Wednesday, May 22, 2019

Awakening Medical Knowledge


Course for Young Doctors. Lecture 4 of 8.
Rudolf Steiner, Dornach, Switzerland, January 5, 1924:

In the three previous lectures I have tried to give you an outline of the kind of knowledge that should serve as a foundation for physicians. Owing to the very brief time at our disposal, it has only been the merest sketch. But you will have realized that to speak in detail would need considerable time. The kind of knowledge I have given as a foundation for medicine would constitute, as it were, a first course which would take at least a year and longer still if that were possible. It is impossible for me to do more than give a general description of these things, so I should like you to regard what I have said in the three previous lectures as a sketch of what a physician ought to have as a basis. Let me call it the exoteric side of medical knowledge, and it ought really to be followed by the esoteric side, of which we will speak now.
This esoteric side must be built upon the foundation of the exoteric knowledge. In your medical studies you must not be too proud to master the exoteric side; you must master this with all earnestness. It is difficult at the present time, but, as we shall see, much will be achieved in this direction by the establishment of the Medical Section here at Dornach.
After all, it is possible now to expand the short sketch that has been given by many details contained in my lecture courses and writings. Up to now, very little has been done in this direction and the work will only begin to develop in the real sense of anthroposophical medicine when this work that I am preparing with the help of Frau Dr. Wegman comes to the fore. It will then be apparent that Anthroposophy can give a great stimulus to medicine and medical studies. But you must realize quite clearly that medicine is a very special kind of study, with definite preliminary requirements — a study in which the results of Spiritual Science simply cannot be ignored. There can be no true medicine without the knowledge that results from Spiritual Science. The chaotic conditions prevailing today are due to the fact that the current trend of study and knowledge is utterly unsuited to medicine. We have a science of nature that has found its way even into theology, a science that is suited only to technical purposes and not at all to a real knowledge of the being of man. This science is not able to impart a true knowledge of man's nature. Medical science in the real sense demands something quite special and you will realize that this is so when I come to speak of how the human being really comes into existence.
I spoke yesterday from the exoteric side and will now make the transition to the esoteric aspect: external substances are, in reality, processes. Salt is only a precipitation of processes; the magnesium process, the iron process are processes which exist outside in nature. The lead and mercury processes are processes in external nature which the human being cannot have within his physical organism. For all that, it is only in outward semblance that these processes are not within the human being.
How does the human being come into existence? The physical germ comes into being through fertilization and there must be a union between this physical germ and the etheric body of the human being. But fertilization does not create the etheric body. The etheric body forms around what are, later on, ego organization and astral organization, in order to receive the being of spirit and soul who comes down from the spiritual worlds, the being who has been living in pre-earthly existence. The real kernel of man is of the spirit and soul. It has come firstly, from earlier incarnations, secondly, from the period between death and rebirth, and has been in existence long before any fertilization takes place. This kernel of spirit and soul exists before a connection is made with the physical germ cell which is the result of fertilization. It unites, first, with the etheric body which in turn unites with the physical embryo. Ego, astral organization, etheric organization — this trinity unites with what comes into being through the physical fertilization. You must regard the etheric body as something that is built in from out of the cosmos. Now at the time when the etheric body first unites with the physical organization it contains within itself the forces which are not suitable for the physical organization, namely, the lead forces, the tin forces and so on. It is only in semblance that the human    being is not a complete microcosm because certain substances are not within him physically. The substances that are not contained in the physical organism of man are of the greatest importance for the constitution of the etheric body, and in the etheric body, before it unites with the physical body, there are lead processes, tin processes, mercury processes, and so on.
And now the etheric body (and the other members, too, of course) unite with the physical body. All the forces derived by the etheric body from the substances that are not contained within the physical body now pass over to the astral body — this happens to a slight degree during the embryonic period but in a high degree when the real breathing begins at birth. The etheric body then takes on those forces which the physical body works up within itself. Thus the etheric body passes through a very significant metamorphosis. It takes on the content and constitution of the physical body and gives over to the astral body its own constitution, its relationship with the environment of the human being. The astral body is now inwardly linked with what the human being is capable of knowing, and the moment you begin, my dear friends, to acquire not merely a theoretical but a true and inwardly digested medical knowledge—in that moment you make alive within you the knowledge that is already within the astral body. It is there, but it remains unconscious, and it is, in reality, a knowledge of man's relationship with his environment.
