Fred Plum (January 10, 1924 – June 11, 2010) was an American neurologist who developed the terms "persistent vegetative state" and "locked-in syndrome" as part of his continuing research on consciousness and comas and care of the comatose.
Plum was born in Atlantic City, New Jersey on January 10, 1924. [1] His father, Frederick Plum, a champion trapshooter and owner of a chain of drug stores, died when Plum was eight years old. [2] Plum chose to pursue a career in neurology after his sister died of poliomyelitis while he was a teenager. He earned his undergraduate degree from Dartmouth College in 1944 and was awarded his medical degree from the Cornell University School of Medicine in 1947. His first published paper was co-written with future Nobel Prize winner Dr. Vincent du Vigneaud. [1]
Plum worked in the US Naval Hospital in St. Albans, Queens, NY during the Korean War. He was named head of the department of neurology at the University of Washington in 1953, making him the youngest chief in the institution's history. [3] There he created a respiratory center to help treat patients who were unconscious or comatose, including those who had suffered drug overdoses. Using the limited clinical tools available at the time, Plum developed guidelines to help determine how to best treat comatose patients, writing The Diagnosis of Stupor and Coma in 1966, together with his longtime research partner Dr. Jerome B. Posner, a work described by neurologist Marcus E. Raichle as having "put stupor and coma on the map as an important consideration in neurology". [1]
Working together with Glasgow neurosurgeon Dr. Bryan Jennett, Plum developed the Glasgow Coma Scale, as an objective way of documenting and monitoring the conscious state of a patient based on eye motion, and motor and verbal responses. Together with Jennett, he coined the term "persistent vegetative state" to describe patients with severe brain damage who were in a coma, and had the appearance of being conscious without any detectable awareness. Plum testified as an expert witness in the 1975 Karen Ann Quinlan case. [1]
Plum later coined the term "locked-in syndrome" to describe a condition in which a patient is aware and awake but cannot move or communicate due to complete paralysis of most voluntary muscles in the body except for the eyes. [1]
Plum advocated that people should prepare an advance health care directive, or "living will", to help guide their treatment in the event that they are not able to make medical care decisions due to illness or incapacity. [1] Plum treated Richard Nixon before his death in 1994, and credited Nixon's living will with allowing the former President to control his course of treatment with authority over how decisions were made at the end of his life. [4]
A resident of Manhattan, Plum died at age 86 in a hospice there on June 11, 2010, due to primary progressive aphasia, a form of dementia similar to Alzheimer's disease. He was survived by his second wife, Susan, as well as by a daughter, Carol, and two sons, Michael and Christopher (married to Maureen B. Cavanaugh), from his first marriage to Jean Houston (died in 1999). [1]
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake–sleep cycle and does not initiate voluntary actions. The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as pneumonia or blood clots. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be the result of natural causes, or can be medically induced.
Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.
Locked-in syndrome (LIS), also known as pseudocoma, is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in their body except for vertical eye movements and blinking. The individual is conscious and sufficiently intact cognitively to be able to communicate with eye movements. Electroencephalography results are normal in locked-in syndrome. Total locked-in syndrome, or completely locked-in state (CLIS), is a version of locked-in syndrome wherein the eyes are paralyzed as well. Fred Plum and Jerome B. Posner coined the term for this disorder in 1966.
Brain death is the permanent, irreversible, and complete loss of brain function, which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some autonomic functions remain. It is also distinct from comas as long as some brain and bodily activity and function remain, and it is also not the same as the condition locked-in syndrome. A differential diagnosis can medically distinguish these differing conditions.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
A vegetative state (VS) or post-coma unresponsiveness (PCU) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state, the patient is classified as being in a persistent vegetative state (PVS). This diagnosis is classified as a permanent vegetative state some months after a non-traumatic brain injury or one year after a traumatic injury. The term unresponsive wakefulness syndrome may be used alternatively, as "vegetative state" has some negative connotations among the public.
A minimally conscious state or MCS is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The natural history and longer term outcome of MCS have not yet been thoroughly studied. The prevalence of MCS was estimated to be nine times of PVS cases, or between 112,000 and 280,000 in the US by year 2000.
Anthony David Bland was a supporter of Liverpool injured in the Hillsborough disaster. He suffered severe brain damage that left him in a persistent vegetative state as a consequence of which the hospital, with the support of his parents, applied for a court order allowing him to "die with dignity". As a result, he became the first patient in English legal history to be allowed to die by the courts through the withdrawal of life-prolonging treatment including food and water for the injuries.
Central neurogenic hyperventilation (CNH) is an abnormal pattern of breathing characterized by deep and rapid breaths at a rate of at least 25 breaths per minute. Increasing irregularity of this respiratory rate generally is a sign that the patient will enter into coma. CNH is unrelated to other forms of hyperventilation, like Kussmaul's respirations. CNH is the human body's response to reduced carbon dioxide levels in the blood. This reduction in carbon dioxide is caused by contraction of cranial arteries from damage caused by lesions in the brain stem. However, the mechanism by which CNH arises as a result from these lesions is still very poorly understood. Current research has yet to provide an effective means of treatment for the rare number of patients who are diagnosed with this condition.
Terry Wayne Wallis was an American man from the Ozark Mountains of Arkansas who, on June 11, 2003, regained awareness after spending 19 years in a minimally conscious state.
Neurocritical care is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury.
William Bryan Jennett was a British neurosurgeon, a faculty member at the University of Glasgow Medical School, and the first full-time chair of neurosurgery in Scotland. He was the co-developer of the assessment tool known as the Glasgow Coma Scale and made advancements in the care of patients with brain injuries. in 1972, Jennett and the neurologist Fred Plum coined the term vegetative state.
Traumatic brain injury can cause a variety of complications, health effects that are not TBI themselves but that result from it. The risk of complications increases with the severity of the trauma; however even mild traumatic brain injury can result in disabilities that interfere with social interactions, employment, and everyday living. TBI can cause a variety of problems including physical, cognitive, emotional, and behavioral complications.
Ronald Eugene Cranford was a neurologist and expert on comas and unconsciousness. He is best known for his work with families on public cases involving persons in a persistent vegetative state. He and three other doctors were responsible for introducing the "do not resuscitate" order. He worked with the families of such notable cases as the Karen Ann Quinlan case, Paul Brophy, Nancy Cruzan case and Terri Schiavo case.
Steven Laureys is a Belgian neurologist. He is principally known as a clinician and researcher in the field of neurology of consciousness.
Rom Houben is a Belgian man believed to be comatose and in a vegetative state for 23 years after a near-fatal automobile accident, who was diagnosed with locked-in syndrome in 2006.
Jerome B. Posner is an American neurologist and co-author of Plum and Posner's Diagnosis of Stupor and Coma. Dr. Posner graduated from the University of Washington with a Bachelor of Science in 1951 and continued there to pursue a degree in medicine which was awarded in 1955.
Disorders of consciousness are medical conditions that inhibit consciousness. Some define disorders of consciousness as any change from complete self-awareness to inhibited or absent self-awareness and arousal. This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe but rare chronic coma. Differential diagnosis of these disorders is an active area of biomedical research. Finally, brain death results in an irreversible disruption of consciousness. While other conditions may cause a moderate deterioration or transient interruption of consciousness, they are not included in this category.