Lecture on Aphorism 40

Last month we discussed what happens when two dissimilar diseases, of which the later is stronger, meet in a human body. We saw that if the disease coming later is stronger, it suspends the former till it completes its course and then the former comes back. We also saw that if two diseases are of comparable strength then the one with more virulence at a particular point of time will suspend the other.

But it is not always necessary that when two diseases meet in a body, they will either get repelled or suspended. They can also form complex diseases, a phenomenon described by Hahnemann in aphorism 40. Today we will discuss the formation of complex diseases in nature.

§ 40

III. Or the new disease, after having long acted on the organism, at length joins the old one that is dissimilar to it, and forms with it a complex disease, so that each of them occupies a particular locality in the organism, namely, the organs peculiarly adapted for it, and, as it were, only the place specially belonging to it, while it leaves the rest to the other disease that is dissimilar to it. Thus a syphilitic patient may become psoric, and vice versa. As two diseases dissimilar to each other, they cannot remove, cannot cure one another. At first the venereal symptoms are kept in abeyance and suspended when the psoric eruption begins to appear; in course of time, however (as the syphilis is at least as strong as the psora), the two join together,1 that is, each involves those parts of the organism only which are most adapted for it, and the patient is thereby rendered more diseased and more difficult to cure.

When two dissimilar acute infectious diseases meet, as, for example, smallpox and measles, the one usually suspends the other, as has been before observed; yet there have also been severe epidemics of this kind, where, in rare cases, two dissimilar acute diseases occurred simultaneously in one and the same body, and for a short time combined, as it were, with each other. During an epidemic, in which smallpox and measles were prevalent at the same time, among three hundred cases (in which these diseases avoided or suspended one another, and measles attacked patients twenty days after the smallpox broke out, the smallpox, however, from seventeen to eighteen days after the appearance of the measles, so that the first disease had previously completed its regular course) there was yet one single case in which P. Russell2 met with both these dissimilar diseases in one person at the same time. Rainey3 witnessed the simultaneous occurrence of smallpox and measles in two girls. J. Maurice4, in his whole practice, only observed two such cases. Similar cases are to be found in Ettmuller’s5 works, and in the writings of a few others.

Zencker6 saw cow-pox run its regular course along with measles and along with purpura.

The cow-pox went on its course undisturbed during a mercurial treatment for syphilis, as Jenner saw.

1 From careful experiments and cures of complex diseases of this kind, I am now firmly convinced that no real amalgamation of the two takes place, but that in such cases the one exists in the organism besides the other only, each in pairs that are adapted for it, and their cure will be completely effected by a judicious alternation of the best mercurial preparation, with the remedies specific for the psora, each given in the most suitable dose and form.

2 Vide Transactions of a Society for the Improvement of Medorrhinum and Chir. Knowledge, ii.

3 In Edinb. Med and Phys. Journ., 1805.

4 In Medorrhinum and Phys. Journ., 1805.

5 Opera, ii, p.i, cap. 10.

6 In hufeland’s Journal, xvii.

This aphorism has many powerful statements, which might go unnoticed to someone reading it superficially. Let us read the aphorism in parts and dive into this soup of information, observation, wisdom and questions.

He first says:

Or the new disease, after having long acted on the organism, at length joins the old one that is dissimilar to it, and forms with it a complex disease, so that each of them occupies a particular locality in the organism, namely, the organs peculiarly adapted for it, and, as it were, only the place specially belonging to it, while it leaves the rest to the other disease that is dissimilar to it.

This is interesting because at other places Hahnemann has written that the Psora or Venereal miasms spread throughout the body and are not something local, something that can be seen. Yet, here he says that the disease occupies a particular locality. What does this mean?

Hahnemann is not saying that the effect of a disease is local. When he says that the disease occupies a particular locality, it means that the manifestation of disease is more apparent on specific organs, depending upon the tissue affinity. The disease still remains all pervasive, affecting the organism as a whole but its end results, the pathological changes are more apparent on organs to which it has affinity.

