260 REPORT OF THE HARVARD AFRICAN EXPEDITION 
one of the Gibi tribe, of a low degree of intelligence, and no satisfactory history 
of the condition could be obtained. There were two tumors, 6 and 7.5 cm. in 
diameter, on both elbows, 2.5 em. in height. These were kindly removed for us 
by Dr. Willis. The nodules were fibroid in character and on cut section were seen 
to consist of fibrous tissue in which there were circular harder areas, whitish in 
color, containing in turn less homogenous pale yellow areas. In the center of 
the yellowish areas, apparently some necrosis of the tissue had occurred. No 
spirochaetes or parasites were seen in the tumors by darkfield examination, or in 
film preparations stained in Giemsa’s solution. The latter specimens showed 
many large swollen endothelioid cells with phagocytized nuclei and cells. Cul- 
tures in spirochaetal media and on agar remained sterile. 
Another case, No. 221, is illustrated in No. 195. The patient was a young 
man of the Kpwesi tribe who stated that the nodules were first noticed about 
two years ago. There were several soft nodules on the back of the left hand, 
on both sides of the wrist, and one just below the elbow. The right wrist 
was similarly affected, but the growth was not so prominent and there was a 
nodule on the dorsum of the foot. The nodules were firmly adherent to the 
underlying structures, but not to the skin. The skin over the nodules, showed 
no visible pathological changes. Two of the nodules, one on the elbow and the 
other on the wrist, were punctured and a small amount of yellowish fluid with- 
drawn from which cultures and film preparations were made. 
The fresh film specimen of the fluid, when examined microscopically was very 
rich in cells. Many leucocytes and a few red blood corpuscles were present, but 
no spirochaetes or bacteria or parasites were found, the specimen also being 
examined by darkfield. After centrifuging the small amount of fluid obtained, 
stained preparations with Giemsa’s solution were made from the sediment. 
These showed many large endothelial cells and polymorphonuclear leucocytes. 
Many of the endothelial cells contained phagocytized nuclei and polymorphonu- 
clear leucocytes. No bacteria or other organisms were observed. Portions of 
the nodules about the elbow and later from the foot were excised and pieces 
placed in Zenker’s solution and formalin. Cultures were also made from the 
cut surface of the nodule on the foot just before its removal. Film preparations 
made from these tumors did not reveal either bacteria or parasites. All the cul- 
tures made on ordinary laboratory media and Sabourraud’s media were ex- 
amined microscopically after a week and still remained sterile. No filariae were 
found in.any of the preparations. Five days after removal of these tumors 
another nodule was removed and also hardened. The stained film made from 
the cut surface of this tumor showed strands. of fibrin, many endothelial cells, 
occasional leucocytes, and a few fibroblasts and very large epithelioid (?) cells. 
No parasites or inclusions suggestive of parasites were found in the cells. The 
nodules in this case were evidently closely associated with the tendons or joints 
and to some of the lesions, particularly on the back of the wrist, it was noted 
in the clinical description that the term “ganglion” might better be applied. 
We also found no spirochaetes and were able to cultivate no organisms from 
the other cases of juxta-articular nodules that we studied. Cultures from fluid 
