Our Heart: Sounding, Serving, Unifying by Philip Kilner

An article from the 1994 Edition of the Golden Blade

An Anthroposophical Scientific Journal

https://www.waldorflibrary.org/images/stories/Journal_Articles/Golden_Blade__1994.pdf

Shielded in the chest, the heart moves unobtrusively, night and day. It is strange that, even at rest, our bodies contain this centre of dynamic movement, in which muscle, valves and elastic vessel walls engage rhythmically with the pressure and flow of streaming blood. It is also remarkable that such a physically active organ seems to participate in the midst of the essentially non-physical: our emotions, our human judgment, our very being.

As in a musical instrument, some fundamental mechanical principles operate in the heart. There is an interplay of forces between fluid and elastic components. And, as in a musical instrument, these components, with their rhythmic movements, tensions and pressures, take part in the mediation of something else.

Different organ systems of tire body are also involved, each in their different ways, in the mediation of non-physical human qualities. The full organic interplay may be likened to a living instrument or orchestra. But in this article, the aim is to consider the heart — an organ with a central, unifying role — and particularly its fluid dynamic origins and action.

 

 

The graspability of the heart’s ‘pump’ action presents some thing of an obstacle to appreciation of other aspects of its function in our organism. But I think we should acknowledge at the outset reasons for the heart being likened to a pump.

Each of the human heart’s two ventricular chambers has an inflow valve, allowing blood to enter via one of the atrial chambers from veins. And each has an outflow valve, allowing blood to be ejected into the great arteries when the ventricular muscle contracts against closed inflow valves. Effective movements of muscle and valves of the main (left) ventricle are absolutely necessary to sustain adequate pressure and flow in the arteries for the viability of various organs, particularly the brain and kidneys. It is the pump-like action of the heart that maintains the vigorous pressure and flow in arteries, giving force to the blood’s movement out into the branches of the circulation, the finest of which are almost inconceivably small and numerous.

Just before the era when microscopes made it possible to see direct evidence of the delicate capillary networks linking the peripheral branches of arterial and venous trees, William Harvey, through dissections, observations and experiments, discovered much about the overall arrangement of the double circulation in man, and the paired pumping actions of the right and left heart. His dissertation, de Motu Cordis, 1 first published in full in 1628, displays the breadth and thoroughness of Harvey’s studies in animals and man. A whole series of observations and arguments were marshalled to overcome long accepted misconceptions regarding the movements of air and blood in vessels. Harvey’s contribution laid foundations for modern cardiology and heart surgery, and much of a heart surgeon’s work (repairs of heart valves and blood vessel connections) follows from the need to sustain effective pump action at the centre of the circulation.

Operations go as far as heart transplantation. In transplantation, the failing heart muscle, with valves and immediate vessels, is replaced by a donor organ in such a way that the recipient’s own blood circulation is once more connected and propelled. The recipient’s own blood must also permeate and sustain the received organ. Naturally, re-establishment of this living synergy is not without difficulties, but it has been achieved many times. During surgery temporary artificial pumps, which may employ one of several distinct pumping mechanisms, are used to maintain blood circulation, and life, while the heart is being opened and repaired or replaced.

But what did Rudolf Steiner have to say on this subject? Here is a passage translated from the second of the cycle of 20 medical lectures 2 given in Stuttgart in 1920:

” What is the generally held view of the nature of the human heart? It is regarded as a kind of pump propelling blood into the different organs. All sorts of intricate mechanical constructions have been put forward to explain the action of this pump device the heart Embryology quite contradicts these mechanical constructions, mind you, but the mechanical heart theory has not really been questioned or tested, at least, not in orthodox scientific circles.

