Vol. 20 No. 4 September 2000
by Will Klunker
The various concepts of miasms bandied about in homœopathic circles these days are far, far away from what Hahnemann intended. These imaginative interpretations have such a hold that people will insist they are not the product of later theorists but are quite clearly expressed in the master’s own writings. This is not so, as the following article demonstrates.
Analysis of Hahnemann’s Chronic Diseases and of the editions of the Organon that appeared before and after the former’s publication reveals that Hahnemann did indeed establish a medical theory of miasms applicable to actual cases of syphilis, gonorrhoea and scabies, but that for the selection of the remedies and in order to ascertain the scientific character of homœopathic healing, he nevertheless always demanded reliance on the perceivable symptoms of the patient’s whole chronic illness, exclusive of any hypothetically presumed “miasmatic” causes.
In contrast, from the standpoint of Hahnemannian homœopathy, today’s tendency to combine in practice the chiefly imaginary concepts of ideological and esoteric theories of the miasms with the patient’s symptomatology must at best be considered questionable.
Admittedly Klunker’s exposition is not easy reading, and is best re-read with copies of the Organon and the theoretical part of Chronic Diseases at hand.
It may appear that Klunker is taking an extreme, way-out, line that hardly anyone else subscribes to – but this is not so as many German speaking scholarly homœopaths endorse this view, rare as it may be outside this well-informed circle.
If you read Hahnemann’s works with an attitude uninfluenced by interpretations imposed by people who are seeking support for their own, chiefly metaphysical, views it would be difficult not to agree with Klunker’s thesis.
The author first presented this material at a conference in Berlin in 1988. The article which follows is an adaption of an English translation of a revised version which appeared in the Classical Homœopathy Quarterly, issue 3, 1990. Passages enclosed in square brackets [ ] were footnotes in the original. Gratitude is expressed to Dr K-H Gypser for his permission to allow its reproduction in Homœopathica.
The use of the words classical homoeopathy suggest that there exists an opposite, a non-classical homoeopathy. However, homœopathy is nothing but practice, that is, it is the practice of healing. Whoever claims to adhere to classical homoeopathy must therefore be alluding to the fundamental difference between classical and non-classical homoeopathy. This difference opposes the scientific certainty of healing to the merely empirical probability of healing.
To identify one’s approach as classical homoeopathy according to Hahnemann means to opt in favour of the scientific practice of drug therapy. According to Article 3 in the Organon , this scientific drug therapy is based essentially on one condition that must be fulfilled in order for a systematic healing process to take place. This condition is the concordance of the drug symptoms with the patient’s characteristic symptoms, that is, the homoeopathically correct selection of the remedy. If this method is not followed it is not any kind of homœopathy at all.
According to Hahnemann’s teachings, the chronic miasms are syphilis, sycosis and psora. The central question of this article is: “What is the significance of the three chronic miasms, syphilis, sycosis and psora in the practice of scientific drug therapy?” However, having stated this, we must ask if this question is synonymous with: “What role do syphilis, sycosis and psora play with respect to the homoeopathically correct selection of the remedy according to Hahnemann’s teachings?”
The works consulted for this investigation are, of course, first of all the 2nd edition of Hahnemann’s Chronic Diseases published between 1835-1839, primarily the first volume. But for the sake of comparison, its 1st edition published between 1828-1830, was also consulted. Upon comparison of the editions of the Organon that appeared before and after the Chronic Diseases, we can expect to find some important information.
Before the publication of the 3rd edition in 1824, the complete cure of the majority of chronic illnesses was still considered impossible. Looking back on a statement of facts he made in 1816, Hahnemann wrote in 1828 that “the beginning (of their treatment) was encouraging, the continuation less favourable, the results hopeless.”
After the publication of the first volume of Chronic Diseases in 1828, the new methodological instructions for the henceforth feasible homoeopathic cure of chronic illnesses unrelated to venereal disease had to be incorporated into the Organon. This was done first in 1829, in the 4th edition, and continued in the following ones, including the 6th edition. A comparison of the content of the pertinent texts must thus reveal the role the three chronic miasms play in the selection of the remedy.
In order to be able to get the full picture, it is important to envision the framework in which Hahnemann’s concept of the chronic illnesses was conceived. He was practising in the particular medical climate of the early 19th century. The physician of that time saw in his practice numerous patients with acute contagious illnesses and those afflicted with one of the frequent epidemics. Among the chronically ill the majority were patients in all stages of syphilis, as far as these could be ascertained as such, as well as those suffering from gonorrhœa. These cases were the rule and not, as today, the exception.
