FRACTURE OF THE PATELLA 463 



showed them that he could raise his hmb, from a position of flexion almost 

 at a right angle, to the completely extended posture. I have not seen him 

 from that time until to-day. Having learned that he was employed in a 

 Birmingham establishment, I wrote to my friend Mr. Chavasse, of that city, 

 who replied as follows : ' I saw G. this morning, and have made arrangements 

 for him to leave by the 2 o'clock train to-morrow afternoon. He will be at 

 your house just before 8 o'clock. In case he should not keep his appointment, 

 there is a faint linear cicatrix present over the joint. The knee can be flexed 

 as well as the other. There is bony union of the patella, a faint ridge being 

 felt on the point of union. No suture is to be detected by the touch. At his 

 work, as a stamper, all day long, he works a pulley with the affected limb, 

 which raises a weight of 60 lb. In damp weather he feels very slight incon- 

 venience in the site of the old fracture.' Happily our patient has kept his 

 appointment, so that we are able to see him to-day. 



[The patient was introduced and shown. He said he could do anything 

 with the limb the same as with the other. He worked a stamp-hammer, and 

 he could work that hammer, weighing one hundredweight, all day long. There 

 was no difference whatever between the movements of the two knees.] 



There is a barely perceptible cicatrix, and he has a perfect patella. 



My sixth patient was a woman, Elizabeth C , fifty-seven years of age. 



She also was a recent case, admitted on the 21st of October, 1881. Going 

 downstairs, she fell with her left leg bent under her, striking the knee against 

 the ground. She was brought at once to the hospital. The left knee was very 

 much swollen from effusion, hot, and tender ; the fragments of the patella 

 were felt, separated from each other about one inch. I believe it is generally 

 wise to let any distinct inflammatory appearances that exist, as the immediate 

 result of the accident, pass off before the operation. In the former case there 

 were no such, or scarcely any ; therefore we operated three days after the 

 accident. In this case they were manifest, and we allowed a week to pass. 

 The operation was performed just as in the last case. The ends of the wire 

 were twisted with two half-turns, that is to say, one complete turn. The ends 

 were cut short, and then, with the small hammer, the twist was hammered 

 flat down upon the patella. 



Here we have the temperature-chart. As we very conunonly find, in 

 cases antiseptically operated upon, the first effect of the operation is a depres- 

 sion of temperature. On the evening of the first day there was a depression ; 

 on the following day, a httle rise, but tluit rise only reached 101° ; after that, 

 there was nothing to indicate an\'thing febrile. Two weeks after the operation 

 passive motion was commenced. The woiuuls \\\mc> then so \'ory nearly healed 



