Pediatrics: The Deadly Membrane

When a baby is born prematurely, he is especially susceptible to a breathing difficulty that develops into hyaline membrane disease. The inner linings of the lungs get covered with a membrane that prevents the exchange of oxygen and carbon dioxide and kills the victim. So far, the most expert and concentrated medical efforts have proved virtually helpless against “H.M.D.”; it was the cause of Patrick Bouvier Kennedy’s death in 1963 when he was only 39 hours and 12 minutes old.

Last week Dr. Daniel Stowens, a Louisville pathologist, said he had found the explanation of H.M.D. and a simple, effective treatment: Epsom salts enemas. He told the College of American Pathologists that he had concluded from post-mortem examinations that H.M.D. victims suffered from an inability to get rid of excess water. Since the premature baby’s kidneys may not be up to the job of ridding the body of excess water, Dr. Stowens suggested helping them with the Epsom salts enemas. In eight months, 28 babies with “severe respiratory distress and all clinical signs of hyaline membrane disease” were so treated, and all did well.

There is one difficulty, though. Pediatricians may suspect that a baby is developing H.M.D., but only an autopsy can prove them right. And although waterlogging is notoriously a problem in all preemies with breathing difficulties, nobody is yet certain whether it is a cause or an effect of H.M.D. Indeed, there are many pediatricians who feel that dryness in the lungs, not waterlogging, is a major cause of the disease.