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Bursæ are lined by a membrane, greatly resembling the synovial in appearance, function, and disease. They are frequently the seat of inflammation of an acute character; but in most instances the action is of short duration, and generally terminates in an increase and accumulation of the secreted fluid. The attendant pain is very severe, and much increased by any motion of the neighbouring parts.

Occasionally a portion of the cellular substance, which is exposed to pressure of motion, as over a prominent portion of bone, assumes the appearance of a bursa, secretes a similar fluid, and is similarly affected in consequence of inflammation. These adventitious bursæ are met with in various situations. Bunion is a good example of such a bursa thickened from long-continued pressure. They are seen on the outer ankles of tailors, on the shins of boot-closers, on the forehead, point of the elbow, &c.

Disease of the bursæ may occur from external injury, and they often become affected subsequently to disease of the neighbouring joint. If the action is violent, lymph is effused on the inner surface, or external to its cavity, causing considerable thickening. The sac is thus sometimes all but obliterated. Tumours, originally housemaid’s knee, aggravated by continued pressure, are met with over the ligament of the patella in almost a solid state. Occasionally the action terminates in suppuration, pus being effused to a greater or less extent into the cavity; and if allowed to remain or accumulate, the abscess extends, and frequently communicates with the neighbouring joint, which may not have been previously diseased. In chronic cases of enlarged bursæ, especially of the bursal thecæ of the tendons of the wrist or ankle, we not unfrequently meet with loose cartilaginous bodies of various sizes, and of a flattened oval form, floating in the accumulated fluid. These have been also supposed to be formed by portions of lymph which have been deposited on the surface, condensed in structure, and afterwards become detached.

When inflammatory action has commenced in a bursa, it must be subdued by copious topical bleeding, along with the exhibition of purgatives; in most cases general bloodletting will not be required. After the inflammation has subsided, the parts remain swollen, from the effusion either of serum or lymph; stimulating applications may then be employed with advantage. In general, the ammoniacal plaster, or the brushing over the surface with tincture of iodine will answer. Blisters are sometimes employed with the same view. In obstinate cases, when the tumour is of no large size, a seton may be passed, retained till suppuration has taken place, and gradually withdrawn. Great risk attends interference with bursæ of large size near joints or cysts containing serous or glairy fluid in any situation. Even trifling punctures into such have been sometimes followed by inflammation of the inner secreting surface and violent constitutional disturbance. When suppuration has occurred, it will in many instances be prudent to evacuate the matter by one or more incisions, in order to prevent farther mischief, especially if the bursa, a superficial one, is in the neighbourhood of a joint. After the matter has been evacuated, the cavity gradually contracts, and ultimately the bursa is completely obliterated. Diseased bursæ, near the surface, and unconnected with important parts, have been dissected out. The operation is not often necessary, and in some situations attended with considerable risk. Tumours, solid or nearly so, arising from diseased bursa of long standing, may sometimes require to be so treated.