68 The Philippine Journal of Science 1913 



quently affected than are other bones and joints. In the order 

 of frequency, the following locations of the lesions may be noted : 



(1) The bones and joints of the upper extremity. 



(2) The bones and joints of the lower extremity. 



(3) The bones and joints of the other parts of the body. 

 The bones of the upper extremity may be involved in the 



following order of frequency : 



(a) Forearm (radius and ulna). 



(6) Arm (humerus). 



(c) Hand (carpal, metacarpal, and phalanges — proximal and 

 distal). 



The bones of the lower extremity may be also involved in 

 the following order: 



(a) Leg (tibia and fibula) . 



(h) Thigh (femur). 



(c) Foot (tarsal, metatarsal, and phalanges — proximal and 

 distal) . 



In regard to age, the bone lesions usually are observed in 

 persons with a history of having had smallpox during early 

 childhood, but the deformity may follow variola contracted at 

 any time before the complete ossification of the bones. The 

 oldest age in which such a complication of variola has been 

 observed occurred in a boy 14 years old. 



DISCUSSION 



The fact that practically no mention of bone-deforming lesions 

 as a complication of variola is found in current literature should 

 make one very cautious not to interpret coincidence as cause 

 and effect. The fact that the masses of the Filipino people are 

 undernourished and underdeveloped as a result of starvation 

 and metabolism incongruities adds to the difficulty of definite 

 conclusions in interpreting the etiology of chronic bone-deform- 

 ing lesions contracted during childhood. 



Both scurvy and rickets are much less frequently encountered 

 in Manila than would be expected from the habits and faulty 

 feeding customs of the people, and these diseases are less fre- 

 quent in our large clinics than is reported from similar clinics 

 in other parts of the world. 



The pathology of these disturbances, their mode of onset, and 

 the course and results are now pretty well known and do not 

 correspond to the conditions found in our smallpox cases suffi- 

 ciently close to make the danger of mistake in diagnosis a serious 

 consideration. 



