Hahnemann's Miasms - the Quick Version
Hahnemann’s miasms are one of the most debated, hated, loved, and criticized areas of homeopathic philosophy. But despite the fact that they seem to be the thing everyone loves to love or loves to hate, they are very misunderstood by most practitioners out there. So at the risk of being yet another one spreading poor information, here is what I believe Hahnemann truly meant.
If you are brand new, then just know that miasms are generally referred to in the context of chronic diseases in homeopathy. Miasms are thought to cause chronic disease, and some argue that remedies need to be selected that "treat the miasm" the person has. I don't necessarily agree, but that's a discussion for another time. For now, let's just go over what they are.
Setting the stage:
This is pre-microbiology. People understood that diseases were contagious of course, and they had this idea that there was some kind of “bad air”; you didn’t need to touch someone to get a disease, you can catch a disease just by being in proximity to someone who was sick, so they had this word “miasm” to mean that the air was poisoned with whatever made you sick. Essentially, miasms were what people called all kinds of infectious organisms – bacteria, viruses and fungi in Hahnemann’s time. Hahnemann didn't come up with this word; it was a word common at his time that fell out of favor once microbiology was discovered. Think of miasms as infectious organisms and you’ll be good to go. Hahnemann refers to both acute miasms and chronic miasms. Acute miasms are a little easier to understand, so let’s look at them first.
Acute miasms:
Hahnemann repeatedly refers to “acute miasms” and defines them as a disease that always followed the same course (aphorism 73 in the Organon). So measles is an acute miasm because measles always looks the same. Because it always looks the same, you can almost always treat it with the same homeopathic remedy, or with one of a small group of homeopathic remedies. He also considered whooping cough and smallpox to be acute miasms. Again, these are diseases that occur in almost exactly the same way every time.
But note that these are also clearly infectious! He meant an infectious, acute disease here. He spoke of acute miasms long before he spoke of chronic miasms (no one, to my knowledge, at his time ever thought chronic diseases were also caused by "miasms").
Hahnemann before chronic miasms:
Hahnemann didn’t have a lot of success treating chronic diseases in the early part of his career. He had a lot of success with acute diseases, syphilis and sycosis. Sycosis... not Psychosis. Sycosis is what he called a combination of gonorrhea, HPV and genital herpes – they were all considered part of one condition that caused genital warts in both sexes.
How he changes:
So Hahnemann, like a good scientist, continually asked himself what he was doing differently with the acute diseases, syphilis and sycosis that gave him good success and tried to figure out how to apply that thinking to chronic conditions like asthma. He was looking at examples of what worked, and tried to apply what he did in acute diseases, syphilis, and sycosis to what he did with all chronic disease (finding bright spots before the Heath brothers!).
Syphilis is a kind of chronic condition if you think about it, because you can be ill for so many, many years. It is also INFECTIOUS. Just like gonorrhea, HPV, and acute diseases. Indeed, in his early editions of the Organon, he called venereal diseases miasms (aphorism 49 in his first edition). So you see, every single disease he had success with was infectious and was therefore caused by what he called a miasm. So what does he do? He starts treating every single chronic condition that comes into his office like a chronic infection (like a kind of syphilis basically), and lo and behold, he starts getting really good results in practice. So his success proves to him that indeed, all chronic disease is infectious. Whether or not that is true is not the point – the point is that he felt he proved to himself that all chronic disease is infectious (ie caused by infection with a miasm).
What it means to treat chronic disease like syphilis:
Now what do I mean when I say he treated chronic disease like syphilis? Well for that, I have to go into the progression of syphilis a little bit. Just be aware that at Hahnemann’s time, they didn’t understand syphilis quite as well as we do now, so what I am about to tell you is what HE thought syphilis was like, but our understanding has changed a bit. I’ll link to some information on our more modern understanding of syphilis below. But for now, here’s what Hahnemann believed.
