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Cancer and the twentieth century
Cancer and the twentieth century L. R . T W E N T Y M A N ,
M . B . , B . C I ~ . , r'.r'.rIOM.
I t is an obvious need of our time to widen our ideas of disease and to grasp it in its whole relationship to human life. Under the influence of modern natural scientific thinking our conception of disease has become narrower and narrower until today we regard it as a tiresome accident of genetic make-up or of environmental hazard. I t is a meaningless nuisance. One way of approaching this task is the historical, extending our outlook from the pressures of the daily surgery to the experiences of centuries. Even in this century there have been remarkable changes in the patterns of disease. Acute lobar pneumonia was a common, severe, dramatic disease of sudden onset, violent course and often sudden crisis and resolution. I t killed many people in the prime of life. Statistics show that it decreased steadily throughout the century and had almost vanished by about 1943, before the antibiotics had come into use. Acute lobar pneumonia is now a rarity. The acute febrile epidemic diseases of childhood have decreased in severity and the mortality from them has become of very little importance. Immunization against diphtheria became more common as the century progressed and the number of eases of diphtheria correspondingly reached vanishing point. But at the same time the mortality from measles, whooping cough and scarlet fever also fell at about the same speed. We have seen a steady fall in tuberculosis which has continued since the introduction of chemotherapy and antibiotics, but it is difficult to show that the pre-existent rate of decline has been appreciably changed. Tuberculosis which was a disease predominantly of adolescence and early adult life is now more likely to be found in the elderly. Meanwhile carcinoma of the bronchus has increased to an extraordinary extent, replacing, so it appears, tuberculosis. Another dramatic change has occurred in heart disease, w:here coronary thrombosis has replaced rheumatic heart disease as the common heart condition filling medical beds. Generally speaking the diseases which used to be responsible for infant, childhood and adolescent deaths have receded in importance. Very many more of us reach 25 years of age, but our statistical expectation of life at 25 has changed very little since the beginning of the century. The acute, inflammatory diseases characterized by a short course and with a tendency to self-cure are now less important, whilst the chronic progressive diseases characteristic of the second half of life assume greater importance. This already gives us the first great division of human diseases which I-Iahnemann had distinguished 150 years ago. They constitute to a considerable extent a polarity, they represent two opposite ways of falling ill. In fever we are in danger of being dissolved back again to the plasticity of prenatal existence; in the hardening diseases Such as arteriosclerosis and cancer we are in danger of being prematurely overwhelmed by the forces of death. From this we can see that Health must be continually re-established as an ever-changing balance
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between these two poles as we pass from childhood to old age. We can see that this balance has changed dramatically during this century. Cancer has become the disease of the age. Turning from diseases themselves for a moment, to the ideas about disease, we can also see a constant change and transformation going on. The old Greek ideas of the four humours, whose disbalance was understood to constitute disease, continued, under the banner of Galen, right through the Middle Ages and only vanished finally during the last century. The last textbook of pathology based on it, written b y Rokitansky (1804-78), was written in 1842. I t is weUnigh impossible for us to understand such ideas today. The four elements and humours were certainly not conceived as is m a t t e r in our modern materialistic conception. They were felt to be at least as much cosmic as earthly. Today we have come to think t h a t the laws of matter discovered by science on earth are equally valid throughout the space of the universe. To the ancients this would have been absurd. The elements aud humours had spiritual qualities as well as material. I t was only gradually that the modern, entirely quantitative idea of m a t t e r became established and the qualitative aspects relegated to the non-spatial world of the soul. Philosophically Locke's separation of the so-called primary and secondary qualities of m a t t e r prepared the way and Dalton's establishment of the atomic theory provided an acceptable method. Simultaneously with this establishment of the atomic theory, which made it possible to pursue a purely quantitative idea of matter, there arose in H a h n e m a n n the discovery of potentization. Through this process the qualitative aspects of substances were released from any molecular, weighable basis. Obviously these two movements arising at the same time in history must be seen together. Through them the old vision of qualitative-quantitative substance was replaced, the dominant movement of science pursuing up to the present time an almost exclusively quantitative method, and the homceopathic school as a minority pursuing an almost purely qualitative approach. At the moment when the medieval world gave way to the Renaissance, the modern natural scientific movement began. Copernicus was a doctor, trained at Padua, and his work in astronomy is usually taken as the great beginning of modern natural science. His contemporary Vesalius (1514-64) founded modern anatomy, the basis of all modern medicine, whilst another great contemporary, Paracelsus (1493-1541), was turning the traditions of 2 000 years upside-down. All this and much more followed almost instantly on Columbus' return from the Caribbean. We shall return to this, but for the moment we must pursue the impact of natural science on medical ideas. Following the work of Servetus, W. H a r v e y (1578-1657) developed the basis of the modern mechanical idea of physiology. All these men were still half embedded in the old world conceptions. H a r v e y himself, who is so often quoted as the example par excellence of the scientific method, nevertheless in his great life's work on embryology regarded anyone a fool who studied the subject apart from astrology. I t should be remembered t h a t the task of editing Newton's most prolific work is only at the beginning, and apparently most of it is concerned with astrology. Gradually the inclination towards exclusively mechanical conceptions gained ground. I n Paracelsus one can still discern a direct perception of life principle in his Archaeus, but soon this degenerated into a mere abstract vital force neither measurable nor perceivable. Morgagni (1682-1771) became the father of modern morbid a n a t o m y and based his conceptions of disease on the observable
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changes in bodily organs. The whole structure of pathology as the basis for medicine took a gigantic stride forward and medical thinking began to assimilate the ideas of disease to observable change in organs, to what can be seen in the corpse. How difficult it has been ever since for a n y trained doctor to raise his thinking about disease out of this trough. Bichat (1771-1802) in Napoleonic France took the next step. I n spite of the fact t h a t he was a most serious Vitalist, his main influence was to direct attention to the tissues which underlay the organs. The seat of disease must be sought in these rather than just in the organs. Histology thus became the inner arcanum of morbid anatomy. The next step taken, after the discovery of the cell, was ~irchow's (1821-1902) cellular pathology. I n this the anatomical basis of disease took a further leap forward and all, even general, diseases were to be studied in terms of disturbed cell function. I n our day we have seen further steps in reducing the seat of the phenomena of illness to the smallest possible points, in genes and other intracellular entities, a process comparable with the movement in physics from atoms to electrons, protons, etc., etc., and now to the lesser fleas, the quarks and their brothers. The forces studied in natural science have until our own day been those radiating from centres in the manner of gravity. To apply the fruit of such work to biology and medicine needed this progressive diminution from the whole body in its cosmic relationships, humoral pathology; to organs, morbid anatomy; to tissues, histopathology; to cells, cellular pathology, and now to genetic studies and molecular biology. Whilst admiring the immense labours which have been devoted to this edifice of modern pathology and the huge amount of knowledge accumulated in it, we must also note, from other viewpoints, t h a t it has its shortcomings. The great fruit of cellular pathology has been the almost monopolistic study of cancer as a disease of the cell. All wider aspects of the disease, its connections with the human being as a whole and with the developing consciousness of mankind, have been weUnigh ignored. I n no disease has so determined an effort been made to treat it as a local disease, a disease of the cell or even of chromosomes and genes, an entirely exclusively localized mechanical conception. Only today are wider conceptions coming in again, with the few studies on psychosomatic aspects of cancer and in the growing field of investigations into immunology and hormone dependence. The fruit of this scientific progress has been a purely mechanical conception of the body and of disease, in which no place remains for a soul. The significance of the body for our inwardness, our experience, has become entirely elusive and problematic. As Bergson said, we have made the concept of the body so exclusively mechanical and of the soul so entirely subjective and non-extended t h a t no connection between them is possible. I t is understandable therefore t h a t in this century a revolution exploded and psycho-analysis and depth psychology came on the scene. Exploring the actual experiences of people and the phenomena of dreams, and art, m y t h and poetry, an old, old world began to re-emerge, one of meaning and significance. But if the main stream of materialist thought was busy eliminating the soul and reducing psychology to behaviourism, the movement of depth psychology has tended to study the soul without relation to the body and organs in which it resides. I n this situation all the a t t e m p t s at a psychosomatic discipline of medicine have grown up, and at the same time social medicine in its wider perspectives.
