Donate books to help fund our work. Learn more→

The Rudolf Steiner Archive

a project of Steiner Online Library, a public charity

Spiritual Science and Medicine
GA 312

Lecture II

22 March 1920, Dornach

Let us now continue our inquiry on the lines already laid down, and attempt to elucidate the nature of man by observing certain Polarities governing the human organism. Yesterday we found ourselves obliged to combine the weighing down forces found in the animal with certain vertical forces to form a parallelogram, and to consider an analogous phenomenon in the chemical reactions of the muscle. If these ideas are followed up in the study of the bone and muscular system and are supported by all the resources of practical experience, we might make Osteology and Muscular Pathology of greater value for medicine than has hitherto been the case. Special difficulties arise, however, if we try to connect the knowledge of man with the needs of medicine today, in our consideration of the heart. What in Osteology and Myology is only a slight defect becomes an evident defect in Cardiology. For, what is the common belief about the nature of the human heart? It is regarded as a kind of Pump, to send the blood into the various organs. There have been intricate mechanical analogies, in explanation of the heart's action—analogies totally at variance with embryology, be it noted!—but no one has begun to doubt the mechanical explanation, or to test it, at least in orthodox scientific circles.

My outline of the subjects for consideration in the next few days will afford piecemeal proof of my general point of view. The most important fact about the heart is that its activity is not a cause but an effect. You will understand this if you consider the polarity between all the organic activities centering round nutrition, digestion, absorption into the blood, and so on: follow, passing upwards through the human frame, the process of digestion up to the interaction between the blood that has absorbed the food, and the breathing that receives air. An unbiased observation will show a certain contrast and opposition between the process of respiration and the process of digestion.

Something is seeking for equipoise; it is as though there were an urge towards mutual saturation. Other words, of course, could be chosen for description, but we shall understand each other more and more. There is an interaction in the first place between the liquefied foodstuffs and the air absorbed into the organism by breathing. This process is intricate and worth attention. There is an interplay of forces, and each force before reaching the point of interplay accumulates in the heart. The heart originates as a “damming up” organ (Stauorgan) between the lower activities of the organism, the intake and working up of food, and the upper activities, the lowest of which is the respiratory. A damming up organ is inserted and its action is therefore a product of the interplay between the liquefied foodstuffs and the air absorbed from the outside. All that can be observed in the heart must be looked upon as an effect, not a cause, as a mechanical effect, to begin with. The only hopeful investigations on these lines, so far, have been those of Dr. Karl Schmidt, an Austrian medical man, practising in North Styria, who published a contribution to the Wiener Medizinische Wochenschrift (1892, No. 15), “The Heart Action and Curve of the Pulse.” The content of this article is comparatively small, but it proves that his medical practice had enlightened the author on the fact that the heart in no way resembled the ordinary pump but rather must be considered a dam-like organ. Schmidt compares cardiac action to that of the hydraulic ram, set in motion by the currents. This is the kernel of truth in his work. But we need not stop short at the mechanical aspect if we consider the heart action as a result of these symbolic inter-penetrating currents, the watery and the airy. For what is the heart after all? It is a sense organ, and even if its sensory function is not directly present in the consciousness, if its processes are subconscious, nevertheless it serves to enable the “upper” activities to feel and perceive the “lower.” As you perceive external colours through your eyes, so do you perceive, dimly and subconsciously through your heart, what goes on in the lower abdomen. The heart is an organ for inner perception.

The polarity in man is only comprehensible if we know that his structure is a dual one and that the upper portion perceives the lower. The following too must be considered: the lower functions—one pole of the whole human being—are considered through the study of nutrition and digestion in the widest sense, up to their interaction with respiration The interaction goes on in a rhythmic activity; we shall have to consider the significance of our rhythmic system later. But linked up with and belonging to the respiratory activity there is the sensory and nervous activity, which includes all that appertains to external perception and its continuation and its being worked up in the nervous activity. Thus, respiration and sensory and nervous activity form one pole of the human organism. Nutrition, digestion, and metabolism in its usual sense, form the other pole of our organisation. The heart is primarily that organ whose perceptible motion expresses the equilibrium between the upper and lower processes; in relation to the soul (or perhaps more accurately in the sub-conscious) it is the perceptive organ that mediates between these two poles of the total human organisation. Anatomy, physiology, biology can all be studied in the light of this principle; and thus light is thrown, and only thus, upon the human organisation. As long as you do not differentiate between these two poles, superior and inferior, and their mediator the heart, you will not be able to understand man, for there is a fundamental difference between the two groups of functional activity in man, according to whether they pertain to the upper or the lower polarity.

