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  Gynecology - Part II - Pelvic Inflammatory Disease
  

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By: Christoph Zerm, M.D.
pgs. 50-58.doc

We could take all inflammatory disease together, because generally, treatment is only by antibiotics. The question is of investigating the different micro-organisms and deciding which antibiotic to use to fight them. Inflammation is really a struggle where the independence of the individual is involved, though conventionally this struggle is seen to be the development of resistance by the micro-organism versus the invention of new antibiotics.

There is generally still a fear of micro-organisms, more or less, and everybody is involved. This phenomenon is interesting, and Rudolf Steiner has made important references to it. He likened micro-organisms and the fear of them to the fear of the specters that were experienced in medieval times. Objectively these are both the same, but each has its own characteristics. In medieval times, spiritual beings were believed in, therefore one feared the specters; now believing goes only to the physical level, so that the object of fear can only be material things, i.e. micro-organisms that are believed in; but the situation is really the same (5-5-14 Basel, GA154).

It is thought that micro-organisms are only a danger if they are multiplying, but there are other considerations. Firstly, it means cultivating the conditions for micro-organisms if man takes into his sleep a materialistic way of thinking. Also, if one lives in an area where a particular illness is epidemic and the people develop fear, this is taken into their sleep. Unconsciously, they are in their imaginations penetrated by substances of fear which provide food for bacteria. It is possible to reduce the fear by love, actively-willed love. The real treatment against fear is the will to love and to help the ill person. This will reduce the active multiplication of bacteria. If one could overcome the materialistic way of mind and work actively out of love with those who were ill, this would work more effectively against infection than all remedies.

Although they cannot be seen, the spiritual forces are stronger than they at first seem. A spiritual community can be a force, sure of the spiritual world and not taking materialistic thoughts into the medical work, and can surround the people suffering from an epidemic, and cure them.

Previously, people had an understanding of the being of the illness, that it was not chance but part of a person's biography. It is not possible merely to go back to the past, but we should try to develop a new way of understanding the essence of an illness.

We know the two polarities of becoming ill - inflammation and sclerosis. And in these two polarities we recognize two forces that can be seen within ourselves - inflammation linked to the metabolic system and sclerosis to the nerve/sense system. So there is the question of being well, which is a struggle for balance between these two forces or tendencies (Dornach, 5-7-23 - Lectures to the Workmen, GA 349).

It is the Christian impulse, the might of Christ, who helps us to achieve ever and again this equilibrium, and in a bodily sense it is Christian to have the picture or the conviction of the struggle towards this equilibrium. In this sense illness is not an accident but part of the inner and outer development of life; inner and outer challenges which strengthen our forces. Also, the contact with micro-organisms can produce immunity against the next contact with them. In this way it can be compared with training the muscles for a particular sport. Through this encounter, the forces of the organism are increased.

One can question how is it possible that some human beings are not able to overcome the dangers of contact? In the individual biography, there may have been things which weakened the organism so that it does not have sufficient force to defeat the challenge. Then infection becomes probable with all that it means for the individual.

With inflammation, there is the probability that micro-organisms are present. In the case of treatment with antibiotics, it is assumed that all will be well. Infection can be understood literally (Latin, inficere) as letting something into the organism. We can ask ourselves what has entered and what is the real cause of the infections. There can be several people in the same situation but only a few become ill, and so, it is not just a question of bacteria, but also of constitution and the disposition of the organism in the moment leading to infection. Rudolf Steiner talked about this in the Young Doctors Course, and also in Spiritual Science and Medicine, (3-24-20, GA 312).

So we need to look at the disharmony of the four members - how they are acting together in pelvic inflammatory disease. Inflammation can be associated with cold insults, with chills, maybe cold feet, inadequate clothing, etc. The ego organization and the astral body act within the metabolic system and produce the polar phenomena of what happens in the upper organism where they act independently and freely thus allowing for consciousness, thinking, memory, etc.