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The concept of cancer which still reigns in practice and research is the conclusion of the trend of materialist thought over four centuries. I t regards the tumour as the disease and its extirpation b y surgical, radiational or chemical means as the logical way to cure. I t believes t h e clue to its understanding is to be found in the cell, in spite of the onslaughts of Prof. Smithers and others who have repeatedly demonstrated the futihty of these views. Let us now return to the critical time when the medieval world was ending and our modern world and modern consciousness were being born. Great changes in diseases accompanied this transition. Leprosy and the plague declined rapidly in importance in the western world and smallpox, measles, chickenpox arose as major pestilences. I t also seems t h a t influenza became a recurring epidemic at this time. But the overwhelming new disease of epidemic, pandemic proportions, and assuming a severity t h a t has since greatly diminished, was syphilis. I t seems to have broken loose at the time when Columbus returned from the West Indies. We can leave scholars to argue the question as to whether the disease was introduced to Europe from the Americas or whether it already existed. Certainly as a major universal disease it erupted at this moment in history in Europe. Syphilis is a type of chronic disease which starting apparently suddenly and with acute manifestations progresses by stages to protean results in all organs, continuing its devastation for decades. But if we consider its whole activity, it is perhaps legitimate to discern its central, most typical, impact as being t h a t on the central nervous system. Certainly, hearts, arteries, bones and the rest are involved, but the most typical, as far as the human being's experience is concerned, is the effect on the nervous system. We are nowadays unlikely in ordinary practice to meet tabes, G P I and other manifestations of neurosyphilis, but even up to the last war medical wards of hospitals were never without their complement of these cases. I f we consider the cultural life of the sixteenth and seventeenth centuries we find it characterized above all by the intense growth of intellectual life. Men began to emancipate their thinking from the all-embracing vision of the older world. I t began to be possible to think anything whilst maintaining one's religious and emotional tradition. Francis Bacon became the key thinker in this movement to liberate thinking from thraldom to authority and m a n y martyrs were created in science as well as in religion. One finds a type of thinking which is prone to speculation, there is metaphysical poetry, wit and aphorism are typical and altogether it is cerebral culture. Music, too, reflects the general movement. One has only to contrast the experience of listening to Bach, H a y d n and earlier composers with the music from Beethoven onwards in the Romantic age. At the same time as syphilis was raging in the nervous systems of men, intellectualism and free thinking were invading the cultural world. Thinking and doubting became almost synonymous; Hamlet typifies the age, sicklied o'er with the pale cast of thought. This age of Rationalism culminated in the French Revolution. Is it at all permissible to connect these two phenomena, the birth and growth of modern intellectualism and the syphilitic epidemic raging simultaneously? At least they are synchronous and therefore do belong together in the common gestalt of the age. Can one see cause and effect working, and if so, which way does it work? Did syphilis destroying the nervous system bring about modern
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intellectualism, or did modern intellectual thinking weaken the nervous system and prepare it as a nice culture medium for syphilis? But nothing stays stationary and in the eighteenth century began the stirrings of new trends. The industrial revolution began to gather impetus at the end of the eighteenth century and with it grew the new wastelands of slums and darkened air, of factories and proletariat. Strangely, very often the same figures who were responsible for introducing this descent into the dark hell of industrialism were also leaders foremost in the wave of social idealism t h a t went with it. As the old life in nature and in the rhythms of nature was lost there came to birth the Romantic movement where nature was re-celebrated in the personal feelings and aspirations. The passions of the individual soul and its struggles towards freedom and attainment became the subjects of art and the novel became the great literary form of the nineteenth century. The emotional life became gradually emancipated and Art claimed the right to express any and every emotion, good and bad. The culmination of this wave was expressed in the phrase Art for Art's sake. I f in the first phase of the modern age thinking was a "thinking thinking", bright diadems of thought, in this second phase third, ing became a "feeling thinking". Dreams were seeking to find expression. Thinking became the servant of dreams and yearnings for a lost paradise. I n this age we find another disease becoming the disease of the age, another ilhmss chronic and insiduous, manifesting in all systems and organs, but choosing as its centre of attack the lungs. Tuberculosis became the disease and one has only to think of its occurrence as a tragic theme in literature to realize how it haunted the whole mood of the time. The lungs, the centre of the rhythmic system of man, became undermined and liable to develop great cavities. The feelings became extravagant and alternating between wild optimism and aspiration and deep melancholy and exaggerated despair. But it was a time of fellow feeling and gregariousness. A certain pathological quality, over-dramatic, over-pathetic, egotistical in some degree, adhered to all the great manifestations of the Romantic age. Can one connect the flowering and emancipation of the emotional life with the epidemic of tuberculosis? Which was cause, which effect? Or are they to be grasped as phenomena of synchronicity in the Jungian sense? G. Booth of New York has made some original and stimulating observations on contrasting characteristics of tuberculosis and cancer-prone individuals. Using Rorschach tests in a rather special way he claims to be able to differentiate the two types with great accuracy. D. Kissen in Glasgow, using the Maudsley Personality Inventory, also studied the differences of personality in these two diseases. Booth has shown t h a t "the cancer patients a r e characterized b y the prevalence of autistic object relationships. The organism strives predominantly toward situations in which it can incorporate animate and inanimate objects into its individual idiosyncratic form of existence." On the other hand "the tuberculosis patients are characterized b y the prevalence of symbiotic object relationships. Symbiosis is defined here in the sense of symbiotic mutualism: different organisms living in mutually beneficial interaction with each other." In the cancer type sex is regarded primarily as a function of self-expression, whereas the tuberculosis type tends to overvalue the love object. Booth proceeds to correlate these types with changes in m a n ' s evolutionary relation to nature. Whereas in earlier times both planters and hunters were each in their own way dependent on nature, during the last centuries a new attitude has been established, m a n as conqueror of nature.
