The concept of miasms has been one area of homeopathic philosophy that has attracted such varied interpretations as no other concept of our Healing Art. Perhaps Hahnemann had anticipated this. In a letter to his friend Dr. Johann Stapf, dated 6th September 1827, shortly before Chronic Diseases was published, Hahnemann wrote, “ … at least a year will elapse before the others get my book; they will then require more than six months to recover from the shock and astonishment at the monstrous and unheard things, perhaps another six months before they believe in it … hence three years from now will elapse before they can do anything useful with it”. Yet in the same letter Hahnemann had also explained that, “you do not need to regard chronic diseases as paradoxes or inexplicable phenomena, the nature of which is hidden, in impenetrable obscurity” . Why then have such variegated interpretations proliferated in our literature? Hahnemann never spoke of inherited miasms, but the writings of Kent, steeped in his Swedenborgian beliefs led him to conclude that, “The miasms, Psora, Syphilis and Sycosis represent Sin in all its forms in the organisms”, and further, “The sins of the father shall be visited upon the children”. Equally intriguing is the fact that stalwarts like Lippe, Hering and Dunham made almost no reference to the concept . In a lighter vein, one of my respected teachers, Dr. Will Taylor says that any talk of miasms invariably ends up in a personal interpretation, and people argue more about my-asms, or your-asms, or their-asms, rather than Hahnemann’s miasms!
According to Hahnemann the cause of chronic disease was an underlying chronic infection. He was very clear about that, and in fact used syphilis as a model to illustrate the evolution of a chronic disease. Syphilis was recognized even by allopaths of the day as a disease acquired by contagious contact which would develop into a chronic disease. However microscopy had not developed, so Hahnemann’s foresight was either accepted or rejected as would any other “belief” system.
Koch’s simple model found too simplistic
In the world of allopathy, final acceptance of the concept of infection by microorganisms had to wait for Koch’s research that demonstrated an association between causative agents and disease. He succeeded in demonstrating the relationship between an infection causing microbiota and disease like anthrax, tuberculosis, cholera and more. Yet the famous Four Postulates of Koch were soon found wanting in their robustness and one could explain a causal relationship with an infectious agent only under a set of special circumstances which included the response of the host’s immune system . Thus a mere 50 years after Koch was lionized and anointed as a Nobel laureate for having solved the mysterious puzzle of the causation of disease, allopathy was looking for a new direction.
It is too well known to mention that unbridled success of antibiotic drugs led to their indiscriminate use to the extent that they were sought even when hygiene, sanitation, and preventive care was the solution. Although the next challenge appeared to be antibiotic-resistant bacteria, the real challenge seems to lie elsewhere.
Hahnemann’s musings come to haunt the allopath
A few decades ago allopaths began facing the same conundrum that had engaged Hahnemann for nearly twelve years. It was discovered that antibiotics were ineffective even against antibiotic-susceptible bacteria when they exist in aggregates, or structures known as biofilms. This resistance has absolutely nothing to do with resistance due to genetic mutation of bacteria. This echoes Hahnemann’s observations that Psora could be most infectious even before any repressive treatment was directed against it.
Until recent times the efficacy of antibiotics was tested in labs and human subjects where the microbes existed in a planktonic state, i.e., each bacterium existing in a free state, as you would find in a contaminated glass of water or on a slide. Using culture methods for the study of bacteria are suited for acute and epidemic infections. Bacteria in the planktonic state are easily phagocytosed or eaten up by the white blood cells through the immune system of the host, or by action of an antibiotic drug. But, if through some mechanism not yet fully understood, they aggregate together, then they form a kind of fortress which cannot be attacked by any amount of antibiotic, even though the very same bacteria in the planktonic state would succumb.
Advanced techniques like confocal laser scanning microscopy, and bacteria-specific fluorescence in-situ hybridization (FISH) seem to suggest that this fortress-like structure of bacteria is a coherent cluster of bacteria embedded in a matrix composed of extracellular DNA, polysaccharides and such molecules. Thus in such a structure, the bacteria are literally taking a bath in DNA! This structure is called a biofilm. A typical biofilm may have layers upon layers of bacteria. The size of a biofilm may be as small as 5 µm in diameter to a few centimeters. The three dimensional structure of a biofilm makes it difficult for antibiotics to penetrate the fortress because antibiotics get entangled in the matrix composed of polysaccharides etc.
