During the 18th century, the word ‘miasm’ was loosely used to denote the discharge coming from decaying animal or vegetable matter. It was also sometimes used to denote the discharge coming from bodies of diseased person. The morbific agents, which were thought to be connected with production of disease, were designated by a general term ‘miasm’ or ‘miasma’.
The use of this term by Hahnemann remains controversial. At some places in his writing, Dr. Hahnemann has used miasm to denote the predisposition for disease and at other places he has used it to denote the morbific agent, similar to bacteria & viruses, and the states arising from their suppression.
History of Miasms
In the early days of his practice when Dr. Hahnemann started using the law of similia, he got good success in acute and epidemic diseases but he failed miserably in a large number of chronic diseases. He himself said – “Their beginning was promising, the continuation less favorable, the outcome hopeless…” (26, CD)
For example, if a patient came to him with pain in knee worse by initial motion and better by continued motion, he would have probably prescribed Rhus tox. If the cause of this symptom were acute, the patient would get cured. If the case were chronic (say arthritis or gout), the patient would often come back with the same symptoms after an initial amelioration.
Such instances made Dr. Hahnemann probe deeply into the concept of disease and the development of the chronic diseases. After 12 years of detailed case takings and case analysis, he found out that nearly all the patients with chronic diseases had a history of either Scabies, Syphilis, or Gonorrhea and most of the patients were not well since the time of infection.
He called these infections and the disease tendency arising from them, miasms. The one arising from Scabies was called Psora or non-venereal miasm. The other two were called venereal miasms as they arose from sexual conduct. The one arising from Syphilis was called Syphilitic miasma and the one from Gonorrhea was called Sycotic miasm.
During the days of Hahnemann, homeopathic world was divided in two parts –
- Those who believed in miasms
- And those who did not
In the early days of this theory, very few of Hahnemann’s pupils accepted this theory whole-heartedly. There were others like Hering who became converts with experience. There were still others like Richard Hughes who never believed it and even went on to call this theory of miasms, Hahnemann’s biggest mistake.
Later with the rise of Kent and advent of microbiology/bacteriology, even the believers split into two groups:
- Those who believed Hahnemann’s miasm were nothing but bacteria and viruses.
- Those who believed in the spiritual nature of the miasms.
Dr. Hering, R. Hughes, Stuart Close, G. Boericke, Margret Tyler, P. Speight, B. K Sarkar, Harimohan Chaudhary – all have favored the concept that miasms are bacteria or originate from bacterial diseases. Some of these people even went on to call Hahnemann as the Father of Bacteriology because his description of miasms was so similar to the bacteria at many places.
Others like Kent, J. H. Allen, J. Paterson, H. A. Roberts etc. strongly believed in the non-material nature of the miasms. They described miasms as a dyscrasia, a state, and a predisposition. Kent even went on to say: “Psora is the underlying cause, the primitive or primary disorder of the human race…. it goes to the very primitive wrong of the human race, the very first sickness of the human race, that is the spiritual sickness..”
The Big Question
So the big question is what exactly Hahnemann meant when he used the term miasm? What was his concept of origin of chronic diseases?
If you go through various works of Hahnemann closely, you will realize that Hahnemann has used the term ‘miasm’ in the both senses at different places. May be he was himself a bit confused. On one hand he was talking about the spiritual vital force and its dynamic derangement as the cause of all disease, on the other hand he was well aware that there was something material (contagion) in acute diseases like Cholera and Typhus, and Chronic diseases like Syphilis and Gonorrhea.
We need to understand that Hahnemann was trying to understand the cause of disease without the aid of any microscopes. He was just relying on his keen observation and apart from his observation, there was nothing much to support him. Developing a whole classification of diseases was a marvelous work done by Hahnemann. He had his own limitations and the work he has done within those limitations is extraordinary.
Now let me quote some paragraphs from Chronic Diseases, which show that Hahnemann believed in the infectious nature of disease and considered miasms as infectious agents.
“the few pustules appearing after infection made but little show and could easily be concealed. Nevertheless they were scratched continually because of their unbearable itching, and thus the fluid was diffused around, and the psoric miasma was communicated more certainly and more easily to many other persons, the more it was concealed. For the things rendered unclean by the psoric fluid infected the persons who unwittingly touched them, and thus contaminated far more persons than the lepers, who, on account of their horrible appearance, were carefully avoided.” (11, CD)
“PSORA has thus become the most infectious and most general of all the chronic miasmas. For the miasm has usually been communicated to others before the one from whom it emanates has asked for or received any external repressive remedy against his itching eruption”
“It may well be conceived that the poorer and lower classes, who allow the itch to spread on their skin for a long time, until they become an abomination to all around them and are compelled to use something to remove it, must have in the meanwhile infected many.” (12, CD)
“The infection with miasmas, as well of the acute as of the above-mentioned chronic diseases, takes place, without doubt, in one single moment, and that moment, the one most favorable for infection.
