Chronic diseases their peculiar nature & homoeopathic cure

A critical book review  by Dr Satheesh Kumar P K

This presentation, basically is my humble attempt in making a critical study of one of the great works of Dr. Hahnemann -“The Chronic Diseases Their Peculiar Nature and Their Homoeopathic Cure”

This paper is intended as a concise book review and a critical study of the work. One may wonder about the need and relevant to review and make critical study of a literary work published around two hundred years back. I myself started this work tentatively, but to my amazement I found most of what Dr. Hahnemann said in his work is very relevant even today and goes hand in hand with the development the world of science has made till this day. This proves that Dr. Hahneman was far ahead of his time. The work is an absolute proof to Dr. Hahneman’s genius.

Unfortunately I found that I disagree with some of his views, which I have given at the end of the critical study. He has made some hasty conclusion, inaccurate and self-contradicting statement in some of the places.  If my work helps in better understanding of the fundamental work of Dr. Hahnemann, I will consider that my work has served its purpose.

Name of book: The chronic diseases their peculiar nature and their Homoeopathic cure.
Number of volumes: Two volumes.
Author: Dr. Samuel Hahnemann. Translated from
2nd enlarged German edition of 1835 by    Prof. Louis H. Tafel with annotation by
Richard Hughes M.D. Edited by
Pemberton Dudley.M.D.
Publisher: B.Jain publishers PVT Ltd. New Delhi ( India )
Price: Rs- 250 (2 volumes set)
Current edition: Reprint edition 1990
Total number of pages: 1600 pages. First volume 855 pages
Second volume 745 pages (856-1600)
Total number of medicines: 48. First volume contain 25medicines and second volume contains 23 medicines.

History of this work
“The chronic diseases” is Hahnemann’s last medical work of fundamental importance. Earlier this work was published in five parts (volumes) and every part except the second had its own preface, discussing some questions of general interest to homoeopathy. In the beginning of the year 1826 Hahnemann wrote the first two parts of this work and although they together contain only 36 sheets his former publisher Mr. Arnold in Dresden took two years to publish these 36 sheets. The volume 3 of the “Chronic disease” published in the year 1837 with a preface, which deals with the technical part of the Homoeopathy.

Mode of construction 
At present this work has two volumes.
Volume –1
It has two parts. i.e. part one and part two.

Part 1 (Theoretical part) consists of:
1. Translator’s preface
2. Annotator’s preface
3. Editor’s preface
4. Author’s preface
5. Nature of chronic diseases
6. Cure of the chronic diseases
Cure
Sycosis
Syphilis
Psora
7. The medicines

Part 2 (Antipsoric medicines) consists of:
1. Preface (concerning the technical part of Homoeopathy)
2. Materia medica –begins with Agaricus and ends with Hepar sulph.
3. Index – to the first or theoretical part.

Volume 2.
Second volume has only one section.

1. Materia medica (23 medicines) — begins with Lycopodium and ends with Zincum.
Translators preface of first volume
(This is the second translation of this work to English. The first translation is done by Dr. Charles J. Hempel and published by Wm. Radde in the year 1845—6.)
Translators preface written by L.H. Tafel. Here, he describe about the mode of translation made from the original work. He has tried to translate the same German word by the same English word, except where words have several meanings.
There are few a words, which require a varied translation according to the context. For e.g: – “ Brust ” is used both for ‘chest’ and for ‘female breast’
He mentioned that the symptoms taken from the old school authorities (poisoning or over dose) are cited with small capitals and that of other provers (intentional proving or clinical experience) are given in italics as in the case of Materia Medica Pura.
E.g.: – Ars alb
Great anguish, trembling and quivering with severe tearing in the abdomen [ALLBERTI, I.C]
Anxiety with inexpressible anguish, he seemed on account of his increasing pains to lie at the point of death. [MORGAGNI, I.C.]
Violent vertigo with nausea, when lying down, he has to sit up to diminish it [Stf]
Pressive, drawing pain in the right side of the forehead [ Lgh ]
Stf –Stapf
Lgh –Langhammer.
There is no separate index for antipsoric medicines because this is furnished in various repertories, especially in that of Boenninghausen. There is a separate index for theoretical part of this work.

Annotator’s preface
In annotator’s preface to the Materia Medica section, Richard Hughes says that as Hahnemann became famous in the treatment of various illnesses, he had to pay more attention to the cases of chronic diseases; thereby he stopped to attend acute cases.
Among the three volumes of the 1st edition of the present work, two latter volumes contain the pathogenesis of 15 medicines, which are not present in Materia Medica Pura.

These medicines are
Ammonium carbonicum,  Baryta carbonica,Calcarea carbonica
Graphitis, Iodum, Lycopodium
Magnesia carbonica, Magnesia muriatica, Natrum carbonica
Nitric acidum Petroleum, Phosphorous
Sepia, Silicea, Zincum.

The pathogenesis of above medicines appear without a word of explanation as to how the symptoms were obtained and with out acknowledgement of fellow observers. At this time Hahnemann was 70 or 80 years old and he was not in a position to conduct proving up on him. So we are compelled to reach in a conclusion that these symptoms are mainly from his experience from treatment of cases.

Hahnemann recommended the medicines to be given in the dilution from 18 – 30th. When the lower triturations (up to 12th) were used, it produced violent symptoms in sufferers of chronic diseases, which make up the bulk of symptoms of the 1st issue of the chronic disease.

In the third volume which was published in 1837, two more medicines were added (Kali carb and Natrum mur) and additional symptoms are given for five other medicines (Carbo animalis, Carbo vegitabilis, Causticum, Conium and sulphur) which already given in Materia Medica Pura.

The second edition of the “ Chronic diseases” published in 1835 – 9 is translated here. It contains 48 medicines. (Besides 23 medicines of first edition it contains 25 others, of which 13 are new and 12 had already appeared in the Materia Medica Pura.)

The new ones are:
Agaricus   Alumina   Ammonium muriaticum
Anacardium  Antimonium crudum  Borax
Clematis   Cuprum   Euphorbium
Mezereum   Nitrum   Platinum
Sulphuris acidum

The old ones are:
Arsenicum  ,Aurum Colocynth
Digitalis  Dulcamara   Guaicum
Hepar sulphuris   Manganum   Muriatic acidum
Phosphoric acidum   Sarasaparilla    Stanum

Hahnemann strongly recommended the use of 30th potency in all drug proving in order to yield good results.

The editorial task of Richard Hughes falls into 3 categories
Richard Hughes appended a note to the list of “fellow observers” which were given by Hahnemann in the preface of each medicine. (This note gives an idea about the time of provers i.e. whether they were provers of the later or earlier times, manner of their experimentation, whether their observations already existed in print and what information we have about them).

In pathogenesis of drugs, the symptoms cited by other authors were thoroughly verified by Richard Hughes and made necessary correction and explanation to set it forth in its full meaning and value.
Additional information to the pathogenesis of symptoms is given at the bottom of the page; represented by small figures 1,2,3 etc and Hahnemann’s own annotations are designated by *, etc.

Editor’s preface
In editors preface Pemberton Dudley mainly deals with the peculiarities of style in writing s of Hahnemann, some of which are not at all common to our English polemical literature. He mentioned some peculiarities of style in writings of Hahnemann as follows
His long and involved sentences
His exceedingly frequent employment of parenthetical clauses and sentences and his not infrequent use of the parenthesis within parenthesis.
His multiplicity of iterations and reiterations occurring twice or thrice in a single paragraph. Sometimes twice in the same sentence.
His frequent interjection of words and phrases expressing a new some minor feature of the subject under discussion but forming no part of the discussion itself.
His introduction of qualifying words and phrases in certain peculiar and unusual connection likely to escape the notice of the casual or careless reader, but evidently indented by the author to be taken at their full significance and importance and to constitute an essential element of the discussion.
At the end of editor’s preface Plemberton Dudley says that no attempt has been made to render this work or any portion of it, a model of concise perspicuity. On the contrary the aim has been to retain, rather than to eliminate the characteristic style of the original text.

Author’s preface  
To the first edition – 1828
Here he expressed his doubt about the acceptance of his great discovery by the contemporaries in other school of medicines.
He criticizes the use of larger dozes which may tends to endanger the patients life.

Preface to the fourth volume
[Inquiry into the process of Homoeopathic healing]
In this preface Hahnemann explain the mode of action of Homoeopathic medicines and how the cure take place. He also mentioned that the vital force alone couldn’t overcome the miasmatic chronic disease. It required the aid of remedies of true healing art.

