Q1.II to Dr. André Saine from Dr. Steven Novella
What do you consider to be the best clinical evidence supporting the efficacy of homeopathy for any indication?
ASKED. 2013-03-28 | ANSWERED. 2013-05-20 / PART II. 2013-07-25
Part II of Dr. Saine’s Answer:
Pneumonia during the 1918-1920 Influenza Pandemic
These statistical records about the survival from pneumonia take on a very particular significance when they are considered within the perspective of recurrent influenza pandemics, which can be associated with an extremely high mortality. Today, the USCDC regroups the mortality from influenza with the one from pneumonia, as the great majority of deaths from influenza are related to pneumonia. The USCDC reported that 50,097 persons died in the USA in 2010 from pneumonia and influenza, of which only 500 or 1% were from influenza and 49,597 were from pneumonia.(108)
In some “highly pathogenic” influenza epidemics, the mortality rate can be very high, particularly at their onset, which is usually characterized by fulminant pneumonia.(109) For instance, from 2003 to 2012, nearly 600 human infections with highly pathogenic H5N1 viruses, which first appeared in Hong Kong in 1997, have been reported to the WHO, and about 60% of these people have died from their illness.(110)
The 1918-1920 influenza pandemic (NIP) had the highest mortality worldwide ever reported for any epidemic, and ranks as the single greatest recorded mortality event in human history.(111) Revised calculations of this influenza pandemic estimate that at least 40-50 million and possibly as many as 100 million persons died worldwide.(112)(113)
In only 24 weeks, between 2-5% (50 to 100 million people) of humanity died. More people died of influenza in a single year than in four-years of the black-death bubonic plague that swept Europe from 1347 to 1351.(114) As an illustration of the great mortality associated with the NIP, 1.9% of the soldiers in Camp Sherman died of the combined effects of influenza and pneumonia (CIP) per month during the fall of 1918.(115)
An estimated 675,000 Americans or 0.7 percent of the U.S. population (103 million(116)) died of influenza during this pandemic, ten times as many as in WWI. When compared to the number of Americans killed in combat in World War I, World War II, Korea, and Vietnam combined—423,000—it becomes apparent that the NIP was far more deadly than all four wars. Of the U.S. soldiers who died in Europe during WWI, half of them fell to the influenza virus rather than to the enemy. An estimated 43,000 servicemen mobilized for WWI died from influenza.(117)
Some countries lost significant proportions of their population from influenza during the NIP, such as 2.6% for Portugal, 2.8% for the Philippines, 3% for Indonesia, 3.7% for Japan, 4% for Guatemala, 4.5% for India (or 13.9 million people), Ghana and the Maori population of New Zealand, 5.5% for Fiji, 6% for Kenya, 24% for Western Samoa, and 45% for Cameroon. (118), (119), (120), (121) Among the Inuit, the death toll was terrible, as some villages lost their entire adult population.(122)
Could such a high mortality rate have been prevented from both a prophylactic and a therapeutic aspects? Dr. Eldridge C. Price of Baltimore wrote in December 1919, “Efficiency is ‘the power that accomplishes a desired or designed work.’ Therapeutic efficiency, therefore, is the restoration of the patient to health by the application of some means designed for that purpose.
“Efficiency is also a matter of degree. One method may be more efficacious than another, and while several methods may be more or lesseffective, yet only that power which comes nearest to the full accomplishment of that designed may be regarded as approximating most closely complete efficiency. The effort to discover the method or detailed means by which more lives were saved in the epidemic influenza of last year, than by any other method or means, should be welcomed by all schools of medicine no less than by the public at large; simply because such research will put it into the power of the general medical profession to reduce the mortality of future similar epidemics to the lowest possible percentage. Should the results of such an investigation contradict our preconceived theories and practices we should not resent such discovery, but welcome the improved resources placed at our command.”(123)
What Dr. Price suggested is not an easy and simple task, namely reviewing the comparative results obtained by homeopathy and allopathy during the NIP, first, because such compilation has never been done and the documentation on this subject is quite voluminous, and would require much work; second, homeopaths published their results obtained through a number of surveys conducted among members of different homeopathic associations, while no similar surveys can be found in the allopathic literature. However, many outcome results have been published by public health services and the armed forces that could be used for outcome comparison.
Physicians like other scientists have been reporting their observations, successes and failures for centuries, particularly in times of epidemics. Homeopaths reported all around better results and felt a greater responsibility to publish them, as it would normally be expected, and as Dr. John Hutchinson of New York correctly pointed out in 1920, “The fact is established that homeopathic remedies cure pneumonia, each and every one when clearly indicated. And that is why the mortality rate in our school is so low—lower, much lower than any other statistics. Witness the extraordinary success of homeopathy in epidemic influenza, the only success that has made a record.”(124) Homeopaths have thus made some efforts to assemble and publish their records following the NIP.
Dr. Lewis P. Crutcher of Long Beach, California pointed out in July 1919 in an editorial that it was in fact a great social responsibility for homeopaths to publicized their results, “The uniformity of results obtained from homeopathic practice in all parts of the country leaves nothing to be desired, for in practically all of the experiences of practitioners of the homeopathic school the mortality was almost nil, while the sequelae were inconsiderable. But what doth it profit a school of medicine if it cures all of its patrons and do not make it known to those who likewise would prefer to be cured, if they but knew? Publish and preach these facts, broadcast and do not be ashamed or afraid, and homeopathy will live again.”(125)
Aside from having less desirable results, there were other reasons that could explain the paucity of outcome reports from allopathic physicians. First, a influenza was then not a reportable disease in most localities, it became incumbent on physicians to keep good records. Second, most physicians were too busy to keep good records. As an illustration of this point, Dr. W. F. Edmunson of Pittsburgh, who followed his private patients as well as hospitalized patients during the NIP, reported, “I do not know the number of cases I treated. I would start out at eight thirty or nine, work until dinnertime, get dinner, tend the office until ten and then go out and work until one. It was a continuous strain which lasted all season, running far into the spring.(126) Dr. Eli G. Jones of Buffalo reported there were so many cases to treat that he “could hardly find time to eat his meals.”(127) Dr. John C. Calhoun of Pittsburgh wrote, “When calls were accumulating at such a rate that there were not hours enough in the day to make them, something had to be done to ge a short route to prescribing. For a time I was seeing from 75 to 100 persons a day. We had a scarcity of doctors due to war conditions and sickness of those at home.”(128)
Dr. Crawford Green, a pediatrician from Troy, N.Y., reported that, despite the heavy work over several months, the results remained consistent, “Unfortunately, I am unable to present accurate statistics from my own practice. I do not know how many hundreds of cases of influenza passed through my hands. Like many of my colleagues I never had time to count my cases. 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. In fact, I have not even separated my cases among children from my cases among adults.
But among them all, there were two deaths in children. One, at eight months, was undernourished and had been a bad feeding case. It survived six days. The other, at twenty-two months, died after a very brief pneumonia. I saw this child only twice. The surroundings were bad and the child had no nursing care.”
Dr. E. E. Vaughan of Chicago painted a similar scenario, “Heavy general work for four weeks. One day, forty-two homes visited, and sometimes six in a family. Epidemic characterized by sudden rise of fever and very high temperature with general aching; serious infections showing marked tendency to pleuro-pneumonia. Four deaths from sequelae to influenza. All were young men; all had taken aspirin freely; two were heavy drinkers. A fifth fatality observed was a man with ‘an earache,’—at the specialist’s office in the afternoon, became unconscious during the night, developed meningitis in the morning, pulmonary complication during the day, and died in the evening. … In Union Hospital of thirty nurses, ten were stricken at the same time, but there was no death either in the nursing or the medical staff.”
Similarly, Dr. O. N. Hoyt, a homeopathic physician from Pierre, South Dakota, wrote, “During this siege of influenza, when we have all been worked to death out here, I have handled over two hundred and fifty cases with no deaths.”
Dr. Dudley A. William of Providence, who had tried to compile outcome statistics of homeopathy for all the New England States, explains the frustration of gathering reliable epidemiological records for the NIP, “I did in a way try to collect statistics regarding our results in the treatment of influenza and its complications but my replies were so indefinite that I gave it up mainly because they lacked accuracy. When replies came in saying, ‘I treated about so many cases with so many deaths,’ no mention made of the exact number of cases or of the frequency of pneumonia in this number, I grew to believe that to offer any definite number of cases with a definite death rate, a definite number of complications with their death rate was impossible if any semblance of accuracy was desired. That our death rate was decidedly low in both the disease and its complications, I know to be true but to be able to quote definite statistics for the purpose of comparison with other methods of treatment I do not think practical with the returns I was able to get.”
He was right as some of the requisites for epidemiological studies, namely, clear differential diagnoses, systematic records of occurrence and all concomitant circumstances and factors, are lacking for the entire NIP throughout the world.
