COCCYDYNIA, OR COCCYGODYNIA.
This condition is generally due to injury of the coccyx, often the result of difficult delivery or trauma; it may be caused by a true neuralgia of the sacral nerves which will only yield to persistence in the use of anti neuralgic remedies. Occasionally it may be the local manifestation of the hysterical condition, in which case it will rapidly disappear after a few applications of the actual cautery or galvanic current. When the pain is due to rheumatism of the sacro-coccvgeal joint Aspirin or Salicylates will be indicated. Relief may sometimes be obtained by wearing a Bella donna Plaster, cut to the shape of the parts, and terminating in a pointed end or tail, which covers the skin over the lower part of the sacrum and coccyx, coming forwards to near the anus. Any local anesthetic may be employed from time to time to give temporary relief, and occasionally benefit is derived from the application of blisters or counter-irritants like strong tincture of Iodine, or Corrinn's Iron.
In traumatic cases Yeomans injects 10-20 mins. So per cent. Alcohol in
the middle line over the most tender spot, as in severe facial neuralgia, and he maintains excision is seldom necessary; 4 or 5 injections may be required.
Menii2re uses the following suppository at bed-time: R . Extracti Belladonna V. gr.
Extract; Hyoscyanti gr. 1.
lodofonni gr.
Oki Theobrontalis gr. xx. .11i5ce.
Or Chloral Hydrat., 1 grs.; Extract. Valeriamu, grs.: bromatis, 20 grs.
When pain continues in spite of rest in the recumbent posture and the use of the above agents the coccyx must be dissected out through a free median skin incision and excised with its periosteum—an operation which gives better results than Simpson's plan of subcutaneous section of the muscles attached to the coccyx. Where the coccygeal pain is asso ciated with difficulty of defecation, the condition will often be found to be due to fracture and displacement of the lower fragment, which should be removed without delay. If due to the presence of anal fissure or hiemorrhoids, these should also be dealt with surgically.