JUXTA-ARTICULAR NODULES 265 
vessel endothelial cells, both infiltrated by lipoids, cannot be stated. They, 
however, are macrophages and according to some authorities the macrophages 
are particularly cells of the connective tissue belonging to the reticulo-endo- 
thelial apparatus. From the study of this tissue nothing more definite can be 
added in regard to the controversial question of the origin of such cells.! 
Near the edges of these abscess-like areas and sometimes within them there 
are islands of fibrous tissue which take on a deep pink stain with eosin and con- 
tain no nuclei whatever. It is about these areas that the cellular proliferation 
and infiltration just described is also observed, as well as in the center of the 
nodules where it alone is present. 
MacGregor apparently first observed these nodules in natives of New Guinea 
and suggested a parasitic origin for them. 
Jeanselme ? in 1899 first applied the name ‘‘nodosités juxta-articulaires”’ to 
these lesions, and described them clinically as nodules of various sizes, globular 
or polyglobular, often collected in groups or masses. ‘The tumors were situated 
deep in the subcutaneous tissue, some being movable and rolling under the 
fingers like ganglia. Others appeared adherent to the periosteum, in which 
some originated. As the nodules enlarged they became more superficial and 
were sometimes incorporated in the skin. Later still they rose above the surface 
as protuberances of very hard consistency. The skin underwent no modification, 
being only distended and sometimes changed in color at the most prominent 
point. It was also noted that the nodules were remarkably symmetrical and 
tended to occupy the external aspect of the extremities, surmounting by prefer- 
ence the bony prominences and grouping about the joints. The points of predilec- 
tion given on the lower extremities were the external malleolus, head of the tibia, 
tubercle of the tibia, anterior surface of the knee, trochanteric and sacrococ- 
cygeal regions, on the upper extremity the olecranon, epitrochlea, acromion, and 
dorsal surface of the digits. 
Jeanselme at first inclined to ascribe as a cause of these nodules the habits 
of the natives who lie with the elbows and knees in contact with the ground. 
His bacteriological examination was completely negative and he states that in 
sections stained by Ziehl or Gram, or after treatment with forty per cent potassium 
hydroxide, he had never demonstrated any microbes. Histological examination 
made first with low magnification showed that the lesions were divided into three 
zones; an internal or zone of degeneration; an external or inflammatory; and 
an intermediate, or zone of transition. The degenerative zone contained areas 
homogeneous and translucent which stained a deep red with eosin. In the 
spaces between these areas, polymorphonuclear cells were seen undergoing dis- 
integration. The numbers of leucocytes increased as one approached the pe- 
riphery of the degenerated areas. The leucocytes were situated particularly in 
the large, otherwise empty spaces, sharply circumscribed in the dense fibrous 
tissue. The inflammatory areas showed two very different appearances; one 
1 Wright (Amer. Jour. Path. (1930), VI, 87) has contributed a valuable discussion upon the origin 
of endothelial leucocytes and monocytes. 
2 Jeanselme: Soc. Méd. Hyg. Trop. (Dec., 1910); ‘‘Précis de Pathologie Exotique,”’ Paris (1909), 
p. 734. Ann. de Derm. et Syph. (1901), II, 833. 