What one should, above all, take into consideration when looking at the heart is that the heart is by no means what one would, in the first place, call a kind of active organ. Heart activity is not a cause; it, is a result. You will only understand this if take into account the polarity that exists between all the activities in the human organism which are involved with the intake of nourishment, and the further processing of nourishment, with its passage directly or through vessels to the blood, and then follow the processing of the nourishment, so to say, from
below upwards to the interaction that takes place between the blood that has taken up the nourishment, and the breathing that allows air to be taken in. If you take a thorough look at what is involved in this — one need only look at it thoroughly enough — then you will find that there is a certain way in which everything that lies in the breathing processes is opposite to that which, in the broadest sense is involved in the digestive process. There’s something there seeking to be balanced out. There are things there which, 1 would say, thirst for one another and wish to be satisfied by each other. One could of course find other words to express this, but it will become clearer as we go on. An interaction takes place which consists, initially, of what passes between the liquified nutrients and that which is taken into the organism in the form of air by the breathing. This interaction must be studied exactly. This interaction consists of an interplay of forces. And these forces which play into each other find themselves held back before their mutual interaction in the heart. This originates as a ‘damming up’ organ [Stauorgan] between what I would call the lower activities of the organism — the intake and processing of the food — and the upper
activities, the lowest of which is respiratory. A damming up organ is inserted and the most significant point is that its action is therefore a product of the interplay between the liquified foodstuffs and the air absorbed from outside. Everything that comes to expression in the heart, all that can be observed there, must be looked upon as an effect which, in the first place, should be seen mechanically.

The only hopeful beginning that has been made towards examining the mechanical foundations of the heart’s activity (though nothing more than that) was made by an Austrian Doctor, Karl Schmidt who published a paper on ‘The Heart Action and the Curve of the Pulse.’ There is not a great deal more to be found in this treatise, but one has to admit that at least there someone has noticed, in the course of his medical practice, that in the heart we are not dealing with a pump in the usual sense, but with the heart as a damming up device. Schmidt likens the whole process of heart movement and heart beat to the action of a water ram, set in motion by the currents. Therein lies the truth in what Dr Karl Schmidt has set out.”

The paragraphs above deserve careful study. They do not amount to ‘the heart is not a pump,’ although they certainly suggest that it did not originate as a pump. They indicate that the heart’s rhythmic action originates from motions of currents held back in their passage between the nutritive organs, on the one hand, and the upper activities on the other (Figures 3.1 and 3.2).

In this extract, Steiner did not specify which ‘upper’ activities he meant, presumably because his concern was to convey the heart’s general situation between poles. The heart’s situation can actually vary considerably: between species, during embryonic and foetal development, and, especially, through birth in higher mammals and man. For example, uptake of nutrients and dissolved respiratory gases are both
via the chorion and placenta before birth, flowing in from ‘below’ the heart, with the growing brain, organs and limbs supplied ‘above.’ Once the lungs become functional with the first breath, however, respiration begins to operate ‘above’ the right side of the heart, although it remains, in a sense below the left heart, with the nerve-sense organization above that.

 

 

Understandably, Rudolf Steiner avoided these convolutions, putting across, very expressively, the heart’s functional location between the nutritive and the upper regions. In terms of biochemistry, several counter-processes can be identified in the organism — nutrition/respiration, respiration/metabolism, metabolism/excretion — with substances arising through localized processes that ‘thirst’ to be
balanced by counterparts elsewhere. I think it is accepted in conventional biology that localized metabolic differences and needs underlie the existence of the blood circulation and heart. Rudolf Steiner goes further, in that he points specifically to a responsive, fluid mechanical origin of the heart beat. And his approach is not reductionist. For him, the polarities are not just physical, they are of the essence, finding expression in overall form and function as well as in chemistry.

After the section translated above, Steiner went on to introduce the idea of heart as sense organ, albeit subconscious, through which ‘upper’ activities sense the ‘lower.’ And in the preceding lecture, he had illustrated how fully realized, or retained, the upper/lower polarity is in the adult human organism compared with that of animals. In the human, the strong polarity is apparent in bodily form and posture. That first lecture of the series must have been one of the seeds for the classic Goethean study of Man and animals by Hermann Poppelbaum.3 I mention it because, although I am not going to attempt to draw essential distinctions between human and animal circulatory systems, overall
bodily organizations can be recognized to manifest the most telling differences, as well as affinities.

