466 



AN ADDRESS ON THE TREATMENT OF 



possibly not occur to any one during the operation. Here (Fig. 3) we have 

 the wire represented twisted, and the twist hammered down. The twist always 

 goes to one side, and, being on the other side in this instance, is not shown 

 in the section represented by the diagram. 



I should hke, gentlemen, with your permission, to make some few general 

 remarks. I think it must be admitted that these cases show that the mode 

 of treatment which I have recommended, when applied to recent transverse 

 fractures of the patella, affords a means of restoring the joint to, practically, 

 a perfectly natural condition, provided only that no disaster occurs. That, 

 however, is a tremendous proviso, and no one is more conscious of it than 

 myself. Before I made the incision in the first case that I have recorded 

 to-night, I remarked to those who were assembled in the theatre that I con- 

 sidered no man justified in performing such an operation, unless he could say, 



Fig. 



Fig. 3. 



with a clear conscience, that he considered himself morally certain of avoiding 

 the entrance of any septic mischief into the wound. Supposing, on the other 

 hand, that a man can say that with a good conscience, then I conceive that 

 he is not only justified, but bound to give his patient the advantages that we 

 see are to be derived from this method of procedure. We know, of course, 

 very well that, by ordinary means of treatment, patients often recover with 

 exceedingly useful limbs. Every now and then, osseous union is obtained ; 

 it is a thing which I used to pride myself formerly on striving to get, and 

 I have got such a thing, but it was rather rare, and it was obtained by a very 

 tedious process ; and, if ligamentous union occurred, we never had any security 

 that what was a very short ligamentous union when the patient was discharged 

 might not be a long ligamentous union at a later period. A gentleman con- 

 sulted me with transverse fracture of the patella a couple of years ago. He 

 happened to come to me just as I was about to start for my autumn holiday. 

 I did not care to operate upon him, and throw the responsibility of the after- 



