“Since the years 1816 and 1817 I have been occupied day and night in efforts to discover the reason why the known Homeopathic remedies did not affect a true cure of the above mentioned chronic diseases; and sought to secure a more accurate, and, if possible, a correct insight into the true nature of these thousands of chronic diseases, which remained uncured despite the uncontrovertible truth of the Homeopathic doctrine.
When behold! the Giver of all good permitted me, after unceasing meditation, indefatigable research, careful observation and the most accurate experiments to solve this sublime problem for the benefit of mankind (1)”
These are Hahnemann’s words in the first part of his last considerable medical work “The Chronic Diseases, their nature and homeopathic treatment” (1st edition, Arnold, Dresden and Leipzig, 1828; 4 volumes, 2nd edition, Schaub, Düsseldorf, 1835 to1839, 5 volumes). And in the footnote he adds:
“During these years nought of these efforts was made known to the world not even to my own disciples. This was not owing to the ingratitude which I had frequently experienced, for I heed neither the ingratitude nor yet the persecutions which I encounter in my wearisome though nor joyless life-path.
No, I said nought thereof because it is unwise, yea, even harmful to speak or write of things yet immature. In the year 1827 I first made known the most important features of my discoveries to two of my most worthy disciples, not only for their benefit and that of their patients, but in addition that the whole of this knowledge might not be lost to the world through my death, for having reached my 73rd year it was not improbable that I might be called into eternity before I could complete this book. (2)”
“Hahnemann would not have been the keen observer we know him, if he had not noticed in the course of the years with ever increasing clearness, that the structure of his therapeutic system lacked the final coping stone. It is true that his homeopathic system offered, as he himself states, far more certain, more convenient and less harmful remedies than allopathy for acute diseases, for epidemic diseases, sporadic fevers, and venereal diseases.” Nevertheless Hahnemann was not satisfied. He argued: “But the number of the tiresome diseases yet in the wide world was incomparably greater, and in spite of all homeopathic experiments they were still uncured. The treatment of such diseases was “even when carried out strictly in accordance with the theory of the homeopathic science, as hitherto practiced, encouraging in the beginning, less favorable in the continuation and hopeless in the end.“(2)
“The starting point for the main ideas of the book was the observation, that certain chronic diseases of venereal origin and otherwise could be alleviated by homeopathic remedies, but not completely cured. Special conditions, such as serious dietary mistakes, cold, wet and stormy weather, temperamental influences, etc., caused the apparently rectified troubles to appear again, frequently with new and stubborn symptoms. New remedies, chosen in the best and most careful way, were again of avail, “but only slightly and imperfectly for a short time, until the next outbreak was brought on by adverse external influences. On the other hand, under favorable, external conditions, such as change of climate and home, careful diet, etc., a remarkable “truce” was observed. Considering all things, however, the chronic malady, was never eradicated, but became worse from year to year, often with the most varied external symptoms.”(2)
At first it was thought that the reason for failure of the homeopathic treatment might be found in the insufficient number of remedies proved and that the prospects would change for the better the more accurately proved medicines the physician had at his disposal. But although this proved to be some consolation for the students, the Master could not rest satisfied with it. Day and night, he was occupied with the question why the ordinary, carefully selected remedies did not produce a lasting cure. At last he came to the conclusion that, in chronic diseases
“One has always to deal with a segregated part of a deeper lying original evil, the large extent of which is shown by new symptoms from time to time…. But the original evil sought must also be of a miasmatically chronic nature – as was perfectly evident to me from the fact that, once it had developed to a certain degree of intensity, it could not be eradicated by the mere vigor of a robust constitution. Neither could it be overcome by the healthiest diet and order of life, nor annulled by itself, but in the course of years it grew worse with the addition of other more serious symptoms – right up to the end of life.”(1)
Samuel Hahnemann was above all a cultivated and prepared physician, and a keen observer. In one of his first works entitled “Instructions for surgeons regarding venereal diseases”, published in 1789, he identified already several concepts which he expressed later in the study on chronic diseases. It is important to point out that he had not discovered homeopathy yet when he wrote this essay, nevertheless, his Hippocratic medical formation is evident.
