Concept of Predisposition and

Disposition & its influence on

development of diseases including
genetics and congenital

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 PREDISPOSITION
• A liability or tendency to suffer from a
particular disease, hold a particular attitude or
acting in particular way.
• Dr. Hahnemann had used the term miasm to
denote predisposition to disease.

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 DISPOSITION
• Dr. Hahnemann has mentioned about
dispostion in aphorism no. 88 and its
footnote.
• Types of physical constitution and internal
organization.

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• Aphorism 88
• § 88
• If in these voluntary details nothing has been mentioned
respecting several parts or functions of the body or his
metal state, the physician asks what more can be told in
regard to these parts and these functions, or the state of
his disposition or mind1, but in doing this he only makes
use of general expressions, in order that his informants may
be obliged to enter into special details concerning them.
• FOOTNOTE TO 88: 1 For example what was the character of
his stools? How does he pass his water? How is it with his
day and night sleep? What is the state of his disposition,
his humor, his memory? How about the thirst? What sort of
taste has he in his mouth? What kinds of food and drink are
most relished? What are most repugnant to him? Has each
its full natural taste, or some other unusual taste? How
does he feel after eating or drinking? Has he anything to tell
about the head, the limbs or the abdomen?
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• Predisposition – F/H + P/H
-- Fundamental + Dominant Miasm

• Disposition – Mental –will, emotion, intellect

-- Physical – Diathesis, constitution,
temperament.

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Evolution Of Disease
Host

Predisposition

Disposition

Diathesis

Expression

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• Miasm is a predisposition to a disease pattern
passed from one generation to the next. These
inherited tendencies can produce a variety of
apparently unrelated conditions.
• For example, if your great-great grandfather
suffered from syphilis, it is possible that you could
be experiencing any number of skin disorders
because of his disease several generations ago.
Hahnemann found that miasms such as sycosis,
syphilis and psora, could be transmitted through
genetic inheritance.

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• HISTORY OF PREDISPOSITION:
• 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.
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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.

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• 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.
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• 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.

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 Unless treated with proper anti –miasmatic
dynamic medicines and completely
eradicated, will persist for whole life and may
be transmitted through generation after
generation.

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 Vithoulkas view:
Predisposition, also called the maintaining
cause., is necessary for producing disease.
Therefore, he proposed that, .disease is a
result of a morbific stimulus which resonates
with the particular level of susceptibility of the
organism.

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As Dr.Hahnemanns believes that genetic composition of an
individual plays a role in shaping the predisposition is in fact
the inherited chronic disease or miasm.. So, Vithoulkas
believes that miasmatic susceptibility is not just a matter of
DNA or genetic composition, since diseases acquired during a
parents lifetime can transmit their influence to the children,
even though no known change has occurred in the genetic
structure of the parent. He further tries to explain this
influence by taking into account the dynamic plane.
If the vital force is extensively weakened in the parents, the
childs electrodynamic field can be also weakened at the
moment of conception.

To him, the PREDISPOSITION of a child is a combination of the

predispositions of the parents and the predisposition
transmitted by parents is a result of both the general and the
specific state of health.

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He even adds that the main reason of relapse in
some cases, despite good therapy, is
predisposition.

So, based on Hahnemanns concept of the

existence of layers of predisposition,
Vithoulkas mentions that these layers have to
be removed one layer at a time by prescribing
remedy each time based on the totality of
symptoms in the moment.

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DISPOSITION:
A child is born with a disposition which is inherited
from parents and further influenced by
environment, society, family especialy mother care.
Thus a child gets distinct DISPOSITION(constitution)
It reacts to each and every change in environment
according to its disposition.
Since we don’t have control on environment we
have to improve disposition of the child.
To improve disposition we should give treatment
from the beginning of life itself.
Pregnant women should be given constitutional
medicine based on her physical and mental make
up for right development of child.
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 A baby at birth should be given antimiasmatic
 To select an antimiasmatic one has to investigate family
history
 On the basis of history of disease one can decide which
miasm runs in the family.

Miasm Antimiasmatic Remedy

Psora Sulphur or Psorinum
Sycosis Thuja or Medorhinum
Syphillis Syphilinum
Tubercular Tuberculinum

One of the above remedies can be prescribed in single dose in

high potency in first week of child life.
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ANTIMIASMATIC TREATMENT
• The Antimiasmatic treatment should be given to
the newly married couples many genetic
diseases may be easily prevented or modified.