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Now Booth points out t h a t whereas the social ethos of the nineteenth century is similar to t h a t of tuberculosis patients, the ethos developing strongly through this century reflects that of the cancer patient. We can observe how warm, gregarious, social conditions, with m a n y people living in the same household, or in poorer sections of the community in the same room, have been replaced by flats and suburban dwellings of isolated individuals. The hygienic impulses resulting in these changes have helped to make tuberculosis rare, but they are, as Booth shows, the values of cancer-prone people. Welfare was inspired b y warm s y m p a t h y and fellow-feeling flowing spontaneously if inefficiently into actions. Today it is an administrative service of the farewell state. I t is more efficient but more distant, less involved. Iu relation to this Anervont has shown t h a t it is much more difficult to induce cancer in experimental mice in overcrowded conditions. The work of Booth certainly justifies further essays in seeing disease in relation to changing social patterns and the changing consciousness of man, and it justifies us in pursuing the change from tuberculosis to cancer as characteristic of the twentieth century. On the basis of age-corrected statistics, it is argued that cancer is no more prevalent, with the exception of carcinoma of the bronchus attributable to cigarette smoking, than it was at the beginning of the century. But from the point of view taken here this is irrelevant. More people do survive the early dangers and live into the cancer age. This belongs to the whole type of civilization we have produced. But many, m a n y more people die of cancer than ever before. W h a t are the features of this age? I f we have sketched the emancipation of thinking and feeling in the previous phases of the modern world we must now note the emancipation of willing. Until recently the spheres of willing and acting were held within the age-old standards of morality. One might think what one liked and anything felt could be expressed, but good and bad remained standards, even when hypocritically ignored. I n Dostoyevsky's Cri~ne and Punishment one finds the character Raskolnikov who flouts the very idea of the will being subjected to standards. One can very well see this as the prophetic warning of the impending problem of the twentieth century. Man has flouted all values. Whatever he has wanted to do, or even found he could do, t h a t he must do. Pollute the earth, water, air, explode atomic bombs, go to the moon and start making a waste tip of it, transplant hearts and so on. An age indeed of mighty conquests, strewing dereliction in all directions. Cancer is again a disease with repercussions affecting all organs, but it is centrally a disease of the metabolic and genital organs. Even carcinoma of the bronchus arises in what has developed as an evagination from the gut. I t is not in the lung as a rhythmic organ t h a t it arises. So we can observe how the wave of ss~philis destroying the nervous system was followed by t h a t of tuberculosis destroying the rhythmic system and now b y cancer destroying the organs of metabolism. Thinking, Feeling and Willing, the three functions of our souls, have become separately emancipated from the old spiritual guidances and we find ourselves as mere egos facing the task of self-guidance in what feels a Vacuum.
The thinking thinking became a feeling thinking and now a willing thinking, t h a t is to say a thinking devoted entirely to technological purposes or administrative machines. Speculation is out, idealism is out. Organization, administration,
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technology are in. The characteristic literary form is journalism whose catch-phrases, slogans, head-lines act straight into the will. They become the hidden persuaders of the advertising industry, to which also most artists are prostituted. I n music the romantic and personal note has vanished and from jazz and folk music of various genres to the higher flights of modern composition, r h y t h m and beat have become dominant. So again we have a question, t h a t of the relation between a ci~lization of unbridled will and the epidemic of cancer involved with the metabohe organs. H o w are they related? We have now depicted three archetypal diseases in relation to three phases of civilization and culture. Can we find significance in this perspective which leads onwards to solutions of our present riddles? I n the first place and in reference to the homceopathic tradition in particular, what relations can be perceived? Hahnemann, in dealing with the problem of chronic, as distinct from acute, diseases, developed the theme of three chronic miasms, Syphilis, Psora and Sycosis. I t would not be going too far to assert t h a t these have remained something of a problem and enigma to his followers ever since. The concept of miasm is certainly distinct from disease as we understand it today. I t is to be grasped more as a dynamic, determining archetype rather than as an ultimate pathological entity. But we can perhaps see a correspondence between the miasm Syphilis and its resultant effects in the organic and mental symptoms of the disease syphilis. The French school of Homceopathy have often seen a near identity between Psora and tuberculois, and though we must retain a broader, more flexible notion of Psora than this it would nevertheless be reasonable to see in tuberculosis a major ultimate of the Psorie miasm. Finally in respect of a connection between Sycosis and cancer we can point to the particular manifestations of Sycosis, always stressed in homceopathic literature. They are, of course, wart formations and catarrhs of mucous membranes. From wart formation the direction is clear to the increasingly malignant epitheliomata and adenocarcinomata and the whole range of tumours. The catarrhs point to the role of chronic inflammations in the genesis of cancer. I f inflammation is not strong enough to bring about self-cure it progresses through fatigue into its opposite, tumour formation. The relation between these three epidemic diseases Mso in a strange way clarifies the different kinds of causes which have been sought for. Broadly men have looked for the causes of these diseases in three reMms. Firstly in that of contagion and infection, leading on to the conception and study of microorganisms; secondly in t h a t of meteorological and climatic and environmental factors; thirdly in t h a t of constitutional or internal cause. Now all three factors are probably always involved, but in Syphilis contagion predominates, so t h a t nowadays at least the disease is only contracted b y direct contact. I n cancer, constitutional or internM factors seem predominantly important in most cases, with environmental factors playing a large p a r t only in cancers produced by contact with specific carcinogens. Tuberculosis combines both contagion or infection and constitution, whilst environment seems to have been perhaps its most specific determining cause. Secondly, we have b y implication drawn attention to the relationship of thinking to the nervous system, of feeling to the rhythmic system, and of willing to the metabolic system. This threefold conception of the human organism was the central contribution of Steiner to the understanding of the