Let me take a special case. Think of some district that is depressing — on account of the soil containing gneiss and the mineral known to you as mica. Mica has a very strong influence on the physical constitution of a person who is born in such a district. The physical body is different in a district where there is much mica. The mica forces work upon the physical body from out of the soil. Now you will find that many rhododendrons grow in districts where the soil contains a great deal of mica. This plant grows plentifully in the Alps and in Siberia and so forth. The rhododendron substance is something that is intimately connected with the etheric body before it comes down into the physical body in such regions. This relationship with the rhododendron the ether body gives over to the astral body. And now, suppose that illnesses occur which are due to a preponderating working of the mica by way of the ground water. The etheric body has given over what came to it from the rhododendron, to the astral body. This element is present externally, in the rhododendron plants. This indicates that the rhododendron contains a sap that has a remedial effect upon this illness. In many cases, though not in all, a specific remedy is to be found in regions where particular illnesses occur.
And now suppose you are a physician. Every night when you go to sleep, you pass, in your astral body, into the environment which was once connected with the etheric body but is now connected with the astral body. If you have medical knowledge, if you know what healing forces exist in the environment, that knowledge becomes experience during sleep, and so you have continually the confirmation of what you learn, externally, through dialectics. And this factor must be reckoned with in medical study, because no outer dialectic learning of medical science really helps. It becomes fragmentary and chaotic if there cannot arise during every sleep, within the span of the astral body, the confirmation that is necessary. If medical knowledge is not acquired in such a way that the astral body, in the intercourse with the environment, is able to say “Yes” to what the student has learned, it is just as if he were listening to something that he cannot understand and only confuses him. So you see, medical knowledge is intimately connected with the sleeping state.
Such things convince us that medical knowledge must be acquired by the whole man, by man as a living, feeling being, for together with this ‘nightly’ intercourse with the healing substances, something else grows up, something that can never be acquired through dialectic — I mean, the true desire to help. Without the sincere desire to heal, the feeling of sympathy on the part of the physician with the person he has to cure, without this strong desire to give personal help, no healing in the real sense is possible.
And here I must say something that may seem very strange and paradoxical, but as you want to know in what way things are wrong today and what ought to be done, I must say it, for in Dornach we are working from esoteric impulses. People have often said to me that steps might have to be taken to protect the remedies that are prepared in our pharmaceutical laboratory, so that they shall not be copied by other people. I once replied that I was not so very anxious about this, provided we succeeded in bringing true esoteric impulses into our medical work. Then people will realize that the remedies are made with an esoteric background, and that it is not the same if the remedies are made here, with the esoteric life behind the work, or whether some factory copies them. This may seem very strange, but it is true nevertheless. Much more important than protecting things by business devices is the growth of an attitude which aims at making the remedies effective from out of the Spiritual. This is not superstition — it is something that can be substantiated in Spiritual Science. Therefore, people possessed of understanding will begin to realize that with the taking of remedies that are produced here, a beginning has been made in the right direction.
Such objections as have been made to me are due to the fact that people do not realize in the least how seriously the esoteric, spiritual life must be taken, above all, in medicine. If you once grasp this, you see that a center for medicine must be instituted here as a reality, not as a mere formality.
And now you will understand that a first, exoteric course of medical study should be followed by a second which approaches the human being esoterically, which merges medical knowledge into what becomes a true medical consciousness, a true medical attitude. There have, of course, always been individuals who sought instinctively for this. And in the last third of the nineteenth century, at a time when there was so little that was capable of producing this attitude, one could see, but only in isolated individuals who were then regarded as cranks, sporadic manifestations of this medical consciousness. The basis of the reputation enjoyed by the Viennese School of Medicine at the time when I was growing up was connected with its attitude to therapy, where the actual therapy hardly mattered at all, especially treatment of pneumonia, an illness where one can do very little for the central disease itself. You have all heard of medical nihilism, and this is its origin. The most eminent physicians in Vienna were deliberate advocates of medical nihilism In other words, they held the point of view that no remedy heals. To a certain extent, Rudolf Virchow (1821–1902), too, held this view. His view was: If a hundred patients are said to have been cured, one can assume with fifty percent of them that it did not matter whether they had been given a remedy or not; they would have got well without it; with 30 percent it could be said that the remedy had done actual harm; and with the remainder, chance might have brought it about that the remedy selected had helped. It is not I who make this statement, but Virchow, who had a great reputation in the medical world last century. I know eminent men today, too, who adhere to this view, although they may be advocates of therapy. No true medical consciousness is expressed in this view. Medical consciousness can never be regarded as a merely formal attitude. It must be a reality. Therefore, the second medical course would have to contain the human aspect that is built up on the basis of the exoteric material. There must be that human factor that worked, in a somewhat degenerate form, but, for all that so magnificently and attractively, in a person like Paracelsus.