In metabolism, there is a need for sufficient warmth for the ego to structure the activity of the astral body thus producing harmony with the etheric body and physical body. With an insult to the organism, the ego cannot work as it should; and the astral body acts more intensely with the physical body (and also with the etheric body) causing pain and in increase of consciousness that should not occur. The etheric body withdraws, and the fluid realm is not structured as it should be, thus producing edema. The etheric body also does not work sufficiently in each part as the body; hence there is the possibility for another force of life to enter - a place for microorganisms to come in.

In the Bandaging Course, Rudolf Steiner spoke of general life forces in the surrounding world and how they can enter where they should not. Bacteria are the enemies of man and in a wound they express the working of general life forces. Man has to develop a counter force; leucocytes come from the bone marrow to the wound. There has to be the possibility of change within the organism. There has to be not only the potential but then the action which is directed against these forces. In this action we can perceive the activity of the spirit (Rudolf Steiner). The belief in the efficacy of the spirit within the body can allow for the development of curative possibilities. There is an event from the outer world which stimulates the healing force of the spirit.

We recognize the four members of the human being in the characteristics of inflammation: color, dolor, tumor, rubor and loss of function. Calor is an expression of increased action of the ego; dolor is an exaggerated activity of the astral body. Both try to regain the normal situation by way of increased activity. Tumor is the expression of the abnormal activity of the etheric body because the swelling shows its increase efforts, but without the structuring influence of the astral body and the ego organization. Rubor is characteristic of inflammation; first there is a color that is abnormal, but when pus formation develops, the red changes to the color of the corpse. This pale yellow is an expression of the mere physical body, the physical body on its own. The fever is an attempt of the ego organization to improve the harmony of all four members. All the characteristics of inflammation are an attempt to regain the equilibrium, the way in the middle, which is the true Christian way.

But whence did the micro-organisms originate, those beings of obviously such a great significance in today's medicine, although they are considered as a senseless, superfluous apparition? On 10-14-17 (GA 177), Rudolf Steiner describes bacilli as the earthly results of one of the defeats of Ahrimanic hosts in the spiritual world, cast down to the earth by the might of Michael. As a consequence of the last struggle between Michael and the Ahrimanic hosts during the nineteenth century, the Ahrimanic beings were overcome once more by Michael and cast down to the earth, precisely to the level of human consciousness. Here they entered the mind of man and produced materialistic thinking. One could imagine the special characteristic of a person who is involved in the specific aims of materialistic man and his personal earthly concerns. There is a strong relationship between these Ahrimanic forces and such a person. If we want to overcome this danger, we need to develop consciousness. In his lecture to overcome this danger, he said that we need to develop consciousness. In his lecture of 5-5-14, (GA 154), Rudolf Steiner refers to "all these beings who have their residence and their activities in other living beings", in animal or human bodies (parasites). All these beings are creatures of real spiritual forces, are creatures of Ahriman and are connected with the relation between him and Man.

Different types of micro-organisms enter and act on the body in different ways. One type remains superficially on the outside, affecting the skin and neighboring orifices, such as trichomonas and several other bacteria. Characteristically, these still have their own vitality. There are other organisms, e.g. viruses, which have lost the possibility to live on their own and have to move towards the center of the body and use the life processes of the organism in order to live. Therefore they produce a different illness process. The one type of organism produces an immediate reaction; in the other its activity is delayed, and the process may proceed in several stages.

So we can differentiate between different types of micro-organisms, and the more such organisms are active in the center of the human organism, the more dangerous they will be. Also, viruses concentrate only on the nuclear material, and in a sense they are comparable to the sperm which also represent, in a certain way, the focus of death. Experiments have been done in which it has been shown that pure animal sperm will kill an organism, it is so poisonous. Dr. Otto Wolff has often referred to it. We also know that this aspect is involved in the AIDS problem. On the one side there is only nuclear material and on the opposite side you have the whole vitality of the cell, such as the ovum, with its large amount of cytoplasm. Like the ovum, there are the bacteria and other organisms which have strong forces and are able to live without favorable conditions.