Regarding the mechanics of heart function, Steiner was clearly scornful of too crude and simplistic an approach. I believe his way of expressing himself bordered, deliberately, on the provocative … towards further investigation and thought.

FLOWFORMS & TRICKLES

My great interest in heart function began after my medical studies, and some years after first hearing of Steiner’s challenging remarks about the heart and circulation. My real engagement with the subject began with what to me felt like a wonderful discovery. I was studying sculpture at Emerson College, and was being introduced by John Wilkes to Flowform design. We had used clay to shape Flowforms, which
will be familiar to many readers as paired cavities that induce rhythmic, swirling movements in streaming water (Figure 3.3), and we were experimenting with flow in meandering clay channels. John said it would be interesting to see pulses of flow moving down a channel, and I began to wonder how we might set this up. It occurred to me that a single cavity, one half of the paired cavity Flowform design, might give
rhythmically interrupted outflow. But when I first tried it, I could not get it to work. Then, a couple of days later, I noticed that a stream flowing from the end of a hose up a clay ridge on a sloping board was doing it! The stream was rhythmically building up along the ridge, curling back on itself and pouring down the board, repeating the cycle, so that the stream down the board flowed intermittently. I experimented with the positions of hose, ridge and board, until I was able to start again and shape a slightly more elegant ‘single cavity Flowform,’ which, on receiving a continuous stream gave rise to a pulsatile, rhythmically interrupted one.

It was at this stage that I really began to consider the flow cycle in a Flowform as a possible model of blood movement in a heart cavity. I later built single cavity forms on a much larger scale, but at the time, discovery of the simple Flowform variant stimulated a series of small scale experiments, exploring the dynamics of pulsatile flow in shaped cavities. These led, in time, to collaboration with a heart surgeon on
studies of flow dynamics in relation to operations for certain severe malformations of the heart, and later to studies using magnetic resonance imaging, enquiring into patterns of flow through living heart and great arteries.4

Early on, a second small, striking discovery gave support to the apparent relevance of the Flowform to heart development and function. John Wilkes had us experimenting with water streaming over waxed surfaces. Large streams raced down the waxed board, smaller streams meandered over it in an amazingly animated way, but a tiny stream would settle to a certain path, flowing steadily under its tube-like surface
film. I found that careful shaping of a small trickle using a match stick, into a bend with a slight swelling, could lead to local, rhythmic pulsations of the surface, as if a small region came to life and pulsed (Figure 3.3). What happens in such a region is that the laminar flow of the trickle separates from part of the surface, and a little eddy current curls round and back, becoming slightly unstable. The eddy forms part of a dynamic cycle, driven by the forward current and contained by the tension in the curved surface, which gives rise to spontaneous pulsation — a small scale version of the Flowform phenomenon, and a liquid ‘cousin’ of the air flows that give rise to sound in a wind instrument.

What were those phrases of Steiner’s? ‘Everything that comes to expression in the heart … must be looked upon as an effect which, in the first place, should be seen mechanically,’ and ‘… set in motion by the currents. Therein lies the truth …’ (in Karl Schmidt’s likening the heart to a water ram).

To consider the water ram analogy, I will describe the ingenious device: It is used for pumping water, perhaps to a home on a hillside from a stream in the valley below. It makes use of the kinetic energy of a fairly generous amount of flowing water to operate a valved system which forcefully raises a small fraction of the total downward flow.

The way it works is that water flows down a straight section of rigid pipe. At the far end of this it escapes up through a valve arranged ‘the wrong way round’ so that the valve slams shut when the escaping stream is fast enough. Sudden interruption of flow by the shutting valve causes a sudden rise in pressure. Water in the pipe is brought to a standstill, and pressure drops again, and so does the valve, and the cycle
can repeat itself. The result is a repeatedly banging ‘water hammer,’ with tremendous fluctuations of pressure in the pipe. The peaks of pressure drive part of the water volume out through a second valved escape hole, this time with a valve arranged the right way round for forward flow into a ‘Windkessel’ pressure chamber containing a cushion of trapped air (included to help smooth the pressure and flow
fluctuations) and on into a pipe leading up the hill.