Preface to the fifth volume
[Dilution and potencies (Dynamization)]
Here he describe about the dynamization. Dynamization are process by which the medicinal properties which are latent in natural substances while in their crude state become aroused, and then become enabled to act in an almost spiritual manner on our life.
Dynamization usually done in two ways
1. In case of dry substance trituration is employed and
2. In case of liquid substance by means of shaking or succussion

The first or theoretical part  

Nature of chronic diseases:
Here he says about the usefulness of Homoeopathic medicines in the treatment of sporadic, venereal and acute diseases and he criticize the crude and inhuman ways of Allopathic treatment- like blistering plasters, leeching, cupping, pain killing narcotics, fumigations, starving treatment etc.

Hahnemann specify the importance of etiological factors which can alter health like some gross errors in diet, some violent exertion of the mind or body, repeated fright, great grief, sorrow and continuous vexation etc.

During the course of chronic disease some joyous occurrence or a pleasant journey, a favorable season, or a dry uniform temperature etc can induce a symptom free interval during which the patient considers himself healthy. But this favorable pause is of no longer duration. Frequent repetition of the well-selected remedy even in appropriate doses during the recurrence of the symptoms is found to be less effective.

Basic nature and progress of the chronic disease can never be changed by the well-selected Homoeopathic medicines. The only thing that can be done is to make a delay in its progress. In short the result of the Homoeopathic treatment in chronic disease is at their beginning were promising, the continuation less favorable and the out come hopeless. [All chronic diseases of mankind, even those left to themselves, not aggravated by a perverted treatment, such a constancy and perseverance, that as soon as they have developed and have not been thoroughly healed by the medical art, they ever more increase with the years, and during the whole of man’s life; and they can not be diminished by the strength belonging even to the most robust constitution. I.e. They never pass away of themselves, but increase and are aggravated even till death]

Even after the administration of most similimum Hahnemann observed a continuous relapse or recurrence of the symptoms occurred at variable intervals and thereby no complete cure. This made him think about the obstacles for complete cure and this led him to the discovery of the nature of the chronic diseases.

After a long lasting investigation and observation in most of the chronic diseases, the master had trace a history of “itch eruption” and many of the chronic sufferers had the disease since then. Many a time this itch was suppressed by faulty practice. Finally he could find out effective means against the original malady, which he named as “ psora”.

Hahnemann’s continued observations of several years taught him that not only most of the many cutaneous eruptions but also almost all adventitious formation- from the common wart to the sarcomatous tumor, from the malformation of the finger nails up to the swelling of the bone and the curvature of the spine are caused by psora. It is the most ancient, most universal, most destructive and most misapprehended chronic miasmatic disease which for many thousands of years has disfigured and tortured mankind and which during the last centuries has become the mother of all thousands of incredibly various chronic diseases by which the whole civilized human race on the inhabited globe is being more and more afflicted. It is the most hydra- headed of all the chronic miasmatic diseases.

The external manifestation of psora on the skin were often so quickly suppressed through baths, washes and ointments of sulphur and lead and by preparation of copper, zinc and mercury; thus in most cases the history of itch infection may remain undiscovered. External eruption of itch cannot only be drawn away by the faulty practices of physician and quacks but also it withdraws from the skin to affect the internal organ. But the syphilis and sycosis have greater advantages over the itch disease in that the chancre or fig warts can never leave the external part until the external repressive remedy destroys them or removed through the simultaneous internal cure of whole disease. The venereal diseases cannot therefore breakout so long as these external manifestations persist.

Oldest documents of history also show that psora was prevalent in several varieties and this was pointed out by Moses 3400 years ago. In Leviticus chapter 13 and 21 mentions about psora where the malignant itch is designated by the word “ garab ” which the Alexandrian translators translated with “ psora agria ”, the vulgate with “ scabies jugis ”.

In ancient times psora was mostly confined to its dreadful cutaneous symptoms. Only during the last few century mankind was flooded with a numberless infirmities like nervous troubles, spasm, painful ailments, ulcers (cancer), adventitious formation, dyscrasias, paralyses, consumptions and crippling of soul, mind and body etc. Hahnemann thought that the basic cause for this multitude of chronic disease was due to drinking of warm coffee and Chinese tea, which so largely increases the irritability of muscle fiber as well as excessive excitability of nerves. This undue prominence given to coffee drinking was due to the fact that Hahnemann had not then discovered the cause of chronic disease as psora.

Psora forms 7/8 of all chronic maladies while the remaining 1/8 springs from syphilis and sycosis or from a complication of two of these three miasmatic chronic disease or from a complication of all three of them. Psora is among all the diseases the one, which is most misapprehended, and therefore, has been medically treated in the worst and most injurious manner.

The modern physician of the common school considered every eruption of itch to be merely a local ailments of the skin with the remaining organism taking no part at all that their basis of treatment also like that (local application of sulphur ointment, solutions of lead and zinc, preparations of mercury etc.) These physicians think that the more quickly these eruptions are driven from the skin the better, and they discharges the patient from their treatment as cured. But it was found that they sooner or later return with some other malady following unavoidably on such a treatment e.g.: – with swelling, obstinate pain in one part or another, with hypochondriac or hysterical troubles, gout, consumption, tubercular phthisis, continual or spasmodic asthma, blindness, deafness, paralysis, caries of the bones, ulcers, spasms, hemorrhages, diseases of mind and soul etc which they consider as entirely new and treat it again in the routine way. After many years of such treatment their suffering continually worsened and at last freed from their hand by death, the end of all earthly maladies.

Many experience of Dr. Hahnemann in chronic diseases were frequently confirmed by observations of others, which are given as references.

Examples of such references are follows
1. Cysts of pus in the Intestines, Krause. Schubert, Diss.de scaie 29    humana, Lips 1770, p. 23.
2. Hydrocephalus, Acta helvet, V, p. 190.

All miasmatic maladies, which show peculiar local ailments on the skin, are always present as internal maladies in the system before they show their local symptoms externally up on the skin. Here the outer local symptoms may either be driven from the skin or may disappear of itself but the internal disease if uncured neither wholly nor in part ever leaves the system; on the contrary, it continually increases with the years, unless healed by art.

Three different important moments in the origin of chronic maladies are
Time of infection
Period of time during which the whole organism is being penetrated by the disease infused, until it has developed within and
Breaking out of the external ailment.

The whole interior man must first have become thoroughly sick before its external manifestation appears on the skin or other part of the body. In impure coition, the specific contagion arises in the spot, which is touched or rubbed, most probably at the very moment of act (immediately after the moment of contagion). The spot remains healthy according to appearance, only the internal organism is called into activity by the infection, so as to incorparate the venereal miasma. When the development of the venereal disease has been completed, the diseased internal organism tries to mitigate the internal evil and to sooth it, by producing a local symptoms which first shows itself as a vesicle and later breakout in to a painful ulcer called the chancre.

If the entire disease thus arising is extinguished through the internally given specific remedy, then the chancre is also healed and the man recovers. But if the chancre is destroyed through local application before the internal disease is healed (and this is still a daily practice with physicians of the old schools) the miasmatic chronic venereal disease remain in the organism as syphilis and it is aggravated, if not then cured internally, from year to year until the end of man’s life, even the most robust constitution being unable to annihilate it within itself.

Psora is much more infectious than the other two chronic miasmata (the venereal chancre disease and fig wart disease). To effect the infection with the latter certain amount of friction is required in the tenderest part of the body as in genital organs or the miasma should touch a wounded spot. But the miasma of the itch needs only to touch the general skin. The disposition of being affected with the psoric miasm is found with almost everyone and almost all circumstances, which is not the case with the other two miasmata.

No other chronic miasma infects more generally, more surely, more easily and more absolutely than the miasma of itch. Psoric miasma can infect through gloves (which had been tried on by an itch patient), towel (contaminated), baby may be infected while passing through the organs of the mother or the baby receives this unlucky infection through the hand of midwife. Here, Hahnemann mentioned there are thousands of possible ways in which things polluted with this invisible miasma may touch a man in the course of his life, so that man who never been infected with the psora are the exception. He also mentioned that the chances of infection are more in crowded hospitals, factories, and prisons or in orphan houses or in the filthy huts etc.

Usually it takes one to two weeks, from the moment of infection, for the development of itch miasm. No eruption or itching will be seen on the skin during the first few days. Thereafter when the infection invades the whole organism the local symptoms break forth, the itch vesicles. After this period with a slight or severe chill in the evening and a general heat followed by perspiration in the following night the itch vesicles come out.

