TYMPANITES. 



manner in which they produce the difeafe, and therefore 

 cannot certainly afcertain them to have been caufes of it. 



The phenomena of this difeafe, in its feveral ftages, are 

 the following. 



The tumour of the belly fometimes grows very quickly 

 to a confiderable degree, and feldom in the flow manner the 

 afcites commonly comes on. In fome cafes, however, the 

 tympanites comes on gradually, and is introduced by an un- 

 ufual flatulency of the ftomach and inteftines, with frequent 

 borborygmi, and an uncommonly frequent expulfion of axr 

 upwards and downwards. This ftate is alfo frequently at- 

 tended with coHc pains, efpecially felt about the navel, and 

 upon the fides towards the back ; but generally, as the dif- 

 eafe advances, thefe pains become lets confiderable. As 

 the difeafe proceeds, there is a partly conftant defire to dif- 

 charge air, but it is accompliflied with difficulty ; and when 

 obtained, although it give fome relief from the fenfe of dif- 

 tenfion, this relief is commonly tranfient and of fhort dura- 

 tion. While the difeafe is coming on, fome inequality of 

 tumour and tenfion may be perceived in different parts of 

 the belly ; but the diftenfion foon becomes equal over the 

 whole, and exhibits the phenomena mentioned in the cha- 

 rafter. Upon the firft coming on of the difeafe, as well as 

 during its progrefs, the belly is bound, and the faeces dif- 

 charged are commonly hard and dry. The urine, at the 

 beginning, is ufually very little changed in quantity or qua- 

 lity from its natural flate ; but as the difeafe continues, it is 

 commonly changed in both refpefts, and at length fome- 

 times a ftrangury, and even an ifchuria, comes on. The dif- 

 eafe has feldom advanced far, before the appetite is much 

 impaired, and digeftion ill performed ; and the whole body, 

 except the belly, becomes confiderably emaciated. Toge- 

 ther with thefe fymptoms, a thirft and uneafy fenfe of 

 heat at length come on, and a confiderable frequency of 

 pulfe occurs, which continues throughout the courfe of the 

 difeafe. When the tumour of the belly arifes to a confider- 

 able bulk, the breathing becomes very difficult, with a fre- 

 quent dry cougrh. With all thofe fymptoms, the flrength 

 of the patient declines ; and the febrile fymptoms daily in- 

 creafing, death at length enfues, fometimes probably in con- 

 fequence of a gangrene coming upon the inteftines. 



The tympanites is commonly of fome duration, and to be 

 reckoned a chronic difeafe. It is very feldom quickly fatal, 

 except where fuch an affeflion luddenly arifes in fevers. 

 To this, Sauvages has properly given a different appellation, 

 that of meteorifmus : and it may perhaps always be con- 

 fidered as a fymptomatic affeftion, entirely diftinft from 

 the tympanites which we are now confidering. 



The tympanites is generally a fatal difeafe, feldom ad- 

 mitting of cure : but we fhall mention what may be at- 

 tempted in this way, after having endeavoured to explain 

 the proximate caufe, which alone can lay the foundation of 

 what may be rationally attempted towards its cure. 



To afcertain the proximate caufe of tympanites is fome- 

 what difficult. It has been fuppofed, in many cafes, to be 

 merely an uncommon quantity of air prefent in the alimen- 

 tary canal, owing to the extrication and detachment of a 

 greater quantity of air than ufual from the alimentary 

 matters taken in. Our vegetable ahments probably always 

 undergo fome degree of fermentation ; and in confequence, 

 a quantity of air is extricated and detached from them in 

 the ftomach and inteftines ; but it appears, that the mixture 

 of the animal fluids which our aliments meet with in the 

 alimentary canal, prevents the fame quantity of air from 

 being detached from them that would have been in their 

 fermentation without fuch mixture ; and it is probable that 

 the fame mkture contributes alfo to the re-abforption of 



the air that had been before in fome meafure detached. 

