Building on the view that miasms are genetically inherited influences, the author discusses how each miasm will dominate physical structure, pathology and mental outlook. Recognising the lifetime influence of a miasm helps to explain the events and circumstances that surround us. Understanding that every individual is dominated by one of the miasms, the author has identified facial features and matched them to each group; these can be used as clinical aids. Themes, together with facial features, enable a practitioner to recognise the dominant miasm of the patient. 'Appearance and Circumstance' contains explanations and facial charts to aid the homoeopath in utilising these concepts. Facial feature identification can be incorporated into any current case-taking method. By the end of his life, Hahnemann regarded himself as a miasmatic prescriber and made a clear distinction between this method and symptom prescribing only. The further he examined the miasm theory, the more convinced he become that miasms are the key to understanding chronic disease, and unlocking a case. 'Appearance and Circumstance' continues this work.