• This treatment of miasm prevents the genetic

diseases.(maximum diseases of the newborn are
genetic and impossible to treat in any system)
• Hence free of miasmatic states free from genetic
diseases and thus healthy child.

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85
 On the other hand if the fetus is genetically diseased or
receives some hereditary disease dyscrasia from it’s
parents, No amount of antenatal care, nutrition to the
expected mother or hygienic precautions can make the
child born healthy

Unless the hereditary dyscrasia is removed by

constitutional, anti miasmatic treatment of the mother during
pregnancy.

BUT The best procedure in such

cases is to treat the parents for
their constitutional disturbances
before they are expected to have
a child
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GENETICS

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 Field of medical genetics has traditionally
focused on chromosomal abnormalities and
Mendelian disorders, with an intention to
assess the genetic predisposition to
common adult onset diseases e.g. diabetes, HT.

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Present case history taking suggests to take
second degree relatives including grand
parents and should be extended to include
additional family members.

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Our Genetic Identity
Every living individual has a unique
genetic identity

•This identity is a formed as a

combination of the genetic signatures of
ancestors, and is passed on to become
part of future generations

•We are thus intrinsically linked to, and

part of, our forebears and our
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 GENETIC DISORDERS

• A genetic disorder is a condition

caused by any abnormality in a
persons genes or chromosomes

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Genes are the instructions for the growth and development
of our bodies.

Genes are paired – one copy of each gene pair is inherited

from the mother and the other copy from the father.

The alteration (mutation) means that the information

contained in the particular gene is either changed or absent

A mutation is a permanent genetic change.

A change in chromosome structure is a

chromosome mutation.
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 Chromosomes

1. Humans have 23 pairs of chromosomes;

22 pairs of autosomes and one pair of
sex chromosomes.
2. Females are XX and males are XY.

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 TYPES OF GENETIC DISORDERS

• Single gene disorders

• Chromosome abnormalities
• Mitochondrial disorders
• Multifactorial disorders

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SINGLE GENE
DISORDERS

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 PATTERNS OF INHERITANCE

• AUTOSOMAL DOMINANT
• AUTOSOMAL RECESSIVE
• SEX CHROMOSOME LINKED-
• i.e X LINKED DOMINANT & X
LINKED RECESSIVE

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 AUTOSOMAL DOMINANT
The alteration is present in every generation

Can occur in either sex and can be transmitted by either

parent.

This is because the altered copy of the gene is dominant

over the healthy copy

Consecutive generations are affected.

Half of offspring's are affected : males = females.

Unaffected individualsHomeobook.com
cannot transmit disease. 30
 For example,
A couple with one affected partner and one unaffected partner will
have half of their children affected
i.e two affected children and two unaffected children

If an individual were to carry two copies of the dominant mutant

gene (inherited from both parents), he or she would
be homozygous (AA). So he or she may be much more
seriously affected; the homozygous condition may be lethal,
sometimes even in utero or shortly after birth.

So a couple with both partners affected will have

two-thirds of their surviving children affected and one-third
unaffected, because 1 out of 4 conceptions will produce a
homozygous fetus who will die before or shortly after birth.
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 Some AD disorders:
Neurofibromatosis - pigmented spots (café au
lait) on skin, skin tumours
Polycysitic kidney disease
Familial hypercholesterolaemia.
Achondroplasia - dwarfism, large head, short
extremities, short fingers and toes
Huntington disease - involuntary movement,
emotional disturbance, dementia
Marfan syndrome -long, thin extremities and
fingers; eye and cardiovascular problems
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 AUTOSOMAL RECESSIVE
The affected person has two copies of the altered
gene (they have inherited an altered copy of the gene
from both parents).
For couples consisting of one carrier (Aa) and one
affected individual (aa), the chance of their having an
affected child is one out of two for each pregnancy.
Unaffected carrier individuals transmit the
disease.
If both parents are carriers, then ¼ of their
offspring are affected, and ½ are carriers and 1
unaffected.
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In this example, two unaffected parents each carry one copy of a gene mutation for
an autosomal recessive disorder. They have one affected child and three
unaffected children, two of which carry one copy of the gene mutation.

