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HEALTH - MODERN CONCEPT
Health is a
state of complete physical and social well being and not merely
an absence of disease or infirmity. -- World Health
Organization (1984).
Operational
definition of Health by WHO – a condition or quality of the
human organism expressing the adequate functioning of the
organism in given conditions, genetic or environmental.
Positive
health – it implies the notion of perfect health in body and
mind. It cannot become a reality, it always remain a mirage
because everything in our life is subject to change.
Dimensions of
health
Health is
multidimensional- mainly physical, mental and social
(also
spiritual, emotional, vocational, political, cultural,
socioeconomic, environmental, philosophical, educational,
nutritional, curative and preventive dimensions).
Physical
dimension –
it implies the notion of “perfect functioning” of the body. A
good complexion, clean skin, bright eyes, firm flesh, not too
fat, a sweet breath, good appetite, sound sleep, regular
activity of bowels and bladder and co-coordinated bodily
movements. All organs are of unexceptional size and functions
normally, all intact special senses, normal pulse rate, blood
pressure and exercise tolerance.
Mental
dimension
– mental health is not mere absence of mental illness. A
mentally healthy person is one who is free from internal
conflicts, well adjusted ( i.e. able to get along well with
others and he accepts criticism and is not easily upset),
searches for identity, a firm sense of self esteem, knows
himself ( his needs, problems and goals), good self control and
faces problems and tries solve them intelligently.
Social
dimension
– it implies harmony and integration with in the individual,
between each individual and other members of the society and
between individuals and the world in which they live.
Spiritual
dimension
– it refers to that part of individual which reaches out and
strives for meaning and purpose in life.
Emotional
dimension
– mental health can be seen as ‘knowing’ or ‘cognition’ while
emotional health relates to ‘feeling’.
Vocational
dimension
– it’s a new dimension of life. It refers to mental and physical
adaptation to work (human goals, capacities and limitations).
Determinants
of health-
Health is multifactorial. Determinants of
health are
1.
Heredity- the genetic make up is unique and cannot be
altered after conception. A number of diseases like chromosomal
abnormalities, errors of metabolism, mental retardation, some
types of diabetes are of genetic origin. 2. Environmental-
the “internal” environment of man pertains to every tissue,
organ, organ-system, parts and their harmonious functioning. The
“external” environment pertains to all that is external to the
human host.
3. Life
style-the way people live. It composed of cultural and
behavioral patterns and life long personal habits (smoking,
alcoholism etc) that have developed through the processes of
socialization.
4
Socio-economic conditions – the health status is
determined primarily by socioeconomic development. Important
socioeconomic factors are;
a)
Economic status: the economic progress is the major factor in
reducing morbidity, increasing life expectancy & improving
quality of life.
b)
Educational status: second major factor influencing health is
education. Literacy coincides with poverty, malnutrition, ill
health, high infant and child mortality rates.
c)
Occupation: unemployed people usually show higher incidence of
ill health and death. It can cause psychological and social
damage.
5.
Health Services – it helps in the treatment of disease,
prevention of illness and promotion of health.
Ecology of
health
Ecology is defined as the science of mutual
relationship between living organisms and their ecology. Health
according to ecological concept is a state of dynamic
equilibrium between man and his environment. Prevention of
disease through ecological or environmental manipulations or
interventions is safer, cheaper and a more effective rational
approach. it is through environmental manipulations that disease
such as cholera, typhoid, malaria etc. are brought under control
or eliminated.
Indicators of
health
Indicators of health are used to measure the
health status of a community and also to compare the health
status of one country to another. They are as follows,
1.
mortality
indicator 7. indicator of social and
mental health
2.
morbidity
indicator 8. environmental indicators
3.
disability
rates 9. socio-economic
indicators
4.
nutritional
status indicator 10. health policy indicators
5.
health care
delivery indicator 11. indicators of quality of life
6.
utilization
rates 12. other
indicators
FACTORS
AFFECTING HEALTH— Modern concept.
Germ theory of
disease:-
This theory emphasis microbe as the sole cause of disease. But
its demerit is that it cannot explain the multifactorial disease
conditions.
Epidemiological triad:-
It is a triad of environment, agent and host
Multifactorial
causation:-
multiple factors are responsible for a disease, ie microbes,
physical, mental, social, economic, genetic and psychological
factor. e.g, coronary heart diseases, lung cancer, c/c
bronchitis etc.
Web of
causation:-
This model is ideally suited in the study of c/c diseases where
the disease agent is often not known, but is the outcome of
interaction of multiple factors.
