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Understanding Aphorism Four – Preventive and Social Medicine

The fourth aphorism states:

He is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health.

I have heard people say that Hahnemann was the greatest medical scientist who ever lived. If you read Organon carefully enough, you will realize the truth behind such statements. Hahnemann was a visionary. He did not limit the scope of his vision to understanding and treating disease; he went further and envisioned a greater role, a greater responsibility for the physician. This extension of his vision is evident in the fourth aphorism.

While in the third aphorism, he discussed the knowledge that a physician must have to treat the sick, in the fourth aphorism, Hahnemann discusses the role of the physician in preventing sickness. The fourth aphorism summarizes the need for the medical subject ‘Preventive and Social Medicine’, which is now taught in all medical schools. But Hahnemann thought about the larger picture much before the subject got introduced in medical schools. Before I venture further into the homeopathic implications of this aphorism, I would like to present a brief history of ‘Preventive & Social Medicine’, so that you can realize how far ahead Hahnemann was from his times:

Preventive and Social Medicine (PSM) is relatively a new branch of medicine. It is often considered synonymous with Community Medicine, Public Health, and Community Health. All these share common ground, i.e. prevention of disease and promotion of health. In short, PSM provides comprehensive health services ranging from preventive, promotive, curative to rehabilitative services. Whereas clinical specialties look after THE individual patient, PSM has to think and act in terms of THE whole community. The scope of medicine has expanded during the last few decades to include not only health problems of individuals, but those of communities as well.

The industrial revolution of the 18th century while bringing affluence, also brought new problems – slums, accumulation of refuse and human excreta, overcrowding and a variety of social problems. Frequent outbreaks of cholera added to the woes. Chadwick’s report on ‘The Sanitary Conditions of Labouring Population (1842)’ focussed the attention of the people and Government on the urgent need to improve public health. Filth and garbage were recognized as man’s greatest enemies and it led to A great awareness of sanitation. This resulted in the Public Health Act of 1848 in England, AN acceptance of the principle that the state is responsible for the health of the people. The act was made more comprehensive in 1875 when Public Health Act 1875 was enacted. The public health movement in the USA followed closely the English pattern. The organised professional body, American Public Health Association, was formed in 1872. The Indian Public Health Association was formed in 1958.

Preventive Medicine developed as a branch of medicine distinct from Public Health. By definition, preventive medicine is applied to ‘healthy’ people, customarily by actions affecting large numbers or populations. Its primary objective is prevention of disease and promotion of health. It got a firm foundation only after the discovery of causative agents of diseases and the establishment of the germ theory of disease. The development of laboratory methods for the early detection of disease was a further advance.

Social Medicine has varying meanings attached to it. By derivation, it is the study of man as a social being in his total environment. It may be identified with care of patients, prevention of disease, administration of medical services; indeed with almost any subject in the extensive field of health and welfare. In short, social medicine is not a new branch of medicine but rather a new orientation of medicine to the changing needs of man and society.

Community Medicine has been defined as that speciality which deals with populations. It comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and who are engaged in research and teaching in the field.

It is very evident that the true understanding of the need for preventive and social medicine, developed somewhere between 50 to100 years after Hahnemann wrote the fourth aphorism, for the first time. Wasn’t he a visionary? A true scientist who was able to think much ahead of his times?

Now let us come back to understanding the fourth aphorism from the homeopathic perspective. I will repeat the fourth aphorism:

He is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health.

In this aphorism Dr. Hahnemann states that apart from being the person who treats diseased individuals, a physician is also the ‘preserver of health’. And he can work as a preserver of health if he knows about:

1. The things that derange health

2. The things that cause disease

3. The methods to remove such things/factors from persons in health.

Most people read this one line aphorism in one breath and are not able to appreciate the difference between the things that ‘derange health’ and the things that ‘cause disease’. But there is lot of difference in them.

Factors that Derange Health.

These include the primary causative factors which decrease our vitality and predispose us to various disease states. There can be a variety of factors which can derange our vital force like:

1. Mental & Emotional Factors: like unusual mental strain due to studies, worries, exposure to too much obscenity or violence through any media, a heart break, exposure to family violence, separation or death of a loved one, suppressed anger, physical or psychological abuse, harassment, a shock etc.

2. Physical Factors: like unusual physical strain or trauma.

3. Environmental Factors: exposure to extremes of heat, cold, damp, or dry atmosphere.

4. Social Factors: like unhygienic surroundings, food adulterations, pollution.

5. Bad Habits: unhealthy diet, lack of physical exercise, irregular sleep cycle, addictions.

6. Suppressive medicine/treatment of any kind.

All these factors can decrease the vitality of the person and predispose him/her to a variety of disease conditions. Usually the diseases start as occasional acutes, then they become frequent acutes and then the disease moves to some chronic state. But it can even start as an insidious chronic disease, right at the beginning. What conditions the person will acquire depend a lot upon the genetic susceptibility that a person is born with.

Factors that cause Disease

Most homeopaths believe that the microbes are not responsible for causing diseases. It is the derangement of the vital force that causes all disease. But this is not the absolute truth. The derangement of the vital force provides the fertile ground for the diseases to grow. The microbes work as the secondary cause of the disease conditions in a large majority of cases. So we can list the factors that cause disease as:

1. Microbes: the viruses, bacteria, parasites work as the ‘factors that cause disease’ in nearly all acute cases and a huge proportion of chronic cases too.

2. Factors that derange health: can work as the ‘factors that cause disease’ in many chronic disease conditions (states) which are not always dependent upon the microbes.

Knowledge of How to Remove Such Factors from Persons in Health

The knowledge of what predisposes a human being to sickness helps a physician to guide his patients and the people around him to remain healthy. A physician is not just supposed to treat a sick patient; he is responsible for giving such advice to his patients by which they can maintain their level of optimum health. He has to work as the ‘preserver’ of ‘health’. Unfortunately, there is no dearth of people in the medical community who are happy to see more people suffering – because it means more money, more business for them! I once met a very famous homeopath from Banglore, the Indian IT hub. During our conversation he told me, “You know Dr. Bhatia, all these young boys and girls working for long hours in BPO’s and IT companies. They all suffer from cervical spondylitis at some point of time. When they come to me I give the medicine for 3 months and then I tell them the exercises which will reduce and prevent such complaints. You have to milk your money first. If you tell them the exercises and everything about the right posture and ergonomic furniture, who will come to you?” I was left speechless.

A physician should be able to find out the cause of the ‘deranged vitality’ in his patients and (apart from giving the correct remedy) should be able to tell them measures to remove the cause and to remain fit and healthy. For this, he should have knowledge about balanced diet, nutrition, exercise, personal and public hygiene, causes of disease, their control and prevention etc. But above all, he should have true compassion for the suffering of man kind!

The fourth aphorism summarizes all this in just 27 words! Hahnemann knew the beauty of brevity. It is for us to understand the real depth of his words.

References

Thakur HP, Pandit DD, Subramanian P. History of preventive and social medicine in India. J Postgrad Med 2001;47:283-5

 

Posted in: Organon & Philosophy
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