Hippocrates was the first physician to use the term "miasm," which originates from the Greek word for "taint" or "fault." Hippocrates postulated that certain infectious diseases were transmitted to humans by air and water tainted by miasms. In the late 18th century it was a common belief that miasms were impure airs responsible for the spread of epidemic diseases. Hahnemann realized that air could carry infectious diseases, but he did not consider the pathogenic material to be gaseous in nature. By the late 1790's Hahnemann had realized that syphilis was an infectious blood disease that could mask itself with the symptoms of many different illnesses. Early in his career he made a special preparation called Mercurius Solubis Hahnemanni that was the standard treatment for syphilis throughout Europe. Hahnemann soon found that Mercury in homeopathic potency worked much better on syphilis than did the crude poisonous form, and he recorded several permanent cures.

The Dutch naturalist van Leeuwenhoek invented the microscope and published his observations of small living "animalcules" before in his death in 1723. This information led Hahnemann to believe that microorganisms were at the root of many infectious diseases. For this reason he supported the ideas of the animalculists, but at the same time upheld the importance of susceptibility of the host constitution. Very early in his career, Hahnemann suggested that certain skin eruptions, such as "crusta lactea," were caused by microscopic "miasmic animalcule" i.e., microorganisms. At this time there were three major theories about diseases that spread in an infectious manner.

1. Miasma as a foul gaseous exhalation
2. The theory of the animalcule
3. The zymotic theory

Hahnemann synthesized the ideas of the animalcule and zymes, and redefined the Hippocratic term, "miasma," to express the constitutional derangements caused by parasitic infections. He carefully separated the self-limiting acute miasms from the syndromes of long lasting diseases and began to develop a special materia medica and repertory for the treatment of the chronic miasms. Therefore, in Hahnemannian homeopathy, the word "miasm" means the effects of microorganisms on the vital force, including symptoms transmitted to following generations. These chronic miasms are capable of producing degenerative illnesses, auto-immune diseases and lead the organism toward immuno-deficiency disorders.

Hahnemann noticed that each of the chronic diseases has three phases: a primary stage, a latent stage, and a secondary or tertiary state. The effects of these miasms were then passed from one generation to the next by inheritance, and caused predispositions to certain disease syndromes. The three chronic miasms that Hahnemann introduced in 1828 were called Psora (the itch miasm), Sycosis (the gonorrheal miasm) and Syphilis (the chancre miasm). Hahnemann published his miasmic theory long before the presence of germs was widely accepted, so most practitioners found it difficult to understand such a sophisticated theory of contagion. From the time of Hippocrates healers conjectured about the possibility of invisible organisms causing disease, but Hahnemann founded the modern concept of infection. In fact, homeopathic pathology is still far more advanced than its modern allopathic counterpart which still does not comprehend the effects of the miasmic processes or their inherited constitutional syndromes.

In the preface of Charles Hempel's translation of the Organon, Constantine Hering recorded that late in his life, Hahnemann made further discoveries and developed a new aspect of the theory of Psora with the introduction of a new miasm he called Pseudo-psora. Hering wrote:

Hahnemann distinguishes the venereal miasms as syphilis and sycosis; and also subdivides psora with pseudo-psora.

Hahnemann's miasmic theory was thus developed to include two venereal and two non-venereal miasms, all of which produced life-long chronic diseases. The two non-venereal miasms are Psora (the itch disease) and Pseudo-psora (the tubercle disease). The two venereal miasms are Sycosis (the fig wart diseases) and Syphilis (the chancre disease). Hahnemann noticed that some apparent Psora cases did not depend exclusively on an external skin eruption for their development. He observed that this disease was infectious in nature and possessed primary, latent, and secondary symptoms, as well as inherited aspects. He decided that it was caused by a miasmic agent with a distinct etiology, so he separated its symptoms from Psora and made a new classification called "Pseudo-psora," the TB miasm. All of these miasms may be acquired through a primary infection, or their effects can be experienced through heredity.

