Notes of cases in surgery: Dislocation

The Lancet

Volume 78, Issue 1987, Pages 293 - 294, 28 September 1861

Frederic C. Skey

Surgeon to St Bartholomew's Hospital, London

Of thirty-five cases of dislocation a few only have fallen under my own immediate charge. [Discussion of various cases follows, omitted here.]

The above list includes a case of dislocation of the coccyx, some particulars of which may be worthy of notice. The subject was an eminently sensitive and hysterical young woman, aged twenty, who sustained the injury by a fall in the street three weeks prior to her admission into the hospital. At the date of the accident she was far advanced in pregnancy, and she miscarried in the interval.

Examination detected a displacement of the bone, which was thrown forwards at a. right angle with the sacrum, the point projecting against the rectum. Tolerably firm pressure made through the bowel readily replaced it, but it returned to its abnormal position immediately on the remission of the pressure.

My first intention was to operate on the bone from within, and with this view I designed a metal spring, as thin in the neck as was compatible with strength, to be introduced into the rectum; but the difficulty of fixing it to the pelvis, and of employing the exact force requisite, was insuperable; besides which, I had no experience as to the capability of the bowel to bear the required pressure for many days, and probably weeks.

I then determined on the experiment of direct traction of the bone, and, having cut down upon it, passed a thin silver wire around it at about three quarters of an inch from its extremity. The wire broke, and I replaced it with a large silk thread, which was drawn tightly round the point of a broad wooden splint adjusted to the woman's back. The experiment, however, was not very successful: symptoms of very active hysteria manifested themselves, and she declared the pain to be insupportable. Some amount of local irritation certainly attended the progress of the case, with local redness and moderate suppuration, but not to an extent commensurate with her suffering. She wore the instrument for twenty days, during the whole of which she declared the pain to be very severe. For a few days she appeared relieved, but the bone returned to its abnormal relation to the sacrum. Subsequently she became eminently hysterical, and even maniacal, and I was compelled to remove her from the ward. From this state she recovered, her condition gradually improved and she left the hospital, relieved from her symptoms, both local and constitutional.

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