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relationship between body, soul and spirit. I t has to be set against the still orthodox scientific view which would allow the soul entry only to the nervous system. I n place of the ghost-like and ineffective soul of science, Steiner maintains the reality and effectiveness of the soul. As will, it finds its basis in the metabolic processes in a sleep-consciousness; as feeling it finds its organic basis in the rhythmic processes in a dream-consciousness, and as thinking it wakes up on the physical basis of the brain which it uses as a mirror for reflection. Thirdly, we must try and see whither this progress through the centuries has brought man. He has emancipated from the spiritual tutelage in which in the childhood of the race he was brought up. He stands bereft and deserted by the spiritual ancestors of the race and even the traditions grow stale and sterile in his hands. He feels himself overwhelmed by the horror and enormity of human crimes through the millenia and in his most weak and uncertain ego quite unable to confront them. At the same time he feels that he must as Man assume the responsibility for his life and actions. To die miserably and despicably or to resurrect and decide to live to the glory of God is the decision facing Man. Only in the hearts and minds of single individuals can the solution be won. The figure of Christ stands as the archetype for all mankind and not for any Church or Religion exclusively, the single in whom incarnated the oversoul of the whole human race. Mankind is being truly born today as a kingdom of individuals. I n our past we have been contained and lived through by the oversouls of particular nations and races, we have been only on the way to becoming human. Today our crisis is one of birth of true humanity in our single selves. And our true self must begin to guide our divided thinking, feeling and willing. I n this light the meaning and riddle of the strange progression of our diseases can be read. We have been moving towards the achievement of free initiative out of our own selves. I n this progress certain inevitable by-effects have come about, like the wearing out of railway-lines by a train running on them. I t is, however, also possible that our illnesses are produced by the providential unconscious to protect us from other dangers incurred in our progress to attainment and fulfilment as individual souls, as persons. We have seen the culmination of the movement of Man as Conqueror of Nature in the universal pollution and destruction of our Mother, the Earth. Yet our unbridled will is checked by the undermining of our metabolic organs. Must we not now conquer ourselves, the conquerors or predators of Nature, and discover the true meaning of our life on earth? Disease belongs to human life. Many people have learnt to be grateful even for serious illness. Does not the ideal of the conquest of disease belong to the whole industrial, technocratic age, an age of ruthless, philistine rape of natural resources, in which everything must serve the immediate comfort and whim of Man? Yet we have no real concept, no image of Man. For Man is not merely a piece of nature, he is not merely what we can see and touch. We stand in this most terrible and apocalyptic of centuries at the threshold of a new world. New life is bubbling up all around and finding only old outworn forms to contain it. We are challenged in our whole being as never before and we needs must transform our thinking to grasp the realities of the age we live in. Are not diseases also the shadows of coming deeds? I f in our terrible age cancer is so terrible a disease, is it not also the shadow cast by the spiritual greatness of the coming culture? Our age is not only the nemesis of past wickedness, but a pregnancy of the new world and our diseases are not only consequences from
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t h e p a s t , c a u s a l l y d e t e r m i n e d , b u t t r e m e n d o u s p r e p a r a t i o n s for t h e f u t u r e . I n t h e forces we can develop in o v e r c o m i n g a n d healing our illness can be f o u n d t h e v e r y forces of our r e b i r t h . The m e a n i n g a n d r e d e m p t i o n o f cancer will be ,in t h e a c h i e v e m e n t of our s p i r i t u a l freedom a n d r e b i r t h .
BIBLIOGRAPHY
Sigerist, Henry E. (1933). Great Doctors. Allen and Unwin. Winslow, C. E. A. (1943). The Conquest of Epidemic Disease. Princeton. Booth, G. (1964}. "Cancer and Humanism", Psychosomatic Aspects o] Neoplastic Disease. Pitman Medical Publishing Co. Ltd. Smithcrs, D. W. (1962). Lancet, 1, 493. Andervont, I-I. B. (1944). J. nat Cancer Inst., 4, 579. Steiner, R. Von Seelenr~itseln (1917). Verlag der Rudolf Steinor :Nachlassvcrwaltung, Dornach, Switzerland. Kolisko, Eugen. The Bodily Foundation of Thinking. Kolisko Archive. Kolisko, Eugen. The Bodily Foundation of Feeling. Kolisko Archive. Kolisko, Eugen. The Bodily Foundation of Willing. Kolisko Archive. Twentyman, L. R. (1952). "Miasms and Archetypes", Brit. Hem. J., 42, 130.
Report on the 24th Congress of the International Homoeopathic League, held at Athens and Cos 21-28 September 1969 INTRODUCTORY-
ADDRESS BY THE M I N I S T E R OF SOCIAL SERVICES
The I n a u g u r a l C e r e m o n y t o o k place in t h e a n c i e n t H e r o d u s A t t i e u s T h e a t r e . I n c o n t r a s t to t h e a t m o s p h e r e of a n t i q u i t y c r e a t e d b y this open a m p h i t h e a t r e , a low-flying helicopter h e r a l d e d t h e a r r i v a l o f t h e Minister of Social Services. I n his address t h e Minister welcomed us t o Greece a n d t o l d us t h a t since t h e m o s t r e m o t e ages Greece h a d been famous for h e r h o s p i t a l i t y , n e v e r rejecting n e w ideas b u t often accepting t h e m a n d refining t h e m b y t h e Greek spirit of careful, connected a n d logical reasoning. H e w e l c o m e d u s w i t h p l e a s u r e b u t p a r t i c u l a r l y because we were invoking as Our precursor H i p p o c r a t e s who was t h e G r e e k founder of Medicine. H e concluded b y h o p i n g t h a t t h e calm G r e e k a t m o s p h e r e w o u l d r e n d e r t h e Congress f r u i t f u l to all.
