Now that the salient points regarding the Psora – theory have been discussed it remains to pronounce our verdict on its validity. It is our considered opinion that Hahnemanns Psora theory is not wrong – rather throws a flood of light on some obscure regions in the field of medicine – but it is tainted, to a certain extent, with some unwarranted assumptions, dogmatic assertions, obscurity of conceptions, undue generalisations, incomplete formulations and arguing in a vicious circle. It is to be noted that since the first publication of Hahnemanns views on the nature of chronic diseases we do not find a single homoeopathic physician of repute (excepting his two disciples Stapf and Gross) who endorses Hahnemanns views in toto.
Another fact is also to be borne in mind that the basic principle of Homoeopathy i.e., the Law of Similars, does not stand or fall with the Psora – theory. It is very aptly remarked by Dudgeon, in his “Lectures on Homoeopathy” that “it is not a doctrine coeval with the promulgation of the Homoeopathic principle, but an after – thought, not developed until thirty – two years later and as we might give credence to it, like Autenreith, Schonlein and others, without being homoeopathists, so we might reject it without losing any of our claims to that title”.
Some are of opinion that there can be nothing more paradoxical than the fact that Hahnemann the promulgator of the medicine of Experience should end in being an enthusiastic sponsorer of a highly speculative theory like the Psora theory. Some note that it is remarkable how extremes meet in Hahnemanns mental organisation. In his homoeopathic law, we have the principle of extreme individualisation, whilst the Psora – theory is an illustration of the opposite extreme of generalisation. But this is not the only instance of swinging of the pendulum to the other extreme by Hahnemann.
Hahnemann had before this in his “Coffee – theory” of Chronic diseases, which he retracted afterwards in favour of “psora”, exhibited the same tendency to generalise and the incubation period of his Coffee – theory, curiously enough, corresponds almost precisely with that of his Psora – theory. He tells us the latter occupied his thoughts for about twelve years before he gave it to the world, and we have evidence from his writings that the Coffee – theory engaged his attention for a nearly equal period.
Thus we find in his “Friend of Health” published in 1792, various hints as to Coffee being at the root of many chronic diseases and his famous essay on the manifold hurtful effects of this common beverage was published in 1803; and we have seen that the germ of his Psora – theory which was finally promulgated in 1828, is discoverable in an essay he wrote in 1816.
The following are the postulates involved in Hahnemanns Psora- theory which we are required to believe:
1. That seventh – eights of all chronic diseases are the consequence of an infection with a skin disease, that has been driven off or removed by external treatment.
2. That his skin disease is identical with what we call itch, though it presents itself under many different forms.
3. That every infectious chronic disease is scabies or a degeneration of it.
4. That none of these seven – eights of all chronic diseases are curable, save by the use of a certain set of medicines that were mostly unknown or unused before Hahnemanns time, consequently that no such chronic diseases were ever cured before the promulgation of his doctrine in 1828.
5. That itch, properly so – called, and all the varieties of skin diseases Hahnemann includes under that term are only safely curable by internal remedies, and that their treatment by external remedies is fraught with the greatest danger to the patient.
Let us now proceed with a critical examination of the above items, one by one.
With reference to the first item it sounds very dogmatic to assert by one individual observer, however vast his personal experience might be, about the relative percentage of incidence of different types of diseases that human flesh is heir to.
With reference to the items No. 2 and 3 regarding the origin of chronic diseases from itch eruptions an exhaustive discussion was attempted previously. Here my conclusion wholly tallies with that of Dudgeon who wrote thus: “I think it must be obvious to all who have carefully studied the evidence Hahnemann adduces in support of his this doctrine, that he fails most signally in proving his point.
In the first place his diagnosis of the disease is of the loosest. He treats with contempt the division of skin disease into different species, so carefully drawn by the dermatologists; and in the ninety – seven instances he takes from allopathic writers of the production of a serious disease after externally treated psora, he includes all manner of skin diseases, many of which have not the slightest claim to be considered of a scabious nature.
Every cutaneous disease that itches, and when scratched burns, more especially if it can be suspected of being contagious, is identical with itch, according to Hahnemann. This is one more instance of Hahnemanns mental trend of undue generalisation which does not stand scientific scrutiny. Thus Otto Lesser aptly remarks in his Text – book of Homoeopathic Materia Medica: “Although one does not have the impression of a loquacity senilis, there is the ring of incompletely formulated mental sequences.
Only in a type of summary has Hahnemann finished these thoughts and then, capricious as he was, attributed itch as the cause of psora and therewith the majority of chronic diseases. He gave the most unimportant aspect of the entire psora – theory an excessive accent and there was and still is the danger that the good is cast away with the bad, that is, in this instance the theoretically and practically important thoughts on the relations of chronic diseases remain unconsidered.”
Many eminent Homoeopaths viz. Dudgeon, Hughes, Burnett etc. openly declared that they have never succeeded in the very slightest degree to cure itch proper or scabies according to Hahnemanns directions. The undue emphasis on the itch laid upon by Hahnemann may be due to the fact that at the time when Hahnemann thought of Psora – theory the whole of Europe was infected with itch to an unprecedented extent, in consequence of the great military operations all over the continent.
