Hahnemann’s doctrine of Chronic disease

A brief outline of the famous psora-theory of Hahnemann, which was first formally given to the world in 1828, and which was given rise to much controversy among Hahnemann’s disciples….

Individualization a peculiar feature of Hahnemann’s teaching before his invention of the psora theory-His contempt for pathological hypothesis-His psora theory a vast generalization and a pathological hypothesis-His early foreshadowings of the theory-He early ascribes a large number of chronic disease to itch-His account of the discovery of the source of chronic disease-He communicates his discovery to Stapf and Gross- Necessity for a miasmatic origin of chronic diseases-Psora the grand source-Syphilis and sycosis the other sources-Itch a degeneration of the ancient leprosy-Error of considering itch a local disease-Under itch he includes many other distinct skin- diseases-Mode in which infection takes place-Itch to be met with everywhere-The most infectious chronic miasm-Mode of development of itch-disease-danger of suppressing the external eruption-Signs of latent psora-He at first thought the disease might be cured by reproducing an eruption-His Burgundy-pitch-He also believed that a fresh infection with itch would cure the chronic disease- Instances of this adduced by him-He afterwards recants these opinions-His mode of treating fresh itch-Psoric diseases require peculiar medicines, termed antipsorics-Before he thought of psora he considered coffee to be the great source of chronic diseases- Traces of this psora theory in ancient writes-Hoffmann ascribes many diseases to suppressed itch-Autenrieth’s psora theory- Hahnemann’s contempt for Autenrieth’s treatment of itch-Wenzel held a psora theory-Stapf’s laudations of the psora theory-Gross testifies to its truth-Unquestioning adhesion to it of many homoeopathists-Peterson corroborates it with cock- and bull stories-He makes out that cholera is of psoric origin-Rau admits the partial foundation in truth of the theory-Wolf considers it an unfortunate idea-Schron defends prae-antipsoric homoeopathy against Hahnemann’s disparagement of it-Hering carries the psora- theory farther than Hahnemann-He announces a prophylactic for itch-Later allopathic authorities who have held the psora-theory- Beer-Schonlein-Weitenweber- Nathan’s apology for Hahnemann.

BEFORE Hahnemann’s enunciation of his peculiar pathological doctrine of the origin of chronic diseases, commonly termed the psora-theory, the grand distinctive feature of his practical directions consisted in oft-repeated injunctions to individualize to the utmost all diseases, that is to say, to regard each morbid case as an individuality, a disease that stood per se, and might never again occur in the precise form then observed, and which demanded for its cure a remedy selected in accordance with the actual symptoms and utterly irrespective of any presumed essential cause or pathological doctrine whatsoever.

No one eve ridiculed the therapeutic maxim of the dominant school, “tolle causam, “more than Hahnemann. His essay entitled the Medicine of Experience, that On the Value of the Speculative Systems of Medicine, and even the introduction to every successive edition of the Organon, abound in passages ridiculing he notion of any inquiry into the essential nature of disease, and no maxim is more frequently or more dogmatically enunciated by our Master than this (I quote from his Medicine of Experience):-

“The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it for the purpose of curing it, express itself by the symptoms, as they present themselves to the investigations of the true observer in their whole extent, connection, and succession.”


“When the physician has discovered all the observable symptoms of the disease that exist, he has discovered the disease itself, he has attained the complete conception o it requisite to enable him to effect a cure.”

Passing over his intermediate works, we find precisely the same doctrine inculcated in the opening paragraphs of the Organon, in even its last edition. Thus in Aphorism vi. we find it written:-

The unprejudiced observer, let his powers of penetration be ever so great, takes not of nothing in every individual disease except the changes in the health of the body and of the mind which can be perceived externally by means of he senses, that is to say, he notices only the deviations from the former healthy state of the now disease individual which are felt by the patient himself, remarked by those around him, and observed by the physician. All these perceptible signs represent the disease in its whole extent. that is, together they form the true and only conceivable portrait of he disease.”

And in a note to this paragraph he once more holds up to ridicule those who would seek to know anything more about the disease than the symptoms presented by the patient.

After all this we should hardly had expected to meet Hahnemann in the woman or pathological hypothesis, and actually promulgating a theory of the origin of all chronic disease. And yet such is the fact, and we shall find that his doctrine of chronic disease-and this I say without thereby implying its fallacy-is an attempt at a dogmatical explanation of the essential nature of a vast proportion of the maladies that afflict mankind; and as all Hahnemann’s views and doctrines were made subservient to his therapeutics, this pathological hypothesis of his was the foundation of a peculiar therapia, differing in some essential particulars from what he had heretofore taught.

