Man has always
been interested in the idea of disease prevention, even before
the discovery of bacteria and viruses. In the earlier days,
talismans, rings, witchcraft etc. were tried according to
different beliefs, in order to ward off illnesses. As the
allopathic system of medicine developed, they too invested
considerable time and money in the field of prophylaxis. Their
preferred prophylactic method against infectious diseases were
vaccinations, but this has turned out to be highly
controversial, with mixed results and unacceptable side effects.
Homoeopathy on the
other hand, has had a good reputation in the field of
prophylaxis, especially against acute infectious diseases. Ever
since the founder, Dr. Samuel Hahnemann advised the use of
Belladonna in the prevention of scarlet fever, homoeopathic
medicines have done excellent service in the field of
prophylaxis in many infectious diseases epidemics.
This paper tries to unearth evidence of the efficacy of
homoeopathic preventive medicines in infectious diseases, and tries to
identify the various methods used and problems faced in this
field. Various hypotheses regarding its mode of action are also
examined.
Historical
evidence supporting homoeopathic prophylaxis
Good studies about the efficacy of homoeopathic prophylaxis
are few - reported success stories often have cases of
prophylaxis mixed with that of treated cases. Still some of the
instances are worth mentioning, and give valuable ideas about
the different approaches to prophylaxis.
" Belladonna in
Scarlet fever - After Hahnemann's successful use of Belladonna
in scarlet fever prophylaxis, many have confirmed its efficacy.
Dudgeon reports the testimony of 10 allopaths who gave
prophylactic belladonna to a total of 1646 exposed children, off
whom only 123 contracted the disease1. This is especially
commendable, considering that the scarlet fever attack rates
were as high as 90%2
" Boenninghausen was successful in the cholera epidemic of
Europe in 1849, using camphor, Veratrum alb and Cuprum met2
" Boenninghausen found Variolinum and Thuja useful in preventing
small pox
" Dr. Burnett reports successfully using Vaccininum as
prophylactic against small pox
" Dr. Eaton of Iowa, prescribed Variolinum to 2806 people in
1902. Off the 547 who were definitely exposed, only 14 got the
disease ( 97% protection)2
" Dr. Fransisco Eizayaga, the Argentinean homoeopath, used
lathyrus sativus 30 in the Polio epidemic of 1957 and says
"nobody registered a contagion" 3
" Meningococcinum was prescribed as prophylactic in the
meningitis outbreak in Brazil in 1974. Only 4 cases were
reported among the 18640 children who were given the medicine,
while 34 cases were reported among the 6430 children who did not
take the medicine.2
Approaches to prophylaxis
On going through the literature, it is apparent that
different homoeopaths have tried different methods, all with
varying degree of success.
1) Nosodes
In this method specific disease nosodes are used in the
prevention of corresponding diseases. e.g. - Morbillinum -
Measles, Variolinum - Small pox, Influenzinum - Influenza,
Diphtherinum - Diphtheria
Though their
routine use in prophylaxis may be strictly considered more
isopathic than homoeopathic, this is probably the method with
the most number of recorded success stories - from
Boenninghausen down to H.C. Allen, Clarke, Kent and modern
homoeopaths. Dr. H.C. Allen notes about the use of Diphtherinum,
"The author has used it for twenty-five years as a prophylactic
and has never known a second case of diphtheria to occur in a
family after it had been administered".
The current favorite in the western world for prophylaxis
against influenza - Anas Barbariae hepatis et cardus extractum4
(prepared from the heart and liver of the Barbary duck, and
popularly known as Oscillococcinum) is actually a sarcode,
though it was originally thought that it contained the causative
agent of influenza.
