|Year : 2020 | Volume
| Issue : 2 | Page : 152-159
Homoeopathy in pandemic Spanish flu 1918
Vaishali H Shinde
Regional Research Institute (H.), Mumbai, Maharashtra, India
|Date of Submission||14-Apr-2020|
|Date of Acceptance||29-Apr-2020|
|Date of Web Publication||29-May-2020|
Dr. Vaishali H Shinde
Regional Research Institute (H.), MTNL Hall No. 4, Shopping Centre, Sector-09, C.B.D. Belapur, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
The mankind has been under the wrath of various H1N1 viruses tracing back to the Spanish flu (SF) in 1918 down to pandemics in 1957 H2N2, 1968 H3N2, 2009 H1N1 and COVID 19 in 2020. Despite a lot of advancements in genomic viral studies, laboratory techniques, medical advancement and treatment options in the form of antiviral and antibiotics, the threat of pandemics is hovering on mankind with a challenge at global and national level to fight against it. Homoeopathy has played a contributory role in the treatment and prevention in various epidemics in the past. In this overview, the role of homoeopathic medicines used in the treatment of Pandemic SF 1918, in reducing the mortality is highlighted.
Keywords: H1N1 viruses, Homeopathy, Pandemics, Spanish flu
|How to cite this article:|
Shinde VH. Homoeopathy in pandemic Spanish flu 1918. Indian J Res Homoeopathy 2020;14:152-9
| Introduction|| |
The most severe pandemic caused by an H1N1 virus in the history has been the 1918–1919 influenza pandemic referred to as the 'Spanish flu' (SF). It was first identified in the military personnel during spring of 1918 in the United States and had spread worldwide thereafter. About one-third of the world's population was infected, estimated at about 500 million people, and the number of deaths was estimated to be 50–100 million worldwide with about 675,000 occurring in the United States.
| Epidemiological and Clinical Facts|| |
The age-specific mortality was highest amongst young children, people 20–40 years of age, and the elderly. In addition, pregnant women had extremely poor prognosis. Genetic factors probably did not play a major role in the pathogenesis of fatal cases.
This pandemic of SF had 3 distinct waves. The first wave which arrived during the spring and summer of 1918 was mild with very less mortality and therefore, went unnoticed. On April 1918, the disease had spread to France, and reached Spain, where the disease was widely publicized, 'A strange form of disease of epidemic character has appeared in Madrid'. Influenza then, acquired its name, 'The SF'. It then spread to Britain, Germany, Switzerland, Poland and reached Greece by May 1818. The second deadly autumn wave had lasted for 6 weeks and this time, there was multi-organ involvement and very high mortality rates, probably owing to a mutated strain of the virus. The third wave of illness occurred during the winter and spring of 1919 and lasted till the summer of 1919. The SF presented in clusters of complaints with high fever, nasal haemorrhage, pneumonia, encephalitis, miscarriage, pulmonary oedema, ruptured muscles of the rectum, swollen ankles, mimicking nephritis, blood-streaked urine and coma. The victims experienced fluid-filled lungs, as well as severe pneumonia and lung tissue inflammation. Due to the unavailability of antiviral drugs, antibiotics, diagnostics measures, critical care measures, such as intensive care support and mechanical ventilation, the doctors were left with non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants and limitations of public gatherings.
The recorded statistics of SF morbidity and mortality are likely to be significantly understated due to non-registration, missing records, misdiagnosis with a consistent upward revision of the estimated global mortality of the pandemic.
| Mortality Rates|| |
It was observed that the areas with larger population experienced an early pandemic. As compared to rural areas, the cities and towns experienced approximately 30%–40% higher death rates. Tuberculosis has been put forward as a predisposing factor for morbidity and mortality.
The SF mortality statistics presented unexpected results. The overall mortality was elevated for young adults, with varying mortality rates in above 65-year-old in various geographical regions, highlighting potential geographical differences and pre-existing immunity to the 1918 virus which suggests their exposure at an earlier date to an influenza strain similar to the so-called SF (H1N1) strain. No evidence for the role of genetic factors in susceptibility to the SF was found.