But sxirely this is also a crude and awkward model for heart function? Taken alone, and too literally, it is quite inappropriate. In the heart, the valves sure all ‘the right way round’ for forward flow. There are no straight, rigid pipes, and the early embryonic heart, to which Steiner alluded, makes its first appearance without valves. The relevance of the water ram model, according to Rudolf Steiner’s comment, is that its rhythmic action is set in motion by the currents. This being the case, I very much prefer to take the pulsating trickle, or the Flowform (each set in rhythmic motion by the currents) as models for a responsive aspect of heart function. Both illustrate how a continuous, steady
stream can spontaneously pass into a rhythmic flow cycle, and the pulsating trickle demonstrates how the currents of the flow cycle can in turn move flexible containing walls, bringing the boundary as well as the stream into rhythmic movement.

THE EMBRYO HEART

The simplest form of pulsating trickle is a bend and swelling which pulses spontaneously as its trapped eddy waxes and wanes in the forward stream. In all vertebrates (creatures with backbones: fish, amphibians, reptiles, birds, mammals and humans) the embryonic heart begins as a delicate tube like structure, formed by the joining of a pair of vessels. This heart tube curves to form a slightly swollen, twisted, S-bend
(Figure 3.2), the loops of which develop into the atrial and ventricular heart chambers. At a certain stage, the overall curvature approximates to a form which, in a non-living trickle, could well induce spontaneous pulsation. It is at about this stage, before the formation of any valves, that the heart is thought to start beating, with blood beginning to circulate. But which comes first? Is there flow round the circulation first, to which the bend of the heart tube responds with spontaneous pulsation, gradually taking up the rhythm with its own active contractility? I would love to know the answer, but it is not easy to be certain about the truth.

Living human embryos cannot be investigated at this stage. It would be about 16-20 days after conception, about the time when the mother may be aware that her menstrual period has not come as usual. The embryo itself would be a delicate formation of membranes, still only about two or three millimetres long, suspended in a sphere of supporting membranes. The outermost layer, the chorion, would be rich
in tiny developing blood vessels in close proximity with the blood of the mother’s womb. The human circulation has its beginnings in and around a membranous drop which is embedded in the wall of the womb, well hidden from prying eyes.

The same cannot be said of a chick embryo’s circulation. Aristotle is supposed to have peered down into an incubated, fertile egg, and marveled at the tiny pulsing red spot which was the heart of the growing chick. So did William Harvey. It is not too difficult to do this, through a window made in the shell. Use of a low-power microscope makes the network of the developing circulation visible, spreading through the area of a disc over the uppermost surface of the yolk as it hangs suspended in clear fluid. The chick circulation begins after only a day or two of incubation, with the tiny granulations of blood cells moving through the net of delicate vessels, and the embryo forming at the centre of the circular network. The heart tube is forming on the ventral (front) aspect of the transparent embryo, located between vessels
converging from the surface of the nutrient yolk, and the vessels flowing up to sustain the growing brain, spinal cord and other organs. But even in the chick, it is not easy to determine whether the blood or the heart move first. A few years agoI studied several incubated eggs, but I am afraid I only ever saw blood circulation when the heart was already beating. I never observed circulation start before heart pulsation, although this was what I was most eager to see.

Others, also following up Rudolf Steiner’s remarks on the circulation, have described evidence of spontaneous movement of blood, independent of heart action, in the embryonic circulation of chicks,5 and also in freshly excised  mammalian organs.6 Their reported observations of spontaneous blood movement were always in circulations, or parts of circulations that included microscopic capillary vessels.
There is no evidence that what was observed was ever more than a gentle, seeping flow or a very small positive pressure on the venous side. I suspect that if spontaneous blood movement occurs, it is dependent on weak interactions between blood and surrounding tissues which are active over  extremely short distances. The capillaries that make up the varied networks of the peripheral circulation are almost inconceivably small, with diameters of about a fifth of a hair’s breadth! Within such small dimensions, forces of gravity and inertia are negligible, and other more subtle, less familiar forces may dominate. But, in the intact, mature circulation, with the heart maintaining substantial flow, there seems little doubt that friction between blood and the delicate boundaries of small vessels greatly exceeds any locally active forward
propulsive force on the blood. Careful attempts at pressure measurements in very small vessels in the living mammalian circulation have recorded, as predicted by the conventional circulatory theory, a gradual pressure drop from the arteries, through capillaries, to veins.’

