Bronchiectasis in Childhood: Its Symptomatology, Course and Cause

There are three conditions, viz: bronchiectasis, chronic or unresolved pneumonia, and pulmonary tuberculosis, which have always given, and still do give rise to difficulty in their differentiation.Until recently the finding of the tubercle bacillus has been our chief, if not our only aid, in this differ- entiation, though from a knowledge that such is not always positive many cases of bronchiectasis and simple chronic pneumonia, at least in childhood, have been certified as cases of pulmonary tuberculosis and admitted to Sanatoria.It might be thought that with the advent of radiology great assistance would have been rendered in this direction, but when we recall that any consolidation of lung tissue will obstruct the passage of the X-rays and cast a shadow the limitations of this method of examination will be apparent.Nevertheless, if one appreciates the usual course of pulmonary tuberculosis during childhood, X-ray examination of the chest does givc considerable help.Pulmonary tuberculosis as it is met with by the paediatrician is on the whole a disease of infancy and very early childhood, an acute or subacute ail- ment leading comparatively quickly to a fatal result, and, unless in the very early stages, involving both lungs.Chronic pneumonia and bronchiectasis, on the other hand, are met with as a rule during later childhood, are eminently diseases of long duration and usually, though not invariably, limited to one lung or one lobe of a lung.Hence the extent of the mischief in relation to its duration and the age of the patient may enable one to speak fairly definitely for or against tuberculosis.Within recent years, however, Sicard and Forestier(l) have shown that it is feasible to introduce into the bronchial tree a substance (iodized oil- lipiodol) which is impervious to the X-rays.By this procedure it is possible to demonstrate the conformation of the whole bronchial tree and to discover if the bronchi, as in health, gradually taper towards their distal extremities or whether bulbous or tubular dilatations are present along their course.It is on the basis of our experience with this method of investigation of cases of chronic pulmonary disease in childhood, and the results obtained, that the present communication is founded.In our discussion of the question we wish to limit our attention to the matter of diagnosis and cause of the malady, and to the condition as met with during childhood.In view of the fact that many authorities are agreed that the onset of the disease, or at least the chronic pneumonia which is one of its main causes.is most frequent during childhood this limitation of the field of study does not produce such a one-sided view of the subject as might at first sight appear.In perhaps the largest series of cases of chronic pneumonia and bronchiectasis, which was recorded by Clark, Hadley and Chaplin(l), 82 % of 45 cases had their origin before 8 years of age.