Hahnemann Lifestyle Diseases Preventive and Social Medicine

Hahnemann, Lifestyle Diseases, Preventive & Social Medicine: A Prelude to the Unsung Hero

Gyandas G. Wadhwani

…My mission… behoves me only to preach upon the greatest of all corporeal blessings, health, which scarcely any take the trouble to seek after, and few know how to value until it is lost… Samuel Hahnemann (1)

Introduction

The term ‘lifestyle’ simply means ‘the way people live’. At the same time the term also represents a whole range of cultural & social values, behaviours, personal or group habits or attitudes and social/ personal activities. Lifestyles are learnt through social interaction with immediate family (micro-environment), community exposure, peer groups, friends, school, place of work and mass media (macro-environment).

Lifestyles can promote health through adequate sleep, programmed nutrition, protection at vulnerable times, efficient working environments etc. More often than not, in the current scenario of disintegrating familial structures, technological advancements, globalisation, consumerism, substance abuse, competitive working styles etc., they give rise to/ maintain plethora of illnesses.

Lifestyle diseases (LSD) are those diseases whose occurrence is primarily based on the regular habits of people and are a result of an inappropriate relationship of people with their environment. They belong to the category of preventable non-communicable chronic diseases (since the onset of these lifestyle diseases is insidious, they take years to develop, and once encountered do not lend themselves easily to cure, Hahnemann named them ‘inappropriately named chronic diseases’ (2)). Under current ICD-10 classification these fall under the Z category of diseases and mostly can be seen under the Z72, Z55-65, Z73.(3)

LSD can include Alzheimer’s disease, Atherosclerosis, Asthma, some kinds of Cancer, Chronic Liver disease or Cirrhosis, Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes Mellitus, Heart disease, Metabolic syndrome, Chronic Renal failure, Osteoporosis, Stroke, Depression and Obesity.(4)

The main factors contributing to lifestyle diseases include bad food habits (high in animal products, fat, carbohydrates, less in fibers etc.), substance abuse (ranging from salt, sugar to smoking, alcohol, narcotic substances etc.) physical inactivity, wrong body posture and disturbed biological clock or biorhythm (for example those working in night shifts). According to a survey, 60% of all deaths worldwide in 2005 (35 million) resulted from non-communicable diseases out of which 44% were premature (5).

In a country like India, where traditional lifestyles still persist, risk of illnesses and death are connected with lack of sanitation (hence ever increasing burden of infectious diseases), poor nutrition, poor personal hygiene (hence poor maternal and peri-natal conditions), elementary human habits, customs and cultural patterns. A report, jointly prepared by the World Health Organization (WHO) and the World Economic Forum, says India will incur an accumulated loss of $236.6 billion by 2015 on account of unhealthy lifestyles and faulty diet (6). Another survey conducted by the Associated Chamber of Commerce and Industry (ASSOC-HAM), 68% of working women in the age bracket of 21-52 years were found to be afflicted with lifestyle ailments such as obesity, depression, chronic backache, diabetes and hypertension (7).

Adoption of a healthy lifestyle with a proper balanced diet, regular physical activity and paying due respect to biological clock is required to prevent or overcome these diseases. To decrease the ailments caused by occupational postures, in recent years, ergonomists (the term “ergonomics” is derived from two Greek words: “ergon,” meaning work, and “nomoi,” meaning natural laws; ergonomists study human capabilities in relationship to work demands) have attempted to define postures which minimize unnecessary static work and reduce the forces acting on the body.(8) 

Hahnemann on LSD, Preventive & Social Medicine

“… As it is never good to overtax one’s strength, he must stop working at 10 o’clock ; then talk with a friend for an hour and after taking his medicine, go to bed with his head free from ideas from books or other intellectual work ; he must walk for three quarters of an hour to an hour every day, but not immediately after a meal, having to rest for three quarters of an hour to an hour first. Without reading, without writing, without relaxing, without indulging in leisure, it’s impossible for the chronically ill organism to recover even with the most suitable remedies….” Samuel Hahnemann (9)

The Park’s textbook of Preventive and Social Medicine states, “The great cholera epidemic of 1832 led…….Edwin Chadwick’s report on ‘The Sanitary Conditions of the Labouring Population in Great Britain’, a landmark in the history of public health, set London & other cities slowly on the way to improve housing and working conditions….. which led to the enactment of Public Health Ac of 1848 in England….” (10). Only a few people in the field of the sciences of Hygiene, Public health, town planning, epidemiology and preventive medicine, acknowledge that it was Hahnemann who first placed these branches on scientific bases long before.(11) 

The Friend of Health (12)
Hahnemann published two very important articles by the name the The Friend of Health in two parts (Part I published at Frankfurt on the Main in 1792 and Part II published at Leipzig in 1795), in which he “advocated active role of person in health management and recommended the use of fresh air, bed rest, proper diet, state responsibility of health, epidemic management and control measures, occupational hazards, sanitation, public hygiene, hospital management etc. at a time when many other physicians considered them of no value.”

