Herbs & Influenza: How herbs used in the 1918 Flu Pandemic can be effective today by Kathy Abascal. Vashon, WA: Tigana Press; 2006. Paperback, 194 pages, black and white historical photos, line drawings of main plants by author. ISBN 0-9788586-7-0. $18.00.

As the title suggests, this book addresses the potential of a modern worldwide influenza outbreak and some botanical options available for addressing such a crisis. The author is a trained herbalist and probably best known for her extensive series of journal articles on botanical medicine co-authored with Eric Yarnell, ND, published in the book Clinical Botanical Medicine. In the initial chapters she addresses the demonstrable lack of preparedness and likely catastrophic occurrence of what many believe is the next likely pandemic. Beginning with a discussion of influenza viruses, she distinguishes between the common seasonal outbreaks and the periodic fatal flu contagion that exceeds other acute illnesses, based on its widespread unmanageable consequences. In considering the inadequacies of vaccines for prevention and currently available conventional medical treatment for control of future outbreaks, she describes the need to evaluate herbal approaches as one vital means to maximize preparedness. In discussing the herbal means of treating an epidemic or pandemic outbreak, she examines historically empirical successes that address specific disease expressions.

In particular Ms. Abascal documents a mostly botanical approach to treatment applied to the flu pandemic that raged from 1918-1919. It is based on the American Eclectic medicine model of practice that employed an efficacious approach but emphasized using botanical remedies often prepared from fresh plants. Her discussion of the history of Eclectic medicine in America from the 19^th to the early 20^th century gives a valuable overview of its methodology and its problematic struggles in medical politics. She relied largely on a survey by the Eclectic-associated Lloyd Brothers Pharmacists that was mailed to doctors on January 1, 1919, requesting the names of the best and the top six remedies considered most essential for treating influenza. Also solicited were the names of the most necessary pneumonia remedies and topical applications to the chest. Finally, the physicians were asked to identify whether they followed the Eclectic practice of Specific Medication.

It is this last feature that distinguishes this book from other modern texts on botanical remedies. The Eclectic method of describing “specific indications” for each medicinal plant allowed prescribers to match the remedy that most exactly fit the presenting symptoms of each individual patient, rather than to prescribe treatment simply on the basis of a diagnostic category. In discussing the 15 major remedies employed by Eclectic physicians for the 1918 pandemic, the features or expressions that called for that particular remedy are carefully described. Ms. Abascal utilized both Eclectic materia medica texts and Eclectic journal articles published around this time to discuss each remedy in the context of influenza symptoms. Therefore, she relies on the authority of those who faced multiple clinical cases on a daily basis to evaluate the remedies deemed most appropriate for that disastrous pandemic. In reviewing these different remedies, it becomes evident that they can likewise be applied to the common flu or potential modern epidemics or pandemics as expressed in individual case presentations. To bear out this point, occasional reference is also made to treatments used in the pandemic of 1889 and the Australian epidemic of 1892. In addition, she quotes recent texts from German and American herbal authorities to augment and update information about these herbs, together with occasional modern journal references on pertinent research.

The responses to the Lloyd queries utilized in this text are from 222 Eclectic physicians published in February 1919. Not included in the book is a March 1919 summary list generated by Lloyd Brothers from answers by 1000 physicians. It provides the top 9 botanicals for influenza and pneumonia based on the survey results for the 6 most useful remedies, giving the following number of endorsements for each, respectively: Aconitum napellus, Ranunculaceae [788, 617]; Gelsemium sempervirens, Loganiaceae [772, 293]; Bryonia alba, Curcubitaceae [707, 723]; Actaea racemosa, syn: Cimicifuga racemosa, Ranunculaceae [384, –]; Veratrum viride, Liliaceae [353, 576]; Eupatorium perfoliatum, Asteraceae [328, –]; Lobelia inflata, Campanulaceae [324, 468]; Asclepias tuberose, Asclepiadaceae [268, 366]; Cephalis ipecacuanha, Rubiaceae [236, 411]; Atropa belladonna, Solanaceae [– , 169]; and Sanguinaria canadensis, Papaveraceae [– , 134]. The results from the prior month’s 222 detailed responses mostly parallel this larger summary and form the core for the botanical discussions in the book.

The author notes that her book is intended for both the lay and professional reader. Due to their potential toxicity, 8 of the main 15 remedies are designated for professionals only, as are 8 of the 20 “honorable mentions.” For example, top remedies for seasonal and pandemic influenza (Eupatorium, Actaea, Asclepias) can be safely used by the general public, while the chief sedatives (Gelsemium, Aconitum, Veratrum) are restricted to professional use only.

For those low dosage professional remedies that present high risk with uninformed use, clinical information about toxicity and some empirical overdose treatment options are provided.

The summary list from 1000 physicians of most useful external chest applications included Libradol [618], Compound emetic powder [185], turpentine applications [110] and others that are discussed in the book. The author discusses the composition and preparation of 8 of these applications, but unfortunately provides little information about the Lloyd Brothers product Libradol that was by far the most popular topical application. Her final chapter on non-herbal remedies includes about a dozen mostly obsolete chemical preparations, along with several botanical derivatives, that are less likely to be of modern general interest or utility. Though there is no summary chapter, she enhances the text with several appendices that include a summary chart of botanicals listed in descending order according to the number of responses given for each as the most useful (and among the top 6) by the 222 Eclectic respondents. Also included are a glossary of medical terms and short lists of resources for obtaining tinctures and finding trained practitioners of botanical medicine.

This book provides a unique perspective on therapeutic options in a potentially life-threatening condition that frequently challenges modern medical limitations. It emphasizes the importance of individual prescribing based on specific indications for each of the botanical remedies in the context of the Eclectic utilization of high-quality hydroalcoholic extracts as the preferred medication. One might wonder about the relative lack of attention paid to echinacea, since it is now considered a standard herbal remedy for the flu. This can be explained by the Eclectics’ primary use of a hydroalcoholic extract of Echinacea angustifolia (Asteraceae) root to treat largely septic, i.e., bacterial, conditions. Modern research indicates extracts of E. purpurea root, whole plant, or aerial plant juice appear more effective in viral respiratory infections. As the author suggests, a combination of these species offers broader therapeutic effects. Clinical studies show this echinacea combination in a proprietary formula and E. angustifolia root with other herbs have been employed successfully for both preventing and treating colds and flu.

A few omissions are noteworthy. One is the remedy successfully utilized by native Americans and others in the Great Basin region of the West during the 1918 outbreak, the root of Lomatium dissectum (Apiaceae). It was probably bypassed due to its absence from the Eclectic armamentarium or possibly because of its limited availability. Also, a basic drawback is the failure to identify the medicinal plant part used to prepare a number of the professional Eclectic remedies, though standard preparations of these botanicals are typically purchased from a phytomedicinal manufacturer rather than self-extracted for clinical use. For many of the herbs the specific preparation solvents, strengths, and doses are described by citing the works of Michael Moore, an herbal authority of the American Southwest under whom the author studied; however, in discussing Moore’s data in many examples, the author sometimes again fails to identify the plant part in question.

Though most of the clinical information can be extracted from still-available Eclectic medical texts, the compilation and organization of material here makes this book one that should be of interest to anyone who wants to be seriously prepared for the next seasonal, epidemic and/or pandemic outbreak of the flu that will inevitably occur.