Rudolf Steiner begins his second lecture in Spiritual Science and Medicine by reminding us of the attempt to observe polarities that govern the human organism: the forces of gravity vs. levity in the skeleton, and the analogous chemical reactions that are either alkaline or acid occurring in human muscle metabolism. As we look into these polarities we have to attempt the journey to an extraterrestrial realm, passing through the point where pressure holds sway and entering through our thinking activity into the ether-realms where suction prevails. Attempts to follow vector analysis or the intricate dance of extraterrestrial chemistry allow this etheric realm of light, life, and ordering activity to become active within us as we turn our thinking virtually inside out.

Steiner next turns to the human heart in a further step along the path exploring the polarities in the human being and the awakening of an inner activity appropriate to taking such a step. In but a few sentences he presents two polar pictures of the heart: "It is regarded as a kind of pump, to send the blood into the various organs," and then, "The most important fact about the heart is that its activity is not a cause but an effect." In the course of a few sentences we are asked to hold in our minds these two pictures of the heart: first as a cause, as a pump whose effect is to move the blood by pressure to the organs; and second, as an effect, as something that receives or absorbs the blood whose movement is caused elsewhere by suction at the periphery.

In moving between these two pictures, the same kind of inner activity is demanded of us as was required to try to perceive the forces of levity in the human skeleton and the extraterrestrial dispersing forces in a muscle's acidity during movement. To make the inward journey so quickly from the heart as pump to the heart as an inner sense organ, from pressure to suction, creates within us a kind of image-vortex such as is created when we stir fluid very rapidly, then suddenly change direction. When this is done, we see the form of the heart created by this gesture in the water.

What we will attempt here, then, is to stir the sluggish water first in one direction, then in the other, then yet again in another, and hope to create in this way an image of the heart's activity and not just confusion! We will investigate what William Harvey had to say about the heart, for he was among the first physicians to present the picture of the heart as the source of movement within a circular pathway of the blood, and as such he really established a threshold in the history of physiology. Most books on Harvey either take their starting-point from his brilliant discovery or finish with his world-shaking treatise on the circulation of the blood, Exercitatio anatomica de motu Gordis et sanguinis in animalibus, published in 1628. In our age, however, we are so imbued with Harvey's picture that it is difficult to un-think his view and to try to live into whatever picture there may have been before Harvey revolutionized physiology. It is quite easy for us to see instantly a certain logic in what Harvey conceived for the first time, but how can we stir the water for a moment in the other direction to unthink the heart as a pumping mechanism?

The predominant view of the heart and blood circulation that endured from ancient times until Harvey can be grasped through the image synthesized by Galen, the so-called Prince of Physicians, for his view was held essentially unmodified from 200 A.D. until Harvey's discoveries in the seventeenth century. It is unfortunately nearly impossible to gain a clear picture of this view from the materialistically oriented histories of science available today, as the images are given thoroughly physical translations and interpretations that most likely distort their original meaning. A suggestion of this is the fact that the word pneuma -- which can mean air, breath, or spirit -- is often indifferently translated as air, possibly giving a false physical impression. In any case, let us try to recreate this pre-Harvey view of the heart and blood circulation, so that we can see what Harvey tried to cut through with his razor-sharp intellect.

The main picture of the heart in Galen's writings is that it serves as the human hearth, the source of innate warmth that then acts to vitalize the whole body. Breathing provides the pneuma -- air, spirit -- that provides the nourishment for this warmth, also serving to cool and refresh the heart by relieving it of burnt and sooty particles. The heart is not regarded as a muscle, since it does not beat voluntarily, and Galen saw the heart's pulsating power as having its origin within the heart itself in the heart's attraction to the air or pneuma it requires for nourishment. The activity of the heart would thus take place in this way: the heart feels an inner yearning for air or spirit, and through this powerful force of attraction it draws the blood fluid or pneuma toward it and dilates, receiving the fluid that is then driver, by the blood vessels into the heart. Galen conceived that the heart's exertion came not in expelling the blood by contracting but in attracting and dilating.

