A clinical history of the medical and surgical diseases of women / by Robert Barnes.

  • Robert Barnes
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: A clinical history of the medical and surgical diseases of women / by Robert Barnes. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    778/842 (page 768)
    interesting memoir on the subject, refers to two cases published by himself in the New Orleans Medical Journal fifteen years before Simpson's first communication. The name is derived from coccyx and 38uvt], pain. The leading symptom is pain in the region of the coccyx felt by the patient when- ever she sits down and rises, and sometimes when she remains in a sit- ting posture. Most of the patients affected with it are obliged to sit on one hip, or with only one side resting on the edge of a chair, or with the weight partially supported by a hand on the chair. Some patients dread sitting down. There are other movements of the coccyx liable to be attended by pain. Thus, patients have pain with every step they take, whilst in others walking causes no uneasiness. Others feel the pain most when the bowels are being evacuated, or under any circumstances in which the sphincter or levator ani, or the ischio-coccy- geal muscles are called into action. The pain is not in every case very acute, nor at all times equally severe. The distinguishing feature of the disease in every case is that the pain is felt at the lowest part of the spine, or rather in the seat of the coccyx, and where pressure always aggravates it. Pressure and movement of the coccyx too, with the finger in various directions, produce pain, and the kind of move- ment which is then attended with suffering differs in different cases. Simpson believes the pain is due to inflammation of the coccygeal joint, or other morbid change, when any action of the muscles in con- nection with it, by moving the joint, produces pain. We might naturally look for the origin of this disease in some injury of the part; and in a considerable proportion of cases injury can be traced. But it is remarkable that the disease occurs in the unmarried, and where no history of injury can be made out. I, myself, have known several aggravated cases follow labor. In these I cannot doubt that the joint received injury during the passage of the child's head. In some cases we know the sacro-coccygeal joint is anchylosed, the tip of the coccyx projecting so much forwards as to form an angle with the lower part of the sacrum. The anchylosis is likely to give way during labor. And where there is no anchylosis, as the head emerges, the coccyx may be felt to be stretched very much backwards, and under the strain some of the fibres of the anterior ligaments which bind this bone to the sacrum may be torn, and in the joint thus ex- posed and injured inflammation is very apt to be set up. Simpson saw abscess follow. The coccyx again is liable to fracture or dislocation from direct violence, as from a fall on the seat. Patients have complained that a bone grows in, and so it is found. It is also liable to malforma- tions, to deficient development, to tumors, and even double monstrosity by inclusion. But in a certain proportion of cases no local lesion can be made out, and we are driven to conclude that the disease is a neurosis, a form of neuralgia, the expression, perhaps, of some remote morbid condition. But latterly some new light seems to be cast upon these more anoma- lous cases. In Virchow's Archiv, 1860 (Die Steissdriise des Menschen), Luschka gives an account of a small gland situated just at the anterior