The Nucleus— Lectures on Chronic Diseases and Miasms

• ES Rajendran Mohna Publications: Calicut, Kerala, India, 2004 Price: Rs200 US$20, ISBN: 8190204807

With experience, homeopathic practitioners become adept at interpreting clinical signs and symptoms by means of an ever-widening array of illness-models. Sooner or later, every clinician will conclude that some of their patients have become unwell within an inherited or acquired context. This is an inevitable consequence of our detailed history-taking methods, which assiduously scan for aetiological events, tendencies, traits and psycho-social contexts.

In his book, The Nucleus, Dr ES Rajendran has applied himself to the subject of Hahnemann's theories of chronic disease and the question of their relevance to modern day practice. The preface states that the book has been derived from his lectures on the subject. This might partly account for a conspicuous ‘notebook’ feel to the book and a tendency for repetition in the earlier chapters. More serious, however, are the inconsistencies in the book's content: Dr Rajendran writes in the preface that he seeks to avoid ‘obscurantism’ in his handling of the subject, but then expressly avoids discussion of all the current science relating to transgenerational phenomena and disease predisposition. The biological and epidemiological studies of recent years are surely the least speculative evidence, for what have hitherto been purely empirical observations.

Within our literary heritage, there are many ideas which can be applied to the teasing question of the relationship between new aetiologies and a person's pre-determined vulnerability (‘morbid soil’, miasms, pre-sensitivity, genetic and non-genetic traits). There is no shortage of speculative writing on the influence these have on the evolution of chronic illness. Any new writer on this subject has the rather onerous task of evaluating the existing literature and identifying what can be verified and clarified, to the benefit of future clinical practice.

Dr Rajendran chooses to spend the first part of his book discussing a rather narrow selection of writings on Hahnemann's theories. One of the most careful writers on the subject, Dr Stuart Close, inexplicably attracts the most vitriolic criticism from Dr Rajendran. Having tracked down the relevant parts of Close's writings (unreferenced by Dr Rajendran), I was immediately struck with the contrast between Close's writing style and that of Dr Rajendran. Whereas the former provides us with a dialectic, based on the ideas of his time (for which references are given). Dr Rajendran gives us little more than a diatribe. In attempting to judge the quality of a text, today's reader routinely expects accurate references and evidence of a scholarly approach to the available literature. These attributes are most conspicuous in the accurate use of quotation and the presence of a glossary and/or bibliography. Unfortunately the reader will find none of these qualities in this book.

Some of the most interesting and, arguably, most articulate sources on miasm theory, include the writings and teachings of Thomas Dishington, John Paterson and Rajan Sankaran, none of whom are mentioned in The Nucleus. When a text is so expressly orientated to the student audience, it is disingenuous to omit important contributions by other authors, especially if their views don’t agree with the ideas on offer.

In the quest for clarity on a subject, it is essential to have some consistency in the way that keywords are both defined and applied. Dr Rajendran has singularly failed to provide clarity on his own central keyword: miasm. As far as I can work out from his context, miasm is used at different times in the book to denote: (a) Hahnemann's theory of chronic illness; (b) a method of case analysis; (c) a clinical methodology; (d) an acquired block to cure; (e) an inherited block to cure; (f) an altered state following an infected aetiology and (g) an illness predisposition induced by an infective aetiology. The intelligent newcomer to homoeopathy (who has the perseverence to read beyond the first chapter) might well be forced to question the very value of perpetuating the word ‘miasm’. He certainly will not be enlightened as to what it actually is.

Our modern literature includes many writers who have attempted to verify a particular theory with a case series. Although it is impossible to ‘prove’ anything with a case series, they can nevertheless be helpful in illustrating the writers clinical approach. Some of Dr Rajendran's cases might be more interesting if they were sufficiently detailed to reveal why they are amenable to his miasmatic analysis and how the conclusions were drawn.

In spite of some well-written sections, it is difficult to recommend this book. I accept many of Dr Rajendran's clinical observations, but his interpretation is limited to a early 19th century model. If we truly want make progress in our understanding of the phenomena that we see within the panoply of chronic illness, we must escape from outdated and abstruse terminologies. The word ‘miasm’ might be usefully redefined as a term for the communal ‘obscurantism’ which still prevails in parts of our homoeopathic community. Merely by failing to address the multiplicity of meanings that this word has accrued, Dr Rajendran has failed in his object of dispelling ‘obscurantism’, rather he has succeeded in making the mist a little bit more impenetrable.