 The extrication, therefore, of an unufual quantity of air 

 from the ahments, may, in certain circumftances, be fuch, 

 perhaps, as to produce a tympanites ; fo that this difeafe 

 may depend upon a fault of the digeftive fluids, by which 

 they become unfit to prevent the too copious extrication of 

 air, and unfit alio to occafion that re-abforptioii of air, 

 which in found perfons commonly happens. An unufual 

 quantity of air in the alimentary canal, whether owing to 

 the nature of the aliments taken in, or to the fault of the 

 digeftive fluid, does certainly fometimes take place ; and 

 may poffibly have, and in fome meafure certainly has, a 

 fhare in producing certain flatulent diforders of the ah- 

 mentary canal ; but cannot be fuppofed to produce the 

 tympanites, which often occurs when no previous diforder 

 had appeared in the fyftem. Even in thofe cafes of tym- 

 panites which are attended at their beginning with flatulent 

 diforders in the whole of the alimentary canal, as we know 

 that a firm tone of the inteftines both moderates the extrica- 

 tion of air, and contributes to its re-abforption or ready ex- 

 pulfion, fo the flatulent fymptoms which happen to appear 

 at the coming on of a tympanites, are probably referred to a 

 lofs of tone in the mufcular fibres of the inteftines, rather 

 than to any fault in the digeftive fluids. 



Thefe, and other confiderations, lead us to conclude, that 

 the chief part of the proximate caufe of tympanites, is a lofs 

 of tone in the mufcular fibres of the inteftines. But further, 

 as air of any kind accumulated in the cavity of the in- 

 teftines fhould, even by its own elafticity, find its way 

 either upwards or downwards, and fhould alfo, by the 

 affiftance of infpiration, be entirely thrown out of the body ; 

 fo when neither the re-abforption nor the expulfion takes 

 place, and the air is accumulated fo as to produce tympa- 

 nites, it is probable that the paffage of the air along the 

 courfe of the intellines is in fome places interrupted. This 

 interruption, however, can hardly be fuppofed to proceed 

 from any other caufe than fpafmodic conftriftions in certain 

 parts of the canal ; and we may conclude, therefore, that 

 fuch conftri£lions concur as part in the proximate caufe of 

 tympanites. Whether thefe fpafmodic conftri&ions are to 

 be attributed to the remote caufe of the difeafe, or may be 

 confidered as the confequence of fome degree of atony firfl 

 arifing, cannot with certainty be determined. 



Cure of Tympanites — Having thus endeavoured to af- 

 certain the proximate caufe of tympanites, we proceed to 

 treat of its cure ; which indeed has feldom fucceeded, and 

 almoft never but in a recent cafe of the difeafe. It may be 

 proper, however, to ftate what may be reafonably at- 

 tempted ; what has commonly been attempted ; and what 

 attempts have fometimes fucceeded in the cure of this 

 difeafe. 



It muft be a firft indication to evacuate the air accumu- 

 lated in the inteftines : and for this purpofe, it is neceffary 

 that thofe conftridlions, which had efpecially occafioned its 

 accumulation, and continue to interrupt its paffage along the 

 courfe of the inteftines, fhould be removed. As thefe, how- 

 ever, can hardly be removed but by exciting the periftaltic 

 motion in the adjoining portions of the inteftines, purgatives 

 have been commonly employed ; but it is at the fame time 

 agreed, that the more gentle laxatives only ought to be em- 

 ployed, as the more draflic, in the overftrctched and tenfe ftate 

 of the inteftines, are in danger of bringing on inflammation. 

 It is for this reafon, alfo, that glyfters have been frequently 

 employed ; and they are the more neceffarj', as the fxces 

 coUedled are generally found to be in a hard and dry ftate. 

 Not only on account of this ftate of the faeces, but, farther, 

 when glyfters produce a confiderable evacuation of air, 



and 



