Provincial Medical and Surgical Journal (Later British Medical Journal)
1850; s1-14: 531
R. U. WEST
Sir - I am somewhat interested by the account in your last Journal of a case of "projecting coccyx."
In February, 1845, I attended a case which very much resembled the one quoted. The woman had previously had many children, (I had attended her seven times myself,) and had always had particularly easy labours; but on this occasion I felt the os coccygis projecting far forward. The labour went on with the usual rapidity until the head came in contact with this unusually prominent bone, when I found that it could advance no further. The pains speedily became very severe, but without any effect. I tried in vain to force back the obstruction with my fingers, and at the end of an hour I was beginning to wonder what I should do, for I thought that, if I applied the forceps I should only be making the head of the child overcome a resistance which would be better overcome by other means, when I heard a loud snap; the bone had broken, and the head was expelled at once. The child was uninjured, but the head was indented.
I have attended the woman twice since, viz., in 1846 and 1847. On the former of these two occasions precisely the same condition prevailed, with the same result, though after fewer pains. On the last occasion there was very little trouble; the head was arrested for a short time, but the bone yielded without breaking ; at any rate I heard no snap.
I fancy it would be difficult to imagine the causes which could have led to so unusual a condition of the bony parts of the pelvis, after so many easy and natural labours. The os coccygis must have been anchylosed to the sacrum in its unfavourable position. An absurd idea may suggest itself that my patient had sustained many a kick behind, but on inquiry I could not learn that any kind of injury had ever been inflicted.