Transactions of the American Proctological Society
1919, Surgery, Gynecology and Obstetrics. 29: 612-613.
New York Polyclinic
Dr. Yeomans said that theories advanced for the causation of the leading symptoms, pain in the region of the coccyx, are: 1, Neuralgic; 2, Neuritic, 3, Injury, and 4, Sympathetic. The first three are based on traumatism and comprise the major number of cases. The traumatism is within the pelvis, as in labor, or external, as a fall. As a rule the periosteum of the coccyx only is injured and the soft parts adjacent to the bone. Injury of these structures initiates an inflammatory reaction with proliferation and later contraction of the new-formed fibrous tissue and compression of the nerves which traverse it, causing neuralgia or neuritis. Fracture or dislocation of the coccyx may cause pres sure pain.
The characteristic pain is spasmodic and aching, aggravated by sitting or rising, but not affected by urination or defecation.
The diagnosis is made by a bidigital examination — the index finger in the rectum, the thumb making counter-pressure outside - thus palpating the coccyx and compressing the soft parts adjacent to it, to determine the portion of the coccygeal plexus of nerves involved.
There must be excluded diseases of the spine and of the nervous system, as tabes, and locally lesions of the anal canal and rectum simulating coccygodynia, as anal fissure, cryptitis, papillitis, blind internal fistulae, thrombosed hemorrhoidal veins, proctitis and foreign bodies in the rectum ; also, in women, disease of the external and internal genitals and, in men, of the urogenital organs.
The prognosis in general is good on the ground that the pain resides in the coccygeal plexus of nerves and not in the bone as was formerly supposed.
The treatment is an application of the principle of injecting sensory nerves with 80 per cent, alcohol, thereby causing their degeneration, as suggested by Schlosser in 1907, and practised with marked success in trifacial neuralgia.
The injections are made aseptically, without anaesthesia, at the office. A sterile syringe is filled with 20 per cent, alcohol and armed with a 2-inch needle of fine gauge. The point of maximum tenderness is determined bidigitally, then, maintaining the index finger in the rectum as a guide, the needle is carried through the skin of the mid-line to the tender spot and 10 to 20 minims are injected slowly. The interval between injections is five to seven days.
The writer has had 28 cases in all, of which he treated 24; and of these 20 were females and 4 males.
External trauma was responsible for 15 cases; difficult labor, 3; 2 followed local operations and in 4 the cause could not be determined.
The duration of the pain before operation was from three weeks to fifteen years, averaging 22 months.
The number of injections varied from 1 to 10, average 4.
Results of treatment: Clinically cured, 16; relieved, 7; failed, 1.
Elapsed time since treatment varies from three months to nine years.
The only case of failure was in an otherwise healthy, robust girl, aged 10 years. As no benefit followed 10 injections, the writer excised the coccyx in October, 1919, with immediate re lief of pain and no recurrence.