So the organisms which lack life enter the very center of the human being and at the level of the warmth of the blood they enter the physical basis of the individuality, because, as we know, the blood is an expression, in a certain sense, of the true individuality. The human organism answers with fever, with the opposing force to this Ahrimanic attack. The ego organization tries, by means of this elevation of temperature, by means of warmth, to enter again in a better way its activity into the human organism and to re-establish the necessary equilibrium.

beings did not live in an environment which is like our present earth. They could not breathe in air, that is, breathe within the air, and therefore neither could they take in the spirit, for the taking in of the spirit corresponded to the breathing of air. Thus they were compelled to carry out within the warm We can have a broader concept of fever when we know where the fever has its origin. Rudolf Steiner has said that in former times, for example in Greek times, people understood by the word "pneuma" not only the air, that is the external air, but also the spiritual level of it. Then he said that on Old Moon, the precursor of Earth, "the Lucifericth principle what the human being today carries out in the air. Now you can imagine therefore that these beings which give to man his free consciousness, his independence, are in a certain way related to the fire. Thus in their manifestation they are bound with a certain greed to everything in man which manifests as warmth, as fire. This greed latches onto the self-generated body of warmth in the human being. Thus the bestowers of knowledge and freedom are connected to something which tries to incarnate in the warmth of man in the way similar to man on the Old Moon. This is the relationship between knowledge on the one hand and birth and death, illness, etc. in the world on the other. Together with knowledge, birth, death and illness came into the world. This is the price man has to pay for knowledge. For this reason we can observe a connection between certain manifestations of warmth and illness, that is, fever. That is the origin of fever. (The Foundations of Esotericism, 11-3-05, Berlin, GA93a).

So we have, from these considerations, more insights into what we have mentioned as the Christian maxim - the struggle to regain the equilibrium between the two opposing forces. When there is an attack of Ahrimanic forces on the one side, then on the other side there is the possibility to introduce the opposite forces to regain their equilibrium. It is very important to work on this level so that we do not continue producing the favorable conditions of fear for these micro-organisms.

In the same lecture of November 3, 1905, Rudolf Steiner says the following of the sort of fear that I have already mentioned:

oppose the efforts of modern medicine with its external remedies, but a true improvement will never be achieved in this external way. And further, the things which have to happen take place out of an inner necessity. It would be meaningless to try We are told how, out of a mood of fear and horror, such as was caused in the conquered populations by the Mongol invasions in the Middle Ages, certain spiritual formations like a kind of spiritual product of decomposition, provided a fertile soil for such beings as bacilli. Fear, hatred and horror preserve such decomposing formations. Also the feeling of hatred between social classes and astral life which is thrust by great masses of people towards others again contributes to such a product of decomposition and thereby becomes the cause of the modern infectious diseases. Anyone who understands these things will nevertheless, of course, notto stop them or hold them back. The anthroposophical movement seeks the suitable and effective means for overcoming the war of all against all, through the cultivation of the principle of brotherhood, for brotherliness dissolves the products of decay and hatred streaming into the world.

From all this, we have a deeper, profounder background for where all these troubles, all these challenges of infectious illnesses take place. If we know this, then we have to take it into consideration in treating people who have these problems.

In some cases, of course, we will not be able to renounce the help of antibiotics because we see that the patient's own forces do not have strength enough to overcome by themselves. But in my opinion it is very important that we take into consideration, that it is not possible to develop certain forces, and one should try to compensate for this lost possibility in these people. It would be a task to try to find out how this could be achieved.

We can go back to pelvic inflammatory disease and in the majority of the cases that we have seen in the past years it has been possible to avoid using antibiotics. We have been able to achieve an improvement, perhaps even a better improvement than with antibiotics, because it is less probable that the patients will later have a relapse.

A basic remedy in this context is, of course, Argentum. It depends on the acuteness or the chronicity if we use it in high or in low potency. In acute cases we use D30, and if it is chronic inflammatory disease, then we use 06.

In the search for a substance as a remedy which is able to defeat microorganisms but not weaken the human being's own forces, there is the plant Echinacea. One substance in it, the glycoside echinacoside, has a weak antibiotic activity, not as strong as an antibiotic, but it does have some antibiotic effects. An extract of this plant helps the organism itself to improve or strengthen its forces, in low potency, D3 or 06.

