Dr Prem Shankar Tripathi
Miasm—miasm refers to the dynamic disease producing power which stain and pollutes human organism with unhealthy tendencies and thus become the producer of different types disease. Miasm may be two types— viz .1 acute miasm and 2. Chronic miasm
Acute miasm—acute miasm is a dynamic disease producing power which causes acute specific infectious epidemic disease having almost fixed manifestation.
According to master kent—an acute miasm is one that comes upon the economy passes through its regular prodromal period longer or shorter, has its period of progress and period of decline and which there is tendency to recovery. the acute miasm are two types
Recurring type—those types of acute miasm that recur in the same manner more than once in life time of a particular person. Example..dengue ,chikengunea , swine flue cholera, yellow fever, plague etc.
Non recurring acute miasm—- this is also called fixed miasm these types of acute miasm are those which attack a person only once in life time and called non recurrent or fixed miasm. Example. Smallpox, whooping cough, etc.
Half Spiritual Miasm – In the book “ CHRONIC DISEASES” Dr. Hahnemannan explained miasm of measles, scarlet fever, pox etc called half spiritual miasm because of after completing their parasitical existence in the system for some period they die out leaving the organism to recover soon, if the patient does not die by the time.
The peculiar characteristic of the half spiritual miasm is that, after they have penetrated the vital force in the first movement of contagion, they produce the disease in their own way. Then the parasites quickly grow within it and usually develop a peculiar fever after producing amature cuteneous eruption (fruit) which in turn is capable of producing its miasm. Finally, they die out leaving the organism free to recovery.
HALF ACUTE MIASM – the miasm hydrophobia has been termed as half acute miasm. The miasm takes effect the moment a person gets bitten by a mad dog. The poison of this miasm gets communicated to the nearest nerves. As soon as the malady develops inside the organism, the madness breaks out as acute, quickly fatal disease.
CHRONIC MIASM- chronic miasms are fundamental cause of chronic disease. They produce chronic diseases and pre-dispose human being to acute diseases. There are three types of chronic miasm viz. psora, syphilis, sycosis.the chronic miasm go on increasing and growing worse inspite of best mental and corporal regimen and torment to the end of the human life. They are ineradicable by the vital force alone without proper medicinal treatment.
PSORA- psora is the most ancient, most universal, most contagious, most destructive and most misapprehended chronic miasm. for many thousand of years it has disfigured and tortured mankind and during the last centuries it has become the mother of thousand of incredible non veneral chronic and acute diseases, by which whole race on the inhabited globe is being more and more afficted. It is most hydraheaded of all the three chronic miasm. It is a itch- dyscrasia leading to functional disorders.
LATENT PSORA- when the primary manifestation of psora are suppressed by local application, the local cutaneous symptoms disappear but the disease is driven inwards and may remain dormant. This state called as the latent state of psora. So latent psora is a state when psora is sleeping producing no active symptoms, and the person may be declared as apparently healthy, but any exciting or maintaining cause may flare up to produce secondary symptoms of psora.
SYCOSIS- sycosis or the veneral fig- wart disease is a veneral chronic miasm primarly manifested externally by the condylomatus and cauliflower like growth on genitals following impure coition.
SYPHILIS- syphilis is a veneral chronic miasm primarily manifested outwardly by veneral chancre developed following an impure coition.
SUSCPTIBILITY- susceptibility is the fundamental quality of a living organism to react to any sort of stimuli that distinguishes the living from the non living. Master Kent says that susceptibility is the influx or the flow of cause into the body. Causes flow in the direction of least resistence. if resistence appears, the cause no longer flow in. the influx ceases. The influx is the flow of causes without resistence. susceptibility ceases when changes occur in the economy that bar out any more influx. Stuart close says By susceptibility we mean general quality or capacity of the living organism of receiving impression the power to react to stimuli. susceptibility is the fundamental attributes of life. All the physiological and pathological function depend on this basic quality of the digestion, assimilation, nutrition, repair, secretion, exertion, metabolism, catabolism as well as all disease process arising from infection or contagion depend upon the power of the organism to react to specific stimuli.