For eg, a person might suffer from Hepatitis and Gonorrhoea simultaneously. Both diseases affect the vitality of the person as a whole, but the effects of Hepatitis will be more visible on the liver and the effects of Gonorrhoea will be more visible in the genitourinary tract. Similarly, a female can suffer from vulvo-vaginitis and sinusitis simultaneously. The diseases/infections affect the organs suited for them. It is also common to come across patient who suffer from chronic urinary tract infections and have other diseases at the same time, affecting different organs.

No chronic disease can be labeled as local. Even most acute diseases result from deranged vitality in general. They are all systemic and affect the person as whole. It is just that their effect might be more visible at some part of the body.

The next statement is of vital interest:

Thus a syphilitic patient may become psoric, and vice versa.

This might make your world of miasms topsy-turvy! What is Hahnemann saying here? A Psoric patient can become Syphilitic and a Syphilitic patient can become Psoric! We know that miasms can change in a person but they can’t fluctuate like this! Haven’t we all learned that a person gets a disease based on his/her underlying susceptibility and miasm? If that were true, how can a Psoric person have the susceptibility to acquire Syphilitic problems and how can a Syphilitic person have the susceptibility to catch Psoric complaints??

Don’t panic! Here Hahnemann has used the words ‘syphilitic’ and ‘psoric’ and ‘miasm’ to denote the actual infections and not their chronic effects. It becomes more clear in next line:

As two diseases dissimilar to each other, they cannot remove, cannot cure one another. At first the venereal symptoms are kept in abeyance and suspended when the psoric eruption begins to appear; in course of time, however (as the syphilis is at least as strong as the psora), the two join together,1 that is, each involves those parts of the organism only which are most adapted for it, and the patient is thereby rendered more diseased and more difficult to cure.

He is speaking about venereal symptoms and psoric eruptions, which are effects of the infection. He is not talking about chronic disease predisposition here. Syphilis, Gonorrhoea and Scabies are infectious diseases, just like smallpox, cowpox and measles. The use of words ‘syphilitic’ and ‘psoric’ should be seen in that light.

Hahnemann notes that once two diseases join together to form a complex disease, it becomes more difficult to cure them. How true! Young students often wonder why the cures in old books look easy but are difficult to achieve in practice today. The reason is that most human beings today are suffering from complex diseases. Those who are not affected by natural complex disease, become sicker because of the artificial disease state created by the allopathic drugs. Today, we need more precision, more patience and more patient guidance for better health, to achieve the desired results in our practice.

In the next few lines, Hahnemann gives examples of two acute diseases presenting together as a complex disease. He says:

When two dissimilar acute infectious diseases meet, as, for example, smallpox and measles, the one usually suspends the other, as has been before observed; yet there have also been severe epidemics of this kind, where, in rare cases, two dissimilar acute diseases occurred simultaneously in one and the same body, and for a short time combined, as it were, with each other. During an epidemic, in which smallpox and measles were prevalent at the same time, among three hundred cases (in which these diseases avoided or suspended one another, and measles attacked patients twenty days after the smallpox broke out, the smallpox, however, from seventeen to eighteen days after the appearance of the measles, so that the first disease had previously completed its regular course) there was yet one single case in which P. Russell2 met with both these dissimilar diseases in one person at the same time. Rainey3 witnessed the simultaneous occurrence of smallpox and measles in two girls. J. Maurice4, in his whole practice, only observed two such cases. Similar cases are to be found in Ettmuller’s5 works, and in the writings of a few others.

Zencker6 saw cow-pox run its regular course along with measles and along with purpura.

The cow-pox went on its course undisturbed during a mercurial treatment for syphilis, as Jenner saw.

These are observations by others that Hahnemann has quoted and there is not much to explain here. But I would like to clarify the last line: The cow-pox went on its course undisturbed during a mercurial treatment for syphilis, as Jenner saw. Here the ‘mercurial treatment of syphilis’ refers to the allopathic use of mercury salts for Syphilis and has nothing to do with Homeopathy. Jenner was not a homeopath!

There is one footnote to this aphorism, which has huge significance for homeopathy practice.