In this large publication that includes 693 paragraphs wit 233 footnotes, Hahnemann identifies the predisposition as a determining factor for the suffering of diseases (§41 and §42). He recognized the correlation between temperament with the severity of the symptoms of the disease (§43 and §98), Natura Morborum Medicatrix (§55 and §71), the sycosis constitution as the most predisposing to suffer from gonorrhea (§111), and he observed that the elimination of discharges and suppurations ameliorated the internal organs (§123). He recognized the great importance of diathesis for the suffering of disease (§198 and §652), and knew already remedies with which he later made provings, like Spon, Con, Dig, Ant-t, and also imponderables like electricity, etc.(§252). He already identified sycotic manifestations (§ 320), discarded the local treatment for chancres and condylomas (§ 353), identified the necessity of non-chemical acting remedies for the cure of the patient (§387 y 388), condemned the great damage done by the use of topically applied remedies in ponderable doses (§390), and disdained local treatment ( §401). He recognized the importance of suppression and of Hering’s law (§392), suggested always to permit the suppurative process to develop before surgical treatment (§405), pointed out the importance of observation and the treatment of chronic diseases (§423). He observed the curative effect of iron in chlorotic anemias (§584), recognized the importance of diet (§585), and the effect of Hepar as an antidote for the ill effects of Mercury (§608), among others.(4)
Some of these concepts were retaken in 1816, in an essay entitled “Essay on the Improper Treatment of the Venereal Disease“(5,6), in which Hahnemann referred to the concept of suppression of external disease manifestations, in this case syphilis, and to the destructive consequences of this procedure. He also mentioned the suppression of some cutaneous ailments (the wool workers’ scabies), which results in the appearance of more profound and severe symptoms. In both cases the internal application of the indicated homeopathic remedy offers the solution and cure for the disease, and the disappearance of the cutaneous manifestations is a sign of cure when proper treatment has been given (7). In this paper, the Master already outlined the knowledge of miasms. But he made his first direct reference to the existence of miasms in a letter to the General Consul of Prussia, Dr. Friedrich Gotthelf BaumgÃ¤rtner, written on January 10th, 1823. In this he wrote (1,5):
“There will always remain some ailments uncured by Homeopathy, the remains of some deep-seated chronic disease. For the perfect healing of a large family of chronic diseases, not even all that I have written on Homeopathy is sufficient.
But incredibly more is effected by it in these old diseases than by the medicines prescribed by the Allopaths. But, in Homeopathic writings as yet published, there is still lacking the great keystone which binds together all that has been thus far published, so that the healing of chronic diseases may be not only expedited, but also brought to the condition of complete recovery.
To discover this still-lacking keystone and thus the means of entirely obliterating the ancient chronic diseases, I have striven night and day, for the last four years, and by thousands of trials and experiences as well as by uninterrupted meditation I have at last attained my object. Of this invaluable discovery, of which the worth to mankind exceeds all else that has ever been discovered by me, and without which all existent Homeopathy remains defective or imperfect, none of my pupils as yet know anything.
It is still wholly my property. Therefore the worst chronic diseases which not only the physicians of the old school, but also the best among the Homeopaths, must leave unhealed, are still in the same condition, since, as said before, the Homeopathic system as till now promulgated by me, however much it can do, has not by a long way reached that perfect healing which has become possible only since this new discovery, the result of unspeakable efforts.”(5)
His careful observations and detailed medical knowledge allowed Hahnemann to identify the origin of these ailments and to assign them to the phenomena of suppression, of ailments such as itching eruptions, gonorrheal growth and discharges fluxes, and syphilitic buboes and chancres.(8,9) This was the starting point for the theory of chronic diseases and miasms.
Hahnemann chose the name Psora, an expression which was commonly known and that time and used in general for a great many of skin ailments, to define the miasm caused by the suppression of itching skin eruptions. He chose the term Sycosis for the miasm that is related with warts and gonorrheal discharges, and Syphilis for the miasm that is caused by the suppression of the syphilitic infection (7, 8, 9).
Two of Hahnemann’s contemporary physicians had also already identified the relation between the suppression of skin ailments and the subsequent appearance of multiple chronic diseases, and were formulating their theories ten years before the appearance of “The Chronic diseases”. Autenrieth of Tübingen and his famous student Schoelein of Würzburg. Both agreed on certain points with Hahnemann, but their concept of cure was very different, supposing that the complete elimination of the eruption would definitely be sufficient to cure the patient. (1)
The only confidants of Hahnemann’s secret were Wilhelm Gustav Gross and Johann Ernst Stapf, who worked with him during the years when he was studying. (10)
Hahnemann’s initial intention was to establish his own hospital to teach the miasmatic doctrine to his students.(1) Unfortunately, the finances of his protector, Duque Ferdinand von Anhalt Koethen’s, never allowed him to begin this undertaking. With that intention Hahnemann wrote to the General Consul of Prussia:
“But this knowledge, now finally attained, is of such kind that I can impart it in a practical way to young students only by special inspection at the bedside in some clinical establishment.