Though Hahnemann brought his encyclopedic knowledge to bear on the subject of itch – theory he failed to establish the causal relation between suppression of itches and the incidence of chronic diseases. Mere succession of phenomena is not logically enough to establish a causal relation between a preceding and a succeeding event.
According to some it would have been a great boon to pathological science had Hahnemann, in place of confounding all skin diseases together under the one head Psora or itch, carefully individualised all skin diseases and endeavoured to discover the particular internal diseases with which it is probable each is in a certain measure connected.
Further Hahnemann distinctly alleges that every person affected with a non – venereal chronic disease must, at one period of his life, have had the itch at one time or another, however slightly; and he argues in a most vicious circle on this point.
Certain medicines, he says cure those chronic diseases that we meet with in persons who have avowedly the itch, we may, nevertheless, infer that they have at one time had the itch, because we can cure then with antipsorics. What wonder, after such a style of argument on the part of the Master, that the disciple Attomyer should say “we dont need to ask if the patient has ever had itch; psora is self evident.”
Thus the psora – theory, viewed as a mere theory of the origin of the most of chronic diseases form itch is by no means always capable of being proved, and the occurrence of the itching of the skin or eruptions thereon be regarded as a proof of the previous existence of itch.
With regarded to item no. 4, we find that when Hahnemann talks of the utter inefficiency of the treatment of chronic diseases he is guilty of great exaggeration, a fault which he frequently commits; for there is no doubt that chronic diseases were cured by Hahnemann himself, as we learn from many cases detailed in his “Lesser Writings” before the discovery of the psora origin of diseases and before he knew a single so – called antipsoric medicine.
With regard to item no. 5 we must give credit to the phenomenal clinical intuition of Hahnemann in discovering a reciprocal relation between skin lesions and affections of internal organs and tissues; and that any attempt to treat the cutaneous part of the disease is merely a palliative one with all the irrationality, difficulties and dangers inherent in the palliative method of treatment.
With regard to obscurity of conception we have dwelt at length over the problems of connotation and denotation of the terms like Infection, miasm and psora. We have also pointed out how it was impossible for Hahnemann to fix the specific denotations of various miasms as microscopy was rudimentary and the bacteriological science was as yet undeveloped.
It is the enthusiasm of some of this followers like Stapf and Gross who hailed Hahnemann as a discoverer of supreme truth that caused them to overlook the omissions, commissions, inconsistencies and incomplete formulations in his theory of chronic diseases; careful critical examinations of the doctrine seemed for a while to be lost sight of altogether and several years after the year 1828 each vied with his neighbour in parading his cases of, now no longer Homoeopathic, but anti – psoric cures.
Homoeopathy receded for a while into the background and the very man – who had been incessantly re – echoing Hahnemanns ridicule for the search for the cause of disease, had now continually in their mouths the expression of itch – disease, latent itch, masked itch, smouldering itch etc.
In this connection Dudgeon humorously writes that “had Hahnemann proposed to have ascribed all diseases under the sun to the influence of the Moon, I believe a certain number of disciples would have started up in ecstasies at the brilliant notion and testified it by miles of print. “full of wise saws and modern instances.”
Another error in Hahnemanns doctrine of chronic diseases was according to Dudgeon, his non – recognition of hereditary maladies. Dudgeon continues that many of the Homoeopathic writers in this country (i.e., U.K.), and some abroad, are so little acquainted with those doctrines of Hahnemann on which they write, as to state over and over again that Hahnemanns psora – theory was a recognition of the hereditary nature of many diseases, and they would make it appear that Hahnemann speaks of the psoric taint being transmitted from parent to child, whereas nothing can be farther from Hahnemanns statements.
Not only does he never in any place speak of hereditary diseases but he distinctly alleges that every person affected with a non – venereal chronic disease, must at one period of life have had the itch at one time or another, however slightly; and he argues in a most vicious circle on this point. According to Hahnemann dyscrasia or a constitutional weakness is not psora but it is brought about by psoric miasmatic infection. Hahnemann left the constitutional problem out of his consideration and busied himself with that of psoric infection.
Much has been said regarding Hahnemanns classification of the sources of chronic diseases viz., psora, syphilis and sycosis. But this classification loses much of its value from the therapeutic side as the division of drugs into antipsoric, antisyphilitics and antisycotic fails due to overlapping (i.e. one and the same drug is found to be antipsoric, antisyphilitic and antisycotic as well.). Hahnemann saved Homoeopathy from decline as he held fast to his previous ideas of strict individualisation of drugs and patients for actual selection of remedies according to the Law of similars.
After the promulgation of the psora – theory by Hahnemann Homoeopathy came to be regarded as a principle mode of constitutional therapy. But an impartial scrutiny of Hahnemanns theory of chronic diseases, at first glance, has nothing to do with the doctrine of constitution. In contrast, the division into syphilis, sycosis and psora is distinctly related to exogenous causes of disease. Further Hahnemann expressly stresses that even the most robust constitution cannot remove a psora which has once succeeded in developing.
