Anthroposophical Approach to Medicine
Stuttgart, 27 October, 1922
If I were asked to map out a course of medical study to cover a certain period of time, I should begin — after the necessary scientific knowledge had been acquired — by distinguishing the various functions in the organism of man. I should feel bound to advise a study, both in the anatomical and physiological sense, of the transformation of the foodstuffs from the stage where they are worked upon by the ptyalin and pepsin to the point where they are taken up into the blood. Then, after considering the whole alimentary canal concerned with digestion in the narrower sense, I should pass on to the system of heart and lungs and all that is connected with it. This would be followed by a study of the kidneys and, later on, their relation to the system of nerves and senses — a relation not properly recognised by orthodox science to-day. Then I should lead on to the system of liver, gall and spleen, and this cycle of study would gradually open up a vista of the human organism, leading to the knowledge which it is the task of Spiritual Science to develop. Then, with the illumination which would have been shed upon the results of empirical research, one would be able to pass on to therapy.
In the few days at our disposal, it is of course possible for me to give only a few hints about this wide and all-embracing domain. A great deal, therefore, of what I have to say will be based upon an unusual conception of empirical facts, but I think it will be quite comprehensible to anyone who possesses the requisite physiological and therapeutic knowledge. I shall have to use somewhat unfamiliar terms, but there will really be nothing that cannot in some way be brought into harmony with the data of modern empirical knowledge — if these data are studied in all their connections. Everything I say will be aphoristic, merely hinting at ultimate conclusions. Our starting point, however, must be the objective and empirical investigations of modern times, and the intermediate stages will have to be mastered by the work of our doctors. This intermediate path is exceedingly long but it is absolutely essential, for the reason that, as things are to-day, nothing of what I shall bring before you will be whole-heartedly accepted if these intermediate steps are not taken — at all events in regard to certain outstanding phenomena. I do not believe that this will prove to be as difficult as it appears at present, if people will only condescend to bring the preliminary work that has already been done into line with the general conceptions I am trying to indicate here. This preliminary work is excellent in many respects, but its goal still lies ahead.
In the last lecture I tried to show you how a widening out of ordinary knowledge can give us insight into the being of man. And now, bearing in mind what I have just said, let me add the following. It may, to begin with, be a stumbling-block to hear it said in Anthroposophy that man, as he stands before us in the physical world, consists of a physical organisation, an etheric organisation, an astral organisation and an Ego-organisation. These expressions need not be an obstacle. They are used merely because some kind of terminology is necessary. By virtue of this Ego-organisation, the point where his inner experiences are focused and unified, man is able to unfold that inner cohesion of soul-life which is not present in the animal. The Ego is really the focus whence the whole organic activity of man proceeds, in waking consciousness at all events. A further expression of the Ego is the fact that during earthly life the relation of man to sexual development is not the same as that of the animal. Essentially — though of course exceptions are always possible — the constitution of the animal is such that sexual maturity represents a certain point of culmination. After this, deterioration sets in. This organic deterioration may not begin in a very radical sense after the first occurrence of sexual activity, but to a certain extent it is there. On the other hand, the physical development of the human being receives a certain stimulus at puberty. So that even in the outer empirical sense — if we take all the factors into account — there is already a difference here between the human being and the animal.
You may say that it is really an abstraction to speak of physical, etheric, astral and Ego organisations. The objection has in fact often been made, especially from the side of philosophy, that this is an abstract classification, that we take the functions of the organism, distinguish between them, and — since distinctions do not necessarily point back to any objective causes — people think that it is all an abstraction. Now that is not so. In the course of these lectures we shall see what really lies behind this classification and division, but I assure you they are not merely the outcome of a desire to divide things into categories.
