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Smallpox - A homeopathic perspective

After the events of September 11, 2001, the world changed. Terrorism in its many forms, once isolated to certain regions, has now become a concern across the globe. Although terrorism has existed throughout the ages, newer, more destructive weapons have created a heightened level of anxiety. Nuclear, biological, and chemical weapons allow small groups of fanatics to terrorize whole societies.
     Perhaps the most historically destructive of the biological weapons is smallpox. British soldiers in North America distributed blankets from smallpox victims to Native Americans during the French and Indian Wars of the mid-18th century.1 Serious epidemics resulted among Native American tribes. Over time, smallpox was responsible for vast numbers of deaths throughout native populations in both North and South America.

Symptoms of smallpox
Smallpox, whose only host is humans, is caused by a pox virus. The virus is transmitted from person to person through the air at close contact (6 feet or less), and through direct contact with the pustules on the skin. The initial symptoms include a high fever (greater than 101°F) associated with malaise, headache, backache, chills, abdominal pain, or vomiting. This early stage of the illness is usually quite severe, and those infected are generally too sick to engage in their normal activities.
     The smallpox rash is slow to develop, usually over several days. The individual lesions begin as small bumps (papules) and then progress to well-demarcated pustules. These pustules are deep in the skin, have clear edges, and are firm to the touch. Unlike chickenpox lesions that progress in crops, these lesions progress simultaneously. The distribution of the rash tends to be centrifugal, that is, mostly on the face, arms, and legs (including the palms and soles).
     At this stage, patients with smallpox are extremely ill and usually bedridden. Patients are contagious from the onset of the disease through the first 7--10 days of the rash.2 Historically, the overall fatality rate of smallpox has been approximately 30%.3 The more severe hemorrhagic form of this disease usually accounts for only 1--3% of all infections and is generally fatal.4

Weaponized smallpox is worse
The use of smallpox as a biological warfare agent has progressed since the mid-1700s. Aerosol forms of the virus now exist that could be released over a wide area. Experience from a 1971 Soviet field test of weaponized smallpox showed that the victims had an unusually high rate of the hemorrhagic (fatal) form of the disease, and even individuals who were vaccinated developed smallpox.5 This strain of smallpox seems to have been unusually potent when compared to the historical form of the disease. Additionally, evidence from outbreaks in Europe in the 1970s showed that a single case could generate 10--20 second-generation cases, despite efforts at containment.6
     The mainstay of the U.S. initiative to develop a rational plan for defense against the threat of a smallpox attack has been isolation and vaccination. Rapid deployment of health teams from state medical agencies and the federal Centers for Disease Control would be used to isolate any infected individuals and identify contacts with these source cases. Then, all potential contact cases would be vaccinated and perhaps even quarantined.

The concept of vaccination
Edward Jenner developed vaccination for smallpox in 1796, when he showed that an infection of cowpox would protect against the more serious disease of smallpox.7 This concept of using a similar disease, "cowpox," to prevent another disease, "smallpox," is in theory, strikingly analogous to our homeopathic tenet of "Similia similibus curentur," or "like cures like." So similar was this concept at the time that many homeopaths gave great acclaim to Jenner, though others were greatly concerned about the frequent side effects that resulted from the new treatment. (The term "vaccination" comes from the Latin word for cow, "vacca.")
     The vaccine is now composed of the vaccinia virus (not smallpox or cowpox). The technique of administering smallpox vaccine is unique; it is placed into the skin by the process of scarification, which involves approximately 15 superficial punctures in a small area (usually the upper arm). A viral infection must develop for the vaccination to be successful. A red itchy bump will form at the site followed by a pustule that will eventually drain and scab over. The first time people are vaccinated, they have a stronger reaction than those who are revaccinated.

Vaccination side effects
The most common side effects of vaccination include soreness of the arm, fever, and body aches. If the pustule is touched, the virus can be transferred to another body part causing a pustule to form at that site. A variety of rashes may also occur which are generally benign and self-limiting. Approximately 1 in 4000 individuals will develop a more severe rash as part of generalized vaccinia. These patients may develop pustules at other sites as a result of the vaccinia virus spreading through the bloodstream but they usually recover completely. In approximately 1 in 600,000 cases, a very severe progressive vaccinia can occur, typically in individuals with immune system deficiency. The site of vaccination becomes progressively necrotic and may lead to fatality. And in about 1 in 80,000 cases, post-vaccinial encephalitis can occur, that is, a brain infection causing confusion, paralysis, seizures, or coma. Approximately 15--25% of these patients die, and 25% of the remainder are left with a permanent neurological injury.8

