The concept of miasm – A critical study by Dr Richard Hughes

Dr  Bindu K

The first volume of Hahnemann’s chronic diseases is devoted to the expositon of psora theory. He begins by assigning one eighth of these maladies to syphilis and its ally sycosis. He points out that each of these diseases depends upon a specific and contagious ‘miasm’. This being received into the organism, after a period of incubation develops an external sign—the chancre and the condylomata respectively. If these are left alone or cured from with in by small quantities of their appropriate specific (Mercury in the one case, Thuja or Nitric acid in the other), no general evils result. On the other hand, the supression of external sign is followed by the well known constitutional symptoms. The maladies thus set up are far more difficult to cure, and are only curable at all by the same or similar specfic—selected not merely on the ground of their homoeopathicity to the existing symptoms, but also because of their relation to the primary taint, in like manner ascertained. Dr.Richard Hughes narrates with his own examples. It would be useless to attempt to cure a syphilitic angina with belladonna or a syphilitic psoriasis with arsenic.

In the remaining seven—eighth of chronic diseases, Hahnemann says that he found the same impossibility of effecting a permanent cure with the common homoeopathic specifics. He sought therefore for some constitutional miasm or miasms, which should explain the protean changes and inveterate duration of these maladies, as the syphilitic poison explained the character of, disorders resulting there from. In the common itch ( psora or scabies ) he thought he had found what he sought. Numerous authors testified to the evils resulting from repercussion of the itch eruption—these evils including nearly every ill to which flesh is heir. Again, many of his chronic patients confessed to having had itch, and in many others he ascertained the same fact by inquiry of parents and nurses. The itch was a specific disease, very contagious, having a period of incubation after infection, and then manifesting itself by one or more vesicles at the point of contact, –in all these features resembling syphilis and sycosis. Unable to discover any other chronic miasm but this to account for the host of chronic diseases which were neither syphilitic nor sycotic, Hahnemann propounded the theory that they were all psoric. Hence followed the treatment. Recent itch could nearly always be cured in a reasonably short time, by one or more infinitesimal doses of sulphur, and the same medicine was curative of many of the consequences of the suppression of the eruption. But these were too multifarious to be homoeopathically covered by any one remedy. Hence a number of other medicines were, on various grounds classed with it as anti psorics and with these, selected according to the law of similars, all chronic non venereal diseases were to be compacted.

The above is a fair presentation of Hahnemann’s theory by Dr.Richard Hughes’s “A Manual of Pharmaco dynamics”. According to Dr.Richard Hughes Hahnemann’s theory is a marvel of erudition, of thought and of reasoning if only the premises were sound. But here is the fatal flaw. Hahnemann lived at a time when the parasitic nature of scabies had been forgotten. His contemporaries Rayer and Biett regarded it as questionable; and Hoffmann, Juncker, Wenzel and Autenrieth had gone before him in tracing numerous diseases to the repercussion of eruption. Now, however, no reasonable doubt can exists but that the reception of the Acarus is the proximate cause of the whole phenomena of scabies. The disease is invariably treated by external applications, chiefly Sulphur ointment and the extensive experience of such men as Hebra and Erasmus Wilson may be taken as conclusive when they say that they never seen any ill effects from the practice, which, Dr.Richard Hughes adds, is as freely used by Homoeopathists as by others.

Is there then no truth in Hahnemann’s theory? Just the reverse. Hahnemann based the logical superstructure of this theory upon thedistinct entity, scabies yet ever and anon he include other cutaneous affections under its name. Dr.Richard Hughes says that it may be thought strange that he considers doctrine of chronic disease as a fourth step of advance on Hahnemann’s part ( the other three were individualization, positive efficacy of infinitesimal doses and treatment by single dose). But it would be so, he mean by so, doing to endorse the psora theory, in its definite dependence on the entity itch Hahnemann was indubitably in error about the pathological significance of this disease. But stripping his doctrine of all reference to this particular disease, it remains, in its essential substance, a most valuable induction from observation and guide to practice. It is the affirmation that when disease becomes chronic it is because of some morbid diathesis, some constitutional taint; that the manifestations of this conditions must not be treated as if they were mere local affections; that even the ordinary internal specifics of homoeopathy are most insufficient for their cure, and must be supplemented by new medicines, of a profound reach and long duration of action. It was this thought which led Hahnemann to introduce the so called antipsorics in to medicines—which enriched the materia medica with alumina, baryta, calc., graphites, kali carb, lyco, sepia, silica.