The difference amounts to this: all the processes of the lower sphere have their “negative” so to speak, their negative counter-image in the upper. The important point, however, is that there is no material connection between these upper and lower spheres, but a correspondence. The correspondence must be correctly apprehended. without search for or insistence on direct material connection.

Let us take a very simple example: the tickling irritation which causes coughing, and the actual cough itself. In so far as they belong to the upper sphere their complementary counterpart in the lower sphere is diarrhea. There is always a counterpart to every such activity. And the key to the understanding of man consists in the correct apprehension of these correspondences with several of which we shall deal in the course of our study.

Furthermore, there is not only a theoretical correspondence, but, in the healthy organism, an actual close contact between upper and lower spheres. In a healthy organism this contact is so close, that any upper function, whether it be associated with respiration or with the nerves and senses, must somehow govern a function of the lower sphere and proceed in harmony with it. This will provide us later on with the key to the process of disease: there immediately arises an organic irregularity, whenever there is a predominance of either the upper or the lower function, which destroys its complementary equilibrium. There must always be a certain proportion and correspondence between these two sets of activities, so that they complete one another, master one another, proceed harmoniously as they are mutually orientated. For there is this definite orientation. It is individually different in individual human beings, but nevertheless it governs and relates the whole of the upper processes to the whole of the lower.

Now we must be able to find the bridge leading from the healthily functioning organism, (in which the upper spheres correspond harmoniously with the lower) to the diseased organism. In describing a disease one may start from the indications in what Paracelsus called the “Archaeus” and we call the “Etheric body”—or, if to avoid offending people who do not like these terms, you can also say you will speak in the first place of indications of disease in the functional or dynamic, i.e. of the first signs of a morbid condition. And if we speak of what is first indicated in the etheric body or in the purely functional, one can also speak of a polarity, but a polarity which bears within it a non-correspondence, an irregularity, arising in the following manner.

Let us assume that within the lower sphere, that is to say, the apparatus of nutrition and digestion in the widest sense, there is a preponderance of the inner chemical or organic forces of the food which has been eaten. In the healthy organism it is essential that all the forces active and immanent in the foodstuffs themselves, which we examine and test in our laboratory work on these foodstuffs, should be overcome by the upper sphere, so that they do not in any way interfere with the efficiency of the inner sphere of the organism and that all activity from external chemistry and dynamics has been entirely overcome. But the upper sphere may be inadequate to the task of penetrating the lower, of thoroughly brewing, or I might say, etherising it—which is more exact—all through. The result is the transference into the human organism of a preponderant process which is foreign to the organism, a process such as normally takes place outside the human body and should not operate within that body. As the physical body does not at once bear the brunt of these irregularities, the first symptoms appear on the functional side, in the etheric body (Archaeus). If we wish to find a current term to designate certain aspects of this irregular function, we must call it Hysteria. We shall use the term Hysteria for the too great autonomy of the processes of Metabolism; and we shall learn later on that the name is not inappropriate.

Specific manifestations of hysteria in its narrower sense are nothing but this irregular metabolism raised to its culmination. In essence, the hysterical process, even in it's sexual symptoms, consists of metabolic irregularities, which are external processes having no rightful place in the human body. That is, they are processes which the upper sphere has been too weak to master and control.

This is one pole of disease. If such morbid manifestations as are hysterical in character appear, we have to deal with an excess of an activity that belongs to the external world, but is operating in the lower sphere of the human organism.

But the same irregularity of reciprocal action can also arise if the upper process does not take place in the proper way and occurs in such a way as to overstrain the upper organisation. This is the opposite, and in some sense, the negative of the lower processes. It is not that the upper processes are over-stimulated; they cease, as it were, before the mediating action of the heart transmits them to the lower sphere. This type of irregularity is too strong spiritually, too organically-intellectual, if I may use such a term, and shows itself as Neurasthenia. This is the other pole. We must keep these two irregularities of the human organism clearly before us—they remain still in the realm of mere functions, they are two defects, expressed respectively in the upper and the lower sphere. And we shall gradually have to learn that the human polarity tends towards either the one or the other deficiency.

