Hydrocephalus

Last winter, after twelve barren years, frail Mrs. Howard Albert Jackson of Manhattan bore her proud husband a baby girl. For two months the joyous Jacksons showed off little Alice to their admiring friends. Then suddenly they noticed that her head was swelling like a little balloon. The tender fontanel at the top of her head was tense and bulging, and thick blue veins stood out like cords underneath her downy hair. The doctor shook his head, told them that the baby had hydrocephalus (water on the brain) and, like 2,000 other hydrocephalic children born in the U. S. every year, was probably doomed to imbecility or death. Water pressure from the interior of her brain, he said, would squeeze the baby's grey matter against her soft skull bones until her head became even larger than the head of a normal adult.

Determined to keep their hard-won baby, the Jacksons frantically combed Manhattan every day for a month, seeking a doctor who would offer them some hope. Last spring at the Neurological Institute they found young Dr. John Edwin Scarff. By this time the head of little eleven-pound Alice measured 18 inches in circumference. Dr. Scarff agreed to operate.

Ventriculoscope. Buried in the middle of the brain are four ventricles or water reservoirs, the two largest shaped like a pair of ram's horns. Each ventricle is partly lined with feathery tissue called the choroid plexus. Function of the choroid plexus is to generate the fluid which bathes the outside of the brain and spinal cord. If the choroid plexus produces abnormal quantities of water, or if the brain fails to absorb the fluid which bathes it, hydrocephalus occurs.

Purpose of Dr. Scarff's operation on Alice was to destroy the choroid plexus in her first two ventricles, thus diminishing the water supply to her brain. (The third and fourth ventricles are smaller, produce minute quantities of water.) First he made a one-inch slit on the top of her scalp, cut out a small plug of bone. Into the tiny hole he inserted his ventriculoscope.

Dr. Scarff's ventriculoscope is a metal tube three-eighths of an inch in diameter, ten inches long. At the bottom is a lens, two tiny electric lights, two threadlike rubber hoses, for maintaining adequate fluid pressure in the brain, and an electric wire for cauterizing. At the top of the instrument is an eye piece and an electric connection. Gently working the ventriculoscope through Alice's grey matter down to one of her ventricles, Dr. Scarff was able to see about two inches of choroid plexus. Turning on the electricity, he seared off all the feathery tissue he could reach with his hot wire. Within a half hour he had cauterized the choroid plexus in both ventricles. After the operation, he gently withdrew the tube, inserted the plug of bone, neatly stitched up the baby's scalp.

Intelligence. Three days after her operation, little Alice was sucking lustily at her bottle. Her fontanel began to sink. Last week, when Dr. Scarff gave Alice a checkup, he found that her head had decreased a quarter of an inch in circumference, while her body had nearly doubled in size. She gurgled, tried to sit up alone and reach for his finger. "We're simply crazy about her now," cried beaming Mr. Jackson.

Dr. Tracy Jackson Putnam, famed Harvard neurologist, who several years ago independently devised an operation and instrument similar to Dr. Scarff's, claims that hydrocephalic babies of normal intelligence whom he has operated upon, grow up to be just as bright as normal children.

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