Friday, April 8, 2016
Spiritual Science and Medicine
Spiritual Science and Medicine. Lecture 1 of 20.
Rudolf Steiner, Dornach, Switzerland, March 21, 1920:
We may take it as obvious that only a very small proportion of what my present hearers probably expect for the future of their professional life can be indicated in this series of lectures; for you will all agree that any confidence in the future among medical workers depends on the reform of the actual medical curriculum. It is impossible to give any direct impetus to such reform by means of a course of lectures. The most that may possibly result is that certain individuals will feel the urge to help and participate in such reform. Any medical subject under discussion today has, as its background, those initial studies in anatomy, physiology, and general biology, which are the preliminaries to medicine proper. These preliminaries bias the medical mind in a certain direction from the first; and it is absolutely essential that such bias should be rectified.
In this series of lectures I should like, in the first place, to submit to you some facts bearing on the obstacles in the customary curriculum to any really objective recognition of the nature of disease per se. Secondly, I would suggest the direction in which we should seek that knowledge of human nature which can afford a real foundation for medical work. Thirdly, I would indicate the possibilities of a rational therapy based on the knowledge of the relationship between man and the surrounding world. In this section I would include the question whether actual healing is possible and practicable.
Today I shall restrict myself to introductory remarks, and to a kind of orientation. My principal aim will be to collect for consideration from Spiritual Science all that can be of value to physicians. It is my wish that this attempt should not be confused with an actual medical course, which it nevertheless will be in a sense. But I shall give special attention to everything that may be of value to the medical worker. A true medical science, or art, if I may call it so, can only be attained by consideration of the factors to which I have referred.
Probably you have all, in thinking over the task of the physician, been baffled by the question: “What does sickness mean and what is a sick human being?” The most usual definition or explanation of sickness in general, and of sick people, is that the morbid process is a deviation from the normal life process; that certain facts which affect human beings, and for which normal human functions are not in the first place adapted, cause certain changes in the normal life process and in the organization, and that sickness consists in the functional deficiency of the organs caused by such changes. But you must admit that this is a merely negative definition. It offers no help when we are dealing with actual diseases. It is just this practical help that I shall aim at here: help in dealing with actual diseases. In order to make things clear it seems advisable to refer to certain views which have developed in the course of time as to the nature of disease — not as indispensable for the present interpretation of morbid symptoms, but as signposts showing the way. For it is easier to recognize where we are now if we appreciate former points of view which led up to those now current.
The accepted version of the origin of medicine derives it from the Greece of the fifth and fourth centuries before the Christian era, when the influence of Hippocrates was supreme. Thus an impression is produced that the system of Hippocrates — which developed into the humoral pathology accepted until well into the nineteenth century — was the first attempt at medicine in the Occident. But this is a fundamental error, and is still harmful as a hindrance to an unprejudiced view of sickness. We must, to begin with, clear this error away. For an unbiased view the conceptions of Hippocrates — which even survived until the time of Rokitansky, that is until the last century — are not a beginning only, but to a very significant degree are a conclusion and summary of older medical conceptions. In the ideas which have come down to us from Hippocrates we meet a final filtered remainder of ancient medical conceptions. These were not reached by contemporary methods, i.e., through anatomy, but by the paths of ancient atavistic vision. The most accurate abstract definition of Hippocratic medicine would be: the conclusion of archaic medicine based on atavistic clairvoyance. From an external point of view we may say that the followers of Hippocrates attributed all forms of sickness to an incorrect blending of the various humors or fluids which cooperate in the human organism. They pointed out that these fluids bore a certain ratio to one another in a normal organism, and that this ratio was disturbed in the sick human body. They termed the healthy mixture or balance Krasis, the improper mixture Dyskrasis. The latter had to be influenced so that the proper blend might be restored. In the external world, they beheld four substances which constituted all physical existence: Earth, Water, Air, and Fire — Fire meaning what we describe simply as warmth. They held that these four elements were specialized in the bodies of man and the animals as black bile, yellow bile (gall), mucus (slime), and blood, and that the human organism must therefore function by means of the correct blending of these four fluids.
The contemporary man with some kind of scientific grounding, who considers this theory, argues as follows: the blending and interaction of blood, mucus, bile, and gall, in due proportion, must produce an effect according to their inherent qualities known to chemistry. And this restricted view is thought to be the essence of humoral pathology — but erroneously. Only one of the four humors, the most Hippocratic of all — as it appears to us today — namely “black bile,” was believed to work through its actual chemical attributes on the other humors. In the case of the remaining three fluids it was believed that besides the chemical properties there were certain intrinsic qualities of extra-telluric origin. (I am referring to the human organism for the moment, excluding animals from consideration.) Just as water, air, and fire were believed to be dependent on extra-telluric forces, so also these ingredients of the organism were believed to be interpenetrated with forces emanating from beyond the Earth.
