tendencies. He will use dusky, reddish colours. The intention of his work will be to alter the existing order, to revolutionize rather than to please. As a politician he will be an anarchist, a constant objector, a demagogue, intriguing, inciting violence, revenge and hatred. The craftsman will choose tortuous forms and will devote himself to objects of an offensive or destructive nature. His works will be unharmonious, repugnant, deformed or absurd.

Of course such examples can be multiplied ad infinitum, especially if we realize that no one has only one miasm, but we are all influenced by all three. For example, the miasmatic element in one individual can be the result of a mixture of psora with sycosis, or of psora with syphilis, or of all three together, even though there is always a degree of superiority of one over the other. With this knowledge we can appreciate the enormous complexity and variety of human expression.

To symbolize the miasms, we have given each a primary colour. Blue, the coldest colour, representing psora. Yellow is a loud colour reminding us of the nature of sycosis. To syphilis we attach the colour red, indicating the destructive- ness of fire. The infinite mixture of these three primary colours indicates the infinite variety of miasmatic conditions that can be found.

A special chapter should be devoted to the interrelations associated with the predominating miasms. One can further investigate why people attract, reject or complement each other, whether as an individual, as a group, or as a nation, within this whole which we call the universe and humanity.

Miasms revisited

ANTHONY CAMPBELL, MRCP, FFHOM

Introduction Generations of homoeopaths since Hahnemann have discussed the miasm theory from every conceivable angle. There have been some, like Richard Hughes, who have rejected it in toto, while others, such as James Tyler Kent and his disciples, have made it into a cornerstone of their system. Today, it seems, Kentian ideas are becoming more widely accepted among homoeopaths in many countries, and this has led to an increased emphasis on the importance of the miasm theory, which is often represented as being essential to homoeopathy. We therefore need to take a close and critical look at the theory to see what exactly it consists in and

A paper read to the 35th LMHI Congress at Sussex University on 29 March 1982.

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what relevance, if any, it has to modern homceopathy. In this paper I propose first, to examine what Hahnemann actually taught

about miasms, as opposed to what he is commonly supposed to have taught, which is by no means the same thing. Next, I shall briefly review some of the ways in which later homo~opaths interpreted the theory. Finally, I shall consider the present meaning and value of these ideas.

Hahnemann's formulation of the miasm theory According to Hahnemann himself, he first thought of his theory of chronic disease in the years 1816-17, though he did not make it public for a further decade. In 1827 he summoned two of his most faithful disciples, Gross and Stapf, to K6then to receive the new doctrine, and in the following year he began to publish his last major work, The Chronic Diseases, in which the miasm theory was set forth. This book eventually went into a second edition; nevertheless it did not sell well, and the miasm theory itself caused much dissension within the ranks of homaeopathy.

Hahnemann was led to formulate his theory by the discovery that although hom0eopathy was effective enough in the treatment of acute disease, many difficulties were encountered in the treatment of chronic disease. Patients often seemed to respond to the indicated remedy initially, but later they ceased to do so or produced new symptoms. Some hommopaths supposed that the answer to this difficulty would come from the proving of new medicines, but Hahnemann rejected this solution and instead produced his own answer: the miasm doctrine.

The outlines of the miasm theory are well known to all homaeopaths. In essence, the theory states that all chronic disease not attributable to faulty diet or environment or to allopathic treatment is due to one of three "miasms": sycosis, syphilis, and psora. Of these, much the most important is psora, which Hahnemann claims is responsible for seven-eights of all miasmatic chronic disease.

Hahnemann did not invent the term miasm, which was already in use in orthodox medicine in his day, but he gave it a new meaning and importance. The word derives from the Greek and means "taint" or "contamination". Hahnemann supposed that chronic disease occurred by the introduction into the organism of one of the contaminating agents - -miasms-- through the skin. The initial sign of this is a skin lesion of some kind. I f the contaminating agent is then "driven inwards" by misguided allopathic treatment it will become established throughout the organism and thereby rendered ineradicable.