However, in the absence of absolutely precise records, Dr. W. H. Frost, who compiled statistics of the NIP for the United States Public Health Service (USPHS), pointed out that “statistics of mortality from the group comprising influenza and all forms of pneumonia afford, perhaps, the nearest approximation to a record of influenza.”(133)
It is widely recognized that the great majority of people who died from influenza during the NIP had pneumonia. A 1919 USPHS bulletin reported, “The death rate was by no means parallel to the influenza attack rate, but was correlated closely with the pneumonia rate. In other words, the case fatality of pneumonia tended to be fairly constant, around 30 percent.”(134)
Dr. Walter Sands Mills, professor of the New York Homoeopathic Medical College, confirmed these numbers from autopsies conducted among the victims of the NIP in an army camp, “When the influenza came in the fall of 1918 I was an officer of the Medical Corps of the Army, stationed at the Base Hospital in Camp Meade, Maryland. All the patients were soldiers, picked men who were physically in the full powers of early manhood. Camp Meade was one of the great army training camps. During the influenza epidemic the average daily census was 43,500 men. Of that number 11,400 had influenza, and about 3,000 of these developed pneumonia. Of the pneumonia cases approximately 800 died. Every case that died had been diagnosed pneumonia beforehand, and of the many that came to autopsy that diagnosis was confirmed. Just one man of the 800 who died, died unexpectedly and abruptly. Autopsy showed an old heart lesion. In every other case death was expected for from 24 to 48 hours before hand. … The Camp Meade death rate from uncomplicated influenza was nil. Someone writing in the Medical Record in 1919 said that there was no authentic autopsy report the country over of a death from uncomplicated influenza. There probably was none. The influenza-pneumonia death rate was 27 percent at Camp Meade, and that corresponds very closely to the average pneumonia death rate at any time in the big hospitals throughout the United States.”(135)
Dr. Victor Vaughan, dean of the “regular” department the University of Michigan School of Medicine and director of the Surgeon General’s Office of Communicable Diseases, was charged with Dr. William Henry Welch (as “the two best epidemiologists”) by the Surgeon General to investigate the mortality and morbidity of the NIP. In 1921, Dr. Vaughan published the most detailed statistics on all influenza epidemics and confirmed that pneumonia was by far the main cause of mortality for both the civilian and military populations during the NIP. He wrote, “The cause of death in the vast majority of cases is some form of pneumonia. In fact it has been questioned whether influenza uncomplicated can cause a fatal issue. Post-influenzal meningitis has been the cause of death in an appreciable number of cases. More remotely the disease has caused many deaths by hastening the fatal outcome of what were otherwise subacute or chronic conditions of the respiratory, cardiovascular, or renal systems.”
He further wrote, "The pandemic of influenza in 1918 seems to have been more closely associated with the pneumonias than appears in any previous pandemic. From the reports as sent to the Surgeon General’s Office, it appears that uncomplicated influenza was not by any means a fatal disease and that the high death rate was due to the pneumonias which followed. Pneumonia is a serious disease at all times. Recent records for the United States Army show that the case mortality rate for this disease has been as follows during the different periods of the last two years:” (136)
| ||Case mortality of pneumonia|
|The year 1917||11.2|
|Six winter months, 1917-1918||23.1|
|Five summer months, 1918||18.8|
|Four autumn months, 1918 (Influenza period)||34.4|
I have not so far found any reliable large-scale case fatality rates from civilian populations in which the allopathic and homeopathic outcomes have been separated, as about 10% of American physicians were homeopaths during the NIP and their respective results would be mixed together in any civilian population outcomes.
On the other hand, armed forces tabulated quite detailed records, and, as enlisted homeopathic physicians and surgeons with few exceptions didn’t have access to their remedies for treatment, we can assume that the outcomes of U.S. armed forces are close to 99% related to allopathic practice. Indeed, despite the fact that 1,862 homeopathic physicians and surgeons were commissioned by the U.S. armed forces, they were not provided with their remedies, and, as a rule, had to follow the medical protocols already established in their treatment manual of the forces.(137)
Dr. Lewis P. Crutcher of Long Beach, California wrote on this point, “The new schools of practice, including the homeopathic, were given to understand, by the medical powers that be in the military army of our government, that none of their un-orthodox ‘nonsense’ would be tolerated, even though soldiers and sailors by the thousands preferred heterodox treatment, and those professional patriots of the new schools of practice who went into active service, were compelled to subscribe to and put into practice the methods outlined by the ‘majority party.’ ”(138)
However, a very small minority of homeopaths found ways to treat their patients homeopathically and were thus able to report their results.
It is important to also note that the US army kept very precise reports from individual camps, such as this one from Camp Bowie in central Texas, “There were received at the detention camp during the course of the epidemic 4,108 drafted white men and 2,360 drafted colored men. Among white men, 252 per thousand men who were exposed developed the infection, 114 per thousand developed pneumonia. Not every case pneumonia patient gave a history of an antecedent influenza infection. Among the 795 cases of pneumonia, a history of influenza within the preceding month was obtained in 728. No deaths were attributable to uncomplicated influenza. The total deaths in the 833 cases of pneumonia, numbered 156, a mortality of 18.7 per cent.”(139)
Of all the many available statistical reports from the numerous camps and troops of the US army stationed in different countries or on ships during different waves(140) of the NIP, we will look at the two largest ones.
The first one comes from the Surgeon General’s Office for the troops stationed in the US during the autumn of 1918. It has been estimated that during the 1918 autumn wave of the epidemic “one out of every four men had influenza” in the United States Army Camps, and “one out of every twenty-four men encamped in this country had pneumonia. … During the four autumn months of 1918, 338,343 cases of influenza were reported to the Surgeon General’s Office; there were 61,691 cases of pneumonia. … During the same period 22,186 men were reported to have died from the combined effects of influenza and pneumonia [a 6.6% mortality rate for the CIP]. This means that among the troops in this country one out of every sixty-seven died [from CIP].”(141)
The second large statistical report regards the entire US armed forces for the autumn of 1918, “In the United States Army there was a total of 688,869 admissions for influenza. The total deaths ascribed to the disease are 39,731 [from CIP].”(142)
||Number of cases with influenza
||Number of cases of CIP
||Number of cases with pneumonia
||% of pneumonia cases
||Number of deaths from CIP
||% of deaths from CIP
|US Army Camps, Fall of 1918
|Entire US army, Fall of 1918
These numbers are similar to the ones of other armed forces stationed overseas. For instance, for the American Expeditionary Forces, the case fatality from CIP in the period between July 1, 1917 and April 30, 1919 was 6.06% out 220,971 cases; for the British Expeditionary Forces, the case fatality from CIP was 6.75% out of 113,801 cases between September 28, 1918 and April 19, 1919, and in the French army in the “Zone of the Army” between September 20, 1918 and April 30, 1919 it was 7.21% out of 145,992 cases.(143)
Prior to the major wave of influenza in October 1918, Dr. S. Anson Hill of San Francisco predicted the outcome that should ensue from homeopathy, as it is a principle instead of an empirical based treatment, “Without having yet seen a case of the present epidemic we predict that careful selection of drugs according to the homeopathic principle will shorten the duration of an attack, permitting an early crisis or rapid defervescence by lysis, will decrease the frequency of complications, and will show the lowest mortality of any form of treatment.”(144)
Dr. Ralph Mellon, doctor of public health and of medicine, and editor of the New England Medical Gazette, wrote in December 1918, immediately after the most deadly wave of NIP of the opportunity to collect large numbers of cases in order to compare therapeutic outcomes, “In this city (Rochester, N.Y.), the impression prevails in some quarters that patients on the whole
have fared better under homeopathic than under ‘regular’ treatment. Three men claim that of three hundred and seventy-
five odd cases under their care, no deaths have resulted, and a very low percentage of pneumonias occurred. It may be argued
that we do not know how many of these cases were true influenza and how many just common colds, but it is fair to assume that in the midst of a raging epidemic a generous percentage of them conformed to the clinical entity known as influenza. One leading allopathic physician reported a mortality of 25-40 per cent of his cases, under 40 drop doses of the tincture of digitalis every four hours. We may conjecture, if we do not know, that such dosage is the result either of ignorance or a hysterical state of mind resulting from a consciousness of therapeutic impotence. These instances are not related for the purpose of drawing conclusions nor for the purpose of holding a brief at this time for the superiority of any form of therapy be it vaccines, convalescents' serums, or drugs; but the opportunity is presented for those treating large numbers of cases to report their findings, if records were kept. Such a widespread epidemic will make such reports of much greater value than those of a few cases covering several seasons. It is only from thousands of cases that we can finally arrive at some estimate of the worth of the various therapeutic agents employed. It is to be earnestly hoped that the reports will contain the data necessary for their scientific employment, inasmuch as so many case reports must be regarded only as anecdotes.”(145)
Homeopaths used this opportunity by making certain efforts in assembling large numbers of therapeutic outcomes. After the second and third waves of the NIP, which occurred in the fall of 1918 and winter of 1919 and were the more severe ones, American homeopathic physicians conducted several surveys among their members to obtain statistical outcomes of treatment. Dr. William Pearson, dean of the Hahnemann Medical College in Philadelphia, reported in a survey made among the members of the American Institute of Homeopathy (AIH), that 88 physicians reported having treated 26,795 patients with a loss of 273 cases, a mortality of 1.02%. 24 of these 88 physicians reported no deaths in 3,519 cases. Dr. Pearson wrote, “The object of this contribution is to present reliable data in regard to the actual mortality of the epidemic when patients were treated by homeopathic physicians. … The original reports are on file for inspection of all interested. I am only sorry that a larger number of physicians did not report their results, but physicians are very poor correspondents. It is evident that the above data are fairly representative of the results obtained by all homeopathic physicians, and it only remains to compare the results with the colossal epidemic influenza mortality (average mortality about 30% [for the pneumonia cases]) to realize how very much better chance a patient had when treated by a homeopathic physician. Since the mortality as reported all over the country includes the much lower mortality ha by homeopathic physicians, the comparison with official records becomes still more favorable for homeopathic physicians. All reports received have been tabulated and no attempt made to report only the more favorable results.”(146)
In the discussion that followed the presentation of this paper before the 1919 annual meeting of the AIH, many doctors who had not yet reported by writing began reporting verbally some of their experience and statistics. One after the other, physicians reported among other things the number of cases treated and deaths. Dr. Pearson, who was chairing the Bureau, eventually put an end to the discussion by saying, “We might go on for an indefinite length of time. We have shown clearly that the mortality rate of influenza patients treated by homeopathic physicians is possibly one-third less than when they were treated by physicians of the other school. If we had an open-minded jury, we would have no difficulty in convincing it of the value of our methods.”(147) This one-third lower mortality estimated by Pearson is either a very charitable estimate, or a stenographer’s mistake, as we can now see.
