Professor Bryan Jennett, Neurosurgen
Glasgow neurosurgeon who described the 'vegetative state' and revolutionised head-injury care
Saturday 16 February 2008
Professor Bryan Jennett was a neurosurgeon who revolutionised head-injury care. He was a master at identifying important but soluble questions, thereby improving the care of brain-injured patients who had previously been regarded as being beyond help. In the 1960s, understanding of issues such as brain swelling, late deterioration, impaired consciousness, prognosis and brain death was rudimentary. Jennett made crucial contributions to all these problems through collaboration, intellectual courage and his "unusually penetrating and analytical mind," to quote the Liverpool physician Henry Cohen (later Lord Cohen of Birkenhead), his first mentor, who nudged Jennett into neurosurgery.
Born in England of Scottish and Irish stock 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 had the ideal physique for a scrum-half and when playing for the Rugby First XV, he was noted for fearlessly falling on the ball when support was not forthcoming – an intimation of what was to follow.
At Liverpool University Medical School, where he met his future wife, a fellow medical student called Sheila Pope, he was both top of his year and president of the British Medical Students' Association. He trained at Oxford (with Sir Hugh Cairns and at the RAMC Military Hospital, Wheatley), where his lifelong devotion to the treatment of head injuries was kindled, 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/university consultant post in Glasgow and to the new Chair of Neurosurgery at Glasgow University in 1968.
In a remarkably short time Jennett made Glasgow a world-class centre of excellence in neurosurgery, first at Killearn Hospital and then at the new Institute of Neurological Sciences at the Southern General Hospital. Glasgow returned to the glory days of Sir William Macewan who, in 1879, was the first person to successfully remove a brain tumour, and became the intellectual home for many academic neurosurgeons from home and abroad. Jennett stimulated their interest, created the resources for them to prosper, redrafted their first sorry attempts at authorship and delighted in their future success in disciplines as diverse as neurosurgery, statistics and psychological medicine.
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, with Michael Bond, he published the deceptively simple Glasgow Outcome Scale.
These tools were the bedrock for all the randomised 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, yet again, picked on 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 brain injury association, and president of the Section of Clinical Neurosciences at the Royal Society of Medicine. His horizons broadened with his courageous and reasoned rebuttal of the infamous 1980 Panorama programme "Are transplant donors really dead?" Much damage to public confidence was averted.
He 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?" The lot of brain-injured patients and their families are much the better for his discoveries.
Bryan Jennett – or "BJ", as he was known – and his wife Sheila, a noted professor of respiratory physiology, and their large family shared an enthusiasm for sailing off the West Coast of Scotland, and he encouraged his family's many musical talents, despite being tone deaf himself.
William Bryan Jennett, neurosurgeon: born Twickenham, Middlesex 1 March 1926; Lecturer in Neurosurgery, Manchester University 1957-62; Consultant Neurosurgeon, Glasgow 1963-68; Professor of Neurosurgery, Glasgow University 1968-1991 (Emeritus), Dean of the Faculty of Medicine 1981-86; CBE 1992; married 1950 Sheila Pope (three sons, one daughter); died Glasgow 26 January 2008.
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