I calculate that there are at least fifty-two separate bursæ (about one
hundred on the two sides of the body) in the normal or fully developed
state, though of these many will be found either absent or with very
little of the full structure of a bursa. One small but significant
point may be referred to here. We are all familiar with the prominence
of the knuckles of the hand and the very efficient bursæ which cover
them, but most persons do not recognise that the foot has no such
knuckles (or prominent metatarso-phalangeal joints) and no bursæ over
these joints, except that of the great toe which happens to be very
much more exposed to friction and has a much greater range of action
than the other four metatarso-phalangeal joints. This might be called
by some persons a beautiful bit of adaptation _for_ locomotion and by
others an equally admirable bit of adaptation produced _by_ locomotion.
Examination of Two Still-born Children.
Some further light may be thrown upon the human bursæ by an examination
of two still-born children I dissected in 1908 in Lewisham infirmary,
and give here the results as to the more important subcutaneous bursæ.
_Male Child_: full term.
_Shoulder_: bursæ under acromion processes absent.
_Elbow_: bursæ over outer condyle of humerus present.
" " inner " " absent.
" " olecranon both present.
_Wrist_: bursæ over styloid process of ulna present.
" " " " of radius present.
_Hand_: bursæ over metacarpo-phalangeal joints D 1 absent, D 2, 3,
4, 5 present.
bursæ over phalangeal joints, first set present, second set
absent.
_Hip_: bursæ over anterior superior spine of the ilium both absent.
_Knee_: prepatellar bursæ well-developed.
_Ankle_: bursæ over both malleoli present:
bursæ beneath tendo achillis well-developed.
_Great toe_: plantar bursa present.
_Little toe_: plantar bursa absent.
_Toes_: D 1 (great toe) bursa over metatarso-phalangeal joint
present.
D 2, 3, 4, 5 bursæ over metatarso-phalangeal joints absent.
Bursæ over _Phalangeal joints_.
D 1 present.
D 2, 3, 4, none over either of the phalangeal joints.
D 5 bursa present over the first and absent over the second
phalangeal joint.
This example of a still-born, but otherwise normal infant illustrates
well the previous statement that certain bursæ are congenital and
others of less functional importance are formed after birth. Whereas
the olecranon, wrist, patellar, ankle and tendo achillis bursæ are
fully formed, those under the acromion processes, one of those of the
condyles of the femur, and the digits of the hand, those over the
superior anterior spines of the ilium and those of the foot are little
if at all developed in this case.
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