Another very important help for the lower part of the organism, for the metabolic part, is Antimony. Antimony provides for the organism something like the replacement of the activity of the spiritual members, mainly of the ego organization with its structuring activities. In this way Antimony helps so that the spiritual members can enter again with their normal activity into this part of the body. Antimony is a basic substance in the treatment of pelvic inflammatory disease.

Then we can also apply potentized parametrium/ovary/fallopian tubes, which are included in a combination - Parametrium /Echinacea comp (Wala). With this compositum, we have the healing forces of Antimony, and of Echinacea, being directed to this region.

If we want to activate the forces of the personality itself and overcome the state of fear, then it would be very good to apply Iron in a middle potency - D8 or D10 and especially Ferrum sidereum. Where the mucosa is weakened and, on examination, is seen to be very much involved, then we can also apply Mercurius 06. If there is also a very high fever, so that the fever itself is a danger to the patient, then we can apply citrus compresses to the calves, i.e., lemon compresses.

Another treatment is the poison of a South American snake, Lachesis muta. Rudolf Steiner said that it creates something like a phantom of the astral body and the ego organization but in potentized form. It makes it possible for the ego organization to push the activity of the astral body toward the etheric body. What we need at this moment is that they act once again together. We commonly use injections - D12 or D30; the higher the temperature, the higher the potency. This helps to overcome the phase of fever and usually within one to two days the fever goes gradually down. As we all know, it is dangerous to bring it down abruptly, but in the ordinary way, just before the fever goes down, the patient already feels quite well. This is a very important sign in treating these patients. If clinically you have the impression that the patient is improving although the temperature is still high, it is a sign that you can rely on this treatment and not have to change to antibiotics.

I had one case of pyelonephritis in pregnancy, which is considered a very dangerous condition. It is some years ago and was for me a very impressive case. She had a fever of 40.5 degrees C, and we treated her also with Equisetumsulphure tostum, with Argentum D30 and Echinacea. On the second day she said: "I am quite well. I'm hot, of course, but I feel quite well". During physical examination she had much pain but could tolerate it at bedrest. She had plentiful intravenous infusions, drank much and ate very little. The third day came and she still had a temperature of 40 degrees C. The fourth day - still 40 degrees - really quite a challenge! However, she still felt and looked quite well and the pregnancy was in good condition. So we continued with this treatment and did not use antibiotics. On the sixth day the fever began to lessen - to 39,38.5, and afterwards, the temperature completely normalized. She felt well and strong again. Although it was quite an extreme situation, there was nothing dangerous in this. This was a very important experience for me, to continue in all circumstances to observe quite subtly how the the patient's subjective feelings are.

In some cases we use Apis/Belladonna. It depends on the individual picture. When I see a patient with a red face and something like a fire within and a heat which the patient cannot stand, I think of Apis/ Belladonna. In the first few days I prefer to inject the Apis (in the area of the abdomen). When the patient is able to take drops, then I give it every half hour.

In nearly every case, we use Argentum. In the acute phase, it is given every two hours - Argentum D30 - but not for long. Soon it would be given twice or possibly three times a day. That is sufficient. In the puerperium the fever will climb very quickly, and you start then with Argentum/Echinacea comp., and it is also very important to give Lachesis in high potency. If then Berberis Radix and Urtica in low potency are also applied, this is a direct help for the uterus. On the other hand, you can also use Oxytocin because in nearly all cases there is weakness of contraction of the uterus. The uterus can contract and involute better after the delivery. This is a real help for dealing with this inflammation.

If we examine the uterus in the acute phase and find that it is still quite soft and enlarged, then we give an infusion of Oxytocin. If it is not so extreme, then we can inject Oxytocin. It is very rare that we use Ergometrine. It has a very strong effect. It can also reduce the milk flow, and in some cases it can close the mouth of the uterus so that the secretions cannot pass out. Qxytocin seems to be more helpful than Ergometrine but it depends, and there are a few cases where Ergometrine is used.

