268 REPORT OF THE HARVARD AFRICAN EXPEDITION 
bian! and Aramaki.2. However, Van Dijke * of the Dutch Indies, and Sobern- 
heim ‘in Berne, and Clapier® in Africa, as well as Van Hoof,‘ have all reported 
the presence of spirochaetes, each in one instance. In Clapier’s case, the spiro- 
chaetes were obtained from a suppurating lesion. Van Dijke and Oudendal ‘ 
also observed spirochaetes with the dark field and by using Levaditi’s silver 1m- 
pregnation method, and they state they invariably succeeded in demonstrating 
the presence of spirochaetes in the tissue. They were unable to decide whether 
these organisms related to syphilis or to yaws. While the histological changes 
they describe agree very well with those observed by us in the material from our 
own cases, they publish drawings illustrating both spirochaetes and elastic fibers 
in their sections and we found no spirochaetes in the lesions of our cases. They 
also describe and illustrate different giant cells in the ‘‘inner zone.” 
A few cases of juxta-articular nodules have been found in individuals who 
have not been outside of Europe and at least one not outside the United States. 
Nevertheless, the disease is said to be rare in white people and only about twenty- 
five cases in the white race have been reported. 
Webber,® Goodman and Young,’ and Worster-Drought ?° have reported some- 
what similar lesions, under the name subcutaneous fibroid syphilomas, and 
Patane,!! Akovbian,” Da Fonseca,” and Jessner 1! have observed juxta-articular 
nodules in cases of late syphilis. Araujo? says that he has found no cases as- 
sociated with yaws but has observed sixty cases in syphilitics. Jessner in a study 
of the literature accepts sixty-two cases of juxta-articular nodules in which he 
believes yaws can be excluded as a cause. Twenty of these were from Europe and 
North America and forty-two from North Africa, including three cases of his own. 
He not only found no spirochaetes in the lesions but rabbit inoculations proved 
negative. Mendelssohn was unable to infect monkeys with material from the 
nodule. 
On the other hand, other recent observers besides Mendelssohn report neither 
the association of yaws nor of syphilis. Among these are Kadaner ' and Ara- 
maki.'’ The latter points out that no cases of juxta-articular nodules have been 
seen in Japanese who had never left their own country, with the exception of the 
one case he reports. Fourteen previous cases in Japanese had been reported 
1 Akovbian: Pensée Méd. d’Usbekistane. Tashkent (1927), No. 8, p. 30. 
2 Aramaki: Japanese Jour. Derm. and Urol. (1928), XXVIII, 58. 
3 Van Dijke: Reports Dutch-Indian Med. Civ. Ser. (1923), pp. 2, 142. 
4 Sobernheim: Arch. f. Schiffs-u. Tropen-Hyg. (1924), XXVIII, 73. 
5 Clapier: Bull. Soc. Path. Exot. (1923), XVI, 553. 
6 Van Hoof: Loc. cit. 
7 Van Dijke and Oudendal: Geneesk. Tijdsch. v. Nederl. Indie (1922) LXII, 418, and Reports of 
the Dutch-Indian Medical Service (1923), Part II. 
8 Webber: Brit. Jour. Derm. (1920), XXXII, 173. 
® Goodman and Young: Loc. cit. 
1 Worster-Drought: Lancet (1926), p. 637. 
11 Patane: Arch. Ital. Sci. Med. Colon. Tripoli (1927), VIII, 20. (Trop. Dis. Bull., Jan. 1928, p. 8.) 
12 Akovbian: Loc. cit. 
13 Da Fonseca: Bol. Inst. Brasileiros de Sci. (1927), II, 365. 
14 Jessner: Loc. cit. 
4 Araujo: Bull. Soc. Path. Exot. (1928), X XI, 387. 
16 Kadaner: Ann. Soc. Belge de Méd. Trop. (1928), VIII, 57. 
7 Aramaki: Loc. cit. 