Certainly, objections to Paracelsus can be made in certain details, but this medical consciousness lived in him, in a splendid way. Whenever he came to a district where the soil was strikingly red, he knew that a number of diseases — especially those that are due to diseases of the blood — were caused by the red sandstone in the soil. {Translator's note: The word in the German is the name of a substance described as a system of sandstone, shale and conglomerates of the lower terrain of Germany.}
The way in which a process of illness develops is very characteristic. We find that the people living in a district where there is this red sandstone soil have accustomed themselves to this soil and have a certain characteristic temperament. They have a very lively activity of the spleen. Coming as a stranger to the district, one does not easily take a liking to them. They are frightfully stubborn, dogmatic, obstinate, and when one considers what they do to be foolish — they just return the ‘compliment!’ But suppose a stranger comes and wants to set up a business or something of the kind. He cannot stand the soil, especially not the water, and he will show certain symptoms of illness. Paracelsus said that illnesses which are contracted in such a district are then passed on to the natives who are born there. He said that something must be present in the etheric body (which he calls the ‘Archaeus’). He said that the ‘Archaeus’ must have undergone something before it entered the embryo. Now in these districts we always find that laburnums are prevalent and in the blossoms, leaves and sometimes also in the roots of the laburnum there is a fluid which can provide a very useful remedy.
What is important is to unfold a quite different perception of nature through this medical consciousness. In my young days I knew a physician whom one often met in the meadows and fields     — among the plants and insects and flowers. In the place where he carried on an unpretentious practice, there were three or four very learned men. But the work of this unpretentious physician who had such a love for the wildflowers in the meadows was much more fruitful for the sick people than that of the city physician and the other learned men. Their wisdom came from the schools, but his wisdom and understanding of remedies came from that direct intercourse with nature which leads to a real medical knowledge when we can love nature, in all her details. To look at fragments of nature under the microscope is not to love her. We must love nature. We must all be able to expand her to the macrocosmic. This shows you how necessary it is to call up this subconscious life of the astral body, particularly for medical knowledge, to call it up in reality.
It is not at all my wish to revive the stock-in-trade of ancient medicine, my dear friends, but only to lay before you the results of present-day observation. One is obliged to resort to the terminology of ancient tradition, because neither modern language nor modern medical terminology contain the right expressions. It might even be more favorable for the spreading of our views if we were to devise an altogether new terminology. But that would take years, and as you want to hear about these things now, I shall have to use the old expressions with certain modifications.
It will be a good thing to look, first of all, at the plant world — not because I want to recommend plant remedies for everything, but because much can be learned from the plants, above all for an esoteric deepening.
It is very important to study three things connected with medical tradition, but not to study them in the way that is current in present-day science. When a student has learned something of today, he knows it and he thinks: Well, that's all right, I know it and I can apply it. But a religiously-minded person learns the Lord's Prayer. He, too, knows it, but he does not think that the mere fact of knowing it is sufficient. He says it every day as a prayer. What he knows, he prays, every day. He lets what he knows pass through his soul every day, and that is a very different matter — very different, indeed.
Or think of an Initiate. We presuppose that he knows the elements of occult science. He himself attaches no importance to the mere fact of knowing them, to the fact that he once assimilated them. He knows that it is much more important to let the very first rudiments and then all that follows flow through his soul from time to time so that his soul can always be receiving new forces of inspiration. A person who is fundamentally religious has quite different experiences from one who merely regards nature as something that is there before us in the physical world. We must live in the rhythms of nature again and again if we desire a living and not a dead kind of knowledge. There must be constant, rhythmic repetition of knowledge and the activity of knowledge. That is what I mean when I say that a real medical consciousness must be the basis for medical science. The acquisition of medical knowledge from the nature of the human being and from his environment — that is what is so important, in therapy as well. Again and again you must let the plants really come to life in the soul.
Three things are of particular significance in the plant. One is the scent that is connected with the oils. The scent, or aromatic element is that which attracts certain elementary spirits who like to come down into plants. The activity (not the substance) which underlies this aromatic nature, is to be found, in its most concentrated form, in the mineral kingdom, in sulfur. This spiritual extract that is active in the aroma of the plants gives rise to a kind of longing in the elementary beings who come down through the scent. In ancient medicine, this element was known as the sulfuric nature of the plants. If we contemplate the sulfuric nature of the plants we can acquire an understanding for their scent, if we know that something spiritual is in play above and below when the plant gives off its scent. That is the first thing.