Neurasthenia is a functional excess of the upper sphere. The organs of that sphere are too much occupied, so that processes which should be transferred and conducted downwards through the heart, take place in the upper sphere and do not pass into the lower organic currents (harmoniously mediated by the damming up in the heart). You will observe that it is much more important to become aware, so to speak, of the specific physiognomy of the disease than to study by post-mortems the organs which have become defective. For post-mortems reveal only the results and symptoms. The essential thing is to form a comprehensive picture of the whole morbid condition; to visualise its physiognomy. This physiognomy will always reveal a tendency in one or the other direction towards the Neurasthenic or the Hysterical Type. But of course, we must use these terms in a wider sense than that usually accepted. If one has acquired an adequate picture of the interaction of the upper and lower spheres, one will gradually learn that irregularity manifesting functionally only in its initial stages—and therefore, as we should say in the etheric sphere—becomes denser in its forces and takes hold of the physical organism. Thus, what was at first merely a tendency to hysteria, may take physical form in various abdominal diseases. And conversely, neurasthenia may develop into diseases of the throat or head.

The study of this imprint of what were originally only functional irregularities of neurasthenia and hysteria, will be of the utmost significance for the medicine of the future. If hysteria has become organic, there will be disturbances of the whole digestive process and all the other processes of the abdominal sphere. Such processes have their repercussions on the whole organism; we must be careful to bear these repercussions and reactions in mind.

Now let us suppose that a manifestation which would be undoubtedly hysterical, if it were manifested functionally, does not come to expression at all as a disturbance of function. It does not appear in the functional sphere, the etheric body imprints it immediately into the physical body. It is there, but it is not evident in any definite disease of the lower organs. We may say indeed that the organs bear the signature of hysteria. It has been driven into the physical organism, and therefore does not manifest by hysterical symptoms on the psychological plane; and it is not yet sufficiently pronounced to become an appreciable physical affliction. But it is strong enough to work within the whole organism. Thus we have this peculiar condition: something on the borderland, so to speak, between sickness and health influences the upper organic sphere from the lower. It reacts on the upper sphere and in some sense infects it, appearing in its own negative. This phenomenon, in which so to speak, the first physical effects of hysteria affect those regions which are subject to neurasthenia in their own typical irregularities, gives a tendency to Tuberculosis. This is an interesting connection. The tuberculous tendency is a repercussion of the abnormal action of the lower body sphere on the upper, as has just been outlined. The whole of this remarkable interaction is set in motion by an uncompleted process which reacts on the upper sphere, and produces a tendency to tuberculosis. And it is necessary to recognise this primary tendency of the human organism before any rational antidote to tuberculosis can be discovered. For the invasion of the human body by pathogenic bacteria is only a result of primary tendencies such as I have described.

This does not contradict the fact that tuberculosis is infectious under certain conditions. Of course these conditions are a necessary prerequisite. But unfortunately this predominance of the activity of the lower organic sphere is alarmingly prevalent in present-day humanity, and this implies a disastrously frequent predisposition to tuberculosis.

The concept of infection, however, is none the less valid here. For any highly tuberculous individual affects his fellow beings: and if any person is exposed to the sphere in which the tuberculous patient lives, then it may happen that the effect turns again into a cause. I have often tried to illustrate the relationship between primary causes of a disease and infection in the following analogy. Suppose that I meet a friend of mine, whose relations with other people do not in general touch me. He is sad and has reason to be so, for he has lost one of his friends by death. I have no direct relationship with this friend who has died, but I become sad with him at his sad news. His sadness is, so to speak, first hand and direct; mine arises indirectly, communicated through him. Nevertheless, the fact remains that the mutual relationship between me and my friend provides the pre-condition for this “infection.”

Thus both concepts—of primary origin and of infection—are justified, and are so especially in the case of tuberculosis. But they should be applied in a rational manner. Institutions for the treatment of tuberculous persons are often breeding grounds for tuberculosis. If tuberculous persons are to be collected and crowded together in special institutions, then these institutions should be dissolved and replaced by others as often as possible. There should, in fact, be a time limit for their dispersion and removal. For this disease has the peculiarity that its victims are extremely liable to secondary infections. A case which may be by no means hopeless, becomes serious if it is surrounded by severe cases of tuberculosis. For the present, however, I am referring to the specific nature of tuberculosis. And it offers a striking example of the interaction of various processes in the human organism. As you will observe, such processes are dominated by the polarity of the upper and lower spheres, which correspond to one another as positive and negative images. The particularly striking phenomena which lead to tuberculosis following the special organic constitution which I have indicated, may be followed up; and they reveal in their future development a general concept of the true nature of disease. Let us take the most frequent symptoms of an individual who is an incipient tuberculous case. Tuberculosis is in his future, and his present state prepares for it. We find perhaps that he coughs, feels pain in the throat and chest, and perhaps also in his limbs; there will be certain states of exhaustion and fatigue; and there will be profuse sweating at night.

