S. B. PRATT, M. D., BOSTON, MASS.
Notwithstanding much has been written on the subject of gastric ulcer, its treatment is by no means simple, by the methods usually advised. This article is written in order to present to the readers of this journal the results of the action of geranium on a very severe case, which I have had under treatment for some time.
From childhood the patient had suffered from sensitiveness in the epigastric region, although the digestion had usually been good. She had craved not so much a large quantity of food, as tasty foods, condiments and coffee. At times she complained of an "all gone" sensation, as if all her strength was leaving her, the sensation originating in the stomach. This appears to be a case where for years the patient had depended upon her food to overcome what, under normal circumstances, psychic forces or the influence of the mind should easily have overcome.
The first symptoms for which I was called, was simple vomiting without nausea. That was perhaps two years ago. This symptom was checked by eupatorium. Later, as the symptoms of gastric ulcer developed, I gave her iris, xanthoxylum, arsenic, hydrastis and cannabis, as indicated. I found she could not take nux but would get along well on ignatia nicely for three days, when it was necessary to omit three days before again exhibiting it.
About two months ago, she began to have agonizing pain in the region of the cardiac orifice of the stomach. She had got into the habit of eating something in the middle of the night, and these attacks would come on about half an hour after her midnight meal. The remedies usually advised were either without effect, or increased the difficulty.
I found that after taking a small dose of lycopodium, collinsonia and ignatia, combined, in as much hot water as she could drink, there would be an emesis of mucus, with considerable hydrochloric acid. (She would not submit to stomach lavage.)
After the emesis she generally remained easy until morning.
Usually in these cases the pain is present for a period of weeks, changing at times from severe spasmodic pains to a faint gnawing, deathly feeling, when the stomach is long empty. With this patient the greatest pain came on half an hour after meals, or at a time when a collection of undigested food had been retained by the stomach for many hours. The only food she could take without trouble was Eskay's Food, alternated at times with the white of an egg, bovinine, panopepton and water, beaten up together, with a few drops of sherry wine.
The patient had a tumultuous, yet feeble heart action, cold sweats, and wandering, childlike talk, preceding these attacks of pain, especially when they were to be very severe. She had a habit of pulling at her underclothes in the region of her stomach, because of a sensation of tightness in that region. At times the vomitus would contain food, which she claimed she had eaten three days before. She refused to submit to enemas or rectal feeding and any mental irritation would, and will, to an extent, even now, bring on a return of the symptoms.
Before her sickness, she responded well to cactus; now a small dose of it, or of ipecac, will bring on the symptoms. Passiflora was of little value, either as a hypnotic or a sedative, although with hyoscine it would give good results, about every fifth evening. If given two evenings in succession, on the second, the patient would pass a restless and irritable night. If she followed her own desires, she would take food every hour, to relieve the gnawing and faintness at the seat of the ulcer.
The patient suffered at times from extreme eructation of gas. During the first two weeks of an acute attack these would succeed the pain, but during the latter part of a prolonged attack, they would appear before meals, probably from the presence of undigested food. The taking of warm food at this time would sometimes check the eructation.
In the treatment of the actual underlying condition there were perhaps thirty remedies used during the progress of the case, that at first helped a little, but afterward failed. These were both approved eclectic remedies and other drugs. Morphine was of little avail after the first few doses. The patient could not be reasoned with concerning diet, and would insist upon eating prohibited food.
Of all the remedies I administered, it seemed that the most satisfactory benefit came from the use of geranium. I therefore made a stand on this remedy. At times I combined it with collinsonia, at other times with milk of magnesia, or the milk of bismuth, as the conditions indicated, the geranium being given continuously.
At this time the patient is able to eat sparingly of quite a generous diet, except fried foods, fats, much sugar or acid. This patient is 75 years old. She was a confirmed coffee fiend with sallow skin, trembling hands and liver proportionately pathological. I interdicted both tea and coffee from the beginning. I believe even a little coffee now would do considerable harm.
She can drink milk, whereas before it caused agony even when peptonized or in any form. Her complexion is clear now. That peculiar form of forgetfulness that accompanies some forms of liver degeneration (it is often mistaken for deliberate lying) has largely disappeared. Instead of being continually hungry, even directly after a meal, and continually asking for something or accusing the nurse, doctor and relatives of endeavoring to kill her by starvation, she now eats four times a day and is satisfied. I attribute this largely to geranium. As to how geranium acts, I cannot even conjure up a glimpse of a theory. I do not think it acts simply as an astringent. I believe it acts chemically on some special tissues.
It may be that it acts upon the plasma circulating in the axis-cylinders of a certain grade of the sympathetic (trophic) nerve tissue, overcoming the toxic elements there, somewhat as echinacea does in the blood current. At least, however it acts, it acted well in this case. The ulceration of the stomach must have been quite extensive, as well as more or less chronic previous to this attack, for perhaps a year and a half.
Just recently I have added one and one-half grains of Metchnikoff's lactic acid bacillis once a day, which has induced a beneficial result, destroying apparently the pathogenic bacteria of the gastrointestinal tract.
Three months ago I used geranium on a gastrointestinal case which was accompanied with much diarrhea and vomiting. All the symptoms but the diarrhea have been satisfactorily controlled. The stomach has regained its normal tone but the diarrhea was not in the least checked until I added the arsenite of copper and bismuth. I am sure geranium has a direct influence in curing conditions in the stomach which induce pain. Pain disappears entirely after it has been used for a time. It also restores the normal tone. I have theorized while writing here, that it may act upon some portion of the trophic nerve tissue in a more or less direct manner as above suggested.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.