When this chronic miasmatic disease affects the whole organism, the diseased vital force endeavors to alleviate and to soothe the internal malady through the establishment of suitable local symptoms on the skin, the itch vesicles. So long as this eruption remains in its normal form, the internal psora with its secondary manifestations cannot rise, but must remain in latent form (latent psora). These troublesome eruptions act as frontrunner of the internal disease and keep the patient free from secondary ailments. Only in this stage the disease can easily be cured by internal administration of well-selected Homoeopathic medicines.

As a result of suppression of primary manifestation of psora by local application or by non- Homoeopathic internal medicines it is driven inwards and remains in a dormant state, which is dangerous. It is called latent psora.

Symptoms of latent psora  

In children:
Ascarides and other worms. Distended abdomen. Insatiable appetite or want of appetite.
Head—frequent one-sided headache even from moderate emotional disturbances. Falling of hair. Scales up on the scalp.
Face- pale. Swelling of cervical glands.
Eyes – Frequent inflammation of the eyes.
Nose — Predisposition to catching cold
Epistaxis in girls and youth.
Long continued obstruction of one or both nostrils.
Dryness or ulcers of nostrils
Mouth — White or pale tongue with cracks. Bad smell from mouth especially in early morning and during the menses. Sour taste inthe mouth.
Throat – frequent pain and hoarseness.
Stomach — Aversion to milk and meat.
Nausea in the morning. Sensation of emptiness in stomach.
Repugnance to cooked, warm food.
Rectum — Hemorrhoids; passage of blood with stools
Constipation with hard stools often covered with mucus.
Itching of anus
Urine — dark urine
Chest — Frequent attack of dyspnoea.
Extremities – Numbness and cramps.
Predisposition to strains even from carrying or lifting a slight weight. Varicose vein. Cracking in one more joints when walking.
Female – Amenorrhoea and all types of menstrual irregularities.
Perspiration- On the head during sleep
On the palms with coldness
On the feet with offensive smell
Perspiration breaks out too easily even with little movement or
Inability to bring out perspiration
Sleep – Unrefreshing sleep.
Frightful dreams
Skin — Unhealthy, dry skin, every little lesion passes into sores; cracked skin of the hands and of the lower limbs. Frequent boils and felons. Rough scaling spot on the skin which causes itching and after rubbing a burning sensation.
Modalities – Aggravation – while at rest, night and winter
Amelioration – while in motion
A person who has the psora slumbering within him, will still consider him self as healthy and is supposed to be so by others, especially when he living under favorable external relations (satisfactory income, do not live in vexation or grief, no overexertion etc).
But when his health have been very much weakened by an exciting or maintaining causes like an acute infectious disease or a shock, fall, severe burn, the breaking of a leg or arm, hard labor, the sad losses of beloved relatives etc, the latent psora awakens and appears as numerous chronic diseases of psoric character termed as secondary manifestation of psora.

Secondary manifestation of psora
Mind– Inability to think or to perform mental labor. Melancholy. Anxiety with restlessness. Usually the patient then find no rest, but has to run here and there and often falls in to perspiration. Weeping disposition.
Weeps for several hours without any cause. All types of fear – fear of fires, fear of being alone, of being insane etc. Changeability of mental state.
Vertigo– Vertigo — while walking, when closing the eyes, on turning around briskly, when down or upward.
Head — Head ache in the morning immediately on waking. Headache with marked periodicity. Head ache after mental exertion. Throbbing headache with violent nausea and vomiting. Itching of scalp with or without dandruff. Eruption on the head. Taenia capitis with   crusts. Falling of hair.
Face – Frequent redness of face. Long lasting scabs under the nose or on the upper lip. Cutaneous eruptions of the beard with itching.
Eyes – Photophobia especially to daylight. Inflammation of eyes.
Yellowness of white of eyes. False vision – (diplopia, see only one half etc). Short sightedness / Farsightedness. Night blindness/ day blindness.
Ear — Over sensitiveness to noise. Many sounds cause pain in the ear.
Offensive discharge from ear.
Nose — Epistaxis. Nasal obstruction with dryness. Nasal polyp with anosmia. Sense of smell perverted. Fetid smell in the nose.
Mouth – Easily bleeding gum. Grinding of teeth during sleep. Looseness of teeth and many kinds of deterioration of teeth even without toothache. Pain in tooth aggravated during night. White coating on tongue with cracks. Dryness of tongue. Stutting and stammering. Fetid smell from mouth. Continued spiting of saliva.
Throat – Frequent inflammation and swelling of throat
Stomach Eructation with smell of food several hours after eating. Empty & loud eructation. Sour eructation after milk. All symptoms of bdomen All symptoms of hyperchlor hydria. Pain stomach eating after. Distension of abdomen with flatulence
Rectum — Constipation with repeated ineffectual urging for stool. Stools  hard as if burnt, in small knots like sheep dung. Stools in the beginning very hard and troublesome followed by diarrhea.
Frequently repeated diarrhea with cutting pain in the abdomen lasting many hours or days. Prostration after stools. Bleeding piles with or without pain.
Urine — Painful retention of urine. When he is chilled he cannot urinate.
Involuntary dribbling of urine while walking, sneezing, coughing or laughing. Increased frequency for urine during night.
Male — Discharge of prostatic fluid while straining at stool or urine.
Nocturnal seminal emission. Long continuing, painful erection without pollution. Hydrocele. Indurations and enlargement of prostatic gland. Lack of sexual desire in both sexes.
Female — Irregular menses or all types of menstrual irregularities.
Leucorrhoea several days before menses.
Respiratory — Hoarseness after exposure to slight cold or least use of voice.
Cough mostly in the evening after lying down and whenever the head lies low. Cough aggravated at night and after eating.
Cough with yellow expectoration. Asthma especially after midnight. The patient has to sit-up and stooping forward. He has to open the windows. Aggravation from motion.
Chest — Pain in the chest on walking as if the chest was about to burst. Pain and enlargement of breast with indurating gland.
Extremities — Pain in the heel and soles of the feet while standing. The     joints of the fingers swollen with pressive pain. Painful when touching or bending them. Increasing disposition to strains.
The joints are easily sprained at any false movement.
Softening and curvature of spine and long bones.
Sleep — nightmare – restless sleep from frightful dreams. Sleepiness during the day especially after meals. Cannot sleep after 3 o’ clock in the morning. Sad, anxious, frightful lascivious dreams. Loud speaking or screaming during sleep. Somnambulism. Unrefreshed sleep— more tired when rising from sleep than in the evening when retiring.
Skin — various types of skin eruptions like [1] herpes –dry or moist with itching and burning after rubbing them. [2] Crusts – raised above the surrounding skin with deep red painless borders. [3] Small round spots on the skin, covered with bran like dry scales. [4]
Freckles in the face, hands and chest. Yellowness of the skin. Warts on the face. Dryness of skin. Glandular swelling around the neck and groin. Corns with burning lancinating pain. Boils returning from time to time, especially in the thigh, the upper arm and body. Pimples without pain in the face, the chest, the back, the arm and the thigh. Frequent flushes of heat especially in the face. Warm air in the room make her rest less- causes her to move about.
Fever – all types of intermittent fever.
Perspiration – One-sided perspiration – Only on one side of the body.
Only on upper part
Only on lower part

These are the characteristic secondary symptoms of the long unacknowledged, thousand headed monster, pregnant with disease, the psora, and the original miasmatic malady, which now makes its manifest appearance.
When the above- mentioned symptoms occur repeatedly or become constant, which showed that the internal psora is coming forth from its latent state.

Cure of the chronic diseases:
Cure
Here Hahnemann describes about the Homoeopathic medical treatment of large number of chronic diseases. The treatment of chronic disease becomes impossible without the help of Homoeopathic anti-miasmatic medicines.
The two miasmata- syphilis and sycosis cause a smaller part of the chronic disease; will treat first in order to make the path free to the therapeutics of the immeasurably greater number of the various diseases, which spring from the psora.

Sycosis
The sycosis is the miasma, which produces the fewest number of chronic diseases and has only been dominant from time to time. This miasma was treated almost always in an inefficient and injurious manner internally with mercury but the excrescences on the genitals were treated by the most violent external ways by cauterizing, burning and cutting or by ligature. The first manifestation of sycosis are these genital excrescence that almost always associated with a urethral discharge, which appears several days to several weeks after infection with coition.

