JUXTA-ARTICULAR NODULES 267 
to periosteum or skin. However, Steiner! points out that nodules may also 
grow elsewhere than in the neighborhood of joints. 
Mendelson * who has suggested the term xanthom tropicum for juxta-articu- 
lar nodules, has described them as hard fibromata in which various degenerative 
changes, amyloid, ete., have been observed. 
Takasaki * also describes these lesions under the name xanthoma tropica and 
regards them as inflamed fibromata. 
In regard to the aetiology, some of the earlier writers thought they were of 
parasitic origin, and Fontoynont and Carougeau ‘ recorded that a fungus, later 
designated a Nocardia, (which Brumpt named Nocardia Carougeaut), was present 
in some cases. Mayer ® reports that he observed in one case short threads of 
fungi which, however, he was unable to cultivate. Others have believed they 
were syphilitic in origin. More recently it has been suggested that they are a 
tertiary manifestation of yaws. Bernard and Broden® have shown that the 
geographical distribution of yaws and of juxta-articular nodules is very much 
the same, and they incline to the view that at least generally the nodules repre- 
sent tertiary lesions of yaws, though not invariably. Mouchet and Dubois,’ 
Van Hoof,® Spittel ° and Bittner © are among those who also take this view. 
MacGregor " has recently reported fifty cases of ganglion about the wrist with 
positive Sachs-Georgi reactions and found that in two cases juxta-articular 
nodules were also associated. No signs of yaws were present, but he considers 
the lesions to be a manifestation of that disease. 
Gutierrez ” in Manila, found that sixteen of twenty cases gave a positive 
Wassermann reaction. In the majority of these a history of yaws from five to 
ten years previously was obtained. Egyedi?® who says that eight per cent of 
the Nias on an island near Sumatra suffer from yaws but that syphilis is un- 
known there, also believes juxta-articular nodules are due to yaws. 
Some recent investigators besides ourselves have failed to find sannhibiie 
in the nodules. Notably among these are Jeanselme, Burnier, and Eliascheff,' 
Joyeux,” Goodman and Young,’® Montenegro,’ Mendelson, Jessner,!® Akoy- 
1 Steiner: Schweiz. Med. Woch. (1927), LVII, 395. 
2 Mendelson: Jour. Trop. Med. and Hyg. (1923), XXVIII, 181. 
3 Takasaki: Acta Dermatologica (1924), IV, 219. 
‘ Fontoynont and Carougeau: Arch. Parasit. (1908-1909), XIII, 583. 
5 Mayer: ‘‘Exotische Krankheiten,” Berlin (1929), p. 346. 
6 Bernard and Broden: Ann. Soc. Belge Méd. Trop. (1925), V, 25. (Trop. Dis. Bull. June, 1926, 
XXIII, 454); Bruxelles Méd. (1925), V, 1144. 
7 Mouchet and Dubois: Bull. Soc. Path. Exot. (1913), VI, 14. (Trop. Dis. Bull. Mar. 1913, p. 530); 
Dubois: Bruxelles Méd. (1925), V, 1453. 
8 Van Hoof: Ann. Soc. Belge Méd. Trop. (1926) VI, 53. 
9 Spittel: ‘‘Framboesia Tropica” (Parangi of Ceylon, London, 1923). 
10 Bittner: Amer. Jour. Trop. Med. (1926), VI, 123. 
11 MacGregor: West Africa Med. Jour. (1927), I, 6. 
2 Gutierrez: Arch. Der. and Syph. (1925), XII, 159. 
13 Egyedi: Meded. Dienst d. Volksgezondheid in Nederl-Indie (1925), p. 175. 
4 Jeanselme: Bull. Soc. Path. Exot. (1916), 1X, 287; Jeanselme, Burnier, and Eliascheff: Bull. Soe. 
Frangaise Dermat. et Syph. (1928), No. 6, p. 450. 
16 Joyeux: Ibid. p. 290. 
46 Goodman and Young: Amer. Jour. Med. Sci. (1920), CLIX, 231. 
1” Montenegro: Brazil Med. (19238), I, 233. 18 Mendelson: Loc. cit. 
19 Jessner: Arch. f. Derm. und Syph. (1926), CLII, 132. 