Australia, with 12,000 deaths, was the last continent to be involved in 1919. Most of the cases recovered quickly, while a few developed severe tracheo-bronchitis compromising oxygenation and immune defences and usually death in the 2nd week with massive destruction of the respiratory epithelium due to secondary bacteria. The virulence of the SF remained a glitch, which is still unexplained.
Records suggest that immune-pathologic responses were a significant determinant of the high mortality rate amongst young adults and other high-risk subgroups. Findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918, for example, A/H3Nx 1890 pandemic strain, were likely to have deregulated pathologic cellular immune response to infection with the A/H1N1 1918 pandemic strain. The immune-pathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia.
| Viral Genome|| |
Sequencing of the entire genome of the 1918 SF virus ended in 2005, with Dr. Tumpey being the first man to reconstruct the complete 1918 virus. Animal studies showed striking ability to quickly replicate and spread infection in the lungs of infected mice with severe lung damage owing to its haemagglutinin gene Studies on human lung cell line showed multiplication and spread within the human lung cells suggesting the role of polymerase genes in the virus' infectivity and virulence. Fertilised chicken egg experiments indicated that the HA and polymerase genes of the 1918 virus both likely played roles in its virulence. Tumpey et al. wrote 'the constellation of all eight genes together make an exceptionally virulent virus'. In that way, the 1918 virus was special – a uniquely deadly product of nature, evolution and the intermingling of people and animals. It would serve as a portent of nature's ability to produce future pandemics of varying public health concern and origin.
Since sporadic human fatalities are witnessed due to H5N1 avian epizootics, concern has been raised that a new pandemic, as fatal as the pandemic of 1918, or more so, could be developing. Thus, the understanding of the events and experiences of 1918 is of great importance.
| The Challenges|| |
Data on influenza pandemics and the characteristics of influenza viruses responsible for pandemics in 1918, 1957, 1968 and 1977 have been studied with mechanisms of influenza virus strains evolving, their mutations causing increased virulence, and also the possibility of human and avian influenza viruses re-assortment process been analysed along with its mechanisms of transformation from mild to highly virulent strains. However, many questions about the 1918 pandemic, its unusual epidemiologic features and the basis of its pathogenicity remain unanswered, despite the genetic sequencing of the entire genome of the 1918 virus, which called for pandemic vigilance, research, preparedness and planning, with greater emphasis on prevention, containment and treatment with antiviral medications and hospital-based intensive care. A great socio-economical burden, SF led to severe dysfunctions, including health services, which highlighted the need for pandemic preparedness.
In spite of advancements in medical science with availability of antibiotics, antiviral drugs, vaccines, laboratory investigations, life-saving medical equipment and various pandemic preparedness plans, strategies and surveillance programmes, both at the global and national levels, the health system still faces a lot of challenges in combating severe pandemic like the COVID-19, which has affected 213 countries, areas or territories with >1,700,000 cases and 111,600 deaths reported so far. The medical science is still devoid of a salutary therapeutic intervention.
| Homoeopathy in the Rescue of 1918 Spanish Flu|| |
The homoeopathic physicians were treating patients of SF with a marked success rate. Dean W. A. Pearson of Philadelphia collected data of 26,795 cases of influenza treated by homeopathic physicians with a mortality of 1.05% while the average mortality of cases treated by conventional medicine was 30%. Mortality rate of SF patients treated by homeopathic physicians was possibly one-third less than those treated by the other physicians. Parallel groups of cases everywhere show a homeopathic mortality almost negligible when compared with any other system of therapy.
