Würzburger medicinische zeitschrift
1861; 2: page 320-331
Friedrich Scanzoni von Lichtenfels
University of Würzburg
Google scan of original paper in German
Translation of a summary of the paper in the British Medical Journal, 1861; 2: page 685.
Dr. Scanzoni (Würzburger medicinische zeitschrift) observes that coccygodynia is far from being rare; for he has seen twenty-four cases of it during the last four years. It has been frequently mistaken for a symptom of some disease of the genital organs, which often accompanies it; and also for hemorrhoidal pain. Dr. Scanzoni has never observed the disease except in women who have borne children; and in nine cases, the patients distinctly traced the origin of their pain to the date of their confinement. Of nine women, six had only had one child; and in five cases, the pain appeared after instrumental labour.
We may, therefore, consider that the act of childbearing is the essential, if not the sole cause of this pain; and we can readily understand why this should be the case, when we recollect the injuries to which the coccyx is liable during confinement. The violent forcing of the lower part of the bone backwards, sometimes to the extent of half an inch, and the stretching and tearing of the attached ligaments, are quite enough to excite inflammation and exudation between the bones which form the coccyx. That this really does frequently happen is shown by the researches of Luschka, who pointed out the frequent anchylosis of the bones of the coccyx which takes place. Dislocation of the bone, of the kind here spoken of, must evidently cause pressure upon and injury of the nerves, by the tearing and rupture of the ligaments which naturally protect and sustain them. Hence, we can readily understand why the delivery of the child should be the cause of coccygodynia.
The persistence of the affection is to be ascribed in part to the peculiar relations of the coccyx to the parts around it, and in part to the diseases which so frequently accompany it. When any change in the position or structure of the bone has taken place, every movement of the lower extremities, sudden sitting down or rising up, or even evacuation of hardened faeces, must produce a movement of the bone. Affections of the neighbouring organs also aid in keeping up the coccygodynia. Chronic metritis, ulcerations of the os uteri, anteversion and retroversion, very often accompany coccygodynia. Dr. Scanzoni cannot, indeed, recollect a single case which was not attended by some one of these affections. He has, for example, seen cases in which the coccygodynia immediately ceased, when an anteverted uterus was reduced to its proper position; or when arrested menstrual function was removed. In these cases, we must consider that the persistence of the coccygodynia (originally excited by the act of parturition) is maintained by the affection of neighbouring organs.
As regards the treatment, Dr. Scanzoni considers that it is of the first importance to remove the affections of any neighbouring organs. He is satisfied that no local treatment is of any avail so long as any of the neighbouring organs either press upon the bone or excite the coccygeal nerves. The first business of the physician, therefore, is to endeavour to ascertain the state of the neighbouring organs and parts. When the coccygodynia is recent, a few leeches, or cupping, should be frequently applied over the bone, warm effusions, hip-baths, etc. The patient should maintain a horizontal position, and refrain from all violent exertion. The bowels should be kept loose. These means are sometimes followed by a temporary cure; but the pain generally returns after a time. In such cases, when there is no sign of inflammation, Dr. Scanzoni has found subcutaneous injections of morphia of great service; and he cannot, like Dr. Simpson, regard them as merely palliative. He has not found the sulphate of atropine so efficacious as the morphia. Dr. Scanzoni has not yet tried subcutaneous section of the muscles and tendons, as recommended by Dr. Simpson; for he had never met with a patient in whom the intensity of the pain was such as to require such an operation, which is not without danger.