But not all biofilms are dangerous or hidden. The plaque on our teeth – the white stuff that we scratch off when we brush our teeth every morning, is a biofilm and is host to the normal bioflora of the mouth. However, if not cleaned for a few days can cause caries. It is interesting to note that Leeuwenhoek, who made the first microscope, had also found biofilms, but only recently it was found that they were highly structured, complex communities that can survive on the basis of a localized homeostatic environment . Within these communities the microbes assume specialized roles which confer survival advantages as witnessed in beehive and anthill communities. This goes against the century old perception that bacteria are clonal with respect to phenotype (development and behavior) and genotype (hereditary). Therefore the research methodology of isolation and pure culture is unsuitable for study of biofilms.
It is found that these multiple layers of bacteria embedded in the matrix slow down the growth of the inner layers of the biofilm. This makes them less invasive and less virulent as they down-regulate the secretion of toxins. Consequently, this leads to a reduced immune response from the host. Further, the deeper layers have low oxygen concentration and many antibiotics are simply ineffective is such low oxygen environments. Thus the bacterial survival is enhanced in a biofilm due to a variety of factors.
Acute diseases as expressions of a chronic diseases
Microbiologists are now converging to a consensus that many acute diseases, which keep revisiting a patient in a more virulent form (in line with Hahnemann’s observation on chronic diseases) are essentially due to the effects of planktonic bacteria that may have separated from a biofilm that has been latent. This biofilm may be formed on a prosthetic device (stent/ joint, etc.) or an insert (vascular or urinary catheter), or due to inefficient elimination of fragments remaining after antigen-antibody reaction. The detached planktonic cells can seed infection in other locations and cause secondary acute as well as chronic infections. This reminds us of the terminology used by Hahnemann – “the awakening of the internal Psora which hitherto slumbered and been latent, and as it were, kept bound by a good bodily constitution”, but which could “develop into a manifest secondary disease”. He then goes on to talk about the “outbreak of internal Psora”. Contemporary understanding of biofilms has led many microbiologists to ask the same questions and propose the same answers that Hahnemann had done two centuries ago.
Understanding misams in the light of biofilms
As mentioned above, Hahnemann had used syphilis as a model to illustrate the evolution of a chronic disease. Leaving aside chronic states associated with the two venereal miasms, Hahnemann had attributed the remaining 7/8th of all disease to Psora, which he aptly termed as a hydra-headed monster, which was “most wide-reaching and difficult of all parasitic microbic diseases”. For the past two centuries homeopaths have been struggling to come to terms with the concept of miasms. Some equated it to Sin, yet others invoked heredity, and some used it as a metaphor for the depth and pace of disease. But our understanding can be greatly enhanced by understanding the effects of biofilms, and perhaps find a logical evolution of Hahnemann’s idea based on infection.
Let us look at just one example of the effects of biofilms formed by Staphylococcus aureus (S. aureus). S. aureus colonizes a certain percentage of healthy adults permanently or transiently. Acute episodes may respond to antibiotics, but if it is introduced through a hematogenous route – by inoculation or due to surgery or trauma, it could colonize the bone and lead to chronic osteomylitis, and in a diabetic patient lead to chronic wound infection, or be the underlying cause of chronic rhinosinusitis, which is often considered to be without a clear etiology. But the list does not end here. It has also been indicted in impetigo, endocarditis, and eye infections like recurrent conjunstivitis, keratitis and endopthalmitis . This list is not exhaustive, only illustrative. The entire list of ailments will be found to tally with the list of disease that Hahnemann had adduced a being caused by “Psora coming forth from its latent state” .
Important to note is the fact that the symptom picture and pathogenesis that follows the infection by each bacterium species is also affected by individual factors such as host response, environment and maintaining factors.
The way ahead
A deeper study of documented cases from allopathic literature needs to be surveyed to determine a basis for differentiating between different microbial agents. Just two examples are used to illustrate. If we study the clinical presentation of bacterial keratitis (inflamed cornea), we find that Staphylococcus aureus lesions are more localized, with dry eyes and have minimal edema, and can have remittent fever accompanied with fatigue. Pseudomonas are more aggressive, and infection is rapid, and have edema and the epithelial infiltration is grayish . How do Staphylococcus aureus symptoms compare when other organs are the seat of infection? Do we recognize any generalities that could help in differential diagnosis of the remedy from the 70+ remedies listed for corneal inflammation (keratitis) listed in the Synthesis Repertory? Endocarditis patients infected by Staphylococcus aureus are characterized by dry cough and fatigue, but concomitants include remittent fever, sub-conjunctival reddening, and/or painful subcutaneous nodules on palm or soles. This information of location, concomitants, and generalities can provide useful clues to finding the simillimum. Where can the homeopath find such information? Often our repertories and material medica are lacking in details that provings can provide. For example, Allen’s Encyclopedia of Pure Materia Medica is a virtual goldmine with detailed descriptions of each of the symptom portraits. In the example of keratitis given above, we find excellent portraits of symptomatology that matches a large number of specific biofilm related symptoms reported in allopathic literature.
