Aphorism 6: Being an unprejudiced observer

Aphorism 6 introduces a few large topics: the definition of disease, and the definition of symptoms, and I think makes the case for medicine as a science.

Like the aphorisms that come before it, Hahnemann makes it clear that this aphorism is in service to being a good PRACTITIONER (see aphorism 1 – the whole point of being a doctor is to make people well – meaning to be a good practitioner, not to sit around and make pretty theories).  Keep that in mind, because he, like in the first aphorism, is very dismissive of theorizing, especially about the root cause.  However, this is not because theories or theorizing about a case is not incorrect but because it’s not in service to being a good practitioner.

Aphorism 6 text: (Boericke/Dudgeon translation)

“The unprejudiced observer - well aware of the futility of transcendental speculations which can receive no confirmation from experience - be his powers of penetration ever so great, takes note of nothing in every individual disease, except the changes in the health of the body and of the mind (morbid phenomena, accidents, symptoms) which can be perceived externally by means of the senses; that is to say, he notices only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by those around him and observed by the physician. All these perceptible signs represent the disease in its whole extent, that is, together they form the true and only conceivable portrait of the disease. (1)

1: I know not, therefore, how it was possible for physicians at the sick-bed to allow themselves to suppose that, without most carefully attending to the symptoms and being guided by them in the treatment, they ought to seek and could discover, only in the hidden and unknown interior, what there was to be cured in the disease, arrogantly and ludicrously pretending that they could, without paying much attention to the symptoms, discover the alteration that had occurred in the invisible interior, and set it to rights with (unknown!) medicines, and that such a procedure as this could alone be called radical and rational treatment.

Is not, then, that which is cognizable by the senses in diseases through the phenomena it displays, the disease itself in the eyes of the physician, since he never can see the spiritual being that produces the disease, the vital force? nor is it necessary that he should see it, but only that he should ascertain its morbid actions, in order that he may thereby be enabled to cure the disease. What else will the old school search for in the hidden interior of the organism, as a prima causa morbi, whilst they reject as an object of cure and contemptuously despise the sensible and manifest representation of the disease, the symptoms, that so plainly address themselves to us? What else do they wish to cure in disease but these?

Definition of disease:

This is elucidated in the last paragraph of the footnote.  Disease is known to a physician by the symptoms it produces, but it is not the same thing as the symptoms.  In other words, what we need to focus on in a case, in order to understand the disease, are the verifiable FACTS – the symptoms (more on that in another post).

Definition of symptoms:

Symptoms, in addition to being verifiable facts, are things that “befall” you (like a bruise or broken bone), pathological (ie clear disease sign – like vomiting or jaundice) and/or changes in the person’s state.  These include things the practitioner can observe as well as things the patient feels or observes. This is why a craving for lemons can be symptomatic.  If it is a clear change, then it’s indicative of a change from health to diseased, or disease progression.  But we want to make sure we don’t fall into the trap of thinking normal human variation (everything exists on a bell-curve!) is not considered symptomatic: “the unprejudiced observer…takes note of nothing in every individual disease, except the changes in the health of the body and of the mind (morbid phenomena, accidents, symptoms)”.  Even if your patient used to love the color green and now hates it, that’s not a change in health, therefore it’s not a symptom.

Why this sets the stage for medicine as a science:

Science is about studying and testing our conclusions about the world around us.  If we are to make medicine a science, we need to focus on things that are verifiable (ie facts) and our conclusions need to be able to be proven true or untrue.  In homeopathy (or any medicine really) our facts are the symptoms.  This is why it is so important to focus on verifiable, concrete symptoms!  We test whether our hypothesis about a case is true (this remedy will help you, for example) by prescribing that medicine. And that hypothesis is either proven (your verifiable symptoms went away) or disproven (your symptoms did not go away).  With multiple cases, we can inductively (after repeated observations of the same phenomena) come to the conclusion that our way of practicing (e.g. homeopathy) follows a law of healing. 

I know that’s a lot to throw into one paragraph.  So let me try to make it a bit clearer.  (more on theories, laws and facts in another post if you want to parse the differences)

A law of healing means if you follow the law, someone will ALWAYS get better. 

To show a law, like gravity is a law, you have to repeated show that when you do x, y happens.  If an apple detaches from it’s branch on a tree, it will ALWAYS fall.  We can see the law of gravity work repeatedly.

In homeopathy, our law is the law of similars.  If you treat an illness with a substance that creates a similar state, the person will get better.  Every time we prescribe based on this law it works, we add more “evidence” for this law and its stance as a LAW gets stronger.  So every prescription is like an experiment.  But if that’s going to be true, the experiment needs to deal with facts.  If you say, I saw an apple detach from its branch on a tree, and I feel like it fell, but did not see it, then that’s not a good validation of gravity!  Similarly “I feel like I’m a bit better” but the rash hasn’t changed, sleep hasn’t changed, etc does not prove or disprove that we have made the person better and that the law of similars has been at work in this case. If you say you need a remedy to help someone be “more grounded” - how are you going to know you were incorrect or correct? If they fidget less, talk with a lower timbre, maybe you say the remedy worked. But in that case, you are really saying the symptoms are fidgeting and a high talking voice, and that “being ungrounded” was the PERCEPTION you had that summarized those facts for you. In order to proceed scientifically in practice, we need to be able to see the difference and stick to the facts in a case.

So much more to say on aphorism 6. Like many of the early aphorisms, he is setting the stage for SO MUCH of what comes next.

But I will leave at these ideas for now.

Happy studies.

B