M . B . , B . C I ~ . , r'.r'.rIOM.
I t is an obvious need of our time to widen our ideas of disease and to grasp it in its whole relationship to human life. Under the influence of modern natural scientific thinking our conception of disease has become narrower and narrower until today we regard it as a tiresome accident of genetic make-up or of environmental hazard. I t is a meaningless nuisance. One way of approaching this task is the historical, extending our outlook from the pressures of the daily surgery to the experiences of centuries. Even in this century there have been remarkable changes in the patterns of disease. Acute lobar pneumonia was a common, severe, dramatic disease of sudden onset, violent course and often sudden crisis and resolution. I t killed many people in the prime of life. Statistics show that it decreased steadily throughout the century and had almost vanished by about 1943, before the antibiotics had come into use. Acute lobar pneumonia is now a rarity. The acute febrile epidemic diseases of childhood have decreased in severity and the mortality from them has become of very little importance. Immunization against diphtheria became more common as the century progressed and the number of eases of diphtheria correspondingly reached vanishing point. But at the same time the mortality from measles, whooping cough and scarlet fever also fell at about the same speed. We have seen a steady fall in tuberculosis which has continued since the introduction of chemotherapy and antibiotics, but it is difficult to show that the pre-existent rate of decline has been appreciably changed. Tuberculosis which was a disease predominantly of adolescence and early adult life is now more likely to be found in the elderly. Meanwhile carcinoma of the bronchus has increased to an extraordinary extent, replacing, so it appears, tuberculosis. Another dramatic change has occurred in heart disease, w:here coronary thrombosis has replaced rheumatic heart disease as the common heart condition filling medical beds. Generally speaking the diseases which used to be responsible for infant, childhood and adolescent deaths have receded in importance. Very many more of us reach 25 years of age, but our statistical expectation of life at 25 has changed very little since the beginning of the century. The acute, inflammatory diseases characterized by a short course and with a tendency to self-cure are now less important, whilst the chronic progressive diseases characteristic of the second half of life assume greater importance. This already gives us the first great division of human diseases which I-Iahnemann had distinguished 150 years ago. They constitute to a considerable extent a polarity, they represent two opposite ways of falling ill. In fever we are in danger of being dissolved back again to the plasticity of prenatal existence; in the hardening diseases Such as arteriosclerosis and cancer we are in danger of being prematurely overwhelmed by the forces of death. From this we can see that Health must be continually re-established as an ever-changing balance
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between these two poles as we pass from childhood to old age. We can see that this balance has changed dramatically during this century. Cancer has become the disease of the age. Turning from diseases themselves for a moment, to the ideas about disease, we can also see a constant change and transformation going on. The old Greek ideas of the four humours, whose disbalance was understood to constitute disease, continued, under the banner of Galen, right through the Middle Ages and only vanished finally during the last century. The last textbook of pathology based on it, written b y Rokitansky (1804-78), was written in 1842. I t is weUnigh impossible for us to understand such ideas today. The four elements and humours were certainly not conceived as is m a t t e r in our modern materialistic conception. They were felt to be at least as much cosmic as earthly. Today we have come to think t h a t the laws of matter discovered by science on earth are equally valid throughout the space of the universe. To the ancients this would have been absurd. The elements aud humours had spiritual qualities as well as material. I t was only gradually that the modern, entirely quantitative idea of m a t t e r became established and the qualitative aspects relegated to the non-spatial world of the soul. Philosophically Locke's separation of the so-called primary and secondary qualities of m a t t e r prepared the way and Dalton's establishment of the atomic theory provided an acceptable method. Simultaneously with this establishment of the atomic theory, which made it possible to pursue a purely quantitative idea of matter, there arose in H a h n e m a n n the discovery of potentization. Through this process the qualitative aspects of substances were released from any molecular, weighable basis. Obviously these two movements arising at the same time in history must be seen together. Through them the old vision of qualitative-quantitative substance was replaced, the dominant movement of science pursuing up to the present time an almost exclusively quantitative method, and the homceopathic school as a minority pursuing an almost purely qualitative approach. At the moment when the medieval world gave way to the Renaissance, the modern natural scientific movement began. Copernicus was a doctor, trained at Padua, and his work in astronomy is usually taken as the great beginning of modern natural science. His contemporary Vesalius (1514-64) founded modern anatomy, the basis of all modern medicine, whilst another great contemporary, Paracelsus (1493-1541), was turning the traditions of 2 000 years upside-down. All this and much more followed almost instantly on Columbus' return from the Caribbean. We shall return to this, but for the moment we must pursue the impact of natural science on medical ideas. Following the work of Servetus, W. H a r v e y (1578-1657) developed the basis of the modern mechanical idea of physiology. All these men were still half embedded in the old world conceptions. H a r v e y himself, who is so often quoted as the example par excellence of the scientific method, nevertheless in his great life's work on embryology regarded anyone a fool who studied the subject apart from astrology. I t should be remembered t h a t the task of editing Newton's most prolific work is only at the beginning, and apparently most of it is concerned with astrology. Gradually the inclination towards exclusively mechanical conceptions gained ground. I n Paracelsus one can still discern a direct perception of life principle in his Archaeus, but soon this degenerated into a mere abstract vital force neither measurable nor perceivable. Morgagni (1682-1771) became the father of modern morbid a n a t o m y and based his conceptions of disease on the observable
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changes in bodily organs. The whole structure of pathology as the basis for medicine took a gigantic stride forward and medical thinking began to assimilate the ideas of disease to observable change in organs, to what can be seen in the corpse. How difficult it has been ever since for a n y trained doctor to raise his thinking about disease out of this trough. Bichat (1771-1802) in Napoleonic France took the next step. I n spite of the fact t h a t he was a most serious Vitalist, his main influence was to direct attention to the tissues which underlay the organs. The seat of disease must be sought in these rather than just in the organs. Histology thus became the inner arcanum of morbid anatomy. The next step taken, after the discovery of the cell, was ~irchow's (1821-1902) cellular pathology. I n this the anatomical basis of disease took a further leap forward and all, even general, diseases were to be studied in terms of disturbed cell function. I n our day we have seen further steps in reducing the seat of the phenomena of illness to the smallest possible points, in genes and other intracellular entities, a process comparable with the movement in physics from atoms to electrons, protons, etc., etc., and now to the lesser fleas, the quarks and their brothers. The forces studied in natural science have until our own day been those radiating from centres in the manner of gravity. To apply the fruit of such work to biology and medicine needed this progressive diminution from the whole body in its cosmic relationships, humoral pathology; to organs, morbid anatomy; to tissues, histopathology; to cells, cellular pathology, and now to genetic studies and molecular biology. Whilst admiring the immense labours which have been devoted to this edifice of modern pathology and the huge amount of knowledge accumulated in it, we must also note, from other viewpoints, t h a t it has its shortcomings. The great fruit of cellular pathology has been the almost monopolistic study of cancer as a disease of the cell. All wider aspects of the disease, its connections with the human being as a whole and with the developing consciousness of mankind, have been weUnigh ignored. I n no disease has so determined an effort been made to treat it as a local disease, a disease of the cell or even of chromosomes and genes, an entirely exclusively localized mechanical conception. Only today are wider conceptions coming in again, with the few studies on psychosomatic aspects of cancer and in the growing field of investigations into immunology and hormone dependence. The fruit of this scientific progress has been a purely mechanical conception of the body and of disease, in which no place remains for a soul. The significance of the body for our inwardness, our experience, has become entirely elusive and problematic. As Bergson said, we have made the concept of the body so exclusively mechanical and of the soul so entirely subjective and non-extended t h a t no connection between them is possible. I t is understandable therefore t h a t in this century a revolution exploded and psycho-analysis and depth psychology came on the scene. Exploring the actual experiences of people and the phenomena of dreams, and art, m y t h and poetry, an old, old world began to re-emerge, one of meaning and significance. But if the main stream of materialist thought was busy eliminating the soul and reducing psychology to behaviourism, the movement of depth psychology has tended to study the soul without relation to the body and organs in which it resides. I n this situation all the a t t e m p t s at a psychosomatic discipline of medicine have grown up, and at the same time social medicine in its wider perspectives.
