Thursday, May 19, 2016
The Real Origins of Pathological Conditions. Spiritual Science and Medicine, lecture 18 of 20
Rudolf Steiner, Dornach, Switzerland, April 7, 1920:
I think that it may after all be necessary to introduce into our medical and biological study what we might term an inquiry into the real origins of pathological conditions. Of late there has been a cumulative tendency to disregard the origins proper, and to fix attention on superficial appearances and events. And with this superficiality is bound up the habit in current medicine and pathology of beginning the description of a disease by stating what bacillus caused the disease by invading the human organism. Of course it is very easy to refute arguments and objections against the invasion of micro-organisms, for the simple reason that we no longer need to point out that these micro-organisms really exist. And since they have different characteristics in different diseases, it is again quite comprehensible that stress is laid on these differences, and specific diseases linked with specific types of micro-organisms.
Now an obvious error enters this whole point of view: namely, that attention is diverted from the primary element. Suppose that in the course of an illness, bacteria appear in considerable numbers in some bodily area. It is only natural that they should cause symptoms such as are the result of any foreign body in the organism, and that from the presence of these bacteria all manner of inflammations arise. But if all these results are ascribed wholly to the action of the bacteria, attention is actually directed only to the activity of these micro-organisms. Attention is thus drawn away from the true origin of the disease, for whenever lower organisms find suitable soil in the human frame for development, that soil has been made suitable by the real primary causes of the disease. And attention must be directed to the region of these primary causes. We must therefore return to the paths of thought we have already traversed and for a short time give them our attention.
Consider the stratum of plant life that covers the Earth's soil, i.e. the entire content of vegetation. We must understand that this flora, which grows outward from the soil toward cosmic space, is not only sent out from the Earth but is also drawn outward by forces that are in continuous operation, and as essential to the growth of plants as the forces working from the Earth itself. There is a constant interaction between the forces passing into the plant from the Earth and those acting on the plant from the cosmos outside the Earth. What is the essential factor in this interaction which permeates our whole environment? Should these cosmic forces attain their full expression and take full possession of the plant, and should the planets not ensure that these forces can withdraw again, then the plant in its growth from the stalk to the blossom and seed would have the perpetual tendency to become animal. There is a tendency toward animalization. But this tendency, which expresses cosmic forces passing into the plant, is counteracted and balanced by the opposite tendency toward suppression of the plant-nature in mineralization.
I would thus emphasize the essential nature of plants: it holds the balance between the tendency to salification, to the deposit of mineral constituents within the vegetable substance, i.e., to mineralization, and on the other hand to self-ignition, to animalization. This is what is perpetually at work in external nature.
This same counteraction, however, goes on, interiorized and centralized, in the human organism itself. By virtue of its lungs the human organism is a genuine Earth in miniature, and all the pulmonary processes work downward in the same manner as the forces of Earth work upward into the plant, passing from the Earth to the plant's organization. All that comes to meet the inner metabolism of the lungs, from the breathing and heart activity, has the same method of operation as the external cosmic forces.
Now, there is a special requirement of the human organism: all that is focused from out of the organism, in the heart's action, must be held apart from the forces that organize and concentrate themselves in the internal metabolism of the lungs. These two sets of activities may only interact through the barrier — if I may so express myself — of an etheric or even an astral diaphragm. They must be kept separate from one another. And so we come to the question: Does this diaphragm — and I only use the term in order to give a picture — really exist? Is there such a diaphragm, which prevents the activities of head, throat, and lungs from blending with those of abdomen and breast, except through the external rhythm of the breath? Yes, there is such a diaphragm, and it is nothing less than the rhythm of breathing itself. Here you find the attunement of the upper with the lower sphere in man. What is termed rhythmic activity in man, the rhythmic pulsation, whose external physical manifestation is in the rhythm of the breathing, continues into the etheric and astral activities and holds apart the telluric forces of the upper human being, which center in the lungs, and the cosmic forces of the lower human being. The latter forces, with their expression ultimately in the heart, work upward from below, just as cosmically they work from the periphery inward, toward the Earth's center.
Suppose now that this rhythm is disturbed and does not work normally. In that case, the symbolic diaphragm, to which I have referred — which has no physical existence, but which results from the interplay of the rhythms — is not in order. Then there may ensue a process analogous to excessive action of the Earth on vegetation. If the Earth's saline action on plants became excessive, the plants would become too mineral. And the result is that the etheric plant inserted into the lungs, that grows out of the lungs, so to speak, as the physical plant springs from the soil, becomes the cause of pulmonary sclerosis. Thus we find that the trend of the plant toward mineralisation may become excessive even in the organism of man.
