Fracture of Patella by a Surgeon during Forcible Flexion

was well-proportioned, taller and stronger than most of her race. There was no evidence of syphilis, scrofula, rickets, lnollities, scurvy, malignant or other disease to account for fragility of the bone. On October 1st, 1895, she was completely anaesthetised with chloroform. When the conjunctival reflex was gone, I grasped the ankle with my right hand and proceeded to bend the knee over my left elbow. There was no spasm or resistance of the muscles. The leg flexed without any great force to an angle of 130? or 140? with the usual sensation of fibrous adhesions giving way. I then noticed a peculiar dimpling over the patella. Examination shewed that 1 had fractured that bone into three fragments. As shewn in the figure, an elongated central piece lay diagonally across the gape between the upper and lower fragments. This was very clearly made out by palpation immediately aiter the accident, before any effusion took place. This case seems to me