I believe the evidence does support the conventional view that high arterial blood pressure, maintained by the heart’s ejection of blood, is (in larger vertebrates, at least) the major force propelling blood around the circulation. But this does not exclude other more subtle, locally acting forces at capillary level, and it does not exclude a responsive aspect to heart function.

Whatever the truth may be about the beginnings of the circulation in the chick or human embryo, the more remote origins of the vertebrate circulation and heart must be even more difficult to determine. Or are they? Paradoxically, I feel more confident about which came first – circulation or heart — in evolutionary development. I feel same that it was not the heart that materialized first. It is likely, on the other
hand, that there were, and still are, primitive fluid circulations seeping round small invertebrate organisms without hearts. Gentle circulatory flow might well be initiated by the movements of nutrients and respiratory gases along diffusion gradients sustained through metabolic processes. And there may be other delicate forces that can maintain an adequate circulation over small distances in a small organism.

These thoughts about the origins of the heart remain speculative. Many interweaving influences and processes, developments and regressions must have contributed to vertebrate hearts as they are today.


DYNAMIC ELEGANCE OF THE VERTEBRATE HEART

It is likely that peripheral and dorsal ‘hearts,’ similar to those found in present day worms, molluscs and insects, existed before the appearance of the localized ventral heart of vertebrates. I believe that the gradual refinement of the vertebrate heart — a heart located at the ‘front,’ between abdomen and head, characterized by the atrio-ventricular double bend — must have been crucial to the evolution/ creation of the vertebrate line. The action of the more primitive peripheral and dorsal hearts could never, I think, be called ‘dynamic.’ The chambers, which in insects are arranged in a line up the body, have something of a milking action, supplemented by valves in larger species, directly
effected by external bodily movement, but never capable of sustaining swiftly streaming flow and firm, pulsing pressure.

The ventral vertebrate heart is different. Its rhythmic action is emancipated from bodily movement. The movements of heart chambers are not directly affected by movements of the limbs and trunk, although the heart is certainly responsive to the needs of the body. It responds, for example, with vigorous activity when blood returns with increased flow and altered chemistry during exercise. Exercising limbs help to
propel blood back to the heart by rhythmic compression of  valved veins. In the heart, the muscle tissue itself has a responsive aspect, the strength of its contraction being positively related to the initial stretch of muscle fibres. And this responsiveness may be ‘tuned’ by influences mediated via hormones (for example adrenaline) and the nerve pathways of the autonomic system. But the point that I want to emphasize particularly is the dynamic elegance of the vertebrate heart.

The atrio-ventricular double bend is uniquely suited for a dynamic, rhythmic redirection and enhancement of flow. When the ventricular loop is ejecting blood, the atrial loop fills, with a turning, swirling movement of blood. Flow into the atrial receiving cavities can be compared, to an extent, with the rhythmic flow cycle of a Flowform (Plate 5, opposite page 64). This flow cycle achieves a natural transition from more or less continuous venous return to the interrupted surges of flow which pass through the atrioventricular valve. This does not mean, however, that the atrium is only passive in function. Its walls contain muscle fibres with their own inherent rhythmicity, led by cells in a ‘pacemaker’ region. But the atrium is a fairly delicate, thin walled chamber, where flow cycles and muscular contraction may be quite
sensitively attuned to one another. In the human heart, it is the right atrium, receiving blood returning from the upper and lower body (plus a smaller stream draining the heart’s own muscle) that can be regarded as the heart’s prime receiving chamber (Plates 6 and 7). Its wall
contains the pacemaker region of modified, rhythmically active heart muscle from which excitation spreads across both atria, and then down into the ventricular muscle.

