Susceptibility and Predisposition
Hahnemann presents a complete system of constitution, temperament, heredity, disposition, idiosyncrasy and susceptibility in his writings. Aphorism 31 deals directly with the subject of the living organism and its disposition toward disease. Vide Organon.
"The-partly psychical and partly physical-inimical potencies in life on earth (which we call disease malignities) do not possess an absolute power to morbidly mistune the human condition. We become diseased by them when our organism is just exactly and sufficiently disposed and laid open to be assailed by the cause of disease that is present and to be altered in its condition, mistuned and displaced into abnormal feelings and functions. Hence these inimical potencies do not make everyone sick every time."
This aphorism points out that the susceptibility of the human organism is partly psychological and partly physical. It has been well proven that physical and mental stress lowers the immunity and makes individuals and groups more susceptible to particular illnesses. Therefore, susceptibility is related to both constitution and temperament. To be susceptible the organism must be sufficiently disposed to specific inimical disease powers. Without this sympathetic relationship there will be no disease. This is why pathogenic agents do not affect every person nor the same person all of the time. The patient must be sufficiently susceptible according to the time and circumstances. Susceptibilities may be inherited as well as acquired.
In the Sacred Diseases Hippocrates opined that most diseases are based on hereditary predispositions. He noted that the diseases found in the mother and father are often found in the offspring. Lamarck, who is considered the founder of modern genetics, published his research on inheritance between the years 1809 and 1822. By 1828 Hahnemann was integrating information about inherited depositions in his dynamic healing system. He speaks of inheritance and predisposition in both the Organon and The Chronic Diseases. Vide aphorism §78 and its note 78.
"The true, natural chronic diseases are those that arise from a chronic miasm. When left to themselves (without the use of remedies that are specific against them) these diseases go on increasing. Even with the best mental and bodily dietetic conduct, they mount until the end of life, tormenting the person with greater and greater sufferings."
"In the most blooming years of youth and with the commencement of regular menstruation, coupled with a beneficial lifestyle for spirit, heart and body, these chronic diseases often remain indiscernible for several years. Those afflicted appear in the eyes of their relatives and acquaintances as if they were completely healthy and as if the disease, implanted in them through infection or heredity, were completely vanished. However, it inevitably comes to the fore again in later years and with adverse events and relationships in life. The more the life principle has been deranged through debilitating passions, grief and worry, and especially through inexpedient, medicinal treatment, the more rapidly the disease increases and the more onerous its character. [Bolds by DL]"
This establishes several important features in homoeopathic pathology and philosophy.
1. First of all, Hahnemann was the first to suggest a complete theory of susceptibility and infection. He makes it very clear that the miasms are infectious in their primary state. He also taught that the microscopic microorganisms he called "animalcule" were the infectious agents of the contagious miasms. He noted that the process of infection includes susceptibility, a moment of infection, incubation period, prodromal stage and primary, latent and secondary or tertiary symptoms. He classified miasms into three categories, the acute, half-acute and chronic and recorded the symptoms in individuals as well as groups affected by the same miasm. On this basis, he established a materia medica of anti-miasmatic remedies in the Chronic Diseases.
2. Second, Hahnemann stated that miasms are transmitted by infection or inheritance. Hahnemann notes three means of transmitting miasms, i.e., by contact with the infected host, congenitally through the mother's womb or by nursing and by heredity. Inherited miasms produce predispositions in the offspring to particular disease states associated with the miasms.
3. Third, Hahnemann records the effects of stress as an activator of inherited and acquired chronic miasms. He points out that mental and emotional stress greatly increases the damaging effects of the chronic miasms. The effects of stress on the human constitution and susceptibility to disease have been discovered by modern medicine but Hahnemann recorded the entire syndrome in 1828 and integrated it into homoeopathic philosophy and treatment.
Hahnemann's view of the global effects of universal chronic miasms is closely linked with his theory of pathogenesis. In his writings he mentions three factors in the evolution of degenerative diseases. These are the suppression of the symptoms of the miasms by allopathic means, the transmission of the miasms through the generations, and the increase of stress caused by modern civilization. Who else has done such a deep study of factors related to the individual as well as to groups suffering from diseases of common cause and similar symptoms? Not only this, Hahnemann established a special section of the materia medica to treat these chronic illnesses!
