64 The Philippine Journal of Science ms 



in the cases where an open lesion was present, and by a careful 

 history of those without open lesions, so as to remove any doubt 

 as to the diagnosis. 



Twenty per cent of the cases of this group of patients, as 

 they presented themselves for treatment, suffered from bone 

 or joint lesions. These patients were persuaded to come to 

 the Department Hospital, Manila, for X-ray pictures and treat- 

 ment. A rontgenological survey of all the bones of the body 

 was made of each case, regardless of whether or not the patient 

 complained of pain in the part X-rayed. Subsequent X-ray pic- 

 tures were made, in order to follow the progress of the lesions 

 under treatment. 



In the majority of cases the lesions show as rarefied areas, 

 irregularly oval or elliptical in shape with the long axis parallel 

 to that of the bone in which the lesions are located. The size 

 varies from the smallest discernible area to one that is two 

 or three centimeters in length. The rarefication presents mod- 

 erately well-defined borders separating it from the unaffected 

 bone and varies in translucency from the slightest differentia- 

 tion of unnatural transparency to one simulating a perforation. 

 Most of the lesions appear to originate in the interior of the 

 bone, while a number can be seen as small excavations on its 

 outer surface. When the lesion is on the surface of the bone, 

 the periosteum is usually destroyed, but occasionally the cortex 

 shows thickening, and the periosteum is separated from the bone. 

 In two cases of this series there is a general thinning of the 

 cortex of the bone and a loss of the cancellous-tissue appearance. 

 About two per cent of the cases show a nodular type of lesion, 

 evidenced by swelling over the surface of the bone, with a lo- 

 calized thickening of the cortex, which sooner or later in the 

 course of the disease shows rarefication in its center. 



In the chronic lesions marked irregularity of the bony out- 

 line is evident, and the picture characteristic of the earlier 

 lesions is more or less lost. The bone as a whole becomes 

 deformed, and the growth of the bone is interfered with both 

 in length and breadth. This dwarflike picture is most fre- 

 quently noticed in the cases showing the lesions in the epiphyses. 

 Within the joints the destruction is most frequently seen on the 

 parts of the articular surfaces most exposed to trauma, as oval 

 or irregularly shaped excavations, making the outline of the 

 articular surface rough and uneven. It is concluded from 

 this series of cases that the joint pains complained of are due 

 in most part to the presence of the lesions on the articular 

 surfaces. 