Dr. Ernest F. Sappington reported that during a symposium on influenza held in November 1918 fifteen physicians of the Homoeopathic Medical Society of the District of Columbia reported having had 15 deaths among 1,500 patients, a mortality of 1 percent despite the difficult working conditions. He said, “This bears out Dr. Pearson’s average as the average of homeopathic physicians all over the country. Recoveries in the Homeopathic Hospital in Washington were 100 per cent. The physicians in the District of Columbia had an unusually hard time. Those who were not familiar with conditions in Washington during war times could hardly appreciate our housing conditions. One doctor found thirteen war workers sleeping in an attic room. This room had only two small windows. Seven of those girls came down with influenza. It was impossible to get nurses, so the other six volunteered to nurse the sick. I escaped without any mortality in that attack. The experience could be multiplied many times in the District of Columbia.”(148)
In another survey, Dr. Herbert Roberts of Derby reported that thirty physicians in Connecticut had lost 55 out of 6,602 patients treated, a mortality of 0.83 percent. He said, “There were 21 cases of meningeal form of influenza, and 496 cases of pneumonia.”(149)
Professor Guy Beckley Stearns of the New York Homoeopathic Medical College reviewed reports of 16,913 cases treated by the members of the International Hahnemannian Association (IHA)(150) with 67 deaths, a mortality of 0.4 percent.(151), (152) These last numbers must be fairly representative of the results obtained by genuine homeopathy, as they received 79 responses out of about 130 active American members of the IHA. Dr. Stearns reported that it was notably difficult to obtain replies from many physicians, especially in such busy times, and the tallying sent in probably represents the usual average outcome of the members of the IHA. In fact, subsequent conversations held by Dr. Stearns with many who had not answered showed about the same mortality average as given in the compilation.(153)
Professor Willis A. Dewey of the University of Michigan reported in a survey of 30 homeopathic physicians a loss of 17 among 9,250 patients, a mortality of 0.18 percent.(154)
Dr. L. A. Royal reported the results of a survey conducted among the Central Iowa Homeopathic Association, “In all we asked twenty-eight physicians, with the flattering results that we heard from eighteen with a report of five thousand thirty two cases, (5,032) enough surely to be of some importance in making a report. … Only one hundred and thirty-seven cases developed pneumonia. … However we should be proud of the small percentage that developed pneumonia less than 3 percent against an estimated 30 per cent of the old-school. The majority of these cases were reported as coming on the fifth or sixth day. With about the following history: the attack of influenza would be practically well in three days the patient then against orders would over expose themselves with a result that on the fifth or sixth day they would develop this so called pneumonia, and you would immediately have a very sick individual on your hands. … In all five thousand thirty two cases were reported quite a few were able to send in reports with no deaths at all (I am sorry that I am not among that number) but I am more than proud to give the others the wonderful results, for in all there were only eighteen deaths reporte [a mortality rate of 0.36%]. I challenge any other school of medicine to show as good percentage in as many cases.”(155)
We can find throughout the homeopathic literature many individual reports of outcomes without any indication as to whether they have been included in one of the above surveys. As an example, Dr. W. B. Stewart of Indianapolis wrote in May 1919, “Homeopathic treatment surely in this epidemic kept the mortality to a minimum. I treated about six hundred cases of what was erroneously named Spanish flu. I say erroneously because the Spanish people never had studied this disease, they never named it, nor did it originate in Spain. All the cases I treated are alive with one exception, and that case died of simple metastatic meningitis. I had seven cases of pneumonia as a complication, and they all recovered.”(156)
The compilation of these five different surveys conducted among American homeopathic physicians shows that there were 445 deaths among 66,092 cases (a mortality of 0.7 percent) from a mixed population of private and hospitalized of both civilian and non-civilian patients who had been treated homeopathically during the fall-winter of 1918-1919.
Let’s now compare side by side the results reported in these five surveys by homeopathic physicians with the ones of the large statistical reports for the US armed forces, namely the one with the lowest mortality rate (5.8%), which represents the case mortality rate from CIP for the entire US armed forces during the Fall of 1918.
|Case Mortality Rate
Fall and Winter 1918-1919
|Entire US Army,
Fall of 1918
Statistics from these outcomes show that at the very least:
- The odds of surviving CIP were 148 to 1 with homeopathy versus 16 to 1 with PAA.
- The relative risk of dying of CIP was 8.3 (95% CI 7.6 to 9.1) or 8 times greater with PAA than with homeopathy (P < 0.0001).
- The odds ratios of surviving CIP with homeopathy were 9.0 (95% CI 8.2 to 9.9) as compared to PAA (P < 0.0001).
The Prophylactic Role of Homeopathic Intervention
The importance of the role of homeopathy during epidemics must also be viewed within the perspective of its omnipresent prophylactic role that it plays through three different ways. The first way of the prophylactic power of homeopathy during epidemics relates to the fact that homeopathic remedies can be given to large segments of populations as protective agents prior or in the midst of an epidemic. For instance, in 1974-75, there was a major epidemic of meningococcal meningitis that devastated Brazil. Around 250,000 became ill, more than 11,000 died and over 75,000 people were left with permanent brain damage. Many victims fell desperately ill in minutes with a stiff neck and fever leading to hemorrhages, coma and death within a day.
Such a paroxysmal epidemic of Neisseria meningitidis is uncommon, but because this microorganism spread easily in overcrowded living conditions, it claimed a lot of victims once it had begun. Without antibiotics the mortality rate sometimes exceeds 80 percent in children. Much like the polio virus, Neisseria meningitidis produces far more “silent” carriers than symptomatic infections. This is a factor that helps fuel hysteria in populations already shaken by the precipitous, seemingly random appearances of gruesome cases.
During this epidemic in Guaratingueta, a city with a population of 78,000 in the state of Sao Paulo, 18,000 children received one drop of Meningococcinum A and C 10 Centesimal, but only once during the entire length of the epidemic. Within the first three months 5 of these 18,000 children fell sick with meningitis. Given that one child fell sick two days after receiving homeoprophylaxis (suggesting that he was already infected) only four cases actually proved a failure, or 0.021 percent compared to 10 cases in a control group of 6,364, a morbidity rate of 0.15 percent or seven times greater incidence (odds ratio) in the ones who didn’t receive homeoprophylaxis with a P= 0.0009. This highly significant fact means that in a population of 100,000 people, the morbidity rate would have fallen from 150 to 21 cases, despite the fact that the posology employed was totally inadequate in such an epidemic.(157)
Homeoprophylaxis is free of side effects compared to conventional vaccination with its introduction directly into the blood stream of microbial toxins and other known and unknown biological and non-biological contaminants such as mercury, aluminum or other very toxic preservatives and agents. The short and long-term consequences of such assaults particularly in immunocompromised persons or in infants with immature immune systems have been poorly studied. While few scientists seem to be interested in investigating such the side-effects of vaccination, they are significant with up to 3 percent of 2 to 6 month old infants developing moderate to severe local reactions, and up to 37 percent developing a fever following the conventional method of vaccination with the meningococcal group C vaccine.(158)
A second example of homeoprophylaxis on large segments of population has been reported in India where epidemics of Japanese encephalitis have been recurrent since 1970. From 1987 to 1989 there were 5,172 deaths among 16,871 cases of Japanese encephalitis, a mortality rate of 30 percent. In 1991, a single dose of Belladonna 200 C (the genius epidemicus) was given as a prophylaxis to 322,812 persons in 96 villages in four districts of India. Follow-ups with 39,250 persons were conducted and it was found that none reported any signs or symptoms of Japanese encephalitis. The research team also treated homeopathically 223 patients with encephalitis in remote areas who had not received any treatment, as well as 14 other patients who had been discharged from hospitals and were suffering from sequellae of encephalitis, such as convulsions (7 cases), unconsciousness (6 cases) and opisthotonos (3 cases). All the 223 patients received symptomatic relief and improvement was seen in varying degrees in almost all the symptoms in the second group of 14 patients. Four out these 14 experienced complete recoveries.(159)
A third example of homeoprophylaxis on large segments of the population was conducted in Cuba in 2007 during an epidemic of Leptospirosis, which is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. The symptoms caused by Leptospirosis infection are extremely variable and potentially dangerous, they include meningitis, pneumonitis, hepatitis, nephritis, mastitis, myocarditis, hemorrhagic crisis and multi-organ failure, with a reported mortality varying between 4 and 50%.