Even after this sort of violent treatment, these excrescences come forth again and they are subjected again to this painful cruel treatment and are always vain.

After this sort of treatment, the fig wart disease which is deprived of the local symptoms, would appear in other and much worse ways, in secondary ailments; because the fig wart miasma which rules in the whole organism, is in no way diminished or destroyed by the external treatment of excrescence or by the internal treatment with Mercury.

The use of Mercury in the treatment of sycosis can only deteriorate the general health of the individual, because it is usually given in very large doses of most active preparations. When general health of the individual become weakened by this type of violent treatment, similar excrescence then breakout in other parts of the body as spongy, sensitive flat elevations in mouth, tongue, palate, lips or large raised tubercle in the axilla, neck and scalp.

Hahnemann says that, the whole sycosis dependant on the fig wart miasma, as well as the excrescence, can only be cured most surely and thoroughly through the internal use of Thuja. When the action of Thuja exhausted it should be alternated with a small doses of Nitric acid, which must be allowed to act as long a time in order to remove the whole sycosis There is no need to use any external application except in the most inveterate and difficult cases. In that cases the fig warts are moistened every day with the mild pure juice prepared from the green leaves of Thuja, mixed with an equal volume of alcohol.

If the patient was at the same time affected with another chronic ailment, i.e. psora complicated with sycosis or both the miasma (psora and sycosis) are conjoined in threefold complication with syphilis; then it is necessary to treat the psoric component first, with specific antipsoric medicines. Then to make use of the remedy for sycosis and lastly proper dose of the best preparation of Mercury is given against syphilis. The same alternating treatment may be continued until a complete cure is affected.

Syphilis
The syphilis is the chronic miasma, which is more widely spread than sycosis.
In the cure of the venereal disease three states are to be distinguished.
When the syphilis is still alone and attended with associated local symptoms (chancre) or the local symptoms has been removed by external application or associated with some other local symptoms which act vicariously for the internal disorder.
When syphilis is alone (without any complication with the other miasmas) and deprived of the local symptoms.

When it is already complicated with another chronic disease. i.e. with psora which is already developed , while the local symptoms may either be present or has been removed by local application.

Impure coition is the usual way through which syphilitic miasma pervade the whole organism, at the same moment of exposure. So all wiping off and washing off the part however speedy, and with whatever fluid this be done is too late—is in vein.
The chancre appears after an impure coition usually between 7th and 14th days; first as a little pustule which changed in to an ulcer with raised borders and stinging pain which if not cured remain on the same place without any secondary symptoms.

The Allopathic physician destroys the chancre by means of corroding, cauterizing and desiccating substances and they suppose that they remove all the venereal disease from the patient. This type of destruction of chancre compels the organism to replace the destroyed chancre by a far more painful substitute –‘the bubo.’ When this bubo drives out through the injurious Allopathic treatment, the nature find itself compelled to develop the internal malady through far more troublesome secondary ailment, through the outbreak of the whole chronic syphilis

The syphilitic miasma can be cured easily, especially when it is not complicated with other miasma or chancre has not yet been driven out by local application. Hahnemann says “ that there is on earth no chronic miasma, no chronic disease spring from a miasma which is more curable and more easily curable than this (syphilis).”

When this syphilitic miasma (first state) not complicated with other chronic ailment from a psoric, latent psoric or sycotic origin but with its associated local symptoms –the chancre, then it needs only one little dose of the best Mercurial remedy in order to cure thoroughly and forever the whole syphilis with its chancre.

In second state (where the syphilitic miasma is not complicated with other chronic disease which spring from the psora or sycosis but has experienced the injudicious driving away of the chancre through the local applications) the internal administration of mercurial medicines will prevent the all outbreaks of secondary venereal disease and the man may be freed from every trace of the venereal miasma.

Cure of third state of syphilis is most difficult when compared to first and second state. Here the syphilis usually complicated with psora. The latent psora cannot obstruct the cure of syphilis. But when the syphilis complicated with developed psora it is impossible to cure the venereal disease alone.

When the syphilis complicated with awakened psora, this combination is called masked, spurious syphilis or pseudo syphilis—a monster of a double disease and it is very difficult to cure. Treating the psoric component first with the suitable antipsoric medicines and then the syphilitic component by the proper dose of the best mercurial remedy can cure such a masked venereal disease.

If the patient was at the same time affected with another chronic ailment, i.e. psora complicated with syphilis or both the miasma (psora and syphilis) are conjoined in threefold complication with sycosis; then it is necessary to treat the psoric component first, with specific antipsoric medicines. Then the one of the other two chronic miasmata, the symptoms of which were at the time most prominent and then last one.

Psora
Psora is the most ancient, most universal, most destructive and most misapprehended chronic miasmatic disease which for many thousands of years has disfigured and tortured mankind and which during the last centuries has become the mother of all thousands of incredibly various chronic diseases by which the whole civilized human race on the inhabited globe is being more and more afflicted. It is the most hydra- headed of all the chronic miasmatic diseases.

For to get an infection of any one of the chronic miasmatic disease, it needs only one moment, but for the development of this infection and to becomes a general disease of the organism it needs a longer periods. Unless and until the miasmatic disease has received its complete internal development in the whole man there is no manifestation of local symptoms. When the local symptom breaks forth, it usually appear on the least dangerous part of the body, so that it may not be able to injure and endanger the vital economy too much.

Then we know that cutaneous eruptions are external manifestation of the internally deranged vital force. But the physicians of the school consider that itch is nearly a disease of the skin in which the internal portion of the body takes no part. So they follow the injurious practice of the external cauterization and suppressive methods through baths, washes and ointments and they’re destroying the original cutaneous eruptions. When the destruction of the original cutaneous eruptions take place, the psora is put in the unnatural position and compelled to develop its secondary symptoms. (When the original itch eruption driven out by local application, we may see from the fact that most severe chronic ailment have followed as secondary symptoms of the internal psora.)

As the original eruption of psora gives some ideas about the internal malady, then the entire disease of the psora may be cured most easily, quickly and surely while it present in its primary state and position. It remains an established truth that the cure of the entire destructive psora through antipsoric remedy is effected most easily only while the original eruption of itch is still present.

Used in small doses, sulphur as one of the antipsoric remedies will not fails to make a brief beginning of a cure of the chronic disease. But excessive uses and frequent repetition of sulphur in chronic diseases, have taken away from it all value and use.

The cure of an old psora that has been deprived of its eruption weather it may be latent and quiescent or already broken out in to chronic disease can never be accomplished with sulphur alone nor with sulphur baths either natural or artificial. Recent itch disease with its primary cutaneous eruption is easily cured from with in by very small dose of a properly potentised preparation of sulphur. But the other psoric diathesis i.e., latent psora &developed psora with its secondary manifestation is very seldom cured by any single antipsoric remedy but requires the use of several of these remedies – in the worst cases the use of quite a number of them one after the other for its perfect cure.

Diet and mode of living in relation with cure  
Diet and mode of living of patient has some vital role in the cure of chronic disease. The daily laborer, if his strength allows, should be continue his labor.

Only labors that would interfere with the health of healthy person should be interdicted. Person with sedentary habit should be directed during their cure to walk more in open air. All classes of chronic patients must be forbidden the use of any domestic remedies or the use of any medicines on their own account. With the higher classes, perfumeries, scented water, tooth powders and other medicines for the teeth must also be forbidden. The physician cannot yield to the request of patients for the continuation of their customary home bath. This part must be left to the intelligence of the rational physician

Coffee?  
Chronic patients must give up coffee, which is insidiously injurious and this patients who have the proper confidence in their physician when it is properly represented to them almost without exception, do willingly and gladly, to the great improvement of their health. Rye or wheat, roasted like coffee in a drum and then boiled and prepared like coffee, has both in smell and in taste much resemblance to coffee can be used as a substitute for coffee with out any injurious effect.

Spiritual liquors?
A sudden abstinence from habitual use of wine would produce a sudden sinking of their strength and an obstruction to their cure and might even endanger their life. But they will allowed to drink it during the first week mixed with equal parts of water, and later, gradually wine mixed with two, three and four and finally with five and six parts of water and a little sugar. The latter mixtures may be allowed to all chronic patients as their usual beverage.

More absolutely necessary in the cure of the chronic diseases is the giving up of whisky or brandy. The consumption of beer is also having some injurious effect on proper improvement of their health, so the honest physician cannot allow his patient to drink beer.