The two sides of the heart, however, serve totally different functions according to Galen and his followers, in fact belonging to two entirely different systems of circulation, the venous and the arterial. The venous system was said to arise like a tree with its roots in the abdominal organs, particularly the liver, having its trunk in the vena cava leading to the heart, and then branching throughout the body, including to the right heart and from there the lungs. The purpose of the venous system was to draw nourishment from the intestines, distribute it to the liver, where it was imbued with the spiritus inherent in all natural substance -- natural spirit -­then distributing this natural spirit or vital activity as well as nourishment to the rest of the body, passing through the right side of the heart and lungs to nourish them. Venous blood was thought to be formed out of the chyle from the digestive tract.

The arterial system had its roots in the left heart and its trunk in the aorta, branching from there to the rest of the body. Some of the venous blood from the right heart was thought to seep through the interventricular septum, separating the right and left halves of the heart, passing through minute channels or pores and entering the left ventricle drop by drop. There it encountered the vital spirit or pneuma brought to the left ventricle by the pulmonary vein. The blood was thus permeated with a higher form of spirit through the respiration connected with the outside world, and this rarefied, enspirited blood was distributed to the body by the arteries. In the arteries leading to the brain, the blood was further charged with a higher form of spirit or pneuma, the animal spirit, distributed by the nerves.

The arterial system, then, had its origin in the heart and distributed air or pneuma to the body derived from respiration in the lungs and through the skin. The venous system had its origin in the liver and distributed nourishment and lower, natural spiritus derived from the chyle. The veins were thus believed to contain a totally different kind of blood from the enspirited blood of the arteries, and there was no concept of a continual circulation of arterial to venous and venous to arterial blood. The two kinds of blood vessels were explained by the different blood they carried. The veins carried mostly blood, thick, dense, and sluggish, so that the thinner veins allowed it to move more freely. The arteries, carrying more air than blood -- air being light and thin and quick -- were thick in order to keep the air confined, preventing it from dissipating in the body.

Right up to the time of Vesalius, this picture of the heart and circulation essentially persisted, with the heart viewed as a kind of mixing chamber where spirit was created to animate the human being in a kindling of warmth. The lesser circulation to the lungs was discovered in the Middle Ages but viewed merely as a way to rid the blood of impurities and to nourish the lungs themselves. Many incoherent fragments of fluid movement were thus pictured, but there was no unified view that could adequately explain the source and ultimate destination of the blood.

So it was understood until the work of William Harvey, who was born in Kent in 1578, a contemporary of Shakespeare and Lord Francis Bacon. He attended grammar school in Canterbury and then went on to Cambridge University, studying at Gonville College, which had been reorganized by a student of Vesalius in Padua, John Caius. From there Harvey went to the famous medical university in Padua, the university of Vesalius and Fabricius, two of the greatest anatomists. Fabricius (1537-­1619) was most famous for his intricate work elaborating the valves in blood veins, and one of his most diligent students in Padua was the young Englishman, Harvey. Harvey always received very high honors, and when he returned to England to practice medicine shortly after the turn of the century, he moved quickly up the professional ladder, eventually being appointed Physician Extraordinaire to King James I in 1618 and later Physician Ordinaire to his son, King Charles I. Among his patients was also Lord Bacon; Bacon's genius did not particularly impress Harvey, who said of him, "He writes philosophy like a Lord Chancellor."

From his careful experimental work and observation Harvey developed his view of the heart and circulation as early as 1616, the year of Shakespeare's death, but he did not actually dare to put it in writing for the public until 1628, whereupon his professional prestige suffered considerably. Nevertheless he continued to work steadily, despite many setbacks personally and professionally. The Civil War raged in England from 1639-49, and as Harvey was obviously a Royalist, his fate suffered after Charles I was beheaded. He lost all his scientific notes and papers, and after Oxford fell to the revolutionaries in 1646, when Harvey was sixty-eight, he gradually retired to a quiet practice of medicine and his exacting work in dissection. He suffered considerably from attacks of gout, dying finally in 1657 of a cerebral hemorrhage.

Harvey's work had a revolutionary effect on his contemporaries, having considerable impact on the social conscience of his age. Whereas for centuries the blood and heart had been surrounded by mystery and regarded as the seat of the human soul, Harvey's view now seemed to dispel that very mystery and to reduce what had been believed to be a spiritual substance to a series of tissues with a central, rhythmically contracting muscular organ.

