To my knowledge, Jahr was the first in advising to include so-called constitutional symptoms into the patient's exam after Hahnemann's explanations in the Organon.

In fact, though I've done a bit of reading of the old German masters, this was the first time that I got such clear and distinct interpretations of Hahnemann's teachings.

The 180 paragraphs of Jahr's book are grouped into 3 sections:

Introduction (§ 1-5)

1. Hahnemann's theoretical views (§ 6-67)

2. Hahnemann's practical teachings and rules of 'How to proceed' (§68 - 162)

3. The theories and works of the homoeopathic school (§ 163 - 180)

Among 'Hahnemann's practical teachings' an entire paragraph is devoted to the value of constitutional additional symptoms which Jahr summarizes in his index as follows:

"§.108.  In chronic diseases the constitutional additional symptoms provide the characteristic indications for the choice of the remedy"

[Original German text:

"§.108. In chronischen Krankheiten sind es die constitutionellen Nebensymptome, welche die charakteristischen Anzeigen für die Wahl des Mittels liefern"]

(I want to quote here the German text as well because translation often makes it difficult to decide when and how a word was used.)

Jahr says that the choice of the right remedy is the most difficult in chronic diseases. Not only because there are often only few symptoms, but also because the symptoms that should determine the choice of the remedy are often not presented to the eye of the observer. One of the reasons is that

"here, because of the origin of the disease in an acquired or inherited diathesis, they [the symptoms; GR] are often so intimately amalgamated with the individual constitution ["Constitution" in the original German text; GR] of the patient that he doesn't even think of communicating the constitutional anomalies, which he doesn't often even consider as pathologic, to the doctor."

This, Jahr concludes, is the reason, that homoeopaths weren't able to select the remedy in chronic diseases like gout, asthma, epilepsy etc. according to the pathogenetic signs, but simply gave  remedies according to their confirmed good results in such diseases, more or less in a way of trial and error.

When these remedies - which seemed preferable by their pathognomic symptoms - failed the question arose 'what to do' next. Jahr states that Hahnemann himself had been in similar doubts and  consequently developped the theory of the chronic diseases  - these being only symptoms of one basic diathesis. Hahnemann then searched for remedies that were able to produce not all, but at least many symptoms which are usually produced in chronic diseases.

These remedies, according to Jahr, are marked by a lot of single, not very characteristic symptoms, which are similar to the single constitutional signs of chronic patients - and which can only be regarded as essential, but not characteristic symptoms.

In every individual, he says, all single morbid appearances, physiologic and organic anomalies are characteristic signs for this constitution. Likewise, in antipsoric remedies of long duration the essential signs can be regarded as characteristic, when they appear several times in different provers.

Therefore the remedy should be chosen

" which contains in its own most essential signs the most essential constitutional symptoms of the patient…..

…the symptoms determining the choice are not to be searched for in the pathognomic signs of the local ailment we want to treat, but in the constitutional symptoms which exist beyond them, that is, the accidental symptoms in the ailment to be cured."

Jahr mentions examples of warts, ulcers, struma etc. which had been treated in vain with all sorts of remedies, but which disappeared only after exploring all the constitutional symptoms, choosing among these the most essential and most characteristic to find a matching remedy. This happened even when the cured ailment wasn't even listed or only less important in the symptom complex of the remedy.

Jahr states that already Hering had noticed what others had confirmed: that

"some remedies cure what they never seem to produce, while others never seem to cure what they produce."

Even in chronic diseases which are able to produce more symptoms, such as gout, or where some remedies seem to be specific, such as affections of the glands, these remedies are only able to cure because they contain in their symptom complex those signs which are corresponding to the constitutional signs of such a patient.

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The entire paragraph has to be understood in the context of many preceding pages where Jahr explains explicitly in § 106:

" the real fitting, especially homoeopathic remedy will be in every case the one whose essential or pathognomic signs correspond to the essential or pathognomic signs of the disease and whose characteristic signs correspond to the individual's not pathognomic, that is, accidental signs which are not caused by the disease itself but by the individual constitution of the sick individual or by other accidental conditions."

To get a better understanding of these lines it is necessary to focus on the terms:

'essential' and 'characteristic' signs

According to Jahr, the essential ['wesentlichen' in German, GR] or pathognomic signs are the signs which constitute a certain disease, i.e. are to be expected. This term is used in a relative way:

The appearance of Acarus siro [the mite Sarcoptes scabiei, GR] is a characteristic sign when trying to differentiate between several sorts of eruptions of the head. As soon as the itch disease is confirmed by its appearance, then the mite is only an essential sign - because all cases of scabies-caused itch disease have the appearance of the mite in common.
The characteristic signs, however, are those which belong to the individual because of his constitution or because of other accidental happenings, i.e. are normally not found in all sorts of cases of this disease.