A short summary of the two articles is reproduced under:

Part I

• Preface: Need for the work on health
• The bite of mad dogs: Giving strict instructions about dealing with bites of dogs whether rabid or not and also about the curative nature of belladonna and hyoscyamus.
• The visitor of the sick: Mere visit to the sick person for showing concern should be avoided to prevent risk of catching/ spreading infection; the sick person would prefer the presence of useful individuals (immediate family and physicians/ nurse and God…
• Protection against infection in epidemic diseases: Chemical antidotes in factories/ places to protect people (from occupational hazards) viz. use of open vessels containing fresh liver of sulphur in manufactories where much quicksilver is employed; fresh air and change of linen in rooms of sick; equilibrium in state of mind and body; dietary care; role of fomites in disease transmission.
• In old woman’s philosophy there is something good, if we only know where to find it: Hahnemann talks about superstition in the realm of medicine
• Things that spoil the air: Importance of proper ventilation for the sick and healthy
• There is good even in hurtful things: one man’s poison another man’s remedy
• Dietetic conversation with my brother, chiefly about the instinct of the stomach: Moderation, strict moderation, that is not bribed by a pampered, corrupt palate, is a sublime corporeal virtue, without which we cannot become healthy not happy.
• An occasional purgative, surely that can do no harm: There is no better preventive than the robust state of health.
• On making the body hardy: The importance of physical exercise and harmful effects of excesses so as to make the body sturdy; importance of mental exercise

Part II

• Socrates and Physon– On the worth of outward show: Man’s worth is from his deeds not his wealth- Mental hygiene
• Plans for eradicating a malignant fever (typhus) in a letter to the minister of police: Responsibility of state to put control measures for epidemic; usage of hospital and directions for maintenance of the same
• More particular directions (typhus fever, continuation of above): attitude and protection of physician and nurse; hygiene and self protection; dealing with those succumbing to infection;
• Suggestions for the prevention of epidemics in general, especially in town: health measures in prisons, military hospitals; measures to be taken during famines, floods (inundations); hygiene on ships; sanitation in societies, civic sanitation; industrial health measures; sanitation for food handlers; health in hospitals (also invalid hospitals), orphan asylums, hospital waste disposal, etc.
• On the satisfaction of our animal requirements, in another than a medical point of view: moderation in food, spices, alcohol, sex etc.
• A nursery: some directions on pediatrics and pediatric hospitals and importance of breastfeeding
• On the choice of family physician: reply to a man not from the realm of clinical medicine on the qualities of a trustworthy physician

Organon of Medicine (13)

§ 3

If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease ……if, finally, he knows the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent…. thenhe understandshowtotreatjudiciouslyandrationally,andheisatrue practitionerofthehealingart.

§ 4

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.

§ 5: Accessory circumstances

Useful to the physician in assisting him to cure are the particulars …. the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration.

§ 7: Accessory circumstances

Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm, and attention paid to the accessory circumstances, §5)….

F.N. 1 to § 7

It is not necessary to say that every intelligent physician would first remove this where it exists; the indisposition thereupon generally ceases spontaneously. He will remove from the room strong-smelling flowers, which have a tendency to cause syncope and hysterical sufferings; extract from the cornea the foreign body that excites inflammation of the eye; loosen the over-tight band-age on a wounded limb that threatens to cause mortification, and apply a more suitable one; lay bare and put a ligature on the wounded artery that produces fainting; endeavor to promote the expulsion by vomiting of belladonna berries, etc., that may have been swallowed; extract foreign substances that may have got into the orifices of the body (the nose, gullet, ears, urethra, rectum, vagina) ; crush the vesical calculus; open the imperforate anus of the new-born infant, etc.