And in order that I might be able to do this before my death, I entreated our Duke to establish a hospital for the purpose.
It appeared acceptable to him, but, notwithstanding his seeming willingness to establish one, I see plainly that nothing will come of it. We have as yet no public hospital in Coethen.
Nothing will be done in the matter in this place, so far as I can see; and it would be much more agreeable to me to have such an establishment in a larger place.
Since this knowledge cannot be communicated by written works, but men must hear, see, and be convinced for themselves, I shall, perhaps, have to take this treasure with me to the grave, and can merely appropriate it in my lifetime to my own needs in thus healing those invalids whom no one else can heal.
This is but a slight advantage to be gained by me, who have so willingly communicated to the world everything prior to this discovery, and have received therefore but little thanks from my own pupils and from Allopathists, as well as persecution from public officials who have an eye to the benefit of apothecaries.
I whisper in your ear this important confession, and I beg that you, who are my very dear friend, will impart it to no one in Leipzig. I may rest assured that you, whose heart is all aglow for the welfare of humanity, will make the very best use of it.”(6)
As the reality prevented the realization of the project to establish a homeopathic hospital, teaching homeopathic practice remained a dream.(11)
Feeling the importance of his discovery, Hahnemann wrote to Stapf on September 6th, 1827:
Your impatient vehemence is no doubt owing to your praiseworthy thirst for knowledge, but as regards its object it must be considered a slight mistake on your part.
I have only written one clean transcript of the symptoms of the antipsorics, and it is in daily use ; it is, therefore, impossible for me to communicate them to you.
You cannot possibly be serious in expecting me to prescribe a treatment for the pathological names you mention. But if you will sometimes communicate to me the symptoms of disease, then if my limited and my remaining vital powers will allow I shall be happy to advise you.
I have cause to be thankful that you do not need to regard chronic diseases as paradoxes or inexplicable phenomena, the nature of which is hidden, in impenetrable obscurity. You possess now the solution of the riddle why neither Nux vomica, nor Pulsatilla, nor Ignatia, etc., will or can do good, while yet the Homoeopathic principle is inexpugnable.
You are now acquainted with the estimable remedies, you have them and can employ them, empirically at least, for you know even what doses to give them in. Just imagine what sacrifices it has cost me to carry out to the end this investigation for the benefit of yourself and the whole medical world.
I cannot do more until my book appears, and it still demands an amount of work which is almost too much for my vital powers. Be reasonable, therefore, and do what you can with your antipsorics. Even after I had them I did not at first know what they would do. You may, whilst using them, make excellent observations on their peculiar effects and gain much knowledge respecting them, as also by the many splendid cures you may perform with them, as you have only six or eight medicines to choose from, and not from the whole Materia Medica.
“You and Gross are the only ones to whom I have revealed this matter. Just think what a start you have in advance of all the other physicians in the world. At least a year will elapse before the others get my book ; they will then require more than half a year to recover from the fright and astonishment at the monstrous, unheard of thing, perhaps another half year before they believe it, at all events before they provide themselves with the medicines, and they will not be able to get them properly unless they prepare them themselves.
Then it is doubtful whether they will accept the smallness of the doses, and wait the long time they ought to allow each dose to act. Hence, three years from this time must elapse before they are able to do anything useful with them.