According to him only the form and manifestation of psora will be modified by the constitution of the individual concerned, furthermore, by the influence of the milieu, fate, mode of living and weather influences. Thus we find that Hahnemanns conception of the most robust constitution (in fact, that of constitution per se) and the soundest mode of living are too general and vague for the scientific terminology. Here is a big gap and incomplete formulation in Hahnemanns theory of chronic diseases.
That is why I always maintain that because Hahnemann based his whole system of therapy on abnormalities (i.e. on pathology rather than on physiology), the scientific portion of Homoeopathy is seriously defective with regard to technical conceptual terminologies and nomenclature. For later Homoeopathy Hahnemanns Psora became interpreted as a composite of disease susceptibles corresponding in extent to hydrogenoid, Oxygenoid or carbo – nitrogenoid types of constitutions as described by Von Grauvogl or to lymphatism and arthritism as noted by some or to tuberculinism as advocated by the French School of Homoeopaths.
In fact, after Hahnemann the limits of psora has been drawn so wide that it practically included the pre – disposition to almost all chronic diseases. But the one great defect of all these doctrines of constitution is that they are all over constructed; and they are not co – extensive with the whole sphere of thought and existence regarding all the diseases that human flesh is heir to. These constitutional types overlap and do not afford a precise indication for selecting the “Similimum” drug according to the “Law of Similars”. Homoeopathy cannot afford to lose its strict principle of individualisation either in drug pictures or in natural diseased conditions.
Thus we find that Hahnemanns Psora – theory is an attempt at a dogmatic explanation of the essential nature of a vast proportion of the maladies that afflict mankind; and Dudgeon rightly remarks that as all Hahnemanns 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 hereto before taught.
It is also to be borne in mind that this psora – theory was not altogether a novelty of Hahnemann in 1828 but that he had already in 1816 enunciated a similar though not so universal a doctrine of the production of chronic diseases of the severest character from the repression of the primary itch – eruptions; and this theory was, to a certain extent, anticipated by Antenreith and Schonlein of Tubingen (Germany) about twenty years before Hahnemanns book on chronic diseases saw the light of the day.
The Psora – doctrine has done another harm indirectly. Hahnemann wrote in Organon that the knowledge of disease in all its aspects, is an essential requisite for the practitioner of a rational art of healing. By accepting psora as a general morbific cause we shut ourselves out further investigating the cause of diseases.
Anti – psoric medicines, as they are termed, are merely remedies of very profound action. But the too facile psora – theory has opened the door to much slovenly treatment and Sulphur – giving, to eradicate the presumed psoric virus, in many cases where Sulphur was not in the very slightest degree indicated.
But the psora – theory has not been without a beneficial influence on Homoeopathic practice, for it has led us to enquire more carefully into the antecedents of diseases and not to rest content with a mere comparison of the symptoms actually present with recorded effects of medicines; into the biological evolution of diseases and unity of diseases into reciprocal relation betwixt the skin and internal organs; and into the doctrine of dose and modes of employing the medicines; and finally, to it we are indebted for a large array of very useful medicines of a wide sphere of action.
To our mind the greatest contribution of Hahnemann through this psora – theory consists in asserting:
(1) That the conception of Psora is more a statement of a fact than a theory.
(2) That chronic diseases like all acute contagious diseases depended on a “contagium Vivum” when nobody thought of living causes of diseases.
(3) That skin diseases may have systemic infections and systemic diseases may have skin lesions; and the skin is an immunising organ and the cutaneous eruptions should not be treated too violently.
(4) That this theory has paved the way for conception of miasmatic states in a wider sense than that of bacterial infection of Pasteur and Koch.
(5) And that this theory paved the way for pioneering work in the field of preventive medicine after solving the mystery of incidence of epidemic diseases.
So we conclude with what we started: that the psora – theory is not wrong but contains a nucleus – big nucleus of truth pregnant with vast potentialities, though its presentation is associated with some unwarranted assumptions, dogmatic assertions associated with some undue generalisations, incomplete formulations and arguing in a vicious circle. And it is not Hahnemann but his followers who misrepresented him and misinterpreted his writings and who are responsible for the widening of the gulf between the Homoeopathic school and the Orthodox school.
This is in no way to criticise or minimise the personality or genius of our great Master but to discuss the pros and cons of his speculative hypothesis, however much based on factual observations it might be – on which he was the last person to put any absolute value or to take them as gospel truths – not meant to be questioned by anybody any time.
N.B. With this paper we conclude our discussions on Hahnemanns theory of chronic diseases. Since the publication of the book on “chronic diseases” many eminent Homoeopaths have written on the subject. The most important and exhaustive contributions on the subject came from Hempel. H.J. Allen and Kent. A fuller discussion on their views has been purposely avoided in view of the fact that they deviated from the main line of Hahnemannian thinking in diverse ways and tried to read many things in Hahnemanns writings which they do not obviously suggest.
Our attempt has been to interpret Hahnemann through his own contributions and not through any other commentaries, however brilliantly written they might have been. Further, a study of the nature of diseases is never complete without a study of metaphysical conception of illness. But that has also been avoided for obvious reasons.