Before entering on a critical analysis and examination of Hahnemann’s doctrine of chronic disease, I think it as well for the sake of those of you who may not have had the time or the opportunity to become familiar with Hahnemann’s peculiar tenets on this point, to trace out for you the exact course of Hahnemann’s views upon the subject as far as they can be learned from his medical writings.

It is commonly stated that Hahnemann first conceived his doctrine of chronic diseases about he year 1827, when he sent for his trusty followers Stapf and Gross to one to Coethen, where he then resided, in order to hear from his own lips his explanation of the psora theory; and that the first published record of it is the first edition of his great work or Chronic Disease, published in 1828. But though it is undoubtedly true that this was the first systematic exposition of his peculiar and remarkable doctrine, we have evidence in his writings that for many years previously, indeed, certain passages in his very first medical work of any magnitude, that on Venereal Diseases, published in 1789, show, that even before his discovery of the Homoeopathic law, his mind had a certain tendency towards the theory which, when formally promulgated, seemed to come so unexpectedly upon his disciples.

In that early work just alluded to he says a great deal about the dangerous effects likely to ensue from the common practice of destroying the chancre, his notion being that the external sore was but the sign of the universal infection of he organism, and that whilst it existed the disease expended all its energy up on this external morbid process; but that if the external affection were removed the disease, which was by no means destroyed by such an act, being deprived of an external seat, preyed upon some internal organ or organs, and gave rise to that series of phenomena we denominate secondary or constitutional syphilis.

But still more marked and striking is a passage which occurs in an essay published by Hahnemann in 1816, just twelve years before the publication of the first edition of his work on Chronic Diseases. (Lesser Writings, p.731.)

Speaking of the itch, he says:-

“This disease belong to the chronic exanthematous diseases, and in it nature also produces the itch-vesicles, at first in the neighborhood of the part that was originally touched by the itch- virus e.g., betwixt the fingers and on the wrists, if the hands were first affected. As soon as the itch-vesicles have made their appearance, this is a sign that the internal itch-disease is already fully developed; for at first there is actually no morbid change observable on the affected part, no itching, no itch-vesicles.

Usually from nine to twelve or fourteen days after the application of the itch-virus there occurs, along with slight fever, which is not noticed by many persons, the eruption of the first itch-vesicle-nature requires this time in order to complete the full infection, that is to say, the development of the itch- disease in the interior, throughout the organism The itch- vesicles that now appear are hence no mere local malady, but a proof of the completion of the internal disease. The itch miasms, as soon as it has contaminated the hand, remains no longer local the instant it has caused inoculation, but proceeds to alter the interior of the organism and to develop itself into this peculiar disease until the entire infection is accomplished, and then only does the eruption produced by the internal malady appear on the skin and that at first in the vicinity of the original point of infection.

The itch-vesicles are an abnormal organ produced by the inner organism upon the skin, designed by nature to be the external substitute of the internal disease, to take the latter upon itself, to absorb it, as it were, and so to keep it subdued. slumbering, and latent. That this is the case is evident from this, that so long as the vesicles remain on the skin and continue to itch and discharge, the internal disease cannot make its appearance; and from this also, that whenever it is partially destroyed on the skin, without any previous cure of the internal itch-disease (especially if it be of some what long standing and have attained to any extent) being effected by means of the internal employment of its specific remedy sulfur, this internal disease then bursts forth rapidly, often in a frightful manner; in the form of phthisis, asthma, insanity, dropsy, apoplexy, amaurosis, paralysis and it not infrequently occasions sudden death.”

This we shall presently find is exactly the doctrine taught in the work on Chronic Diseases, with this difference, that in the latter place it is made much more general or universal in its application.

Let us how see from Hahnemann’s own account, contained in the first part of this Chronic Diseases, how it was he came to invent his fully developed doctrine of the peculiar nature of chronic disease. We shall best learn this form the work on that subject I have so often alluded to.

In comparison with allopathy, he observers, Homoeopathy has been exceedingly successful, not only with acute disease, epidemics, and sporadic fevers, but also with he numerous array of chronic maladies in which allopathic treatment was so often worse than useless. Under homoeopathic treatment, the actual morbid state of these chronic maladies was often removed in the very short time, so that the patients in their improved state could again enjoy happy days. Hahnemann denominates the condition of these patient are the homoeopathic treatment expressly improvement or amelioration, and alleges that through they were often very much relieved, they were not cured, for their complaints would allow to a great degrees be brought back by many unfavorable circumstances, such as great errors of diet, a chill, raw, wet, or stormy weather, the autumn session, but particularly the winter and a wintry spring, violent corporeal or mental exertion, an injury, some mental emotion, such as fright, grief, care, or vexation; their return under these circumstances was generally attended with the appearance of new symptoms; and if they were not more serious, they were generally more troublesome and more difficult of removal than before.