It is sometimes thought that Hahnemann taught that all long lasting diseases were caused by chronic miasms. This is not the total picture. In the Organon he mentions three classifications of long lasting disease: those caused by continual stress factors (disorders upheld by maintaining causes which by their nature are not necessarily true chronic disorders #73), those caused by drug toxicity and faulty treatment (physician caused #74), and those caused by infectious miasms (naturally caused #78). In modern times the disease produced by man-made toxins must be expanded to include the thousands of potential harmful chemicals released into our environment. Between the environmental degradation caused by our massive industrial complex, the vaccinosis miasm caused by compulsory immunization, and the great number of new medicines produced by the pharmaceutical industry, the second category of chronic disease has grown tremendously. Illnesses that involve all three factors of causation (continual stress; drugs, toxins, vaccinosis; and natural miasms) are the most difficult to treat because all these factors intermingle to create complex layers.

The Development of the Miasmic Theory

There has been a tendency in modern homeopathy to focus more and more on the mental and general symptoms of the individual while paying little, if any, attention to the classical doctrine of the chronic miasms. This is not a new phenomena. In his Lesser Writings, Baron von Boenninghausen bemoaned the fact that many practitioners were ignoring Hahnemann's teachings on the miasms as expressed in Aphorisms 5 and 206 of the Organon. Even Constantine Hering was skeptical when Hahnemann first introduced his miasmic theory. But after observing the syndromes in his own patients, Hering became a great contributor to the further development of the doctrine. One of the reasons the original theory of the miasms has fallen out of use in case taking is because it has somehow become associated with the concept of orthodox pathology. Are the detailed syndromes recorded under the miasmic process just another form of useless pathology? Can we take a complete constitutional case through the use of the general symptoms alone while ignoring the presence of the inherited or acquired miasms?

According to the founders of homeopathy, to overlook Hahnemann's doctrine of chronic disease is to miss the main point of Aphorism 5 of the Organon, which deals with the importance of causation, constitution, and the chronic miasms. This trinity forms the foundation of the anamnesis to which the concept of the totality of the signs and symptoms is added in Aphorisms 5, 6 and 7. Hahnemann classified some remedies into anti-miasmic categories because he discovered that certain deep acting medicines have a similar nature to the syndromes produced by the miasms.

What did Kent think about the miasmic doctrine? Did the doctrine affect his case taking methods? Let's see what he has to say about the doctrine of the chronic miasms. Vide Kent's Lectures on Homeopathic Philosophy, from the lecture, "The Examination of the Patient."

A great deal depends upon a physician's ability to perceive what constitutes the miasm. If he is dull of perception he will intermingle symptoms that do not belong together. Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance. Hahnemann was skillful in this respect because he was a hard student of Materia Medica and because he proved his Materia Medica daily.

Why does Kent speak of mixing up symptoms that do not belong together if we only need to consider the totality of the symptoms? Why should we understand which symptoms constitute a miasm? Why is Kent praising Hahnemann's understanding of miasmic layers if his teachings on chronic disease play no part in classical homeopathy? In his lecture on Natrum Sulphuricum, Kent points out the shortcomings of prescribing on the simple totality of symptoms without any understanding of the underlying miasms. Vide Kent's Lectures on Homeopathic Materia Medica.

Asthma, when it is hereditary, is one of the sycotic diseases of Hahnemann . . . For years I was puzzled with the management of asthma. When a person came to me and asked: "Doctor can you cure asthma?" I would say "No." But now I am beginning to get quite liberal on asthma, since I have learned that asthma is a sycotic disease, and since I have made judicious application of anti-sycotics I have been able to relieve or cure a great number of such cases. You will find in the history of medicine that wherever asthma was cured, it has been by anti-sycotic remedies. That is one of the first things I observed, that outside of sycotics you will seldom find a cure for asthma.

Kent goes on to speak about the limitations of the use of homeopathy only on the symptoms without taking into account the underlying miasmic causes and their syndromes.

