Harvey’s breakthrough did no harm to the conventional reading of the heart as the centre of things, though. Though in fact slightly off-centre (to the left) within the body, the heart represents a sensible centricity, a midpoint between the head and the sex, the fulcrum of reason and lust. Its newly understood role in pumping blood round the entire body simply strengthened its metaphoric importance, as Harvey himself was not slow to realize when he wrote his gushing dedication to Charles I. The heart was now appreciated as a regulator of the body, and became therefore more powerful than ever as a symbol of moral self-regulation. We speak from the heart when we mean what we say. We keep secrets in our heart. Even though we know the brain is the centre of perception and cognition, the heart is still where we wish to feel things. In the West, the heart has for long been the organ most closely associated with the emotions, though in the East it has often had more to do with the intellect and intuition. Once, Western beliefs called on the heart to perform these duties, too. ‘For as he thinketh in his heart, so is he,’ warns Proverbs 23:7. The prayer known as the Sarum Primer after the 1514 book in which it is found runs:
God be in my head,
And in my understanding;
God be in my eyes
And in my looking;
God be in my mouth.
And in my speaking;
God be in my heart
And in my thinking;
God be at my end
And at my departing.
At this date, the heart is identified with thinking, while the head, or brain, is concerned with understanding. Ironically, Harvey’s discovery a little over 100 years later that the heart was a pump – a central pump, regally important in the body, but just a pump for all that – was one of the first breakthroughs to begin to persuade people that the brain was in fact more important, marking what the cultural historian Fay Bound Alberti calls the ‘scientific transition from a cardio-centric to a cranio-centric body’.
In 1997, a Canadian cardiologist, Andrew Armour, published a paper making the revolutionary claim that the heart actually has a ‘little brain’ of its own. Neuronal circuits observed on the heart may be capable of ‘local information processing’, Armour suggested. The heart is here reframed as analogous not to a pump or any mechanical contrivance, but more fashionably to a computer system: the brain is our mainframe while the heart and perhaps other organs too are served by local processors. Dismissed in some quarters as pseudoscience, Armour’s findings were seized upon by churches and theosophists as providing scientific evidence for the biblical thinking heart.
One way or another, the heart retains its place in our hearts, as it were. Metaphors to do with the heart seem very real. To die of a broken heart is surely one of the most awful ways to die, never mind that this squashy, elastic organ cannot break in a physical sense. It can weaken, become atrophied and diseased, but it is never the brittle object implied by the cliché of a heart with a lightning bolt cracking it in two. The emblematic status of the heart is assisted by its compactness and portability. Especially in the case of saints and martyrs, the heart was often buried separately from the rest of the body. This practice stemmed in part from necessity – guts and eviscerated organs were buried first in order to lessen the stink of a rotting corpse in church. But it was also symbolic. The heart, as Young tells us, can also be ‘pickled, sent, given, kept, eaten, or worn round the neck’. A heart could even be repatriated from foreign wars when plague laws prevented the return of the body.
Given its symbolic importance, it is perhaps surprising that we are happy to remain largely ignorant about the real appearance of the heart. The beating, visceral thing itself plays so invisible a part in our lives that we do not even know its shape. This is true of the human heart and animal heart alike, for the latter has been marginalized in the kitchen, not central at all, but classed with offal. At the same time, the heart has become ever more standardized as a symbol. Drawings of the seventeenth century show the heart shaded as a three-dimensional object, not always delineated with anatomical accuracy perhaps, but nonetheless at least displaying some of the irregular morphology of the real organ. But during the eighteenth and nineteenth centuries, on playing cards, in woodcuts and embroidery, and finally on commercial Valentine cards, the heart became far more familiar as a flattened and symmetric figure.
How did the heart arrive at this stylized, and most unrealistic, two-dimensional device – a red, twin-lobed, inverted triangle? Theories are many and ancient. In Egyptian hieroglyphics, a vase stood for the heart. Is our heart icon the outline of a vase? The curlicued design of a lyre offers a Greek explanation. Or it may simply be a development from that inverted triangle used to represent the female sex, a symbolism celebrated by the fashion designer Mary Quant, who got her husband to clip her pubic hair in this shape. In fact, the design we interpret today as a symbol of the heart had its beginnings as the depiction of an ivy leaf or a bunch of grapes. The symbol on the suit of cards that we call ‘hearts’ was originally such a leaf.
