1894, 2: 149-150
This paper describes a modified version of the operation first described by James Simpson (1859), later called coccygotomy, in which the attachments of muscles to the coccyx are severed, but the coccyx is not removed.
The patient is anaesthetised and placed lying on their back with the hips and knees flexed and the thighs apart. The surgeon places his left index finger into the rectum, and grasps the coccyx between that finger and his thumb on the skin outside. With his right hand he passes a tenotomy knife (with a narrow handle and blade) in front of the coccyx, then turns the blade backwards to cut the attachments to the levator ani and coccygeus muscles on either side of the coccyx. He then draws the blade back to separate the coccyx from the sphincter.
In cases where the glutei are causing the problem, the attachments are severed by passing the knife down the side of the coccyx far enough to divide the attachments. The knife is then withdrawn and introduced horizontally a little above the tip of the sacrum, and the soft parts divided transversely from the deep surface of the skin down to the bone, the subcutaneous wound being 2.5 to 3 inches long.
Out of 23 patients treated for coccydynia over a number of years, Barwell operated on 17, and reported that 16 were quite recovered from the condition.