When we speak of the physical organisation of man, this includes everything in the organism that can be dealt with by the same methods that we adopt when we are making experiments and investigations in the laboratory. All this is included when we think or speak of the physical organisation of man. In regard to the etheric organisation that is woven into the physical, however, our mode of thought can no longer confine itself to the ideas and laws obtaining when we are making experiments and observations in the laboratory. Whatever we may think of the etheric organisation of man as revealed by super-sensible knowledge, and without having to enter into mechanistic or vitalistic theory in any way, it is apparent to direct perception (and this is a question which would be the subject of lengthy study in my suggested curriculum) that the etheric organisation as a whole is involved — functionally — in everything of a fluid, watery nature in the human organism. The purely physical mode of thought, therefore, must confine itself to what is solid in the organism, to the solid structures and aggregations of matter. We understand the organism of man aright only when we conceive of its fluids as being permeated through and through with life, as living fluids — not merely as the fluids of outer Nature. This is the sense in which we say that man has an etheric body. It is not necessary to enter into hypotheses about the nature of life, but merely to understand what is implied by saying that the cell is permeated with life. Whatever views we may hold — mechanistic, idealistic, animistic or the like — when we say, as the crass empiricist also says, that the cell has life, this direct perception to which I am referring shows that the fluid nature of man is likewise permeated with life. But this is the same as saying: Man has an etheric body. We must think of everything solid as being embedded in the fluid nature. And here already we have a contrast, in that we apply the ideas and laws obtaining in the inorganic world to the solid parts of man's being, whereas we think not only of the cells — the smallest organisms present in man — as living, but of the fluid nature in its totality as permeated with life.
Further, when we come to the airy nature of man, it appears that the gases in his being are in a state of perpetual permutation. In the course of these lectures we shall have to show that this is neither an inorganic permutation nor merely a process of permutation negotiated by the solid organs, but that an individual complex of law controls the inner permutation of the gases in man. Just as there is an inner law in the solid substances, expressing itself, among other things, in the relationship between the kidneys and the heart, so we must postulate the existence of a law within the airy or gaseous organism — a law that is not confined to the physical, solid organs. Anthroposophy describes this complex of law, which underlies the gaseous organism, as astral law, as the astral organisation. These astral laws would not be there in man if his airy organisation had not permeated the solid and the fluid organisations. The astral organisation does not penetrate directly into the solids and the fluids. It does, however, directly penetrate the airy organisation. This airy organisation penetrates the solids and the fluids, but only because the presence of an organised astral nature gives it definite, though fluctuating, inner form. A study of the aggregate conditions thus brings us to the following conclusions: In the case of the solid substances in man we need assume nothing more than a physical organisation; in the case of the living fluidity which permeates the solid, physical organisation, we must assume the existence of something that is not exhausted in the forces of physical law, and here we come to the etheric organism — a system that is self-contained and complete in itself. In the same sense I give the name of astral organisation to that which does not directly penetrate into the solids and fluids but first of all into the airy organisation. I prefer to call this the astral organism because it again is a self-contained system.
And now we come to the Ego-organisation, which penetrates directly only into the differentiations of warmth in the human organism. We can therefore speak of a warmth organism, a warmth ‘being.’ The Ego-organisation penetrates directly into this warmth being. The Ego-organisation is a super-sensible principle and brings about the various differentiations of the warmth. In these differentiations of warmth the Ego-organisation has its immediate life. It also has an indirect life in so far as the warmth works upon the airy fluid and solid organisations.
In this way we gradually gain insight into the human organism. Now all that I have been describing expresses itself in physical man as he lives on the earth. The most intangible organisation of all — the Ego-warmth-organisation — works down indirectly upon the gaseous, fluid and solid organisations; and the same is true of the others. So that the way in which this whole configuration penetrates the constitution of man, as known to empirical observation, will find expression in any solid system of organs, verifiable by anatomy. Hence, taking the various organ-systems, we find that only the physical
— I mean the physically solid system — is directly related to its corresponding (physical) system of laws; the fluid is less directly related, the gaseous still less directly, and the element of warmth least directly of all, although even here there is still a certain relation.
Now all these things — and I can indicate them here only in the form of ultimate conclusions — can be confirmed by an extended empiricism merely from the phenomena themselves. As I say, on account of the short time at our disposal I can only give you certain ultimate conclusions.
