FRACTURE OF THE PATELLA 457 



by a violent movement during a state of intoxication. The fragments were 

 then found widely separated. Dr. Cameron again treated him on ordinary 

 principles for eight weeks, at the end of which time the fragments were still 

 so widely apart, and the limb so feeble, that Dr. Cameron determined to cut 

 down and apply the wire suture antiseptically. This he did on the 5th of 

 March, 1877. On making a longitudinal incision, he exposed a condition of 

 the parts, of which, through his kindness, I am able to show you a sketch, 

 viz. a ligamentous union one inch in length, connecting pretty equal-sized 

 fragments, with nipple-like projections extending from their attenuated margins 

 much thinned by absorption. He cut away the fibrous material, and, having 

 pared the edges of the fragments, and drilled them in two situations with 

 a bradawl, he connected them with two sutures of stout silver wire (as shown 

 here in another drawing), the ends of the wires being left projecting at the 

 wound. At the same time, he introduced an independent drain into the joint. 

 The wound healed without suppuration or fever ; and, though osseous union 

 was not obtained — which, as Dr. Cameron remarks in his report of the case, 

 was not to be wondered at, considering the thinned state of the surfaces — 

 yet he had the satisfaction of discharging the patient with close approxima- 

 tion of the fragments, and a thoroughly useful limb. 



In October of the same year, 1877, a patient with transverse fracture of 

 the patella was admitted under my care in King's College Hospital. He was 

 a man forty years of age, who, while riding on horseback, had his horse stumble 

 and fall. He was thrown over the horse's head, falling on the right knee. 

 He could not rise, and was brought to the hospital. In the first instance, 

 I attempted with this patient to bring the upper fragment down, so that it 

 should be in contact with the lower. For this purpose I applied an apparatus, 

 into the details of w^hich I need not enter further than to sa\' that it was so 

 arranged that the upper fragment, by means of weights and pulleys, was drawn 

 down. Four days later, however, I found that there was still a quarter of 

 an inch interval between the fragments, and I suggested to the patient the 

 operation of cutting down and applying the wire suture. This, however, he 

 would not then consent to, and preferred returning home to be under the care 

 of his ordinary medical attendant. Eight days later, or fourteen days after 

 the accident, he was readmitted, expressing a wish to be operated upon. On 

 the 26th of October, I accordingly proceeded to operate, making a vertical 

 incision, about two inches in length, over the patella, exposing the fragments, 

 which were then one inch apart. My inability to bring down the up]x^r 

 fragment into contact with the lower became explained when the i)arts were 

 exposed ; for there were found between the fragments extremely firm coagula, 



LISTER 11 H ll 