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The concept of cancer which still reigns in practice and research is the conclusion of the trend of materialist thought over four centuries. I t regards the tumour as the disease and its extirpation b y surgical, radiational or chemical means as the logical way to cure. I t believes t h e clue to its understanding is to be found in the cell, in spite of the onslaughts of Prof. Smithers and others who have repeatedly demonstrated the futihty of these views. Let us now return to the critical time when the medieval world was ending and our modern world and modern consciousness were being born. Great changes in diseases accompanied this transition. Leprosy and the plague declined rapidly in importance in the western world and smallpox, measles, chickenpox arose as major pestilences. I t also seems t h a t influenza became a recurring epidemic at this time. But the overwhelming new disease of epidemic, pandemic proportions, and assuming a severity t h a t has since greatly diminished, was syphilis. I t seems to have broken loose at the time when Columbus returned from the West Indies. We can leave scholars to argue the question as to whether the disease was introduced to Europe from the Americas or whether it already existed. Certainly as a major universal disease it erupted at this moment in history in Europe. Syphilis is a type of chronic disease which starting apparently suddenly and with acute manifestations progresses by stages to protean results in all organs, continuing its devastation for decades. But if we consider its whole activity, it is perhaps legitimate to discern its central, most typical, impact as being t h a t on the central nervous system. Certainly, hearts, arteries, bones and the rest are involved, but the most typical, as far as the human being's experience is concerned, is the effect on the nervous system. We are nowadays unlikely in ordinary practice to meet tabes, G P I and other manifestations of neurosyphilis, but even up to the last war medical wards of hospitals were never without their complement of these cases. I f we consider the cultural life of the sixteenth and seventeenth centuries we find it characterized above all by the intense growth of intellectual life. Men began to emancipate their thinking from the all-embracing vision of the older world. I t began to be possible to think anything whilst maintaining one's religious and emotional tradition. Francis Bacon became the key thinker in this movement to liberate thinking from thraldom to authority and m a n y martyrs were created in science as well as in religion. One finds a type of thinking which is prone to speculation, there is metaphysical poetry, wit and aphorism are typical and altogether it is cerebral culture. Music, too, reflects the general movement. One has only to contrast the experience of listening to Bach, H a y d n and earlier composers with the music from Beethoven onwards in the Romantic age. At the same time as syphilis was raging in the nervous systems of men, intellectualism and free thinking were invading the cultural world. Thinking and doubting became almost synonymous; Hamlet typifies the age, sicklied o'er with the pale cast of thought. This age of Rationalism culminated in the French Revolution. Is it at all permissible to connect these two phenomena, the birth and growth of modern intellectualism and the syphilitic epidemic raging simultaneously? At least they are synchronous and therefore do belong together in the common gestalt of the age. Can one see cause and effect working, and if so, which way does it work? Did syphilis destroying the nervous system bring about modern
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intellectualism, or did modern intellectual thinking weaken the nervous system and prepare it as a nice culture medium for syphilis? But nothing stays stationary and in the eighteenth century began the stirrings of new trends. The industrial revolution began to gather impetus at the end of the eighteenth century and with it grew the new wastelands of slums and darkened air, of factories and proletariat. Strangely, very often the same figures who were responsible for introducing this descent into the dark hell of industrialism were also leaders foremost in the wave of social idealism t h a t went with it. As the old life in nature and in the rhythms of nature was lost there came to birth the Romantic movement where nature was re-celebrated in the personal feelings and aspirations. The passions of the individual soul and its struggles towards freedom and attainment became the subjects of art and the novel became the great literary form of the nineteenth century. The emotional life became gradually emancipated and Art claimed the right to express any and every emotion, good and bad. The culmination of this wave was expressed in the phrase Art for Art's sake. I f in the first phase of the modern age thinking was a "thinking thinking", bright diadems of thought, in this second phase third, ing became a "feeling thinking". Dreams were seeking to find expression. Thinking became the servant of dreams and yearnings for a lost paradise. I n this age we find another disease becoming the disease of the age, another ilhmss chronic and insiduous, manifesting in all systems and organs, but choosing as its centre of attack the lungs. Tuberculosis became the disease and one has only to think of its occurrence as a tragic theme in literature to realize how it haunted the whole mood of the time. The lungs, the centre of the rhythmic system of man, became undermined and liable to develop great cavities. The feelings became extravagant and alternating between wild optimism and aspiration and deep melancholy and exaggerated despair. But it was a time of fellow feeling and gregariousness. A certain pathological quality, over-dramatic, over-pathetic, egotistical in some degree, adhered to all the great manifestations of the Romantic age. Can one connect the flowering and emancipation of the emotional life with the epidemic of tuberculosis? Which was cause, which effect? Or are they to be grasped as phenomena of synchronicity in the Jungian sense? G. Booth of New York has made some original and stimulating observations on contrasting characteristics of tuberculosis and cancer-prone individuals. Using Rorschach tests in a rather special way he claims to be able to differentiate the two types with great accuracy. D. Kissen in Glasgow, using the Maudsley Personality Inventory, also studied the differences of personality in these two diseases. Booth has shown t h a t "the cancer patients a r e characterized b y the prevalence of autistic object relationships. The organism strives predominantly toward situations in which it can incorporate animate and inanimate objects into its individual idiosyncratic form of existence." On the other hand "the tuberculosis patients are characterized b y the prevalence of symbiotic object relationships. Symbiosis is defined here in the sense of symbiotic mutualism: different organisms living in mutually beneficial interaction with each other." In the cancer type sex is regarded primarily as a function of self-expression, whereas the tuberculosis type tends to overvalue the love object. Booth proceeds to correlate these types with changes in m a n ' s evolutionary relation to nature. Whereas in earlier times both planters and hunters were each in their own way dependent on nature, during the last centuries a new attitude has been established, m a n as conqueror of nature.