Our vital force always produces in the human organism the opposite of the impressions caused by physical and medicinal potencies in all cases in which there are such opposites. Thus the spiritual liquors, after having stimulated refreshment and heightened vital warmth immediately after partaking them, must have just the opposite after effects, owing to this opposite reaction of the vital force of the organism. Weakness and a diminution of the vital warmth are the inevitable consequences of their use, that every true physician must remove this state as far as possible from the chronic patient. A genuine Homoeopathic physician will never allow his patient to drink the spiritual liquors.

Among the articles of diet which are generally injurious to chronic patient are given below:
All dishes containing vinegar or citric acid,
Very acid fruits like sour cherries, unripe gooseberries etc (are to be allowed in very small quantities)
Sweet fruits (only in moderate quantity)
Chickens and eggs (are to be allowed in very small quantity especially to those whose sexual powers are low)
Saffron and cinnamon (are to be avoided by ladies with scanty menses)
Cinnamon, pepper, ginger and bitter substances (should avoid person with weak stomach)
Vegetables causing flatulency should be forbidden in all abdominal troubles.
Salt –only little should be used.
Pickled and smoked meats should be rarely used and only in small quantities.
Old rancid cheese must be avoided
Smoked fish and salted fish should be rarely used and only in small quantities.
Smoking should be always be limited especially when the mental activity, sleep, digestion or evacuation are defective.
Snuff is a great hindrance in the cure of chronic disease there for it cannot be allowed with such patients.
There are certain injurious influences which resulting in the outbreak of latent psora into serious chronic disease. Some of them are given below:
Bodily injuries and wounds.
Excess of cold or heat
Unsatisfied hunger of poverty
Disappointment in love
Grief
Unexpected loss of dearest person etc.

What are the important hindrances to the cure?
Allopathic treatment   
Allopathic treatment which has no true healing power with respect to the disease, but internally assaults other delicate parts and  gans of the body, in such cases the vital force, in order to protect the whole from destruction, dynamically and organically transmute these fine organs, i.e. either make them inactive or paralyzes them or dull their sensitiveness or make them altogether callous. On the one side the most tender fiber is abnormally thickened or hardened and the more vigorous fibers consumed or annihilated then there arise artificially adventitious organism, malformations and degeneration, which at postmortem examination are cunningly ascribed to the malignancy of the original disease. Such an internal state is so frequent, and is in many cases incurable.   For who could find remedies for all these ailments artificially produced by a confused mass of strong unsuitable medicines?

Modern so called civilized life
A similar great hindrance to the cure of far advanced chronic disease is often found in the debility and weakness into which youth fall who are spoiled by rich parents and seduced by wicked companions through destructive passions and excesses, through reveling, abuse of sexual instinct, gambling etc.

Suppressed sexual instinct
Another important obstacles to the homoeopathic cure of chronic disease is the suppressed sexual instinct with marriageable person of either sex, either from no marriage owing to various causes not removable by a physician or when in married person sexual intercourse of an infirm wife with a vigorous husband or of the infirm husband with a vigorous wife has been absolutely and for ever interdicted.
A cure will certainly effected if the above-mentioned obstacles do not prevent by a judicious use of the antipsoric remedies, but only with much patience and considerable time and only with patients who observe the directions and who are not too aged nor too much debilitated.

Homoeopathic physician must know how to use the antipsoric remedies for the cure of chronic disease successfully. Hahnemann warns the physician to be cautious about the dose, unwanted hastiness of repetition and wrong choice of remedy.

Choice of remedy:
Since the majority of the chronic diseases spring from psora alone so it can be cured thoroughly by antipsoric medicines only. (Antipsoric remedies are remedies, which in their proving on the healthy human body manifest most of the symptoms, which are most frequently seen in latent as well as in developed psora)

Avoid hastiness in repetition:
Well selected homoeopathic antipsoric medicine and which given in the appropriate potency and in the proper dose should allow to finish its action without disturbing it by an intervening remedy.

If symptoms were occurred during the action of the remedy and such occurrence have also occurred in some weeks before or some months before in a similar manner are merely a homoeopathic excitation, through the medicines and they are a sign that the medicines acting deeply in to the essence of the disease and that consequently it will be more effective in the future. The medicine, there fore, should be allowed to continue and exhaust its action undisturbed without giving the least medicinal substance between its doses.

But if the symptoms are different and had never before occur or never in this way and there for are peculiar to this medicine and not to be expected in the process of the disease. Such symptoms frequently pass off without interrupting the helpful activity of the remedy. But if they are of a burdensome intensity, they are not to be endured, in such a case it is a sign that the given antipsoric medicines were not correct. Its action must then be checked by an antidote or when no antidote to it is know another antipsoric medicines more accurately answering its symptoms must be given in its place.

Usual customary symptoms are aggravated during the action of the remedy and show most prominently on the first days but gradually less and less. This so-called Homoeopathic aggravation is a sign of an incipient cure, which may be expected with certainty.

But if these aggravated original symptoms appear on subsequent days still of the strength as at the beginning or even with an increased severity it is a sign that the dose of the antipsoric medicine, although properly selected according to the Homoeopathic principle, was too large and no cure will be effected by it.

The antipsoric medicines in chronic diseases continue their action for a longer period (30, 40 even 50 days) but those medicines, which in the healthy body show a large period of action, act only a short and quickly in acute disease, which speedily run their course.

Action of an appropriately selected antipsoric medicines are never interfered either by another antipsoric medicines or by a new dose of the same remedy, both will interrupt the complete action of the preceding remedy. This method forbids any new prescription, any interruption by another medicines and forbids as well the immediate repetition of the same remedy. (An immediate repetition of the same medicines is allowable when the dose of a well-selected remedy has made some beginning toward an improvement but its action leaves too quickly and the cure does not proceed any further). It is better to give a different degree of dynamic potency when repetition is necessary.

In order to make the Homoeopathic dose moderate and soft, the method of inhalation of the selected remedy in suitable potency is applicable by Homoeopathic physician.
Physician should be given every day at the usual time for medicine a dose of sugar of milk about 3 grain, in order to fill up the many days after giving a dose.

During the treatment of chronic disease by antipsoric remedies we often need the other non- antipsoric medicines in cases where epidemic or intermediate diseases arising usually from meteoric and telluric causes and attack our chronic patients and it disturb and interrupt the treatment for a longer time. Here other homoeopathic remedies will have to be used and during that period the antipsoric treatment must be totally discontinued until the treatment of the epidemic diseases were over. After the disappearance of the intermediate disease, physician must choose his antipsoric remedy according to the totality of the remaining symptoms and this medicine administered for the continued treatment of the patient.

The frequent request of patient to have one symptom, which above others is troublesome to him, removed first of all, is impracticable, but the ignorant patient should be excused for his request.
How and when to takes the antipsoric medicines to get maximum benefit for the patient?
The best time for taking a dose of antipsoric medicine seems to be early in the morning while fasting. It should be taken in dry and allowed to dissolve in the tongue or be moistened with 2 or 3 drops of water on a spoon and by itself, without in either case drinking any thing after it or eating anything within half an hour or a whole hour.

After taking the medicine the patient should keep perfectly quiet at least a full hour without going to sleep (sleep delays the beginning of action of medicine). He must avoid throughout the treatment all disagreeable excitement and strain immediately after taking the dose.

The dose of antipsoric medicines must not be taken by female shortly before their menses are expected, or during their flow, but the dose can be given if necessary four days after the menses have set in. but incases the previous menses have been premature or too profuse or too long lasting it is often necessary to give on this fourth day small dose of Nux vomica to be smelled and on the 5th or 6th day following the antipsoric.

During pregnancy the symptoms of the internal psora are often manifested most plainly, on account of the increased sensitiveness of the body and spirit while in this state, the antipsoric medicine therefore acts more definitely and perceptibly during pregnancy, which gives the hint to the physician to make the dose in these cases in small and in as highly potentized attenuations as possible and to make his selection in the most Homoeopathic manner.

Sucklings never receive medicine, the mother or wet- nurse receiving the remedy instead and through their milk it acts on the child very quickly, mildly and beneficially.

The medicines
In this section Hahnemann mentioned about the medicines, which are found most suitable in the treatment of diseases originated from psora, syphilis and fig- wart miasma.
Hahnemann says that we need only few remedies to treat syphilis and fig wart disease than psora, since the psora is the most universal and which forms 7/8 of all chronic maladies while the remaining 1/8 springs from syphilis and sycosis or from a complication of two of these three miasmatic chronic disease or from a complication of all three of them. The mode of living and occupation with their inherited bodily constitutions gives to the psoric diseases so many modifications, so that more numerous and varied remedies are needed for the extirpation of all those modifications of the psora—known as antipsoric remedies.

