46o AN ADDRESS ON THE TREATMENT OF 



running across a green, he slipped upon a piece of turf, and, in trying to recover 

 his balance, he snapped his knee-pan and fell. He was taken to a military 

 hospital ; and the limb was put in splints, which were kept on for seven weeks, 

 a starched bandage being applied after their removal. On admission, the 

 fragments were found separated by an interval of three-quarters of an inch. 

 There was a firm fibrous band of union between them. The knee, however, 

 was quite stiff in consequence, apparently, of the rigidity of the extremely 

 atrophied quadriceps extensor. He was quite unable to walk. If he attempted 

 to do so, he held the leg in his hand. He complained of frequent uneasy 

 sensations in the knee. On the 22nd of October, I cut down over the patella, 

 as in the former case, making an incision abput two inches in length. Having 

 cut away the fibrous tissue between the fragments, I refreshed the osseous 

 surfaces, and then, having provided for drainage as before, drilled the frag- 

 ments, and drew them together with stout silver wire. Nothing occurred 

 worthy of notice until four weeks after the operation, when I proceeded to 

 attempt passive motion. Without chloroform, this proved impossible ; but, 

 under chloroform, I used considerable force, when, the rigid quadriceps extensor 

 refusing to yield, the twist of the wire gave way ; the cicatrix, which had 

 quite healed except where the wire projected, opened ; and there was heard 

 a sound of air being sucked into the joint, the fragments becoming, at the 

 same time, widely separated. I injected the joint with an antiseptic solution, 

 a procedure which I candidly confess I should now regard as probably super- 

 fluous. However, such was done ; and, six days later, when all disturbance 

 caused by this second injury and the irritation of the antiseptic injection had 

 passed .off, I proceeded to operate upon him a second time. Chloroform was 

 again administered, and an incision similar to the former one was made, the 

 cicatrix being laid open. I then found that the ends of the wire were lying 

 in place, ready to be twisted together. I found, at the same time, a con- 

 siderable mass of coagula present. These I cleared away from between the 

 fragments and from the joint, twisted the wire again, and thus we had a second 

 operation in one patient. The after-progress was as in the other cases. Here 

 we have a doubly long temperature-chart, because we have two cases in one, 

 so to speak ; but there was no deviation whatever from the normal state ; 

 neither as the result of one operation nor the other has any febrile condition 

 as regards temperature been produced. In due time the wire was removed, 

 and, the wound made through the cicatrix having healed, he was discharged 

 eight weeks after the second operation. He was then able to walk, but 

 with a stiff knee, with scarcely any mobility. I did not attempt any more 

 passive motion after previous experience, and while I was well pleased to see 