2) Generic
similarity
According to this approach, a medicine is selected which has
a general similarity to the disease in question. There is no
individualization of the epidemic, and selection is based on
common symptoms.
e.g. Drosera - Whooping cough, Eupetorium perf - Dengue fever,
Pulsatilla - Measles, Bell - Scarlet fever (smooth type),
Lathyrus sativus - Poliomyelitis
This method has
been very successful in practice, as Hahnemann's and others
experience with Bell in scarlet fever, lathyrus in polio etc
proves. Dr. Arthur Grimmer, a student of Dr. Kent, says "lathyrus
has given the most certain protection in thousands of exposed
cases of polio through many epidemics in the last forty years"5.
It has to be remembered that though there is no
individualization as such, in diseases of a fixed character
(which presents each time with very little variability in
expression), the remedy based on the generic similarity may very
well be the similimum i.e. the genus epidemicus.
3)
Constitutional Remedy
Pierre Schmidt says6 that the constitutional remedy given in
early childhood is the ideal way to protect the organism from
common childhood diseases. Other homoeopaths have suggested the
use of the constitutional remedy when there is a threat of
exposure to acute infectious epidemics7. The remedy selected
based on the characteristic mental, physical general and
particular symptoms is thought to increase the vitality and
offers protection against a wide range of infectious diseases.
4) Homoeopathic
"Vaccinations"
This method involves the routine administration of a series
of remedies (usually nosodes) in the hope of protecting against
a variety of (childhood) infectious diseases. This is a
relatively contemporary innovation, borrowing on the methodology
of universal immunization of the allopaths. It is highly
controversial, and apparently contradictory to the principles of
homoeopathy, but is very popular in certain circles as an
alternative to allopathic vaccination. It should be pointed out
that it is rarely used when a specific epidemic is imminent or
is spreading in the community (except in the case of some
variations like the BCT programme) - its proponents aim to
confer long term immunity to a variety of common infectious
diseases.
E.g. Dr. Isaac Golden's Homoeoprophylaxis programme (HP)
The HP programme8
involves giving children a total of 28 doses of different
remedies - mostly nosodes of childhood diseases except for
Lathyrus - during the first five years of life. The interval
between doses is approximately 2 months. A questionnaire survey
of 1305 subjects revealed that off the 267 children who were
definitely exposed to the various diseases covered in the
programme, only 30 were affected (89 % protection)
BCT Programme against JE
The department of Indian System of Medicine &
Homoeopathy has successfully implemented the BCT programme
against Japanese encephalitis in Andhra Pradesh9. The programme
consists of administering Belladonna, Calc carb and Tuberculinum
in series to all the children in the state according to a
time-table - much like the pulse polio programme. Each medicine
is given at an interval of two weeks after the previous one, and
this is followed by a "booster" dose of Belladonna after a
month.
The Peak incidence and mortality from JE was in 1986, with 2038
cases and 638 deaths. After the introduction of the BCT
programme in 1999, the incidence and number of deaths decreased
to 343 and 72 in 2000, 33 and 4 in 2001 and no deaths were
reported in 2002. Though other factors (e.g., vector control)
may also be responsible for the reduction in morbidity and
mortality, it is thought that homoeopathic medicines have played
an important part.
5) Genus
epidemicus
The term Genus epidemicus (GE) usually denotes the remedy
similar to the totality of symptoms found in majority of
patients suffering from an epidemic disease6, which will cure
the disease as well as prevent its occurrence in the healthy. In
other words, it is the remedy similar to the totality of the
epidemic (Strictly speaking, the genus epidemicus refers to the
totality of the epidemic, and the similar remedy should be
called the "remedy epidemicus"). Though "specific" remedies,
nosodes etc as mentioned above may be useful in prophylaxis, it
is thought that the GE provides a much higher degree of
efficiency, both in prophylaxis and early treatment of cases5.
E.g.: In a cluster
of cases4 of whooping cough in the united states in 1996,
remedies like Drosera, Kali-bi, etc were tried initially without
success. Based on the indications of copious post nasal
discharge, vomiting of stringy mucus etc. Corallium rubrum was
prescribed, and was effective in 12 of the 14 cases of this
cluster. It was also successful in prophylaxis of family and
friends of the patients.