In general practice, you see a kind of slow, chronic pelvic inflammatory disease, where the gynecologist usually doesn't do anything more. They are given antibiotics once or several times, and they are left. The patient just goes on having pain and tenderness.

Here is a significant problem. Some time ago it was found by using laparoscopic examinations that a third of all those women with presumed chronic inflammatory disease did not in fact have it. (Professor Hirsch, Tuebingen). So very many women who are not suffering a bacterial infection senselessly receive antibiotics. This is the reason why, if there is any doubt, we do laparoscopy to see whether there is really an infection or just a "pelviopathy" - which is a word meaning precisely nothing.

It is very easy to mistake this for inflammation, because if your examination is rough, then all women will have "inflammatory disease" because it is painful. Normally you can equate the painfulness of your examination with the extent of the pelvic inflammatory disease. But in this situation as described above there will be many, many women to whom you give this diagnosis. It depends partly on the nature of your examination and on the type of woman also.

There is also the case of the woman who has many different types of problems. These problems are traumatic, and it is not without reason that it is in just this part of the body that she will suffer continuous pain. At some moments it seems to me like a wound, an unhealed wound, both on the emotional level, and in consequence, the bodily level. This requires a different treatment than antibiotics, and it also does not require the combination which I gave for the treatment of inflammatory disease. In these cases I always try to apply the plants which are very close to the influences of warmth and light. These are the labiates, for instance Melissa and Marjoram. We can also use Melissa Cupro culta, a combination with copper, which helps to introduce this warmth element. Also as a basic treatment, Argentum 0.4% pessaries can be used. In general, vaginal douches are not very helpful, but Marjoram/Thuja gel may be helpful.

With severe Candida infections, antifungal pessaries can be used to "take off" the Candida and then anthroposophical treatment can be started in order to restrengthen the area. This can be Argentum/Quercus comp. pessaries or Argentum pessaries, when the vagina is macerated. It is important to remember that the vagina is skin; it is not mucosa. This is a very widespread error, but it is skin, only not keratinised. It is a stratified epithelium, not a columnar one. The first mucosa that you reach is just inside the neck of the cervix. The vulva and vagina can be very weak. Besides the Argentum or Argentum/Quercus pessaries, I also suggest external baths with vinegar, because that also strengthens the skin.

With regard to internal treatment, this depends on whether the illness has reached deeply into the vagina. If it is only affecting the vulva, then internal treatment is not so important, but very often it develops immediately in the depths of the vagina.

Yogurt can also be used as a local treatment in the vagina. There are three reasons why this could be used. The first is that the yogurt bacilli are very similar to the normal vaginal flora and so free the way for its redevelopment. Secondly, yogurt has the correct pH and so provides favorable conditions within the vagina. Thirdly, in other situations, fermented milk products are used to cure the skin. Whey is also used in cosmetics to strengthen the skin.

Practically, a 20 ml syringe is attached to a disposable catheter and the tube introduced into the vagina. Only 3-4 ml are needed, but it is important that the tube is very flexible so that no damage is done. The treatment is repeated for one to two weeks, once a day (preferably during the night).

In some patients, the infecting organisms are not Candida but an anaerobic organism or mixed flora. Then treatment with yogurt and vinegar baths can be helpful. 3-4 tablespoons of vinegar are used per bath at 37 degrees. The bath should be for about five minutes and the patient should dry herself very well afterwards before using the yogurt. Cider vinegar is a very old treatment for skin problems. It was known to strengthen the skin and to help urticaria. Other sitz baths that can be used are with Quercus essence. Taken internally, fermented bread drink - two to three glasses per day - in conjunction with baths, can be helpful.

I consider it important for myself, and I hope that for you also, to have this panorama of what is really happening with micro-organisms in inflammation and also with the bodily force of fever and where it comes from. When I had worked it out, it was a real discovery for me and has brought me to the point that in knowing this, I feel a responsibility to it when I stand in front of a patient whom I have to treat.


Christoph Zerm, M.D.

Gemeinnuetziges Gemeinschaftskrankenhaus Herdecke
Beckweg 4
D-W-5804 Herdecke, Germany





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