In the anatomy and physiology of the human organism we can observe, to begin with, the course taken by the foodstuff. It reaches the intestines and the other intricate organs in that region, and is absorbed into the lymph and blood. We can follow the process of digestion or nourishment in the widest sense, up to that point. If we limit ourselves to this, we can get on quite well with the mode of observation (and it is not entirely mechanistic) that is adopted by natural science to-day. An entirely mechanistic mode of observation will not lead to the final goal in this domain, because the complex of laws observed externally in the laboratory, and characterised by natural science as inorganic law, is here functioning in the digestive tract: that is to say, already within the living organism. From the outset, the whole process is involved in life, even at the stage of the ptyalin-process.
If we merely pay heed to the fact that the complex of outer, inorganic law is involved in the life of the digestive tract, we can get on well quite, so far as this limited sphere is concerned, by confining ourselves merely to what can be observed within the physical organisation of man. But then we must realise that something of the digestive activity still remains, that the process of nourishment is still not quite complete when the intestinal tract has been passed, and that the subsequent processes must be studied from a different point of view. So far as the limited sphere is concerned, we can get on quite well if, to begin with, we study all the transformations of substance by means of analogies, just as we study things in the outer world. But then we find something that modern science cannot readily acknowledge but which is none the less a truth, following indeed from science itself. It will be the task of our doctors to investigate these matters scientifically and then to show from the empirical facts themselves that as a result of the action of the ptyalin and pepsin on the food-stuff, the latter is divested of every trace of its former condition in the outer world.
We take in foodstuff — you may demur at the expression ‘foodstuff’ but I think we understand each other — we take in foodstuff from the mineral, plant and animal kingdoms. It belongs originally to these three realms. The substance most nearly akin to the human realm is, of course, the mother's milk; the babe receives the milk immediately it has left the womb. The process enacted within the human organism during the process of nourishment is this: When the foodstuff is received into the realm of the various glandular secretions, every trace of its origin is eliminated. It is really true to say that the human organisation itself conduces to the purely scientific, inorganic mode of observation. In effect, the product of the assimilation of foodstuffs in man comes nearest of all to the outer physical processes in the moment when it is passing as chyle from the intestines into the lymph and blood-streams. The human being finally obliterates the external properties which the foodstuff, until this moment, still possessed. He wants to have it as like as possible to the inorganic state. He needs it thus, and this again distinguishes him from the animal kingdom.
The anatomy and physiology of the animal kingdom reveal that the animal does not eliminate the nature of the substances introduced to its body to the same extent, although we cannot say quite the same of the products of excretion. The substances that pass into the body of the animal retain a greater resemblance to their constitution in the outer world than is the case with man. They retain more of the vegetable and animal nature and proceed on into the blood-stream still in their external form and with their own inner laws. The human organisation has advanced so far that when the chyle passes through the intestinal wall, it has become practically inorganic. The purely physical nature comes to expression in the region where the chyle passes from the intestines into the sphere of the activity of heart and lungs.
It is really only at this point that our way of looking at things becomes heretical as regards orthodox science. The system connected with the heart and the lungs — the vascular system — is the means whereby the foodstuffs (which have now entered the inorganic realm) are led over into the realm of life. The human organisation could not exist if it did not provide its own life. In a wider sense, what happens here resembles the process occurring when the inorganic particles of albumen, let us say, are transformed into organic, living albumen, when dead albumen becomes living albumen. Here again we need not enter into the question of the inner being of man, but only into what is continually being said in physiology. On account of the shortness of time we cannot speak of the scientific theories as to how the plant produces living albumen, but in the human being it is the system of heart and lungs, with all that belongs to it, which is responsible for the transformation of the albumen into living substance after the chyle has become almost inorganic.
We can therefore say: The system of heart and lungs is there in order that the physical system may be drawn up into the etheric organisation. The system of heart and lungs brings about a vitalising process whereby inorganic substance is raised to the organic stage, is drawn into the sphere of life. (In the animal it is not quite the same, the process being less definite.) Now it would be absolutely impossible for this process to take place in the physical world if certain conditions were not fulfilled in the human organism. The raising and transformation of the chyle into an etheric organisation could not take place within the sphere of earthly law unless other factors were present. The process is possible in the physical world only because the whole etheric system pours down, as it were, into the physical, is membered into the physical. This comes to pass as a result of the absorption of oxygen in the breath. And so man is a being who can walk physically upon the Earth because his etheric nature is made physical by the absorption of oxygen. The etheric organisation is projected into the physical world as a physical system; in effect, that which otherwise could only be super-sensible expresses itself as a physical system, as the system of heart and lungs. And so we begin to realise that just as carbon is the basis of the organisms of animal, plant and man (only in the latter case in a less solid form) and ‘fixes’ the physical organisation as such, so is oxygen related to the etheric organisation when this expresses itself in the physical domain.