In the midst of an epidemic occurring in 2007, homeoprophylaxis was administered orally to 88% of 2.4 million persons living in three high-risk provinces of Cuba. Homeoprophylaxis was initiated in week 45 of 2007 with two oral doses of Nosolep 200 C with an interval between doses of 7-9 days was administered to 2.1 million persons (88% of the population).
Ten to twelve months later, the schedule was completed by the administration of another two oral doses (7-9 days apart) of Nosolep 10 M to 2.3 million persons (96% of the population).
There was a significant decrease (84%) of the disease incidence in the intervention provinces, while incidence rose in the non-intervention regions by 22%—despite significantly higher risk of disease in the intervention regions.
The cost of homeoprophylaxis was about 2% of the one for the conventional vaccine even though that the world’s only commercially available vaccine against Leptospirosis is manufactured in Cuba.(160)
During the NIP, homeopathic physicians applied homeoprophylaxis, as they have commonly done in all epidemical diseases since Hahnemann. Many reports on homeoprophylaxis during the NIP can be found in the homeopathic literature. For instance, Dr. W. A. Pearson, dean of the Hahnemann Medical College in Philadelphia, wrote, “Just previous to the epidemic of influenza the Hahnemann Unit of the Students Army Training Corps was organized. Dr. G. Harlan Wells was chief Medical Officer and was directly responsible for the health of our students. Gelsemium 3 Decimal was given to every student four times a day as a prophylactic and not a single serious case of influenza developed, and, of course, no deaths, while the Spring Garden Institute Unit, which was housed in the same armory with the Hahnemann Unit, had seven deaths directly attributable to influenza. This is even more remarkable since our senior and junior students were released for one week to do emergency work with influenza patients, and many of them worked day and night during this period. During the epidemic when all the nurses in the Hahnemann Hospital were working day and night without any consideration for their own health, a total of fifty-seven of them at different times had to finally go to bed, and a large proportion of these had influenza, but not a single one of them developed pneumonia. It is perfectly proper to state that these nurses were under the care of Dr. William R. Williams. How would it be possible to convince any one of the merits of homeopathy if he failed to believe that homeopathic physicians had a much lower mortality that the average? Homeopathy requires no apology. Its practical value is its greatest asset.”(161)
The second way of homeoprophylaxis relates to the prevention of the development of the complications and the later stages of an epidemical disease as soon as homeopathic treatment is initiated. When genuine homeopathic treatment is administered to persons experiencing the first symptoms of an epidemical infection the progression of the infection is soon mitigated, and it would therefore be very unlikely for such persons to develop the more advanced stages of morbidity and complications, the ones leading to death. Professor A. H. Grimmer of the Hering Medical College in Chicago, who was known to be a Hahnemannian, pointed out while in the midst of the NIP, “It is a rare thing for a pneumonia to develop if a good homeopathic physician is called during the first twenty-four hours of an attack of influenza.”(162)
Dr. John McBride of Zanesville, Ohio remarked, “During the epidemic of 1918, when in my city the death rate was very high, it was the other fellow who kept the undertakers busy, so that they said our profession did not have cases of pneumonia. I do think our treatment prevented the development of pneumonia.”(163)
A good example of this aspect of homeoprophylaxis is found in the survey mentioned earlier that was conducted in Central Iowa among homeopathic physicians, in which Dr. L. A. Royal reported that, out of 5,032 cases of influenza, only 137 developed pneumonia, which is 3% instead of the 30% reported under allopathic care.(164) This 27% difference could also be related to other factors, such as the promotion of pneumonia and other complications of influenza from the use of the allopathic interventions used during the NIP.
The third way that homeoprophylaxis takes effect is through the heightened resistance to the causes of diseases in people who have already been under homeopathic care for some years prior to an epidemic. Dr. R. F. Rabe pointed out this aspect of homeoprophylaxis in his September 1919 editorial of the Homoeopathic Recorder, “It is an undoubted fact that patients accustomed to good homeopathic prescribing, have been more resistant to the infection of influenza, or for that matter, to the infection of any other disease. When such patients do become ill the illness is likely to be less severe and more quickly and easily overcome. For this reason homeopathic physicians are often charged with having the easy cases, when in reality they prevent them from becoming difficult. This is at the same time an advantage, as well as a disadvantage of homeopathy, for to the uninitiated it appears so ridiculously simple that to their minds there can be nothing in it.”(165)
In the same editorial pages, Dr. Rabe added, “Homeopathy, being [based on] a law of nature and working in harmony with her, raises resistance by gradually restoring the physiological balance, in other words, by bringing about a state of health. Real homeopathy does not suppress, change or distort disease manifestations. The cure is never worse than the disease! … The homeopathic treatment of such bacterial diseases as influenza, pneumonia, typhoid fever, erysipelas, etc., amply proves that bacteria need have no terrors for him who understands the art of homoeopathic prescribing. Such a prescriber raises the resistance of his patient to bacterial attacks, increases the phagocytic power of the leucocytes; or, in plain language, enables the sufferers to throw off the disease.”(166)
Many confounding factors, aside from allopathic and homeopathic interventions, could possibly explain the great difference in mortality between the ones reported by homeopaths and the US army, such as differences in their respective population (a mix of ambulatory and hospitalized patients of all ages, races and socio-economic status, including infants, pregnant women, elderly people and persons with compromised respiratory, cardiac or renal functions for homeopaths while it was limited to mostly young men between 18-40 years for the army), differences in their respective environments (such as rural, urban, camps, ships, boarding schools for the homeopaths while it was limited to camps, troop ships and battlefields for the army), and differences in the waves of reported treatment (reports from the homeopaths included the waves of the fall of 1918 and the winter of 1919 while the army reports were limited to the four last months of 1918).
The higher percentage of patients presenting with complications, such as pneumonia, or meningitis, would certainly be the major factor to explain mortality differences. Patients with compromised health, e.g. respiratory diseases (tuberculosis, asthma, emphysema, silicosis), or cardiac or renal failure, at the time of influenza are rarely mentioned and would affect outcome negatively for homeopaths who treated mostly civilian populations. Lastly, could the numerous inoculations given to US soldiers during WWI have affected their immune response to the influenza virus and subsequent bacterial infections, and played a role in the higher morbidity and mortality of the military versus the civilian populations?
During the NIP, the University of Michigan had two departments in its school of medicine, one homeopathic and the other allopathic. Dr. W. B. Hinsdale was the dean of the Homeopathic Department of the University of Michigan Medical School at that time and rightly pointed out that confounding factors must be examined in order to come to a correct assessment of the differences in mortality between the homeopathic and allopathic departments of the university, “No matter how good a comparison we can make as to recoveries and deaths, it was a staggering experience. Our homeopathic record is not particularly a piece of work of which to be proud, although somebody else did considerably worse. At the best it is only a negative consolation that we derive from comparison. As we had it at the university, with about two hundred students, it melted the heart to see even one side. … With him who treated three hundred cases of influenza without a death or with him who reported twenty-seven deaths out of one hundred and eighty-five cases, it is not recorded whether the influenza was simple or complicated. The reports would have very much more value if we could know this and just how many pneumonia as well as influenzas the one lost and the other saved.”(167)
However, the more one examines the various existing therapeutic outcome reports on the NIP, no clear or significant confounding factor seems to emerge, and the more the consistency of the results obtained by homeopathy and allopathy are confirmed regardless of the place, population, circumstance or wave of the epidemic.
This consistency is very clear for anyone perusing the homeopathic literature as expressed in 1920 by Dr. Crawford Green, a pediatrician from Troy, N.Y., “From every corner of our great country, wherever homeopathy is practiced and wherever there is opportunity for the exact study of comparative statistics, there comes indisputable testimony of the wonderful efficacy of homeopathy. Parallel groups of cases everywhere show a homeopathic mortality almost negligible when compared with any other system of therapy.”(168)
Dr. H. O. Skinner, a pediatrician from St. Paul, Minnesota, similarly remarked, “The remarkable thing about the homeopathic record in this epidemic is not so much its low mortality, as the fact that it was made by physicians widely separated, even to different countries and without inter-communication, with the same line of treatment and the same drugs. When it is considered that this epidemic was unlike anything which had ever preceded it, that it came on so suddenly as to forbid any
study (to say nothing of the fact that subsequent study has not yet revealed much) and that it had, therefore, to be met, not specifically, but on general principles, the uniformity of the homeopathic treatment the world over and the uniformly
good results there from, demonstrating homeopathy's ability to cope with this protean emergency, when the other schools
of medicine failed utterly, behooves us no more by apathy than by design to permit it to perish from the face of the earth.”(169)
A clear illustration of the consistency of the results obtained by the two schools of medicine is found in the following report from Dr. E. B. Finney of Lincoln, Nebraska, “I know of a physician on the border line of Kansas and Nebraska who reported to Kansas and Nebraska 700 cases without a single death when he was taken sick and had to go to bed. The disease was very virulent. There were forty deaths in one week which speaks well for his treatment as he was the only homeopathic physician in that city.”(170)
The fact that the outcome of the entire army is related to a population of young men between 18-40 years old who were in relatively good health prior to the epidemic would tend to disfavor the homeopaths who treated an overall less healthy and more susceptible population, which included infants and the older segment of the population. Statistics support this hypothesis, as it can be seen in the District of Columbia where the Commissioners kept good records during the epidemic and reported that in 1918 the average case mortality rate for influenza and pneumonia was 8.6%, but was 20% for the ones under 1 year-old, 7.3% for the ones between 20-29 years, 14% for the ones between 60-69 years, and 33% for the ones with 70 years and over.(171) Similarly the average case mortality for the entire US civilian population was about twice as much for infants and the older segment of the population, as it was for the 20-39 year-old segment (1.9% for the ones between 20-24 years, 3% for the ones between 25-29 years, and just above 2% for the ones between 30-39 years, but was about 5% in infants, and about 4% for people over 65 years).(172)
Also, regardless of the different conditions associated with the armed forces, such as inoculations and confined spaces, it appears that the same demographic group was similarly affected in the civilian population. The Metropolitan Life Insurance Company based in New York City found that the disease killed 3.26% of its insured US industrial workers aged 25–45, a population of young men most similar demographically to the one of the armed forces.(173) Given that 25–40% of the population contracted the disease, the case mortality can be estimated to have been between 8–13% in that population.(174)
Age and being a civilian do not therefore appear to explain the higher case mortality of 5.8-7.21% for the different armies versus the much better results of 0.7% reported by the homeopaths.
