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XLVIII] First discovered in 1901 by Macgregor, and subsequently named by Jeanselme, these parasitical tumours are now known to occur in the natives of many tropical countries, as Java, Siam, Madagascar, and, especially, tropical Africa, where, owing to concurrence in tropical distribution and similarity in appearance, they are apt to be mistaken for Onchocerca volvulus cysts (p. 788), and vice versa. In both cases these swellings are originally subcutaneous; they increase in size very slowly, and may attain the dimensions of a small orange; they are round or oval, and firm in consistence. They are painless, and very rarely ulcerate or suppurate. The juxta-articular nodules are generally multiple; they occur, as the name implies, in the neighbourhood of joints, occasionally on the external surfaces of limbs, and are arranged symmetrically. They are of a woodeny hardness in contrast to the elastic firmness of the volvulus tumour, and, unlike the latter, of a somewhat irregular surface. In case of doubt, diagnosis may be readily cleared up by aspirating the tumour with an exploring needle. A volvulus tumour will yield a viscid yellowish or turbid fluid containing microfilariæ; a juxta-articular nodule yields no fluid or, at most, a drop of clear serum. At times, though rarely, these tumours disappear spontaneously. If they are inconveniently located they may be excised.

Macgregor and others considered that these tumours were of parasitic origin, and Fontoynont and Carougeau claim to have discovered the parasite as an extremely delicate fungus, Nocardia carougeaui. Clapier, who has given much attention to, and has had long experience of, these tumours in French Guinea, failed to confirm this claim.

This is a disease of a very peculiar character, affecting the toes, particularly the little toes, of negroes, East Indians, and other dark -skinned races.