In those days scabies had attained an almost total morbidity among people of all social classes and ages. This means that in a medical practice of that time, contagious (miasmatic) illnesses of acute and chronic nature were so frequent that especially the non contagious chronic illnesses were obscured and consequently almost unavoidably confused either with the prevalent syphilis, sycosis or scabies, and whatever was mistaken for these, or considered to be a result of the latter.
And in order to adequately comprehend Hahnemann’s teachings on the chronic illnesses it is furthermore necessary to focus on the fundamental difference between medicine and homoeopathy. It is too easily forgotten that homoeopathy is merely a method of healing with drugs and all other fields of medical knowledge, in both experience and theory, still have links to the contemporary medicine of the day. Thus Hahnemann, in his capacity as the founder of homoeopathy, also took part in the medicine of his time, just as we, his followers, take part in the medicine of today.
Therefore, the homoeopathic cure of scabies, for instance, is strictly a problem of homoeopathy; whereas the manner of contagion, the course of the illness, the consequences of its suppression and the hygiene for the prevention of scabies are a medical concern and cannot be claimed to belong to the realm of homoeopathy. Hahnemann took from the medicine of his day, and he in turn gave to it his doctrine of the nature of the chronic diseases. This doctrine is Hahnemann’s doctrine, but it is not homoeopathy – it was, and remains, part and parcel of early 19th century medicine.
In order to be able to understand Hahnemann’s doctrine correctly, it is furthermore necessary to say a word about the difference between theory and simple observation and experience, which also relates somewhat to the distinction made earlier between medicine and homoeopathy.
In its proper sense, homoeopathy is a method for practising and the practice itself and nothing but practice. The word practice is derived from the Greek verb pratto: to complete, to achieve, to realize, to trigger, to bring about, to produce – for instance a cure. As the word practice relates to pratto, meaning to bring about, this relates to work, to bringing about a cure, to do the work of healing.
Business also means calling or mission, and Hahnemann understood the practice of homoeopathy in that sense of the term. In order to grasp the character of homoeopathy as practice, we must, of course, not associate the terms manage or business with the context suggested by today’s usage of these words. Hahnemann demands only of homoeopathy, of this work of healing alone, that it be based on simple observation and experience.
It is only in that sense that homoeopathy is empirical medicine. This does not preclude that Hahnemann would establish and teach theories dealing with medical considerations and explanations – medicine in general does not seem to be able to do without them.
However, medical theories and the business of homœopathic healing must not be confused. Hahnemann insisted relentlessly that all theoretical considerations, any hypothesis, speculation, supposition, etc, be banned from the work of healing as such. Because he, unlike many of his followers, had recognized that the conditions of a priori certain, scientific healing, that is, of the classical work of healing, could only be met in this fashion.
Formulated in other words, this means that whenever anything theoretical, hypothetical, merely imagined or accepted is mixed with the concrete work of healing, the scientific aspect of healing disintegrates, and what remains, as always, is merely a healing art based on a posteriori probability, an art of supposition, statistical medicine.
Further consideration must be given to the path along which Hahnemann established his doctrine of miasms. There is no indication that he was led by any other than purely practical medical intentions; he had no philosophical, theological, ideological or esoteric ones. His concept of the miasms was based on the medical views accepted at the time, which he modified.
The contagiousness of many acute and chronic illnesses had long since been known, but it could not be ascribed to a recognizable agent. Thus, miasm became a provisional working term for (as yet) unknown causes of contagion. What is new is Hahnemann’s doctrine of a triad of chronic miasms: syphilis, sycosis and psora.
From the Greek sykosis, a fig-like excrescence (from sykon, fig), and psora, scabies (man), mange (animal), derived from psao, to rub, to scratch. The frequently expressed opinion that Hahnemann’s “which may be called by the general name of Psora” (page 12 of Tafel’s translation of Chronic Diseases) suggests something metaphysically profound is contradicted by the context and the subsequent explanatory parenthesis “(internal scabies with or without eruptions on the skin).” The “general name” refers to what is nosologically common to all individual afflictions; the “internal” scabies is contrasted, from a medical point of view, with its “exterior” manifestation.