Dr. H. O. Skinner, a pediatrician from St. Paul, Minnesota, reported having loss not a single child out of several hundred cases.(175) Dr. Plumb Brown, a pediatrician from Springfield, Massachusetts, said, “My experience was entirely outside of the hospital. I was in general practice. Fortunately the Board of Health obliged us to report our cases. Afterwards by looking up the records we were able to differentiate and find what percentage of cases were children. I found that 44 per cent of my cases were in children below the age of 14, many in young infants. The mortality in all cases was 16 per cent [for Springfield]. Ten per cent of all the cases developed pneumonia. I did not lose a single child.”(176)
Dr. Stella Q. Root, a homeopathic obstetrician from Stamford, Connecticut, reported, “I only had 91 cases of influenza altogether, and 20 per cent of these were among children; 25 per cent of the children had pneumonia. I had no deaths among the children, and but one death in the 91 cases.”(177)
Dr. J. G. Dillon of Fargo, North Dakota further remarked, “The children cases I saw were those in general practice, as well as the patients at the Institution known as the North Dakota Children’s Home. … Sixty-seven cases developed [influenza] at the Children's Home without any complicating pneumonia or death; most of these cases were on Bryonia and Gelsemium, which seemed to be successful in carrying them through to complete recovery.”(178)
Also some particular segments of the civilian population were greatly more affected than the members of the armed forces. For instance, it was known that the mortality of coal miners was much higher for the same age-male population. For instance, the death rate in coal miners from the 1918 flu epidemic was 36% higher than the same age-adjusted population.(179) Dr. Geo Krepreka of Stacyville, Iowa reported in a paper on pneumonia secondary to influenza, “During the months of October, November and December, as an assistant surgeon in the U. S. Public Health Service, approximately 2,000 cases of influenza were thrust into my hands, and as a result, received at least some form of homeopathic treatment. About one half the time was devoted to the coal mining camps in the vicinity of Albia and Ottumwa, while the other half was spent in towns where the residing physicians were either stricken with the disease themselves, or were in the army. During this time I had visited 15 different localities, so that I undoubtedly must have come in contact with the disease in all forms of its virulence. The death rate under homeopathic treatment, as we all know, has been exceedingly low, in fact I know of but four deaths out of the list wherein homeopathic treatment failed.”(180)
The fact that it is widely recognized that the case mortality was highest in pregnant women enhanced the value of outcomes reported by homeopahts, as this population wasn’t present in the army.
According to a survey sent to all the physicians in Maryland, it was reported that the case mortality was 27% in 1,350 pregnant women with influenza. About 50% of the pregnant women with influenza eventually developed pneumonia, and 54% of these died. Miscarriages occurred in 26% of the ones without pneumonia and in 62% in the ones with pneumonia. 60% of the ones who developed pneumonia in the last three months of pregnancy died.(181)
Despite these outstanding and difficult odds, the consistency of results under homeopathic treatment was maintained in the population of pregnant women, as it was reported by many homeopathic obstetricians. Dr. Stella Q. Root, a homeopathic obstetrician from Stamford, Connecticut, said, “I did not complete my record in time to write Dr. Huntoon, and so I brought it with me. It is comparatively simple. I only practiced six weeks of the influenza period. During that time I had 91 cases of influenza, with 23 cases of pneumonia. I had 42 pregnant women, varying from two months to term. Of these 42 pregnant cases, a little less than 25% had influenza, and only three of these ten had pneumonia. I only lost one case out of the 91. I thought until I heard the statistics this morning in the Bureau of Homeopathy that my record was nothing but luck, but now I hope it was due to homeopathic therapeutics. The case I lost was a woman four months pregnant. She induced an abortion on herself, had been flowing for five days and was almost exsanguinated. Her home conditions were such, that although the hospital was well filled with pneumonia I had no alternative but to take her there. She stood the curettage well and was in fair condition when I sent her home in an ambulance at the end of a week. A week from the time she went home she developed influenza, and almost immediately pneumonia. We felt that a week was rather long for the exposure if she had contracted it from cases in the hospital. She died within four days. The fetus was stillborn. There were four others with influenza delivered during this period. One had pneumonia quite severely but did not have premature labor, but a few days after her temperature went to normal she was normally delivered. Two others had influenza but not pneumonia, and were delivered almost immediately after the subsidence of the temperature, with no bad symptoms afterwards. One was delivered who had influenza with mild pneumonia after her delivery. Of the other five cases three have since been delivered safely. Two were only about two months pregnant at the time of the influenza and are still not delivered. This was not the experience of Stamford Hospital generally. Of course a good many cases were sent in in rather extreme conditions, but the superintendent told me that the feeling at the hospital was that if a woman had influenza and was pregnant, or had a miscarriage, it was practically a fatal case. The cases I treated were all treated homeopathically, so I give all the credit to homeopathy.”(182)
Similarly, Dr. Anna Johnston of Pittsburgh reported the same consistency of results in pregnant women, “Before I left home I was too busy to fill out the questionnaire. I had 266 patients and did not lose a single case. I had 12 cases of pneumonia, mostly among children. Part of those were in the hospital. We had some very sick children there who had come in from different families. They had originally had influenza but developed pneumonia. One child ran a temperature of 106.6, and the worst one had a temperature of 107, pulse 180, respirations 80. She got well. I had eight pregnant cases, two were seven months pregnant. The peculiarity of one case was that she was practically over the influenza when she developed pernicious vomiting. The vomiting was very severe and lasted for days. We had to resort to rectal feeding. We thought we would lose her, but she recovered. I did not lose any of those cases. All went through to term, were delivered, and everything was all right.”(182)
Dr. L. A. Royal of West Liberty, Iowa reported in the survey of homeopathic physicians from Central Iowa that was mentioned earlier, “Another complication or condition that complicated the ‘flu’ was pregnancy. I had a report of about fifty cases. Four of which miscarried. Two poorly developed blue babies were reported where the mother had the ‘flu’ late in her pregnancy. I had six cases with the combination of pregnancy, ‘flu’ and pneumonia at the same time with no mortality. In fact of the forty some cases reported of pregnancy complicated with ‘flu’ and pneumonia there was no mortality reported. This is a striking contrast between no deaths out of fifty and the reports by Harris in the A. M. A. journal, volume 72, page 978 where he recorded 1,350 cases of ‘flu’ and pregnancy of which 54 per cent resulted fatally and 62 percent aborted.”(184) In the survey from Harris in JAMA, out of 678 pregnant women with pneumonia 365 died.(185)
Also homeopaths had their share of difficult cases in pregnant women. Dr. Susan J. Fenton of Oakland reported several difficult cases with late stage pneumonia, as in this pregnant woman with double bronchial pneumonia, “Mrs. H., mother of three, had been under another [allopathic] physician’s care for one week when I was called. I found a complication of seven-month pregnancy with double bronchial pneumonia, temperature, 102-103 degrees, pulse 110-120, respiration 50-60. The patient was unable to breathe except by having the head rose on three pillows, mild delirium was present, and great restlessness. She has no nurse except a sister who attended her by day while the husband was at work, and he took care of her at night. On the eighth day, her baby was delivered, weighing four pounds. A wet nurse was secured and the child is well and thriving. Fortunately the lungs began to clear after delivery, and while she made a slow recovery, she is now well.” She concluded, “I had thought my record pretty good with only one death in 100 cases during the first epidemic, and none in the same number of cases for the second, until I read in some journal of one homeopath who reported 2,000 cases without a single death.”(186)
Complications and Mortality Rates in Military versus Civilian Populations
Whether the percentage of complicated cases and the ensuing death rate were higher in the military versus the civilian population is not obvious at first glance. However, there are more indications that the mortality rate was overall actually higher in the civilian population, of which about 90% received allopathic treatment and 10% received homeopathic treatment. For instance, following the NIP, the Health Commissioner of Buffalo conducted a very thorough survey with more than 2,000 public school teachers at his command for a house-to-house canvass. He was able to establish the fact that during the influenza epidemic practically all influenza cases in the city of Buffalo had been reported. He wrote regarding the verification of their statistics, “Much has been said and written about the inaccuracy of morbidity statistics relative to influenza. … With 2,000 teachers at my command I was enabled to accomplish much which otherwise would have remained impossibility. First, I was enabled to check up the reported cases. As a result of this comparison I found that fully 95 per cent of all the cases were reported, the remaining 5 per cent, being practically those in which the patients were only slightly ill, therefore deeming it unnecessary to call a physician, or those in which, for some reason or other, it had been impossible to obtain a physician.” Out of 31,842 cases of influenza and pneumonia there were 28,663 recoveries and 3,179 deaths, a mortality of 10%. (187)
These numbers are not dissimilar to the ones of another reliable larger scale report from the Public Health Service conducted in the District of Columbia: “The total number of cases of influenza reported to the Public Health Service from October 1, 1918 to February 1, 1919 was 33,719, and the total number of deaths from that disease was 2,215, a mortality of 6.6%. In addition to the number of deaths from influenza during this period, 680 deaths resulted from pneumonia, probably largely due also to influenza.”(188) Without including the pneumonia cases, the cases mortality rate is similar to the ones reported by the different armies. However, by including the pneumonia cases as it was done in the army, the mortality was significantly greater at 8.6%. Unfortunately, the statistics of the outcomes from both the homeopathic and allopathic health care are mixed together in this civilian population, and can’t be used for comparison. However, as the homeopaths had significantly less mortality throughout the country as well in the District of Columbia, as seen in the survey mentioned earlier,(189) the case mortality average for this civilian population would even be higher by subtracting the homeopathic outcome.