§ 77

Those diseases are inappropriately named chronic which persons incur who expose themselves continually to:

• avoidable noxious influences
• the habit of indulging in injurious liquors or aliments.
• dissipation of many kinds which undermine the health
• undergo prolonged abstinence from things that are necessary for the support of life
• reside in unhealthy localities, especially marshy districts, who are housed in cellars or other confined dwellings
• are deprived of exercise or of open air
• ruin their health by over-exertion of body or mind.
• live in a constant state of worry etc.

These states of ill-health, which persons bring upon themselves disappear spontaneously, provided no chronic miasm lurks in the body, under an improved mode of living, and they cannot be called chronic diseases.

§ 94

While inquiring into the state of chronic diseases, the particular circumstances of the patient with regard to his ordinary occupations, his usual mode of living and diet, his domestic situation, and so forth, must be well considered and scrutinized, to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may be promoted.

§ 204

If we deduct all chronic affections, ailments and diseases that depend on a persistent unhealthy mode of living (§ 77), as also those innumerable medicinal maladies (V. (§ 74)) caused by the irrational, persistent, harassing and pernicious treatment of diseases often only of trivial character by physicians of the old school….

§ 208

The age of the patient, his mode of living and diet, his occupation, his domestic position, his social relations and so forth must next be taken into consideration, in order to ascertain whether these things have tended to increase his malady, or in how far they may favor or hinder the treatment. In like manner the state of his disposition and mind must be attended to, to learn whether that presents any obstacle to the treatment, or requires to be directed, encouraged or modified.

§ 224- Role of psychotherapy

If the mental disease be not quite developed… result from faults of education, bad practices, corrupt morals, neglect of the mind, superstition or ignorance; the mode of deciding this point will be, that if it proceed from one or other of the latter causes it will diminish and be improved by sensible friendly exhortations, consolatory arguments, serious representations and sensible advice; whereas a real moral or mental malady, …..

§ 225- Psycho-somatic ailments

There are, however, as has just been stated, certainly a few emotional diseases which have not merely been developed into that form out of corporeal diseases, but which, in an inverse manner, the body being but slightly indisposed, originate and are kept up by emotional causes, such as continued anxiety, worry, vexation, wrongs and the frequent occurrence of great fear and fright. This kind of emotional diseases in time destroys the corporeal health, often to a great degree.

§ 226- Psychotherapy in psycho-somatic ailments

It is only such emotional diseases as these, which were first engendered and subsequently kept up by the mind itself, that,while theyareyetrecentand beforetheyhavemadeverygreatinroadsonthecorporealstate, may, by means of psychical remedies, such as a display of confidence, friendly exhortations, sensible advice, and often by a well-disguised deception, be rapidly changed into a healthy state of the mind (and with appropriate diet and regimen, seemingly into a healthy state of the body also).

§ 238- Fevers due to unhealthy environment

…. This return of the same fever after a healthy interval is only possible when the noxious principle that first caused the fever, is still acting upon the convalescent, as is the case in marshy regions. Here a permanent restoration can often take place only by getting away from this causative factor, as is possible by seeking a mountainous retreat, if the cause was a marshy fever.

§ 244- Endemic fevers

The intermittent fevers endemic in marshy districts and tracts of country frequently exposed to inundations ….. It sometimes happens that when these patients exchange, without delay, the marshy district for one that is dry and mountainous, recovery apparently ensues (the fever leaves them) if they be not yet deeply sunk in disease, that is to say, if the psora was not completely developed in them and can consequently return to its latent state; but they will never regain perfect health without antipsoric treatment.

F.N. to § 260

Coffee; fine Chinese and other herb teas; beer prepared with medicinal vegetable substances unsuitable for the patient’s state; …. dishes of herbs, roots and stalks of plants possessing medicinal qualities; … old cheese, and meats that are in a state of decomposition, or that possess medicinal properties … ought just as certainly to be kept from patients as they should avoid all excesses in food, and in the use of sugar and salt, as also spirituous drinks, undiluted with water, heated rooms, woolen clothing next the skin, a sedentary life in close apartments, or the frequent indulgence in mere passive exercise (such as riding, driving or swinging), prolonged suckling, taking a long siesta in a recumbent posture in bed, sitting up long at night, uncleanliness, unnatural debauchery, enervation by reading obscene books, reading while lying down, Onanism or imperfect or suppressed intercourse in order to prevent conception, subjects of anger, grief, or vexation, a passion for play, over-exertion of mind or body, especially after meals, dwelling in marshy districts, damp rooms, penurious living, etc. All these things must be as far as possible avoided or removed, in order that the cure may not be obstructed or rendered impossible. Some of my disciples seem needlessly to increase the difficulties of the patient’s dietary by forbidding the use of many more, tolerably indifferent things, which is not to be commended.

