment of head injuries was ignited, and
then at Cardiff, Manchester and finally at UCLA in Los Angeles as a
Rockefeller Fellow with Horace Magoun. In 1963 he was appointed to a new
NHS (National Health Service) university consultant post in Glasgow and to
the new Chair of Neurosurgery at Glasgow University in 1968.
In a remarkably short period of time Dr. Jennett made Glasgow a
world-class center of excellence in neurosurgery, first at Killearn
Hospital and then at the new Institute of Neurological Sciences at the
Southern General Hospital. He was ahead of his time in understanding the
potential of large clinical databases and set up an international
head-injury data bank. His landmark monograph Epilepsy After Blunt Head
Injuries (1962) and his pioneering studies of prognosis after head injury
were of immense practical value. The MRC Cerebral Circulation Research
Group, which he co-directed with Murray Harper, discovered why different
anaesthetics might induce brain swelling during neurosurgery. A method for
measuring brain blood flow in the operating theatre was devised and used
to define which patients would or would not tolerate clamping of one of
the brain arteries as a treatment for "balloon" weaknesses
(aneurysms).
In 1972, with Fred Plum of New York, he described the "Vegetative
State" – awake but not aware – of that group of patients who have
become of great interest to students of consciousness through functional
brain imaging. In 1974, with Graham Teasdale, he devised and validated the
Glasgow Coma Scale (GCS) with which to describe the depth of coma. In
1975, along with Michael Bond, he published the Glasgow Outcome Scale.
These tools became the foundation for all the randomized controlled trials
and studies of prognosis after all forms of acute brain injury that
followed. In collaboration with his neuropathology colleagues, he defined
the avoidable factors that can cause secondary deterioration after the
initial injury and, selevted the key patient population with which to
explore the concepts in this case, the "talk and die" group,
i.e. patients who were able to talk after sustaining an injury, but went
on to die, suggesting that something preventable had occurred between
injury and death. Such work led to the successful introduction of
guidelines that have saved many lives and reduced disability.
He became Dean of Medicine at Glasgow University (1981-86) and
subsequently president of Headway, the UK brain injury association, as
well as president of the Section of Clinical Neurosciences at the Royal
Society of Medicine. In 1980 Dr. Jennett took a leading
role in the response to a BBC Panorama programme which cast doubt on the
validity of the diagnosis of brain death, and hence of organ donation.
Jennett’s courageous and committed support for the concept, based on
telling scientific, clinical and ethical grounds, avoided long-term
disruptions to transplantation programs.
Dr. Jennett understood the practical difficulties and ethical tensions in
managing critically ill patients. When should expensive and futile
interventions be withdrawn? His Rock Carling lectures and monograph High
Technology Medicine: benefits and burdens (1984) provided a rigorous
analysis and revealed his wide scholarship and incisive clarity of prose.
His books Introduction to
Neurosurgery (five editions from 1964 to 1995), Management of Head
Injuries (1981), and most recently The Vegetative State: medical facts,
ethical and legal dilemmas (2002) were hugely influential internationally.
In the last few months of his life, he was the first person to be awarded
the Medal of the Society of British Neurological Surgeons for his
outstanding contributions. His last paper, "The early diagnosis of
spinal tumours: a personal story spanning 50 years", was published
recently and perfectly exemplified the clinical academic's creed:
"How can I help this patient? What can this patient teach
me?" Individuals with brain injury and their families have benefited
from his discoveries.
Reflections
on the Life and Work of William Bryan Jennett, CBE,
M.D., FRCS
By Nathan D. Zasler, M.D., FAAPM&R, FACRM, FAADEP,
DAAPM, CBIST CEO & Medical Director, Concussion Care
Centre of Virginia, Ltd.
William Bryan Jennett, CBE, M.D., FRCS, passed away
peacefully, at home, surrounded by his loving family on
January 26, 2008, at the age of 81.
I had the distinct honor of working with Dr. Jennett on
several projects over the last 15 years. My interactions
with him gave me a true perspective for the brilliant
mind and person that was Dr. Bryan Jennett. It is rare
to meet an individual who was, at the same time,
unassuming, yet commanded the attention and respect of
all those around him. In the early 1970s, he really went
where no scientist or physician had gone before and
addressed issues germane to a sector of the patient
population that most clinicians would rather have
ignored…the vegetative state.
When he first proposed and described the vegetative
state (along with Dr. Fred Plum), he created
neurobehavioral phraseology that would stand the test of
time and become ingrained in the neuroscience
nomenclature. He subsequently developed the Glasgow Coma
Scale in 1974 with Graham Teasdale followed by the
Glasgow Outcome Scale in 1975 with Dr. Michael Bond.
These seminal ideas led to a high level of visibility
within the field of neurosurgery, as well as, brain
injury medicine in general.
During his career, Dr. Jennett not only distinguished
himself as a clinician and scholar but lectured and
wrote extensively on issues relating to brain injury. As
has been said, he sustained a commitment to a
challenging and controversial issue as related to the
vegetative state, and he was able to draw concepts from
many fields into a cogent analysis of the topic as was
demonstrated, later in his career, in his 2002 monograph
entitled "The Vegetative State," Medical Fact
Epic, Ethical and Legal Dilemmas."
He received many honors during his career and in 1991,
upon retiring, he was made a commander of the British
Empire. In 2007, he was the first person to be awarded
the Medal of the Society of British Neurological
Surgeons for his outstanding contributions in
neurosurgery.
In my interactions with him, I always had to pinch
myself because I found it hard to believe that I was in
the same room with “the Dr. Bryan Jennett”; yet, he
was one of the most down-to-earth people I have ever met
and one of the most likable. His keen interest and depth
of understanding regarding disorders of consciousness
following traumatic brain injury stimulated my own
interest in the topic and that of many of my
contemporaries.
He remained one of the driving forces behind some of the
more recent international work in the area of disorders
of consciousness over the last 15 years. What was most
amazing was Dr. Jennett’s ability to look back on his
own work and be constructively critical of it, including
acknowledging some of the limitations of his own
thinking. He continued to provide encouragement to other
clinicians to pursue further honing of our collective
understanding of the complexities of both assessment and
management of this special population of persons with
acquired brain injury.
He certainly will be remembered for many reasons by many
different people but, as far as I'm concerned, brain
injury and Bryan Jennett were, are and will always be
pretty synonymous. Dr. Jennett was and remains in many
ways what the field of brain injury medicine is and
should be about and with a small cadre of other
significant early names in the field, such as Dr.
Caveness and Dr. Russell,will always be
remembered for his academic and intellectual
contributions and maybe most significantly for his
ability to share that knowledge with others, as well as,
stimulate critical inquiry and debate on topics that had
historically not garnered much attention or
introspection.
Source:
International Brain Injury Association, Courtesy: Nathan
D. Zasler, M.D.