While the pharmacologists are busy developing newer, more potent antibiotics, the homeopathic armamentarium could offer more by means of nosodes developed from biofilms. While infections even in a single location can be multi-species, recent findings indicate that chronic infection sites are pervaded by single or dominant strains of low species diversity . This makes the case for a suitable nosode even more compelling. Some purists may argue that the use of remedies made out of biofilms is isopathy and not homeopathy. It would be in order to remind ourselves that while introducing Psorinum in his list of anti-psorics, Hahnemann had explained , “I call Psorinum a homoeopathic anti-psoric, because if the preparation of Psorinum did not alter its nature to that of a homoeopathic remedy it never could have any effect upon an organism tainted with that same identical virus. The psoric virus, by undergoing the processes of trituration and shaking, becomes just as much altered in its nature as gold does, the homoeopathic preparations of which are not inert substances in the animal economy, but powerful acting agents”. Besides, the homeopathic choice of a remedy is always guided by the totality of the symptoms and not by identification with a bacteria or virus. This is so because the host response to any infective agent is the decisive individualizing factor.
In his seminal work on remedies derived from bacteria and viruses, Vermeulen has given a material medica of nosodes prepared from most microbes associated with biofilms that are indicted in common chronic diseases, and include Pseudomonadaceae, Staphylococcacae and Clostridiales . But sadly one finds these nosodes are used only too infrequently, and are difficult to repertorize. Encouragingly, S. aureus has been effectively used in veterinary homeopathy, principally for treatment of conditions arising out of methicillin-resistant S. aureus (MRSA) .
We can also develop a better understanding of the rubric Never Been Well Since surgery, especially if the surgery has involved implanting inserts in the body and has given rise to symptoms in other regions not apparently associated with the surgery. It is now confirmed that dental as well as cochlear implants (often resorted in otitis) can cause derangements of the Vital Force throughout the economy.
It is worth pointing out that even with modern microbiological laboratory techniques it is difficult to collect biofilm samples. Perhaps only sputum samples from chronic cystic fibrosis (CF) patients is direct and easy. But most other tissues require surgical intervention. Once again Homeopathy proves efficacious because symptomatology is one of the principal means of understanding disease. Another problem faced by allopathy is the difficulty in delivering or transporting antibiotic drugs (often in aggressive, heroic doses) to the seat of infection. Homeopathic remedies by contrast work on the Dynamis. Thus Homeopathy looks poised to offer succor to patients suffering from many chronic conditions if it capitalizes on the new vistas provided by microbiology.
References Bradford, Thomas Lindsley MD: The Life and Letters of Dr Samuel Hahnemann, Ch. 34  http://www.drfarokhmaster.com/Ref_material_Editorials.html  Evans, AS: Causation and Disease – The Henle-Koch Postulates Revisted, The Yale Journal of Biology and Medicine, 49, 175-195 (1976)  Stoodley P et-al: Biofilms as Complex Differentiated Communities, Annual Review of Microbiology, Vol. 56: 187-209, 2002.  Archer, NK et al: Staphylococcus aureus biofilms – Properties, regulation and roles in human disease. Virulence. 2011 Sep-Oct; 2(5): 445–459  Hahnemann, S: The Chronic Diseases – Their peculiar nature and their homoeopathic cure  Al Mujaini et al: Bacterial Keratitis: Perspective on Epidemiology, Clinico-Pathogenesis, Diagnosis and Treatment. Sultan Qaboos Univ Med J. 2009 Aug; 9(2): 184–195  Mette Burmølle et-al: Biofilms in chronic infections – a matter of opportunity – monospecies biofilms in multispecies infections, Immunology & Microbiology, Federation of European Microbiological Societies, Volume 59, Issue 3, 1 August 2010  Vermeulen, Frans: Monera Kingdom Bacteria & Viruses, Spectrum Materia Medica Vol. 1, Emryss.  Passeti, et-al: Action of methicillin on the “in vitro” growth of bacteria Staphylococcus aureus methicillin-resistance previously treated with homeopathic dilutions. International Journal of High Dilution Resarch . 2015, Vol. 14 Issue 2, p57-58.