When the smallpox or the cowpox catches, this happens in the moment when in vaccination the morbid fluid in the bloody scratch of the skin comes in contact with the exposed nerve, which then, irrevocably, dynamically communicates the disease to the vital force (to the whole nervous system) in the same moment. After this moment of infection no ablution, cauterizing or burning, not even the cutting off of the part which has caught and received the infection, can again destroy or undo the development of the disease within. Smallpox, cowpox, measles, etc., nevertheless will complete their course within, and the fever peculiar to each will break out with its smallpox, cowpox, measles etc., after a few days, when the internal disease has developed and completed itself.
The same is the case, not to mention several other acute miasmas, also when the skin of man is contaminated with the blood of cattle affected with anthrax. If, as is frequently the case, the anthrax has infected and caught on, all ablutions of the skin are in vain; the black or gangrenous blister, nearly always fatal, nevertheless, always comes out after four or five days (usually in the affected spot); i.e., as soon as the whole living organism has transformed itself to this terrible disease.” (33, CD)
“Does it not take ten to twelve days after infection with smallpox, before the inflammatory fever and the outbreak of the smallpox on the skin take place?
What has nature been doing with the infection received in these ten or twelve days? Was it not necessary to first embody the disease in the whole organism before nature was enabled to kindle the fever, and to bring out the emption on the skin?
Measles also require ten or twelve days after infection or inoculation before this eruption with its fever appears. After infection with scarlet fever seven days usually pass before the scarlet fever, with the redness of the skin, breaks out.
What then did nature do with the received miasma during the intervening days? What else but to incorporate the whole disease of measles or scarlet fever in the entire living organism before she had completed the work, so as to be enabled to produce the measles and the scarlet fever with their eruption.)” (33, CD)
“In that part of the sexual organs where the infection has taken place, nothing unnatural is noticed in the first days, nothing diseased, inflamed or corroded; so also all washing and cleansing of the parts immediately after the impure coition is in vain. The spot remains healthy according to appearance, only the internal organism is called into activity by the infection (which occurs usually in a moment), so as to incorporate the venereal miasma and to become thoroughly diseased with the venereal malady.
(* Or have these various, acute, half-spiritual miasmas the peculiar characteristic that – after, they have penetrated the vital force in the first moment of the contagion (and each one in its own way has produced disease) and them, like parasites, have quickly grown up within it and have usually developed themselves by their peculiar fever, after producing their fruit (the mature cutaneous eruption which is again capable of producing its miasma) – they again die out and leave the living organism again free to recover?
On the other hand, are not the chronic miasmas disease-parasites which continue to live as long as the man seized by them is alive, and which have their fruit in the eruption originally produced by them (the itch-pustule, the chancre and the fig-wart, which in turn are capable of infecting others and which do not die off of themselves like the acute miasmas, but can only be exterminated and annihilated by a counter-infection, by means of the potency of a medicinal disease quite similar to it and stronger than it (the anti-psoric), so that the patient is delivered from them and recovers his health?)” (P35)
Also, in his article on Asiatic Cholera, published in 1831, Dr. Hahnemann has written:
“In those confined spaces, filled with mouldy water vapours, the cholera miasm finds a favorable element for its multiplication, and grows into an enormously increased brood of those excessively minute, invisible, living creatures, so inimical to human life, of which the contagious matter of cholera most probably consists”
Now let me quote some paragraphs from Organon & Chronic Diseases, which show that Hahnemann considered disease as dynamic, non-physical and the origin of chronic diseases as dynamic predisposition to disease.
“all miasmatic maladies which show peculiar local ailments on the skin are always present as internal maladies in the system before they show their local symptoms, externally upon the skin..” (32, CD)
“Is not, then, that which is cognizable by the senses in diseases through the phenomena it displays, the disease itself in the eyes of the physician, since he never can see the spiritual being that produces the disease, the vital force?” (§6)
“He calls such effects dynamic, virtual, that is, such as result from absolute, specific, pure energy and action of he one substance upon the other substance.