Human beings are susceptible to infection or contagion in varying digrees. One man will become infected in contact with disease individual, while another person will experience no ill effect whatsoever. Adjustment of the organism to the adverse environmental states is the result of normal susceptibility. A normal level of susceptibility is responsible for the maintenance of the healthy state. But prolonged exposure of to the adverse environmental effect may lead to change in the state of susceptibility. These adverse factors can be either mechanical, chemical, or dynamic in nature (Exciting and maintaining cause). If such adverse condition are not controlled in time, uneasiness is exhibited by the host which leads to the production of disturbance in the organism in the form of sign and symptoms, which we call disease.
MIASM AND MICRO –ORGANISM
The question of whether Master Hahnemann’s miasm are microorganism? Is there any correlation between Hahnemann’s views and microbiological theories? Stuart Close says, the greater practical value of Hahnemann’s theory of chronic diseases has never fully appreciated because it has never been fully understood. Comparative study of the concept of infection of the modern medical terms and the Hahnemann’s comments on the mode of infection of each miasm seem to have similarities. Observe the following statements:
“With respect to the origin of these three chronic maladies as in the acute, miasmatic eruptional diseases, three different important movements are to be more attentively considered than hitherto been done.” Says Hahnemann
- Firstly , the time of infection.
- Secondly, the period of time during which the whole organism is being penetrated by the disease infused, until it has developed within.
- Thirdly, the breaking out of the external ailment.
In the first point, Master Hahnemann is clearly indicating that the miasm enters an organism through the process of infection. In case of psora, general touch to the skin, in case of the veneral miasm syphilis and sycosis, impure coition is the mode of infection. Further he says,“ the infection with the miasm, as well of the acute as of the above mentioned chronic diseases, take place, in one single moment, and that moment , the one most favorable for infection.”
The second point clearly remind us the incubation period of the modern science. The miasmatic disease dose not manifest immediately after the infection but after few days when the infection has dynamically spread into the entire vital force.
Regarding the third point, once the incubation period is over the infection has been communicated to the entire part of the body , the disease symptoms manifest in a visible observable manner.
Master Hahnemann had no microscope. All his conclusion were made by his own clinical observations, including his classification of diseases. He used the term miasm in more precise form. During his life time the term miasm was vaguely used by many physicians as morbific emanation from purulent organic matter, effluvia arising from the bodies of the patient etc. but infact in using the term miasm he had some other idea in mind. The following explanation given by stuart close makes its clear. In the year 1831, Asiatic Cholera invaded Europe , Hufeland, one of the famous physician of those times, belived and taught that cholera was an atmospheric – telluric origin. Master Hahnemann protested against this belief in his essay “ the mode of propagation of Asiatic cholera” . he explained that cholera miasm is communicable by contagion only and propogated from one individual to other. “ on board ships, in those confined spaces filled with mould , watery vapors, the cholera miasm finds a favorable element for its multiplication” “ and grows into an enormously increased brood of those excessively minute, invisible living creatures, so inimical to human life of which the contagious matter of cholera most probably consist.” In this essay he uses the term like “ communicable by contagion “, “ multiplication” ,“ growth”, “ minute living creature”, and even “animated being” etc. only living thing will grow and multiply . Hahnemann’s explanation of mode of transmission and spread of cholera though not understood by then practitioners, came out to be true and are close to today’s microbiological terms.
In aphorism 73 he explain about different types of acute diseases as individual, sporadic, epidemic diseases. In his attempt to explain the epidemic disease he states,“ these disease generally become infectious (contagious) when they prevail among thickly congregated masses of human being”.
