Geranium in Hypertrophic Cirrhosis of the Liver.

During the past summer, I was consulted by a patient, aged about sixty-five years, for abdominal enlargement. The patient had for years suffered from a very severe ulcer of the tibia.

She was a very "fleshy," plethoric woman, and a year before had sustained an impacted fracture of the head of the femur, and had therefore, for the past year been exceedingly inactive.

The first symptom that had attracted her attention, was the excessive enlargement in the upper part of the abdomen; the encroachment upon the stomach and the persistent vomiting after eating. I found no evidence of extreme enlargement in the lower part of the abdomen, and no dropsical effusion anywhere within the body or the extremities at that time.

There was a slight jaundiced condition of the skin—a mild icterus. The liver dullness plainly gave a clew to the condition. The enlargement of this organ was extreme. It extended across the stomach to the left side of the abdomen and down well below the navel.

The surface of the liver was smooth and its edges were round and very distinct. The dullness was also high in the chest, extending up to the fifth or sixth rib and posterially it was distinctly marked. It caused an upward displacement of the diaphragm, as there was considerable difficulty in breathing, the patient being obliged to occupy a sitting posture during. the greater part of the night.

With the vomiting there were many symptoms of gastric catarrh, and extreme acidity militated against the diagnosis of a cancerous condition of the stomach itself.

With these symptoms there was extreme tenderness over the region of the spleen and occasionally mild, shooting pains in this organ, although no great degree of enlargement.

The skin symptoms were distinctly pronounced. There was itching and a general roughness of the skin, resembling greatly exaggerated goose-flesh. This appearance with the mild jaundice was pronounced and persistent. In addition to this there was a local inflammation of distinct areas of the skin which was announced by a petechial appearance first, then by red discoloration with blebs and blisters which closely resembled impetigo contagiosa. This condition had persistent special treatment and only yielded after the utmost care and faithfulness in carrying out this treatment.

I diagnosed this condition as one of hypertrophic cirrhosis, and gave an unfavorable prognosis. I put the patient strictly to bed and laid out a plan of treatment which seemed to be suggested. The temperature at no time ran above 101°, and during the first four weeks I gave for the congestive symptoms with the general tenderness, belladonna and bryonia in small doses persistently repeated.

I gave various alkaline remedies for the stomach with but little avail. After the expiration of perhaps four weeks, I put the patient on ten drop doses of specific geranium every two hours, and gave subnitrate of bismuth suspended in water, when necessary for the immediate stomach symptoms.

This has constituted almost the entire treatment from the first day of September until the present time—the end of December. As a result of this treatment, there has been a reduction of at least one-half in the size of the liver; the tenderness and shooting pains have long since abated, as well as the oppression in breathing; for the past ten weeks, the patient has been able to lie down and sleep quietly all night; there is only an occasional attack of vomiting-perhaps once each week; in general, the patient and her friends remark upon her satisfactory improvement.

The- fact that she is able to get around the house on a crutch and assist very materially in doing her housework, doing the entire sewing for a medium sized family, convinces them that she is greatly improved.

I cannot explain the action of geranium in this disease, if it is that agent which has produced the satisfactory results. The fact that steady improvement has followed the persistent administration of this remedy, almost alone, in a disease which seldom shows improvement under any treatment, convinces me that the agent must have had some influence.

The abatement of the stomach symptoms and the return of the normal appetite are very satisfactory results. At no time has there been any constipation since geranium has been given.

If any reader has made an observation concerning the action of geranium in conditions of this kind, we ask them to report, either in private letter or for publication.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.