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 SOME AR DISORDERS
Cystic fibrosis - chronic lung and intestinal symptoms
Hemochromatosis
Wilsons’ disease
Phenylketonuria - light pigmentation, mental
retardation, seizures
Albinism -lack of pigment in skin, hair, and eyes, with
significant visual problems
Thalassemia mild or severe anemia, enlarged spleen and
liver, stunted growth, bone deformation
Sickle cell anemia fatigue, shortness of breath, delayed
growth, muscle and abdominal pain
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 X- LINKED INHERITANCE
Only males are affected and females are carrier.

Unaffected female carriers can transmit.

Affected males cannot transmit the disease to their

sons but all of their daughters are carriers.

The carrier female (heterozygote) has a 50 percent

chance of passing the mutant gene to each of her
children; sons who inherit the mutant gene will be
hemizygotes and will manifest the trait, while
daughters who receive the mutant gene will be
unaffected carriers.
X-linked diseases are Homeobook.com
occasionally dominant. 37
• X-linked dominant – this type of disorder generally occurs in
females. The ‘X’ refers to one of the sex chromosomes that decide
gender. The mother always provides an X, while the father provides
either X (female child) or Y (male child). Women with an X-linked
dominant disorder have one altered copy and one normal copy of a
gene that is on the X chromosome. An example of an X-linked
dominant genetic disorder is a rare form of rickets known as
hypophosphataemic or vitamin D resistant rickets.

• X-linked recessive – this type of disorder is more common in

males. It is caused by an alteration in a gene on the X chromosome.
Since a male has one X and one Y (XY), he does not have a second
‘healthy’ copy of the gene. Examples of X-linked recessive genetic
disorders include Duchenne muscular dystrophy and haemophilia.

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 In this example, a man with an X-linked recessive condition has two unaffected
daughters who each carry one copy of the gene mutation, and two unaffected sons
who do not have the mutation.
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In this example, a man with an X-linked dominant condition has two affected
daughters and two unaffected sons.

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 SOME X-LINKED DISEASES
Alport’s syndrome
Hemophilia A and B.
Duchenne muscular dystrophy.
Occular albinism.
Colour blindness.

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 2.CHROMOSOMAL
DISORDERS
• A chromosome disorder means there is
a change in either the structure or the
number of chromosomes.

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1. Changes in number of chromosomes
Error occurs during the division:
• for example, the egg or sperm might be missing a chromosome (22 chromosomes) or have an
extra one (24 chromosomes), so at conception the baby has either too few (45) or too many (47)
chromosomes.
• Example: Down syndrome, where a person has 47 chromosomes rather than 46.

2. Changes in chromosome structure

• Sometimes the information contained in a chromosome breaks up and the pieces reform in a
different pattern. For example, a fragment of chromosome may break off and be lost during the
formation of either the egg or sperm cell. A section of chromosome might also break away and
‘stick’ to another chromosome and are unlikely to result in a genetic disorder.
• Example: Cri du chat syndrome (French: “cry of the cat”) , which is associated with the loss of a
small segment of the short arm of chromosome 5. Newborns with this disorder have a “mewing”
cry like that of a cat. Mental retardation is usually severe.

3. ABNORMALITIES OF THE SEX CHROMOSOMES

• Turner syndrome is a condition of females who, in the classic form, carry only a single X
chromosome (45,X). Turner syndrome is characterized by a collection of symptoms, including short
stature, webbed neck, and incomplete or absent development of secondary sex characteristics,
leading to infertility.
• Klinefelter syndrome (47,XXY) occurs in males and is associated with increased stature and
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 3.MITOCHONDRIAL DISORDERS
Mitochondria produces energy within each cell.
The energy source is a chemical called adenosine
triphosphate (ATP).

Organs like the brain, heart and liver can’t survive

without ATP.

Males and females are equallyaffected.

No males transmit disease.
e.g. lebers optic atrophy, MELAS syndrome.

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In one family, a woman with a mitochondrial disorder and her unaffected husband
have only affected children. In another family, a man with a mitochondrial
condition and his unaffected wife have no affected children.

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• The symptoms of a mitochondrial disorder,
depending on the genes involved, can affect
the:
• Brain and spinal cord– intellectual disabilities,
deafness, vision problems and seizures
• Heart – cardiomyopathy (heart failure) and
irregular heartbeat disorders
• Musculoskeletal (locomotor) system – poor
muscle tone and floppiness.