Hahnemann’s explanation of half acute miasm (hydrophobia) and half spiritual miasm(small pox) , also suggest that his views were far ahead of his time and equal to modern concepts. “ these various acute, half acute spiritual miasms there peculiar characteristic that after they have penetrated the vital force in the first moment of contagion and then , like parasites have quickly grown up within it and have usually developed themselves by their peculiar fever after producing their fruit (the mature cuteneous eruption which again capable of producing its miasma)-they again die out and leave the living organism again free to recovery?”
Communicable disease—a disease that is transmitted through direct contact with an infected individual or individual discharge or indirectly through a vector . also called contagious disease.
Disease transmission- communicable diseases are transmitted from reservoir/ source of infection to susceptible host . basically there are three link in the chain of transmission, viz, the reservoir, mode of transmission and the susceptible host.
Sources and reservoir- the starting point for the occurrence of communicable diseases is the existence of a reservoir or source of infection .
Source-“ the person, animal, object or substance from which an infectious agent passes or is disseminated to the host.
Reservoir- any person , animal, arthropod, plant , soil, or substance (or combination of these) in which an infectious agent lives and multiplies , on which it depends primarily for survival , and where it reproduces itself in such manner that it can be transmitted to a susceptible host.” Reservoir may be three type viz. Human reservoir, Animal reservoir, and reservoir in non living things.
Human reservoir may be case or carrier—
Case— A case is an infected person having clinical feature of the disease. Such a case may be mild, moderate or a severe case Mild case is more dangerous than the severe cases because they are ambulatory and go on spreading the disease wherever they go. Cases do not act as source throughout the duration of illness. They do so only during the period of communicability, which varies from disease to disease.
Carrier—A carrier is an infected person but not having the clinical feature of the disease and severe as a source of infection to other in the community. Such carrier are seen in typhoid, Diphtheria, Gonorrhea, Aids, etc. they can be detected only by doing laboratory investigations. The carrier constitute the submerged portion of ice in iceberg phenomenon. According to the stage in the disease cycle,
A –Type- there are three types of carriers, namely- incubatory, convalescent, and contact carrier.
Incubatory carrier- is one who is spreading the disease during the incubation period- itself. Such a state occurs in disease like measles, mumps, diphtheria, poliomyelitis, pertussis, influenza, and hepatitis A and B. after the incubation period that individual develops the clinical features and become a case.
Convalescent carrier– is the one who is acting as a carrier during the period of recovery from an illness. That means such a person is getting cured clinically but not bacteriologically, may be due to incomplete course of treatment. Such a state occurs in condition like diphtheria, typhoid, amoebiasis.
Contact (healthy) carrier – is the one who is subclinically infected and act as a source of infection to others. The nursing staff, the patient`s attendants, or the family member who are in close association with the case often become healthy carriers.
B- Duration- depending upon the duration of the carrier state,
Temporary carrier– these are those who are actlng as carrier and spreading the disease for a short period of time. All incubatory, convalescent, and healthy carrier are temporary carriers.
Chronic carriers– those who transmitted the disease for long period of time, several week to several months. This state occurs because of persistence of the organism in the organs like gallbladder in typhoid fever, tonsils in diphtheria, liver in hepatitis B, etc.
C- Route of exit— Depending upon the route of exit , the carriers are also grouped into the following –
- Urinary carriers, where the focus of organism is the kidney as in the Typhoid.
- Intestinal carriers, where the focus of organism is the intestine, as in typhoid amoebiasis
- Biliary carriers, where the focus of organism is the gallbladder as in typhoid.
- Cuteneous carriers as in staphylocci,
- Nasal carriers as in the nasal diphtheria,
- Genital carriers as in gonorrhea, AID
Typhoid – Mary is classical example of a carrier found to be dangerous to the community. She was a chronic typhoid carrier working in the food establishment as a cook. She was responsible for 25 death due to typhoid and 1250 cases for typhoid, because of her poor personal hygiene and poor sanitation.
