AN ADDRESS ON THE TREATMExNT OF 

 FRACTURE OF THE PATELLA 



Delivered at the First ^Meeting of the Session (1883) of the Medical Society of London. 



{Briiish Medical Journal, 1883, vol. ii, p. 8;;.] 



Sir Joseph Fayrer, and Gentlemen. — Some time ago, Mr. Holmes 

 remarked to me that it would be well for me to place before the profession 

 statistics of the operations which I had performed for fracture of the patella. 

 And when you, sir, did me the honour to request that I should open this session 

 of the Medical Society witli a paper, it occurred to me that I could hardly do 

 better than act on Mr. Holmes's suggestion. But, before entering on the strict 

 subject of the communication which I have the honour to bring before you, 

 it will be advisable to make some prefatory remarks regarding the circum- 

 stances that led me to it. In March 1873, my friend Dr. Hector Cameron, 

 of Glasgow, recommended to my care, in the Edinburgh Infirmary, a case of 

 ununited fracture of the olecranon. Dr. Cameron had formerh' been my house 

 surgeon in the Glasgow Royal Infirmary, and I had afterwards for several 

 years the great advantage of his assistance in private practice ; and he reminds 

 me that I had often expressed to him the opinion that the use of a metalhc 

 suture, antiseptically applied, which we had employed in ununited fracture of 

 the shafts of the long bones, ought, in suitable cases, to be extended to the 

 olecranon and patella. The patient to whom I refer presented himself to 

 Dr. Cameron in the out-patient department of the intirmary ; and, as he had 

 not at that time beds in the institution, and therefore could not operate him- 

 self, he sent him to me. He was a man thirtv-four vears of a"e, who, five 

 months previoush', had received a blow from a policeman's baton on the left 

 elbow. This occasioned great swelling, which seems to have concealed the 

 true nature of the case from the medical man whom he first consulted. On 

 admission, there was a considerable interval between the olecranon and the 

 shaft of the bone ; and, although the limb was muscular, it was comparatively 

 helpless, as he could not extend the forearm at all wilhoul the aid of the other 

 hand. On the 28th of the month I made a longitudinal incision, exposing 

 the site of the fracture, and, at the same time, bringing into \iew the articular 

 surface of the humerus ; and, having pared away the librous material from 