And the contrary trend toward animalization may also exceed normality. When this happens, a region is created in the upper portion of the organism which should not exist. In this region the affected organs are embedded as in an etheric sphere, and this favors the multiplication of what should not multiply in our organism, namely the minute forms of life between animal and plant. We need not trouble to inquire whence they come. We need only interest ourselves in the factors which create a favorable sphere of life for them. This favorable sphere of life should not exist for them. It should not arise as a specially enclosed sphere; it should permeate and operate throughout the whole organism. If it does so, it sustains the life of the whole organism. If it works only within a small enclosure, it becomes the appropriate medium for the presence and multiplication of little plant-animals, of microscopic forms of life, which can be detected in much — if not in all — that causes illness in man's upper organic sphere.
So in going back to the rhythmic activity and its disturbance, we must trace the emergence of a special area within the organism, and thus solve the riddle of the working of bacilli in it. But unless we go back to the spiritual causes, we shall not reach the solution of the riddle.
Just the same processes as work on the life of plants — in the external sphere of the Earth, that is to say — are also at work in the same region on the external life of animals and of man.
These forces here (see Diagram 27 — orange), at work on animal and man, come from the extra-telluric cosmos, and are met and opposed by forces that come from within. The latter, coming from the interior of the Earth, are localized in man in certain organs of the upper bodily sphere, while the forces that pour on to the Earth from outside are localized in man in organs belonging to the lower bodily sphere. Again, if I may so express myself, a dividing wall must be set up between the two forms of action. The regulation of this separation is normally achieved through the activity of the spleen, and in this connection we again find rhythm active in the human organism, but a rhythm different from that of respiration. The rhythm of the breath is in short pulsations, and it continues throughout life; it must be in order, if illnesses of the upper sphere — or such diseases as can affect that upper sphere only — are not to develop. Bear in mind that there may be illnesses which affect the upper sphere yet have their origin in the lower — for the process of digestion extends both above and below. This we must clearly realize. We cannot picture man divided diagrammatically into compartments, but the various members interpenetrating one another. At the same time, there must be a barrier between that which works from above as though coming from the Earth, and that which works upward from below as though from celestial space. For we do indeed send the forces of our lower sphere out against those of our upper, and there must be a regulated rhythm for each human individuality between these two sets of forces; a rhythm manifesting in a proper alternation between waking and sleeping. Every time we wake, there is in a certain way the one beat of this rhythm, and every time we sleep, there is the other beat. And this rhythm of waking-sleeping waking-sleeping is intersected with other minor rhythmic oscillations which are due to the fact that in the waking state we wake in our upper sphere but sleep in our lower. There is a continuous rhythmic systole interplay between the upper and lower man, which is only captured, so to speak, in major rhythms through the alternation of waking and sleeping.
Now suppose that the barrier set up by this rhythm between the upper and lower man is broken through. What happens in such a case? As a general rule, what happens is that the activities of the upper sphere break through into the lower. This means that an etheric breach takes place. The forces that should only act etherically in the upper organic sphere of man penetrate downward into the lower. It is a breaking through of more subtle forces; by this fact a special area is created in the abdomen, which should not be localized there but should permeate the whole body. The result is a species of poisoning, a toxification of the lower abdominal regions. The functions proper to the lower abdominal sphere can no longer be adequately performed under this intrusion of the upper sphere. Moreover, this new sphere creates a favorable condition for lower organisms of the type intermediate between animal and plant. So you may sum up as follows: Through the downward escape of forces from the upper sphere, something is provoked in man that becomes abdominal typhus. The creation of this atmosphere provides, as a byproduct, the suitable soil for the typhus bacilli.
In this way you have a clear-cut distinction between what is primary and what is secondary. You will realize that it is necessary to distinguish between the original causes of such illness and the secondary phenomena, which are simply inflammatory and due to the proliferation of legions of intestinal fauna — or flora, especially in the smaller intestine. All the physical manifestations in the smaller intestine represent the reaction to this escape of the upper activities of the human organism into the lower activities. These physical manifestations include the working of the bacilli, whether vegetable or animal — we need not trouble ourselves with their precise origin — for they could neither vegetate nor “animalize” if an atmosphere had not been suitably prepared. All this is a result, a secondary phenomenon. And the curative effect must be sought not in the treatment of the secondary manifestations but of the primary. We shall discuss this later, for it is only possible to speak about these things if one is in a position to trace their true causes. This is hardly possible within the boundaries of the official medicine of today, for current medicine excludes a point of view that passes from the material process to that of the spirit. But beneath and behind all material existence there is spirit. And you will easily envisage the symptomatology of typhus abdominalis if you keep in mind what has just been put before you. Remember that this particular disease is very often accompanied by disturbances of consciousness. The symptoms of pulmonary catarrh appear because the upper sphere is deprived of what emerges in the lower. In the same way, the organs mediating consciousness in the upper human sphere can no longer work properly if what should be mediator to their activity has broken through into the lower sphere. If you once grasp this primary causation you will have the whole picture of typhus abdominalis before you.