Antipsoric substances: While proving several powerful substances on healthy body produced symptoms which are similar to the clearly defend psoric diseases.
Next, Hahnemann describes about the preparations of medicines peculiar to Homoeopathy –(i.e. trituration & succusion) by which not only the medicinal powers are incredibly developed but also change their physico chemical demeanor in such a way that they become wholly soluble in water as well as in alcohol—a discovery invaluable to the healing art.
E.g.: – the brown black juice of the marine animal sepia which was formerly only used for drawing and painting, is in its crude form soluble only in water not in alcohol but by trituration it become soluble also in alcohol

SECOND PART
ANTIPSORIC MEDICINES-  PREFACE
(Concerning the technical part of Homoeopathy)  

Here Hahnemann describes about the best possible mode of administration of the doses of medicines to the patients.
A small pellet of one of the highest dynamization of medicines laid dry up the tongue, or the inhalation of an opened vial, which contain one or more such pellets –is the smallest and weakest dose with the shortest duration of action.
(A pellet is the finest of the size of poppy seeds of which about 200 weigh a grain)

Hahnemann from his experience says that it is most useful in diseases to give the patient the powerful Homoeopathic pellet or pellet only in solution and this solution in divided doses. In this way medicines dissolved in 7 to 20-tablespoonful of water with out any addition, in acute and very acute disease even 6, 4 or 2 hours, when the danger is urgent every hour or every half hour, a tablespoonful at a time; with weak person or children only a small part of a table spoon may be given as a dose.
But in chronic diseases it best to give a dose of solution of the suitable medicine at least every two days more usually every day.

Our vital force cannot bear the same unchanged dose of medicine when given twice in succession even in less frequency to a patient. By the frequent repetition, the good effect of the former dose of medicine is either neutralized in part or new symptoms proper to the medicine appear, and which obstruct the cure. Thus even a well-selected Homoeopathic medicine produces ill effects on the organism and attains its purpose imperfectly or not at all.

When a particular medicine is found effective in a case and it become necessary to take the one and the same medicine repeatedly, it is better to make a modification in its degree of dynamisation in order to receive the same medicine by vital force calmly and willingly at brief intervals.
This slight change in the degree of dynamisation is attained by shaking the bottle, which contain the solution of medicine, 5 or 6 times every time before taking it.

When a particular medicine is found effective in a case and the repetition is indispensable to secure the cure of a serious chronic disease, here Hahnemann suggest the repetition of same medicine in a lower potency. (E.g.: – if before he had used the 30th dilution, he will now take one or two pellets of the 24th). This solution of the lower potency must be shaken 5 or 6 times before taking it. This will be continued so long as the remedy still produces improvement and until new ailment appear for in such a case a new remedy will have to be used.

On any day when the remedy has produced too strong action, the dose should be omitted for a day.
Well selected Homoeopathic medicine can be administered through the sensitive spot other than the nerves of the mouth and the alimentary canal, i.e.: – if the same remedy that has found useful is at the same time in it’s watery solution rubbed in into one or more parts of the body which are most free from the morbid ailments (e.g., on an arm, or on the thigh or leg which have neither cutaneous eruption, nor pains or cramps) – then the curative effects are much increased. The limbs, which are thus rubbed with the solution, may also be varied, first one then another. Thus the physician will receive a greater action from the medicine Homoeopathically suitable to the chronic patient and can cure him more quickly, than merely internally administering the remedy.

This procedure will also explain the wonderful cures. E.g.: – Chronic crippled patients with sound skin recovered quickly and permanently by a few baths in a mineral water. The limb, there for, on which the solution is to be rubbed in, must be free from cutaneous ailments.

Frequently it is useful in treating chronic diseases to take the medicine, or to rub it in the evening, shortly before going to sleep, because we have then less disturbance to fear from without, than when it is done earlier
In cases where a great irritability of the patient is combined with extreme debility, and the medicine can only be administered by allowing the patient to smell a few pellets contained in a vial, when the medicine is to be used for several days, allow the patient to smell daily of a different vial containing the same medicine, but every time of a lower potency, once or twice with each nostril.

ANTIPSORIC MEDICINE
List of medicines of first volume is as follows:
1. Agaricus muscarius
2. Alumina
3. Ammonium carb
4. Ammonium mur
5. Anacardium orientalis
6. Anti crudum
7. Ars alb
8. Aurum
9. Aur mur
10. Baryta carb
11. Borax veneta
12. Calcarea carb
13. Carbo animalis
14. Carbo veg
15. Causticum
16. Clematis erecta
17. Colocynthes
18. Conium mac
19. Cuprum
20. Digitalis
21. Dulcamara
22. Euphorbium
23. Graphatis
24. Guajacun
25. Hepar sulphuris calcareum

List of medicines of second volume is as follows:
Iodum
Kali carb
Lycopodii pollen,
Magnesia carbonica
Magnesia muriatica
Manganum
Mezerium
Muriatic acid
Natrum carb
Natrum mur
Nitric acid
Nitrum
Petroleum
Phosphorus
Phosphoric acid
Platina
Sarsaparilla
Sepia
Silicea terra
Stanum
Sulphur
Sulphuric acid
Zincum
(Name of the medicines has some difference when compared to modern materia medica. The common name of the medicine is also given along with the name of medicines. )

General presentation of a medicine is as follows:
Begins with the name of medicines and its common name. Then there is a brief introduction about the medicines which include – the parts from which the Homoeopathic medicines prepared, its non Homoeopathic or empirical uses
Symptoms are arranged in the usual schematic order seen in other materia medica. (Mind, vertigo, Head, eye, ear, nose, face, mouth, throat, stomach and abdomen, rectum and stool, urine, male, female, respiratory, chest, back, extremities- upper and lower, sleep & fever.). But there is no separate heading for these symptoms.
Abbreviation of the name of his fellow observers are given at the introductory part of each medicines and this abbreviations are given at the end of the each symptoms which designate the name observer of that symptoms.
Symptoms are numbered in groups of five. I.e. symptoms are numbered as 5,10, 15, 20, 25 etc.
E.g.:-for annotation of Richard Hughes – under Antimonium crudum
Gangrene of the foot, which is quite black (388th symptom) [WEPFER, 1ibid.]
1. This set in soon after violent vomiting had subsided (? Embolism)—Hughes.

A general analysis and a critical study
After a detailed study of this book I would like to say that
Dr. Hahnemann was a great man with indescribable foresight and we are very much inducted to him for his invaluable discoveries, he made in this new system of medicine. Many of his observations, which he made two hundred years back, even without the proper facilities for investigation and modern equipment, are still found relevant, without much change.

The earliest discovery of a pathogenic microorganism was probably made by Augustine Barsi (1835) who showed that the muscardine disease of silk worms was caused by a fungus. Oliver Wendell Holmes in the USA and Ignaz Semmelweis in Vienna 1846 had independently concluded that peripheral sepsis was transmitted by the contaminated hands of obstetricians and medical students and demonstrates the efficacy of simple measures such as washing hands in an antiseptic solution. Robert Koch made discovery of bacilli, as the causative organism of various infectious diseases in 1882. All these inventions were made either during the time of Hahnemann or many years after the death of Dr. Hahnemann. But we are able to see from his work, that Hahnemann was able to realize the infective nature of the disease, its way of spread and the method of prevention very accurately. (But certain postulates regarding the invisible causative organism of disease were present many years before the time of Hahnemann. Varo and columella in the first century BC postulated that diseases were caused by invisible beings inhaled or ingested. Fracastorius (1546) proposed a contagium vivum as the possible cause of infectious diseases and Von Plenciz (1762) suggested that each disease caused by a separate agent. In 1683 Antony Von Leeuwenhock made accurate description of various types of bacteria.)

Hahnemann explains three important things to be considered, with respect to the origin of the chronic disease, they are:
1.The time of infection,
2.The period of time during which the whole organism is being penetrated by the disease infused, until it has developed within and
3. The breaking out of the external ailment.
These findings were later clarified by the modern science and they described each infectious disease under the title as 1] Time of infection. 2] Incubation period. and 3] clinical manifestation (clinical features).

