May 28, 1887, Vol. 129 No. 3326 p 1088
Hertford General Infirmary
(Under the care of Mr. William Odell.) For the notes of the following case we are indebted to Mr. H. G. Shore, house-surgeon.
A housemaid, aged twenty, was admitted on March 3rd with the following history. Last July she fell and injured the bottom of her spine. She had also a second fall on the ice last December, and the coccyx was again injured. Since July she had felt pain at each catamenial period, but for the last five weeks the pain had been excessive and continuous when in the sitting position; there was also slight momentary pain on coughing. The pain and distress of late became so great that the patient begged to have the bone removed.
On examination per rectum, the coccyx was found to be bent at a right angle, in-curved, and pressing upon the rectum. It could be straightened at its lower part, but would not remain in position. On March 9th, the bowels having been previously freely relieved by a dose of castor oil, followed by an enema, the patient was placed on her left side and ether administered. An incision was then made from the end of the sacrum over the coccyx to its extremity, the parts being divided down to the bone, from which all ligamentous and muscular structures were then removed. The coccyx was separated at its junction with the sacrum, to which it had become ankylosed at an obtuse angle. There was rather copious haemorrhage at one time during the operation, but it was controlled by applying sponges soaked in very hot water. A piece of gutta-percha tissue was put in for drainage, the wound closed with silver sutures, and dry boracic lint applied. In addition to the ankylosis with the sacrum - the result of previous fracture - the coccyx was found to be broken about an inch from its extremity, the lower part being freely movable. To avoid moving the dressing the urine was drawn off until the 11th, when the patient passed it herself by turning upon her face. Half a drachm of laudanum was given each night, and the bowels kept from acting until the 14th, when a dose of castor oil and a soap enema were given. The gutta-percha tissue was removed on the 13th and the sutures on the 15th. The wound healed almost by first intention; the patient made an uninterrupted recovery, and was discharged cured on April 7th.
Remarks by Mr. Odell: From the time of the operation until May 2nd the patient was entirely free from pain or even inconvenience when sitting, all the distressing symptoms which rendered the operation necessary had disappeared, and there was no pain or difficulty in defecation.