In the course of evolution, Western science has completely lost this reference to extra-terrestrial forces. For the scientist of today there is something absolutely grotesque in the suggestion that water possesses not only the qualities verifiable by chemical tests but also, in its action within the human organism, qualities appertaining to it as a part of the extra-terrestrial universe. Thus the Ancients held that the fluids of the human body carried into the organism forces derived from the cosmos itself. Such cosmic forces were regarded less and less as the centuries went on; but nevertheless medical thought was built up on the remains of the fading conceptions of Hippocrates until the fifteenth century. Contemporary scientists therefore have great difficulty in understanding pre-fifteenth century treatises on medical subjects; and we must admit that the writers of these treatises did not, as a rule, themselves fully comprehend what they wrote. They talked of the four elements of the human organism, but their special description of these elements was derived from a body of wisdom that had really perished with Hippocrates. Nevertheless, the qualities of these fluids were still matters of discussion and dispute. In fact, from the time of Galen till the fifteenth century we find a collection of inherited maxims that become continuously less and less intelligible. Yet there were always isolated individuals able to perceive that there was something beyond what could be physically or chemically verified, or included in the merely terrestrial. Such individuals were opponents of what “humoral pathology” had become in current thought and practice. And chief among them were Paracelsus and Van Helmont, who lived and worked from the end of the fifteenth century into the seventeenth, and contributed something new to medical thought, by their attempts to formulate something their contemporaries no longer troubled to define. But the formulation they gave could only be fully understood with some remainder of clairvoyance, which Paracelsus and Van Helmont certainly possessed. If we ignore these facts, we cannot arrive at any conclusion concerning peculiarities of medical terminology whose origin is no longer recognizable.
Paracelsus assumed the existence of the Archaeus as the foundation for the activity of the organic humors in man; and his followers accepted it. He assumed the Archaeus, as we today speak of the “etheric body" of man.
Whether we use the term Archaeus, as Paracelsus did, or our term, the etheric body, we refer to an entity which exists but whose origin we do not trace. If we were to do this, our argument would be as follows: Man possesses a physical organism
(see Diagram No. 1) mainly constructed by forces acting out of the sphere of the Earth; and also an etheric organism (Diagram No. 1 in Red) mainly constructed by forces acting from the cosmic periphery. Our physical body is a portion as it were of the whole organism of our Earth. Our etheric body — like the Archaeus of Paracelsus — is a portion of that which does not belong to the Earth, but which acts on and affects the arth from all parts of the cosmos. Thus Paracelsus viewed what was formerly designated the cosmic element in man — of which the knowledge had perished with Hippocratic medicine — in the form of an etheric body, which is the basis of the physical. But he did not investigate further — though he gave some hints — the extra-terrestrial forces associated with the Archaeus and acting in it.
The exact significance of such facts grew more and more obscure, especially with the advent of Stahl's medical school in the seventeenth and eighteenth centuries. Stahl's school has wholly ceased to comprehend this working of cosmic forces into terrestrial occurrences; it grasps instead at vague concepts such as “vital force” and “spirits of life.” Paracelsus and Van Helmont were consciously aware of the reality at work between the soul and spirit of man and his physical organization. Stahl and his followers talk as though the conscious soul-element was at work, though in another form, upon the structure of man's body. This naturally provoked a vehement reaction. For if one proceeds like this and founds a sort of hypothetical vitalism one comes to purely arbitrary assertions, and the nineteenth century opposed these assertions. Only a very great mind, like Johannes Müller (the teacher of Ernst Haeckel), who died in 1858, was able to overcome the noxious effects of this confusion, a confusion of soul forces with “vital forces” which were supposed to work in the human organism, although how they operated was not very clear.
Meanwhile a quite new current made its appearance. We have followed up the other current, which faded out; the new current in the nineteenth century had a rather different bearing upon medical thought. It was set in motion by one extremely influential piece of work dating from the preceding century: the De sedibus et causis morborum per anatomen indugatis by Morgagni. Morgagni was a physician of Padua, who introduced an essentially materialistic trend into medicine; the term materialism is used here, of course, as an objective description, without sympathies and antipathies. The new trend initiated by Morgagni's work consisted in turning the interest to the after-effect of disease upon the organism. Post-mortem dissections were regarded as decisive; they revealed that, whatever the disease may have been, typical effects could be studied in certain organs, and the changes of the organs by disease were studied from the autopsy. With Morgagni, pathological anatomy begins, whereas the former content of medicine still retained some traces of the ancient element of clairvoyance.