For instance, the dynamic effect of the sick-making influences upon healthy man, as well as the dynamic energy of the medicines upon the principle of life in the restoration of health is nothing else than infection and so not in any way material, not in any way mechanical. Just as the energy of a magnet attracting a piece of iron or steel is not material, not mechanical. ..A purely specific conceptual influence communicated to the near child small-pox or measles in the same way as the magnet communicated to the near needle the magnetic property.” (Footnote to §11)
“It is the morbidly affected vital energy alone that produces disease, so that the morbid phenomena perceptible to our senses express at the same time all the internal change, that is to say, the whole morbid derangement of the internal dynamis; in a word, they reveal the whole disease.” (§12)
“Therefore disease (that does not come within the province of manual surgery) considered, as it is by the allopathists, as a thing separate from the living whole, from the organism and its animating vital force, and hidden in the interior, be it ever so subtle a character, is an absurdity” (§13)
“But as nothing is to be observed in diseases that must be removed in order to change them into health besides the totality of their signs and symptoms, and likewise medicines can show nothing curative besides their tendency to produce morbid symptoms in healthy persons and to remove them in diseased persons” (§22)
So we see that the confusion about the cause or origin of diseases was evident to a great extent in Hahnemann’s writings even up to the 6th edition of the Organon. On one hand he was saying that nothing material could be found in sick persons as disease results from the dynamic derangement of the Vital Force and on the other hand he was describing microscopic living organisms as the cause of Cholera!
Miasms in The Modern World
After Hahnemann, many homeopaths have suggested that since miasms are disease syndromes, there can be more miasms that psora, syphilis and sycosis. The concept is to look for diseases which leave a diseased state in the body even after apparent recovery, especially after suppression. In this regard, the following miasms have been proposed so far:
- Tubercular – J. H. Allen
- Vaccinosis – Dr. Burnett
- Malaria – R. Sankaran
- Ringworm – R. Sankaran
- Typhoid – R. Sankaran
- Leprosy – R. Sankaran
The understanding and approach of those who have put forward newer miasms is varied and at odds with Hahnemann’s ideas as well. Such differences arise from a different understanding and approach to the disease process. As a result of this the world of miasms has become more chaotic.
Now I will pick up 3 modern authors – Vithoulkas, Sankaran, and Vijayakar and probe into their approach and understanding of chronic miasms.
George Vithoulkas does not fall into the trap of whether miasms are bacteria or simple predisposition to disease. According to him it can be both – a predisposition acquired through a suppressed disease or other strong influences on the vital force like vaccination, strong emotional or mental shocks OR a predisposition which is inherited from parents.
Vithoulkas defines miasms as:
“A miasm is a predisposition towards chronic disease underlying the acute manifestation of an illness –
- Which is transmissible from generation to generation
- Which may respond beneficially to the corresponding nososde prepared from either pathological tissue or from the appropriate drug or vaccine.”
He also says: “…any homeopath who has studied the course of degeneration of patients over a long period of time can attest to the presence of a large number of ‘miasms’.”
Vithoulkas believes that miasms appear as layers (of suppression?) in chronic cases, which need to be peeled one by one through medicines based on the totality of symptoms. Also Vithoulkas believes that any miasm can produce any pathology and the notion that tumors are sycotic, ulcers are syphilitic etc is wrong. Except for the fact that Vithoulkas considers there are many miasms, his approach to the miasms is very classical.
In his work ‘The Spirit of Homeopathy’, Sankaran had described disease as ‘delusion’, the ‘awareness’ of which becomes a ‘cure’. In his subsequent work ‘The Substance of Homeopathy’, he extends his approach to disease to the concept of miasms. Unlike others who developed their understanding of miasms through the cause and classification of diseases, Sankaran evolved his ideas of miasms by trying to find the common theme in the mental states and delusion of known anti-miasmatic remedies. From there he extended the concept to the physical and pathological states corresponding to the miasms.
For example, to develop an understanding of Psora he studied known anti-psoric remedies like Sulphur and Psorinum and compared their underlying theme, delusions and state to find the common miasmatic ground.
Sankaran says – “The acute (miasm) is the immediate reaction necessary to survive. Psora is the reaction to a situation which demands struggle with the circumstances outside in order to survive. Sycosis is the reaction to a situation that demands that he accepts his own weakness and cover it up to survive. The syphilitic reaction comes with the realization that adjustment is no longer sufficient and that in order to survive he must bring about a radical change in the internal or external circumstances, or both.”
Sankaran’s approach on the mental plane may seem radical to many but on the ground his use of physical symptoms of the miasms is very classical. The only difference is that Sankaran has come to hold the ear from behind the head! Sankaran has evolved his understanding of miasms with his understanding of medicines and their mental states.