§ 261

The most appropriate regimen during the employment of medicine in chronic diseases consists in the removal of such obstacles to recovery, and in supplying where necessary the reverse: innocent moral and intellectual recreation, active exercise in the open air in almost all kinds of weather (daily walks, slight manual labor), suitable, nutritious, unmedicinal food and drink, etc.

Conclusion
A casual glance at timeline of history of medicine shall suffice to establish Hahnemann as the Father of modern medical hygiene and sanitation (14). Also the genius of the legendary physician makes him a torch-bearer in the realm of preventive & social medicine, health psychology, hospital management, clinical medicine, dietetics and epidemiology. As Mark Twain had rightly expressed (15):

…But for the introduction of homoeopathy, which forced the old school doctor to stir around and learn something of a rational nature about his business, you may honestly feel grateful that homoeopathy survived the attempts of allopathists to destroy it, even though you may never employ any physician but an allopathist while you live.

Bibliography

1. Hahnemann, S. Dudgeon, R.E. Marcy, E.E. The Lesser Writings of Samuel Hahnemann- The Friend of Health-I-Preface. B Jain Publishers Pvt. Ltd, India. Reprint edition 1995. Pgs 155
2. Hahnemann, S. Organon of Medicine-§ 77. B Jain Publishers (P) Ltd, India. Reprint edition 2008. Pgs 69-70
3. http://www.icd10data.com/ICD10CM/Codes/Z00-Z99 as accessed on 17-11-12
4. http://en.wikipedia.org/wiki/Lifestyle_disease as accessed on 17-11-12
5. Preventing noncommunicable diseases in the workplace through diet and physical activity: WHO/World Economic Forum report of a joint event. 2008. ISBN 978 92 4 159632 9
6. Ibid 5
7. ASSOCHAM Study on Preventive Healthcare 2009 as quoted in Sharma M, Majumdar, PK. Occupational Lifestyle diseases: An emerging issue. Indian Journal Occup Environ Med 2009: 13:  Pgs 109-12
8. http://www.ergonomics.org/ as accessed on 17-11-12
9. Hanemann, S. Extract of the patients’ diaries seen in Paris between 1835 to 1843 (DF4 page 130) as quoted in article by Par le Dr Bruno Laborier L’œuvre de Samuel Hahnemann:
   Étude de publications et  de ses journaux de malades (The role of patients in Hahnemann’s patients’ diaries and publications) available on http://www.homeoint.org/site/laborier/patientseng.htm as accessed on 17-11-12
10.  Park, K. Park’s Textbook of Preventive and Social Medicine. 21^st Edition. M/s Banarsidas Bhanot Publishers Jabalpur, Madhya Pradesh, India. 2011. Pgs 5
11.  Nigam, H. Samuel Hahnemann :: Neglected Medical Pioneer of 19th Century. Homeopathic Journal :: Volume: 1, Issue: 2, Jan-Feb 2008 (General Theme)   –   from Homeorizon.com
12.  Hahnemann, S. Dudgeon, RE. Marcy, E.E. The Lesser Writings of Samuel Hahnemann- The Friend of Health-I & II. B Jain Publishers Pvt. Ltd, India. Reprint edition 1995. Pgs 155-242
13.  Hahnemann, S. Organon of Medicine. B Jain Publishers (P) Ltd, India. Reprint edition 2008. Pgs 31-132
14.  Nigam, H. Samuel Hahnemann :: Neglected Medical Pioneer of 19th Century. Homeopathic Journal :: Volume: 1, Issue: 2, Jan-Feb 2008 (General Theme)   –   from Homeorizon.com
15. Twain, M. A Majestic Literary Fossil. Harpers Magazine, February 1890, Pgs 444 as mentioned by Harris Coulter in Divided Legacy: The conflict between Homeopathy and the American Medical Association. North Atlantic Books, Richmond, California, 2^nd edition, 1982. Pgs 289

Gyandas G. Wadhwani, MD (Hom)
Senior Medical Officer (Homoeopathy), Directorate of ISM& Homoeopathy, Govt of NCT of Delhi;
Senior Lecturer (Organon of Medicine & Homoeopathic Philosophy), Dr B. R. Sur Homoeopathic Medical College, Hospital & Research Centre.
Email: homoeopathygyan@gmail.com