A second thing that we acquire is an inner feeling-filled understanding of what is growing in the leaf. The form and character of leaves is so manifold; they may be serrated, with pointed or round ends, geniculated, and so forth. We should evolve a delicate perception of this leaf nature of the plants. For those spiritual beings who come down through the scent can draw life from this leaf nature. And streaming from the cosmic periphery inwards, there is everywhere the striving to the drop formation. This can give you a marvelous feeling for the cosmic, form-loving principle that is contained in the leaf. And then, think of the plant covered with glistening drops of dew in the morning. In their essential nature these drops of dew are a reflection of the striving of the cosmic periphery to produce the spherical form, the drop form in the plant kingdom. The principle of drop formation is at the basis of the leaf nature in the plant. If the peripheric, cosmic forces alone were spiritually active in the plant, it would always produce this spherical form. The spherical formation is particularly to the fore when the cosmic forces get the upper hand in the formation of berries, also in the formation of many leaves, but the drop formation here is immediately taken possession of by the earthly forces, and manifold forms arise.
This striving towards drop formation is concentrated, in the mineral world, in quicksilver. Therefore, ancient medicine called this 'striving towards drop formation', the Mercurial principle. In ancient medicine, Mercury was not the substance of quicksilver but the dynamic striving towards the drop formation.
On the earth, quicksilver is the metal which has the drop form because the conditions for this exist. On the earth, quicksilver has the form which silver has on the moon, where it would also have to exist in the drop form. The point is that ancient medicine called everything that had the drop form Mercury. All metals were also 'Mercury' in ancient medicine. This ancient medicine had living, mobile concepts, and we, too, must develop them. We must gradually grow into a frame of mind which makes us say: “When I walk over the fields in the morning and see the silver pearls of dew on the leaves, these pearls of dew reveal to me what is living spiritually in the leaves themselves; it is the striving towards the cosmic form of the sphere.” But this must become a feeling within us, so that we are able to understand the plants. We must understand them in their cosmic, spherical form.
If you get such an insight into the nature of the plants that you understand the forces in them which are striving towards drop formation, and then again think of their scent, you will gradually begin to understand everything that works centrifugally in the human being. There is a centrifugal force at work when the nails are cut. The centrifugal forces working through the human being make the nails grow again. During the first seven years of life particularly, the forces which come to a conclusion with the second dentition, work out centrifugally through the human being. They express    themselves strongly in the formation of sweat. The element which in the scent of plants strives upwards and attracts the Nature Spirits is also active in the smell of sweat which works in the centrifugal direction. And so if you want to look for the plant nature in the human being, you must seek it where it strives outwards, and in this way you unfold an intimate knowledge of the connection between what is outside and what is within the human being. For you see, when the etheric body gives over its special features to the astral body, the whole thing is changed. The inclination of the etheric body would be to unfold what it takes from the environment, in the upward direction; inasmuch as this is given over to the astral body, it unfolds in the centrifugal direction. In this respect, too, the human being bears the plant existence within him.
And now think of how the plant sinks into the earth with its root; how with its root it enters into a close connection with the salts in the soil. A process takes place here that is exactly the opposite of the one we know in the material world. Take sodium chloride which, in solution, tastes salty, and now think of the process being exactly reversed, the solution being arrested, a congealment taking place and the smell and the taste become latent. There you have the process which goes on between the soil and the root of a plant. That is what was known as the salt process in ancient medicine. Ancient medicine did not use the word salt in the way we use it today, but meant by salt that element which, in the downward-pointed root of the plant, enters into a connection with the substances of the earth. That is the salt nature.
By directing your attention rhythmically to these wonderful secrets of nature you fill your medical knowledge with life that is capable of practical application. If you try in this way to fill your medical knowledge with life, you will begin to regard nature and the human being in such a way that the capacity to heal will be born of the strong impulse to give help, of which I have spoken. The capacity to heal can only come from this foundation. It must be quickened by keen, diligent, and zealous exoteric learning, for otherwise mere vagueness will be the result. But it is necessary to know that the real foundation of medical knowledge lies in this rhythmic, meditative absorption in the natural environment of the human being, and not in theoretical study.
What I am now going to write on the blackboard is not there in order that you may “learn” it, but in order that it may quicken life in your medical thinking.
You healing Spirits,
You unite
With Sulfur's blessing
In the ethereal fragrance;

