I N 1911, I saw a psychopathic woman, past the menopause, who, with her protuberant abdomen, was sure that she was pregnant by the Holy Spirit. She insisted on going to a lying-in hospital and was outraged when told that she was not going to have a baby. I learned then that a bloated abdomen can be produced purely by nervous means. Later I saw an occasional nervous, unhappy woman who during the day would become more and more bloated, until by evening she would appear about eight months pregnant. The abdomen usually became flat during the night. Soon I began to realize that in these cases the cause could not be gas. Why? Because (1) a roentgenogram of the enlarged abdomen showed that there was no excess of gas in the stomach or bowel, and (2) as the swelling went down, sometimes suddenly, there was no passage of flatus.
ALVAREZ WC. HYSTERICAL TYPE OF NONGASEOUS ABDOMINAL BLOATING. Arch Intern Med (Chic). 1949;84(2):217–245. doi:10.1001/archinte.1949.00230020020002
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