The whole series of external and apparently independent symptoms, which otherwise are only perceived from without, so to speak, become so clearly evident that they might almost be painted in their inner relationships. And in certain circumstances the human consciousness may be so strongly impressed that there arises an urge to objectify prophetically this picture before it portrays itself in the organism. In such cases a person will feel compelled to depict or symbolize the elements of which his upper organic sphere is deprived by painting blue spots of color on the wall, and to represent the elements of which the lower sphere is deprived by spots of red. In the case of an individual with a belief that his vocation is art, as distinct from tailoring or shoemaking, but with little knowledge of the craftsmanship of painting, you may find that if at the same time he is robust enough to repress the constantly arising tendency to diseases of the lower abdomen, these diseased conditions are exteriorized and “thrown off” on wall or canvas, instead of developing internally. The paintings of the expressionist school supply examples of this remarkable activity. Examine much of what comes to light in these paintings, in the red and yellow colors; there you can trace the painter's condition in the lower abdominal sphere. And in the blue and blue-violet parts you can find a clue to his condition in the upper bodily sphere, in the lungs, and all that moves rhythmically upward toward the head. If you study such things carefully, they will lead you to discover a remarkable harmony between the general type of action of a given individual and his internal organization. You will be in a position to form a certain intuitive impression of the functional conditions of his body from his way of living and behaving. For as a matter of fact it is wholly erroneous to believe that the soul activity of a man in the external world, through actions and behavior, is only connected with his nervous system. It is connected with the whole man, and is an image of the whole man. We can grasp intuitively in children how man's intellectual part behaves and how it strives toward the later age. We only have to consider, e.g., how somebody may be doomed in later life to cope with all the embarrassments of an arrested growth; and how in childhood he showed plainly that the forces that did not allow him to complete his growth make him clumsy and rough in his behavior. From the way in which the child behaves, as for instance whether he puts his feet lightly on the ground or strongly, you may form an intuitive picture of the way of its growth. Numerous other manifestations suggest that the whole gesture and behavior of the individual is nothing else than the interplay of internal organic parts, transferred into movement.
It would indeed seem wise to include these subjects in the medical curriculum. When a medical student is about twenty the most favorable conditions obtain for this kind of knowledge. In the thirties one loses this gift; it becomes harder to enter into these things. But it is possible to educate and train oneself to enter into such intuitive knowledge. In spite of the devastating routine of the intermediate and later states of our university education, it is possible (by means of a return to the forces active in childhood) to train this insight into the human being. If organized medical study attached due weight to the more intimate aspects of plastic anatomy and physiology, it would be of immense assistance in the whole treatment of mankind.
So too must those diseases which can appear as epidemics be studied according to their primary causes. To take an example: in all persons with a disposition to disturbance and damage of the head and breast rhythms, which find their crudest expression in the respiratory rhythm, there is a tendency to be much affected by a certain atmospheric and extra-telluric conditions. Others again, in whom the respiratory system is congenitally sound, are able to resist such influences. Of course we must make allowances for additional influences, and other factors of a complicated kind, but this brief and bare outline may make the principle understood.
Let us suppose a winter season in which there is a powerful influence on the solar activity — and note please, not the operation of light, but the solar action — through the outer planets: Mars, Jupiter, and Saturn. A constellation of that description in the winter operates quite differently from the unimpeded action of the Sun when Mars, Jupiter, and Saturn are at a greater distance. In such a winter the atmospheric conditions will differ from the norm; and there will be a remarkable influence (on persons constitutionally so disposed) upon the rhythmical activity between chest and head, of which the most conspicuous is the act of breathing itself. We may state, however, that such cosmic conditions considerably strengthen the inclination to make this rhythm regular in people who have been born from sound conditions, and who are inwardly robust — though their external appearance may be very slight and delicate. In the case of such persons the respiratory rhythm is very well regulated and so also is the whole rhythm between chest and head. Such a stabilized inner rhythm is not easily disturbed from outside; serious injuries are required to affect it. But on persons with an irregularity of this rhythm, the external influences referred to work very strongly to disturb still more the already disturbed rhythm. Thus everyone with this disposition and resident in those parts of the Earth under the special influence of the constellation in question become liable to the complaints grouped as influenza and grippe. These conditions and factors must be in operation in order to create favorable soil for such ailments as influenza.