The totality of
symptoms of the epidemic consists of the common symptoms of the
disease as well as uncommon ones, and it is the uncommon
symptoms which distinguish one particular epidemic from another.
To ascertain the totality, the homoeopath notes down after
examination of each case, the new and unique symptoms, till no
new symptoms are observed. The subsequent cases usually present
the symptoms already observed, with little variation. This
totality will usually become clear (and a GE can be selected)
following the treatment of the first few cases of the epidemic,
though some epidemics may require additional cases to obtain a
fuller picture. The methodology has been described in the "Organon"
in aphorisms 100 -102
The totality of
symptoms of the epidemic may change as the epidemic evolves over
time and different geographic areas. Different variables like
age, nutrition, climatic conditions, susceptibility of the
population etc. of a particular location has an influence on the
totality2,10. As the influenza epidemic spread across the United
States in 1918 -1919, it was observed that while Gelsemium,
Arsenicum and Bryonia2 were the remedies used most often, other
remedies like Cuprum, Causticum and Kali bich were indicated in
particular localities11. Thus it can be said that the totality
(and hence GE) is peculiar to a particular epidemic in a
particular region.
Selection of the right approach
Though Hahnemann has advised the administration of
the epidemic remedy for each epidemic, it is apparent from the
experience of various authors that other methods are also
successful. Many authors, including Kent, are also of the
opinion that for successful prophylaxis the exact similimum is
often not required, the near similimums are also equally useful.
For the selection of the right approach for prophylaxis, the
following suggestions may be helpful.
¢ ¢ In every
epidemic, finding out the GE is the ideal we must strive for. It
provides the best short term protection against a particular
epidemic in a particular region. But this requires a lot of
effort, and interaction between different homoeopaths in the
locality. Further in the case of some infectious diseases, it is
difficult for the homoeopath to get a first hand experience in
treating the cases. This may be because of lack of awareness
among patients or the insistence of the authorities that certain
disease are treated only with conventional medicine.
Treating cases
with the GE is very important in epidemics (as opposed to merely
using it as a prophylactic) as the cured cases help to confirm
the selection of the remedy - Then we are doubly sure that a
particular medicine is going to act as a prophylactic.
¢ ¢ In cases where
the GE is not clear or cannot be ascertained because of reasons
mentioned above, The remedy with the generic similarity to the
disease, or the disease nosode may be given. For e.g. in a case
of influenza epidemic, while the GE may be Arsenic or Gelsemium,
Eupetorium may provide prophylaxis based on a generic similarity
and Influenzinum may be tried as the nosode.
¢ ¢ In selecting
the nosode, some authors have stressed the need for ensuring
that the nosode is prepared from the same strain as the one in
the locality7. This is especially true in the case of viral
illnesses, which show different strains in different areas.
¢ ¢ If there is an
epidemic disease nearby, but has not actually spread to the
community (the threat of exposure is less imminent) the
constitutional remedy is an option to be considered for
individuals seeking protection.. It is of course not a practical
method for mass prophylaxis7. As described below, it must also
be the method of choice for patients with chronic diseases, even
if the threat of exposure to the epidemic disease is great.
Potency and repetition
There are no hard and fast rules regarding potency
and repetition, most of the homoeopaths have been guided by
their own clinical experiences. Many of the authors have
suggested the use of a lower or medium potency (30 or 200),
while some have used LM potencies7
Repetition
Different authors have suggested different regimens -
including a single dose. But the majority suggest a daily or
weekly repetition for the duration of the epidemic. The
repetition has to be stopped if any new symptoms (of proving)
are observed7.
Hahnemann in his first experience with prophylaxis12, used
Belladonna in a low potency (close to 3c) repeated every 3 days
throughout the duration of the epidemic. The frequency of 3 days
was arrived at considering the duration of action of Belladonna.
In the case of Asiatic cholera, he recommended the 30th potency
of Cuprum repeated every week.
Problems during Homoeopathic
prophylaxis
Attention to the following points is essential for an
efficient homoeopathic prophylaxis programme.
