JUXTA-ARTICULAR NODULES 269 
from Palau Island. In Aramaki’s case there was no history of syphilis or yaws 
and the Wassermann reaction was negative. Joyeux! and Jeanselme ” have also 
excluded yaws and syphilis in the cases they recently have reported. 
Jeanselme apparently has not appreciably modified his position with refer- 
ence to his views of these lesions as originally described. The description of the 
pathological histological changes we have observed, given on page 262 on the 
whole, is generally in accord with Jeanselme and Eliascheff’s * observations out- 
lined in their last publications upon the histological examination of cases of 
juxta-articular nodules. In one of these cases the node was described by them 
as composed of irregularly disposed bundles of fibrous tissue, poorly vascularized 
and without any elastic fibers, enclosing a central area of necrosed amorphous 
tissue. A few polymorphonuclear cells were noted and at the periphery of the 
amorphous zones there were large polygonal endothelial-like cells which were in 
reality swollen connective tissue cells, inclosing numerous nuclei, but there was 
no lymphoid infiltration, no endarteritis and no thrombophlebitis. 
In another case, three zones were distinguished; an outer zone of young con- 
nective tissue, in places richly vascularized and in which the medium-sized vessels 
-showed endothelial proliferation and thickening of the walls with some peri- 
vascular leucocytic infiltration, but no plasmocytes. In the middle zone was 
found rather denser connective tissue, with fewer collections of cells and the 
characteristic large swollen endothelioid cells were also present in this case. The 
innermost zone consisted of homogeneous necrotic tissue showing vessels com- 
pletely obliterated by endarterial proliferation. 
In another case the node was found to consist of fibrous tissue which also in 
the center showed necrotic changes. About the upper border of the necrotic 
zones, pseudo-giant cells were noted, but no lymphoid cells. There was no evi- 
dence that the process originated about the blood vessels and neither endarteritis 
or thrombophlebitis was present such as, they remark, is seen in syphilitic lesions. 
No spirochaetes or other organisms were demonstrated in the tissues. In a case 
reported by Jeanselme, Burnier, and Eliascheff * of a single nodule on the ulnar 
crest, just below the olecranon, there was no history of infection with syphilis 
nor of yaws, but the Wassermann reaction was positive and the patient had 
suffered with some symptoms which might possibly have been of syphilitic 
origin. 
Quite a different histological picture is described by Goodman and Young 
in their excellent clinical pathological study of a case resembling juxta-articular 
nodules. They found microscopically that the tissue of the tendon was inter- 
spersed with larger and smaller accumulations of round cells. These aggrega- 
tions were about the blood vessels which were unusually numerous and indicated 
that new blood vessels and capillaries had formed in the tendon, which is or- 
dinarily almost free of blood vessels. The type of cell predominating in the 
1 Joyeux: Loc. cit. 
2 Jeanselme: Loe. cit. 
3 Jeanselme and Eliascheff: Bull. Mém. Soc. Méd. Hépit. de Paris (1926), L, 1404; Schweiz. Med. 
iW oeh. (1927), LVIL, 25. 
4 Jeanselme, Burnier, and Eliascheff: Bull. Soc. Francaise Derm. et Syph. (1928), No. 6, p. 450. 
