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Date posted: February 27, 2012

Dr Arun Prasad K P  
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

Dr Arun Prasad K P  BHMS,MD(Hom)
Asst. Professor,Govt Homoeopathic Medical College Calicut. Kerala
Email: appoo@sancharnet.in

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