You come to life
In upward springing Mercury
Of growing
And becoming.

You make your halting place
In the Earth Salt
Which nourishes the root
In the soil.
Ihr heilenden Geister
Ihr verbindet euch
Dem Sulphursegen
Des Ätherduftes;

Ihr belebet euch
Im Aufstreben Merkurs
Dem Tautropfen
Des Wachsenden
Des Werdenden.

Ihr machet Halt
In dem Erdensalze
Das die Wurzel
Im Boden ernährt.
This is what the soul receives in looking out into the universe around. The human being answers:
I will unite
The Knowledge of my Soul
With Fire of the flower's fragrance;

I will bestir
The Life of my Soul
On the glistening drop of leafy morning;

I will make strong
The Being of my Soul
With the all hardening Salt
Whereby the Earth with loving care
Nurtures the root.

Ich will mein Seelenwissen
Verbinden dem Feuer
Des Blütenduftes;

Ich will mein Seelenleben
Erregen am glitzernden Tropfen
Des Blättermorgens;

Ich will mein Seelensein
Erstarken an dem Salzerhärtenden
Mit dem die Erde
Sorgsam die Wurzel pflegt.
If over and over again, as the pious are wont to do in prayer, we make this inwardly living, it will quicken in the soul the forces which render us capable of medical work. The ordinary powers that are educated in the schools cannot awaken true medical knowledge, for true medical knowledge must be drawn forth from the soul. And so at the very summit of the esoteric studies which we are to pursue, I always place this thought: that the powers of the soul must first be quickened in order to bring to birth in the soul the faculty that can lead to true medical knowledge.

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