Agent factor:
– Defined as a substance, living or non living, or a force,
tangible or intangible, the excessive presence or relative lack
of which may initiate or perpetuate a disease process. They are
–
1.Biological agents-- Living agents of disease, viz. bacteria,
viruses, rickettsiae, fungi, protozoa and metazoa.
2. Nutrient agents – The excess or deficiency of proteins, fats,
vitamins,
minerals and water may results in nutritional disorders.
3. Physical agents – exposure to excessive heat, cold,
humidity,
pressure, radiation, electricity, sound, etc
may result in illness.
4.
Chemical agents – i) endogenous: ie, formed in the body as a
result of derangement of functions. eg, urea
(uremia),
bilirubin (jaundice), etc…
ii) Exogenous; agents outside the human host, eg.
allergens,
metals, fumes, dust, insecticides, etc..
5.
Mechanical agents – sprains, dislocations, c/c friction, etc…
6. Absence
or insufficiency or excess of factor necessary to health –
these
may be i) chemical factors eg. hormone, ii) nutrient factors,
iii)
lack of structure iv) lack of part structure, v) chromosomal
factors
eg. Turner’s syndrome and vi) immunological factors eg.
agammaglobulinaemia.
7.
Social agents – these are poverty, smoking, abuse of drug and
alcohol,
social isolation, maternal deprivation, etc.
Host factor
(intrinsic)-
host is ‘soil’ and disease agent is ‘seed’. It includes age,
sex, ethnicity biological characteristics such as genetic
factors, blood groups, etc, socio-economic factors such as
status, education, occupation, stress, etc and life style such
as personality traits, drugs, alcohol, smoking behavior patterns
etc.
Environmental
factors (extrinsic)-
it is complex and all-embracing. Defined as all that which is
external to individual human host, living and non living and
with which he is in constant interaction. Environment of man is
divided into three components – physical, biological and
psychological.
Risk factors-
defined as an attribute or exposure that is significantly
associated with the development of the disease. Risk factors are
often suggestive, ie, presence of a risk factor does not imply
that the disease will occur, and in its absence diseases will
not occur. Risk factors may be causative (eg, smoking for CA
lung), contributory (lack of physical exercise for CHD) or
predictive (eg, illiteracy for prenatal mortality).
HEALTH – HOMOEOPATHIC CONCEPT
Homoeopathy is
a therapeutic system which implies a particular way of applying
drug to disease according to a specific principle- ‘similia
similibus curentur’; and it implies as well the theories of
vital force, chronic miasms and dynamisation of drugs. It
considers two important phenomena – the drug phenomenon and the
disease phenomenon.
Homœopathy, or
homœotherapy, is the department of science in general medicine
which has for its principal objects the observation and study of
the action of remedial agents in health and disease, and the
treatment and cure of disease by medication, according to a
fixed law or general principle.
Homœopathy
the principles of the Inductive Method of Science as developed
by Lord Bacon. Its practice is governed by the principle of
Symptom-Similarity, which is the application in medicine of the
universal principle of Mutual Action formulated by Sir Isaac
Newton in his Third Law of Motion: "Action and reaction are
equal and opposite." Homœopathy, as a science, rests
fundamentally upon four general principles: Similarity,
Contrariety, Proportionality and Infinitesimality, reducible to
the universal principle of Homœosis, or Universal Assimilation.
(Fincke.) - Dr. Stuart Close
Dr. Samuel
Hahnemann was a great humanitarian. If we go through his life
and works, we can see his quest for a divine therapeutic system
for the removal of disease and preservation of health. His prime
concern was health. Hahnemann gave extreme importance to the
heath in all levels of homoeopathic philosophy.
In the introduction of “The Friend Of Health” (1792) Hahnemann
says - ‘My mission is only to preach upon the greatest of
corporeal blessings – health’ i.e. regarding the rational care
about the health. In this book, we can see how seriously and
comprehensively Hahnemann wished to see all questions of health
and public hygiene treated even in the earlier years of his
activity.
Vital force and health
- “Organon of Medicine” is the book containing the concept of
health, disease and its cure - the authority of homoeopathic
philosophy. Homoeopathy explains the various dimensions of
health in terms of vital force. In 9th aphorism-
“In the healthy condition of man, the spiritual vital force, the
dynamis that animates the material body, rules with unbounded
sway, and retains all the parts of the organism in admirable,
harmonious, vital operation, as regards both sensations and
functions, so that our indwelling, reason-gifted mind can freely
employ this living healthy instrument for the higher purpose of
our existence”. ie, health condition in which all the harmonious
vital operations are going on were vital force is the supreme
power, which animates and rules providing normal sensations and
functions.