Hahnemann’s writings demonstrate the important relationships between the congenital constitution, inheritance, predisposition and diathesis. The individual constitution and temperament is the most important feature in individualizing the symptoms of the chronic miasms. In the Chronic Diseases Hahnemann pointed out that the physical constitution, the mental temperament, hereditary dispositions, habits, lifestyle as well as environmental factors like diet are the most important conditioning factors in the symptoms of the miasms. This careful assessment of inheritance (nature) and environmental factors (nurture) is found in no other system of healing. Vide page 102 of the Chronic Diseases.
"The awakening of the internal Psora which has hitherto slumbered and been latent, and, as it were kept bound by a good bodily constitution and favorable external circumstances, as well as its breaking out into more serious ailments and maladies, is announced by the increase of the symptoms given above as indicating the slumbering Psora, and also by a numberless multitude of various other signs and complaints. These are varied according to the difference in the bodily constitution of a man, his hereditary disposition, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc. [Bolds by DL]"
Hahnemann wrote that the same disease state (such as psoric miasm) is varied according to the differences in "bodily constitution" and "hereditary disposition" as well as the patient’s turn of mind, morals, diet, etc. This is because the human constitution and temperament (Nature) are the most important influences in the development of disease signs and symptoms. The next most important factors are environment, climate, diet and stress (nurture). For these reasons, a homoeopathic remedy should be similar to the negative changes found in the constitution and temperament as presented by the signs, befallments and symptoms. Hahnemann repeats a similar refrain in aphorism 81 of the Organon where he discusses the influence of the congenital bodily constitutions (angebornen Koerper-Constitutionen).
" It is, to some extent, understandable how psora could now unfold itself in so many countless disease forms in all the human race since this age-old infectious tinder has gone, little by little, through many millions of human organisms over the course of hundreds of generations, thus attaining incredible proliferation. This is all the more understandable when we consider the multitude of circumstances that have tended to contribute to the formation of this great diversity of chronic diseases (secondary symptoms of psora), as well as the indescribable variety of human congenital bodily constitutions, which already, in and of themselves, deviate so greatly from one another. [Bolds by DL]"
The diversity of human constitutions and the environments in which human beings live are a major contributing factor in the development of the manifold symptoms of psora and the miasms. As the infectious agents of the miasms have been passed through millions of human beings over the course of hundreds of generations its symptoms have greatly mutated. For hundreds of thousands of years the infectious miasms have been present either in endemic pockets or as universal epidemics. The effects of the miasms have been found in the remains of the most ancient human beings and are found on every continent in every culture. It is no wonder that the symptoms produced by the universal miasms have been mistaken for manifold different diseases.
Diathesis, Inherited and Acquired Constitutions
The idea of a diathesis is very closely linked with the inherited constitutional predispositions to particular symptoms. What does Diathesis mean? The Greek term, diathesis, is very closely linked with the inherited and acquired miasms and constitutional predispositions to particular symptom syndromes.
1. A diathesis is an inherited or acquired condition of the organism which makes it susceptible to peculiar disease states; a constitutional predisposition toward certain disorders. From the Greek, diathesis, dia-asunder and tithenai-to place.
2. A constitutional state which mistunes the body, and/or mind.
3. Diathetic constitutions are a category of constitutional predisposition or susceptibility to certain disorders, i.e., lymphatic, venous, leuco-phlegmatic, scrofulous, psoric, sycotic, etc. A diathesis is a permanent (hereditary or acquired) condition of the body that renders it liable to certain special diseases or affections; a constitutional predisposition or tendency. This word comes from the Greek for disposition or state. Thus a diathesis is a constitutional state that can be physical and psychological as well as inherited or acquired. The concept of diathesis is closely linked to both predisposition and the inherited miasms in Homoeopathy. This material is very cryptic to most modern homoeopaths yet those who have put this system to work find it practical and indispensable to daily practice. Homoeopathic reference works have recorded a great amount of information on constitutional diathesis and dynamic remedies that reflect a similar state. Hering and Knerr recorded a large amount of material in their writings.
For example, Knerr's Repertory to Hering's Guiding Symptoms includes the following rubric in the general section.
In this section Knerr gives rubrics of various diathetic constitutions and their remedies. The source of this information is Hering's Guiding Symptoms in the section called Stages of life and Constitutions. Here is a sample of the types of rubrics included and a few examples.
1. Rubrics related to constitutional diathesis include; Hysterical, constitutions; Hemorrhagic, constitutions; Lymphatic, constitutions; Venous, constitutions; Plethoric, constitutions; Rheumatic, constitutions; Scrofulous, constitution; Paralytic, constitutions; Gouty, constitutions; Tubercular, constitutions; Asthmatic constitutions; and their similar remedies.