Hahnemann had also explained the various factors, which lead to the spread of this disease. He mentioned there are thousands of possible ways in which things polluted with this invisible miasma may touch a man in the course of his life, so that man who never been infected with these miasma (especially psora) are the exception. It is communicated so easily, that even the physician, hurrying from one patient to another, in feeling the pulse has unconsciously inoculated other patient with it; baby when being born, is infected while passing through the organs of the mother, who may be infected with this disease; or the baby receives this unlucky infection through the hand of midwife which has been infected by another parturient women or again, a suckling may be infected by its nurse or while on her arm. By her caresses or the caresses of a strange person with unclean hands. He also mentioned that the chances of infection are more in crowded hospitals, factories, and prisons or in orphan houses or in the filthy huts etc.

These are now found to perfectly true in the case of all infectious disease.
Lack of exercise and sedentary life style are two major contributing factors leading to the development many so called modern diseases like hypertension. Diabetes mellitus, backache etc.
Hahnemann realizes the importance of exercise in proper maintenance of health, prevention of many diseases, and its usefulness in treatment of cases. So he encourages physical exercise for the maintenance of good health.
He says – “ the daily laborer if his strength allows, should continue his labor; the artisan his handiwork; the farmer, so far as he is able, his field work; the mother of the family her domestic occupations according to her strength; only labors that would interfere with the health of healthy persons should be interdicted”.
“ The class of men who are usually occupied, not with bodily labor, but with fine work in their rooms, usually with sedentary work, should be directed during their cure to walk more in the open air, without, on that account, setting their work altogether aside ”.
“ Person belonging to the higher classes should also be urged to take walks more than is their custom.”
Hahnemann was well aware that many psychosomatic diseases of modern life were the result of suppression of sexual desire, mental stress and strain, anxiety, worry, repeated fright, great grief, sorrow continuous vexation etc. These contributing factors lead to the outbreak of secondary manifestation of psora.
In order to maintain a good health Hahnemann advise certain
dietary restriction are necessary—such as

Coffee –– Chronic patients must give up coffee, which is insidiously injurious to health. Rye or wheat, roasted like coffee in a drum and then boiled and prepared like coffee, has both in smell and in taste much resemblance to coffee can be used as a substitute for coffee with out any injurious effect.

Alcoholic liquors–. According to Hahnemann a genuine Homoeopathic physician will never allow his patient to drink the spiritual liquors. Alcoholic liquors have a primary stimulating effect and secondary depressing influence after consumption.

Weakness and a diminution of the vital warmth are the inevitable consequences of their use, that every true physician must remove this state as far as possible from the chronic patient.
Among the articles of diet which are generally injurious to chronic patient are given below:
All dishes containing vinegar or citric acid,
Very acid fruits like sour cherries, unripe gooseberries etc (are to be allowed in very small quantities)
Sweet fruits (only in moderate quantity)
Vegetables causing flatulence are to be avoided as it leads to digestive disturbances
Chicken and egg are to be limited.
Pickles and smoked meat are only to be rarely used.
Only little salt is to be used

The most natural and harmless food suggested by Hahnemann:
Beef and good wheat bread or rye bread, together with cow’s milk and a moderate use of fresh butter, seem to be the most natural and harmless food for men and also for chronic patients.
This dietary restriction suggested by Hahnemann is also still made use of by modern school of treatment in the prevention and treatment of various diseases.
Hahnemann discovered three miasms as the obstruction for cure in
chronic diseases and named these miasms as psora, syphilis and sycosis. After the discovery of the chronic miasm, the diseases were classified based on this concept. This made easy for selection of medicine based on this miasmatic background, or else to make a prescription only on this basis in cases where symptoms are lacking (advanced pathological condition) and also as an intercurrent remedy when the progress of the case come to a stand still.
Even though Hahnemann was a physician from the old school of medicine, he could not tolerate the inhuman methods of treatment that was prevalent during that time such as cupping, leaching etc. more over the medicine used for treatment were in massive doses and in crude form which are capable of producing adverse effect upon the organism. These factors lead him to the discovery of this great humanitarian method of treatment – Homoeopathy.

The principle aim of the book – ‘ Chronic disease’ is to convey the essence of the nature, peculiarity and treatment of chronic disease. But the language used and the mode of presentation adopted by Hahnemann was not simple. He used very long sentence for expressing his ideas. More over he frequently used parenthesis and parenthesis with in parenthesis, which make the presentation complex.
(The peculiarities of style in writing s of Hahnemann is very complex, some of which are not at all common to our English polemical literature)

Unwanted, frequent repetitions of same ideas are given at many places. This sort of repetition reduces the enthusiasm of reader rather than creating the interest.
Hahnemann was able to explain many things very accurately, without the aid of modern scientific investigation and procedure, many years back; and many of his findings are still relevant. But while explaining the cause of chronic disease Hahnemann showed over enthusiasm and hastiness in coming to a conclusion. For example- once he explain drinking of Chinese tea and warm coffee were the causes of chronic disease. But he often showed the mentality to correct when it was proved wrong

Richard Hughes in his annotator’s preface reveals a fact that the second and third volumes of first edition of ‘ Chronic disease’ contain the pathogenesis of 15 medicines, which are not present in Materia Medica Pura.

These medicines are  
Ammonium carbonicum Baryta carbonica Calcarea cabonica
Graphitis Iodum Lycopodium
Magnesia carbonica Magnesia muriatica Natrum carbonica
Nitric acidum Petroleum Phosphorous
Sepia Silicea Zincum.

The pathogenesis of above medicines appear without a word of explanation as to how the symptoms were obtained and with out acknowledgement of fellow observers. More over at that time Hahnemann was 70 or 80 years old and he was not in a position to conduct proving up on him. So we are compelled to reach in a conclusion that these symptoms are mainly from the sufferers from the chronic disease who were under the treatment of Dr. Hahnemann. (His experience from treatment of cases.) Here Hahnemann violated one of the basic rule of Homoeopathy that every medicine should be tested in healthy human being (drug proving) before used it for curative purpose.

In 21st aphorism Hahnemann says that the morbid symptoms that medicine produce in healthy individual are the only thing wherefrom we can learn their disease curing power.
Many of the above-mentioned medicines have more than five hundred or six hundred symptoms (Amm. Carb –789 symptoms, Baryta carb –794 symptoms). It is unbelievable that Hahnemann has got this much of symptoms from his clinical experience only, with out conducting drug proving on healthy human being.

While explaining the nature of chronic disease Hahnemann says that all chronic diseases of mankind, even those left to themselves, not aggravated by a perverted treatment, such a constancy and perseverance, that as soon as they have developed and have not been thoroughly healed by the medical art, they ever more increase with the years, and during the whole of man’s life, and they cannot be diminished by the strength belonging even to the most robust constitution. I.e. they never pass away of themselves, but increase and are aggravated even till death.

Then how the general health of the individual becomes worsened by the Allopathic or other method of treatment?
But at another occasion Hahnemann says “ by such treatment (Allopathic), which are incapable of curing the original disease, but are exhausting and debilitating, the aggravation of the psora is not only hastened from within, but new artificial and threatening ailments are generated by such delusive Allopathic cures, so that the vital force, thus attacked from two sides, often is unable to escape.
Here it meant that a perverted mode of treatment like Allopathy could aggravate the chronic disease by its rudeness and massive dosage.

6. While discussing the treatment of multimiasmatic disease, Hahnemann cannot suggest a satisfactory method for the treatment of this type of disease, but he given two entirely different opinions, which he expressed at two different places that are as follows.

1] Under the chapter “Nature of chronic disease & cure” he says; in
multimiasmatic diseases, the two miasmata- syphilis and sycosis cause a smaller part of the chronic disease; will treat first in order to make the path free to the therapeutics of the immeasurably greater number of the various diseases, which spring from the psora.
2] In another occasion, while discussing the treatment of sycosis,
Hahnemann says that if the patient was at the same time affected with another chronic ailment, i.e. psora complicated with sycosis or both the miasma (psora and sycosis) are conjoined in threefold complication with syphilis; then it is necessary to treat the psoric component first, with specific antipsoric medicines. Then to make use of the remedy for sycosis and lastly proper dose of the best preparation of Mercury is given against syphilis. The same alternating treatment may be continued until a complete cure is affected.
This contradicting opinion of our Master showed that Hahnemann himself was in a state of confusion regarding the treatment of multimiasmatic diseases.