If a medicine was found that answered both the old and new symptoms, it would soon produce an amelioration; but if it was only the old symptoms that recurred, the medicine that had at first done good was now no longer so effectual, and if it required to be repeated again, it was still less so. But notwithstanding the observance of the best- regulated diet and the employment of the apparently best-suited homoeopathic remedy, new symptoms constantly made their appearance, which were with difficult and imperfectly removed by other medicines, or perhaps were not at all ameliorated, if the unfavorable influences above alluded to occurred. occasionally, some favorable influence, such as a piece of good fortune, an ameliorated condition of life, an agreeable journey, a good season and dry uniform weather, would cause the malady to come to a stand for some time; but this was never of long duration, the disease would continue to progress, the remedies employed would do little or no good, and the disease increased from year to year.

“This, “he says, m”was and continued to be the more rapid or slower course of such treatment of all non-venereal, considerable chronic disease, even when apparently conducted strictly according to the doctrines of the homoeopathic art as hitherto known. Their commencement was cheering, their progress less favorable, their issue hopeless.

“And yet” he adds, “the doctrine itself is built upon the impregnable pillars of truth, and must every remain so. As proofs of tits excellence and almost infallibility, he cites the splendid successes obtained by it in disease of a fixed character, such as the scarlet fever of Sydenham, the miliary fever the whooping-cough, the croup, the sycosic disease, autumnal dysenteries, pleurisies, typhus, fever, etc., and then he asks, ‘Whence this inferior success, the absolute want of success in the prolonged treatment of non-venereal chronic disease?” His disciples attributed it to the want of a sufficient number of medicines properly proved; but to this Hahnemann could not ascribe it, especially as, in spite of the additions yearly made to the Materia Medica, no progress was made in the cure of chronic disease. He says that from there 1816-17 the solution of this problem occupied him and and night, and at length he succeeded in solving it, and in 1827 he summoned to his side two of his most esteemed disciples, viz., Dr. Stapf and Gross, and communicated to them his discovery, in case his death, for he was then in his seventy-third year, should have occurred before the publication of his book on the subject. This remarkable book duly appeared the following year.

His researches and reflections, as he tells us in this work, led him to the conclusion that the cause of the constant recurrence of chronic disease after the symptoms present had been removed by the homoeopathically selected remedy, and their recurrence with new and grave symptoms, was that the Homoeopathic physician in these disease had not merely to do with the morbid phenomena actually present, but that these phenomena only represented a portion of the deeply-seated fundamental malady, whose great extent was manifested by the new symptoms peculiar to it, he could not hope to discover any medicines which should correspond in their peculiar pathogenetic effects to the whole fundamental malady, and therefore he would be unable cure it in its whole extend, or in its several features. That the sought-for fundamental malady must be of a chronic miasmatic nature, Hahnemann was convinced from the fact that it could not be overcome by the spontaneous efforts of the most robust constitution, nor by the most healthy diet and careful regimen, but that it increase in intensity and extent from year to year, and became always worse and worse until the termination of life, like every chronic miasmatic disease; for example, syphilis, which if not cured by its specific mercury, increased from year to year, and always developed new and graver symptoms.

His further researches showed that the obstacle to the cure seemed to lie in a previous scabious eruption which the patient frequently confessed to having had, and from which he often dated all his sufferings. When the patients did not confess to any such infection, they yet showed in their persons slight traces of it, such as scabious vesicles, herpetic eruptions, etc., that appeared from time to time to time as infallible signs of a former infection of this nature.

These circumstances and innumerable observations of other physicians, together with his own experience, that chronic disease occurred on the suppression artificially, or disappearance from other causes of a scabious eruption from the skin in otherwise healthy individuals, left no doubt on his mind as to the character of the internal enemy with which he had to deal.

By degrees he became acquainted with more efficient remedies for this fundamental malady, the cause of so many sufferings, which he called psora, meaning thereby the internal itch-disease, with or without its exanthema, and he was convinced by the excellent services rendered by these same medicines in similar chronic disease, where the patients could not call to remembrance any such infection, that these diseases also must have owed their origin to some psora communicated to them either when they were infants, or at some unrememberable period of their lives and it often happened that careful inquiries among their parents or friends confirmed the accuracy of this conjecture.

