Hyaline Membrane Disease: Morbid Anatomy, Hypothesis of Its Pathogenesis, and Suggested Method of Treatment

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Abstract
An attempt has been made to correlate hyaline membrane disease with various aspects of the physiology of the newborn infant and the adaptive mechanisms coincident with birth. The basic anatomic observations consist of demonstrable immaturity, especially of the lungs and kidneys, and evidence of disturbed fluid circulation in the form of dilatation of lymphatics in all tissues. It is known that the total body water of the premature infant is higher than that of the term infant and that immediately after birth there is a rapid excretion of large amounts of water. This led to the hypothesis that the basis of the respiratory difficulty in premature infants might be related to inability of the infants to achieve the proper level of total body water necessary for extrauterine existence. This was thought to be the result of inadequacy of the renal means of excretion because of the incomplete development of the kidneys. Because of this immaturity of the kidneys, the lungs might be used as an accessory pathway of fluid excretion; however, difficulty is encountered because the immature alveolar lining acts as a dialyzing membrane and impedes the passage of protein. This causes an accumulation of protein between the alveolar lining and the capillary endothelium. This protein, when it achieves sufficient density, is visible as a hyaline membrane. Because direct proof of the hypothesis was not obtainable, indirect evidence for its support was sought. This evidence consisted of altering the direction of flow of body fluids by diverting the fluid from the circulation into the gastrointestinal tract by means of saturated magnesium sulfate solution enemas. This treatment was administered to 28 babies with severe progressive respiratory distress, and all recovered.