" Allay fear and anxiety - The homoeopathic physician often have
to tackle two epidemics when there is sudden spread of an
infectious disease in the community - One the original epidemic
itself and the other the epidemic of fear, exaggerated by the
almost obsessive coverage in the mass media. The fear and
anxiety can reach such levels that it can act as a "stress" on
the organism, making it susceptible to various diseases,
including the current epidemic. Indeed Kent has even remarked
that "those who fall prey to fear are likely to become sick, but
those who face disease with no fear are likely to remain
well"13. Though people should be advised to be careful and to
take the right preventive measures, excessive fear and anxiety
may do more harm than good.
" Awareness programmes - the target community should be made
aware about the nature of the illness, general preventive
measures, the exact schedule of repetition of the remedy etc.
" Management of
Prophylactic failure - In spite of the best efforts of the
homoeopathic community, the prophylaxis programme may not give
the desired results on some occasions. In such instances it is
important to analyze the reasons and to correct it if possible.
Some of the probable causes for apparent failure are given
below.
a) Wrong remedy
- the totality should be reviewed to select another remedy
or another approach (e.g. nosode) should be considered.
b) Change in totality - As described by many authors, the
totality of the epidemic may change as it evolves over time and
geographical areas. In some cases the genetic mutation of the
organism may also be responsible in part10. In such cases the
totality should be studied afresh and a new remedy based on the
changed totality should be selected
c) Patients
with chronic diseases - It has been observed that patients
with chronic diseases often are not affected by an acute
epidemic. Some have also noted that when they do get the
epidemic disease, the acute disease expression is modified by
the chronic sickness, so that it is often different from that of
the rest of the community. In such cases it is better to use the
constitutional /chronic remedy as a prophylactic rather than the
GE4
Mechanism of
action of Homoeopathic prophylaxis.
The successful use
of homoeopathic prophylaxis in various epidemics has aroused
interest on its possible mode of it action. But just as in the
case of homoeopathic cure, we can only postulate about possible
mechanisms, we do not as yet understand the exact nature of
action of remedies on the dynamic plane.
The modus operandi of homoeopathic prophylaxis can be considered
from a Philosophical, Psychological as well as Physiological
stand points.
Philosophical
The important difference in treatment and prophylaxis is
that the latter takes place on healthy people. It is thought
that the administration and repetition of the remedy creates an
artificial disease or sub clinical proving - sub clinical in
that symptoms are usually not produced. Since the vital force is
under the (stronger) influence of the artificial disease, the
epidemic disease force cannot take hold of the organism10
The artificial
disease (remedy) needs to be similar because during an epidemic,
the vital force of the majority of people in a geographical area
is more receptive to the similar remedy than a dissimilar one.
This has been attributed to a group change in susceptibility -
the susceptibility of the population is altered in an identical
manner, making all of them susceptible to the epidemic disease,
as well as to the similar artificial one.
An alternative
hypothesis proposes that the homoeopathic remedy acts by
correcting the recipient's altered susceptibility - removing
specific disease predispositions if they exist in the case of
the GE and nosodes, or in a general manner in the case of the
constitutional remedy7,8. In the absence of an altered
susceptibility (predisposing the organism to sickness), the
person is not affected by the epidemic disease force.
Psychological
It is an undisputed fact that fear and anxiety is an
overwhelming cause of sickness. As pointed out previously, this
"stress" may adversely affect the system during an epidemic,
making it susceptible to the illness. At least in a few cases in
an epidemic the fear and anxiety itself may be the main factor
responsible for the individual being affected by the disease.
The very act of taking a preventive remedy may subside the fear
and anxiety levels in such cases, making them less prone to
develop the disease.
Even in the majority, the "comfort" offered by the homoeopathic
remedy may have a positive effect, complementing the action of
the similar remedy on the immune system
Physiological
Very little is known about the physiological mechanisms that
cure or prevent diseases, under the action of the homoeopathic
remedy. However research in the field of action of high
dilutions and "memory of water" and its effect on physiological
systems has provided some interesting viewpoints.