It first states:

From careful experiments and cures of complex diseases of this kind, I am now firmly convinced that no real amalgamation of the two takes place, but that in such cases the one exists in the organism besides the other only, each in pairs that are adapted for it…

Here Hahnemann clarifies that a complex disease is not a new disease, not a separate entity. The two diseases run in parallel but do not mix together. The next part of this sentence is where the meat lies.

…and their cure will be completely effected by a judicious alternation of the best mercurial preparation, with the remedies specific for the psora, each given in the most suitable dose and form.

It looks like Hahnemann is saying that to cure a complex disease you need to alternate two drugs – one for one disease, another for another. If a person is suffering from Syphilis and Scabies simultaneously, use one drug for Syphilis and another for Scabies and alternate them. Read in isolation, these lines do look like a license to use many drugs for one patient. People have used this line as an excuse to use multiple drugs simultaneously or in alteration.

David Little has studied Hahnemann’s original case books and nowhere he has found Hahnemann repeating two drugs alternately. If an alteration is found, it is because of the changed symptoms.

Also Hahnemann’s guidelines to treat diseases are not in sync with the general guidelines given elsewhere. In aphorisms 17 and 18 and in many other places, he has said that the symptoms of the patient need to be taken as a whole and not in parts. His guidelines to treat medicinal symptoms also state that the new symptom picture, which is a combination of the disease symptoms and the drug symptoms, need to be taken as a whole to find the simillimum.

§ 167

Thus if there occur, during the use of this imperfectly homoeopathic remedy first employed, accessory symptoms of some moment, then, in the case of acute diseases, we do not allow this first dose to exhaust its action, nor leave the patient to the full duration of the action of the remedy, but we investigate afresh the morbid state in its now altered condition, and add the remainder of the original symptoms to those newly developed in tracing a new picture of the disease.

So then the question comes up, what exactly is Hahnemann saying here? Also, do we use mercurial preparations for Syphilis? What Hahnemann is sharing in this footnote is his clinical experience. One, he is telling us that he has found homeopathic preparations of mercury effective in cases of Syphilis. Two, he is telling us that in cases with such complex diseases, the symptom picture often changes when you give a medicine, requiring the use of another medicine. The remedies in such cases need to by ‘judiciously’ alternated according to the alteration of the symptom picture.

The ‘judicious’ is very crucial here. He is not in favour of blind alteration like “Take A in morning, B in afternoon, A again in evening and B again at night”. The word ‘judicious’ is derived from ‘judgement’. What is the need to make a judgement if blind alteration for two disease conditions is alright? Judgement is needed when you closely observe a patient and find his symptoms changing enough after the first remedy that they warrant a second one now.

To drill down even stronger, I would like to share with you aphorism no’s 169-170 from the Organon:

§ 169

If, on the first examination of a disease and the first selection of a medicine, we should find that the totality of the symptoms of the disease would not be effectually covered by the disease elements of a single medicine – owing to the insufficient number of known medicines, – but that two medicines contend for the preference in point of appropriateness, one of which is more homoeopathically suitable for one part, the other for another part of the symptoms of the disease, it is not advisable, after the employment of the more suitable of the two medicines, to administer the other without fresh examination, and much less to give both together (§ 272, note) for the medicine that seemed to be the next best would not, under the change of circumstances that has in the meantime taken place, be suitable for the rest of the symptoms that then remain; in which case, consequently, a more appropriate homoeopathic remedy must be selected in place of the second medicine for the set of symptoms as they appear on a new inspection.

§ 170

Hence in this as in every case where a change of the morbid state has occurred, the remaining set of symptoms now present must be inquired into, and (without paying any attention to the medicine which at first appeared to be the next in point of suitableness) another homoeopathic medicine, as appropriate as possible to the new state now before us, must be selected. If it should so happen, as is not often the case, that the medicine which at first appeared to be the next best seems still to be well adapted for the morbid state that remains, so much the more will it merit our confidence, and deserve to be employed in preference to another.

I think this makes it amply clear and there is no room for confusion and there is no room for blind alteration in homeopathy. Change the remedy, when the symptom picture changes enough!

With these words, I wish you all a Very Happy New Year and we will meet again next month with a new lecture on complex diseases arising due to allopathic drugs.