The significant aspect of Sankaran’s concept of miasms is his focus on newer miasms like Tubercular, Leprous, Cancer, Malarial, Typhoid and Ringworm. He says Typhoid miasm is a subacute miasm, which lies between the acute, and Psoric miasms. It has the main feeling of a critical situation, which, if properly handled for a critical period, will end in a total recovery. Ringworm miasm lies between Psora and Sycosis. It is characterized by an alteration between periods of struggle with anxiety about its success, and periods of despair and giving up.
Malarial miasm, which lies between acute miasm and Sycosis, has an acute feeling of threat that comes up intermittently. Tubercular, Leprosy and Cancer miasm lie between Sycosis and Syphilis. In Tubercular miasm the feeling is of intense oppression and exploitation, and a desire for change. Cancer miasm has a feeling of weakness and incapacity within, with a desire for perfection. Leprosy has the feeling of intense oppression, intense hopelessness, and an intense desire for change.
The other difference in Sankaran’s approach is his list of anti-miastmatic remedies. Since he uses a different classification of miasms and also relies on the ‘state’ of the patient to judge the miasm, he has his own list of antimiastmatic remedies.
I cannot dwell deeper on Sankaran’s approach here but I would like to say that although Sankaran’s miasms appear very different from Hahnemann’s miasms, they are actually not. Sankaran has picked all his miasms from infections and uses physical symptoms too, to identify a miasm just like others.
The difference in his work is that he has been able to associate different mental states with each miasm and the transition from one miasm to another is shown through successive changes in the mental state. The only drawback in Sankaran’s approach is that his process relies so heavily on a specific method of case taking, analysis and understanding of mental states that it introduces a lot of subjectivity and others may find it difficult to get the same results by following his approach.
Vijayakar’s approach to miasms is not new. He is using very classical Hahnmeannian approach of Psora, Syphilis and Sycosis. The uniqueness in his approach lies in his understanding of these miasms.
Vijayakar’s basic approach is similar to the established understanding of miasms: Psora is related to irritability, Sycosis to excess or deficient growth and Syphilis to destruction. But he does not seem to believe in the concept of infections as the primary source of the miasms. He correlates miasms with the cellular defense mechanisms. Dr. Vijayakar’s approach is that mere symptom-similarity will not give results in chronic diseases, unless the underlying miasm of the patient is taken into consideration.
Vijaykar correlates the physiological defense of the cell with Psora, the constructive defense with Sycosis and the destructive defense with Syphilis. He says that everyone has all the three miasms but the type of cell-defense dominant in a person reflects his dominant miasm.
Although novel, this approach to the understanding of miasms appears very one-sided and deficient in many aspects. The excessive focus on the cell to the exclusion of the ‘whole’ leaves lots of open-ended questions. He has tried to present miasms in a scientific garb but has not succeeded much in his efforts at a deeper level.
What he has succeeded in is clinical use of the miasms. If you leave his efforts to explain the miasms through genes and all, the rest of his clinical approach is very easy to follow and good indeed. Vijayakar’s approach is to rely on the totality of the case, which includes the underlying miasm.
Unlike Sankaran, who relies on current mental state of the patient, Vijayakar relies on the inherent mental traits (like conscientious, diligent etc) of the person to narrow down his search for the similimum. The way Vijaykar differentiates between the importance of medicines in a given case based on the underlying miasm is worth taking note of. The clinical approach of Vijaykar is very easy to follow and unlike Sankaran, has much less subjectivity.
After going through Hahnemann’s works and understanding the way in which his thoughts evolved, I have come to realize that the theory of miasms has three different aspects –
- Genetic or Inherent predisposition to acquire a disease.
- Acquired predisposition for chronic diseases – through suppression or use of allopathic / antipathic measures.
- Diseases which when untreated or maltreated, lead to chronic disease syndromes related to natural progression of disease or lead to an increase in susceptibility for other diseases.
Hahnemann has talked about all these aspects at one place or other but due to the lack of scientific advancements, he was not able to systematize his understanding of the cause of chronic diseases and chronic miasms.
The confusion that is apparent in his works has trickled down to the homeopathic community since the time of Hahnemann. The reason for this is that while homeopaths are often dogmatic about what Hahnemann has written, they rarely try to understand why he wrote, what he wrote. The approach used by Kent, Vithoulkas, Sankaran and Vijayakar is just one-sided approach to this multi-dimensional theory. We need more work to systematize this concept and bring it upon a scientific platform.