Disfunction in bladder has consequences

Shahar Madjar, MD

I told you that a good train-ride story is a tale of transformation in which the protagonist arriving at his destination is a man changed forever. Such is my third train-ride tale.

On the evening of Sept. 25, 1919, Thomas Woodrow Wilson was aboard the Mayflower, the presidential train, when he developed difficulties breathing, facial twitching and nausea. The event followed a period in which he experienced worsening headaches, asthmatic attacks and congestive heart failure.

It was in the early days after World War I had ended. Wilson took the train journey — a grueling speaking tour that was supposed to start in Seattle, follow the Pacific Coast, and continue to Colorado and Kansas — in order to take his case to the people. His goal was to promote the idea of the Covenant of the League of Nations which he believed would discourage future military conflicts.

Wilson was only 63 at the time, but not a healthy man: at age 39 (1896), he felt pain in his right arm and numbness along the fingers of his hand. In 1904, he noticed weakness in his right hand. In 1906, he awoke with loss of vision in his left eye and weakness of his right arm.

And so, in 1919, while on a train journey on the Mayflower, it became evident that more of the same was about to happen. The train trip had to be terminated and the Mayflower sped back to Washington, D.C.

Three days after his arrival in Washington, D.C., President Wilson noticed a loss of feeling in his left hand. His left arm and leg were paralyzed, the left side of his face drooped. A neurologist diagnosed him with ischemic stroke.

A stroke is a medical condition in which the blood supply to a part of the brain is interrupted. Without proper blood flow, the affected part of the brain is deprived of oxygen and nutrients; it cannot function properly.

In the hours that followed, Wilson’s abdomen became distended and he could urinate only a few drops at a time.

Dr. Hugh Hampton Young, the preeminent urologist at the time, was summoned. In his autobiography, Dr. Young recalled that he found that “…the President has had gone thirty hours without voiding urine,” and that “His abdomen was hugely distended. He presented a sad picture as he lay there with his mouth drawn on one side and with paralytic left arm and leg. The condition was evidently desperate.”

I often see patients with a history of a stroke, or an injury to their spinal cord. These patients often sit in a wheelchair, or use a cane or a walker to ambulate. It is intuitively clear to them that they can’t move their arms, or legs because of their brain, or spinal cord injury, “but why doesn’t my bladder work?” They ask.

“The brain is like a light-switch,” I tell them, pointing at the light-switch on the wall. “Then, there is the spinal cord that contains many neurons which run like the electrical cords in the ceiling above us, connecting the light-switch to the light bulb. In this analogy,” I continue, “the light bulb is your bladder. Any damage to areas of the brain that control the bladder, any injury to the spinal cord that transmits messages to the bladder, could result in bladder dysfunction. If the light-switch wouldn’t work, if the electrical wire is damaged, there would be no light.”

The bladder-switch in President Wilson’s brain had shut off and Dr. Young had to come up with a solution. But there were no good solutions at the time. It was a time when presidents were taking the train to convey their message (commercial passenger flying began in 1914; the first electronic TV was invented in 1927). It was a time when bladder catheters were rudimentary, when bladder catheterization was dangerous, for it could cause a severe, deadly infection (Dr. Frederic Foley invented the indwelling Foley catheter in 1929; Alexander Fleming discovered Penicillin, the first antibiotic, in 1929).

Dr. Young wrote: “… it seemed that a surgical operation would have to be carried out through a median line abdominal incision to open the bladder, and relieve the terrific distention. But could he [President Wilson] stand the shock of it? I hardly thought so.”

Based on his experience with patients who sustained spinal cord injuries in France, during World War I, Dr. Young decided to wait. President Wilson’s bladder became further distended but the bladder neck eventually gave way and urine began to escape through the urethra. Surgery was avoided.

Over the next several months, President Wilson’s general health continued to be dire. No explanation was explicitly given to the public and matters of state were managed by the President’s secretary, Mr. Joseph Patrick Tumulty, and Edith, Wilson’s second wife.

Wilson served out his term and died of another stroke in 1924.

On a train-ride aboard the Mayflower, President Wilson was confronted with his own frailty. His dream of a League of Nations remained unfulfilled at the time of his death. It would take 21 more years and another world war until the founding of the United Nations in 1945. And wars still abound.

Editor’s note: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.