The material, organism without vital force, is capable of no
sensation, no function, no self preservation; it derives all
sensation and functions of life solely by means of the
immaterial being (the vital force). In disease the vital force
is primarily deranged by the dynamic influence upon it of a
morbific agent inimical to life. The resulting abnormal
sensations and functions are expressed as morbid symptoms. So
symptoms are the outcry of vital force in disease.
Disease is the alternation in state of health of
the healthy individual which is expressed by signs and symptoms.
Cure is only possible by a change in diseased individual by
medicines. Thus health, disease and cure all phenomena are
operating in the dynamic plain.
H A Roberts says, In order to obtain
a thorough knowledge of these vital functions we must study them
in their manifestations during health. From the earliest period
of its existence growth is manifest from within the cell out; it
is never observed growing from without in. The one point most
vital to observe is the course and direction of its
expression-always from within outward. This is true in the
embryonic state and is always maintained as long as life exists.
This is equally true in the specialization of functions. The
especial organs are developed and their functions maintained by
the expression of the vital energy as the life-giving principle.
All expression of the mind are such manifestations. Indeed, it
is the expression of the vital force in and through the mind and
intellect that has a very great influence in the functioning of
all life and of the special organs. In health all expressions of
vital force may be expressed by perfect functioning of all parts
of the body and by a sense of general well-being.
Physician’s mission and heath- In 1st aphorism
he says – the physician’s high only mission is to restore the
sick to health. Beside a therapeutist, physician has others
functions also, like diagnostician, a prognosticator, a
preventive and public health officer, and a medico-legal jurist
as well. But the chief duty is concerned with curing the sick ie,
to restore the sick to health.
Ideal cure and
health
- In 2nd aphorism he says- the cure must be rapid,
gentle and permanent ie, removal of disease in it whole extent,
in shortest, most reliable and most harmless way on easily
comprehensive principle. Cure should be affected in the most
harmless way- harmless to the patient, to his bystanders and to
the society. We can see a lot of examples of it, from the old
school medicine to the modern medicine. Thus in the treatment
level also health has got prim importance.
The 5th aphorism deals with the
cause of the disease or factors affecting health. In acute
disease the exciting cause and in chronic disease the
fundamental cause ie the chronic miasm. For this the physical
constitution of the patient, his moral and intellectual
character, his occupation, mode of living and habits, his social
and domestic relations, age, sexual functions etc are to be
taken into consideration.
According to Stuart close health is the balanced
condition of living organism in which the integral harmonious
performance of the vital functions tends to the preservation of
the organism and the normal development of the individual. A
healthy man, who lives in a favorable environment moves, feels,
thinks acts and reacts in an orderly manner. But when he
becomes the victim of an unfavorable environment, deterioration
of health is the result.
Life, health and disease
- According
to Dr. Stuart Close, Health
is that balanced condition of the living organism in which the
integral, harmonious performance of the vital functions tends to
the preservation of the organism and the normal development of
the individual.
Life is the invisible, substantial,
intelligent, individual, co-ordinating power and cause directing
and controlling the forces involved in the production and
activity of any organism possessing individuality.
Disease
is an abnormal vital process, a changed condition of life, which
is inimical to the true development of the individual and tends
to organic dissolution.
"Power resides
at the center, and from the center of power, force flows." The
phenomena of life, as manifested in growth, nutrition, repair,
secretion, excretion, self-recognition, self-preservation and
reproduction, all take their direction from an originating
center. From the lowest cell to the highest and most complex
organism, this principle holds true. Cell wall and protoplasmic
contents develop from the central nucleus and that from the
centrosome, which is regarded as the "center of force" in the
cell. All fluids tissues and organs develop from the cell from
within outwards, from center to circumference.
Organic control is from the center.-
In the completely developed human organism vital
action is controlled from the central nervous system. The
activities of the cell are controlled from, the centrosome,
which may be called the brain of the cell. The central nervous
system may be compared to a dynamo. As a dynamo is a machine,
driven by steam or some other force, which, through the agency
of electro-magnetic induction from a surrounding magnetic field,
converts into electrical energy in the form of current the
-mechanical energy expended upon it, so the central nervous
system is a machine driven by chemical force derived from food
which, through the agency of electro-vital induction from a
surrounding vital field, converts into vital energy, in the form
of nerve current or impulses, the chemico-physical energy
expended upon it.
