§ 2. Tympanites.—The presence of flatus in the abdomen, as it always results from any disorder of the bowels, would not deserve mention except that cases are occasionally seen in which this is the principal ailment. We search in vain for other direct evi dence of faulty secretion ; and, except that the bowels are usually sluggish, and the patient suffers much inconvenience from the dis tension, the circumstance might be disregarded altogether. The cases do not present any great difficulty in diagnosis, but they are very troublesome to manage : the only point which we have to ascertain with care is, that the enlargement of the abdomen is not produced by some other cause, while the resonance is no more than that usually heard on percussing over the intestines when thus pushed forward. Such a combination of distension and re sonance, for example, may be observed when a small quantity of fluid exists low down in the peritoneum; and mistakes of this kind have been made when the distension was produced by en largement of some of the pelvic viscera ; e, g., the uterus or the bladder.
A tympanitic condition exists, very generally, in peritonitis, both in its acute and chronic forms; it is also very common in bowel-fever. Each of these diseases present symptoms which ought not to be overlooked and can not be misunderstood; in them the distension is not caused so much by any abnormal condition of the secretions as by the loss of muscular power, which allows the flatus to accumulate. It is possible that a similar condition may
have to do with the production of genuine tympanites, and that it may be in part due to muscular paralysis : it seems, however, scarcely possible that it should exist to any great extent from this cause alone, and I think there can be no doubt, whether any other disorder of the bowel mark its presence or not, that faulty secretion is an essential element. The diagnosis of this con dition of things rests, indeed, rather on negative than positive evidence ; the tympanitic distension may be proved, but in the further analysis of the case, we have to make out rather the absence of actual disease than the presence of any morbid condition of which pathology can lay hold; hence, it is one in which we are very liable to error, and one which increasing knowledge may at some future period enable us to discard altogether from our neology. The difficulties are certainly not lessened by the circumstance that it is very often associated with hysteria.