Percentages of Cases with Complications
It is possible that homeopaths as a whole had less cases of influenza that developed complications (pneumonia, meningitis, etc.), as homeopathic treatment will prevent influenza from further progressing as soon it is implemented and will thus greatly prevent the incidence of complications.
However, homeopaths did have their share of complicated cases as Dr. C. Martz of Fort Wayne, Indiana pointed out, “During the influenza epidemic I was busy day and night, treating the most serious and complicated conditions of this disease. However, throughout the entire run of the epidemic I had no serious developments of pneumonia, no bad ‘after effects’ of the disease, and not one death. This is sure proof of the efficiency of homeopathic treatment, as I treated all cases strictly homeopathically.”(190)
Similarly, the assumption that physicians didn’t see fulminant cases in the civil population is clearly contradicted by Dr. Royal H. S. Hayes’ experience, who wrote in the winter of 1919, “I would say that Waterbury [Connecticut] was one of the hardest-hit cities in the country and there were many cases of pneumonia here of that malignant type during October with occasional cases since. … Dr. George Royal furthermore says he studied but could not find a simillimum for these desperate cases.(191) If we turn to the Hahnemann’s provings of Cuprum metallicum, it will be seen that Cuprum metallicum is exactly the remedy. It has, in fact, checked many of the cases for me, and quickly, the cure being more rapid than the progress was downward, sometimes. If the condition is so far advanced that the rattling has become extensive in both lungs and the pulse above 120, Cuprum metallicum can only palliate, and often with borderline cases careful observation and dexterity is necessary to bring reactions to the viable point. I have had no experience with potencies lower than the 200th, preferring after some observation to hit hard at once with the 40 M or 50 M.”(192)
In an article written in 1921, Dr. Hayes described several such cases with fulminant pneumonia he treated during the NIP, “ ‘Black’ cases and swift ensuing deaths raged in certain neigh¬borhoods as if struck by overwhelming fate. Cuprum metallicum was the genius of the ‘Spanish’ strain of influenza here and often, turned the vitality streaming back where the apparently indi¬cated Bryonia had not availed.
“The writer lost two malignant cases right at the start of the epidemic and had a third going, which necessitated a halt in the rush to find out why men in the prime of vitality should go down almost as if struck by lightning without response to his efforts. The first case was known to be a Cuprum metallicum case—after the patient was dead. The second case got Cuprum metallicum in time to palliate the wild delirium, causing sleep after each rather frequent dose, but not in time to cure.
The first case was so typical and inclusive not only of the entirety of the genius epidemicus but also of Cuprum metallicum that its course and symptomatology deserves description: October 10. Mr. D., 50, short, fleshy, dark skinned and dark eyed, the old-styled lymphathic temperament. This is the type which succumbs quickest to malignant influenza. He had been ill two days when I first saw him. Besides extensive areas of pulmonary consolidation he presented the usual symptoms of the epidemic. Frontal headache, muscular pains, prostration, mental dullness, painful cough, dizziness when rising, chilliness, sweat. All these symptoms were so aggravated by motion that he refused to move except when urged. Bryonia was, of course, given and on October 12th he was bright with pulse and temperature about normal. The physical signs were much; improved. Contrary to advice he arose and went about the house. By afternoon his fever was up and tubular breathing had returned with extensive mucous rattling in the left. From then on he sank rapidly and died on the 15th.
“His symptoms were significant but because of the rush and delays the remedy arrived apparently too late. This will look familiar to those who have studied the provings of Cuprum metallicum and its salts: Sudden effusion of fluid into the air spaces of the lungs, coarse rattling, intense dyspnea, jerky respiration, shooting pains through sides of the chest but soon disappearing because of exhaustion, respiratory motions of the alae nasi, intense thirst for cold drinks, drenched with sweat; at first refused to move, later throwing himself about the bed partly to find a cool place. Cold sweat on hands, feet and forehead, would not remain covered, intense mental anguish, premonition of death, constant groaning, cried out repeatedly ‘Wait a minute,’ thought he was going to be stabbed, shrinking to a corner of the bed in terror, could not be appeased, staring as at some object in terror. Stabbing pain in epigastrium, drenched with cold perspiration, cold breath, running tongue out quickly to lick lips like a snake, eyes brilliant, complexion ashy and dark, lips white, later bluish, frequently escaping from bed in spite of attendants. Convulsion began suddenly with cramps in feet then legs then all over, the face last, muscles rigid but quivering, thumbs turned in at first then snapped out; cyanosis, then sudden agitation of face and neck muscles and death. Cuprum metallicum was not given because of my absence in the rush. These later symptoms were obtained from the nurse.
“Another case that died: Mrs. C, 27, same type, had been ill five days when first seen. T. 105.6, P. 130, R. 40. Hunger during fever; craving cold drink, copious sweat, expected to die; thought her mother had died out in the yard. Consoli¬dated areas in the lungs, mucous rales in the lungs; the true remedy was not recognized. Phosphorus was given. A few hours later, sudden delirium, supernatural strength, restrained with difficulty, tried to ‘go home,’ constant chattering and scream¬ing, eyes brilliant, countenance sunken, dark, ashy countenance, lips purplish. Dr. D. was sent for in my absence and injected one-half grain morphine with no effect whatever. Cuprum metallicum CM in water every half hour, gradually lengthening the doses until twelve hours had elapsed. Became quiet before the sec¬ond dose was given, remained quiet and rational all night and slept considerably. Next morning, P. 120, T. 101. The Cuprum metallicum was discontinued. I was delayed in seeing the patient, all symptoms became aggravated and death occurred a day later. The palliative effect of Cuprum metallicum was striking. Had it been used differently the patient might have survived.
“Some pleasanter experiences: Mr. T., 34, same type. Sore throat, headache which cough aggravated, moves about the bed, thirstless (fever), dizziness on rising, some ordinary remedy was given, P. 80, T. 102. October 15th, no change. Next day, coarse rattling in tubes, areas not recorded but ex¬tensive, tracheal rhonchi audible in the adjoining room, rest¬less tossing, eyes brilliant, staring as if at something frightful, escaping from bed, fear of death, dark, ashy, sunken counte¬nance, copious sweat, sleepless. P. 112, T. 104, jerky, dis¬tressing. Cuprum metallicum CM, one dose. Next day, no delirium, small area of moist rales at base of right only, uninterrupted con¬valescence, no other medicine used.
“A striking cure: Edw. W., 39, same type except fair skin, light fine hair and blue eyes. Influenza began October 17th; lung involvement suspected but not detected until the 20th, then consolidation and many moist rales. No response from Phosphorus or previous remedies. October 21st, prostration had rapidly increased, strange quivering sensation all over, trembling with anxiety like delirium tremens, spells of thirst, cough hurt the head, headache aggravated by motion, dizziness when moving, sweating spells, lying on the back only, rattling in trachea, countenance darkened, ashy; abject sunken expression, skin doughy and relaxed. Dreams of crashing accidents, of the house being pushed over, of someone about to be hurt. Cuprum metallicum CM, one dose. Next day improved and the day after much improved. Then sudden but mild delirium. He arose at 1 A.M. and went downstairs, refused to return to bed saying it was wet, wanted to ‘go home,’ speech indistinct, confused and interrupted. Staring blankly at whoever entered the room, lies long with motionless staring, rising in bed looking intently and moving arms slowly as if seeing something that appeared queer. Pulse and temperature low. Hyoscyamus 1 M, one dose was given. Four days later was found much worse. Had been out and around house and outdoors all night, there being no one to restrain him, bluish countenance, lips and nails, pulse too feeble and quick to be counted. Cuprum metallicum CM, one dose. Next day unconscious, incontinence of urine but pulse full, 80, T. 99. Ten hours later P. 100, T. 104, mind clear, resting, no further medication was needed.
“We met scores like this: Influenzal fever with or without sweat, with or without spells of thirst, with or with¬out perceptible lung involvement. Frontal headache aggravated by motion, hurting with cough. Cough, tearing or scraping or causing sharp pains. Muscular pains aggravated by motion.
