These diseases were responsible for 6.1% of the deaths in the age-group of infants, who were included in our investigation. Among the toddlers it appeared that diseases of the respiratory tract were the cause of death in 8.4 to 9.5 per cents. Of the cases, while after the 4th year of life this percentage dropped to 3.6-5.7. The most important type of respiratory disease which lead to death in many cases was acute bronchiolitis.
Out of the 93 children who died by respiratory diseases 47 ( = 50%) died by acute bronchiolitis. The course of acute bronchiolitis was mostly very rapid. Thirty-five of the patients who died of acute bronchiolitis did so within 24 hours after admission. Especially infants and toddlers become victims of this disease, The age distribution of the patients suffering from acute bronchiolitis is mentioned in table IX-14.
Table IX – 14.
Age distribution of 112 patients suffering from acute bronchiolitis and admitted in two children’s wards at Jogjakarta in the period July 1, 1954 till July 1, 1958.
Diagnosis was based on the data of anamnesis, the manifestations of sever dyspnea, prolonged exspiration, fever, the rales which could be heard all over the chest, while X-ray examination demonstrated no symptoms of pneumonia. In the peripheral blood signs of infection can be demonstrated. The white cell-count is increased and immature white cells are present.
It is nearly always possible to distinguish between acute bronchiolitis and an asthmatic attack. Bacteriological examination of the sputum was impossible. The treatment which was given to patients suffering from acute bronchiolitis was penicellin and streptomycin intramuscularly, Oxygen-treatment, and in a number of cases small doses of epinephrine (adrenalin) 0.2 cc hypodermically once or twice after an interval of 30 minutes. This treatment was started immediately after admission and yet the mortality was 42%.
The other types of respiratory diseases which were of importance as causes of death in childhood are mentioned in table IX-15.
Table IX – 15.
Survey of 587 patients suffering from respiratory diseases, admitted in two children’s ward at Jogjakarta during the period July 1, 1954 till July 1, 1958.
After bronchiolitis pneumonia appears to be the next important cause of death in this group of diseases. In 7 out of the 31 children who died by pneumonia also a severe malnutrition was present, which favoured the lethal course of the pneumonia. The diagnosis pneumonia was in the greater part of these patients confirmed by X-ray examination. Out of the 8 patients who died of upper respiratory tract infections 6 died of acute laryngitis. The reason that such a great number of patients suffering from diseases of the upper reapiratory tract was admitted to the children’s wards was caused by the circumstance that 41 cases were admitted just after a convulsion, while in a number of patients the diagnosis acute bronchiolitis could not be excluded in a busy and noisy out-patients department. The experience that patients who were examined in the morning and diagnosed as bronchitis returned in the afternoon because of bronchiolitis was the reason that in doubtfull cases we decided on admission of these patients, because the diagnosis acute bronchiolitis in a crying child is very difficult to make with certainty.
The patient who died of bronchiectasis was a girl aged 7 who had already been admitted several times with a severe infection of her bronchial tree. During the last examination it appeared to be impossible to cure the infection of her broncial tree. In the course of her disease a cor pulmonale developed. The development was progressive and led to death in hospital. The diagnosis cor pulmonale was confirmed by the specialist for internal diseases (Ong Sie Tiong) by electrocardiagraphical examination.