He supposes the cause of all non-syphilitic and non-sycotic chronic illnesses to be exclusively psora, and this leads him to attribute much greater significance to the latter. The 12 years of labour that went into the Chronic Diseases were limited to the discovery of psora and of its cure. It is significant that this work consists of two parts: a theoretical one, dealing with the “nature of the chronic diseases”, and a practical one, relating to the work of healing, encompassing the general indications, (the methodology), followed by four volumes of materia medica constituting the a priori condition for scientific healing.
The homœopathic physician cannot hope to cure scientifically and with the certainty based on law, if he is not beforehand (a priori) familiar with the healing powers of the drugs, that is with their symptomatology.
This clearly shows Hahnemann’s steadfast tendency not to associate the medico-theoretical teachings about the nature of the chronic diseases with the scientific prerequisites for their cure.
But what is the basis for Hahnemann’s teachings on the nature of psora? As is evident in the first part of his Chronic Disease, the doctrine of psora is demonstrably based on two observations and five conclusions by analogy. With respect to the conclusions by analogy, it must be noted that being based on probability, they do as such not represent any necessity, but only probability. In the sciences, conclusions of this nature have a certain heuristic value, especially when working hypotheses are sought.
This is the case here. Hahnemann was fully aware of the hypothetical character of his doctrine on psora, he significantly calls it a theory (Organon 284, footnote), he is convinced of its accuracy, but leaves open the possibility to falsify it.
Now the question can be posed as to the role the three chronic miasms of syphilis, sycosis and psora play in the practice of the scientific drug therapy for chronic diseases – for the selection of the remedy according to Hahnemann’s teachings.
When discussing this problem, it must be kept in mind that Hahnemann’s indications in the Chronic Diseases and in the Organon always relate to the cure of patients who really were afflicted with syphilis, sycosis, psora, of suffered from them simultaneously, with or without local symptoms.
The cure of syphilis and sycosis is treated only very cursorily in Chronic Diseases. The emphasis lies on healing psora. Hahnemann has repeatedly stated what he meant to qualify as scabies (psora): an individual vesicular dermatosis acquired through contagion and characterized by voluptuous itching, forcing the patient to scratch continuously. What he actually subsumed this to be will never be elucidated completely. It is certain that this definition must cover several itching types of dermatosis which were either truly contagious or believed to be so. Because of its well known and widespread occurrence, the classical scabies was most likely predominant among the former, and among the latter, infantile eczema and neurodermatitis, as well as chronic eczema, must have been common.
This means that in the cure of psora, contrary to the situation in today’s medical practices, Hahnemann and early homoeopathy had to cope with scabies that was either still present or suppressed, and with recurring or newly acquired scabies eruptions and their chronic results. It was, therefore, paramount to conduct the anamnesis in view of syphilis and sycosis. As to the selection of the remedies, Hahnemann in general assigns in Chronic Diseases the treatment of the chronic diseases to the homoeopathic treatment of human illnesses generally, as taught in the Organon. In this 1828 book, the question is thus referred to the Organon, note this, the third edition of 1824!
In Chronic Diseases Hahnemann returns to the subject of the selection of remedies when he discusses, for instance, the unhomœopathic selection of the remedy as the principal mistake in the treatment of chronic illnesses. Hahnemann states that for the correct choice of the remedy one must discover “first the total situation of the patient, the causes remembered and the causes for the subsistence of the illness, lifestyle, his mental, spiritual and physical condition, in addition to all his symptoms (according to the instructions given in the Organon), following which one is to select a remedy which, if possible, is most similar to all these findings, or at least to the most striking and unusual, the most characteristic ones.” This selection is to be carried out by referring to the materia medica of Chronic Diseases.
And Hahnemann insists the curative remedy can be determined only through a striking homoeopathic similarity of the symptoms of disease and remedy. It is thus obvious that, according to Hahnemann’s Chronic Diseases, the decisive factor in the selection of the remedy is the patient’s symptomatology. Only the observable phenomena of illness, the precise symptoms, not their supposed causes such as miasms, are allowed to participate in the work of healing, in the managing of the cure. Other than these few indications, Chronic Diseases gives no further instructions regarding the selection of the remedies.
Both editions (1828 and 1835) refer to the Organon; to its 3rd edition (1824).
The 4th edition of the Organon (1829) was considerably modified from the earlier ones, in view of the discoveries revealed in Chronic Diseases. Whatever applies to our question about the indications for healing through the similarity of symptoms must be found in it.
Article 6 of this edition was lifted unchanged from the 3rd and states that the totality of the symptoms is the only evidence the physician can observe and is the foremost knowledge he can gain of the illness, and the only thing he needs to know for the purpose of healing.