It is of interest to observe the suddenness with which this great change finally occurred. The volte-face took place within two decades. The ancient inheritance was abandoned and the atomistic-materialistic conception in modern medicine was founded. Rokitansky's Pathological Anatomy (published in 1842) still contains some traces of the “humoral” tradition, of the conception that illnesses are due to the abnormal interaction of the fluids. Rokitansky achieved a brilliant combination of the study of organic change, with a belief in the importance of the fluid (humors); but it is impossible to consider these bodily fluids adequately without some recognition of their extra-terrestrial qualities. Rokitansky referred the degenerative changes revealed in autopsies to the effect of the abnormal mixture of the bodily fluids. Thus the last visible trace of the ancient tradition of “humoral pathology” was in the year 1842. The interlocking of this perishing heritage of the past with attempts such as Hahnemann's — attempts forecasting future trends of dealing with more comprehensive concepts of disease — we shall consider in the next few days, for this subject is far too important to be relegated to an introduction. Similar experiments must be discussed in their general connection and then in detail.
The two decades immediately following the appearance of Rokitansky's book were decisive for the growth of the atomistic-materialistic conception in medicine. In the first half of the nineteenth century there were curious echoes of the ancient conceptions. Thus, for example, Schwann may be termed the discoverer of the vegetable cell; and he believed that cells were formed out of a formless fluid substance, to which he gave the name Blastem, by a process of solidification, so that the nucleus emerges together with the surrounding protoplasm. Schwann derived cells from a fluid with the special property of differentiation, and believed that the cell was the result of such differentiation. Later on the view gradually develops that the human frame is “built up” of cells; this view is still held today; the cell is the “elementary organism,” and from the combination of cells, the body of man is built up.
This conception of Schwann's, which can be read “between the lines” and even quite obviously, is the last remainder of ancient medical thought, because it is not concerned with atomism. It regards the atomistic element, the cell, as the product of a fluid which can never properly be considered as being atomistic — a fluid which contains forces and only differentiates the atomistic from itself. Thus in these two decades, the forties and fifties of the nineteenth century, the older, more universal view approaches its final end, and the atomistic medical view shows its faint beginnings. And it has fully arrived when, in 1858, appeared the Zellular Pathologie (Cellular Pathology) of Virchow. Between Pathologischen Anatomie, 1842, by Rokitansky and Zellular Pathologie, 1858, by Virchow one must actually see an immense revolution — proceeding in leaps and bounds — in the newer medical thinking. Cellular Pathology derives all the manifestations of the human organism from cellular changes. The official ideal henceforth consists in tracing every phenomenon to changes in the cells. From the change in the cell the disease is supposed to be understood. The appeal of this atomism is its simplicity. It makes everything so easy, so evident. In spite of all the progress of modern science, the aim is to make everything quickly and easily understood, regardless of the fact that nature and the universe are essentially extremely complex.
For example: It is easy to demonstrate through a microscope that an amoeba, in a drop of water, changes form continuously, extending and retracting its limb-like projections. It is easy to raise the temperature of the water and to observe the greater rapidity with which the pseudo-podia protrude and retract, until the temperature reaches a certain point. The amoeba contracts and becomes immobile, unable to meet the change in its environment. Now, an electric current can be sent through the water: the amoeba swells like a balloon, and finally bursts if the voltage becomes too high. Thus it is possible to observe and record the changes of a single cell under the influence of its environment; and it is possible to construct a theory of the origin and causation of disease through cumulative cellular change.
What is the essential result of this revolution which took place in two decades? It lives on in everything that permeates the acknowledged medical science of today. It is the general tendency to interpret the world atomistically which has gradually arisen in the age of materialistic thought.
