VIII, B. 2 Musgrave et aL.- Bone Lesions of Smallpox g9 



The close resemblance in the character of the deformities, 

 their constant association with a history of smallpox during 

 early life, and the absence of similar lesions under other con- 

 ditions seem to warrant the conclusions that the deformities 

 are a complication of variola. 



NATURE OF THE LESIONS 



The morbid anatomy and histology' of the lesions and de- 

 formities have been studied in one case by Crowell. (Case 

 III.) 



In our preliminary report we stated that: 



The process appears to be due to destructive lesions in the epiphyses 

 of the bones. The shafts of the ulna and radius seem to be normal, except 

 in length. The ends of the bones are enlarged and irregular in shape 

 and similar changes may be encountered in the carpal, metacarpal and 

 phalangeal bones. 



The circumferential growth of these bones is not disturbed in the least. 

 There is no sign of underdevelopment in diameter thus proving that the 

 periosteum upon which the circumferential growth depends is not affected. 



The bones are markedly shortened and stunted in longitudinal growth, 

 in some cases they are reduced to less than one half the length of the 

 normal bone. The obvious conclusion from this fact is that the seat of 

 the primary lesion is in that part of the bone between the epiphysis and 

 diaphysis which develops actively "ex utero." 



Further study of the additional cases reported here with the 

 additional information secured by one autopsy as well as that 

 afforded by Roentgen records apparently confirms the statements 

 made in the preliminary report. 



CASE RECORDS 



Case I (file and record No. 6992, fiscal year 1912). ^Y. P., female, 

 Filipina, 27 years old, seamstress, born in Malabon. 



She had smallpox during childhood, and as a complication she developed 

 deformity of the left elbow joint, with partial ankylosis and shortening 

 of the bones of the left arm and forearm. (Plate I.) 



Case II (file and record No. 5368, fiscal year 1912). — P. B., male, Filipino, 

 born in Mindoro. Had smallpox when a little boy and as a complication 

 he developed deformity of both elbow joints with marked shortening of 

 the bones of the forearms and slightly of the arms, with partial ankylosis 

 of both elbow and wrist joints. Deformity also of both knee joints and 

 some shortening of the bones of both legs. (Plate II and Skiagrams I, 

 II, and III.) 



Case III (file and record No. 21,6^, fiscal year 1912). — A. A., female, 

 single, washerwoman, age 32; born in Silang, Cavite. Had smallpox when 

 a little girl with subsequent deformity of the elbow joints and left wrist, 

 with distinct shortening of the bones of forearms on both sides. Deformity 

 of both knee joints and distinct shortening of the bones of both legs exist. 

 There is a partial ankylosis of the elbow joints. (Plate III, figs. 1 and 2; 

 Plate IV, figs. 1 and 2.) 



