There is still a difference of opinion as to the best way of treating a recent _fracture of the patella_ (knee-cap). Many surgeons are still content to follow the old plan of fixing the limb on a back-splint, or in plaster of Paris splints, and awaiting the result. It is beyond question that a large percentage of these cases recover with a perfectly useful limb--especially if the fibrous bond of union between the pieces of the broken knee-cap is adequately protected against being stretched by bending the leg at too early a date. But in some cases the fragments have been eventually found wide apart, the patient being left with an enfeebled limb. Still, at any rate, this line of treatment was unassociated with risk. But after Lister showed (1883) that with due care and cleanliness the knee-joint could be opened, and the fragments of the broken patella secured in close apposition by a stout wire suture, the treatment of the injury underwent a remarkable change. The great advantage of Lister's treatment was that the fragments, being fixed close together by the wire stitch, became solidly united by bone, and the joint became as sound as it was before. Some surgeons, however, objected to the operation--in spite of the excellence of the results obtainable by it--because of the undoubted risk which it entailed of the joint becoming invaded by septic micro-organisms. As a sort of compromise, Professor A.E.J. Barker introduced the method, which he deemed to be less hazardous, of holding the fragments close together by means of a strong silver wire passed round them vertically by a large needle without actually laying open the joint. But experience has shown that in the hands of careful and skilful surgeons Lister's operation of openly wiring the fragments gives a perfect result with a comparatively small risk. Other surgeons secure the fragments in close contact for bony union by passing a silk or metal suture around them circumferentially. Many years ago Lister remarked that the careful selection of one's patients is an antiseptic measure--by which he meant that if a surgeon intended to get the most perfect results for his operative work, he must carefully consider whether any individual patient is physically adapted for the performance upon him of any particular operation. This aphorism implies that not every patient with a broken knee-cap is suited for the opening of his knee-joint, or even for the subcutaneous adjustment of the broken fragments. An operative procedure which is admirably suited for one patient might result in disaster when adopted for another, and it is an important part of the surgeon's business to know what to advise in each individual case. (E. O.*)