It is the left ventricle, on the other hand, that can be considered the principal output chamber, with the weaker right ventricle wrapped round to the right and in front of it The ventricles also contain cycles of fairly orderly flow, but here the energy contained in the momentum of fluid (kinetic energy) is dwarfed by the squeezing strength of the ventricular muscle. Forceful ejection of blood does, however, have a dynamic consequence: as the ventricle accelerates blood into the aorta, the contracting chamber recoils, like the body of a swimming squid, propelled by what it ejects. You may feel this on your own chest wall, particularly after exertion — the apex beat of the heart results, in part, from
the left ventricle recoiling downwards as it propels blood up into the aorta. If such an active, dynamic ventricle were arranged linearly, that is with atrium, ventricle and aorta lying in a straight line (like chambers of an insect heart), ventricular recoil would push back on the blood waiting in the preceding chamber, giving it momentum in the wrong direction for ventricular filling. With the double bend arrangement of vertebrate hearts, the opposite is true. Ventricular recoil now pulls atrial blood towards itself so that ventricular filling follows immediately and efficiently.

In other words, the turns and twists of the vertebrate heart allow exchanges of momentum and energy — a rhythmic pull and push — between atrial and ventricular muscle and blood. They also, like Flowforms, accommodate relatively stable cycles of flow. They are streamlined for coherent, secondary flow patterns which readily curl back on them selves in spontaneous, rhythmic cycles (Plate 5). Neither laminar nor turbulent flow are really appropriate for the heart. The shapes and movements of heart cavities, and of the ventricular inflow and outflow valves, accommodate curling, vortical flows which carry and redirect the momentum of returning blood.

The stability of flow (avoidance of excessive turbulence) and the dynamic exchanges between muscle and blood become crucial during exercise. But they are also a key to the efficiency and continuity of the heart at rest. The heart continues its second-by-second work, day and night, beating about a million times per week, for all the years of a lifetime. This untiring reliability is founded on the flexibility and
coordination of parts. Blood, muscle, valves, veins and elastic arteries are all mobile, pliable, and sustained in life — moulding organically to life’s requirements. How different from the parts of ‘man made’ mechanical devices.

Heart movement swings between receiving and giving, responding and impelling. The atrial aspect receives and gathers up, until the curling streams and stretching muscle switch neatly over into the active, impelling wave of movement that is taken on more forcefully by the ventricles. The ventricles squeeze and sling the blood up into the arteries (Figure 3.5), where the heart’s pulse is conveyed out to all parts of the body. Not least, the brain is continuously bathed in the rhythms of the heart, although this background presence rarely intrudes on our conscious awareness.

In the heart’s cycle of activity, the two sides, left and right, are entwined, but distinct. The two streams move closely together, swinging round one another in their outward movement like partners swinging from the centre of a dance. They are dynamically linked — the more powerful left and the more responsive right — their flows separated only by a flexible dividing septum.

THE HEART & THE WHOLE

These dynamic, surging, entwined streams of the heart represent the midst of the double circulation, surrounded by both peripheries: the branches of the pulmonary blood vessels reach to and from the lungs. Surrounding the lungs, permeating the chest wall and all other parts of the body, are the arterial and venous branches of the systemic circulation.

The blood circulation does not really have the circuit-like arrangement often drawn in explanatory diagrams, although, functionally, blood follows the double, systemic/pulmonary circuits that are linked through the two sides of the heart, as William Harvey described. The branches of the arterial and venous trees are actually, like trees, volume-filling. The outflowing arterial tree of each organ occupies the same
volume as the inflowing venous tree, with paired branches flowing counter to one another, side by side. The liver even has two out-flowing trees — arteries and hepatic portal veins, both passing over into the inflowing hepatic veins (with secretion of some fluid into a fourth set of branches: the biliary tree). Around the hollow organs, and in the retina of the eye, blood vessels are distributed more like creepers,
branching to cover surfaces, but the principle of streaming and counter-streaming still applies … except towards the finest branches, where transition from artery to vein is through one of a variety of capillary networks.

