Author Affiliation: Department of Neurology and Neuroscience, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine Center, New York, New York.
Fred Plum died on June 11 at 86 years of age after a long illness that cruelly robbed him of two of his most striking assets: first, expressive language (primary progressive aphasia) and then his prodigious intellect. He bore this long illness with little complaint, continuing to read journals and attend Neurology Grand Rounds, despite his language deficit, until he was no longer able. He was, in his time, one of the world's most important neurologists and certainly one of its most colorful. Fred Plum stories abound. Perhaps the best known involves Fred's demonstration of parietal neglect to students and house staff. He would remove his arm from the right sleeve of his white coat and place his glasses askew on the right. He would then ask the patient if they noticed anything unusual about him. Most of the time this resulted in the patient's denying there was anything unusual but one patient, after peering at him for many seconds, responded, “Yes, you have bad acne.” Residents loved to tell the story.
Fred Plum, MD
He was born in Atlantic City, New Jersey, in 1924. His motivation for medicine, and particularly neurology, was said to have been prompted by the death of a sister from poliomyelitis, an illness to which he made substantial contributions. He attended Dartmouth College and Dartmouth Medical School, then a 2-year school, and graduated from Cornell University Medical College in 1947. His first scientific article described work done as a medical student with Vincent du Vigneaud, subsequently a Nobel Laureate. After graduation, he served first as an intern and then as a neurology resident under the direction of Harold Wolff, MD, whom he eventually succeeded as Neurologist in Chief at New York Hospital. While a resident, he published several articles on poliomyelitis encompassing treatment of respiratory insufficiency and unusual manifestations of poliomyelitis including arterial hypertension and papilledema.
After residency he served in the US Navy for 2 years. In 1953, at age 29, he was recruited by Robert Williams, MD, to head the Neurology Division of the Department of Medicine at the University of Washington. He was one of a large number of young physicians in their late 20s and early 30s who were appointed division chiefs by Dr Williams, almost all of whom became leaders in their respective fields. Because of his expertise in poliomyelitis, he developed a respiratory center at Harborview Hospital located between the neurology ward and the infectious disease ward that housed patients with acute polio. With August Swanson, MD, his first resident, he flew to Alaska to help in their polio epidemic. He flew from town to town with bush pilots, advising physicians in respiratory care. Because the most common cause of coma at that time was barbiturate overdose, an illness that often led to respiratory failure, neurology became the logical place to admit all comatose patients and, later, virtually all patients with alterations of consciousness. Over time, Fred's reputation for diagnostic expertise became so great that when one of the interns in the emergency department was confronted with a “blue man,” a disorder he had never heard of, he called the neurology division, “Because I have no idea what the patient has, I didn't even know in whose domain the problem belongs, so that I figured it was best to call neurology.” Fred, of course, recognized methemoglobinemia from inadvertent nitrite ingestion. Prompt treatment corrected the situation. The patient recovered; his friends, who also ingested nitrites and did not reach the hospital, died.
Fred's interest in comatose patients led to a classic article written with his resident, Don McNealy, MD, titled “Brainstem Dysfunction With Supratentorial Mass Lesions” in the Archives of Neurology in 1962. This article described his approach to the clinical diagnosis of the comatose patient. Recall that acute imaging techniques (computed tomography and magnetic resonance imaging) had not yet been developed, and arteriography and pneumoencephalography were not appropriate emergency procedures, so accurate clinical diagnosis was essential. This work eventually led to the publication of the first edition of the Diagnosis of Stupor and Coma1 in 1966, Fred's book, and a work for which I get much more credit than I deserve.
Harold Wolff, MD, died in 1961, and in 1963 Fred became Chairman of the newly created Department of Neurology at Cornell Medical College and Neurologist in Chief at New York Hospital. Although he was happy at the University of Washington, he believed that his effect on American neurology would be greater if he were at Cornell, rather than Seattle. At that time the University of Washington had not yet achieved the reputation it now has.
At Cornell he continued his work on coma and expanded that work to the study of cerebral blood flow and metabolism, making contributions to patients with metabolic systemic illnesses, strokes, and seizures. He also made major contributions to defining prognosis after cardiac arrest. He published more than 300 original research articles and reviews and trained a large number of residents who subsequently became chairs of departments.
As a clinical teacher he was unparalleled. In 1971, when he went to Sweden on sabbatical, a number of the country's leading neurologists were invited to Cornell for Grand Rounds and clinical rounds with the residents. The residents were uniformly disappointed; none were as electrifying or challenging as Fred.
Of interest to readers of this journal, Fred served on the editorial board of the Archives from 1955 to 1961 and became Chief Editor in 1971. He, along with the entire editorial board, resigned in 1975 in a dispute over the nature of the journal's cover and the question of interspersing advertising among the editorial content, a dispute that now seems almost quaint. Maurice Van Allen took over editorial responsibilities with a new editorial board, and Fred went on to become the Founding and Chief Editor of the Annals of Neurology, a position he held until 1984.
Over time his progress as a clinical investigator, an outstanding clinician, and a superb teacher led to too many honors and appointments to list here. He served as president of the American Neurological Association, the Association for Research in Nervous Mental Disease, the Harvey Society, the New York Neurological Society, and the Society of Cerebral Blood Flow and Metabolism. He received an honorary doctorate from the Karolinska Institute. He was a member of the Institute of Medicine, Association of American Physicians, and American Academy of Arts and Sciences. He coined the term locked-in syndrome and, with Brian Jennett, MBChB, MD, the term persistent vegetative state.
Fred did not “suffer fools lightly.” He was often sharp in his criticism of those he thought deserved it. Conversely, if he believed that one had good potential as a neurologist or investigator, he would go to great lengths to assist that person, often giving credit beyond what was deserved. His personality was such that, at the end of the day of presentations at national meetings, residents and some faculty would gather in the bar to have a beer and exchange Fred Plum stories. They could not resist. Even now, in a review of the fourth edition of Diagnosis of Stupor and Coma, David Shaw includes in his review a Fred Plum story.2
Fred is survived by his wife Susan and 3 children from his first marriage, Michael, Carol, and Christopher. They will miss him sorely, as will those of us who were fortunate to have had contact with him and his teaching, either directly or indirectly. Those who did not know him cannot know how much they have missed.
Correspondence: Dr Posner, Department of Neurology and Neuroscience, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine Center, New York, NY 10065 (email@example.com).
Financial Disclosure: None reported.
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