Dizziness, nausea or faintness when rising or moving. Aggravated entirely by moving and desire to keep perfectly still. Is this Bryonia? No. Bryonia would act but would seldom act well. It usually had to be repeated, perhaps several times, the patient making a slow, prostrated recovery with slow pulse, later rapid, and slow return of strength. Searching further, especially for slight but peculiar mental, nerve or dream symptoms, Cuprum metallicum is then found to be the remedy; the patient is found to be much improved next day with pulse and temperature nearly normal and strength is re¬covered rapidly as in other acute diseases.
“To illustrate with a real case: Mrs. M., 43, tired out caring for others. Chilliness aggravated by cold drinks (the opposite in large type in Kent's Repertory, not found elsewhere in materia medica or toxicology). General soreness, head heavy and dull, nausea, hard cough, tightness in chest, all symptoms relieved by quiet and lying down. P. 112, T. 101. Cuprum metallicum 10 M, one dose. Fourteen hours later, felt better than, in several days, P. 78, T. 99.
“Son of same, age 11, headache ameliorated by cold applica¬tions. Thirst for cold one day, thirstless the next; chilliness when moving; dizziness when rising; cough that hurts; strained pain in the back; wanted to be quiet—all like Bryonia—but also, pain in epigastrium; respiratory dilating of alae nasi (verified with Cuprum metallicum many times). Fidgety; delirium, went out of bed, said a man was in his room. Cuprum metallicum 10 M, one dose. Improved that same evening and almost normal next day.
“A striking cure: Boy, 6 years. October 25th. Projectile vomiting, bloody. Sweaty and flushed all over. Beating frontal headache ameliorated by holding it with the cold hand. Averse to touch or motion. Delirium about his play; appears wild. Dozing and starting, escaping from bed. P. 144, T. 103. Belladonna 1 M, one dose (was not then familiar with Cuprum metallicum) That evening: active delirium, great muscular strength, could hardly be held down by two strong women, constant attempts to escape, constant stream of talking and screaming, tears running down face, drenched with sweat; insatiable thirst but taking only small drinks, pain in epigastrium, rapid running of tongue out and in, gnashing teeth, right lung involved. T. 106, P. about 160. Cuprum metallicum CM, one dose at noon. Next day his tempera¬ture was 100 and he was sitting at the table eating soup not¬withstanding which he made a rapid recovery. His mother said that she could see him improve each hour until at night he fell asleep.
“Cuprum metallicum made the most brilliant and sensational cures of severe or prolonged cases besides curing the mild ones at every turn. It is difficult to resist the temptation to report them but we will close by reporting one or two actions of the remedy in sequelae or imperfect recoveries. … There were many cases of debility persisting weeks or months after allopathic treatment presenting more or less clear symptoms for Cuprum metallicum and the remedy acted quite satis¬factorily.”(193)
Mario DiCecco of Litchfield, Connecticut reported having discussed with his grand-father, Dr. Royal Hayes, the great influenza epidemic, and Dr. Hayes had told him that after losing a few cases at the beginning of the epidemic he discovered that Cuprum metallicum was the genius epidemicus for the area, and subsequently didn’t lose any more case in over 900 patients, of which 69 presented with the “malignant” type of pneumonia.(194)
It is known that patients, even in the most advanced and desperate state of pneumonia, or any other acute infections, will recover under the simillimum if it is properly administered. Dr. C. A. Dixon of Akron, Ohio described such a desperate case of pneumonia he saw being treated by a more experienced colleague during the NIP, “The patient was in complete collapse, jaw dropped, tongue black, breathing irregular, unconscious defecation, etc. A desperate case I think you will all admit. The homeopath who had it in charge did not resort to morphine, nor to digitalis, nor anything but the indicated remedy, which in that case we thought was Lycopodium. That was given I think in a 50 M. The lady made a complete recovery from that deathbed scene, and is now well, very much to the surprise of even the nurse who was on the case.”(195)
Case Fatality in Pneumonia Cases
As we are more interested in pneumonia cases, not all returns from homeopaths separated the cases of pneumonia from the ones of uncomplicated influenza. However, there are a sufficient number of reports from homeopaths indicating the total numbers of influenza and pneumonia cases and deaths with the same consistency of outcome, as the following one from Dr. T. O. Barnhill of Findlay, Ohio, “We had a whirlwind in Ohio, which lasted until the first of January. I treated four hundred and fifty-five cases of influenza and twenty-six of pneumonia. I lost not a case.”(196)
Comparative Records Between the Two Schools Within the Same Locality
When physicians were practicing in the same town with the exact same population this consistency of results is again observed, as it was reported by Dr. H. H. Crum of Ithaca, New York, “I had three hundred cases with one death. One good homeopathic doctor had two hundred and seventy-
five cases and no deaths [0.17% mortality for the combined outcome from these two homeopathic physicians]. I am the health officer for the city of Ithaca and had all cases reported to me. In October and November 1918, twenty-four hundred cases of influenza were reported. Seventy-five died [3% mortality for the combined homeopathic and allopathic outcomes]. Of the twenty-four hundred cases, between nine and ten hundred were Cornell students, eight hundred of them belonging to the army. They were students of military tactics and all of them were cared for by army doctors. They were hospital cases. The dormitories were turned into hospitals. The treatment was entirely allopathic. Students of the army class were healthy but, even so, forty-five of the seventy-five deaths occurred among those nine hundred students [5% mortality]. Private patients fared much better. In going over the records of deaths, I found that I had but one death while the old school man next to me, who has patients of the same class as mine are, had fifteen deaths among the same number of cases. Think of it! Two hundred and ninety-four cases with fifteen deaths! [5% mortality] … There are other homeopaths in Ithaca and we feel that we have a right to be proud of losing so few patients.”(197)
Dr. Martha I. Boger of Portsmouth, New Hampshire reported, “During the first epidemic, I treated 531 cases with two deaths. One patient committed suicide. The temperature had become normal, but there was insanity in the family. The other patient was mahogany colored, having been pronounced as dying by the regular physicians who preceded me. In spite of that, she lived five days longer. Had I been a better prescriber, I believe she would have recovered. In the second epidemic, I have not kept so close a record, but I have lost but one, also diagnosed by my predecessors as hopeless. However, two other cases with similar verdict recovered. Dr. Stone of the Kittery, Portsmouth U. S. Sanitary Zone, said that I had the lowest death record in the community. This sounds boastful, but I have openly declared that it was not my luck, but the therapeutics which I have practiced.”(198)
In some localities, homeopaths were reporting an almost nil mortality rate. Dr. Harry B. Baker of Richmond, Virginia wrote, “Our results have been much superior to those of the old school. Neither Dr. Tabor nor myself have lost a case. Gelsemium was the genius epidemicus and covered probably 95% of the cases. I used it as a prophylactic also with very satisfactory results.”(199) While Dr. B. E. Miller of Portland, Oregon wrote, “We have had our quota of influenza, but I have not heard of a death under homeopathic treatment. One of the severest cases I have had is that of Dr. A. L. Canfield, who developed pneumonia with influenza. He is now well and on the way to recovery. Our doctors are worked to the limit.”(200)
In December 1918, the editor of the Iowa Homeopathic Journal reported a similar experience, “In Iowa City for instance, our practitioners have had their full share of them to treat and thus far have had but a single fatality. What is true here is also true the state and country over. The death rate has been almost negligible.”(201)
Dr. A. P. Stauffer of Hagerstown, Maryland further remarked that his results were consistent with his homeopathic colleagues in town, “It is with special delight that I have heard these statistics for I have had the same experience. I treated during the month of October five hundred and fifty-five cases. During the first three weeks I did not lose a case. In the last week of the month I lost three cases, due to pneumonia. My experience in Hagerstown is like that of other homeopaths of the city. It makes a man feel that his life is worthwhile when he realizes what he has accomplished in an epidemic of this kind, while the other school of medicine lost case after case. We may certainly be grateful for the fact that we belong to a school that can bring such results.”(202)
Dr. W. J. Grier of Independence, Kansas reported, “I have been about as busy as any and lost one case,” and after describing a difficult case in a pregnant woman who recovered and her baby was saved he said, “These cases have been nearly 100 per cent fatal here in the hands of the regulars. … Dr. W. B. Kelley, who is 75 years young, has practiced here for thirty-three years and never lost a case of influenza going day and night. He is homeopathic. People are beginning to comment on the record of the homeopaths in this epidemic.”(203)
Likely the most obvious of such examples occurred in Washington, D.C., as we earlier saw that a reliable large scale report from the Public Health Service conducted in the District of Columbia reported that from October 1, 1918 to February 1, 1919 there were a 8.6% mortality among 33,719 cases of influenza/pneumonia among the civilian population treated by the different schools of medicine.(204)
Dr. Ernest F. Sappington of Washington, D.C. reported, “I escaped without any mortality in that attack. The experience could be multiplied many times in the District of Columbia.”(205) For instance, Dr. F. A. Swartwout of Washington, D.C. reported, “In Washington we were very active and I had a great opportunity to notice the effects of our treatment. Eleven of us got together about the middle of November  and talked things over. The eleven men reported thirty-six hundred cases treated and six deaths among them. We had another whirlwind in January and it ran the number of cases up a great deal. The exact number is not known. Some of the men treated fifteen hundred to two thousand cases with only three or four deaths. I questioned one man just before coming here and he had had four hundred cases with one death. My record shows about seven hundred and fifty cases with one death. We kept no account of percentage. The National Homeopathic Hospital figured up the records of its cases. At one time no cases were in but influenza and there was not a single death from that disease. I can't give you anything further on statistics. These facts were noted by the health department in Washington. One of our leading physicians, Dr. Kingsman, said that a health officer had called him up to find out why he had sent in no death certificates. His only reason was that he had had no deaths. That was the way the record ran in Washington. An old school friend of mine said that he was ‘tickled to death’ to be able to keep his mortality rate down to fifty per cent.”(206)