Effectiveness of vaccination
Vaccination programs have been conducted for approximately 200 years. The World Health Organization announced the elimination of smallpox from the human population in 1978, because of vaccination programs. The last vaccinations in the U.S. were given in 1972.
     Vaccination during outbreaks showed a 91% reduction in secondary cases compared to unvaccinated people. Data from outbreaks in Europe during the 1950s and 1960s showed fewer fatalities among those who were vaccinated. The fatality rate for people vaccinated less than 10 years previously was 1.3%; for people vaccinated 11--20 years previously it was 7%; and for those vaccinated more than 20 years previously it was 11%. The overall fatality rate for unvaccinated people was 52%.9
     It can be assumed that 90% of all U.S. citizens are susceptible to some level of smallpox infection, as most were vaccinated more than 20 years ago or were never vaccinated (in 1998, 42% of the population was aged 29 or younger and would not have been vaccinated).10 The U.S. government is currently considering a vaccination plan to cover military service members, emergency response providers, and state and national infectious disease workers. Mass vaccination of the public is not currently being considered.

Homeopaths debate vaccinations
Vaccination effectiveness and side effects have been hotly contested in the homeopathic world since the invention of vaccines. Some homeopaths have emphatically stated that smallpox and other diseases would have simply disappeared from the population with improved hygienic practices and modernization. Some modern-day experience seems to run contrary to this opinion, however. A case of smallpox introduced into Germany in 1970 resulted in 19 secondary cases. This outbreak occurred in a thoroughly modern and very hygienic society. The outbreak was only contained through isolation and massive vaccination of the exposed population.11
     Other homeopaths feel that the efficacy of vaccination has been clearly demonstrated through the systematic and total elimination of smallpox from humans. And still others may agree that the vaccine is effective, but believe that there has been a high price paid in the lessening of health of our entire population as a result of the use of this and other vaccines.
     An excerpt from the British Homeopathic Journal of 1912 illustrates this longstanding division among homeopaths quite well: "Hahnemann, himself, was impressed with the homœopathicity of the principle upon which vaccination is based, and cites certain diseases which have been known to be cured after vaccinia; yet the majority of homoeopaths, while they do not refuse to vaccinate, feel that it is a very crude method of procedure. Opinions vary; one class does not hesitate to vaccinate, others vaccinate only under protest and then antidote its possible ill-effects by an appropriate homoeopathic remedy; still another class will not inoculate under any circumstances whatsoever." 12
     While vaccination for smallpox has a clear efficacy, some side effects seem unavoidable. With the higher frequency of immuno-suppressed individuals in our current population, that side-effect frequency would likewise increase should mass vaccinations take place
in the future. Of even more concern is the potential relationship of various vaccinations, including smallpox, and the development of miasmatic diseases in
our populace. Allergies, ear infections, asthma, and behavior disorders have shown alarming rates of increase in the past 40 years. Although the cause of this increase is unknown, some homeopaths have suggested a direct link to vaccinations. While this is an interesting theoretical topic, if there were a massive outbreak of smallpox, the government currently has plans to mandate vaccination for all potentially exposed individuals. Public health concerns would likely take precedence over personal beliefs.

Smallpox treatment and prevention
What is a homeopath to do? How likely is it that the homeopath will be called for consultation for the smallpox patient? Fairly unlikely, given that very few homeopaths practice in a hospital setting, where nearly all smallpox victims will be treated. However, if there is a massive outbreak, homeopaths will undoubtedly treat many patients. I can say this with some confidence for two reasons: first, there is currently no acceptable allopathic treatment for smallpox, and second, numerous cases of smallpox have been treated successfully with homeopathic remedies in the past. Patients will inevitably seek effective treatment.
     The homeopathic repertory lists 48 different remedies for the treatment of smallpox. Hering alone described the use of 46 different remedies in his treatment of the disease. The most commonly used remedies include Antimonium tartaricum, Rhus toxicodendron, Mercurius vivus, Thuja occidentalis, Sarracenia purpura, Belladonna, Carbolicum acidum, Sulphur, Arsenicum album, and Variolinum. Ultimately, the nature of the epidemic will determine the actual remedies that will be used. Given that the virus may have been altered to make it a more effective weapon, the experience of the past might not be truly useful for any future event.
     But homeopathy may actually offer more than just a potential treatment for smallpox. The most important information from the historical literature comes in the data surrounding the use of homeopathic remedies and nosodes in the prophylaxis of smallpox. While homeopathic remedies have not been shown to be truly effective for long-term prophylaxis for endemic diseases, they have shown benefit in true epidemics. In 1902, during a smallpox epidemic in Iowa, Dr. Eaton reported that 2806 patients were treated with Variolinum (homeopathically prepared smallpox pustule). Of the 547 patients who were definitely exposed, only 14 developed the disease. The overall protection rate was 97%.13