As an electrical transportation system
depends for its working force upon the dynamo located in its
central power station, so the human body depends for the force
necessary to carry on its operations upon the central power
station, located in the central nervous system.
Any disturbance of conditions at the central
power station is immediately manifested externally at some point
in the system; and any injury to or break in the external system
is immediately reflected back to the central station.
In health and disease it is the same, both
being essentially merely conditions of life in the living
organism, convertible each into the other. In each condition the
modifying agent or factor acts primarily upon the internal life
principle, which is the living substance of the organism. This
reacts and produces external phenomena through the medium of the
brain and nervous system which, extends to every part of the
body. Food or poison, toxins or antitoxins, therapeutic agents
or pathogenic micro-organisms, all acts upon and by virtue of be
existence of the reacting life principle or living substance of
the organism.
Cure of disease, or the restoration of
health, likewise begins at the center and spreads outwardly, the
symptoms disappearing from within outward, from above downward
and in the reverse order of their appearance.
Resistance to morbific agents is from the
center where life reigns. Vital resistance is the defensive
reaction of living substance to noxious elements and organisms
and to disease-producing causes and agents in general, in
obedience to the inherent instinct or law of self-preservation,
which belongs to life in organism.
Strictly speaking, it is not against disease that we
struggle, but against the causes of disease - the actual
causes of disease. They do not exist in the life substance
itself. They become operative or effective in the organism
conditionally, by virtue of the existence of the vital
principle of susceptibility, reaction and resistance, and of a
living organism in and through which action and reaction can
take place.
Health and
susceptibility-
In
aphorisms 30, 31 & 32 of Organon of medicine, Master
Hahnemann explains the susceptibility in relation to health,
disease and cure.
The human body appears to admit of being much
more powerfully affected in its health by medicines (partly
because we have the regulation of the dose in our own power)
than by natural morbid stimuli for natural diseases are cured
and overcome by suitable medicines.
The
inimical forces, partly psychical, partly physical, to which our
terrestrial existence is exposed, which are termed morbific
noxious agents, do not possess the power of morbidly deranging
the health of man unconditionally; but we are made ill by them
only when our organism is sufficiently disposed and susceptible
to the attack of the morbific cause that may be present and to
be altered in its health, deranged and made to undergo abnormal
sensations and functions, hence they do not produce disease in
every one, nor at all times.
But it is quite otherwise with the artificial
morbific agents which we term medicines - Every real medicine,
namely, acts at all times, under all circumstances, on every
living human being, and produces in him its peculiar symptoms
(distinctly perceptible if the dose be large enough) so that
evidently every human organism is liable to be effected, and, as
it were, inoculated with the medical disease, at all times and
absolutely (unconditionally), which, as before said, is by no
means the case with the natural disease.
According
to Dr. Stuart Close, susceptibility is the general
quality or capability of the living organism of receiving
impressions; the power to react to stimuli. In health- Upon it
depends all functioning, all vital processes, physiological and
pathological. Digestion, assimilation, nutrition, repair,
secretion, excretion, metabolism and catabolism, as well as all
disease processes arising from infection or contagion depend
upon We power of the organism to react to specific stimuli.
The cure and alleviation of diseases depend upon the same power
of the organism to react to the impression of the curative
remedy. Men we give a drug to a healthy person for the purpose
of making a homœopathic "proving" or test, the train of symptoms
which follows represents the reaction of the susceptible
organism to the specific irritant or stimulus administered. When
a homœopathically selected medicine is administered to a sick
person, the disappearance of the symptoms and restoration of the
patient to health represents the reaction of the susceptible
organism to the impression of he curative remedy.
"Susceptibility in organism, mental or bodily, is equivalent to
state, which involves the attitude of organizations to internal
causes and to external circumstances. It is all the resource of
defense or the way of yielding. "In health we live and act and
resist without knowing it. In disease we live but suffer; and
know ourself in conscious or unconscious exaggeration."
We must also predicate a state of normal susceptibility to
remedial as well as toxic agencies, which it is the duty of the
physician to conserve and utilize. No agent or procedure should
be used as a therapeutic measure which has the power to,
diminish, break down or destroy the normal susceptibility or
reactibility of the organism, because that is one of the most
valuable medical assets we possess. Without it all our efforts
to cure are in vain. To use agents in such a manner or in such a
form or quantity as to diminish, impair or destroy the power of
the organism to react to stimuli, is to align ourselves with the
forces of death and disintegration. Conservation of the power of
the organism to react defensively to a toxin, a contagion, or an
infection is as important as it is to conserve the power to
react constructively to food and drink, or curatively to the
homœopathic remedy. It is as normal and necessary for the
organism to react pathogenetically to a poison, in proportion to
the size and power of the dose, as it is to react
physiologically to a good dinner.