| Testimonials of Spanish Flu Treatment|| |
Below are the testimonials by the physicians who treated Spanish flu patients with homoeopathy.,,,,
- Dr. Harry B. Baker, Richmond Virginia: Results of homoeopathic treatment had been much superior to those of the old school. Neither Dr. Tabor nor he had lost a case. Gelsemium was the genus epidemicus and covered probably 95% of the cases and was used as a prophylactic with very satisfactory results
- Dr. B. L. Miller, Portland, Oregon: They had their quota of influenza, and had not heard of a death under homeopathic treatment. One of the severest cases reported was of Dr. A. L. Canfield, who developed pneumonia with influenza and recovered
- Dr. B. W. Henderson: Strict bed rest and straight homeopathic treatment cured most of them. During service at Hahnemann Hospital, no case coming under treatment early was fatal. Remedies used in order of choice were Belladonna, Bryonia, Phosphorus, Calcarea iodide, Arsenic iodide. Even Gelsemium was used
- Dr. E. E. Vaughan: Remedies used were Baptisia, Bryonia, Phosphorus, Ipecac and Arsenic
- Dr. A. L. Black'wood: Given a well-ventilated warm room, good general care and 75%–80% require nothing but Eupatorium or Gelsemium, or for the pulmonary involvement, Sanguinaria nitrate
- Dr. A. H. Gordon: There reported no pneumonia and no fatalities in patients seen in early stage. Aconite, Arnica and Arsenic iodide; later (for the gastric involvement), Nux vomica
- Dr. Julia Strawn: Gelsemium, Ferrum phos., Bryonia and phosphorus were used
- Dr. Mar-ion Russell: Many cases, one death from pneumonia. The selected homeopathic remedies as adjuvant even in cardiac complication contributed to low mortality
- Dr. Edward Cobb: Children are less susceptible than grown-ups. Remedies: Gelsemium and Bryonia
- Dr. Agnes Fuller: Bryonia, Hepar sulphur, Arsenic or Chininum Arsenic, aromatic spirits of ammonia and crystals of ammonia carbonate were frequent remedies
- Dr. H. M. Srhofield: Advocated Gelsemium, Echinacea, Eupatorium and Belladonna
- Dr. W. F. Edmundson, Pittsburgh, Pa: Aconite, Gelsemium, Bryonia, Eupotarium and Ferrum phos. Lachesis for oedema of lungs
- Carleton A. Harkness, M. D., Chicago: Was complemented by chief medical officer at Camp Lee for having lowest death rate
- Dr. Pearson: Had 13 deaths in the 6 weeks, and was complimented by chief medical officer as having the lowest death rate in the hospital. Measles entirely disappeared from the camp which had been a good many up to that time. This made him believe that the two infections could not exist at the same time
- Dr. Laura A. Hurd., M. D. San Francisco: In homoeopathic Hospital of San Francisco many flu patients treated and Homeopathic remedies acted in a curative way
- Dr. Ernest F. Sappington, Washington, D. C: Recoveries in the Homeopathic Hospital in Washington were 100%
- Dr. C. J. Loizeaux, Des Moines, la: Not one developed pneumonia. He stated that the German aspirin has killed more people than the German bullets have
- Dr. E. B. Ftnncy, Lincoln, Web: A physician from Nebraska treated 700 cases without a single death. Dr. E. B. Ftnncy used Aconite, Belladonna, Bryonia, Gelsemium, Eupatorium perfoliatum, Euphrasia, Phosphorus, Tartar emetic, Iodide of arsenic and Arsenicum. Several eclectic practitioners told him that as soon as they began the treatment of their cases as outlined by our little Johnson's 'Homeopathic Key,' the death and pneumonia developments ceased
- Dr. H. A. Roberts, Derby, Conn: During the first voyage over to Brest was sent over load of 2000 men and in course of 2 weeks developed over 81 cases of influenza with three meningeal and several of the pneumonic form. Every man received homeopathic treatment, and careful individual treatment. However, every man was landed in Brest in good condition. This ship was the only ship in convoy of nine ships that had that record. Other ship in that convoy, which carried 4000 troops, lost 31 on the way over
- Dr. W. H. Hanchette, Sioux City, Iowa: Tinctures of Gelsemium, Bryonia, Eupatorium were given to some old school men who used them successfully. When the epidemic raged severely, Aconite was given most as many of the patients feared they were going to die; they expectorated mucus full of blood, In a Society meeting in Sioux City, all the doctors said that they had not lost a case if called in at the beginning of the attack
- Dr. J. H. Wilms, Cincinnati: Dr. Hinsdale after analysing 110 cases found that these cases had been treated mostly by Rhus tox., Hepar sulph., Gelsemium, etc.