The following example is of a more complex nature. The whole rhythmic activity within man is a unity, although the one continuous rhythm which has its crudest expression in breathing, and that other and wider rhythm determined by the alternation of sleep and waking, form a separate unity in themselves. It may come to pass that owing to a weakness of the upper rhythm in breathing, that other and wider rhythm determined by the alternation of sleep and waking form a separate unity in themselves. It may come to pass that owing to a weakness of the upper rhythm (between chest and head), the lower rhythm becomes relatively too pronounced. It follows that the upper process, already enfeebled and out of gear, is made more so by the powerful impact of the lower, which is focused in the splenetic function, as well as in others of which we shall treat later. If this lower rhythm is working too strongly upward, it causes a tendency to a kind of hypertrophy of the upper digestive process, with all its sequelæ. Again a most favorable sphere is created for certain lower organisms. There ensue phenomena of inflammation and paralysis in the upper organization, even rudiments of organic malformation, new organic formations; in short we have the picture of diphtheria. Diphtheria might be termed a sort of breakthrough from below upward, an inversion of the typhus breaking through from above downward, and its main origin is as I have described. Of course, in all these conditions, the age of the individual must be taken into account.
You need only keep in mind that during childhood the whole interaction of the upper and lower spheres, and of the rhythmic action that links the two, must differ widely from that of later life; e.g., during childhood there must be much more powerful and pronounced action of the upper human being upon the lower than in maturity. Actually the child “thinks” very much more than does the adult. This may sound strange, but it is true; only, the thoughts of the child are not conscious thoughts, they are absorbed into the organism, manifesting in its growth and formation. Especially in the earliest years of life, thinking activity is used mainly for the formative processes of the growing body. Then there comes a stage wherein the body does not need to use up so much of the formative forces, and thus they are, as it were, dammed back, and become the fundamental forces of memory. So memory emerges only when the organism requires less formative force for itself. The forces which supply the organic foundation of memory are the transformed growth forces and formative forces plastically at work at the beginning of life. Everything is fundamentally based on metamorphosis. That which we observe as a spiritual element is only the re-spiritualization of what worked in a more bodily way when the spirit incarnated into the material. So it can be understood that there must be strong defensive forces in the child to cope with particular processes of the lower abdominal sphere. This sphere is the special scene of action for cosmic-celestial forces, that is to say, for extra-terrestrial forces.
Now turn again to the regions outside the Earth. Let us assume that a special constellation results from the position of Sun and planets, which gives rise to a powerful reflection in the lower abdominal organs of man. What will be the result? It will be relatively unimportant in adults, for in them the upper and lower organic rhythms have reached a certain equipoise. But in children there will of necessity be a vigorous resistance to the cosmic conditions that seek a mirror and replica in the abdominal parts. So if the cosmic configurations act forcibly on the lower abdominal sphere in the child, the upper bodily sphere must defend itself with all its powers. From the convulsive exertion of powers which should not be used so much in the immature upper organic sphere, cerebral meningitis can result —Meningitis cerebro-spinalis epidemica. Here, then, you have an illustrative example of the influx of such diseases into man from extra-human nature. If you keep these origins in the background of your thought, as it were, you will be able to reconstruct the whole clinical picture of meningitis, including the typical rigidity of the muscles in the nape of the neck. For this strain and effort of the upper organic sphere in the child is bound to lead to inflammatory states of the upper organs in the membranes of the brain and spinal cord, and these acute inflammations provoke the other symptoms typical of meningitis.
We need above all to sharpen our perception for seeing man as a whole both as regards the interactions of his organic parts and as regards the interactions of human functions with the external world, and even with the extra-terrestrial world. These hints are not meant to increase the meddling with horoscopes and so on which I consider the greatest nonsense in the form it takes today; but we should realize the origin of the forces in question; such knowledge is necessary for the healing art. It is not so important to be able to trace this or that condition to the quartile aspect of such and such stars — that knowledge can sometimes help toward a cosmic diagnosis, but the main matter for us is to be able to cure. So tomorrow I propose to pass from our present inquiry to the consideration of substances in external nature that are defensive, i.e., contain defensive powers against the extra-telluric influences pouring into the human organism. It would seem necessary that this distinction between the upper and lower organic spheres in man should receive recognition in medicine, for I suggest that such recognition would promote greater cooperation within the profession in the interests of human health. Too often, a physician loses interest in man as a whole if he specializes in one direction. Far be it from me to suggest that physicians should not specialize; the manifold technique evolved in the course of time necessitates a certain amount of specialization. But if specialization has occurred, then, as an equipoise, the socialization, the cooperation of the specializing experts, should steadily increase.
