78 
into which the fingers could be sunk, and the 
terior articular surface of the patella could 
felt and the condyles of the femur also could 
be recognised through the skin. The liga- 
mentum patelle seemed to be of its natural 
length. tient, when standing on the 
sound limb, could easily flex the affected one, 
but could not elevate it nor advance it in the 
least. When supported under each arm and 
desired to throw his weight on the injured limb, 
it instantly gave way under him, becoming 
suddenly flexed ; and if the man were not my 
ported, he would instantly fall forwards. It 
is now five months since he met with the acci- 
dent, and being unable to earn his living he is 
obliged to seek a shelter in the poor-house. 
The upper edge of the patella can now be 
plainly felt, and the muscular fibres normally 
attached to this margin are separated from it 
fully one inch, this interval being increased in 
flexion. The surface of the trochlea and the 
condyles of the femur can be plainly felt. The 
man is obliged to use crutches in moving about. 
The result has been unfavourable, but it is to 
be recollected that the man was of a weak and 
debilitated frame and neglected to seek assis- 
tance for many days. A dignitary of the esta- 
blished church in this country, aged 70 years, 
who had met with this accident, was more for- 
tunate; he was under the care of Mr. Wilmot, 
Professor of Surgery at the College of Surgeons, 
who informs me that his recovery from this 
accident took about a year, but that he 
could walk without lameness, and that the 
recovery was perfect. 
The tendon or ligament which connects the 
lower extremity or front of the patella to the 
tibia is sometimes broken transversely. This 
rupture sometimes takes place across the fibres 
of the ligament, and sometimes one or other of 
the extremities of the tendon is detached from 
the bone to which it is naturally connected. 
This rupture usually takes place in a fall upon 
the knee, the leg being at the time carried sud- 
denly in the greatest possible degree of flexion 
while the — is drawn upwards by the con- 
traction of the extensor muscles. We recog- 
nize this rupture by the following signs: the 
patient cannot raise himself from the ground ; 
the leg has a singular tendency to flex itself, 
and cannot voluntarily be extended. If we 
examine the knee immediately after the acci- 
dent and before any swelling has supervened, 
we observe that the patella is elevated, that its 
lowest point is now directed forwards, that a 
great degree of lateral movement can be com- 
municated to it, and that its ligament is preter- 
naturally relaxed. We observe underneath 
the skin at the place of the rupture a depres- 
sion or considerable vacuum. If we push the 
finger from below upwards undemeath the 
apex of the patella, we can elevate this bone so 
as to distinguish by the touch the eminence 
which se the two articular surfaces of 
the tibia from each other. Such signs leave no: 
doubt of the rupture of the ligament of the 
patella; but as. this rupture takes place as a 
consequence of a fall upon the knee, and as 
this. part: is more or less contused, there fol- 
LACRYMAL ORGANS. 
lows sometimes so considerable a 
it is impossible to recognize the rupture. It is 
not until after the disappearance of the swelling 
that we can often assure ourselves of the tn 
nature of the accident, Undercareful manage 
ment complete recovery takes place. . 
( Robert Adams.) — 
LACRYMAL ORGANS, or lacrymal 
sages, organa lacrymalia s. vie lac 
Fr. Les organes ou voies lac: 
Ital. Gli organi spettanti alle lagrime ; 
Die Thranenorgane. 
Under this head it is proposed to deser 
not only the lacrymal organs properly so ¢ 
but also the eyelids and conjunctiva. 
article therefore comprehends all the accessory 
or protecting parts of the eye ( tutamina oculi 
Haller) exceptthe orbit and muscles of the eye- 
ball, for which see the articles Face and Oxxrr 
Those parts of the orbit directly connected with 
the lacrymal organs are however noticed here. 
I. The eyelids.—P * Fr. Les paw 
we Ital. Le palpebre; Germ. Die Augen- 
ieder. “ 
The eyeball is invested in front by a mucous 
membrane called conjunctiva. Towards the 
margin of the orbit, this membrane leaves the 
eyeball and forms together with the skin, with 
which it is continuous, two horizontal fol 
an upper and a lower, intended i 
cover and so to protect the delicate and trans- 
poses front of the eyeball. The folds thus 
ormed by the application against each other 
of a layer of mucous membrane and a layer of 
skin are eyelids. 
Such is the simplest idea of eyelids, and 
are they found in the salamander and axole 
among reptiles, and so far as in certain 
stances they exist among fishes; such even 
is their state in man and the higher animals at 
the commencement of development. But, as 
in the perfect condition of the of vision, 
it is essential that the eyelids should admit of 
being readily drawn over the front of the eye~ 
ball, and as readily retracted in order again to 
permit the access of light, so something e 
than a mere tegumentary fold was required to” 
constitute a perfect eyelid. There was, in fact, 
uired something to impart firmness, espe- 
cially to the margins of the folds,—a structure 
which, oe. served See an ad une 1S 
int on which the muscles necessary he 
Saoneaans of the eyelids might exert their 
action, should cause no undue re on th 
eyeball, but rather give it an equable suppor 
and shield it from that irregular compression 
which might otherwise have been produced 
All these desiderata we find > pee bos i 
fibro-cartilaginous lamina, called ; 
lage, contained in either eyelid, within the fold 
formed by the skin and conjunctiva. « 
The tarsal cartilages do not oceupy the whole 
of the folds, but only a part at their free mar= 
gins. Between the upper edge of the carti- 
1 
* Palpebra, a palpitando, quod palpitare 
tremere videantur, propter citissimum et frequen- 
tissimum motum. 