Syphilis
Syphilis is a sexually transmitted infection. You have sex with someone with syphilis and you immediately become infected. However, there is what is called a latent period. This is true for all infectious diseases. If you breathe in someone’s bacteria when they have a cold, do you immediately start sneezing? No. It takes a few days for the bacteria to reproduce and then you get symptoms. Syphilis is the same way. It takes a while for the bacteria to reproduce and create symptoms. The first symptom is a skin eruption, called a chancre. It’s basically a very specific, distinctive kind of ulcer. If you did not treat the chancre, Hahnemann believed the chancre would stay there forever, and you would never get any other symptoms. So the eruption was like a steam valve that stopped the infection from getting worse. If you treated this ulcer with topical creams or some other nonhomeopathic treatment, then the ulcer would go away. There would be a period where you would have no symptoms, called latency. But after a period of latency, you would get a lot of different, strange symptoms. Syphilis can go to the brain and create something that looks like dementia, or to the skin and create other strange eruptions. You can have liver problems, kidney problems, teeth problems, heart problems, you name it. It’s an absolutely horrible disease. So this one infectious agent can create a disease that has many different symptoms, could involve any organ system, and will stay in your system for decades, getting worse and worse and worse.
Hahnemann then, thought maybe all chronic disease not caused by Syphilis or sycosis was caused by another infectious agent. A person would become infected, then a skin eruption would appear, then a latent period if the skin eruption was treated, followed by an outbreak of different conditions like asthma, cancer, heart disease, diabetes, tuberculosis, anything. He called this infectious agent “psora”. He believed psora caused an itching, vesicular skin eruption (scabies, poison ivy, eczema, psoriasis, craddle cap - all were what he thought of as "psora") that would then go dormant if treated. If the person then encountered some kind of stress like a break up, college exams, death of a family member, particularly bad weather, etc, psora would take advantage of the weakened system and cause chronic diseases.
Say what?
So again, because I know this can be hard the first time round, Hahnemann thought miasms were infectious diseases. Chronic miasms were chronic diseases that were caused by an infectious agent. He believed there were only 3 infectious agents that caused chronic disease: Syphilis, Sycosis (gonorrhea or HPV), and Psora. Every single chronic infection, whether or not it was syphilis, sycosis, or psora, started with infection, then a period with no symptoms (called a prodromal period today), then a skin symptom. If the skin symptom is treated with something other than homeopathy, the person enters a period of latency. This period has very few or no symptoms of illness. If the person then encounters a stressful situation, the infection breaks out into what we call chronic disease: asthma, heart failure, cancer, ulcers, you name it (in psora), or secondary/tertiary syphilis (in syphilis cases). Think chicken pox and shingles: you get chicken pox, the virus goes latent for years and then you get stressed and suddenly, bam, you have shingles. It’s the same idea.
But that's ridiculous!
I feel you. I mean, cancer from an infectious disease when you were two years old? I mean, really? Only 3 infectious organisms in the whole world? Really Hahnemann? The first time I read the book where Hahnemann outlines this theory, I threw the book across the room after 15 or 20 pages and didn’t touch it again for 5 years, because it sounded absolutely insane.
But after Hahnemann started using his theory in practice, he got much better clinical results. so there has to be something valuable to it.
Clinical relevance
If you think about it, what Hahnemann did when he postulated that if someone came in with a bunch of chronic diseases – think about the atopic triad of eczema, asthma and allergies – was he basically said “Ok, at 2 years old you got eczema for the first time. Before that time you were healthy. So your 3 different diseases are actually 3 parts of one big chronic disease that started when you were 2. So to treat you, I need to take the case of the eczema, the asthma and the allergies and find a remedy that works for all of them. Because they are one thing, not 3 separate things”. So when he started going back in time like this and taking the case from the very beginning of when someone got sick, then he got better results. So to me, clinically, his miasmatic theory has nothing to do with sorting remedies or patients into different “psora” “syphilitic” or “sycotic” buckets. What’s important is going back in time, and taking the case of each of someone’s complaints. I would argue this is probably why homeopaths have gotten such a reputation for being "wholistic"; we take a much larger case than most health practitioners.
Conclusion
Hahnemann believed that all chronic disease behaved like syphilis; after an infection, the infectious agent could wreak havoc on your body, causing any kind of chronic disease. However, what is important is not his theory, but how his clinical practice changed. In practice, his theory created a larger "totality" of disease, meaning he took the case of the whole person in front of him and all their complaints. He then prescribed a remedy that covered all (or the most important) complaints best.
Some information on syphilis:
*Note the biggest difference between what Hahnemann believed and what we know today is that we now know that secondary and tertiary syphilis can develop, regardless of whether or not you treat the chancre.*