The clue to an understanding of Hahnemann's idea, therefore, is to realize that he believed skin disorders to be merely the outward, visible manifestation of a systemic disorder. He was by no means alone in this view, which he shared with a number of his orthodox contemporaries, but he emphasized its importance much more than anyone else had done hitherto.

Each of the three miasms has its own characteristic skin lesion: for sycosis it is fig warts, for syphilis the chancre, and for psora the itch-vesicle (scabies). Notice, however, that the range of skin disorders that Hahnemann regards as primary lesions of the miasms is a good deal wider than the modern labels imply. For example, any warty growth anywhere on the skin is sycotic, and almost any kind

16 The British Homceopathic Journal

of skin eruption is psoric. To identify psora with scabies pure and simple is thus a considerable over-simplification.

Hahnemann's concept of the way in which the chronic miasms act can best be understood by considering syphilis. Hahnemann held (rightly, from our point of view) that in syphilis the disease is not confined to the so-called primary lesion-- the chancre--but is systemic from the outset. Treatment of the chancre alone is therefore ineffective (Hahnemann would say, positively harmful), and the disease, if left to itself, will produce all kinds of subsequent manifestations.

Sycosis and psora are exactly analogous to syphilis. In each, an apparently trivial skin lesion is merely the outward sign of a deep-seated disorder that has already become established. The course of events is therefore as follows. First, the contamination takes place; second, it becomes generalized throughout the organism (probably travelling via the nerves); third, it gives rise to a skin eruption?

The most important miasm, psora, is much more contagious than syphilis, and can be communicated--especially to children--simply by touching the skin. 2 Almost everyone is susceptible to contamination with the psoric miasm, whereas sycosis and syphilis are more selective. 3 A doctor may transmit the taint to a patient while feeling the pulse, or it may be transmitted by fomites or from the mother to the new-born during delivery. In view of this extraordinary contagiousness, we need hardly be surprised that virtually the only human being to have escaped psora seems to have been Hahnemann himself. 4

The symptoms of latent psora are almost infinitely varied and are quite impossible to summarize; they correspond to almost every mental and physical disease imaginable. Hahnemann gives a confessedly incomplete list, which in Hempel's translation occupies some 33 pages2

In summary, Hahnemann's miasm theory depends on the idea of contamination through the skin by one of three agents. To the modern reader the temptation to equate miasm with "infective agent" is almost irresistible, and I shall return to this later. We must be clear, however, that Hahnemann himself did not make this identification; on the contrary, he held that the actual nature of the miasms is for ever unknowable.

Later inte~retations Succeeding generations of hom~eopaths have made many attempts to interpret the miasm idea in the light of medical ideas of the day. In the early part of this century, for example, orthodox medicine was much preoccupied with the notion that chronic sepsis (in teeth, appendix, and so on) was an important cause of disease, and consequently we find homoeopaths attempting to equate psora with sepsis. More recently, ideas of allergy and of autoimmunity have been invoked.

The Kentians, however, with their scorn for pathology, adopted a different view, which derived from the teaching of Constantine Hering. This is the notion that the miasms are hereditary (constitutional). Hering and his followers recognized a number of other miasms in addition to Hahnemann's (for example, tuberculosis), and developed appropriate nosodes to treat them.

Today, Kentian and other hom~eopaths often claim that Hahnemann made a

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brilliant anticipation of the modern orthodox teaching that there exist heritable tendencies to various diseases (for example, the well-known association between blood groups and certain diseases). As we have seen, however, there is no justification for this in Hahnemann's own writings, which make it quite clear that the miasms are acquired and not hereditary. (Hahnemann does not even appear to have recognized the existence of congenital syphilis.)

It is an interesting question why it should be so widely believed today among hom0eopaths that the miasms are hereditary. What seems to have happened is that Hahnemann's early followers, especially in America, introduced a meta- physical element into the miasm theory to explain why human beings should be liable to contamination in the first place. After all, if a man is perfectly healthy, how can a miasm gain entry? There must logically be some kind of predisposition or susceptibility to the miasm in question, and this susceptibility is presumably inherited.