We all begin with this image of the heart as a mechanical pump ingrained in us. We have tried here to stir the water in the other direction to recreate the more ancient picture of the heart as a gathering and mixing chamber for the spirit, split between two entirely separate circulations, the lower venous and the more enspirited arterial circulation. Now let us quickly stop and try to stir the water again in the other direction. Harvey had many reasons for his discomfort with the materialized remnants of Galen's pictures, filled as they were with inconsistencies, gaps, and obvious errors, like that of the blood seeping across from the right to the left side of the heart. While Harvey avoided the more unapproachable questions of the origin of spirit, he tried through meticulous observation to arrive at a consistent and coherent picture of the blood's movement through the body. In doing so he also totally reversed the picture of the heart, moving from an image of reception and suction to one of expulsion and pressure. Having observed that the heart grows pale and small like a muscle in contraction, he concluded that the heart is indeed a muscle that acts by squeezing the blood out of its chambers during contraction, rather than actively receiving blood during dilation. As he wrote,

"So the opposite of the commonly received opinion seems to be true. Instead of the heart opening its ventricles and filling with blood at the moment it strikes the chest and its beat is felt on the outside, the contrary takes place so that the heart while contracting empties. Therefore the motion commonly thought the diastole of the heart is really the systole, and the significant movement of the heart is not the diastole but the systole. The heart does not act in diastole but in systole, for only when it contracts is it active."

The blood would thus fill the arteries not by their dilation, attracting the blood toward the periphery, but by the pressure from the heart's systole: "The arteries dilate because they are filled like bladders or leathern bottles; they are not filled because they expand like bellows." Harvey felt this was proven by the spurts of blood coming from a wounded artery, corresponding rhythmically to the beat of the heart.

In addition, Harvey calculated that the amount of blood expelled by the left ventricle into the aorta in one hour would be 8640 fluid ounces, or three times the weight of a heavy man in blood (2 ounces of blood per contraction x 72 contractions per minute x 60 minutes). Where, he queried, could all this blood come from? Surely not from a little blood seeping across the septum through channels no one could discover. Surely not enough new blood could be manufactured hourly from the chyle. He concluded, then, that the massive amount of blood flowing through the arteries must come from the venous system, that there must be a continuous circulation of blood in one direction, guided by the action of valves in heart and veins. The blood, he realized, must be in continuous motion, as motion is necessary to generate and preserve heat and spirit in the organism. The blood in the extremities loses its warmth and spirit, growing thick and cold, and must return to the source, the heart, to take on new heat or spirit.

"The blood is thus more disposed to move from the circumference to the center than in the opposite direction, were there even no valves to oppose its motion; whence that it may leave its source and enter more confined and colder channels, and flow against the direction to which it spontaneously inclines, the blood requires both force and impelling power. Now such is the heart and the heart alone. . ."

Harvey thus conceived the first coherent view of the blood's circulation from arterial to venous blood and back into the arteries, finally comprehending the role of the lesser circulation to the lungs in the process. He saw that the venous blood enters the heart through the right atrium, passes down into the right ventricle, and from there can exit only via the pulmonary artery to the lungs. It was a totally new picture that the entire mass of blood in the human body might be able to pass through the lungs and then back into the heart via the pulmonary vein, entering the left atrium, moving down into the left ventricle, and from there up into the aorta and to the periphery of the body.

Without having the possibility of microscopic investigation, Harvey could only surmise the transition from arterial to venous blood taking place at the capillary level. He presumed that the initial force of the heart's pumping action was also sufficient to impel the arterial blood into the venous system and then back against the flow of gravity to the heart. He thus described the circulation in the following way:

"This motion may be called circular in the way that Aristotle says air and rain follow the circular motion of the stars. The moist earth warmed by the sun gives off vapors, which, rising, are condensed to fall, again moisturizing the earth. By this means things grow. So also tempests and meteors originate by a circular approach and recession of the sun.

"Thus it happens in the body by the movement of the blood, all parts are fed and warmed by the more perfect, more spiritous, hotter, and I might say, more nutritive blood. But in these parts this blood is cooled, thickened, and loses its power, so that it returns to its source, the heart, the inner temple of the body, to recover its virtue.

"Here again it regains its natural heat and fluidity, its power and vitality, and filled with spirits, is distributed again. All this depends on the motion and beat of the heart.

"So the heart is the center of life, the sun of the microcosm, as the sun itself might be called the heart of the world."

It should be clear from this that although Harvey became convinced that the heart moved the blood to the body's periphery through pressure, he nevertheless maintained a more cosmic view of the heart as a source attracting the blood than is now held by his legion of followers.