The same sort of differentiation needs to be done with the remedy:
the symptoms, that are found more often in several provers like flu-like symptoms, diarrhea or something like that, could be reagrded as essential signs. The characteristic symptoms are those, which differentiate the diarrhea of Podophyllum from the diarrhea of Veratrum, like time of onset, modalties, concomitants etc.

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My interpretation of Jahr's conclusion:

In general, the remedy should be chosen among those, whose pathognomic signs correspond to the essential pathognomic signs of the patient.

To differentiate between these remedies, the characteristic signs of the remedies need to be matched

- to the characteristic signs of the individual, which have their roots in the individual constitution

- or to accidental conditions.

If, in case of a chronic disease, there are no outstanding pathognomic signs which allow a primary selection of a remedy group, then we have to turn at once to the characteristic symptoms of the individual, i.e. the most characteristic of the individual constitution should match those of the remedy - even when there are no confirmed cures of such an ailment, and even when no other signs of this pathology did ever appear in the provings or were only rarely observed.

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What tackled my interest after reading the book were 2 questions:

1) Who was this man, who was able to give such clear interpretations of Hahnemann's doctrine?

2) were did the term 'constitution' come from? Was it used before Hahnemann, and if so, how was it used?

The first question will be answered by a short biographical sketch:

Georg Heinrich Gottlieb Jahr (1800 – 1875), having been cured from a serious disease by Dr. Julius Aegidi, got interested in homoeopathy and with Aegidi's recommendation went to Koethen to visit Hahnemann in 1825. The Belgian journal 'Revue Homéopathique Belge' from August 1875 tells us, that Hahnemann sent Jahr, the teacher, who lacked any knowledge of medicine, to the University of Bonn, where he spent 3 years of studying medicine without getting a final degree. During the time of his medical studies he kept on studying Hahnemann's MMP and continually kept a correspondence with him. Back in Koethen, he assisted Hahnemann in finishing the 2nd edition of the Chronic diseases between 1830 and 1835. The 'Revue Belge' confirms that Jahr stayed several years with Hahnemann and participated in the provings of Digitalis and Magnesia muriatica.

(Source: F. Cousset, Bordeaux,1996)

Due to staying so close to Hahnemann, no wonder Jahr can tell us a lot about what Hahnemann did and thought. Anyone who wants to know more about him, should start reading in T.L. Bradford's 'Pioneers of Homeopathy'.

Now to the 2^nd question:

Where did the term 'Constitution' appear?

Thomas Sydenham  (1624 - 1689) compares diseases with migrant birds and talks about the secret 'instinct of nature' taking effect hereby. According to the seasons he differentiates spring, summer, autumn and winter diseases as separate parts of the 'constitutio annua'. Besides, according to Sydenham, there is also a 'constitutio epidemica' which is influenced by cosmic and telluric influences, miasms rising from the centre of earth, unclean influences of the atmosphere etc (Sudhoff).

Nearly 200 years later Eduard von Grauvogl (1811-1877) differentiates the hydrogenous, the oxygenous and the carbo-nitrogenous constitution. People with hydrogenous constitution were the ones suffering from cold and wet weather, who are also aggravated by cold food or when staying near the water or sea-side, with  symptoms showing a certain periodicity. People with an oxygenous constitution suffer from lack of fats and protein, as well as being sensitive to all sorts of change of weather. People with a carbonitrogenous constitution feel well when being outside with fresh air; wet and cold weather doesn't cause any aggravation, breathing and pulse rate are often accelerated.

According to these classifications, Grauvogl added some remedies, such as Natrum nitricum, Natrum sulfuricum and Thuya for the hydrogenous constitution.

Grauvogl's views were probably influenced by Baumès, Bertele, J.Chr. Reil.
Jean Baptiste Theodore Baumès († 1815) was sure that diseases were caused by the influence of 5 chemical substances onto the vital force, by an excess or lack of Oxygen, Nitrogen, Carbon, Hydrogen and Phosphorus ( "Essai d'un système chimique de la science de l'homme", 1798).

Johann Christian Reil (1759 - 1813) had lived in Halle and Berlin and got famous by important works about neurophysiology and neuropathology and others, like "About the vital force", 1795. He belonged to the vitalistic school of Montpellier.

Another medical doctor was also trying to classify different types:

Mathias Marenzeller (1765 - 1854) was the first Austrian doctor who entered the homoeopathic path after having read Hahnemann's works in 1816. Already in 1804 he had started to differentiate slim, fat and strong constitutional types, probably influenced by Lavater's physiognomy. (This is quite similar to more modern constitutional types, such as the asthenic or leptosom, athletic and pycnic constitutional types as classified by Kretschmer). Unfortunately neither Marenzeller himself nor his son Adolf published anything about this work [Tischner].

