Boston Medical and Surgical Journal
Volume 92, number 21: 613-614, 1875
Miss C, forty-four years old, an unmarried seamstress, at the age of fifteen received a fall, whose force came upon the coccyx. The injury was immediately attended in the vicinity of the bone with great pain and soreness, which, however, after a few weeks measurably though not entirely subsided. Four years afterwards, while engaged in her avocation, she began to suffer from neuralgia affecting all the pelvic organs but more .especially the anus and rectum. The sitting posture greatly aggravated the pain, as did any movements calling into exercise the muscles attached to the coccyx. Defecation was attended with extreme suffering. Menstruation was regular and normal, except that it was attended with severe neuralgia, referred mainly to the rectum. The patient suffered constantly from pain and tenderness, involving all the pelvic viscera. The several physicians under whose care the patient had placed herself could afford her merely slight and temporary relief, although all the ordinary remedies for neuralgia received a thorough trial.
At the time of examination by Dr. Burnham, January 23, 1875, he found extreme tenderness over the coccyx, the two lower segments of the bone displaced and directed anteriorly at a right angle to the remaining portion, and pressing upon the rectum. He also found retroversion of the uterus. The patient was suffering constantly from severe neuralgic pain, which was greatly increased by sitting or walking. Being informed that nothing but surgical interference would probably afford her any permanent relief, she readily consented to any operation that might be deemed necessary.
January 26th. The patient having been placed on her right, side and etherized, Dr. Burnham made an incision two inches in length along the median line, and carefully dissected off' the attachments of muscles and ligaments, carrying the knife in close proximity to the bone. This dissection was rendered somewhat tedious from the anterior displacement of the terminal segments; next, the lower portion of the bone was removed with the bone-forceps; lastly, all the remaining muscular attachments as far as the cornua of the coccyx were detached with the scissors. The haemorrhage was very slight, no vessel of sufficient size to require ligation being severed. The wound was dressed with a compress wet in carbolic acid. During the forty-eight hours following the operation, the patient suffered severe pain, which after that time gradually and entirely subsided. For two weeks the discharge from the wound was very copious, but six weeks after the operation it had entirely ceased. The bowels were kept quiet during the first six days, by opiates, and after that time the patient had perfect control of the sphincter ani.
The result has been an entire cure of the coccyodynia, with a most marked improvement in the general health of the patient. No cause for the retroversion was apparent, unless it were due to her general weakness and consequent laxity of the uterine ligaments; possibly, also, the displacement of the coccyx, by relaxing the levatores ani and sphincter vaginae, thus weakening the posterior uterine supports, may have contributed considerably to the production of this displacement of the uterus.
This operation, first suggested and performed by Dr. J. C. Nott, has been but rarely resorted to, though coccyodynia is by no means an in frequent affection. In all those cases, so far as I know, in which the two last segments of the bone have been removed, the cure has been complete and permanent. Removal of the whole or the larger portion of the bone seems to me preferable to subcutaneous division of the attachments, because the former procedure precludes all chance of a return of the disease and but slightly increases the gravity of the operation, while in cases of displacement it is much more easily performed than the latter.