Diseases attributed to this bone, or at its junction with the sacrum, are so common and often referred to the rectal specialist that their consideration here can hardly be considered out of place.

The Coccyx is sometimes Congenitally Deformed as the result of an neoplastic defect during embryo logic formation. It may be deviated either laterally, anterior or posterior In cases of anterior deviation the rectum may be pressed upon by it and fecal concretions cause irritation or ulceration. Lateral and posterior deviations seldom or never give trouble, except when subjected to an injury during parturition or from an external injury.

Treatment. This condition is best relieved by removing the coccyx.

Dislocation of the Coccyx, due to a fracture, or a separation at its junction with the sacrum, the result of injury, is quite a common condition. Patients complain of pain and discomfort in sitting when the condition has involved the nerves supplying this articulation.

Treatment. The removal of the bone is recommended in these cases also. The backward or forward displacements of the bone produces almost the same symptoms as the congenital deformity and are practically the same pathological condition.

Congeniality is a condition which is commonly met with after parturition - the result of a rupture or the stretching of the ligaments and the fractures of the bone at that time. The pain is most persistent and definitely referred to the region of the coccyx. The condition may also be due to an mastitis rheumatism or to neuralgia, but is more commonly due to an injury to the bone.

Symptoms. The pain is described as a dull ache, often with a feeling of heat and soreness, producing in turn a disturbance of the nervous system. It is ordinarily increased by exercise by bending the body forward, at defecation, or by slight injury to the bone. Ulceration at the posterior margin of the rectum or scars, the result of operation in the segment of the anal ring, cause pain which resemble congeniality very much.

The diagnosis can ordinarily be made from the history given by the patient and examination, with the index finger in the rectum and the thumb over the coccyx. The slight manipulation of the bone increases pain so greatly that there can hardly be any mistake in the diagnosis. A tumor of the coccyx will manifest itself in the form of a swelling.

The treatment ordinarily extends over many months or years, as these patients are loath to seek medical advice. Rest, with painting the affected part with iodine, will in mild cases prove of benefit. The bowels should be kept open so as to avoid injury from hard fecal masses. The application of the actual cattery has in some cases proven quite a success. At a dull heat it is brushed over the parts. After palliative treatment has failed to give relief, the surgical methods of total excision, or tracheotomy should be advocated.

Tracheotomy Tracheotomy is performed as follows: With a tracheotomy knife, an incision through the skin is made near the tip of the coccyx, and then carried upward over the back surface of the bone, which is then freed from all its attachments to the surrounding parts. The knife is then turned at an acute angle and the lateral attachments severed on both sides. The incision is then extended beyond the tip of the bone on both sides, freeing it from all its attachments excepting at its base or junction with the sacrum. In this manner, the bone is freed from all its muscular attachments and rest secured. This form of treatment is applicable to cases in which the bone is free from disease, but will not relieve malformations or fractures.

Total Excision is preferable in the majority of cases, affording a greater degree of success and making the field of operation technically more perfect. The blood vessels which may be severed during tracheotomy are easily controlled during this procedure without undue traumatize to the surrounding tissue; and the muscles which are divided are not left to inflame the sacra-coccyx joint afterward The operation as recommended by Ant is deserving of description for its simplicity and the short period of time consumed during its performance. The operation is practically bloodless and the special requisites for its performance are a pair of strong, blunt scissors, specially designed by Ant, a large curved needle and two or three catgut sutures.

The technique of the operation is as follows: The skin and deeper tissue over the end of the coccyx are grasped with the thumb and finger, making a fold at right angle to the coccyx. These structures are cut through down to the bone with one stroke of the scissors, making an incision one inch long, parallel with the coccyx. The coccyx is then freed and the end lifted upward with the left index finger. The ligaments and muscles are then cut away from both sides and the end, at the same time keeping the scissors pointed outward. While the position of the fingers are unchanged, the scissors should be placed at right angles to the coccyx, and the bone dis articulated The wound should be closed with two or three interrupted sutures and dressed with sterile gauze which is held in place by adhesive plasters.

Coccyx Tumors and Cysts. Lusaka’s gland or the cox-congeal body may be the seat of inflammation and undergo degeneration in the form of cysts or abscesses. Neoplasms are less frequent than tumors which originate as the result of a congenital deformity. Dermis cysts are probably the commonest form of tumors found in this region. Tumors are found in the adult which upon examination reveal a congenital origin not clearly understood. Supernumerary fingers, toes, and other portions of the body have been discovered in growths which originated in the sacra-coccyx region. Spain bifocal are situated as a rule directly in the medium line and should warrant careful investigation to make a certain diagnosis. When opened the fluid of these spinal tumors shows the presence of sugar which points to the involvement of the spinal canal.

The diagnosis of these growths is as a rule easy because of their location and size.

The treatment consists of tapping, ligation with partial resection, and complete extirpation.

Tapping in the majority of cases is an extremely dangerous proceeding particularly when these tumors are connected with the spinal cord in the form of a spins bifocal, and the process is followed, as a rule, by convulsions, meningitis, and sometimes death.

Partial resection and ligation is only resorted to when extirpation is not attempted on account of the extension of the growth into the deeper tissue. In these cases the tumor should be ligated and as much removed as possible after the ligature has been placed about the mass to control bleeding.

Ligation. When the tumor is small and peculated it may be ligated with the idea of having it slough off. This method of treatment is not indicated when the tumor is very large or when the ligature cannot be applied high enough to include all of the sac. Sometimes the ligature fails to cut through all of the pedicab and will leave the tumor only partially severed from its attachments.

Complete Extirpation. This method of treatment is followed by the best results, with the exception of those tumors of spinal origin which are best left alone. The operative technique for the removal of these tumors is as follows: An incision is made over the tumor and it is dissected out with the fingers or blunt scissors. The pedicab of a cystic tumor should be traced to its attachments to the sacrum so as to make complate extirpation certain. The greatest care should be exercised against puncturing these cystic tumors. When they are found invading the pelvis and involve the peritoneum, the latter should be closed with catgut sutures before closure of the external incision. Necroses bone should be curettage so as to permit healthy granulation Supernumerary limbs found within or attached to these tumors should be amputated or respected as demanded by circumstances.