Unfortunately, no detailed records from the National Homeopathic Hospital have so far been found. However, from a rare allopathic hospital outcome that could be found in the literature the hospital mortality in Washington, D.C. was far from being negligible. A temporary influenza hospital with a capacity of 19 beds was opened by the USPHS in Washington, D.C. at the beginning of the second wave. From its opening on December 19, 1918 to its closing on March 15, 1919, the number of patients admitted was 223, of whom 30 died, or a case mortality of 13.4%.(207)
The more detailed studies on the NIP reported that the incidence and mortality of influenza were higher in people living in confined spaces, such as crowded troop ships, camps or boarding schools with dormitories. Surgeon General William Gorgas told one training camp commander, “We know perfectly well that we can control pneumonia absolutely if we could avoid crowding the men, but it is not practicable in military life to avoid this crowding.” The Medical Department even asserted, “There is to be expected a definite relation between the degree of crowding and the amount of respiratory infection.”(208)
As an example of the high incidence of cases in more confined spaces, in the fall 1918 influenza developed in 90% of the 1,217 persons on board the New Zealand “crowded” troop ship Tahiti.(209) Also, about 75% of the crews of two destroyers of the Brazilian fleet developed influenza in the fall of 1918, of which nearly 10% of the crews died, a case mortality of 13–14%.(210)
Aside from influenza, other infectious diseases were clearly more prevalent in the confined spaces of army camps, as Dr. Alexander Lambert, president of the American Medical Association, pointed out for meningitis, “The occurrence in the camps of meningitis, another disease of the respiratory group, as far as its portal of infection is concerned, has been forty-five times as frequent in the army as its occurrence in civil life among the same age group. This has been due to overcrowding and the diminution of air space allowed the individual soldier in badly ventilated barracks.”(211)
However, homeopaths reported the same consistent favorable results whether they were practicing in rural or urban areas, hospitals, camps, troop ships or boarding schools. For instance, Dr. Herbert A. Roberts recalled some of his experience as the physician in charge on a US troop ship. “During the first voyage over to Brest I was Transport Surgeon. We had very little influenza during September. In the month of October, I was sent over with another load of 2,000 men, and we developed on the way over in the course of two weeks, over 81 cases of influenza. This is what we did. We put all these cases in the Hospital Bay of the ship, and from sunset to sunrise every porthole had to be closed tight on account of danger of submarines. These cases of influenza presented three meningeal and several of the pneumonic form. However, I landed every man in Brest in good condition. This ship was the only ship in our convoy of nine ships that had that record. I was the only homeopathic surgeon on these nine ships. One ship in that convoy which carried 4,000 troops, lost 31 on the way over. Every man in our ship received homeopathic treatment, and careful individual treatment.”(212) Once another boat pulled alongside to get all the spare coffins from Dr. Roberts’ boat because it's mortality rate was so high. On his return to port, the commander said to Roberts, “Used all your coffins?” To which Roberts replied, “Yes, and lost not one man!”(213)
Dr. Roberts explained that despite the fact that a great number of homeopathic physicians had joined the army their medicines were not included in the armed forces Medical Manual, “The remedies which are used largely by the homeopathic physician should be at our command. This would seem just, especially as we have had 1,862 surgeons from our school of medicine in service in this war. There is a proviso that other remedies than those in the Medical Manual may be obtained and used when it is deemed necessary for the saving of life. It was by taking advantage of this proviso of the Manual that we were able to prescribe homeopathically while in service.”
When called to service he was first assigned at the base hospital in Newport News and was put in charge on the mumps ward for five weeks. His results were here complimented and he was moved to the measles ward. He wrote, “I had charge of the measles ward for six weeks and homeopathic remedies were used entirely. This gave a very good opportunity to demonstrate the value of our school of medicine, for measles in the army is a serious disease and up to the time I took it over the ward had a mortality of 4%. This disease ranks next to pneumonia in importance. When a disease of childhood is contracted by an adult many complications are sure to develop. … These six weeks were well spent and brought a deal of satisfaction, for I closed the service with no deaths under my care during this busy period.” Then he became Ship Surgeon for troop transport. In his first trip he reported having to deal with his “old friends, mumps and measles, and some influenza.” He wrote, “We were laboring in the hold of the ship with port holes all closed from sunset to sunrise during rough weather and no attendants but enlisted men of the medical corps. No trained nurses were aboard either trip and we landed each time all of the men we started with and in good condition, thereby gaining a deal of satisfaction in the use of, and confirming our faith in the homeopathically applied remedy.”(214)
It is not clear how many homeopathic physicians and surgeons had access to homeopathic remedies during the war, but it seems to be a very small minority. Base Hospital No. 48 was one of the rare units having access to a complete homeopathic pharmacy. This Base Hospital had been organized by the Metropolitan (originally homeopathic) Hospital of New York City, which was at that time the largest hospital in the United States with 2,200 beds. Dr. Frederick M. Dearborn, who was in charge of the organization of this hospital pointed out, “We were the only Unit in the Center possessing a complete line of homeopathic remedies.” There were 21 homeopathic physicians in this Unit(215) .
Dr. J. Arnold Rockwell related his experience as a physician who had access to homeopathic remedies in a base hospital near the battlefront in France, and how extreme was the crowded spaces he was working in, “The staff of Base Hospital No. 44 was made up mostly from the homeopathic hospitals in Boston and consisted of thirty-eight officers, one hundred nurses and two hundred enlisted men. … During that epidemic of influenza which raged at the time it did in this country, the trains were filled regardless of medical or surgical cases, with mixed cases, so when the trains came to us forty per cent of the cases had influenza which had spread through car after car, so those who at first needed surgical attention only had been infected with influenza as well as others. That condition ought to have been averted. As a result, there were many deaths, much time was lost, and many patients came down with influenza which possibly otherwise would have been free.”
He further explained that despite the most dire therapeutic conditions they came out with an unusually low mortality rate, “When these cases arrived, and especially those complicated with influenza, they were in a pitiable condition because of the two days on the road in excess of the time expected that they would put in. There were thirty-eight fresh pneumonias taken off the train. These pneumonias were lobar, apparently, and were very fatal. We had no time to give much medical care. The small rooms into which these patients were crowded gave no opportunity for any method of isolation. The fresh pneumonias were put in a room by themselves, and the uncomplicated influenzas by themselves. We did the best we could, but had no opportunity of making a study of them, or giving the proper care. When I tell you that the surgical teams of our unit were at the front, that fifty-seven of the nurses had been requisitioned and taken from us before the flu epidemic came on, and ten of our men down with influenza, and had from one thousand to seventeen hundred patients—that in this critical condition the work piled up in proportions which we were not able to cope with. We found that Gelsemium, Eupatorium perfoliatum, Arsenicum album and Bryonia made up our group of remedies, which did excellent work as far as we could give it. Some only lasted two or three days. We lost thirty-three cases out of the three thousand patients under our care [a mortality rate of 1.1%]. Many of the three thousand were convalescent patients. It seemed to us as if they were dying by thousands—they were in such a critical condition that they died in a short time after arriving in the hospital.
I do feel that if they had received proper care on the train, with proper allotment of air space, and with little more than army regulation consideration of the value of human life, we would have made a better record on the pneumonia cases. It was brought out in the Bureau of Homeopathy that we did better in pneumonia than any other school, and I am glad we can make these assertions. However, we could not get this in the army because we did not have the essentials to work with to secure good results. We had many cases of poliomyelitis, diarrhea, gangrene, aggravated by exhaustion, poor food and drinking water. These cases will probably present intestinal difficulties for many years, and will have a long and tedious recovery.”(216)
Dr. W. Y. Mackenzie, physician of the Knights of Pythias Widows and Orphans Home in Weatherford, Texas, reported that, despite the confined space common to an orphan home, no deaths in 103 cases of influenza, of which four had pneumonia. He had as many as sixty patients in bed simultaneously.(217)
Dr. George H. Wright of Forest Olen, Maryland reported a similar experience in a boarding school for girls, “I had charge of a young ladies' academy of about 360 girls. I attended over 100 cases there without any fatalities.”(218)
Similarly, Dr. W. H. Hanchette of Sioux City reported the same consistency of good results when homeopathy was introduced in a boarding trade school
in the midst of the epidemic, “There was a school nearby my office, a tractor and automobile school, where young farmers came in large numbers. These young men had come from twelve states, and brought the influenza with them. They were dying at the rate of two a day at that time. The school was
turned into a hospital. After they became ill they lived, on an average, only two or three days. One of the teachers had been a patient of mine. He had been sick with pneumonia, and had recovered. This man went to the manager of the school, and said, ‘Why don't you try homeopathic treatment?’ The manager said, ‘I will try anything. We will have to close the school if this keeps up.’ He was panic-stricken. He came to me in the midst of a very busy office hour, and said it was important that he see me at once. He said, ‘I want you to take charge of the school, and give talks on how the students shall take care of themselves, regarding ventilation, proper clothing, etc.’ I treated 40 cases at this school, and every one recovered. The principal of this school will bear me out in my statement. Any of you with your homeopathic medicines could have done the same.”(219)