Death in the Formula

Nearly all week, half of the 29 babies in the nursery of Binghamton (N.Y.) General Hospital had been finicky at feeding time. Some gagged on their bottled formula and tried not to swallow it, while a few who swallowed it promptly vomited. The nurses became edgy and puzzled, but were not at first alarmed.

On Friday, three babies died. Hospital officials began to worry about a virulent infection, but found no evidence of any. On Saturday, three more babies died. Still no one thought of checking the formula, partly because some babies were taking theirs well. Finally, Practical Nurse May Pier, pausing in her Sunday morning duties, mixed herself a cup of instant coffee, and to sweeten it she dipped into the formula room's canister for sugar. The coffee tasted like sea water. Curious, she tasted what was in the canister. It was not sugar but salt, and it had been going into the formulas of 14 babies. (Those who thrived were getting a patented formula or one sweetened with a special sugar.)

The Doctors Gather. Medical Director Jason K. Moyer called in all ten of the pediatricians, headed by Dr. John H. Ford Jr., who serve the hospital. They knew that salt poisoning can be deadly, especially to babies. But their medical library contained only one good account of its dangers, published in 1960 by two Baltimore researchers. The Binghamton doctors were faced with the first case of mass salt poisoning in U.S. hospital annals. They summoned one of the Baltimore team, Dr. Laurence Finberg of Johns Hopkins, and began their own frantic efforts to save the poisoned babies.

Some had been sent home and put on homemade formula soon enough to head off death. But some had been sent home with a day's supply of the salty formula. One of these was Lisa Marie Bealo, whose photographer father reported: "We brought the baby home with a quart of formula. She wouldn't take it. She gagged and made a gurgling noise. She was supposed to have four ounces, but we managed to make her swallow only an ounce. She drank water though. We took her back to the hospital." A day and a half later, she died.

Exchange of Fluids. For the worst cases, Dr. John E. Kiley of Albany Medical College hurried in to perform peritoneal dialyses--exchange of body fluids in the abdominal cavity. The doctor put a big hypodermic needle through the abdominal wall of each baby, and through it he dripped a sugar solution until the little bellies were slightly bloated. After an hour, a similar amount of fluid was drained off, and some of the salt, mixed and diluted, came with it. The needle stayed in place, and the drip-and-drain process was repeated every four hours, round the clock. Dr.Kiley worked on five babies this way for 36 hours, with only an hour's nap, until Dr. Finberg, delayed by bad weather, arrived to relieve him. One by one, all but one of the remaining babies were taken off the critical list, though some were still sick.

As autopsies showed a catastrophically high salt level in the bodies of six babies to be the almost certain cause of their deaths, the hospital's officials tried to figure out how the accident happened. Mrs. Lillie Mae Colvin, 29, a Negro practical nurse, mother of three and pregnant, had filled the formula room's canister on Tuesday. She did this from one of two identical 20-gal. galvanized cans standing side by side in the kitchen, their lids marked with stick-on labels that said "sugar" and "salt'' (the salt label was torn). Mrs. Colvin was sure she had filled the canister from the can labeled sugar--but this might have contained salt, perhaps because the lids had been accidentally switched.

Bomb Threats. Binghamton General is owned by the city, and under the law in New York (unlike many states) can be sued for negligence. What the hospital got first, however, was not suits but anonymous phoned bomb threats, and a mysterious fire broke out as well. Moreover, the tragedy is not finished. Even after the salt is flushed out and the baby seems well, parents must wait for as long as a year to see whether it will develop normally. By a mechanism not clearly understood, salt poisoning may cause irreversible damage to the brain. The tablespoonful of salt that many Binghamton babies had swallowed, said Dr. Finberg, was as lethal a dose as 4 lbs. of salt to an adult.

Because ordinary granulated sugar* is widely used in formulas, most hospitals have standard rules that salt and sugar must not be kept on the same shelf or in similar containers. Binghamton belatedly adopted similar rules, and state officials decided to make them mandatory.

* It has the same caloric value as costlier dextrose, which many doctors prescribe. Dextrose, they contend, is better assimilated; being a powder, it is less likely to be confused with salt.

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