This becomes obvious if we study a condition on which a question has been put: Pyorrhœa alveolaris, the inflammation of the alveolar rim. If pyorrhœa develops, it is not solely owing to some local cause, as many suppose, but it is due to a tendency of the whole organism, a tendency localized only in the mouth and teeth. If it were accepted as part of the professional routine that dentists who observed the onset of this condition were somehow to suggest to physicians that the patient suffering from this particular alveolar inflammation was very probably also liable to diabetes, much good could be done. For that same process — already outlined in these lectures — which manifests as diabetes is also (while it remains localized in the upper sphere and amenable to treatment) the germ of Pyorrhœa alveolaris. It is far too little realized that the lower sphere can, as it were, seize or invade the upper; and in consequence there is either an impoverishment or an undue augmentation of the one sphere or of the other. If the inflammatory tendency is first manifest in the upper sphere, one form of disease ensues; if first manifest in the lower sphere, there ensues its polar opposite. So very much depends on this knowledge.
It will therefore also be readily understood that the whole etheric body, containing the forces of growth in man, must work differently in childhood and in maturity. In childhood, the etheric body must intervene much more in the physical functions; and must have organs as its direct points of attack, so to say. It is especially necessary in the fetal stage that the etheric body should have these points for direct working upon the physical; but the need persists in early childhood, when there is not only organic formation but growth as well, and during growth the plastic activity must be exercised. Hence the need for organs such as the thymus gland, for instance (and even to some extent the thyroid as well); these have their greatest task in childhood, and then enter on a phase of regression, and if too much seized upon by the physical forces, degenerate during the retrogressive phase. During childhood, there must of necessity be a powerful chemism at work within the body, which is replaced, at a later stage, by the working of warmth. One might say that during the life of the individual, man passes through something of which the prismatic spectrum is a symbol: inasmuch as we observe the more strongly chemical extremity (blue and violet), and then the luminous portion (green and yellow), and finally the other extremity, connected with heat (red). For man experiences constitutional changes of this nature and in this direction. (see Diagram 27). During childhood the human being is more dependent on activities working chemically, then passes on to those which act through light, and those acting through warmth. The organs which enable the etheric body to promote the chemism in the physical body are such glands as the thyroid and thymus. On the activity of these organs (to which in a certain sense the chemism is bound) there also depends the particular individual complexion and skin coloring — that is to say, on the etheric activity behind the physical organs. Among the functional offices of the adrenal glands is the determination of the complexion, and if the adrenals degenerate there must be changes in pigmentation in consequence. As an example you need only consider what is known as Addison's Disease, arising from degenerative conditions in the adrenal glands — when the whole skin becomes brown. All this strongly indicates a certain chemism in the human organism. It is at work more especially in the fetus, while the action of light has more importance after approximately fourteen years of age. And then appear the activities connected with the life of warmth. Here we have a most significant indication and gauge for the whole course of human life. The period of childhood, and before birth, especially the latter, the fetal stage, represents a certain predominance of the salt-process; early middle life is predominantly a mercurial process; and later life and old age, in the relation referred to, represent a kind of sulphur process. This implies that in childhood most attention should be paid to the salt-process, in middle life to the mercurial, and in later life to the sulphuric or phosphoric, and these require regulation. Here again, if you realize this triad of organizing chemism — organized light process, organized mercurial process, and organized saline process —at work in the human organism, you will gain a conception of the manner in which the whole of life works on man, organizing him. The manner of life — not only the diet, but the whole habit and action of life — operates chemically on the child, impinging strongly upon the organism; the even more strong light process has such a great influence on the very young, that it sows a seed that may even manifest in disorders of the soul. In youth, man is most sensitively receptive to all the impressions of the external world. Whether at this stage of life we encounter an external world formed regardless of reason and logic, or one which is formed according to reason and logic, has a great significance for the whole constitution of the soul in later life. We shall go further into this in the next lecture, passing from the pathological aspects, just considered, to the therapeutic.