HOUSE-MAID'S KNEE. — This popular term is applied to chronic swelling of the prepatellar bursa, as a result of con tinued or repeated pressure while scrub bing, etc. It is located immediately at the knee, and the globular swelling projects anteriorly when the patient is sitting. It is usually quite large. the size of a small orange, and, its wall being comparatively thin, it generally fluctu ates. At times it becomes irritated through continued pressure and may be come slightly painful, the limbs at the same time becoming somewhat stiff and weak at the knee.
Treatment. — Aspiration followed by injection and subsequent removal of a 1. to 1000 solution of corrosive sublimate or a solution of iodoform suffices in many simple cases. If the presence of pus is detected, a free incision is resorted to nowadays, and that without the least danger if asepsis is carefully adhered to. An opening into the sac may be made on each side, and a drainage-tube passed through to insure complete evacuation of the fluid. When there is ulceration the same incisions are of service, but lower down. Again, the sac may be com pletely extirpated through a lateral in cision.
BUNION.—This consists of an enlarge ment of the bursa over the metatarso phalangeal articulation of the big toe, but which may also present itself over other joints of the foot. It is often due to the pressure of ill-fitting shoes, which not only exert pressure upon the bursa overlying the articulation, but also tend to force the big toe away from its nor mal line and the metatarsal extremity of the second phalanx outwardly. The bursa thus finds itself pinched between the bone and the overlying leather. Bunions may cause but little trouble, when not compressed, but, irritated in the manner outlined, they become in flamed and at times exceedingly painful; the skin becomes highly congested and tense; tumefaction occurs, accompanied by accumulation of fluid in the bursa; and locomotion becomes difficult. In some cases suppuration follows; the pus may then burrow through the bursal wall, give rise to cellulitis, and involve the metatarso-phalangeal joint.
shape of the foot wear is of primary importance in the treatment of the cases. The inner side of the shoe should accommodate the bunion in such a manner as to avoid all pressure, while the great toe should have ample room to project in a straight line from the foot, and not be pushed toward its median line. Pointed shoes are per
nicious in this connection. A change of foot-wear is sometimes sufficient to bring about recovery. The local treatment is that of bursitis. Iodine painted over the projection is advantageous. When the applications become irritating, a salve of equal parts of cosmolin and tannic acid, as advised by Gross, soon brings on lution. Tapping or the evacuation of pus by incision, followed by curetting of the bone, sometimes become necessary. These are absolutely safe proceedings if conducted antiseptically.
Jn bunion the writer makes an in cision about an inch in length on the dorsum of the toe. In a mild case, after retracting the tendon of the extensor proprius pollicis outward, he chisels off all the overprominent portion of the inner side of the head of the metatarsal bone, removing as much bone as neces sary to do away with all protuberance; he then sutures the wound and lets it heal under one dressing. In severe cases the head of the metatarsal is removed with a chisel or bone-forceps, and the prominent inner side of that bone cut off.
The dressing must be carefully done and close attention given to the after treatment, which should include the ap plication of a plaster splint. The writer advises never to operate during an acute attack of inflammation, always to treat the deformity, and never operate on the . bursa. Parker Syms (N. Y. Med. Jour., Oct. 2, '97).
Ganglion.—This name is given to a rounded tumor usually about the size of half of a hazel-nut, which generally forms on the back of the hand. It may be soft and yielding when pressed upon, or exceedingly hard, suggesting the pres ence of an osteoma. It is not painful even under pressure, and gives rise to no inconvenience. When, however, as in the case of pianists, the fingers are moved rapidly and with power long peri ods at a time, a sensation of weight or stiffness is experienced and occasionally slight pain. According to Volkmann, a ganglion is a pouch-Eke projection of the synovial membrane of a joint in the ma jority of cases, and rarely arises from a tendon-sheath. It contains a thick, honey-like liquid, thus forming an inde pendent cyst, or a synovial hernia.