While Ipecac, Spongia, and Arsenicum will correspond just as clearly to the supervening symptoms and to everything that you can find about the case, yet what do they do? They palliate; they repress the symptoms; but your asthma is no better off, your patient is not cured.

From these quotes we can see that Kent truly followed Hahnemann's teachings and saw the validity of the theory of anti-miasmic remedies. He also clearly states that using the totality of the symptoms without understanding the miasms underlying the case may lead to mere palliation or suppression of the disease. This is why Aphorism 5 of the Organon stresses the need to understand the fundamental cause as well as the totality of the symptoms. The reason that Ipecac, Spongia and Arsenicum will not cure in these cases is because they are not anti-sycotics. Another experienced homeopath, H.C. Allen, offered his opinion as to the use of the totality without an understanding of the chronic miasms and their layers in his classic, The Chronic Miasms.

I think I hear many say, are not the totality of the symptoms, all there is to disease? Yes, but to me it is necessary to know something of what is behind that grouping of the totality. If you do not know this you are prescribing for a Jack-in-the-box. You cannot follow the evolution of the curative process; you cannot even prescribe intelligently the proper diet for a patient, unless you know the basic miasm. Of course the diseases that are present will help you to some extent, but you have no surety unless you know the underlying basic disturber of the disordered life.

Dr. Allen's example of a "Jack-in-the-box" is quite illustrative. If the homeopath does not know the layers of the miasms in their proper order, she or he will not know what to look for in the future, so that some dramatic complication may just "pop" out of the vital force as if came out of nowhere. Those who study Hahnemann's teachings are more prepared for what the future might bring, and know what to do when obstructions arise. In reference to the hallowed law of the totality of the symptoms, and its use as a guide to the choice of the remedy, Dr. Allen shared his feelings in this way.

We make no attack upon the law; no cure can be made outside of the law. But we do believe it is necessary to know whether the phenomena presented in a given case are of sycotic, syphilitic or tubercular origin; for the totality grouping of the symptoms must be around the symptoms of the active miasm.

Thus we can see that in Hahnemann's method the totality of the symptoms includes the signs and symptoms of the miasms classified by layers and listed according to development. The active miasm is the center on which the totality of symptoms is built, so that the chosen remedy matches the underlying miasm syndromes. The symptoms should be arranged in a manner such that the homeopath may envision the layers of the case and know what to expect. Hahnemann states in The Chronic Diseases that in severe chronic cases the homeopath may have to use a series of anti-miasmic remedies to complete the cure. This is because, in complex disease, the layers may represent several etiologies and the miasms can require different remedies as they become exposed. Of the need to know the layers of a chronic case, Allen asserted:

Those brilliant cures that are occasionally made with the single remedy, occur where a single miasm lies behind the phenomena, but where the mixed miasms are present, brilliant cures are not so made, and it is in those cases that it is so necessary to understand the order of their evolution.

Some homeopaths spend all their time searching for the single constitutional remedy for the patient. When the remedy picture fits Phosphorus, they state that the patient is a Phosphorus constitution. In this way, they search for that one special remedy that will solve all the patient's problems. Our elder homeopaths of years passed might have asked, "When was this person a Phosphorus? When he was born? Now? Forever? When he had pneumonia? Because he has the inherited TB miasm?" The search for the grand constitutional remedy may lead the homeopath to construct permanent essences out of an entity in continual change. What do we do if after a time the Phosphorus no longer works? Does a person have more than one constitution?

Complex chronic diseases are often made up of many interdependent components rather than one single constitutional factor. Although many cases have been ameliorated by just one constitutional prescription, such miraculous responses are the best of circumstances. Homeopaths who wish to treat chronic diseases must be prepared for the worst! In a more complex chronic illness, it may not be so easy to pigeon-hole the entire case into one single remedy. It may take a series of related remedies to remove the miasmic layers as the person moves toward the state of health. This is why it is necessary to know in what order the layers of the case have formed so that they may be unraveled in the reverse order from which they developed.