- Dr. Frieda Weiss, Cleveland: Was acting surgeon under the U. S. P. H. S., State of New Jersey, during the flu epidemic with the 83 beds in the hospital occupied continuously. Not one of the patients died because he used the indicated homeopathic remedies
- Dr. William L. Love, Brooklyn:. At the Cumberland Street Hospital, Brooklyn, they cared exclusively for naval men and mortality rate was so much less than that of other hospitals
- Dr. N. R. Perkins, Dorchester, Mass.: Did not lose a single case he treated
- Dr. J. C. Irvine, Denver, Colo.: Idid not use Gelsemium as a general remedy in all cases but got good results from it when it was indicated. Spongia produced good results with children who were inclined to be croupy. There were a number of these cases. One child had been gasping for breath for days and in 30 min after the first dose of Spongia, was comfortable. Another case had been running on for a week. It required three or four people to keep the woman in bed. Within an hour or two after belladonna was given, the patient's temperature was normal. After three visits, she was out of bed
- Dr. Pearson: The mortality rate dropped from 25.8% to 15%. with just no aspirin or other old school medicine
- Dr. W. F. Edmundson, Pittsburgh, Pa.: Had five deaths. Do not know the number of cases treated. The most useful remedies were Aconite, Gelsemium, Bryonia, Eupatorium and Ferrum phos. He quoted, 'I don't believe I have ever used so much Ferrum phos. Oedema of lungs was treated by Lachesis. They were afraid to go to sleep for fear of choking up. Another patient was sinking gradually and under that remedy got better. His jaundice was very pronounced. He was so yellow that you could not tell what his complexion might have been'
- Dr. Rabe: Iwould like to move that it is the wish of this bureau that the law, 'Similia similibus curentur', be respectfully called to the attention of the members of the medical profession at large, including those of the homeopathic persuasion
- Dr. Anna Johnston, Pittsburgh: Found Ferrum phos very beneficial, also Belladonna. I did not use so much Gelsemium with the children. Tartar emetic was also useful
- Dr. Brown: Did not lose a single child. With children used homeopathic remedies almost entirely
- Dr. E. B. Hooker, Hartford, Conn.: Gelsemium was most always the first remedy, and served the purpose well in early conditions. It was more often indicated than aconite. Lost only one case of meningitis in a very young child
- Dr. H. Lischner, San Diego: The directors wrote a letter to the local newspapers commenting on the excellent results obtained by Homoeopathy. Routine treatment was Gelsemium first, later Kali carb., and if epistaxis or local congestions showed up, Sanguinaria. A case cited of influenza during pregnancy who developed influenza in the last month of pregnancy. Given Gelsemium she apparently progressed satisfactorily, her temperature rose again and she immediately developed symptoms of pneumonia, and remedy was changed to Sanguinaria. She held her own fairly well, but on the third night she went in labour. Kali carb prescribed and within 2 h she gave birth to a six-pound baby, and she collapsed completely. Under the administration of Carbo veg and mild stimulation, her condition gradually improved; she regained consciousness. An hour after birth, the baby had a temperature of 104 and showed a marked tendency to catarrhal symptoms and cough; its skin was covered completely with a vesicular eruption. These symptoms continued for about 5 days, and under the administration of Kali carb and other adjuvant measures, the temperature and cough soon subsided, and the baby became normal in every way'
- Dr. J. G. Dillon, Fargo, A *. D.: Children that had previously been bothered with a weak gastro-intestinal tract would show lots of vomiting and diarrhoea as the leading symptoms, for which Arsenicum and Ipecac were usually given. Others were predisposed to glandular, throat and ear symptoms, for which Ferrum phos and belladonna were given
- Dr. E. E. Vaughan: Used Baptisia, Bryonia, Phosphorus, Ipecac and Arsenic
- Dr. H. M. Srhofield: Gelsemium, Echinacea, Eupatorium and Belladonna