In the kidneys capillaries form the tiny hollow tufts of the glomeruli and also run as filaments, up and down the tubules, radially arranged in each kidney. In the spleen and bone marrow, there is a more open system of irrigating ‘sinusoids’ between loosely arranged cells. In the liver,
cells and sinusoids are arranged hexagonally, a honey comb of slightly chaotic, microscopically small irrigation regions.

The capillary beds of the body are inconceivably numerous, delicate, densely packed and varied. They are varied not only in form but also in ‘taste,’ each cellular environment exchanging characteristic ‘flavours’ with slowly seeping blood. The capillaries are so very numerous that,
in spite of their minute size, their summed cross-sectional areas are very large — in total, several thousand times that of the great vessels emerging from the heart. Consequently flow is very slow in capillaries. There is a gradual slowing of the pulsatile flow out along arteries, a gentle seepage through capillary beds and sinusoids, and then steady acceleration back through the venous branches towards the heart.

The veins draining different organs carry blood of different chemistries. Major confluences bring together qualitatively different streams, which may flow fairly smoothly beside one another until the right atrium is reached. Here they swirl forward and down, slipping through into the right ventricle, then up through the pulmonary valve to the arteries, capillaries and veins of the lungs, and back through the left atrium and ventricle. All this results in thoroughly mixed, oxygenated blood emerging from the left heart for passage back to the various organs.

The heart is at the centre of multitudinous convergences and divergences of streams, a turning point and passing point; the conference centre of the organism. Blood gathering in left and right atrium at any instant in time was, shortly before, distributed throughout the lungs and the body, respectively. And what is ejected from the left and right ventricle a moment later will branch and permeate, it can be imagined almost cloud-like, to pass through the varied, delicate webs of peripheral vessels throughout the entire body and lungs. Then, transformed by passage through different organs, scattered and mixed in new ways, it is gathered back through veins into the swirling stream moving
through the opposite side of the heart.

This simultaneous out-streaming, in-streaming, and dynamic engagement at the centre is in you as you read this. Your heart is the ever-present, ever-moving meeting point of the diversity of your organism … continuously sounding and serving your organism as a whole.

In this article I have used a range of models or metaphors in trying to describe the heart and circulation. But none should be grasped to the exclusion of others. The aim is appreciation of the reality, which, if only it could be seen, would be absolutely breath-taking. The movements of the heart accommodate a unifying continuity of flow at the centre of our physical organism. It seems strange … and it seems natural,
that this responsive/active gathering point should, at times, be experienced as central to our very being.

REFERENCES

1. William Harvey. The Movement of the Heart and Blood. Trans from Latin by G. Wetteridge, Blackwell Scientific Publications, Oxford, 1976.

2. Rudolf Steiner. Geisteswissenschafl und Mediziru Rudolf Steiner Verlag, Dornach, 1976.

3. Hermann Poppelbaum. Mensch und Tier. Reprinted Fischer, Frankfurt 1981.

4. P.J. Kilner, L.S. Wann, D.N. Firmin, D.B. Longmore. Three-directional magnetic resonance flow imaging of the human heart. Dynamic
Cardiovascular Imaging 2:104-109.

P.J. Kilner, G.Z. Yang, R.H. Mohiaddin, D.N. Firmin, D.B. Longmore. Helical and retrograde secondary flow patterns in the aortic arch
studied by 3-directional magnetic resonance velocity mapping. Circulation November 1993; 88.

5. K. Appenzeller, Blutkeislauf und Herzfunktion, Beitrage zu einer Erweietemng der Heilkunst, 13,3 (1960). K. Appenzeller, An anthroposophical medical approach to cardiac auscultation, Journal of Anthroposophic Medicine, 9,4 (1992) 21-34.

6. Leon Manteuffel-Szoege. On the movement of the blood: the specific haemodynamic properties of blood, Journal of Anthroposophic Medicine, 9,4 (1992) 35-52.

7. Y.C. Fung, Biodynamics: circulation Pages 224-248. Springer Verlag, New York, 1 9 8 4 .

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