7. Hahnemann always support the treatment of diseases by internal
administration of similimum ie.cure is always from within outward and never in the opposite way. He was always against the suppressive method of treatment by means of external application of medicinal substances. Still then in the case of sycosis Hahnemann support this type of treatment. He says “ there is no need to use any external application except in the most inveterate and difficult cases. In that cases the fig warts are moistened every day with the mild pure juice prepared from the green leaves of Thuja, mixed with an equal volume of alcohol.”

The human skin does not evolve of itself, without the co-operation of the rest of the living whole, any eruption, nor does it become sick in any way without being induced and compelled to it by the general diseased state by the lack of normality in the whole organism. In every case there is at the bottom a disorderly state of the whole internal living organism which state must be first considered; and there for the eruption is only to be removed by internal healing and curative remedies, which change the state of the whole; then also the eruptions which is based on the internal disease will be cured and healed of itself without the help of any external remedy and frequently more quickly than it could be done by external remedies.

Why applicable only in sycosis? (Why it not applicable in psora or Syphilis?)
Hahnemann has given no explanation for this.
Since the fig wart miasma which rules in the whole organism, the external     application of the mild pure juice prepared from the green leaves of Thuja, mixed with an equal volume of alcohol will it make any change in the internal disorder?
“ The fig wart increase and grow while the sycosis is not cured (internal)” –aphorism 201- organon.

More over, in 197th aphorism of organon Hahnemann himself criticize the simultaneous local application, along with the internal employment. “ This treatment, however, is quite inadmissible, not only for the local symptoms arising from the miasm of psora, but also and especially for those originating in the miasm of syphilis or sycosis, for the simultaneous local application, along with the internal employment, of the remedy in diseases whose chief symptoms is a constant local affection, has this great disadvantage, that by such a topical application, this chief symptom (local affection) will usually be annihilated sooner than the internal disease, and we shall now be deceived by the semblance of a perfect cure; or at least it will be difficult , and in some cases impossible , to determine , from the premature disappearance of the local symptom, if the general disease is destroyed by the simultaneous employment of the internal medicine.”

8. Hahnemann says ‘ When the syphilitic miasma (first state) not complicated with other chronic ailment from a psoric, latent psoric or sycotic origin but with its associated local symptoms –the chancre, then it needs only one little dose of the best Mercurial remedy in order to cure thoroughly and forever the whole syphilis with its chancre.’

In second state (where the syphilitic miasma is not complicated with other chronic disease, which spring from the psora or sycosis but has experienced the injudicious driving away of the chancre through the local applications) the internal administration of mercurial medicines will prevent the all outbreaks of secondary venereal disease and the man may be freed from every trace of the venereal miasma.

Here Hahnemann suggest a specific remedy – ‘Mercury’ for the removal of entire syphilitic miasmata. That means the total symptomatic presentation of the syphilitic miasma must be always like that of mercurial preparation. More over each chronic miasma has its own peculiar character which expressed through the various bodily constitution of individual man who different from one another in their domiciles (place of living) their climatic peculiarities, their education, habits, occupation, mode of life and of diet and was molded by varying bodily and psychic relations. It is there for, not strange, that one single and only medicines is insufficient to heal the entire miasma (weather it is psora, syphilis or sycosis) and all its forms and that it requires several medicines in order to correct the entire chronic miasma.

According to 7th aphorism, the symptomatic palliative mode of treatment directed towards a single symptom is to be rejected. (The symptoms alone by which the disease demands and points to the remedy suited to relieve it- and, more over, the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force must be the principal or the sole means, where by the disease can make known what remedy it requires- the only thing that can determine the choice of the most appropriate remedy- and thus in a single word the totality of the symptoms must be principal, indeed the only thing the physician has to take note of in every case of disease and to remove by means of his art in order that it shall be cured and transformed in to health.)

Since the totality of the symptoms is the only indication, the only guide to the selection of a remedy, this type of prejudiced specific remedy prescription in order to correct a particular miasma is quite unfortunate.

Now we know that other medicines like Syphilinum, Aurum met etc have a symptomatology, which can correct the syphilitic miasma.

Similarly in the case of sycosis Hahnemann suggest Thuja and Nitric acid as specific. But we know the medicines like Medorrhinum and Sabina has the ability to correct the sycotic disorder even when Thuja and Nitric acid fails.

9. Under the chapter ‘cure of psora’ Hahnemann gave many reasons against the frequent repetition of the medicines. He says that Well-selected homoeopathic antipsoric medicine and which given in the appropriate potency and in the proper dose should allow to finish its action without disturbing it by an intervening remedy.

Action of an appropriately selected antipsoric medicines are never interfered either by another antipsoric medicines or by a new dose of the same remedy, both will interrupt the complete action of the preceding remedy. This method forbids any new prescription, any interruption by another medicines and forbids as well the immediate repetition of the same remedy. (An immediate repetition of the same medicines is allowable when the dose of a well-selected remedy has made some beginning toward an improvement but its action leaves too quickly and the cure does not proceed any further). It is better to give a different degree of dynamic potency when repetition is necessary.

But in the preface concerning the technical part of the Homoeopathy (second part) Hahnemann says “ in chronic diseases it best to give a dose of solution of the suitable medicine at least every two days more usually every day.”
These two ideas are contradicting each other so we are in confusion now, weather to repeat the remedy frequently or not? (Ie.the time of repetition of the medicine in chronic disease become confused.)

10. Hahnemann says that smoking can be permitted in chronic cases when the patient had been accustomed to an uninterrupted use of it. But at the same time it should be limited if smoking leads to defects in mental activity, sleep digestion, evacuation etc. According to him snuff is most objectionable than smoking, because it touches the nerves of inner nose and cause injury just as if a foreign medicine where as smoking tobacco in which the strength is disintegrated by the heat.

But now we know that tobacco smoking is the one major cause for many diseases like cancer, TAO, hypertension etc. Heavy smokers suffer from tachycardia, palpitation, cardiac irregularities, insomnia, tremors, anorexia and agitation. Smoking is the major risk factor for chronic bronchitis, emphysema, and carcinoma of lung, larynx, esophagus, bladder, kidney, pancreas and cervix uteri. Smoking mothers have an increased risk of spontaneous abortion and their children have lower birth weight, higher perinatal mortality and greater risk of sudden infant death syndrome. So a genuine Homoeopathic physician will never allow his patient to smoke tobacco even if he had been accustomed to an uninterrupted use of it, especially in chronic diseases.

11. Mental diseases are chronic disease of one-sided nature where the symptoms of derangement of the mind and disposition peculiar to each of them are increased whilst the corporeal symptoms decrease till it attains the most striking one-sidedness. Moreover many of the physical ailments might have been transformed in to insanity, melancholia and mania like mental illness; even then Hahnemann didn’t mentioned a single word about the mental disease, their nature and treatment. So reader will not get an idea about the mental disease from reading this book and he has to refer organon of medicine for this purpose.

12. When a particular medicine is found effective in a case and the repetition is indispensable to secure the cure of a serious chronic disease, here Hahnemann suggest a contradicting view to that given in organon of medicine.

Hahnemann’s view given in– Chronic disease
When a particular medicine is found effective in a case and the repetition is indispensable to secure the cure of a serious chronic disease, Hahnemann suggests the repetition of same medicine in a lower potency. (E.g.: – if before he had used the 30th dilution, he will now take one or two pellets of the 24th). This solution of the lower potency must be shaken 5 or 6 times before taking it. This will be continued so long as the remedy still produces improvement and until new ailment appear for in such a case a new remedy will have to be used.

Organon of medicine – 247 & 248 aphorisms
It is better to give a different degree of dynamic potency when repetition of the same medicine is necessary. The vital principle does not accept unchanged doses without resistance, because the former dose has already accomplished the expected change in the vital principle and a second dynamically similar unchanged dose of the same medicine has no role to act on vital principle. Hence no step towards cure can follows after the repetition of the same unchanged potency. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher, then the vital principle may be altered without difficulty by the same medicine and thus the cure brought nearer. (For the repetition of the same medicine it is better to modifying the solution of the every dose with thorough vigorous successions, thus changing its degree of potency and increasing it somewhat)

So we are in a confused state regarding the repetition of the potency of the same medicine after the preceding prescription (higher or lower?).

13. A controversial point regarding the Hahnemann’s statement with reference to the present day concept in venereal disease. Hahnemann stated that until the primary manifestation of a venereal disease is not destroyed by artificial means, the secondary manifestation does not appear. This cannot be corrected with the present day concept of medicine and pathology.

 Dr Satheesh Kumar P K BHMS,MD(Hom)
Medical Officer, Dept. of Homoeopathy, Govt. of Kerala