- Dr. B. W. Henderson: Cases reported in early case was treated at Hahnemann hospital. Belladonna, Bryonia, Phosphorus, Calcarea iodide, Arsenic iodide, Gelsemium was used
- C. E. Fisher, M. D., Chicago: In new Mexico, no deaths reported under homoeopathic medications. Veratrum viride, Gelsemium and Bryonia used frequently
- Homcopathic Recorder, October, 1920: Reported the role Gelsemium, Rhus tox, Eupatorium
- Loyd. Brothers, Cincinnati: 1000 eclectic physicians reported that Aconite and Bryonia are useful in Pneumonia
- Olive Branch, Ky: Bryonia and Gelsemium served all cases in early conditions with no mortality reported
- New York podiatrist: At a symposium of influenza held on Paediatrics of the New York Academy of Medicine, made the following statement: 'I do not know how many hundreds of cases of influenza passed through my hands. From September 20, 1918, to May 12, 1919, there was not a single day that I did not have influenza under my care. I have had as many as 17 cases of influenza pneumonia at one time, but I do not know how many I treated altogether. Aconite very early in the disease was the perfect simillimum, at other times it did splendid work in cases that suddenly developed an excessively high temperature after the disease had been progressing moderately for a number of days. Antim ars was used very frequently in bronchopneumonia. Antimonium tart was also used frequently in the cases which had pneumonia or bronchitis. Arsenicum album came in but seldom, and then only in advanced, severe cases. Arsenicum iod., third decimal, seemed so often applicable at the beginning of convalescence that its use became empirical and routine. Belladonna was often indicated for nervous symptoms, the rather common neuralgic pains, and particularly for the typical pharyngitis so many influenza patients presented early in the disease. Bryonia alba proved of great value, especially in pneumonias in which the lobar type was simulated and the characteristic pleuritic pain was in evidence. Ferrum phosphoricum was the most important remedy of all used in uncomplicated influenza, unusual type of bronchopneumonia and severe epistaxis. Case after-case that seemed almost hopeless responded to its beneficent influence. Indeed, if I were confined to one remedy I should choose Ferrum phos. Gelsemium is another remedy entitled to our highest consideration bur not useful in children that I could with adults. Ipecacuanha, while its respiratory symptoms were often present, frequently had to be introduced empirically to control nausea and vomiting. Phosphorus, on its so common tracheolaryngeal symptoms, was prescribed very often. In some cases, the rapidity with which it cleared up persistent, dry, irritating coughs seemed almost miraculous. Rumex is another with a special affinity for the trachea and larynx which occasionally gave excellent results. Sanguinaria proved of great service in pneumonia when there was great dyspnoea and evident need of an expectorant. Spongia was used in several cases in which the children developed croup as a complication. For sedatives, Chamomilla or Magnesium phosphate was occasionally given in addition to other homeopathic remedies'
- JOHN C. CALHOUN: He was seeing from 75 to 100 persons a day and gave Gelsemium to cases with chilliness, followed by fever with tiredness, general aching, loss of appetite. He gave Eupatorim perfoliatum in cases where pains were greater, complained bitterly of the headache, bone aching and backache. Veratum viride given to those taken down with severe chill, nausea or vomiting, fever 103–105, pulse 110–120, the appearance of one coming down with pneumonia. If cough followed in a day or two Phosphorus was given. If pneumonic symptoms appeared on consequent days Bryonia was the choice. Calcarea carb given with persistent night sweats
- O. S. HAINES, M. D., Philadelphia Professor of Materia Medica in the Hahnemann Medical College of Philadelphia: Reported that three things were noted surely in the treatment of uncomplicated influenza was that convalescence started easily and early, complications were not apt to supervene during the convalescent period, in those cases that called you early – That the final recovery was really quite complete and clear cut; and sequelae were not common.
