The prognosis of bronchiectasis in childhood.

In England Ogilvie (1941), Field (1949) and Conway (1952) have collected cases of childhood bronchiectasis over the long term and on the large scale needed for worthwhile information. The gloomy prognostication, based on old clinical and necropsy studies, that the bronchiectatic child will not grow up or will be a burden to himself and his neighbours, is not generally true. Since 1926-that is, during 20 to 30 years of active bronchographythe diagnosis has depended on an x-ray appearance of dilatation in more or less of the bronchial tree. On this basis it seems now established that: (1) dilatation once present always persists, except where tubular widening is confined to lobes or segments temporarily collapsed (atelectatic reversible bronchiectasis); (2) under natural conditions the distribution of the affected areas does not alter; and (3) the clinical picture changes little and the tendency is for any change to be for the better even without surgery and without chemotherapy. In 1944, I (Franklin, 1944) reviewed 24 personal cases of bronchiectasis, observed for periods of four and a half to 13 years, and found 15 of them completely well and free from symptoms, while four were assessed as invalids, and five were classed as delicate according to criteria described below. The x-ray evidence of bronchiectasis had remained constant in distribution throughout the period of observation in all but one of the cases. This boy had the severest form of bronchiectasis clinically, with the added complications of steatorrhoea, an anaemia of pernicious type, and for a short period signs of subacute combined degeneration of the cord. Despite all this and the fact that the bronchiectatic areas spread he is, at the age of 23, well grown, normal and healthy and has been free from respiratory symptoms for six years. With a further follow-up it is possible to take from this whole group 19 cases with an interval from the onset of symptoms of between 13 and 26 years, and one with