As I stated at the beginning of this address, the medical worker today must of necessity inquire: What sort of processes are those we term diseased? What is the essential difference between the diseased and the so-called normal processes in the human organism? Only a positive representation of this deviation is practicable, not the official and generally accepted definitions, which are merely negative. These deviations from normality are stated to exist, and then there are attempts to find how they may be removed. But there is no penetrating conception of the nature of the human being. And from the lack of such a conception our whole medical science is suffering. For what, indeed, are morbid processes? It cannot be denied that they are natural processes, for you cannot make an abstract distinction between any external natural process, whose stages can be observed, and a morbid process within the body. The natural process is called normal, the morbid one abnormal, without showing why the process in the human organism differs from normality. No practical treatment can be attained without finding out. Only then can we investigate how to counter-balance it. Only then can we find out from what angle of universal existence the removal of such a process is possible. Moreover, the term “abnormal” is an obstacle to understanding; why should such-and-such a process in man be termed abnormal? Even a lesion, such as a wound or deep cut with a knife in the finger, is only relatively “abnormal,” for to cut a piece of wood is “normal.” That we are accustomed to other processes than the cutting of a finger says nothing; it is only playing with words. For what happens through the cutting of my finger is, when viewed from a certain angle, as normal as any other natural process. The task before us is to investigate the actual difference between the so-called diseased processes, which are after all quite normal processes of nature, but must be occasioned by definite causes, and the other processes, which we call healthy and which occur every day. We must ascertain this essential difference; it cannot, however, be ascertained without a knowledge of man which leads to his essential being. I shall give you, in this introduction, the first elements; we shall later on proceed to the details.
As these lectures are limited in number, you will understand that I am principally giving things which you cannot find in books or lectures and am assuming the knowledge presented in those sources. It would not seem to me worthwhile to put a theory before you which you could find stated and illustrated elsewhere.
Let us therefore begin here with a simple visual comparison which you can all make: the difference between a human skeleton and that of a gorilla, an ape of so-called high grade. Compare the visible outlines and proportions of these two bony frameworks. The most conspicuous feature of the gorilla, in point of size, is the development of the lower jaw and its appurtenances. This enormous jaw seems to weigh down, to overload, the whole bony structure of the head (see Diagram 2), so that the gorilla appears to stand upright only with an effort.
But there is the same weightiness in comparison with the human skeleton if you examine the forearms and hands and fingers. They are heavy and clumsy in the gorilla; whereas in man they are delicate and frail; there the mass is less obvious. Just in these parts — the system of the lower jaws and forearms with the fingers — the mass recedes in man, whereas it is very obvious in the gorilla. The same comparative peculiarities of structure can be traced in the lower limbs and feet of the two skeletons. There, too, we find a certain weight pressing in a definite direction. I should like to denote the force which one can see in the systems of underjaw, arm, leg, foot — by means of this [down and left slanting arrow] line in the diagram. (See Diagram 3).
These differences in structure suggest to the observer that in human beings, where the weight of the jaws recede and the arms and finger bones are delicate, the downward-pressing forces are countered everywhere by a force directed upwards and away from the Earth. The formative forces in man must be represented in a certain parallelogram of forces which results from the same force which is directed upwards and which the gorilla appropriates externally only, standing upright with difficulty. I then arrive at a parallelogram of forces that is formed by this line and by this one. (See Diagram 4).
As a rule nowadays we are content to compare the bones and muscles of the higher animals with our own, but to ignore the changes in form and posture. Yet the contemplation of the formative changes is of essential significance. There must be certain forces acting against those other forces that mold the typical gorilla frame. They must exist. They must operate. In seeking them we shall find that which has been lost inasmuch as the ancient medical wisdom has been filtered from the system of Hippocrates. The first set of forces in the parallelogram are of a terrestrial nature, while the other set of forces, which unite with the terrestrial forces so as to form a resultant which is not of terrestrial origin, must be sought outside the terrestrial sphere. We must search for tractive forces which bring man into the upright posture, not merely on occasion, as among the higher mammals, but so that these forces are at the same time formative. The difference is obvious: the ape if he walks upright has to counteract forces which oppose the erection with their mass; whereas man forms his very skeleton in accordance with forces of a non-terrestrial nature. If one not only compares the particular bones of the man with those of the animal, but examines the dynamic principle in the human skeleton, one finds that there is something unique and not to be found in the other kingdoms of nature. Forces emerge that we have to combine with the others to make the parallelogram. We find resultants not to be found among the forces of extra-human nature. Our task will be to follow up systematically this “jump” leading from animal to man. Then we can find the origin and essence of “sickness” in animals as well as in man. I can only indicate little by little these lines of inquiry; we shall find much of importance from these elements as we continue further.
