Meteorism, tympanites, or flatulency signifies a condition in which there is an excessive accumulation of gas in the intestinal tract.

If not caused by an organic obstruction in the bowel this condition is due to an abnormal state of the intestinal motion and absorption. Owing to the first factor we describe this anomaly under motor neuroses.

Etiology

The causes of the excessive accumulation of gas are: 1, an increased ingestion of gases themselves or of substances which easily form them; and 2, a diminution or impairment of their elimination from the intestines. The increased introduction of gases may consist in 21 swallowing of air or in drinking beverages highly charged with carbonic-acid gas. In both instances the gases principally accumulate in the stomach, although a portion of them reaches the intestines.

Increased formation of gas within the intestine is the consequence: 1, of various processes of fermentation and disintegration of carbohydrates and fats, hydrogen and carbon dioxide being the principal gases; 2, of the decomposition of proteids which produce besides the gases just mentioned sulphuretted hydrogen, carburetted hydrogen, and methyl mercaptan. The increased formation of gas is mostly due to an increased ingestion of easily fermenting food.

A diminished elimination of the gases may be due: 1, to an inhibition of the passage of the flatus; and 2, to retarded absorption. The passage of flatus is inhibited either by an intestinal obstruction or occlusion, or by a paresis or paralysis of the intestinal muscles. The latter condition is found in peritonitis and in grave infectious diseases, after shock, in severe anaemia, in spinal affections, and also in general neuroses. Most cases of meteorism, which quickly appears and just as quickly leaves the patient, are due to paresis of the intestinal walls and are usually associated with a large number of other nervous symptoms.

Symptomatology

A certain degree of tension about the abdomen, more or less pronounced, is almost always expe-rienced by the patient. In some instances the abdomen protrudes in balloon-shape, the region of the navel being principally involved. This picture is mostly met with in patients with relaxed abdominal walls. In cases in which the latter are tense the accumulation of gases may push the diaphragm upward. Sometimes the lungs and heart are forced upward and severe dyspnoea develops, which in rare Instances may be followed by asphyxia, collapse, and even death. There is a constant feeling of pressure and a desire to pass wind, while colicky pains are also occasionally met with. As a rule no flatus can be passed or very inconsiderable amounts at long intervals.

Differing from the form of meteorism just described are those cases in which there is a slight tension over the abdomen and wind is passed from the anus almost constantly for a long time with much noise. It is highly improbable that the gases emitted in this variety of cases are really produced in the intestinal tract for the following reasons: 1, there is no considerable change in the size of the abdomen after a repeated passage of considerable amounts of gas from the anus; 2, the absence of relief felt by the patient after the passage of flatus; and 3, the almost odorless character of these gases. Rosenheim compares these cases with those of nervous eructation from the stomach. While in the latter the air is constantly swallowed by the patient and belched up again, in the intestinal variety Rosenheim assumes that the air is constantly pumped into the rectum in order to be again emitted as flatus.

The diagnosis of meteorism is made whenever an excessive amount of gas is discovered in the intestines.

The prognosis will depend upon the cause which creates the tympanites. If it be due to organic lesions of the intestines (occlusion of the lumen) the prognosis is very grave, while meteorism due to a purely nervous disturbance gives a favorable outlook.

Treatment

In instituting a curative plan for this affection it will be necessary to elucidate the etiological factor of the meteorism. If the latter is caused by an obstruction of the bowel, this primary affection will have to be treated as such. In most instances of meteorism of neurotic origin the following points are of importance: Drinks and foods containing or forming a large amount of gas should be prohibited; thus all carbonated waters, beer, champagne, and cider should be avoided. Fresh fruits, all kinds of cabbage, leguminous foods, potatoes, coarse rye bread, sweetened cake, rich gravies should be carefully abstained from. These rules apply not only when the mete-orism is fully developed but in patients with a disposition to flatulency.

Formerly numerous intestinal antiseptics were given with the object of lessening the fermentative processes in the bowels. Recently, however, the general view prevails that they are of no benefit whatever. Benzonaphthol, salol, and salicylate of sodium are still regarded as the most efficient in this respect and may be tried in suitable cases. They can perhaps be advantageously administered in Sahli's 1 glutoid capsules in order to prevent their absorption in the stomach. Calcined magnesia, lime water, charcoal, testa praeparata, and subnitrate of bismuth are given with the intention of absorbing the gas, although their actual effect in this respect can naturally be only very limited.

The following drugs are believed to have a beneficial influence in diminishing the gas, especially in mild forms of flatulency: poppy-seed, peppermint, spearmint, thyme, cinnamon, cloves, nutmeg, anise, fennel. These are best given in infusions. It has not as yet been scientifically proven whether the reaction following their administration is due to a slight increase of the intestinal peristalsis. Brunton and Cash2 are of the opinion that the carminatives, such as asafetida and oil of cloves, have a distinct effect upon the absorption of several gases (carbonic-acid gas and sulphuretted hydrogen).

1 Sahli: Deutsche med. Wochenschr., 1897, No. 1.

2 Brunton and Cash: St. Barthol. Hosp. Report, 1887.

The removal of the gas per vias naturales through the anus is the most efficient therapeutic measure. This can be done through cathartic remedies whenever there is no contraindication against their use. Large cleansing enemas of water, with the addition of a teaspoonful of essence of peppermint or oil of turpentine emulsified with an egg to a quart, are of benefit.

When there are no anatomical lesions, massage of the abdomen and faradization may be of advantage. This also applies to friction of the abdomen with a cloth dipped in some alcoholic solutions of aromatics or ethereal oils (linimentum saponis, oleum carvi, cajuputi, terebinthinae, etc.). The introduction of a tube into the rectum may be helpful in favoring the escape of gas from the lower parts of the colon. In desperate cases in which the meteorism has reached such dimensions as to endanger life, puncture of the intestine through the abdomen with the trocar has to be resorted to. The meteorism of hysterical persons often requires no treatment, as it usually disappears of itself. Sometimes, however, it is very obstinate to all therapeutic measures.