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  Cardiac Function in Upper School Study of Man: Suggestions for School Doctors
  

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By: Armin Husemann, M.D.
School Physician.doc

(Original title: Die Funktion des Herzens im Menschenkrndeunterricht der Oberstufe. Ein medizinisch-paedagogischer Hinweis fuer Schulaerzte. Der Merkurstab 1996; 49: 371-5. English by A. R. Meuss, FIL, MTA.) 

"Does it matter what model concept one has - the mechanical image of a pressure suction pump or the almost plant-like model we have in modern science?" This is how Paul Vogler, former head of the Charite Hospital in Berlin, formulated a question in 1971 that could not be better put for the study of man in Waldorf education.

When Rudolf Steiner opened the Stuttgart Waldorf School on September 7, 1919 he wished to characterize the view of the human being on which it was based and said that they could not base themselves on a view of the human being at this school in which the heart was seen as a suction pump. A year later he went into more detail in The Renewal of Education, the course given for teachers in Basel. It is important for pupils and their feeling for life how they think of the heart that beats in their breasts as a living organ or a mechanism. It is no less important how a teacher is able to think about the function of the heart for this influences the inner contact he develops with the children- Taking up Paul Vogler's words, we may ask: how modern is our teaching when we speak to our pupils of the function of the heart?

"Seeing the human being as alive and in motion (we gain) the insight that the heart is not a pump pumping the blood through the organism but (we see) that the human being is inwardly alive, and that the movement of the fluids and the movement of the heart also arise from this quickness. If we give our minds the configuration to think in this way, certain powers the teacher possesses make him able to see how the children develop. And if we thus develop an eye for this, it may indeed happen that something important is revealed to us, even concerning a child in a very large class whom one has only been able to consider a few times. If we train mind and spirit in this way, making strong contact, they will be able to look into the individual child in a way that may be said to be clairvoyant" {The Renewal of Education, Lecture 3). To change the way we see the heart, Steiner suggested we should first of all replace the pump with a hydraulic ram model.

The nature of a pump is to set fluids that are at rest in motion by imposing a force from outside. The hydraulic ram takes a flowing current, a stream, for instance, and increases the pressure by damming it up. At the mechanical level, the ram is therefore a far better model for the heart than the pump.

In the view presented by Rudolf Steiner, the hydraulic ram does no more than show how a machine works that: 1) uses existing movement in the fluid, 2) brings this movement to a halt by stopping the flow, and 3) increases the pressure by this means.

If one shows a 10th, llth or 12th class how a hydraulic ram works, the pump idea first of all changes into its opposite at the mechanical level. This model of the heart does not set the fluid in motion but makes it be at rest. At the same time, the pressure increases. This opens the way for seeing through the highly suggestive argument that initially appears to "prove" the pump theory - it being generally believed that the increase in pressure during systole proves the pump theory. The hydraulic ram shows quite beautifully that pressure rises through stasis, with existing movement inhibited. Fluid motion and pressure rise show positive correlation with a pump, and nega- tive correlation with a ram. Lauboek was the first to demonstrate by means of echocardiography that blood pressure and blood movement in the heart follow the laws of the hydraulic ram, at least with exercise.

Having evolved the phylogenetics and embryology of the heart in a living way and, indeed, of the blood vessels altogether, we need not be afraid that the pupils will end up thinking the heart to be a "better" machine than a pump. An exemplary opportunity is given here to present the machine/ organ relationship and the value and limitations of analogies used to help understanding.

Following a suggestion by Wolfgang Schad, a firm (Peter Wenger, Bluetenweg 10, D-78233 Stockach; tel/fax 077 71 39 14) now offers a hydraulic ram for classroom use (DM 420). For the same reason, the author of this paper has compiled an (incomplete) bibliography that may be helpful in preparing lessons. Upper school pupils at Waldorf schools (from class 10 upwards) should know that the pump theory has been in dispute for a long time (Thomas Aquinas, Hegel, K. Schmid, P. Vogel, Leon Manteuffel-Szoege). Rudolf Steiner's teaching on the heart in is line with their thinking. Having taught the main lesson in class 10, I would like to refer to the work of some of the authors listed, though this does not imply that they are of greater value.

Eugen Kolisko's paper "It is Not the Heart that Drives the Blood..." offers the excellent suggestion for teachers to start from the evolution of sap circulating in plants and lower animals. He shows the complex, differen- tiated circulation that can develop in organisms that have no vascular system or heart. Wolfgang Schad correspondingly speaks of situations in the world of nature where muscles move with an inherent rhythm yet there is no medi- ating nerve function (Schad 1992). Christiane Liesche presents a most useful review of the evolution of the cardiovascular system in vertebrates, taking her orientation from Kipp's and Schad's concept of emancipation from the environment as an evolutionary principle. In the first part of his paper, Hermann Lauboeck presents the arguments that go against the pump theory, e.g. experiences with heart-lung machines and pacemakers, which carry special weight because they are based on his own research. Karl Schmid's paper gives a very clear picture of the hydraulic ram. It has historical significance because Rudolf Steiner referred to it (2nd lecture. Spiritual Science and Medicine).

The paper by Gisbert and Friedwart Husemann is historically the first en the subject of the hydraulic ram from the anthroposophical and Goethean point of view. The authors speak of a double ram (driving water in a stream and bringing up well water). The ram is made part of the earth's water circulation, and this is important from the educational point of view. Gisbert Husemann's paper presents a heart type in the landscape organism of the Hegau area where Rhine and Danube meet. Friedwart Husemann's paper on the heart as an endocrine organ is important because it refers to scientific findings that show the extent to which the heart is a sense organ for the circulating blood volume (hormone secretion dependent on diastolic expansion).

As teachers and physicians, we are called upon to work together to develop a new approach to the heart. At the suggestion of Paolo Bavastro, a research group on the subject has recently been established in the Medical Section at the Goetheanum. Perhaps this paper will encourage colleagues to write how they present cardiac function in their lessons. Reinhold Sorms, physics teacher at Uhlandshcehe Waldorf School, has also built a model of a hydraulic ram that demonstrates the action extremely well. He will be happy to advise others.

Armin Husemann MD Anthroposophisches /Erzteseminar Haberschlaiheide 1 D-70794 Filderstadt Germany

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Bargmann W, Doerr W. Das Herz des Menschen 2 Bde. Stuttgart 1963. Band I, S. 22 ff, S. 180. (Blood stream as cause for heart configuration. ECG in basic form derivable even at embryonic stage.)

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