Both editions give a footnote in which he criticizes the foolishness of “seeking out the invisible, unknowable internal condition of the illness, the so-called prima causa morbi, as indication for the cure.”
This prima causa morbi is the miasm; it is obviously not the most important factor, it cannot and must not determine the information suitable for the physician’s business of healing.
[Though Hahnemann, in Chronic Diseases, calls psora the “original scourge” (Ur-Übel) he meant this to be merely theoretical. That he did not imply anything metaphysically profound is obvious not only from the context, but it is also clear from the meaning of the prefix “ur” (urait = very old) implying first, primary, original, causal. In old German, “Ur-sache” originally meant the primary cause (the motive) of a dispute. In modern German “Ur-Übel” means basic scourge. In Chronic Diseases Hahnemann uses the word in that sense. Both are echoed in this “Ur-Übel”: on the one hand, psora is the super scourge in the sense that it represents a combination of all apparently individual diseases of a chronic evolution, on the other hand, it is the basic scourge to which belong all those quasi-individual diseases with which it forms a unit. In so far as “basic scourge” comprises something akin to “cause” (Ursache), yet the actual condition “cause” is not recognizable from experience as Hahnemann stipulates, the purely medico-theoretical character of psora, as far as homoeopathic practice is concerned, is again demonstrated.]
This is further clarified in the new Article 7: “In his effort at healing, in order to figure out the basic cause which, most frequently, has its origin in a chronic miasm, the physician uses . . . the most significant elements from the entire report of the ailment of long standing. The noticeable condition of the patient’s (particularly long suffering) body, his mental and psychological state, his occupations, lifestyle, his social standing, his age and his sexual functions, etc, are to be taken into consideration.”
Article 9 was expanded by the remark that, since “it is not possible to observe anything other than the signs of the illness . . . all the while giving consideration also to any possible miasms and paying attention to secondary conditions (Article 7), . . . the only manner in which the illness can call for the appropriate remedy (must be) by means of its symptoms.” Hahnemann then continues, without any changes, with the passage from the 3rd edition: “. . . thus, the totality of these symptoms . . . must be the main elements or the only factors . . . that can determine the choice of the correct remedy – consequently, in one word, the totality of the symptoms must be the main element or the only thing that the physician needs to recognize in each case of illness.” (This is Article 7 in the 6th edition, and the reference in brackets there is to Article 5).
Hahnemann unambiguously emphasizes that, while in chronic illnesses, miasms are to be taken into consideration, not be overlooked, no more than the secondary conditions mentioned in Article 7, it is, independently, the patient’s symptomatology that leads to the cure.
The unchanged former Article 81 becomes 66 in the 4th edition. It again stresses that, in practice, “everything the physician can find that is truly morbid and in need of cure . . . must consist only of the patient’s troubles and of the changes in his condition that are observable by the senses. In one word, only the totality of the symptoms. Whereas any imagined, interior cause or hidden condition can only be a futile fantasy” (Article 70 in the 6th edition).
Again, he separates an unprejudiced observation of the symptomatology from an interpretive, explanatory representation of symptoms according to a merely imagined cause as, for instance, of a chronic miasm looming in the background and also needing to be cured. Only the former can determine the choice of the remedy, the latter is mere fantasy.
Article 68 describes the difference between acute and chronic illnesses (Article 72 in the 6th edition). Article 70 is new and deals with so-called chronic illnesses that must be cured by a change in the deleterious life style that causes them (Article 77 in the 6th edition). The following three Articles, which are also new, develop Hahnemann’s theory on the truly miasmatic chronic illnesses (78), syphilis and sycosis (79) and psora (80). The footnote to 80, the “psora section”, gives an overview of the history of chronic illnesses, and further deliberations: If, in light of its concentration on the prevailing phenomena, and therefore its disregard of the chronological extension of the total symptomatology, homoeopathy could cure successfully even before the discovery of the nature of chronic illness, how much more content can it now be, given the much more specific remedies and the unique precept for their preparation and administration “among which the true physician may now select those whose drug symptoms are most similar to the chronic illness at hand.”