If we take all these symptoms together what do they mean? They are, first of all, the effect of those internal irregular interactions to which I have referred. And at the same time, they represent the resistance offered by the organism, its struggles against the deeper foundation of the disease. Let us take the simpler manifestations first. It is certainly not always and under all circumstances beneficial to attempt to stop a cough. It may even sometimes be necessary to stimulate coughing by artificial means. If the lower organic sphere cannot be controlled by the upper, the healthy reaction manifests as the irritation leading to coughing, in order to prevent the invasion of certain things which are undesirable. To suppress coughing as an invariable rule, may be deleterious, for the body will then absorb injurious substances. Coughing is the attempt to get rid of such substances, which cannot be tolerated under the prevailing conditions. Thus the tickling irritation which provokes coughing is a danger signal of something which is wrong in the organism, so that the need arises to repel the invaders, which could otherwise easily effect an entry.

What of the other symptoms, enumerated above? They too are forms of organic defence, ways of doing battle with the dangers which approach as the tubercular tendency. The pains in the throat and limbs simply proclaim the obstruction of those processes in the lower sphere, which are not adequately controlled by the upper. If the tubercular tendency is perceived in good time, it may be beneficial to support the resistant organism by moderate stimulation of the coughing, by stimulating the resultant phenomena—as will be indicated in the subsequent lectures—by appropriate diet, and even by stimulating the typical fatigue. Again, if there is marked emaciation, this too is only a form of organic defence. For if this emaciation does not take place, the process which develops is perhaps that activity of the lower sphere which the upper cannot control. The organism dwindles and loses weight, in order to defend itself by getting rid of those elements which cannot be controlled by the upper sphere.

Thus it becomes exceedingly important to study symptoms and cases in detail, but not in order immediately to prescribe a corpulency treatment for any one suffering from emaciation. For this emaciation may be highly beneficial, in relation to the actual organic conditions at the time.

An especially instructive characteristic of the incipient tuberculous subject, is the heavy loss of perspiration at night. This is a form of organic activity taking place during sleep, which should really take place during working hours, during full physico-spiritual awakeness. But it does not do so, and is obliged to find expression during sleep. This is both a symptom and a method of defence. When the organism is relieved from spiritual occupation, it has recourse to the form of activity manifest in “night sweats.”

To evaluate this fact properly, we must know something of the close connection between all the excretory processes and those activities which include soul and spirit. The constructive processes, the vital processes proper, are the foundation of the mere unconscious. Corresponding to the conscious soul and organic functions of our waking hours, are always processes of excretion. Even our thinking does not correspond to constructive cerebral processes, but to processes of excretion, i.e. destruction. And night sweats are an excretory phenomenon which should be concurrent with a spirit and soul activity in normal life. But as the upper and lower spheres are not in correct interaction with one another, the excretory process accumulates and then takes place at night, when the organism is relieved from spirit and soul activity.

Thus you will see that a careful study of all the processes connected with growth and development in the healthy and the diseased human organism leads to the conclusion that there is an interaction between the phenomena of disease. Emaciation is one phenomenon. But in its relation to the tubercular tendency, it is part of the disease. Indeed I would say that the phenomena of disease are organically linked up. They constitute an ideal organisation. One such phenomenon belongs in a sense to another. Therefore it is entirely reasonable to come to the help of an organism—keeping to the example of incipient tuberculosis—which has not the strength to react adequately and to provoke from outside the necessary reaction, viz. that one form of disease is made to follow on another. The doctors of old enunciated this truth as a significant educational rule of medicine. They said: The danger of being a physician is that he must not only be able to cure sicknesses but must also provoke them. And in the same measure in which the physician is able to heal diseases he can also provoke them. The ancient world was more aware of these subtle inter-relationships (through the atavistic power of clairvoyance) and they beheld in the physician a double power, who could smite with sickness, if he were of evil will, as well as cure. This aspect of medicine is associated with the need to provoke certain states of disease, in order to put them into a certain relation to others. Such conditions as coughing, pains in the throat and chest, emaciation, persistent fatigue, profuse nocturnal perspiration, all are symptoms of disease, yet they must sometimes be provoked, even though they are diseased.

This will naturally lead to the duty not to abandon the sick person when only half-healed, i.e. when the necessary phenomena have been provoked for then the second stage of the healing process begins. We must not only see to it that the appropriate counter-reactions have taken place, but that these reactions are now cured and the whole organism restored to its proper way of functioning. Thus in tubercular cases, having stimulated coughing and pains in the throat, for example, we must then pay heed to the processes of elimination; for there will then be always a tendency to constipation and stasis. It will be necessary to quicken the digestive function into a function of evacuation, even to the extent of stimulating diarrhea. It is always necessary to stimulate diarrhœtic action, following the provoked coughing, pains in the throat and similar symptoms. For we must not consider or treat manifestations of the upper sphere, as though confined to that sphere alone. We must often seek a cure through the processes of the lower sphere, even where there is no direct material connection but merely a correspondence.