Now let me mention another fact, which concerns the muscular system. There is a remarkable difference in muscular reactions: when in repose, the chemical reactions of the muscles are alkaline, though very slightly so in comparison with most other alkaline reactions; when in action, the muscular reactions are acid, though also faint. Now consider that from the point of view of metabolism the muscle is formed out of assimilated material, that is, it is a result of the forces present in terrestrial substances. But when man passes to action the normal properties of the muscle, as a substance affected by ordinary metabolism, are overcome. This is quite evident. Changes take place in the muscle itself, which are different from ordinary metabolic processes, and can only be compared with the forces active in the human bone-system. Just as these formative forces in man transcend what he has from outside, inter-penetrating terrestrial forces and uniting with them so that a resultant arises, so we must recognize the force that is manifested through the altered metabolism of muscles in action as something working chemically from outside the Earth into terrestrial chemistry. Here we have something of an extra-terrestrial nature, which works into earthly mechanics and dynamics. In metabolism there is something active beyond terrestrial chemistry, and capable of other results than those caused by terrestrial chemistry alone.
Those considerations, which are concerned both with forms and qualities, must be the starting point in our quest for what really lies in the nature of man. Thus we may also find the way back to what we have lost yet sorely need if we are not to stop at formal definitions of disease that cannot be of much use in actual practice. An important question arises here. Our materia medica contains only terrestrial substances taken from man's environment, for the treatment of the human organism which has suffered changes. But there are non-terrestrial processes active in him — or at least forces which cause his processes to become non-terrestrial — and so the question arises: How can we provoke an interaction leading from sickness to health, by methods affecting the sick organism through its physical earthly environment? How can we initiate an interaction which shall include those other forces which work in the human organism yet are not limited to the scope of the processes from which we take our remedies, even when they take effect through certain forms of diet, etc.?
You will realize the close connection between a correct conception of human nature and the methods that may lead to a certain therapy. I have intentionally chosen these first elements which are to lead us to an answer, from the differences between animals and men, although well aware of the objection that animals, like men, are subject to diseases, that even plants may become diseased, and that morbid states have recently been spoken of even among minerals; and that there should therefore be no distinction between sickness in animals and in the human race. The difference will become obvious when it will be apparent how little value, in the long run, adheres to the results of animal experimentation undertaken solely to gain knowledge for use in human medicine. We shall consider why it is undoubtedly possible to attain some help for mankind through experiments on animals, but only if and when we understand the radical differences, even to the smallest detail, between animal and human organisms.
I want to emphasize that in referring to cosmic forces, far greater demands are made on man's personality than if we merely refer to so-called objective rules and laws of nature. The aim must be set before us to make medical diagnosis more and more a practice of intuition; the gift of basing conclusions on the formative phenomena of the individual human organism (which may be healthy or sick) can show how this training in intuitive observation of form will play an ever-increasing part in the future development of medicine.
These suggestions are only intended to serve as a sort of introductory orientation. Our concern today was to show that medicine must once more turn its attention to realms not accessible through chemistry or comparative anatomy as usually understood, realms only to be reached by consideration of the facts in the light of Spiritual Science. There are still many errors on this subject. Some hold the main essential for the spiritualizing of medicine to be the substitution of spiritual means for material. This is quite justifiable in certain departments, but absolutely wrong in general. For there is a spiritual method of knowing the therapeutic properties of material remedies; spiritual science can be applied to evaluate material remedies. This will be the theme of that portion of our subject matter which I have termed the possibilities of healing through recognition of the inter-relationships between mankind and the external world.
I shall hope to base what I have to say about special methods of healing on as firm a foundation as possible, and to indicate that in every individual case of sickness it is possible to form a picture of the connection between the so-called “abnormal” process, which must also be a process of nature, and those “normal” processes, which again are nothing else than nature processes. This primary problem of how the disease process can be regarded as a natural process has often cropped up. But the issue has been evaded again and again. I find certain facts about Troxler of great interest in this connection. Troxler taught medicine at the University of Berne and in the first half of the last century he devoted much energy to maintaining that the “normality of disease” should be investigated; that such investigation would finally lead to the recognition of a certain world connected with our own, and impinging on our world, as it were, through illegitimate gaps; and that this would be the key to something bearing on morbid phenomena. Please imagine such a diagrammatic picture: a world in the background whose laws, in themselves justified, could cause morbid phenomena among the human race. Then, if this world meets and interpenetrates our own, through certain “gaps,” its laws, which are adapted to another world, could do mischief here. Troxler wanted to work in this direction. And however obscure and difficult his expressions on many subjects may be, one notes that he had struck out a path for himself in medicine with the purpose of working toward a certain restoration of medical science.
A friend and I once had the opportunity of inquiry into Troxler's standing among his Bernese colleagues and into the results of his initiative. The detailed History of the University had only one thing to say about Troxler: that he had caused much disturbance in the university! That had been remembered and recorded, but we could find nothing about his significance for science.