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Enlargement of

knee-pan, joint and housemaids

ENLARGEMENT OF BURS/E.

It has been pointed out (p. 119) that synovial sacs occur between bony prominences and the skin to prevent undue pressure. In the case of the knee-pan there is a sac both hetween it and the skin and between it and the knee-joint. The bursa in front of the knee-pan is parti cularly liable to swelling in those who kneel much, and forms housemaid's knee.

Housemaid's may be an acute disease accompanied by severe pain, much swell. ing, and inability to move the joint. As a result of the inflammation matter may be formed and an abscess developed. In the chronic form, permanent swelling, through the fluid not being absorbed, and stiffness, may be the only trouble.

Housemaid's knee is to be distinguished from inflammation and dropsy of the knee-joint by the fact that when the disease is in the joint the knee-pan is forced forwards and can easily be felt under the skin, while in housemaid's knee it is the sac in front of the knee-pan, not the joint, that is affected, and the knee-pan is therefore masked, and cannot be felt owing to the swelling in front of it.

Treatment.—The acute form demands rest, a pillow being placed under the joint to support it. In the early stages leeches will relieve the

inflammation, and later hot cloths or poultices are valuable. To aid in reducing the Illation a purgative of salts or seidlitz should be given to the patient. If an abscess forms it ought to be opened to let the matter escape, and the wound ought to be dressed afterwards with carbolic lotion (1 of acid to 60 of water), a small pledget of lint, soaked in the lotion, being thrust between the lips of the wound to permit free escape to any matter that may form later. When the affection is chronic, blisters and iodine paint are employed. The application of a starch or plaster bandage over a layer of stimulating ointment is very successful.

Miner's similar affection, from pressure or injury, may attack the bursa over the point of the elbow, or the bursa which lies between the prominence of the hip-bone, that supports the body iu the sitting posture and the muscles above it. The swelling over the point of the elbow is often seen in miners and students, and is if heeded called miner's or student's elbow.

The treatment is the same for all.