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 4.MULTIFACTORIAL DISORDERS
• They are multifactorial in origin
• These disorders are caused by the environment
interacting with the action of several genes.
• (This is also sometimes called polygenic
inheritance.)
• For example, the birth defect spina bifida is
caused by the action of several genes and also
depends on the amount of folate in the mother’s
diet during pregnancy (the environment).
• High blood pressure is influenced by a large
number of genes, but also is influenced by a
person's diet and salt intake.
• Other common conditions as cancer, heart
disease, and diabetes
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 The ABO blood group is a major system for classifying blood types in humans.
Blood type AB is inherited in a codominant pattern. In this example, a father with
blood type A and a mother with blood type B have four children, each with a
different blood type: A, AB, B, and O.

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CONGENITAL
DISORDERS

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• Congenital disorder, also known as
congenital disease
birth defect
anomaly
• It is a condition existing at or before birth
regardless of cause.
• Any substance that causes birth defects is
known as a teratogen.

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• A limb anomaly is called a dysmelia. These include all forms of limbs
anomalies, such
as amelia, polymelia, polydactyly, syndactyly, polysyndactyly,oligodactyly,
brachydactyly, achondroplasia, congenital aplasia or hypoplasia, amniotic
band syndrome, and cleidocranial dysostosis.

• Congenital anomalies of the heart include patent ductus arteriosus, atrial

septal defect, ventricular septal defect, and tetralogy of fallot.

• Congenital anomalies of the nervous system include neural tube

defects such as spina bifida, meningocele, meningomyelocele. Other
congenital anomalies of the nervous system include the Arnold-Chiari
malformation, the Dandy-Walker
malformation, hydrocephalus, and agenesis of the corpus callosum.

• Congenital anomalies of the gastrointestinal system include numerous

forms of stenosis and atresia, and perforation, such as gastroschisis..

• Congenital anomalies of the kidney and urinary tract (CAKUT) include

renal parenchyma, kidneys, and urinary collecting system.

• Defects can be bilateral or unilateral, and different defects often coexist in

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 CAUSES
• Socioeconomic and demographic factors
• 94% of severe congenital anomalies occur in low- and middle-income countries, where women often lack access to
sufficient, nutritious food and may have increased exposure to agents or factors such as infection and alcohol that
induce or increase the incidence of abnormal prenatal development.
• Advanced maternal age increases the risk of chromosomal abnormalities, including Down syndrome, while young
maternal age increases the risk of some congenital anomalies.

• Genetic factors
• Consanguinity (when parents are related by blood) increases the prevalence of rare genetic congenital anomalies.
Some ethnic communities (e.g. Ashkenazi Jews or Finns) have a comparatively high prevalence of rare genetic
mutations, leading to a higher risk of congenital anomalies.

• Infections
• Maternal infections such as syphilis and rubella are a significant cause of congenital anomalies .

• Maternal nutritional status

• Iodine deficiency, folate insufficiency, obesity and diabetes mellitus are linked to some congenital anomalies. For
example, folate insufficiency increases the risk of having a baby with a neural tube defect. Also, excessive vitamin A
intake may affect the normal development of an embryo or fetus.

• Environmental factors
• Maternal exposure to certain pesticides and other chemicals, as well as certain medications, alcohol, tobacco,
psychoactive drugs and radiation during pregnancy, may increase the risk of having a fetus or neonate affected by
congenital anomalies. Homeobook.com 52
• As Congenital abnormalities are caused by
problems during the fetus's development
before birth.
• It is important for moms and dads to be
healthy and have good medical care before
and during pregnancy to reduce the risk of
preventable congenital anomalies.

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 Prevention of PREDISPOSITION to
diseases
Married couple must be treated for their chronic
diseases before they plan conception.
Children born with latent dyscrasia for severe
chronic disease e.g. diabetes, hypertension,
asthma, rheumatoid arthritis, TB, cancer etc. may
be prevented from these diseases by proper
constitutional anti miasmatic treatment in early
childhood

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Expectant mothers should be treated throughout
the period of pregnancy with constitutional anti
miasmatic medicines

Repeated abortion, still birth may be prevented

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