464 AN ADDRESS ON THE TREATMENT OF 



that the milder antiseptic boracic Unt was used for the superficial sore which 

 remained. Three weeks after the operation the limb was bent to a right 

 angle ; it was painful to her, but caused no disturbance of the fragments. 

 Four weeks after operation, passive motion was again employed ; the wounds 

 were completely healed. Six weeks after the operation the patient was 

 allowed to get up, and could already walk fairly. Three days later she was 

 discharged ; she could then walk very well. On the 23rd of February of this 

 year we took this note regarding her : * The patella appears perfectly natural, 

 with the exception that the wire is felt, causing the slightest projection under 

 the skin, which, however, moves freely over it. The movements of the joint 

 are perfect ; from complete flexion at a very acute angle to perfect extension. 

 She kneels as she used to do, and only occasionally the wire comes into con- 

 tact with anything, and then she feels the skin over it tender. She can walk 

 any distance, as before the accident, and does so without a limp.' 



[The patient was now introduced to the Society, and confirmed in every 

 respect the previous report.] 



My last case is a man sixty-seven years of age, John P , admitted into 



King's College Hospital on the 6th of January of the present year. He had 

 fallen from an omnibus on the previous day, striking his knee upon the ground. 

 There was transverse fracture of the patella, and great swelling of the joint. 

 Six days after the accident I proceeded to operate. On making a vertical 

 incision and exposing the seat of fracture, I found a condition of things which, 

 possibly, had I known it, might have induced me to abstain from operating. 

 I found that the lower fragment was very small, and was comminuted. There 

 was one entirely loose piece, as big as a filbert, and another about half that 

 size, which, of course, had to be extracted. Such a condition, taken in con- 

 nexion with the advanced age of the patient, did not promise well for satis- 

 factory union. Having sponged the clots out from between the fragments 

 and from the joint, and established a drain, I drilled ; but as the lower frag- 

 ment was so exceedingly small, I was obliged to drill, not through it, but 

 through the ligamentum patellae ; and, by this means, I was able to bring 

 the large upper fragment into contact with the raw surface below. Now, 

 however, I do not regret having operated upon this poor man. You will see 

 that his temperature-chart is free from any febrile indication ; and the wounds 

 healed without any suppuration. Here, as in the last two cases, the ends of 

 the wire were cut short, and the twist hammered down upon the patella. 

 Three weeks and four days after the operation, the wound was nearly healed. 

 The knee was bent through an angle of thirty degrees, and from that position 

 the patient could himself raise it to complete extension ; a thing which, with- 



I 