Article 87 (94 in the 6th edition) deals with the anamnesis for chronic illnesses. It is the unchanged 100 from the previous edition. Its footnote had already anticipated the incorporation into the case history of central areas, such as the menstrual symptoms in women’s chronic illnesses. Article 88 (95 in the 6th edition) continues the discussion of the anamnesis in chronic illnesses. It must be particularly thorough, descriptive, paying attention to detail and secondary conditions – it must include the exact symptoms and the totality of the symptoms. Article 109 from the 3rd edition became 97 in the 4th, to which was added a passage stating that the manner to record all symptoms and to select the characteristic ones is especially valid also for chronic illnesses (104 in the 6th).
In the (new) 203 (206 in the 6th edition) he discusses the prior query into the possibility of venereal diseases, so as to be able to recognize and to separate complications from syphilis and sycosis from simple psora. [Those who have not yet grasped the elementary difference between real chronic illnesses based on miasms and the imaginary “miasms” of today’s homœopaths who are theorising miasmatologists, should understand from this paragraph, that Hahnemann speaks exclusively of patients who really were afflicted with these contagious diseases and their “complications”- the latter’s simultaneous occurrence in patients. Those who speak today of psora-sycotic, psora-syphilitic or better yet, of psora-syco-syphilitic illnesses, patients or remedies, are not taking into account this substantial referential background which proves these modern theories to be devoid of any factual foundation and, consequently, it confirms their advocates’ lack of any justification for claiming themselves to be followers of Hahnemann.]
Once this is verified the patient must also (Article 204, 207 in the 6th edition) be interrogated regarding any allopathic course of therapeutic bathing.
Finally, age, lifestyle, diet, work, social status, etc, must be taken into consideration (an addition taken from the Chronic Diseases). This is not to be done for the purpose of selecting the remedy, but in order to find out the conditions that might impede or further the healing process during the treatment of chronic illnesses (205, 208 in the 6th edition).
Only then, according to 206 (209 in the 6th edition), can the outline for the exact picture of the illness, for the characteristic symptoms, be drawn: “Only then does the physician attempt . . . to draft the patient’s disease picture as completely as possible . . . in order to be able to select the most prominent and peculiar (characteristic) symptoms according to which he chooses as the first . . . remedy the one with the most similar signs, to begin the cure.”
The preceding includes all the important statements Hahnemann made in the Chronic Diseases and the 4th edition of the Organon , regarding the selection of remedies and the importance of miasms with respect to this selection.
The role the triad of miasms plays in the scientific homoeopathic business of healing can be summarized in the following short statements:
• Given the incidence of true syphilis, sycosis and scabies in patients in Hahnemann’s days, the triad of miasms is a medical hypothesis which had practical value under the conditions of practice of that time.
• None of the passages in the Chronic Diseases, nor any of the paragraphs in the Organon that were reformulated following the publication of the former, furnish any proof that Hahnemann’s theory of miasms – let alone its purely hypothetical further development under today’s different conditions of practice – has any immediate bearing as an attribute to the remedy selection in the scientific homoeopathic business of healing.
• On the contrary, Hahnemann effects an almost hygienic segregation between the theoretical doctrine of miasms and the conditions of cure in chronic illnesses in practice.
• The correct choice of the remedy must, as ever, be based on nothing but the patient’s given symptomatology, devoid of any hypothetical interpretations of these symptoms. A methodology of scientific cure tolerates no contamination with hypotheses, mere assumptions and fantasies.
Under these considerations, the contemporary preoccupation with the “question of miasms” as part of classical homoeopathy must be regarded as suspect, especially when considered from the standpoint of its founder.
What is essential today is an unprejudiced re-examination of the true foundations of Hahnemann’s homœopathy. This does not preclude a correctly understood reiteration of Hahnemann’s questions about the nature of the chronic illnesses; on the contrary, it rather commands it. But it must be based on today’s possibilities of medical knowledge and on real phenomena of human illness.
Friedrich Wilhelm Joseph Schelling, one of Hahnemann’s contemporaries, wrote: “If we wish to honour a philosopher (and Hahnemann, the great discoverer, certainly may be called that), we must understand him on the basis of his fundamental thought processes . . . whence he began, not on the basis of later interpretations.” (Philosophie der Offenbarung).
Hahnemann’s homoeopathy is founded on scientific grounds. This is whence any progression, his own as well as that of any future practitioner, must begin. On it rests the foundation for its vital evolution as well as that for any substructure capable of supporting any essential living development.
We do not pay homage to Hahnemann by an atavistic regression to a supposedly Hahnemannian question of miasms. In reality, such behaviour merely relegates Hahnemann into the confinement of a historical falsification, and thus is tantamount to his mummification.