CHRONIC BURSITIS.—Chronic inflam mation of a bursa is met with much more frequently than the acute form. It develops insidiously, is unattended by pain, and manifests itself only by marked swelling, which varies in density accord ing to the thickness of the bursal wall. This becomes quite dense sometimes, and conveys to the touch a feeling of hardness suggesting bone. In some cases it may be thin and the cavity be greatly distended with fluid. The harder bursa is usually separated into various cavities by thick, fibrous partitions, or the interior is studded with villous growths, which sometimes become de tached and form riziform bodies. Occa sionally it undergoes calcification.
Sixty cases of disease in the bursa under the ilio-psoas and in the bursa beneath the aponenrosis of the gluteus maxitnus over the great trochanter have been personally collected. The subiliac bursitis, of which there were fourteen examples, gives rise to a swelling below Poupart's ligament, which may extend downward as far as the middle of the thigh; the swelling is smooth, more or less sensitive, and usually fluctuating; there may be neuralgic pains, from pressure on the adjacent nerves, and venous thrombosis from pressure on the vessels. The movements at the hip-joint
may be interfered with, and the limb may assume an abnormal attitude; e.g.. abduction, external rotation, and slight flexion, resembling that of hip-joint disease. It is to be differentiated from the latter by the absence of rigidity. of shortening, and of tenderness over the joint. The development of a bursal by groma may occupy several years. The bursitis over the great trochanter re sembles that under the ilio-psoas, and it is to be diagnosed from a periarticular abscess in hip disease and from disease in the trochanter itself. The bursa it self is not infrequently the seat of tu berculosis, and more often on the left side than on the right. Sulzer (Cen tralb. 1. Chir.. No. 21, '99).