VIII, B, 2 Musgrave et al.: Bone Lesions of Smallpox 73 



The head of the fibula is considerably changed in its external archi- 

 tecture. The summit of it is convex externally from before backward 

 and concave exteriorly from side to side. Located anterolaterally is an 

 articular surface which provides articulation for the lateral condyle of 

 the tibia. The inner side of the head is represented by a vertical ridge, 

 terminating below in a sharply pointed process 0.5 centimeter in length. 

 Anteriorly is a convex, slightly elevated surface partially overhanging 

 the shaft of the bone. Posteriorly is a straight ridge which extends 

 from the styloid process obliquely outward. Externally is a tuberosity 

 formed by the union of the posterior ridge and the anterior rounded 

 edge or convex portion of the head. This tuberosity is very prominent, 

 rounded, smooth, and visibly chondroid in consistence. 



Summarizing the conditions in the bones above described, it 

 is apparent that the diaphyses of the bones are shorter than 

 normal and that the ends of the bones, representing the original 

 epiphyses, are much altered in configuration. In the shafts of 

 the bones which were removed for examination there is no 

 apparent change from normal in contour or diameter. Me- 

 sial longitudinal section through the ends of the bones shows 

 complete ossification of the epiphyseal extremities, and no 

 indication of the line of junction between the epiphyses and 

 diaphyses is present. The deformities of the epiphyses must, 

 therefore, have occurred before the period of full growth, and 

 the interference with the longitudinal growth of the diaphyses 

 must have been due to some disturbance at the line of junction 

 with the epiphyses. 



As is to be expected from the above description of the con- 

 dition of the bones, examined at a period after the cessation of 

 active disease and after healing has taken place, the microscopic 

 examination of the bones .shows nothing which will further 

 elucidate the nature of the active process. Complete ossification 

 has taken place, and decalcified sections of the bones show no 

 alterations from the normal condition of bone growth at this 

 period of life. The epiphyseal line of growth is obliterated, 

 and the compact bone and marrow bear normal relations. The 

 only alteration is in the size and conformation of the epiphyses. 



Case IV (file and record No. 1367, fiscal year 191-2). — J. M., male, 

 Filipino, single, carpenter, 23 years old. Had smallpox when a little 

 child, as a result of which he developed deformity of the left knee, 

 with partial ankylosis and some shortening of the femur. There also 

 is deformity of the toes of the left foot, with shortening of the 

 phalanges, and of both elbow joints with partial ankylosis and shorten- 

 ing of the bones of forearms on both sides. (Plate V, figs. 1 and 2.) 



Case V {file and record No. 3611, fiscal year 1912). — C. E., female, 

 Filipina, 29 years old, born in Manila. 