Careful observation, he says, of the curative powers of the antipsoric medicines discovered in the eleven years of his researches, taught him how frequently severe and most severe as well as moderate chronic disease were derived from his source. It likewise taught him that this Proteus-like psora was the source not only of most of those varieties of skin diseases so carefully distinguished by Willam, but also of almost all abnormal growths, from the wart on the finger to the largest insisted tumour, from the deformed nail to the tumours on bones and the distortions of the spine, and many other kinds of softening and deformity of the bones; that it was the origin of a tendency to epistaxis and haemorrhoids if haemoptysis, haematemesis, and haematuria, of suppressed as well as of excessive catamenial discharge, of long-continued nocturnal diaphoresis and of a parchment -like dryness of the skin, of a habit of diarrhoea as well as inveterate constipation, of neuralgic pains and convulsive disease, of chronic ulcers and inflammations, of hypersarcoses and tumours, of marasmus and excessive sensitiveness, of the many abnormal condition or complete loss of the senses of hearing, sight, smell, taste and touch, of excessive salacity and of complete impotence, of all mental diseases from from imbecility to extasis, from melancholia to fury, of syncope and vertigo, of diseases, of the heat and those of the viscera of the abdomen, going under the name of hysteria and hypochondriasis-in a word, of many thousands of the chronic diseases described under different names in pathological works. In a word, his observations convince him that all those chronic diseases which could not be said to arise from the infection of the two venereal maladies, syphilis and sycosis, were but partial developments of the very ancient chronic leprous an scabious miasm, that is to say, were only derivatives from one and the same fundamental disease; just as in an epidemic, say of typhus, all the patients on their disease to one and the same pestilential influence, though some may present on series of symptoms, others another, and all the symptoms from all the patients together present the complete picture of the disease; and every case is curable by one, or at the most two remedies, however much the case may apparently differ from each other from each other, and present the appearance of being totally different diseases.

In Europe, and he believes also in all other parts of the world, there are only three chronic miasms, whence all or nearly all chronic diseases are derived. First, syphilis; second, sycosis, or the fig-wart disease; third, psora, the diseases which has the scabious eruption for its local manifestation.

Psora is, according to Hahnemann, the oldest, most universal, and most destructive, by at the same time most misunderstood of the chronic miasmatic diseases, and it has for centuries been the parent of the thousands of different acute and chronic non- venereal diseases which have afflicted man in every quarter of the globe. The leprosy of the Israelites described in Leviticus was but a variety of psora so were the various forms of leprosy that prevailed during the middle ages, likewise that malignant form of erysipelas that spread throughout Europe in the dark ages, termed St. Anthony’s fire.

Under these forms of the disease its whole malignity seemed to be expended on the skin. By the introduction of habits of greater cleanliness, the frequent use of warm baths, greater attention to diet, and a better regulated mode of life, the external repulsive aspect of the psora was so far mitigated in the course of time that towards the end of the fifteenth century it came to present the form in which we seen it now-a-days, viz., the scabious eruption or itch. In this form the degenerated lepra or psora is much more easily removed from, the skin by means of baths, lotions, and ointments of sulphur, lead, copper, zinc and mercury, but the evil is thereby greatly increased. The leprosy of the Israelites and of the middle ages was much less dangerous, for in this form of psora the disease rendered the skin disgusting that every one fled from the contact of those affected by it, whereas the itch is often quite overlooked, and may readily be communicated without the victim being aware that he is in contact with an individual affected by itch; and it is, says Hahnemann, one of the most infections of diseases.

The fatal facility with which the external manifestation of psora-the itch-can be suppressed by means of external applications (which was not the case with it when it existed under the form of leprosy,) whereby the internal psora is made to develop itself, is the cause of the great increase within the last three hundred years of the chronic maladies that afflict humanity. Hahnemann calculates that at least seven-eighths of all chronic diseases are derived from it, and that the remaining eighth is derived from syphilis and sycosis, or from a combination of some two of these three miasmata, or of all three. Hahnemann alleges that a great mistake has hitherto been committed by all modern medical men without exception, the most celebrated as well as the least celebrated, in viewing the itch as a merely local disease, and using their utmost efforts to drive it away as rapidly as possible by means of all sorts of salves and lotions.

R.E. Dudgeon
Robert Ellis Dudgeon 1820 – 1904 Licentiate of the Royal College of Surgeons in Edinburgh in 1839, Robert Ellis Dudgeon studied in Paris and Vienna before graduating as a doctor. Robert Ellis Dudgeon then became the editor of the British Journal of Homeopathy and he held this post for forty years.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.