Medicine: Drain for the Brain

The baby was suffering from a stubborn form of hydrocephalus (water on the brain): spinal fluid, collecting in his skull cavity, caused his head to enlarge and threatened to squeeze the brain so that the child’s mental development would be arrested. Some hydrocephalus cases can be treated with fair success by putting a tube in the spinal canal half way down the back and draining the fluid from the brain through the spinal canal into the urinary system. But this child, son of a Philadelphia industrial technician named John W. Holter. was in a worse plight because he had a barrier between the brain cavity and the spinal canal.

At Philadelphia’s Children’s Hospital, Neurosurgeon Eugene Spitz, 37, tried running a tube direct from baby Charles’ head to his abdomen. It worked only for a few days at a time, then another operation was needed to clean it. To the father Dr. Spitz explained that he would like to drain the brain fluid into the jugular vein. But this would need a valve (to prevent back flow by the blood), and so far no satisfactory valve had been devised-they all had a tendency to clog.

That night Holter went home and stared at his drawing board. He drew the design of a valve with two fins that opened and shut like the gates of a canal lock. But what to make it of? Holter began a frantic search for a suitable material. He worked evenings and weekends, got only three or four hours’ sleep a night. The valve had to be durable. It must be inert, so as not to corrode or cause reactions in the blood. While Holter worked, surgeons operated again, put in a temporary tube in the hope of keeping his son alive until Holter could find his material. Finally Holter hit upon silicone plastic fins in a stainless steel body, and a plastic-molding company made up several sample valves.

On May 3 Dr. Spitz opened the baby’s jugular, made an opening between the vein and one of the fluid-filled brain cavities, set the valve into the opening, and closed the skin over it. The valve worked. In less than two weeks Charles Holter went home. Last week, nearing his first birthday, he was still doing well. Though fluid might continue to collect for the rest of his life, it could drain off through the valve, which would stay in place. Pediatricians, who had just heard Dr. Spitz’s report, were hopeful that his technique and Holter’s valve would be the answer to hundreds of cases of this type of hydrocephalus each year in the U.S. John Holter quit his technician’s job, was devoting his whole time to making the valves that had saved his son.