INTESTINAL TYMPANY 195 



caecum being fixed there renders that position always the 

 most Hkely to give certain results. 



Failing to obtain flatus on the right side, the left should 

 next be tried. Unrewarded by a rush of air from one 

 spot, it sometimes happens that a second puncture in 

 the same region, only i or 2 inches removed from the 

 seat of the first, is followed by a ready and voluminous 

 outrush. That being so, when once the surgeon has 

 diagnosed tympany, he should not desist from his attempt 

 to give the gases outlet until he has punctured both the 

 right and left flanks — if necessary, in more places than 

 one. 



The trocar should be at least 6 to 8 inches in length, 

 and the cannula vary from -J to -^^ inch in diameter. 



Considerable difference of opinion exists as to the 

 portion of intestine punctured. I do not think there is 

 much room for doubt. In the vast majority of cases it 

 is certainly some portion of the large colon. 



As illustrating the rehef afforded by puncturing the 

 bowel, I give a digest of a case reported by Mr. T. H. 

 Merrick, of Northampton :^ 



* On July TO, about noon, I was summoned to a cart 

 mare. The messenger informed me that she was in 

 great pain, and very much " blown." I found her to be 

 suffering from an acute attack of tympanites, the 

 abdomen being greatly distended. The mare was first 

 observed to be unwell in the morning about four o'clock, 

 when the horsekeeper went to fetch her from the field. 

 She was in so much pain that it was with difficulty that 

 he got her home. On my arrival the mare's pulse was 

 very weak and indistinct, and numbered 80 per 

 minute ; the mucous membranes were much injected ; 

 the surface of the body and extremities cold ; quickened 

 respiration, and great uneasiness. I administered the 



1 Veterinary Journal, vol. v., p. 316. 



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