Animal Reservoir– there are many animals who acts as reservoir and transmit the disease to human beings. These disease are called as Zoonotic disease (anthropozoonoses). For example- Cattle – Q- fever, Bovine tuberculosis, Brucellous etc. Horse- Tetanus Dogs –Rabies Sheep- Anthrox , Monkey – Yellow fever , KFD, Birds- Ornithosis, Psittacosis pigs- JE Rodents –Plague, Endemic typhus.etc.
Soil reservoir – soil acts not only as reservoir but also as sourse of infection and transmit disease like tetanus, gas gangrene, ankylostomiasis, mycetoma
Routes of Transmission
Communicable disease is transmitted from the reservoir or source to a susceptible person either directly or indirectly depending upon whether they are in close proximity or not.
Direct modes of transmission
- Direct contact – when the reservoir and the susceptible host are in close, physical, skin to skin contact. for example Scabies, STD, AIDS, lepromatus leprosy,, opthalmia neonatrum etc.
- Droplet infection- when the susceptible host inhale the infected droplet coming out of the mouth or nose from the reservoir during the act of coughing, sneezing, laughing. For example, pulmonary tuberculosis, diphtheria, measles pertussis etc.
- Contact with the contaminated soil – for example all soil born disease e. g. tetanus, anthrax, ankylstomiasis.
- Contact with the animal—Rabies is a classical example transmitted from animal by bite and inoculating the virus into the skin or mucous membrane.
- Transplacental (vertical) transmission— transmission of disease from mother to the fetus through placenta. Ex. Rubella, AIDS, Syphilis etc.
Indirect mode of transmission
- Vehicle route: the vehicle which are capable of transmitting the disease are water, food, milk, biological products like blood, tissue, or organ( as in organ transplant )
- Vector route : an arthropod capable of transmitting the disease. Ex. Mosquitoes, flies, lice, tics etc. vectors transmit the disease in following ways.
- Mechanically : carrying the pathogens from the filthy substance to food substance by soiling the legs. For ex. House fly transmitting typhoid, trachoma, etc.
- Biting and inoculating the pathogens percutaneously. For ex. Mosquitoes, fleas, ticks, etc.
- Defecation; scrtching in of the infected feces, into the abrasions of the skin , for ex. Trench fever transmitted through the feces of infected louce, epidemic typhus.
- Contamination: contamination of the abraded skin of the host by the body fluid of the infected arthropod when it is crushed. For ex. Transmission of relapsing fever when infected louce is crushed in the scalp.
- Biologically: when the pathogen undergoes multiplication or development from one stage to another stage or both multiplication and development, inside the body of vector. This mode of transmission is of three type.
- Propagative type: pathogen undergoes only multiplication inside the vector. Ex. Plague bacilli in in the body of rat flea, yellow fever virus in the body of female aedes mosquito, KFD virus in the body of hard tick.
- Cyclopropagative type: the pathogen undergoes not only multiplication but also a phase of development in life cycle. Fpr ex. Plasmodium parasites in the body of the female anopheline.
- Cyclodevelopmental type: the pathogen undergoes only a phase of development but not multiplication. For ex. Microfilariae developing into larval stage in the body of female culex mosquito.
- Air borne route of transmission: by droplet nuclei and infected dust, by air pollution.
- Fomite route of transmission: fomites are the inanimate objects capable of transmitting the disease. Ex. Cloths, clinical thermometer, spoons.etc.
- Unclean hand and finger: these contaminate the food and drink and transmit disease like typhoid, streptococcal and staphylococcal infection, diarrhea, dysentery.etc.
All above theories and example shows that, if a susceptible host ,and agent is present, environment is favorable disease will come.
- Dr.G Nagendra Babu’s Comprehensive study of organon.
- A H Suryakatha’s community medicine with Recent Advances.
- K. Park Textbook of preventive and Social Medicine.
- Prof.(Dr.) A. K. Das’s A TREATISE ON ORGANON OF MEDICINE.