It has been
acknowledged by many that the exposure to infectious disease
challenges helps to mature the immune system. On exposure to the
antigen (bacterial / viral etc), the immune system sets into
motion several defence mechanisms including the production of
protective antibodies - These antibodies usually prevent the
subsequent occurrence of an illness. Many have argued that it is
beneficial to let children develop some of the common childhood
diseases - so that the immune system is stimulated and its
mechanisms more perfected.
It is thought that
prophylactic homoeopathic remedies (due to its similarity to the
illness) provide a dynamic challenge to the immune system, very
much like the occurrence of a mild attack of the illness8. The
cells of the immune system respond by producing protective
antibodies, preventing the occurrence of the specific illness.
Some of the
laboratory and clinical observations appear to support this
concept. Studies conducted by Dr. Chavanon show that
homoeopathic remedies somehow have a stimulatory effect on the
immune system. He observed that 45 children changed from shick
test +ve (no antibodies against diphtheria) to shick test - ve
(antibodies present) after the administration of Diphtherinum.
This effect has been replicated by other experimenters2. Dr.
William Boericke's assertion that Baptisia in low dilutions form
antibodies to the Typhoid bacilli may also be remembered in this
regard.
Future trends in research
The concept of cells of the immune system responding
to a "dynamic" challenge may not be as far fetched as it sounds,
as research into the action of high dilutions reveal. It has
been shown that cells like the human basophil respond even to
high dilution of allergen - dilutions which appears to the
materialistically minded as pure water, as it does not contain a
single molecule of the allergen. It is thought that water
molecules carry the "energetic imprint" of the original
allergen, and this is adequate for the basophil to respond.
Though these studies have not been consistently replicated, they
may be the best bet to provide the answer to the modus operandi
of prevention and cure, at least at the physiological level.
References:
1) Dudgeon RE: Lectures on the Theory and Practice of
Homoeopathy Reprint B Jain Publishers (P) Ltd., 1994
2) Hoover TA: Homeopathic Prophylaxis: Fact Or Fiction http://www.homeopathic.org/crtoddh.htm
3) Winston J: Some history of the treatment of epidemics with
homeopathy http://www.homeopathic.org/crhistJW2.htm
4) Tailor W: On the Genus Epidemicus. http://www.wholehealthnow.com/homeopathy_pro/wt10.html
5) Currim AN: The Collected works of Arthur Hill Grimmer
Accessed from Encyclopaedia Homoeopathica, V1.3, by Archibel,
Belgium
6) Mathur KN: Principles of Prescribing. Reprint B Jain
Publishers (P) Ltd., 1998
7) Little D: Prophylaxis in Homoeopathy http://www.simillimum.com/Thelittlelibrary/Homoeopathicphilosophy/prophylaxis.html
8) Golden I: Homeopathic Disease Prevention http://www.lyghtforce.com/HomeopathyOnline/text/golden.htm
9)TheHindu online"JapaneseEncephalitisonthe decline in State"
dated april 2, 2003 from http://www.hinduonnet.com/thehindu/2003/04/02/stories/2003040204970400.htm
10) Chatterjee TP: Fundamentals of Homoeopathy and Valuable
Hints for Practice Accessed from Encyclopaedia Homoeopathica,
V1.3, by Archibel, Belgium
11) Olson OA: The treatment of Influenza. The homoeopathic World
1931. Vol. LXVI. No. 792 accessed from Tresorie, by Dr. Jawahar
Shah, Mumbai.
12) Dudgeon RE: The Lesser Writings of Samuel Hahnemann. Reprint
B Jain Publishers (P) Ltd., 1999
13) Kent JT: Lectures on Homoeopathic Philosophy. 5th ed.
Reprint, B Jain Publishers (P) Ltd., 1989
14) Hahnemann S: Organon of Medicine. 6th ed. Translated by
Boericke W Reprint B Jain Publishers (P) Ltd., 1991 |
