SYNOPSIS The pathological changes are described in 22 children with proven or suspected virus infection of the lower respiratory tract. Two main patterns of disease were found: acute bronchiolitis and interstitial pneumonia. Particular viruses were not specifically associated with particular histological changes. The prime importance of the respiratory syncytial virus (RSV) as a cause of disease and death in young infants is again shown. Structural lesions and clinical dysfunction correlate fairly well; in acute bronchiolitis the main lesion is epithelial necrosis when a dense plug is formed in the bronchiolar lumen leading to trapping air and other mechanical interference with ventilation: in interstitial pneumonia there is widespread inflammation and necrosis of lung parenchyma, and severe lesions of the bronchial and bronchiolar mucosa as well. The implications of these structural changes for clinical management are discussed. The possibility of a hypersensitivity reaction in the cot death syndrome is raised, mediated by a serum antibody-antigen-complement reaction.In 1967 3,000 children died in England and Wales from infection of the respiratory tract. They accounted for 27 % of all deaths in children between the ages of 1 month and 15 years. Seventy-five per cent were infants under the age of 1 year, and 46 % died at home (General Register Office, 1967, and personal communication). The corresponding figures for our community, the northern region of England, were 204 deaths of which 80 % were infants. In Newcastle, of every 100 acute infective illnesses in the first five years oflife, 60 affect the respiratory tract, and 17 are either bronchitis, bronchiolitis, or pneumonia. A large and challenging task, therefore, still faces those concerned with the clinical management of these illnesses and a clearer understanding of their aetiology and pathogenesis is urgently needed.Except in proven bacterial infections aetiology

Symptoms and spirometric evidence of COPD are common among people aged 40 years or older and increase with age. Further research is needed to better understand the diagnosis and management of COPD in Australia, along with continuing efforts to prevent the disease.

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A 7-week-old albino infant developed acute haemolytic anaemia following an operation for strangulated inguinal hernia. This was considered to be due to polyagglutinability of the red cells, the haemolysis subsiding as the cells returned to normal. The red cell changes were shown to be due to activation of T-antigen, reacting with anti-T in the adult blood transfused to the infant.