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Now Booth points out t h a t whereas the social ethos of the nineteenth century is similar to t h a t of tuberculosis patients, the ethos developing strongly through this century reflects that of the cancer patient. We can observe how warm, gregarious, social conditions, with m a n y people living in the same household, or in poorer sections of the community in the same room, have been replaced by flats and suburban dwellings of isolated individuals. The hygienic impulses resulting in these changes have helped to make tuberculosis rare, but they are, as Booth shows, the values of cancer-prone people. Welfare was inspired b y warm s y m p a t h y and fellow-feeling flowing spontaneously if inefficiently into actions. Today it is an administrative service of the farewell state. I t is more efficient but more distant, less involved. Iu relation to this Anervont has shown t h a t it is much more difficult to induce cancer in experimental mice in overcrowded conditions. The work of Booth certainly justifies further essays in seeing disease in relation to changing social patterns and the changing consciousness of man, and it justifies us in pursuing the change from tuberculosis to cancer as characteristic of the twentieth century. On the basis of age-corrected statistics, it is argued that cancer is no more prevalent, with the exception of carcinoma of the bronchus attributable to cigarette smoking, than it was at the beginning of the century. But from the point of view taken here this is irrelevant. More people do survive the early dangers and live into the cancer age. This belongs to the whole type of civilization we have produced. But many, m a n y more people die of cancer than ever before. W h a t are the features of this age? I f we have sketched the emancipation of thinking and feeling in the previous phases of the modern world we must now note the emancipation of willing. Until recently the spheres of willing and acting were held within the age-old standards of morality. One might think what one liked and anything felt could be expressed, but good and bad remained standards, even when hypocritically ignored. I n Dostoyevsky's Cri~ne and Punishment one finds the character Raskolnikov who flouts the very idea of the will being subjected to standards. One can very well see this as the prophetic warning of the impending problem of the twentieth century. Man has flouted all values. Whatever he has wanted to do, or even found he could do, t h a t he must do. Pollute the earth, water, air, explode atomic bombs, go to the moon and start making a waste tip of it, transplant hearts and so on. An age indeed of mighty conquests, strewing dereliction in all directions. Cancer is again a disease with repercussions affecting all organs, but it is centrally a disease of the metabolic and genital organs. Even carcinoma of the bronchus arises in what has developed as an evagination from the gut. I t is not in the lung as a rhythmic organ t h a t it arises. So we can observe how the wave of ss~philis destroying the nervous system was followed by t h a t of tuberculosis destroying the rhythmic system and now b y cancer destroying the organs of metabolism. Thinking, Feeling and Willing, the three functions of our souls, have become separately emancipated from the old spiritual guidances and we find ourselves as mere egos facing the task of self-guidance in what feels a Vacuum.
The thinking thinking became a feeling thinking and now a willing thinking, t h a t is to say a thinking devoted entirely to technological purposes or administrative machines. Speculation is out, idealism is out. Organization, administration,
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technology are in. The characteristic literary form is journalism whose catch-phrases, slogans, head-lines act straight into the will. They become the hidden persuaders of the advertising industry, to which also most artists are prostituted. I n music the romantic and personal note has vanished and from jazz and folk music of various genres to the higher flights of modern composition, r h y t h m and beat have become dominant. So again we have a question, t h a t of the relation between a ci~lization of unbridled will and the epidemic of cancer involved with the metabohe organs. H o w are they related? We have now depicted three archetypal diseases in relation to three phases of civilization and culture. Can we find significance in this perspective which leads onwards to solutions of our present riddles? I n the first place and in reference to the homceopathic tradition in particular, what relations can be perceived? Hahnemann, in dealing with the problem of chronic, as distinct from acute, diseases, developed the theme of three chronic miasms, Syphilis, Psora and Sycosis. I t would not be going too far to assert t h a t these have remained something of a problem and enigma to his followers ever since. The concept of miasm is certainly distinct from disease as we understand it today. I t is to be grasped more as a dynamic, determining archetype rather than as an ultimate pathological entity. But we can perhaps see a correspondence between the miasm Syphilis and its resultant effects in the organic and mental symptoms of the disease syphilis. The French school of Homceopathy have often seen a near identity between Psora and tuberculois, and though we must retain a broader, more flexible notion of Psora than this it would nevertheless be reasonable to see in tuberculosis a major ultimate of the Psorie miasm. Finally in respect of a connection between Sycosis and cancer we can point to the particular manifestations of Sycosis, always stressed in homceopathic literature. They are, of course, wart formations and catarrhs of mucous membranes. From wart formation the direction is clear to the increasingly malignant epitheliomata and adenocarcinomata and the whole range of tumours. The catarrhs point to the role of chronic inflammations in the genesis of cancer. I f inflammation is not strong enough to bring about self-cure it progresses through fatigue into its opposite, tumour formation. The relation between these three epidemic diseases Mso in a strange way clarifies the different kinds of causes which have been sought for. Broadly men have looked for the causes of these diseases in three reMms. Firstly in that of contagion and infection, leading on to the conception and study of microorganisms; secondly in t h a t of meteorological and climatic and environmental factors; thirdly in t h a t of constitutional or internal cause. Now all three factors are probably always involved, but in Syphilis contagion predominates, so t h a t nowadays at least the disease is only contracted b y direct contact. I n cancer, constitutional or internM factors seem predominantly important in most cases, with environmental factors playing a large p a r t only in cancers produced by contact with specific carcinogens. Tuberculosis combines both contagion or infection and constitution, whilst environment seems to have been perhaps its most specific determining cause. Secondly, we have b y implication drawn attention to the relationship of thinking to the nervous system, of feeling to the rhythmic system, and of willing to the metabolic system. This threefold conception of the human organism was the central contribution of Steiner to the understanding of the