So please have patience with me and excuse me for not being able to put my book into your hands just yet, and try and do as much good as you can with what you know and have.”(1)
Monstrous and unprecedented was the reaction when the book was published. In the allopathic sphere as well as amongst homeopaths rejection and criticism were often expressed. Baron Ernst von Brunnow, who was one of Hahnemann’s big friends and had translated “The Organon” into French, and to whom Hahnemann had dedicated the first volume of “The Chronic Diseases”, wrote:
“Hahnemann’s complete isolation from doctors with different views and the hitherto almost unconditional loyalty and veneration of most of his adherents are probably the chief factors responsible for the way in which this man of genius pushed his theories to extremes. … This was most obvious in his work on “Chronic Diseases”, where he declared psora to be the sole source of all chronic maladies with the single exceptions of those from syphilis and sycosis and where he proceeded to diminish medicinal doses to an extent hitherto unknown.” (3)
There is nothing to say about Hahnemann’s and homeopathy’s worst enemies. Only a few remained faithful, and continued practicing the miasmatic doctrine (1, 11, 12). The opinions in this selected group were very different:
According to Stapf, the book “The Chronic Diseases” gives surprising explanations about the nature and treatment of the chronic diseases. With these, homeopathy is a few steps closer to achieving this. In this knowledge Stapf even saw the beginning of a new era in the history of homeopathy. The first condition to achieve results is of course to adhere strictly to Hahnemann’s instructions. Any deviation would be punished “with all certainty”, because Hahnemann taught them an “exactly recognized and through nature manifested law”.
It is important to mention that Boenninghausen received the Master’s teachings with enthusiasm. Hahnemann had told him frankly about everything related to the theory of miasms during the years after its publication, and some years later Boenninghausen published the special repertory for antipsoric remedies.(1)
One of the most loyal followers of the theory of Psora was Constantine Hering. Some time after the publication of the first edition of “The Chronic Diseases” he wrote to Hahnemann, from Paramaribo in the Dutch Guyana, in May 1829, on the occasion of the Doctoral Jubilee of the Master(13):
“Leprosy has been conquered. I really see the most extraordinary proofs for this. The antipsoric remedies in the smallest doses, defeat this monster which has been invincible for a long time. I have only been able to apply these remedies for about four month, but I have already achieved brilliant results in all patients. There is not a single patient who did not ameliorate, and many of them are very close to their complete cure.”
“The Chronic Diseases” was printed in 1828. After its publication the author was occupied with the compilation of a repertory of antipsoric remedies. He looked for collaborators among his friends and students, and wrote in the following letter to Dr. Schwiekert:
Dr. Rummel has given me hope that you might be so kind as to help me with the compiling of an alphabetical repertory of the antipsoric remedies. The honorarium we will then share in a friendly way between ourselves. The book must be printed in the smallest type possible, so that it may not become too voluminous. For the same reason, we must be careful only to chose words which express conceptions of value , to use as headings for our reversed symptoms; so that whichever way the sentence may be turned by our German syntax, it will still convey the same meaning it originally had and yet every word be omitted which is not necessary.
All symptoms must be written in such a way (on quartfolio and only written on one side) that I can separate every one of them by cutting them up and pasting them in alphabetical order for the purpose of printing. They must also be written so that only the first line projects while the other recede by one syllable. I take the liberty to hand Phosphorus over to you (Calcarea, Sulphur, Silica, Sepia and Lycopodium have already been dealt with) and to show you the elaboration of some symptoms in the enclosed. I hope that this may meet with your approval.
I remain, with kindest intentions,
The planned repertory was never published. Dr. Ernst Ferdinand Rückert, who was Hahnemann’s guest from September 1829 until Easter 1830, utilized the preliminary works of Jahr, Rummel, Schweikert, etc., and completed the book of about 1,500 pages in an excellent and easy to consult way. Unfortunately, this book never saw the light, because Hahnemann was never able to publish it due to the printing costs. Currently it is in the Robert Bosch Institute for the History of medicine, in Stuttgart, Germany. (1)
The fourth edition of the “Organon” was published in 1829, with 292 paragraphs and radical differences in its contents in relation to the previous three editions. The most important change was the inclusion of the theory of miasms, as well as the use of infinitesimal, imponderable potencies. The use of the decillionth potency (X), presently called 30 CH, was as controversial as the theory of chronic miasms (11,12).
The fifth edition of the Organon was published in 1833, and was the last edition published by Hahnemann. There were profound modifications in its 294 paragraphs with regard to the inclusion of the theory of miasms and the preparation and dosification of homeopathic remedies. He also developed the concepts of animal magnetism further, which was originally developed by Franz Anton Mesmer, and mentioned in §319 in the third edition of the “Organon”, and can now be found in § 293 and § 294 (11, 12).