Dr. Richard Hughes continues, in his lecture “ Homoeopathy what it is ” as what I have said about the distinction between the speculative theory and the practical doctrine of chronic diseases applies to much else in Hahnemann’s work at this time. His discovery of the efficacy and sufficiency of infinitesimal, for example, was mixed up with the hypothesis of all diseases being a derangement of the ‘vital force’ and of a ‘dynamisation’ effected in medicines by the process of trituration and succession to which he subjected now. All this may be rejected, as it generally has been rejected; but the discovery remains Dismissing, therefore, the theories of the master as of doubtful value and only speculative interest, let us fix our attention upon him in the sphere of his true greatness, and consider his practical rules.

In ‘knowledge of the physician’ Dr.Richard Hughes says that Every science – that is branch of knowledge, scientia from scire – consists of three parts,phenomena,laws,and causes. It is the first which, for positive theraputic action, chiefly concern us in disease.Not that the other two are worthless to us, even for this end .Our laws here are classifications-the recognition in morbid states of genera, species and varieties analogus to those of animated nature.These enable us to form groups of remedies associated with them, instead of having to wander through the whole materia medica for each prescription; they also give a continuity to medicinal treatment, without which the uses in morbis were of no avail.Hahnemann led the way here, by consantly insisting on the existence of fixed and definite type of disease, to which standing remedies should be applied ; and by giving us his group of antipsoric.According to Hughes, Hahnemann by explaining psora theory, rejected all enquiry into causes- the proximate causes, the noumena of the phenomena. In so doing we need not follow him .His ground for taking symptoms as true element of parallelism between disease and drug action was that they were surely known. In his day this was true, and his selection of them was most prudent. But to maintain that they only were knowable was unwarrantably to bar the advance of science.

His stricter followers have acted on the dictum, and have looked askance on the positive pathology of the present day, with its physical diagnosis and postmortem confirmations. They are always a decade or more behindhand in their recognition of such distinctions as those between typhus and typhoid, between chancre and chancroid, and in their use of such means as auscultation and thermometry. Now this is altogether wrong. An inference from symptoms, if sure, is as good a basis for treatment as symptoms themselves. This sureness is assumed in the prognosis given and the general management instituted: why should it not be also for purpose of drug selection ? By proceeding upon it we secure another route to the simile we desiderate.We use symptoms to reach it, because they are its most certain expression; but, it can be otherwise attained, the alternative access may often be useful. Morbid lesions sometimes occur almost, if not quite, without symptoms, as for instance caries of the vertebrae,and senile pneumonia.

To attempt to “cover”these from the results of the provings of the drugs would be futile.But toxicology and experiments on animals here come to our aid. But we should never, if possible, rest content with identity of seat between disease and drug: we should aim also at making their kind of action the same, and this can only be done by securing similarity in their symptoms.In this way we elevate the simile to a similimum, and proportionately enhance its energy in cure.

According to Dr.Richard Hughes two types of homoeopathy is present before us ie the teachings and practise of Hahnemann from the period 1806 – 1828 and the period from 1830 – 1843.The first three editions of organon upto1824 and all other Hahnemann’s work during the first quarter of 19th century is of enduring worth; it is positive, experimental and sound. But from this time onwards we see a change. The active and public life he had led at Leipzig, with the free breath of the world blowing through his thoughts, had been exchanged, since his exile to Kothen in 1821, for solitude , isolation, narrowness. The reign of hypothesis began in his mind- hypothesis physiological, pathological, pharmacological.Dr.Richard Hughes says that making Hahnemann of 1830-43 is our guide, we commit ourselves to his senility.

The sum of what has now been said thus: homoeopathy is a theraputic method, an instrument for the selection of the most suitable remedy for each case of disease. But in adopting this method of Hahnemann as our chief guide in therapeutics, we do not necessarily become followers of his, in other departments of thought; we are homoeopathists, not Hahnemannians. The steam engine of today is not altogether that of Watt. Homoeopathy , like the candlestick of Hebrew Tabernacle, has been shaped by hammering not by casting: or rather, it is a vital thing, growing as the years go on, and legitimately influenced by its environments. It is in our hands some what different from what it was when it dropped from Hahnemann’s; but it is Hahnemann’s still. All study, exposition, practice of it must start from and the results it achieves must be accounted a monument reared to his honour.

References
1 .The principles and practice of Homoeopathy- Dr Richard Hughes
2. A manual of pharmacodynamics – Dr Richard Hughes
3. The knowledge of physician – Dr Richard Hughes published in IHMA panorama

Dr  Bindu K BHMS,MD(Hom)
Medical Officer, Department of Homeopathy
Government of Kerala