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relationship between body, soul and spirit. I t has to be set against the still orthodox scientific view which would allow the soul entry only to the nervous system. I n place of the ghost-like and ineffective soul of science, Steiner maintains the reality and effectiveness of the soul. As will, it finds its basis in the metabolic processes in a sleep-consciousness; as feeling it finds its organic basis in the rhythmic processes in a dream-consciousness, and as thinking it wakes up on the physical basis of the brain which it uses as a mirror for reflection. Thirdly, we must try and see whither this progress through the centuries has brought man. He has emancipated from the spiritual tutelage in which in the childhood of the race he was brought up. He stands bereft and deserted by the spiritual ancestors of the race and even the traditions grow stale and sterile in his hands. He feels himself overwhelmed by the horror and enormity of human crimes through the millenia and in his most weak and uncertain ego quite unable to confront them. At the same time he feels that he must as Man assume the responsibility for his life and actions. To die miserably and despicably or to resurrect and decide to live to the glory of God is the decision facing Man. Only in the hearts and minds of single individuals can the solution be won. The figure of Christ stands as the archetype for all mankind and not for any Church or Religion exclusively, the single in whom incarnated the oversoul of the whole human race. Mankind is being truly born today as a kingdom of individuals. I n our past we have been contained and lived through by the oversouls of particular nations and races, we have been only on the way to becoming human. Today our crisis is one of birth of true humanity in our single selves. And our true self must begin to guide our divided thinking, feeling and willing. I n this light the meaning and riddle of the strange progression of our diseases can be read. We have been moving towards the achievement of free initiative out of our own selves. I n this progress certain inevitable by-effects have come about, like the wearing out of railway-lines by a train running on them. I t is, however, also possible that our illnesses are produced by the providential unconscious to protect us from other dangers incurred in our progress to attainment and fulfilment as individual souls, as persons. We have seen the culmination of the movement of Man as Conqueror of Nature in the universal pollution and destruction of our Mother, the Earth. Yet our unbridled will is checked by the undermining of our metabolic organs. Must we not now conquer ourselves, the conquerors or predators of Nature, and discover the true meaning of our life on earth? Disease belongs to human life. Many people have learnt to be grateful even for serious illness. Does not the ideal of the conquest of disease belong to the whole industrial, technocratic age, an age of ruthless, philistine rape of natural resources, in which everything must serve the immediate comfort and whim of Man? Yet we have no real concept, no image of Man. For Man is not merely a piece of nature, he is not merely what we can see and touch. We stand in this most terrible and apocalyptic of centuries at the threshold of a new world. New life is bubbling up all around and finding only old outworn forms to contain it. We are challenged in our whole being as never before and we needs must transform our thinking to grasp the realities of the age we live in. Are not diseases also the shadows of coming deeds? I f in our terrible age cancer is so terrible a disease, is it not also the shadow cast by the spiritual greatness of the coming culture? Our age is not only the nemesis of past wickedness, but a pregnancy of the new world and our diseases are not only consequences from
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t h e p a s t , c a u s a l l y d e t e r m i n e d , b u t t r e m e n d o u s p r e p a r a t i o n s for t h e f u t u r e . I n t h e forces we can develop in o v e r c o m i n g a n d healing our illness can be f o u n d t h e v e r y forces of our r e b i r t h . The m e a n i n g a n d r e d e m p t i o n o f cancer will be ,in t h e a c h i e v e m e n t of our s p i r i t u a l freedom a n d r e b i r t h .
BIBLIOGRAPHY
Sigerist, Henry E. (1933). Great Doctors. Allen and Unwin. Winslow, C. E. A. (1943). The Conquest of Epidemic Disease. Princeton. Booth, G. (1964}. "Cancer and Humanism", Psychosomatic Aspects o] Neoplastic Disease. Pitman Medical Publishing Co. Ltd. Smithcrs, D. W. (1962). Lancet, 1, 493. Andervont, I-I. B. (1944). J. nat Cancer Inst., 4, 579. Steiner, R. Von Seelenr~itseln (1917). Verlag der Rudolf Steinor :Nachlassvcrwaltung, Dornach, Switzerland. Kolisko, Eugen. The Bodily Foundation of Thinking. Kolisko Archive. Kolisko, Eugen. The Bodily Foundation of Feeling. Kolisko Archive. Kolisko, Eugen. The Bodily Foundation of Willing. Kolisko Archive. Twentyman, L. R. (1952). "Miasms and Archetypes", Brit. Hem. J., 42, 130.
Report on the 24th Congress of the International Homoeopathic League, held at Athens and Cos 21-28 September 1969 INTRODUCTORY-
ADDRESS BY THE M I N I S T E R OF SOCIAL SERVICES
The I n a u g u r a l C e r e m o n y t o o k place in t h e a n c i e n t H e r o d u s A t t i e u s T h e a t r e . I n c o n t r a s t to t h e a t m o s p h e r e of a n t i q u i t y c r e a t e d b y this open a m p h i t h e a t r e , a low-flying helicopter h e r a l d e d t h e a r r i v a l o f t h e Minister of Social Services. I n his address t h e Minister welcomed us t o Greece a n d t o l d us t h a t since t h e m o s t r e m o t e ages Greece h a d been famous for h e r h o s p i t a l i t y , n e v e r rejecting n e w ideas b u t often accepting t h e m a n d refining t h e m b y t h e Greek spirit of careful, connected a n d logical reasoning. H e w e l c o m e d u s w i t h p l e a s u r e b u t p a r t i c u l a r l y because we were invoking as Our precursor H i p p o c r a t e s who was t h e G r e e k founder of Medicine. H e concluded b y h o p i n g t h a t t h e calm G r e e k a t m o s p h e r e w o u l d r e n d e r t h e Congress f r u i t f u l to all.