Classical homoeopathic authors also used the word 'constitution' and 'constitutional':

Dr. Adolph von Lippe writes in his 'Keynotes Of The Homoeopathic Materia Medica'

"Aloe is frequently called for in correcting the bad effects from sedentary life and habits and is especially suitable to persons of a lymphatic and hypochondriacal constitution."

James Tyler Kent, in some of his 'Lectures on homoeopathic philosophy':

Lecture 29 : Idiosyncrasies:

There are persons who are sensitive, not merely to one or a few things, but to all things; oversensitive to the high potencies, oversensitive in taste, oversensitive to light, and a great many other things.

This is a constitutional state ; the patient is born with it.

Lecture 16 : Oversensitive patients. Organon § 44 et seq.

All these patients will have alternating symptoms which will confuse the physician before he knows their constitutional state.

It is an important thing to know the constitutional state of a patient before prescribing.

You will always be able to do better for your patients when you know all of their tendencies.

Of course, in acute diseases symptoms sometimes stand out so sharply that an acute remedy can be administered without reference to any constitutional state.

Lecture 21 : Chronic diseases-sycosis

The suppression cannot bring on the constitutional symptoms called sycosis.

It cannot be followed by fig warts, nor constitutional states, such as anaemia.

But while constitutional symptoms cannot follow the suppression of the acute miasm, they will follow suppression of the chronic miasm, and become very serious.

From Kent's 'Lesser writings':

Syphilis as a miasm

Thus syphilis, being a constitutional disease, is made, I may say, ten times more constitutional by suppression.

Homoeopathy : its fundamental principles outlined

Hahnemann describes three constitutional miasms that may exist in latency, that develop and progress in the vital "dynamis" without changing the tissues, that may spring into destructive activity and attack organs and give shape to countless lesions called disease; that these miasms should be recognized as primary wrongs out of which grow incurable maladies, and all structural changes.

About Kent's "constitutional prescribing" already much has been written, therefore I limit myself here in quoting J.Winston in his 'Faces of Homoeopathy' who writes in his chapter about Kent and his influence:

"In Kent's view (as influenced by Swedenborg) all disease process starts at the level of "will and understanding." Since the mind is the deepest level in the hierarchy of the physical body, treating the symptoms expressed through the "will and understanding" will heal that level,and permit it, in turn, to heal the other levels. To treat "constituionally" was to treat that level - the symptoms expressed as those of the whole being, the "general symptoms" as Kent called them - those expressed by the "I", as seen in the expressions "I am tired at 3 p.m.", or "I have no appetite," etc.  These expressions of the whole person would take precedence over expressions of a part, "My leg hurts," or "My nose is running." This is not to say that the particular symptom should not be considered in the case, but, rather, that in a deep-seated chronic case, the "constitution" is what needs to be treated."

In his "Guiding symptoms" under the rubric 'Stages of Life, Constitution' Hering often lists the temperament of people, for which the remedy was said or had proven to be useful, e.g.

"Pulsatilla: Especially suitable for slow, phlegmatic, good-natured, timid people…"

"Nux vomica: nervous melancholic people…suits thin, irritable, choleric persons with dark hair…."

"Platina: Women with dark hair, thin, of a sanguine or bilious temperament,…"

E.Whitmont writes in his book 'Psyche and Substance', 1991:

"Thus we may say that the constitution is the inherent tendency to respond automatically along qualitatively predetermined individual, characteristic pattern. Constitutional differences are the differences of response patterns to identical situations. Constitutions can be defined by characterizing these fixed response patterns. Thus we may speak of psoric, allergic constitutions; of Sulphur, Nux vomica constitutions, etc."

Constitution - Konstitution - constitutio……an important homoeopathic term over the centuries!

Sources:

Hahnemann, Samuel 'Organon der Heilkunst', 1999, Haug Verlag, Heidelberg

Hering, Constantine 'Die pathologische Anatomie vom unnützen Standpunkte', AHZ 30 (1846), 270-272, in 'Herings medizinische Schriften'

Hering, Constantine 'The guiding symptoms of our Materia Medica', 1994, Jain, New Delhi

Jahr, Georg Heinrich Gottlieb "Die Lehren und Grundsätze der gesammten theoretischen und praktischen homöopathischen Heilkunst",  Verlag von Samuel Gottlieb Liesching, Stuttgart,1857, 506 p.
("The doctrines and principles of the entire theoretical and practical homoeopathic art of healing")