According to H A Roberts, We may define susceptibility
primarily as the reaction of the organism to external and
internal influences. In analyzing susceptibility, we find it is
very largely an expression of a vacuum in the individual. This
is illustrated by the desire for food. The vacuum attracts and
pulls for the things most needed, that are on the same plane of
vibration as the want in the body. Susceptibility varies in
degree in different patients, and at different times in the same
patient. Susceptibility can be increased, diminished or
destroyed. It therefore becomes a state of lowered resistance or
attraction.
It is incumbent upon us to recognize, conserve and utilize
normal susceptibility, to physical environments, to foods, to
remedies and to toxic agencies. It should be our aim never to
use any agent or anything of any nature, or to adopt any
procedure, that would in the least diminish or destroy this
power of susceptibility and the reaction of the organism in its
normal manner. Upon this normal susceptibility and reaction
depends the status of health. It is just as much the province of
the physician to exercise conservation of susceptibility in the
organism that it may act defensively against a toxin, contagion
or infection, as it is to have this susceptibility react
constructively to food and drink or to the curative remedy.
Again, it is just as natural and important for the organism to
react pathogenically to the size and power of a dose of poison
as it is for it to react to the demand for food.
Health and drug proving-
In the aspect of proving also health has got prime importance,
because in Homoeopathy drug are proved in healthy human beings.
Aphorisms 105 to 145 deals with drug proving. Proving in lower
animals will not gives exact symptoms, especially the subjective
symptoms; also their body is different from that of man. Proving
in sick persons will give you the mixed symptoms of disease and
the drug.
“ There is, therefore, no other possible way in which the
peculiar effects of medicines on the health of individuals can
be accurately ascertained - there is no sure, no more natural
way of accomplishing this object, than to administer the several
medicines experimentally, in moderate doses, to healthy persons,
in order to ascertain what changes, symptoms and signs of their
influence each individually produces on the health of the body
and of the mind; that is to say, what disease elements they are
able and tend to produce, (1) since, as has been demonstrated
(Aphorism 24-27), all the curative power of medicines lies in
this power they possess of changing the state of man's health,
and is revealed by observation of the latter” (Aphorism 108).
Before Hahnemann Albrecht von Haller was the only man who
mentioned about it.
Three essential things for proving- 1. The quality of the drug
must be pure, 2.The prover must possess the proper balance in
functions and be in a normal, healthy state, so that we can
estimate and weigh the amount of the disturbance caused when we
deliberately upset the balance of health. 3. The circumstances
surrounding the prover must be those of his normal surroundings.
The ordinary habits of life must be observed, and his ordinary
work maintained; otherwise changes from his routine might cause
some deviation from his normal balance which would be attributed
to the drug action.
Qualities of prover - The prover must be intelligent enough
properly to appreciate and record the subjective symptoms as
deviations from his normal conditions of life, as these
subjective symptoms are of the utmost value. Honesty is a
prerequisite of a good prover, for he must be very careful to
record all phenomena as fact. Remember always to treat a fact as
a fact and do not try to add to or subtract from its importance;
it is not for the prover to sift the symptoms produced. At the
beginning of this work, the prover must be in that state of
mental, moral and physical equilibrium that is characteristic of
a normal, healthy being. One who is subject to rapidly changing
equilibrium on any one or all of these planes will not make a
good prover.
Homoeopathic
physician and preserver of health-
Prevention is
better than cure- is a truism. 4th Aphorism deals
with the social and preventive medicine. “He is like wise a
preserver of health if he knows the things that deranges health
and cause disease and how to remove them from persons in health”
The cause of
disease is internal (chronic miasm), but many of the
disturbances that aggravate the disorder are external (e.g. -
improperly selected food, living in damp cellars etc.). These
are the measures that disturbing him, making him sick and
aggravating his chronic miasm, i.e. things “which keep up
disease”. Any ordinary physician with a well knowledge in
hygiene can remove these external obstacles and preserve his
patient’s health.
The book “The Friend Of Health” published in 1792 Hahnemann
deals with both individual and social hygiene and its measures.
Hahnemann gives clears cut directions for prevention of
contagious and other epidemic diseases.
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