Here we have the two substances of which living albumen is essentially composed. But this mode of observation can be applied equally well to the albuminous cell, the cell itself. Only we widen out the kind of observation that is usually applied to the cell by substituting a macroscopic perception for the microscopic perception of the cell in the human being. We observe the processes which constitute the connection between the digestive tract and the system of heart and lungs. We observe them in an inner sense, seeing the relation between them, perceiving how an etheric organisation comes into play and is ‘fixed’ into the physical as the result of the absorption of oxygen.
But you see, if this were all, we should have a being in the physical world possessed merely of a digestive system and a system of heart and lungs. Such a being would not be possessed of an inner life of soul; the element of soul could have its life in only the super-sensible; and it is still our task to show how that which makes man a sentient being inserts itself into his solid and fluid constitution, permeating the solids and fluids and making him a sentient being, a being of soul. The etheric organisation in the physical world, remember, is bound up with the oxygen.
Now the organisation of soul cannot come into action unless there is a point d'appui, as it were, for the airy being, with a possibility of access to the physical organisation. Here we have something that lies very far indeed from modern habits of thought. I have told you that oxygen passes into the etheric organisation through the system of heart and lungs; the astral nature makes its way into the organisation of man through another system of organs. This astral nature, too, needs a physical system of organs. I am referring here to something that does not take its start from the physical organs but from the airy nature (not only the fluid nature) that is connected with these particular organs — that is to say from the airy organisation that is bound up with the solid substance. The astral-organic forces radiate out from this gaseous organisation into the human organism. Indeed, the corresponding physical organ itself is first formed by this very radiation, on its backward course. To begin with, the gaseous organisation radiates out, makes man into an organism permeated with soul, permeates all his organs with soul and then streams back again by an indirect path, so that a physical organ comes into being and plays its part in the physical organisation. This is the kidney system, which is regarded in the main as an organ of excretion. The excretory functions, however, are secondary. I will return to this later on, for I have yet to speak of the relation between the excretions and the higher function of the kidneys. As physical organs the kidneys are excretory organs (they too, of course, have entered the sphere of vitality), but besides this, in their underlying airy nature, they radiate the astral forces which now permeate the airy nature and from thence work directly into the fluids and the solids.
The kidney system, therefore, is that which from an organic basis imbues man with sentient faculties, with qualities of soul and the like — in short with an astral organism. Empirical science has a great deal to say about the functions of the kidneys, but if you will apply a certain instinctive inner perception to these functions, you will be able to discover the relations between inner sentient experience and the functions of the kidneys — remembering always that the excretions are only secondary indications of that from which they have been excreted. In so far as the functions of the kidneys underlie the sentient faculties, this is expressed even in the nature of the excretions.
If you want to extend scientific knowledge in this field, I recommend you to make investigations with a man of the more sensitive type and try to find out the essential change that takes place in the renal excretions when he is thinking in a cold or in a hot room. Even purely empirical tests like this, suitably varied in the usual scientific way, will show you what happens. If you make absolutely systematic investigations, you will discover what difference there is in the renal excretions when a man is thinking either in a cold or a warm room. You can also make the experiment by asking someone to think concentratedly and putting a warm cloth round his head. (The conditions for the experiment must of course be carefully prepared.) Then examine the renal excretions, and examine them again when he is thinking about the same thing and cold compresses have been put on his feet.
