Exfoliation of the Coccyx

Boston Medical and Surgical Journal

1856 54 (26) page 516-517

D. W. Hershey

Williaimsville, N. Y.,

J. F., age 18, a farmer by occupation, had been suffering for about 18 months from a discharge of pus in the perineum. The first indication of disease in that region was an ordinary furunculus [boil] which never healed.

Upon examination, there appeared lo be two or three sinuses close together, from which the discharge took place. These were situated about two and a half inches anterior to the anus, and to the left of the raphe. Introducing a probe, the fistula was found to extend as far as the margin of the anus, and appeared to be just under the subcutaneous cellular tissue, which from infiltration had become thickened and dense. The operation consisted in the ordinary method of laying open the sinus its whole extent, and introducing lint to promote granulations from the bottom.

A day or two after the operation, while cleansing the wound, a substance was discovered at its bottom, appearing like some foreign body. Extracting it by means of the forceps, it presented every appearance of the terminal bone of the coccyx. From this time. the wound continued to heal kindly, and a perfect cure was soon established.

How came this bone detached from its normal connections and so far from its original locality? Several years before, the patient had typhoid fever, which was of a low grade. Eschars formed upon the sacrum, and other parts of the body, and life was preserved only by the most unremitting diligence.

It is quite probable that at this time the activity of the absorbents disconnected this bone from its nutritive dependencies, and made it, to all intents and purposes, a foreign body; and having remained until some irritation or external violence caused it to act upon the adjacent, tissues, it became the cause of the fistula.

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