In that year, the publisher Arnold intended to publish a second edition of “The Chronic Diseases”, although the first edition had been a true failure. Arnold wrote:
…”in the end , I will always be ready to restitute the publication as long as I am sufficiently rewarded for the 800 copies of the first edition, which have been sold like waste paper… I will be happy to renounce the possible profits of the second edition, if I can only get the cost for the printing and the payment for the first part.”
Hahnemann first agreed with the new publication of his book and sent the manuscripts to his publisher.(1) Nevertheless, almost 10 months passed without Arnold giving a sign of life; and Hahnemann, deeply annoyed and upset, wrote to his son-in-law, Dr. Wolff, in Leipzig, in December 1834:
“To my son-in-law, Dr. J.H. Wolff.
I herewith give you full power to demand in my name my manuscript of the first part of Chronic Diseases, from Mr. Arnold, the publisher, unless he can prove to you by giving some proof-sheets, that this first part is already printed or almost so.
Your true father,
Hahnemann’s students heard about the problem with the second edition of the book, and one of them opined:
“The behavior of the publisher Arnold is very annoying, and apart from the detriment to the public, the made insult is also most regrettable. All editors have this in common; they only want to get rich at the expense of knowledge, and there are probably only very few who work honestly. Therefore, if I were you and your written contract with Arnold allows it, I would cancel it and not make this hard sacrifice of devotion, the world would not even be grateful. All your true students and followers cannot fiercely wish anything more than to know the purpose of your healing art, and how many human lives could be lost if this is unduly delayed. Therefore, venerable Hofrath, don’t let your good-natured heart stop controlling the situation and show compassion instead of demanding your rights.
C. von Boenninghausen”
Finally, Arnold published only the first two volumes of the book, forced by the threat of a lawsuit. The remaining book was published by J. F. Schaub, in Düsseldorf. He began to publish 1,500 copies of the four volumes in 1837, when Hahnemann already lived in Paris. He wrote:
“…The edition comprehends 1,500 copies. I assumed that the works of the master would be sold better than those of the pupils; but unfortunately my conjecture was greatly disappointed. What is the reason for the diminished interest of homeopaths in this new edition? Hopefully you won’t be angry with me, Mr., if I tell you frankly what I have heard. It is said that the main reason is the progress of the homeopathic system itself, and that many of your older pupils have advanced whereas you still adhere continuously to the old system. I cannot judge this as a layman, but as the editor I can only say that this article does not sell. “
Finally, Schaub shared the same fate as Arnold, an enormous loss with the publication of the book. These were the only two editions in Germany, but in foreign countries the publication was more successful. In France the first edition was translated by Jourdan in 1832, and published in Paris. Later there were two further editions. In the United Kingdom Geddes M. Scott of Glasgow published an English translation in 1842. A Spanish edition was published in 1849. In the United States two editions were published, one in 1846 by Hempel, and another in 1894 by L.H. Tafel (5, 11). With the years the text was translated also into other languages.
The fact that Hahnemann went to live in Paris in 1835 was very important for his scientific work (1, 10, 11, 12). After the commercial failure of the publication of “Chronic Diseases”, there was no other editor in Germany interested in publishing literature written by Samuel Hahnemann. The sixth edition of the “Organon”, was already ready in 1842, but could not be edited because Hahnemann wanted to have a French edition for publication together with the German edition, and he left the work for a translator who could not finish it. Death surprised him so that he could not deliver his precious legacy for the mankind.
The master scarcely described the theory of miasms, and it is not to forget the great confusion and problems which were associated with the second edition of the “Chronic Diseases”. As the sixth edition of the “Organon” only appeared in 1921, Hahnemann’s last observations only became known much later. (3, 8, 9)
Apparent contradictions regarding various aspects of the miasm theory can be explained with the fact that Hahnemann wrote the first two volumes of the second edition of the “Chronic Diseases” in 1834, and the sixth edition of the “Organon” in 1842, at a time, when he had a more complete and experimentally verified vision of the miasm theory (3,9).
In a recent investigation which involved the revision of 54 volumes of Hahnemann’s clinical studies, it could be observed that he applied the concepts described in the “Organon” and the “Chronic Diseases” in his practice until the end of his days. Controversial subjects like the application of remedies by rubbing into the skin and olfaction are recorded in the description of the mostly successful treatment of these cases (15). In these archives, which are still partially unexplored until today, one cannot find any evidence that Hahnemann changed his concept of, neither in theory nor in practice (15).