The reason why there is so little concern with such inquiries to-day is because people are averse from entering into these matters. In embryological research into cell-fission, science does not study the allantois and the amnion. True, the discarded organs have been investigated, but to understand the whole process of embryonic development the accessory organs must be studied much more exactly even than the processes which arise from the division of the germ-cell. Our task here, therefore, is to establish starting-points for true investigation. This is of the greatest significance, for only so shall we find the way, as we must do, towards seeing man, not as a visible but as an invisible “giant” cell.
To-day, science does not speak of the cell as it speaks of the human being, because microscopy does not lead so far. The curious thing is that if one studies the realm of the microscopic with the methods I am here describing, wonderful things come to light — as for instance the results achieved by the Hertwig school. The cell can be investigated up to a certain point in the microscope, but then there is no possibility of, further research into the more complicated life-processes. Ordinary empiricism comes to a standstill here, but with Spiritual Science we can follow the facts further. We now look at man in his totality, and the tiny point represented by the cell grows out, as it were, into the whole being of man.
From this we can proceed to learn how the purely physical organisation is connected with the structure of carbon, just as the transition to the etheric organisation is connected with the structure of oxygen. If, next, we make exact investigations into the kidney system, we find a similar connection with nitrogen. Thus we have carbon, oxygen, nitrogen; and in order to trace the part played by nitrogen in the astral permeation of the organism, you need only follow, through a series of accurate experiments, the metamorphoses of uric acid and urea. Careful study of the secondary excretions of uric acid and urea will give definite evidence that the astral permeation of man proceeds from the kidney system. This will also be shown by other things connected with the activity of the kidneys, even to the point where pathological conditions are present — when, let us say, we find blood corpuscles in the urine. In short, the kidney system radiates the astral organisation into the human organism. Here we must not think of the physical organisation, but of the airy organisation that is bound up with it. If nitrogen were not present, the whole process would remain in the domain of the super-sensible, just as man would be merely an etheric being if oxygen were not to play its part. The outcome of the nitrogen process is that man can live on earth as an earthly being. Nitrogen is the third element that comes into play.
There is thus a continual need to widen the methods adopted in anatomy and physiology by applying the principles of Spiritual Science. It is not in any sense a matter of fantasy. We ask you to study the kidney system, to make your investigations as accurately as you possibly can, to examine the urea and the excretions of uric acid under different astral conditions, and step by step you will find confirmation of what I have said. Only in this way will the mysteries of the human organism reveal themselves to you.
All that enters into man through the absorption of foodstuff is carried into the astral organism by the kidney system. There still remains the Ego-organisation. The products of digestion are received into the Ego-organisation primarily as a result of the working of liver and gall. The warmth and the warmth-organisation in the system of liver and gall radiate out in such a way that man is permeated with the Ego-organisation, and this is bound up with the differentiations of warmth in the organism as a whole.
Now it is quite possible to make absolutely exact investigations into this. Take certain lower animals where there is no trace at all of an Ego-organisation in the psychological sense, and you will find no developed liver, and still less any bile. These develop in the phylogeny of the animal kingdom only when the animal begins to show traces of an Ego-organisation. The development of liver and gall runs absolutely parallel with the degree to which the Ego-organisation unfolds in a living being. Here, too, you have an indication for a series of physiological investigations in connection with the human being, only of course they must cover the different periods of his life. You will gradually discover the relation of the Ego-organisation to the functions of the liver.
In certain diseases of children you will find, for instance, that a number of psychical phenomena, tending not towards the life of feeling but towards the Ego-activities, are connected with the secretion of gall. This might form the basis for an exceedingly fruitful series of investigations. The Ego-organisation is connected with hydrogen, just as the physical organisation is connected with carbon, the etheric organisation with oxygen and the astral organisation with nitrogen. It is, moreover, possible to relate all the differentiations of warmth — I can only hint at this — to the specific function carried out in the human organism by hydrogen in combination with other substances. And so, as we ascend from the material to the super-sensible and make the super-sensible a concrete experience by recognising its physical expressions, we come to the point of being able to conceive the whole being of man as a highly complicated cell, a cell that is permeated with soul and Spirit.