"Lymphatic, constitutions -am-c., Apis, arn, ars, aster, aur-m., bapt, BAR-C., Bar-m, BELL., CALC., calc-ar., Cann-i., Carb-v., Chin., dulc., FERR., GRAPH., Hep., kalm., Lyc., MERC., murx., Nat-m., nit-ac., Petr., phos., Puls., Rhus-t., Sep., Sil., Sulph., thuj."
2. Rubrics related to the bodily constitution include; Lean, thin people; Large fat, people, bloated; Emaciated constitutions; Fibre, lax, constitutions; Fibre rigid, constitutions; Tall lean, constitutions; Dwarfish, constitutions; and their similar remedies.
"Fibre, lax., constitutions-agar., bar-c., bor., CALC., calc-p., Caps., cinnam., hep., KALI-C., MAG-C., MERC., OP., PHOS., SABAD., Sil., spong."
3. Rubrics related to the Hippocratic temperaments and humours include; Bilious, constitutions; Choleric, constitutions; Phlegmatic, constitutions; Sanguine constitutions; Melancholic, constitutions; Nervous, constitutions and their remedies.
"Bilious, constitutions; acon., Aesc., ail., ambr., ant-c., ant-t., ars., Bell., berb., BRY., cann-i., CARD-M., Cham., CHEL., CHIN., chion., chol., Cocc., Ip., iris., Lach., lept., mag-m., Merc., nat-s., NUX V., Phos., plat., ptel., PSOS., Puls., sang., sep., Sulph."
Rubrics related to the miasms include; Psoric, constitutions; Sycotic constitutions; Tubercular, constitutions; Syphilitic, constitutions; Cancerous constitutions (mixed miasms).
"SYPHILITIC, constitutions-Ars., aec-t., AUR., Benz-ac., Clem., Cor-r., Crot-h., cund., euph., ferr-i., Fl-ac., Guai., Kali-b., KALI-I., MERC., Merc-c., Merc-d., Merc-i-f., Mez., NIT-AC., Petr., Phos., Ph-ac., Phyt., Sars., Sil., Still., sulph., SYPH., Thuj."
There are literally 100's of rubrics on this subject in the old materia medicas and repertories. These are general symptoms of the constitution, temperament, diathetic states and miasms. A miasm can produce a number of diatheses depending on the constitution and temperament and conditioning factors. For example, pseudo-psora TB miasm tends to produces a hemorrhagic diathesis while sycosis tends to an arthritic rheumatic diathesis. If the individual is of a sanguine temperament and acquires the TB miasm the chance of dangerous hemorrhage is increased greatly. This is because the fiery sanguine temperament that rules the warm/moist blood humour and the TB miasm both have an easy tendency to bleed. Such knowledge forms the basis of the homoeopathic view of constitution, temperament, susceptibility, miasms and diathesis.
Constitution and Concomitants
Hahnemann paid close attention to the constitution in both acute and chronic diseases. Vide Sycosis, The Chronic Diseases, the footnote on page 150.
"The miasm of the other common gonorrhoea seem not to penetrate the whole organism, but only to locally stimulate the urinary organs. They yield either to a dose of one drop of fresh parsley juice, when this is indicated by a frequent urgency to urinate, or a small dose of Cannabis, of Cantharides, or of the Copaiva balm, according to their different constitutions and other ailments attending it. [Bolds by DL]"
In this example Hahnemann suggests using the constitutional concomitant symptoms to help in the selection of a remedy. He expects homoeopaths to understand that the term "constitution" simply means the whole living organism. All chronic remedies are "constitutional" in this sense as they reflect the essential nature of the totality of the symptoms.
I think we have proved beyond a doubt that Hahnemann had a deep understanding of classical constitution, temperament, inheritance, susceptibility, diathesis and miasms. He also introduced temperamental pictures that included both the natural traits of the individual when healthy compared with the negative changes brought on by illness. Hahnemann’s writing and the Paris casebooks include Hippocratic terms like the choleric, phlegmatic, sanguine and nervous temperaments. Each of these temperaments is associated with positive and negative qualities and predispositions toward certain disease states, signs, befallments and symptoms. They are also prone to particular diathetic states such as the venous, lymphatic and leuco-phlegmatic constitutions. If one studies material of the first generation of homoeopaths they will find such references with their concomitant signs and symptoms.