These correspondences deserve the most careful consideration. Let us take as an example the typical fatigue and exhaustion. I should prefer not to regard this fatigue as purely subjective, but as organically determined, as emerging always when the metabolic processes are not fully controlled by the upper sphere. Now if these conditions of fatigue have to be stimulated in the treatment of tuberculosis, they must be subsequently countered, at the appropriate moment, by means of a diet which activates the digestion. (We shall deal later with the special requisites of such a diet). Thus the person in question will digest his food better and more easily than usual.

Emaciation, similarly, should receive a dietary treatment, leading to a degree of fat formation which cushions the organs and their tissues. And the subsequent treatment of night sweating, after powerful stimulation, must be through the suggestion of activities in which there are spiritual efforts to be made; the patient makes efforts bound up with thoughts, which make him sweat until a normal perspiration is gradually regained.

It is obvious that if we first realise the correspondence between the upper and lower sphere in man, by a correct understanding of the cardiac function, then we can understand the first fore-shadowing of the disease on the functional plane in the etheric body, as we have done in the case of Neurasthenia and Hysteria. Then we can pass on to an understanding of its imprints on the organic and physical structure, and finally to the physiognomy of the disease as a whole. This comprehensive image will enable us to stimulate the course of sickness in the direction of a more or less secondary disease, in order, when the time has come, to lead the whole process back to health.

Of course the worst obstacles to these therapeutic methods are external and social conditions; therefore medicine is to a large extent a social problem. On the other hand, the patients themselves offer grave difficulties, for they expect their doctors to “get rid of something”, as they often express themselves. But if we simply “get rid of” some existent condition, it may well be that we make their state worse than before. This must be taken into account; often one does make them worse than before, but they must then wait till the opportunity arises to restore them to health once more. Before that can happen, however, as many of you can testify, they have only too often fled and ceased treatment!

So the proper study of both the sick and the sound human being convinces us that the physician must have a hand in the after-treatment if the whole treatment is to be of real value. And you must direct your efforts publicly to this goal. We live in a time of belief in authority and it should not be difficult to initiate such public efforts and emphasise their necessity. I must, however, beg your permission to observe that neither the individual patients of the medical profession find it inopportune to follow up all the ultimate ramifications of disease, and are more or less satisfied if they have “got rid of” something.

You will observe that this correct perception of the role of the heart in the human organism is able to lead us gradually into the essence of the state of disease. It is, however, vital to note the radical difference between the activities of the lower organic sphere, which have to some degree overcome external chemical processes (but are yet at the same time somewhat like the upper activities)—and the upper activities which are opposed and polar to them.

It is extraordinarily difficulty to define this organic dualism adequately, for our language has hardly any terms to indicate processes contrary to the physical and the organic. But perhaps you will understand clearly—and I shall not hesitate to come up against possible prejudices amongst you—if I try to elucidate this dualism with the following analogy. We shall deal in detail with the subject later on.

Diagram 5

Let us think of the qualities proper to any sort of material substance, that is, the qualities essential to its working when absorbed into the lower sphere of the organism, e.g. through the digestion. But if I may use the expression—we can homeopathise, we can dilute the aggregate states of the substances in question. This is what happens if one dilutes in the way of homeopathic doses. Here something occurs which does not receive due attention in the Natural Science of today, for mankind has a strong tendency to abstractions. They say, for example, that from a source of light—for example, the sun—the light radiates in all directions, and finally disappears into infinity. But this is not true. No such form of activity vanishes into infinite space, but it extends within a certain limited orb and then rebounds elastically, returning to its source, although the quality of this return is often different from its centrifugal quality. (See Diagram 5). In Nature there are only rhythmical processes, there are none which continue into infinity. They revert rhythmically upon themselves. That is not only the case in quantitative dispersion, but also in qualitative. If you subdivide any substance, it has at first certain distinctive qualities. These qualities do not decrease and diminish ad infinitum; at a certain point, they are reversed and become their opposites. And this intrinsic rhythm is also the foundation of the contrast between the upper and lower organisation. Our upper organisation works in a homeopathic way. In a certain sense it is diametrically opposed to the process of ordinary digestion, its opposite and negative. Therefore we might say that when the homeopathic chemist manufactures his minute dilutions, he thereby transfers the qualities which are otherwise linked with the lower organic sphere, into those which belong to the upper sphere. This is a most significant inner relationship and we shall discuss it in the ensuing lectures.