Old school soon found that it could not dictate medical measures to the populace at large, and in this open field, Homoeopathy clearly displayed its superior advantages. The uniformity of results obtained from Homoeopathic practice showed that practically all of the experiences of practicing of the Homoeopathic school the mortality was almost nil, while the sequelae were inconsiderable'. Dewey was professor of Materia Medica and therapeutics at Michigan University which acquainted him with academic standards, so he recorded with utmost care data highly significant for research as exhibited in [Table 1].,,,,
|Table 1: Number of Spanish flu cases treated with mortality rates by homoeopathic physicians|
Click here to view
| Relevance of Homoeopathy in Epidemics|| |
There have been antecedents suggesting the use of homeopathy in the various epidemics in the past wherein its role reportedly has been documented for the prevention of Cholera, Spanish Influenza, Yellow fever, Scarlet fever, Diphtheria, Typhoid, etc. Central Council for Research in Homoeopathy has found usefulness of homoeopathic Genus Epidemicus (Bryonia alba 30C) for the prevention of chikungunya. In Japanese Encephalitis, (JE) positive role of Belladonna in prevention was assessed in preclinical studies.,, Further exploratory observational comparative study of JE conducted showed the reduction of mortality and morbidity with add-on homoeopathic medicine. Randomised controlled trial on the evaluation of homoeopathic medicines as add-on concluded that adjunctive homeopathic medicines may improve clinical outcomes associated with acute encephalitis syndrome. Studies have also shown that homeopathy may be an effective adjunct in Dengue outbreak prevention., In the 2009 pandemic of A/H1N1 influenza, contribution with regard to influenza-like illness has also been done.,
| Discussion|| |
Homeopathic remedies have been used to treat influenza symptoms for two centuries. Since 1918, the world has experienced various epidemics namely Asiatic Flu– H2N2 1957, the Hong Kong Flu – H3N2 1968, Swine flu 2009, SARS corona virus (SARS-CoV) in 2003, Middle East respiratory syndrome corona virus (MERS-CoV) in the Kingdom of Saudi Arabia in 2019 and now the on-going COVID-19. These subsequent epidemics were less severe and caused considerably lower mortality rates than the 1918 pandemic of SF. This, perhaps, begged the question whether a high severity pandemic on the scale of 1918 could occur in modern times. However, the magnitude of COVID 19 has brought back the memories of 1918 pandemic.
The average mortality of the SF victims who were under conventional treatment was about 30 per cent, which was presumed to be based on a compilation of all civilian statistics obtainable at the time, believing it to be fairly representative. The obtainable mortality rate of homoeopathic treatment from Dr. Pearson's tabulation was <2%.
The exceptional success attained by homoeopathic practitioners during the pandemic of 1918 was commendable, and brought enough recognition to Homoeopathy. The facts highlighted here by the retrospective evaluation of the outcomes of homeopathic treatment in SF 1918 are of high relevance, as it also guides, and inspires, the homoeopathic prescription for combating the on-going pandemics. Homeopathy has the capability to treat masses of people infected, or at risk of being infected, by influenza like illnesses, and therefore, should no longer be ignored. Moreover, it is also relatively easy to dispense these medicines to public in the event of a national crisis.
| Conclusion|| |
The scope and effectiveness of application of homeopathy in community health during epidemic situations is huge. The homoeopathic intervention has played a significant role in managing SF 1918 pandemic, not only by treating, but also by reducing the mortality. This paves the way for considering homeopathy for curtailing the devastating effects of epidemics/pandemics worldwide. With its therapeutic victory over the influenza pandemics, Homoeopathy, if embraced with open mind, will alleviate the suffering of mankind due to COVID-19. Bigotry or ignorance cannot be valid reasons to rule out homeopathic treatment as an adjuvant tool in the fight against resurgent epidemics/pandemics.
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