TYMPANITES.

Tympanites, Sauv. gen. 291. Lin. 219. Vog. 316. Sag. 118. Boerh. 226. Junck. 87. Affectio tympanitica, Hoffm. III. 339. Meteorifimus, Sauv. gen. 292.

This is an inflation of the abdomen, and is of two kinds: 1. That in which the flatus is contained in the intestines, in which the patient has frequent explosions of wind, with a swelling of the belly commonly unequal. 2. When the flatus is contained in the cavity of the abdomen; in which case the swelling is more equal, and the belly swells when struck, without any considerable emission of flatus. Of these two, however, the former disease is by much the most common; insomuch, that many, even extensively engaged in practice, have never met with an instance of true abdominal tympanites. In both cases the rest of the body falls away.

Causes, &c. The tympany sometimes takes place in those who have been long troubled with flatulencies in the stomach and intestines. It happens frequently to women after abortion; to both sexes after the suppression of the hemorrhoids; and sometimes from tedious febrile disorders injudiciously treated.

Prognosis. This disease is generally very obstinate, and for the most part proves fatal by degenerating in- Practice.

MEDICINE.

Intumercentia. Sometimes, if the patient be healthy and strong, the disease may terminate favourably, and that the more readily if it has followed from some disorder. A hectic consumption, dry cough, and emaciated countenance in a tympany, with a swelling of the feet, denote approaching death in a very short time.

Cure. With a view to the prevention of this affection, it is necessary, in the first place, to avoid, as far as it can be done, causes giving rise to an uncommon extrication of air, by preserving the proper tone of the alimentary canal. After the affection has taken place, the indications are, first, to expel the air already extricated and confined in different cavities; and, secondly, to prevent further accumulation. On these grounds different remedies are employed. The cure, however, is principally attempted by carminative, resolvent, and stomachic medicines, gentle laxatives, and at last tonics, especially chalybeates. In the Edinburgh Medical Essays, vol. i. we have a very remarkable history of a tympany by Dr Monro senior. The patient was a young woman of 22 years of age, who fell into the distemper after a tertian ague, in which she was badly treated. She became a patient in the Edinburgh Infirmary the 24th of March 1730; took several purgatives, and some doses of calomel; used the warm bath; and had an antihysteric plaster applied over the whole belly, but with very little effect. She was monstrously distended, insomuch that the skin seemed to be in danger of bursting: her breathing was much stinted; but the swelling sometimes gradually decreased without any evacuation. The returns and degree of this swelling were very uncertain; and when the belly was most detumesced, several unequal and protuberant balls could be felt over the whole abdomen, but especially at its sides. Her stomach was good, she had no thirst, and her urine was in proportion to the quantity she drank. She was very collicute, her menses at irregular periods, but no oedematous swellings appeared in the feet or anywhere else. In this situation she continued from the time of her admission till the 21st of June, during which interval she had only menstruated twice. Throughout this space of time, the following circumstances were observed, 1. Several times, upon the falling of the swelling, she complained of a headache; once of pains throughout all her body, once of a giddiness, twice of a nausea and vomiting, and the last time threw up green bile; and once her stomach swelled greatly, whilst the rest of the abdomen subsided. 2. During the flowing of the menses she did not swell, but became very big upon their stopping. 3. Blood-letting and emetics, which were made use of for some accidental urgent symptoms, had no very sensible effect in making the tympany either better or worse. 4. She never had passage of wind either way, except a little belching some days before the monthly evacuation.

Some time before the last eruption of the menses, the purgatives were given more sparingly; and antihysteric of the strongest kinds, such as asafoetida, oleum corn. cerv. &c. mixed with soap, were given in large doses, accompanied with the hotter antiflatuses as they are called, as horseradish and ginger-root infused in strong-ale with steel. The patient was ordered to use frequent and strong frictions to all the trunk of her body and extremities, and to use moderate exercise. Immediately before the menses began to flow, Physometra of the same kind of medicines were injected. The menses were in sufficient quantity; but as soon as they ceased, her belly increased in its circumference four inches and a half, but soon subsided. She then complained of pains, which a gentle sweat carried off. Borborygmus were for the first time observed on the same day, June 25th; and having taken some tin Aura facra at night, she passed a small quantity of blood next day by stool. This was the first appearance of the return of the hemorrhoids, to which she had been formerly subject.

The two following days her saponaceous, antihysteric, and antiflatus medicines being still continued, she had such explosions of wind upwards and downwards, that none of the other patients would remain in the same room, nay scarce on the same floor with her. Her belly became less and softer than it had been from the first attack of the disease; her medicines, with a dose of syrup of buckthorn at proper intervals, still were continued, only the proportion of stool was increased; her flatus discharge went on successfully, and she gradually recovered her former health.