Condensed from Town Journal Howard La Fay
It was just a year ago Christmas, in a Philadelphia hospital, when John and Mary Holter heard the crushing news about their baby The tiny, blue-eyed boy was a victim of dread hydrocephalus-- water on the brain.
In hydrocephalus, the fluid secreted by tissues within the skull increases excessively, swelling the cranium and squeezing the brain. Often, part of the fluid flows from the brain into the spinal canal, and can be drained off by inserting a tube between the spine and the abdominal cavity. But the Holter baby had an obstruction between the brain and spine which could not be removed and which prevented drainage. Many cases with this form of hydrocephalus died early or suffered serious brain damage.
Today Charles Case Holter-- fondly nicknamed "Casey"-- not only has cheated death but his inventor-father is turning out a device that is saving the lives of many other hydrocephalic babies. The Holter story is one of the medical triumphs of the year.
When little Casey was a few weeks old, the Holters' doctor told them that an operation could provide relief-- but probably only temporarily, because of the kind of hydrocephalus involved. He explained it; a tube would be inserted in Casey's skull, running down to the stomach where it would discharge the excess fluid now crowding the tiny brain. But there were two serious drawbacks: usually the child's body out grows the tube, and sometimes tissue causes it to clog.
Prayerfully, the Holters approved the operation. Ten days later, just as the doctors feared, tissue had clogged the tube and another operation was necessary. The outlook now appeared bleak indeed.
At Philadelphia's Lankenau Hospital, the Holters stood by with other parents of hydrocephalous children, all of them ready to pat a tiny hand or soothe a misshapen brow. As the days wore on, these parents snatched at every shred of hope. Somebody was perfecting a better tube! A new treatment! Tomorrow! But always tomorrow brought fresh despair.
One night two weeks after Casey's third operation he took a turn for the worse. The tube was clogging inexorably, the pressure on the tiny brain mounting. In the next room John Holter could hear a couple praying tearfully for their child. He listened for a moment, then hunted up a surgeon. "There must be some way to save these kids," he said. "Why can't you make a brain tube that works?"
By trade Holter was a technician at the Yale & Towne Research Center. He had been interested all his life in engineering, and had often handled problems in hydraulics. Now he listened intently as the neurosurgeon outlined the impossible assignment. "The ideal solution," the doctor said, "would be a tube from the cranium to the jugular vain in the neck, where the fluid could be absorbed in the blood stream. But to make this work we need a tiny, extremely efficient valve. It must be sensitive enough to open whenever the pressure in the brain reaches a certain point; it must also be absolutely tight to prevent any backflow from the jugular vein. We've tried a number of models, but all have failed." Holter drove the 20 miles to his home, thinking. "By the time I got there," he says, "I was sure I had the answer."
Next morning he took leave of his job to begin experiments Working feverishly 18 to 20 hours at a stretch in his company's laboratory, Holter turned out, in less than a week, his first working model of a valve for hydrocephalics. Ingeniously encased in a tube three inches long and only 3/16 of an inch in diameter were two nipple-like valves set to open slightly whenever fluid pressure in the brain rose above normal. Holter rushed his trial valve to Lankenau Hospital. The doctors were enthusiastic, but pointed out that one super-obstacle remained: the tiny valves, designed to tolerances of 3/10,000 of an inch, had to be made of a plastic-like material which could stand the high temperatures of sterilizing. Where would Holter find such a material? There was neither time nor money for special research, so, with his son dying, John plunged into a solitary quest. A Norristown firm offered a special polyvinyl-chloride tubing. It withstood the heat, but shrank slightly after sterilizing. Holter made the rounds of other plastic manufacturers. Various materials were suggested; none worked. For three weeks the search went on, and tiny Casey continued to fail. John pleaded with the doctors to operate again, if only to install one of the older, unsuccessful valves to buy time. Given an extra week or two he might solve the problem. And so for the fourth time the doctors probed, under the powerful lights. Now the Holter story almost came to an end. For the strain was to much; Casey's heart stopped beating. But the surgeon made an incision in the infant's chest and, reaching inside, massaged the small heart. Seconds ticked off on the big wall clock in the green-walled operating room. At length Casey's heart began to beat again. For the next five days the baby, barely alive, lay pale, unmoving, in an oxygen tent. Meanwhile, Holter kept up-his dogged search. Finally, when he called the Lee Rubber & Tire Co. research lab in Conshohocken, Pa., an official came up with a promising lead. "Why don't you try silicone?" he suggested. "It's one of the new materials they're using in heart surgery." For the delicate molding job the scientist recommended the West Co. of nearby Phoenixville, manufacturers of precision stoppers for medical vials. Dr. R. C. Hughes, research director at the West Co., ordered an immediate all-out effort for his staff. Two days later he delivered to Holter the first finished valves. John assembled a complete unit and rushed it to Lankenau, where the surgeons decided to try it. But Casey, still in the oxygen tent, was unable to stand further surgery, so the doctors would use the valve first on an other hydrocephalous child. The operation was a complete success! The Holters had their final triumph several weeks later when Casey had gained sufficient strength to undergo the same operation. With his father's invention in place, his life was saved. The valve must remain there always, but special endurance tests indicate the life-giving device will fulfill its job. Since then, Philadelphia surgeons report that the Holter valve has effectively controlled 57 hydrocephalous cases. Meanwhile, having saved his son, John Holter is working round the clock to save others. Quitting his job permanently in order to manufacture valves full time, he has poured his savings into precision machinery and set up shop in the garage of his home in Gulph Mills, a Philadelphia suburb. One corner of his bedroom is his testing laboratory, and there he works far into the night in hard, nerve-grinding labor. He can turn out only a few valves a week, and already the demand for them is so heavy that he is arranging to expand production. I visited the Holters recently. Casey's head is now nearly back to normal. John reached fondly for his son and held him high. "God put each of us here to make some contribution," he said. "And whatever happens now, maybe Casey has made his." .
REPRINTED FROM THE JANUARY 1957 ISSUE OF READER'S DIGEST©1956 THE READER'S DIGEST ASSOCIATION, INC., PLEASANTVILLE, N.Y. 10570 PRINTED IN U.S.A