Installment 10 of a series on case analysis
© Will Taylor, MD 2001 (bio)
On the Genus Epidemicus
In the mid-1800's, John Minz, Canton, Ohio, was faced with an epidemic of scarlatina not responsive to the remedies in common use. An excoriating nasal discharge in conjunction with a few other symptoms peculiar to this individual epidemic led him to select Arum triphyllum for this cluster of cases, which he applied with great success. This individualization to a particular occurrence of an epidemic will be described below, as the selection of a genus epidemicus.
The success of the two approaches outlined above - the use of the acute-disease nosode, and the identification of a genus remedy for the acute miasm - may hinge on the temporal behavior of acute illnesses. In their earliest stages, these diseases are often ill defined, or generic in appearance; in flu, there is a mild poorly-defined malaise with confusion in temperature regulation; in measles, fever with morbiliform rash on the forehead and mild coryza; etc. As the individual case of disease evolves, differentiating features then appear which further characterize the case and point to an individually specific simillimum; but early on, this less-differentiated disharmony may respond to a remedy bearing more generic similarity.
When a remedy specific to the individual occurrence of an epidemic - the genus epidemicus - is identified, this remedy will act more surely in homoeoprophylaxis and early treatment of cases, and is to be preferred to the approaches described above. This genus epidemicus may often become clear following the treatment of 5-6 cases in a particular epidemic; though it may require additional cases to obtain a clear picture, particularly when the situation is complicated by the presence of more than one viral illness moving through the community. This remedy will not only be useful in prophylaxis, but will often be the simillimum to developed cases of the acute disease.
Finding the Genus Epidemicus
Hahnemann describes the process of determining the genus epidemicus concisely, in his Organon:
Usually the physician does not immediately perceive the complete picture of the epidemic in the first case that he treats, since the collective disease reveals itself in the totality of signs and symptoms only after several cases have been closely observed. Nevertheless, an observant physician can often come so close after seeing only one or two patients that he becomes aware of the characteristic picture of the epidemic and can already find its appropriate homoeopathic remedy.
From writing down the symptoms of several cases of this sort, the outline of the disease picture becomes more and more complete - not more extensive and wordy, but more characteristic, containing more accurately the peculiarity of the particular collective disease. The ordinary symptoms - e.g., loss of appetite, sleeplessness, etc. - become more precisely qualified, and those that are more exceptional, special, and, in the circumstances, unusual, and belong to only a few diseases, reveal themselves and constitute the characteristic picture of this epidemic.
All those who catch an epidemic at a particular time have a disease flowing from the same source and therefore the same disease. But the entire scope of such an epidemic disease, the totality of its symptoms (which we need to know in order to grasp the whole disease picture and choose an appropriate remedy for it) cannot be perceived in any one patient, but can be fully distilled and gathered only from the sufferings of several patients with different physical constitutions.
In subsequent cases either the appropriateness of the homoeopathic remedy chosen in the first cases will be corroborated or else a more appropriate one, the most appropriate one, will be revealed to the physician.
Examples from a Pertussis Epidemic
As a specific example of this process, in a cluster of cases of Pertussis I treated in November-December of 1996, early cases I saw yielded the following repertorizations:
Cases 1, 2 and 4 lack sufficiently characterizing symptoms to indicate a clear remedy choice. Case 3 however reveals a clear picture of Corallium rubrum, with the highly characterizing symptoms of copious postnasal discharge and vomiting of stringy mucus.
These 4 cases taken together, "as if of one person", provide a group anamnesis of this particular epidemic of pertussis:
Cases 1 & 2 were treated when first seen with Drosera and Kali bichromicum, respectively; but did not respond to these initial reasonable prescriptions.
After the initial several cases seen confirmed the genus epidemicus to be Corallium rubrum, these early cases were re-treated successfully, and Corallium rubrum served to effectively treat 12 of 14 cases seen in this cluster; and was used with apparent success in the homoeoprophylaxis of numerous siblings and playmates of the cases seen.
Potency and dose
Potency and dosage for prophylactic treatment are guided by the same issues that guide the treatment of active disease; largely, the dynamic nature of the illness, the vitality and sensitivity of the individual patient, and, most importantly, what you happen to have on hand at the time. In general, the lower potencies suffice. I'll commonly use 12C or 30C, occasionally 200C, and on rare occasions have used 1M potencies in prophylaxis.
Single doses in pellet form are clearly effective in prophylaxis, conferring a good window of protection; but as most epidemic illnesses I encounter have a drawn-out presence in the community, I generally prefer to give the remedy in repeated doses of gradually ascending potency in medicinal solution.
A typical regimen for a highly virulent disease such as scarlatina (for the patient of average vitality and sensitivity) would be to put 1 pellet of 12C, 30C or 200C in 1 ounce of distilled water in a small dropper bottle; and dose 2 drops daily, after 4 succussions of the bottle, for the duration of the epidemic in the community. An alternative is to use 1 pellet in 4 oz distilled water in a larger bottle, with a 1/2 tsp dose after 4 succussions. Dosing is reduced in patients judged of lower vitality and/or higher sensitivity.
During the more lengthy 'flu season, I'll often recommend weekly (rather than daily) repetition in a similar manner. In patients considered particularly at risk of complications from the 'flu', I might anticipate the epidemic - until a genus epidemicus is clear - by using Anas barabare 8 (the commercial preparations are 200C), 1-2 pellets in 1oz distilled water, in this same manner, dosed once weekly.
This frequency of repetition has as much to do with the pace of the disease and the (similar) pace of the remedy as it does with the duration of the epidemic. Scarlatina generally has a rapid and furious pace, calling for a simillimum (e.g., Belladonna) with a matching pace and more limited duration of action. Influenza more often has a more indolent pace, calling for a simillimum of matching slow pace (e.g., Bryonia, Gelsemium) and longer duration of action. There are no recipes here which can be followed in cook-book fashion; rather, consider the dosing directions above as examples, and allow yourself to be guided more by your clinical experience in homoeopathic treatment for the cases at hand.
8. Sold as Oscillococcinum® by Boiron, and Flu Solution® by Dolisos.