The parallel with the Christian doctine of Original Sin is obvious, and was pointed out by early criticis. In his Preface to the Chronic Diseases Hering rejects this parallel 6 (although without saying why he finds it inexact), but the translator, Hempel, disagrees with Hering and appends a long footnote in which he accepts the parallel and indeed equates the eventual future eradication of the psoric miasm through homoeopathy with a general spiritual transformation of mankind. 7 Here we find hom~eopathy actually being assimilated to a form of miUenarism-- something that recurs from time to time in the writings of later enthusiasts down to our own day.

The signO~eance of the miasm theory today The first thing to say about the miasm theory from a modern standpoint is that it is essentially pathological. As we have seen, it is very easy to equate the miasms with infective agents, and indeed it is almost impossible today not to make this identification.

Now, Hahnemann, as we know, rejected all theorizing about disease processes, and taught that disease is nothing more than the sum of its symptoms: no symptom, no disease. Clearly this is quite inconsistent with the miasm theory, which depends on the idea that the miasms can persist for long periods without giving rise to overt symptoms. However, inconsistency never troubled Hahnemann, and his Writings contain many glaring examples of it. At one stage, he did in fact anticipate the modern, microbial, theory of disease, at least in the case of cholera. Thus he writes of the (acute) miasm responsible for cholera as "probably consisting of a murderous organism, undetected by our senses, which attaches itself to a man's skin, hair, etc., or to his clothing and is thus transferred invisibly from man to man". s He does not seem to have made the same suggestion in respect of the chronic miasms, but for us today the temptation to do it for him is overwhelming. But where does this leave the miasm theory of chronic disease?

If we equate miasm with infective agent, the theory states that virtually all chronic disease is due to infection. This seems improbable. We know that many forms of chronic disease are, in fact, due to infection, but many other things do not appear to be, at least in the light of our present understanding. On this

18 The British Homoeopathic Journal

interpretation, therefore, the miasm theory is a gross over-simplification. An alternative way of expressing the miasm theory is to say that all internal

disease has a cutaneous manifestation and vice versa. Again, however, this is a considerable over-statement. Certainly s o m e diseases m a y have cutaneous manifestations (cancer, for example), but the associa t ion is by no means invariable or even very frequent.

No doubt many supporters o f the miasm theory would reject both these interpretations. I f we do so, however, we are left with some very vague general statement to the effect that chronic diseases fail to get better because there is some underlying factor which prevents them from doing so. This is true but trite. It amounts, in fact, to little more than a tautology: chronic diseases are chronic because they fail to get better.

The miasm theory is not only platitudinous; it is comprehensive to the point where it fails to explain anything at all. Hahnemann lists literally hundreds of symptom complexes as due to psora. So vast and all-embracing is the list that it is almost impossible to think of any disease that is no t attribute to psora. But a theory that excludes virtually nothing has almost no explanatory value.

At least if the theory had useful practical implications that would be some- thing. In fact, however, the choice among the various "antipsoric" remedies still has to be made in the usual way, on the similimum principle, so we are not much enlightened. Indeed, it could be argued that the theory has been actively harmful, in that it has concentrated the minds of homceopaths on the "antipsorics" to the relative exclusion of m a n y other remedies that might be indicated. Certainly if one reads some of the homoeopathic literature of the nineteenth century, written by homo~opaths who were not over-awed by the miasm idea, one finds a much wider range of remedies being used in chronic disease than is commonly the case today.

REFERENCES 1 Hahnemann S. The Chronic Diseases, tr. Hempe ! CJ. New York 1845; 1, 50. 2 Chronic Diseases, I, 55. 3 ChronicDiseases, I, 56. 4 Chronic Diseases, I, 63n. 5 Chronic Diseases, I, 73. 6 Chronic Diseases, I, 2. 7 Chronic Diseases, I, 2n. 8 Haehl R. SamueIHahnemann, London 1922; I, 176.

COPY D A T E S

Copy for the July 1983 issue of the Journal should reach the editors (for addresses, see back cover) by the end of March 1983. The final date for very short last-minute items is Thursday 4 April 1983.

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