We can imagine, I think, the awe and relief that must have dawned slowly as people gradually took in the simple coherence of this circular picture of the blood circulation. We take such a picture absolutely for granted, yet try again to think it away, and you see how difficult it is to return to a notion that has the gaps and physical inconsistencies of Galen's.

Yet once again, as Rudolf Steiner challenges us to do, let us stir the water vigorously in another direction. Is it necessary, if we accept the coherent circulation of the blood discovered by Harvey, also to arrive at the conclusion that the heart's pressure is the only dynamic means by which this circulation is active? How can we see the circulation as Harvey does, moving coherently in a circle, yet not regard the heart's beat as its impelling force? And how can we regain an understanding of the polarity of the digestion and the respiration and nerve-sense activity, perceived so clearly by Galen in his view of the venous and arterial systems, without resorting to conflicting, unjustifiable hypotheses about the structure and action of the human organism? How can we truly see the heart as an organ of effect, not of cause, of suction, not of pressure, of inwardly sensing, not of outwardly impelling? Steiner points the way as incisively as he does when bringing these two opposing pictures before us in a moment, creating in us a vortex of picturing activity: he points us to embryology, where we can see clearly the heart emerging out of activities already existing within the developing embryo. Here we are guided through the null-point from matter into spirit. Steiner develops this further in his lecture cycle, Man, Hieroglyph of the Universe:

" . . . the heart does not work like a pump driving the blood through the body, but . . . the heart is moved by the circulation, which is itself a living thing, and the circulation is in its turn conditioned by the organs. The heart, as can be followed in embryology, is really nothing more than a product of the blood circulation ... Just as the movement of the heart is the product of the life force of the circulation, so the Sun is no other than the product of the whole planetary system. The Sun is the result, not the point of departure. The living cooperation of the solar system produces in the center a hollow, which reflects as a mirror ... a hollow space of suction which annihilates everything within it. A space indeed that is less than hollow ... What shines to us in the light is the reflection of what first comes in from cosmic space -- just as the movement of the heart is, as it were, what is arrested there in the cooperation of the organs, in the blood movement ...

"By following up embryology, we find how the heart is gradually welded together or piled up, as it were, by the blood circulation, and it is not a primary form ... To illustrate the idea, let us say we have a stream of water falling over the rock. It throws up a variety of formations and then flows on. These formations are caused by the forces of equilibrium and motion at this place. Now imagine that suddenly all this were to petrify; a skin would be formed like a wall, then the rest would flow on again, and we should have an organic structure formed. We should have the current going through the structure, coming out again, and flowing on further in an altered form. You can imagine something like this in the case of the flow of blood, as it circulates through the heart."

Harvey himself was intrigued by the questions that embryology raises, devoting his quiet later years to their study. He asked, in fact, "Why does blood appear before anything else, and how does it possess the vital animal principle? How does it desire to be moved here and there, for which reason the heart seems to be provided?" His fixed thought, however, apparently prevented him from seeing that the blood, appearing before anything else in the embryo, was not simply desiring to be moved but was actually in motion already.

For us to be able to think away the material deposits of the heart and to conceive the pure inner activity that precedes it is an activity that in itself sucks us toward the etheric realm. First we look out into the world and see our whole being scattered in fragments, a single point extended in every direction to infinity. We then push our thinking inside out, as it were, and look into our own heart, where the heavens are inverted and the infinite circle of the periphery is concentrated into a single point. To explore embryology is to make this same journey continually from point to periphery, from periphery to point, and this is the method to which Steiner points us in the exploration of the mysteries of the human heart.

*Based on a talk given at the May 1985 meeting of the Anthroposophical Therapy and Hygiene Association (ANTRA) in Spring Valley, N.Y.

References

Harvey, William. "An Anatomical Disquisition on the Motion of the Heart and Blood in Animals" (1628), in Classics of Cardiology, edited by Fredrick A. Willius, M.D., and Thomas E. Keys. New York: Dover Publications, 1941.

Sigerist, Henry E. The Great Doctors, A Biographical History of Medicine. Garden City, N.Y.: Doubleday & Company, 1958.

Steiner, Rudolf. Man, Hieroglyph of the Universe. London: Rudolf Steiner Press, 1972.

Steiner, Rudolf. Spiritual Science and Medicine. London: Rudolf Steiner Press, 1975.