John Holter, brain engineer

In 1955, after seven years of trying, John and Mary’s first child was born. The birth of Casey Holter turned John Holter’s life upside-down and changed the course of medical history.

Agonisingly, Casey had spina bifida, a condition where the spine doesn’t fully form and may be dangerously misshapen.

The condition was also causing hydrocephalus, a life-threatening build-up of fluid in the brain.

The fluid that surrounds the brain is called cerebrospinal fluid or CSF and acts as a fluid ‘bath’ which cushions and protects the delicate organ.

It is produced by a structure in the brain stem called the choroid plexus and circulates around the brain before being drained into the blood supply.

If the drainage system is blocked, however, it can lead to a dangerous build-up that can pressure, distort and eventually damage the brain beyond repair. If left untreated, it can be deadly.

In 1955, the only thing keeping Casey Holter alive was a twice daily procedure where a needle was inserted into the fontanelle, the soft spot on a baby’s head, and the excess fluid was removed with a syringe to reduce the pressure.

Eventually, Casey was given an operation by the neurosurgeon Eugene Spitz to insert a ball and spring valve that would, in principle, allow the fluid to drain into the blood supply, without letting anything dangerous from the blood wash back into the CSF.

Unfortunately, the valve was clumsy technology, and when inserted, it irritated Casey’s heart to the point where the young child had a heart attack and suffered permanent brain damage.

John Holter, then working as a technician in a hydraulics factory, asked Eugene Spitz about the details of the procedure. He was surprised that the problem, which seemed to him like a simple hydraulics issue, had not been solved.

He had noticed that when nurses inserted needles into certain types of medical tubing, leaks didn’t occur because the gap was water-tight under low pressure conditions.

But, like a teat on a baby’s bottle, when the pressure was high enough the gap opened and the fluid forced its way through. A perfect valve for releasing built-up CSF and preventing backwash.

Holter went home, sat in his workshop, and constructed the first version that very evening. It was a rough-and-ready rubber-tubing and condom prototype, but it worked.

While the principle was sound, Spitz noted that that the valve must made of a material that wouldn’t irritate the body, as this might cause the same problem that had brain-damaged his son.

Holter contacted Dow Chemical and was advised to use silicone, at the time, a newly developed material.

Holter had created a usable version within months. So quickly, in fact, that his son was still too weak from the last operation to have it installed.

It was first and successfully installed in another child, and then in March 1956, Eugene Spitz installed John Holter’s valve into Casey, successfully treating his hydrocephalus.

Sadly, Casey never fully recovered from his brain damage from the initial operation, and died during an epileptic seizure five years later.

Fittingly, Casey’s legacy is that Holter’s invention, now called the Spitz-Holter shunt, is still in use today.

Holter spent the rest of his life developing valves for medical use and passed away in 2003, having saved the lives of thousands children affected by the same condition as his son.

It is estimated that 15,000 valves based on Holter’s design are installed every year in the United States alone.

John Holter’s remarkable story was retold in a 2001 paper published in the Journal of the American College of Surgeons upon which this article was based.

Link to PubMed entry for Journal of the American College of Surgeons paper.

5 Comments

  1. james lee
    Posted November 30, 2011 at 6:03 am | Permalink

    Thank you for your discovery. It saved my life.

  2. Aase-L Hasselgaard
    Posted December 14, 2011 at 4:48 pm | Permalink

    Because of John Holter and his inventions, my life was saved in 1998, and in 2000. Thank you!! R.I.P. <3

  3. Posted January 6, 2014 at 11:55 pm | Permalink

    I have Spina Bifida, but don’t have a shunt, and I consider this man a hero. I knew a lot of children growing up that had them, though.

  4. Posted January 7, 2014 at 4:10 pm | Permalink

    I was born in 1972 with congenital hydrocephalus. I was diagnosed, and had my first shunt installed, three weeks later. I’ve had a total of 17 shunt surgeries, the last two in the summer of ’04. When I was diagnosed, my parents were told I might never walk, talk, speak or learn. I was speaking in complete sentences by 18 mos, reading by 3.5 yrs old, and attended a school for gifted children up through the end of fifth grade (10-11 yo). Conversely, I couldn’t ride a bike without training wheels until I was 10.5 yo, and I still can’t drive. I’ll be turning 42 in a couple of weeks. Without the gift of the Spitz-Holter shunt, I wouldn’t be alive today.

  5. Anne Mortimer
    Posted August 31, 2014 at 10:21 pm | Permalink

    My sister was born in October 1957 with spina bifida and hydrocephalus. The doctors at Great Ormond Street Hospital told my father of the Spitz Holter valve in america and he found the money to buy one and get it shipped over. He picked it up from London Airport and took it to the hospital and two days later my sister became the 4th in UK and 7th in the world to have the Spitz Holter valve. We believe she is only surviving one with one of the early valves. At twelve she had her head x-rayed and they discovered that she was not using it anymore and the valve had parted. The doctors decided to leave it in situ and there it has remained all these years later. My father at almost 99 is proud of the fact that he had a hand in bringing the Spitz Holter valve to the UK.


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