Homeopathy for vaccinia syndrome
Since massive vaccination is the most predictable public health response to a smallpox epidemic, the largest group of casualties from such a catastrophe may actually be secondary to the vaccination program itself. During mass vaccinations for smallpox in the past, homeopaths were somewhat divided on how best to deal with the consequences of vaccinia (mentioned earlier). While some promoted routine use of homeopathic remedies before vaccination, others suggested only treating those who developed symptoms. Some of the remedies that have been most often used to treat vaccinia are described below.
     Thuja occidentalis has been the most frequently prescribed and most highly touted remedy for patients with vaccinia. (On an interesting side note, I once worked with a physician who would inoculate patients with smallpox vaccine to treat plantar warts—a condition that Thuja occidentalis has proved useful in treating.) Thuja occidentalis is useful for diseases that result from a suppressed eruption or from suppression of the immune system. The eruptions may be papular, vesicular, or pustular. In patients who develop any chronic effects after vaccinia, such as weakness, fatigue, growths of tumors or infections, Thuja occidentalis should be strongly considered.
     Antimonium tartaricum has been very useful for eruptions resembling chickenpox. (Dr. Arthur Grimmer even reported that when placed on abraded skin in the third trituration, Antimonium tartaricum will produce a typical vaccination scar.) Boericke noted that the eruption may leave a bluish red mark after the pustule resolves. Cough that is typically present in patients needing Antimonium tartaricum may be absent during vaccinia.
     Silicea is a remedy that is complementary to Thuja occidentalis. Silicea is indicated for diseases that result from suppression of the individual by an external force such as a vaccination. Enlargement of the glands and malaise may be strong features. Pustules do not seem to progress and improve.
     Belladonna is useful when the patient progresses toward sepsis or meningitis. The fever is high and there may be delirium due to the effects on the brain. These patients will most likely be in the intensive care unit and should only be treated by a skilled homeopath.
     Malandrinum has been mentioned as being the most potent treatment for the septicemia or blood infection that sometimes follows smallpox vaccination.
     Variolinum has been suggested as the foremost treatment of both smallpox and vaccinia, but there is only anecdotal evidence from a few prescribers to support its use. No well-performed provings, or even the method by which this remedy was produced, exist at this time. Without guiding symptoms, the selection and use of a remedy like Variolinum can only be made on a purely empiric basis. Homeopathic medicine has continued to exist because it is practiced according to a scientific discipline. Once that discipline is abandoned, the results of practice are unpredictable.

Final thoughts
Smallpox is a deadly disease. Very few people alive today still have any significant immunity to it, and it is highly likely that a weaponized version of smallpox would be even more deadly than what we have seen historically. Public health will most likely dictate the course of action each community would take in the event of an outbreak. What is little known in the allopathic community is that homeopathic medicine has shown some historical effectiveness for the treatment of this horrific disease, where allopathic medicine has little to offer other than supportive care.
     Some have written to their governmental delegates to raise awareness of the need to increase research into the potential benefit of homeopathy in the treatment of epidemic diseases such as smallpox. But the government is only likely to respond to a significant groundswell of public demand for such research. The past has shown that allopathic medicine, with all of its powerful tools, has done little, if anything, to raise the overall resilience and adaptability of human beings. Homeopathy may well hold vital keys to the future health and well-being of our society.

References
1.     Stearn EW, Stearn AE. The Effect of Smallpox on the Destiny of the Amerindian. Boston, Mass: Bruce Humphries; 1945.
2.     Mack TM. Smallpox in Europe, 1950--71. J Infect Dis. 1972;125:161--169.
3.     Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID. Smallpox and Its Eradication. Geneva, Switzerland: World Health Organization; 1988:1460.
4.     "Smallpox Outbreak 1971—Soviet Union: Revealed." The New York Times, June 15, 2002.
5.     Ibid.
6.     Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID.
7.     Hopkins DR. Princes and Peasants. Chicago, Ill: University of Chicago Press; 1983.
8.     Atkinson, W.L. "Smallpox: What Every Clinician Should Know," www.cdc.gov. 2002.
9.     Ibid.
10.     US Bureau of the Census. Resident Population of the United States: Estimates, by Age and Sex. Washington, DC: US Bureau of the Census; 1998.
11.     Henderson D.A.; Bioterrorism as a Public Health Threat; Johns Hopkins University; Emerging Infectious Diseases; Vol 4:3; Jul--Sep 1998.
12.     The Homeopathic School of Medicine, "Attitude
of Homeopath toward Vaccination," British Homeopathic Journal, 1912; Vol 27:6.
13.     Eaton, CW, "Variolinum," Journal of the American Institute of Homeopathy, 1907.

About the author:
Todd A. Hoover, MD, is a board certified family physician and homeopath practicing in Narberth, Pennsylvania. He is a graduate of Jefferson Medical College and studied homeopathy at the New England School of Homeopathy, as well as with Ananda Zaren, Vassilis Ghegas, and others. He has been practicing homeopathy for nine years. He is also a yoga teacher, father, avid cyclist, and "full-time explorer of things unknown."