It is really only a matter of taking the trouble to examine and develop the marvelous results achieved by natural science and not simply leaving them where they are. My understanding and practical experience of life convince me that if you will set yourselves to an exhaustive study of the results of the most orthodox empirical science, if you will relate the most obvious with the most remote, and really study the connections between them, you will constantly be led to what I am telling you here. I am also convinced that the so-called ‘occultists’ whom you may consult — especially ‘occultists’ of the modern type — will not help you in the least. What will be of far more help is a genuine examination of the empirical data offered by orthodox science. Science itself leads you to recognise truths which can be actually perceived only in the super-sensible world, but which indicate, nevertheless, that the empirical data must be followed up in this or that direction. You can certainly discover the methods on your own account; they will be imposed by the facts before you. There is no need to complain that such guiding principles create prejudice or that they influence by suggestion. The conclusions arise out of the things themselves, but the facts and conditions prove to be highly complicated, and if further progress is to be made, all that has been learned in this way about the human being must now be investigated in connection with the outer world.
I want you now to follow me in a brief line of thought. I give it merely by way of example, but it will show you the path that must be followed. Take the annual plant which grows out of the earth in spring and passes through its yearly cycle. And now relate the phenomena which you observe in the annual plant with other things — above all with the custom of peasants who, when they want to keep their potatoes through the winter, dig pits of a certain depth and put the potatoes into them so that they may keep for the following year. If the potatoes were kept in an ordinary open cellar, they would not be fit to eat. Investigations have proved that the forces originating from the interplay between the sunshine and the earth are contained within the earth during the subsequent winter months. The dynamic forces of warmth and the forces of the light are at work under the surface of the earth during the winter, so that in winter the after-effects of summer are contained within the earth. The summer itself is around us, above the surface of the Earth. In winter, the after-effects of summer work under the earth's surface. And the consequence is that the plant, growing out of the earth in its yearly cycle, is impelled to grow, first and foremost, by the forces that have been poured into the earth by the sun of the previous year. The plant derives its dynamic force from the soil. This dynamic force that is drawn out of the soil can be traced up into the ovary and on into the developing seed. So you see, we arrive at a botany which really corresponds to the whole physiological process, only if we do not confine ourselves to a study of the dynamic forces of warmth and light during the year when the plant grows. We must take our start from the root, and so from the dynamic forces of light and warmth of at least the year before. These forces can be traced right up into the ovary, so that in the ovary we have something that really is brought into being by the forces of the previous year.
Now examine the leaves of a plant, and, still more, the petals. You will find that in the leaves there is a compromise between the dynamic forces of the previous year and those of the present year. The leaves contain the elements that are thrust out from the earth and those which work in from the environment. It is in the petals that the forces of the present year are represented in their purest form. The colouring and so forth of the petals represents nothing that is old — it all comes from the present year.
You cannot follow the processes in an annual plant if you take only the immediate conditions into consideration. Examine the structural formations which follow one another in two consecutive years — all that the sun imparts to the earth, however, has a much longer life. Make a series of experiments into the way in which the plants continue to be relished by creatures such as the grub of the cockchafer, and you will realise that what you first thought to be an element belonging to the present year must be related to the sun-forces of the previous year. — You know what a prolonged larval stage the cockchafer passes through, devouring the plant with relish all the time.
These matters must be the subject of exact research; only the guiding principles can be given from the spiritual world. Research will show that the nature of the substances in the petals and leaves, for instance, is essentially different from that of the substances in the root or even the seed. There is a great difference between a decoct ion prepared from the petals or leaves of plants and an extract of substances found in roots or seeds. The effect of a decoction prepared from petals or leaves upon the digestive system is quite different from that of an extract prepared from roots or seeds. In this way you relate the organisation of man to the surrounding world, and all that you discover can be verified in a purely material sense. You will find, for instance, that disturbances in the process of the transition of the chyle into the etheric organisation, which is brought about by the system of heart and lungs, will be influenced by a preparation decocted from the petals of plants. An extract of roots or seeds influences the wider activity that works on into the vascular system and even into the nervous system. Along these lines we shall discover the rational connection between what is going on within the human organism and the substances from which our store of remedies may be derived.
In the next lecture I shall have to continue this subject, showing that there is an inner connection between the different structures of the plants and the systems of nerves and senses and digestion in man.