554 MUSGRAVE AND SISON. 



ulna and the radius are enlarged and irregular. Motion in these joints is fair 

 in every direction, and there are no signs of abnormal limitation of movements. 

 Musculature in good condition. 



Case III (Plate II, figure 2). — V. P., Filipino, 33 years old, single, horn in 

 Santa Cruz, Province of Marinduque, was admitted to St. Paul's Hospital on 

 August 22, 1909, because of chronic gastritis and was readmitted to the same 

 Hospital for the same trouble on November 7 11, 1909. 



When 8 years old, the patient had smallpox. The attack was followed by 

 deformity and shortening of the ulna and the radius in both forearms, more pro- 

 nounced in the left arm. Changes in the articular surfaces of the bones are the 

 same as those described in the above cases. No deformity in the bones of the 

 hands and fingers. 



Case IV [Plate III, figures 1 and 2), — N. D., Filipino, about 25 years old, 

 single, born in Santo Tomas, Province of Union. He came to the Free Dispensary 

 complaining of beriberi. 



When 5 years of age, the patient had smallpox which was followed by deformity 

 and shortening in the bones of the forearms, more in the left than in the right 

 forearm. No bone changes in the hands and fingers. Joints apparently not 

 involved. 



Case V (Plate IV, figure 1) . — N. de la C, female, Filipina, 7 years old, born 

 in Manila. History of smallpox at 3 years of age which was complicated by bone 

 and joint lesions; the complications at present consist of bony ankylosis of the 

 left elbow joint with distortion of the joint due to irregularities in the bones; 

 apparent shortening of its ligaments about the right elbow and an enlargement 

 of the end of the radius which gives deformity of the joint. 



Case VI (Plate IV, figure 2). — P. S., male Filipino, 58 years old, born in Ma- 

 nila. History of smallpox at the age of 7 years, complicated by bone and joint 

 lesions. At the present time deformity consists of shortening of both humeri, 

 deformity of the left wrist with shortening of the ulna. 



Cases V and VI both show extensive smallpox pitting over the principal 

 areas of deformity. 



Two other cases with histories similar to the above have failed to 

 report to be photographed. Lesions similar to those described in the 

 other cases were present in these patients. 



DISCUSSION. 



We have been unable to find in the literature of smallpox any mention 

 of lesions similar to those here described. A condition involving changes 

 in the bone marrow is recognized in a considerable percentage of cases of 

 smallpox, and acute suppuration and other forms of acute arthritis oc- 

 casionally are encountered in the disease. Paraplegia, clue to lesions in 

 the cord, are reported, and Osier mentions that "inflammatory process may 

 occur. in the bones." 



However, none of these conditions are at all comparable to the findings 

 in our cases, and for this reason it is necessary to elucidate two questions, 

 (a) Are the deformities caused by smallpox? (5) If so, what is the 

 nature of the lesion and what is its exact etiology ? 



The considerable number of cases with a similar history of smallpox 