Hearts in medieval art and literature were often described as pear- or peach-shaped. Giotto’s fresco of Charity in the Scrovegni Chapel in Padua has her offering a teardrop-shaped heart from a bowl of fruit. But at some point the flattened ivy leaf motif seems to have taken over as the preferred shape for the human heart. The first heart with a cleft may be that depicted in Francesco da Barberino’s book of emblems, I Documenti d’Amore, dating from around 1310, while the first stylized heart in an illustrated anatomy dates from 1345. In churches, worship devoted to the Sacred Heart of Jesus gradually supplanted the Franciscan devotion of the five wounds of Christ. Later, the Sacred Heart alone became the symbol of the Roman Catholic backlash against Protestantism. This lurid symbol was not without its problems, however. At the end of the nineteenth century, for example, Catholic missionaries in Rwanda found themselves accused by their would-be converts of cannibalism because of the graphic nature of their crusading logo.
The simplified heart shape was cut into furniture by the Amish and the carpenters of the English Arts and Crafts movement. Today, it features in the branding of many products, promising, confusingly, either that they are good for you or that they are naughty-but-nice. There is even a key option for a heart symbol on my Apple computer, which has served me no purpose until now: .
The New York designer Milton Glaser was the first to put the in a sentence: I NY. This long-lived slogan – it dates from 1976 – has succeeded far beyond its creator’s anticipations. It sends an unmistakable warm embrace, disarming the city visitor who might otherwise tremble before the urban chaos. I NY is ingenious above all because it has a truth at its core to do with our love of place and how that in turn creates community. There is a more calculating cleverness about it, too. The logo is easily copied. There are knock-offs of the I NY symbol everywhere in the city, and this is not accidental. Whereas great effort goes into ensuring that a corporation’s logo is only reproduced by the right people in the right way, Glaser’s logo has no copyright protection. The idea was that anybody and everybody in New York could use it. It was an unpredictable strategy, but more than thirty years on, it has yielded huge dividends. True, it is not replicated with precision on every occasion. The heart shape may not swell in quite the way of the original; the typeface will more than likely not be the one (American Typewriter) that Glaser chose. But, in its way, the design is doing its job all the better because of this, showing as well as everything else that New Yorkers are nobody’s conformists. And there is undreamed-of multicultural diffusion far beyond the five boroughs. Clumsy homage is paid by other states: ‘Virginia is for lovers’, for example, or ‘I LVERMONT’, both official bumper stickers. J’ Quebec, Me Antigua and I Allah are found further afield. All these variants subliminally recall New York too, effortlessly augmenting the message of many cultures rubbing along together that is such an intrinsic fact of New York life, even as they announce their own passions.
The kidney is quite as shapely as the heart.
Any self-respecting St Valentine’s Day confection must be heart-shaped lest its amatory purpose be overlooked. But today we also find kidney-shaped cakes being made to celebrate successful transplant operations. In the manner of party cakes, these are often gruesomely realistic, sometimes with the ureter and major blood vessels sculpted in colour-coded icing as if copied from an anatomy textbook. The implications of this new custom seem not to have been worked through. The giving of heart-shaped gifts is clearly meant to represent the giving of one’s own heart. A kidney-shaped bakery item starts off well enough as a kind of ‘rebirthday’ cake. In eating it, the recipient perhaps re-enacts the incorporation of the donated organ. But the symbolic consumption of the donated kidney by any other celebrant seems a touch macabre.
Most organs have, like the heart, a shape that is characteristic, but still sufficiently irregular as to elude easy description. In other words, one heart is shaped pretty much like the next, but not enough like any familiar object that it may be used as a visual index. The kidney goes a step further, having a shape that is so characteristic of itself only that it has given its name to a miscellany of other natural and manmade objects, from kidney beans to the garden swimming pools advertised as ‘kidney-shaped’, presumably designed that way to look more natural than the obvious rectangle.
The leaves of plants, too, are sometimes kidney-shaped, or reniform to use the technical term. There is a single explanation for the occurrence of this unusual shape in so many natural organisms (if not in swimming pools). We have seen how the stylized heart may have developed (and perhaps the diamond, club and spade, too) from diagrammatic representations of different leaves. D’Arcy Thompson, in his masterly work On Growth and Form, shows how all these shapes originate from small alterations in the radial and tangential vectors of leaf growth (that is to say, the rate at which growth thrusts upward from the stem and the rate at which it spreads aside). A high thrust and a low spread results in a lanceolate leaf, or ‘diamond’, whereas a heart shape arises when the spreading force is greater relative to the thrusting force so that part of the leaf fans out wider around the stemming point. Further restriction on the nominal upward growth leads to the squashed but otherwise symmetrical kidney shape seen in the leaves of plants such as pennywort, many beans and our own kidneys.
Various hard-to-describe shapes come to the fore in Vladimir Nabokov’s novel Bend Sinister. Recurrent visual motifs – puddles oblong and ‘spatulate’, the water-filled outline of a footprint, an ink stain in the shape of a lake – seem to hint at something of vital importance that has been forgotten by the recently bereaved central character, Adam Krug, who is engaged in a struggle against the totalitarian regime run by his former schoolmate. The tale also abounds in images of human organs – an inflated football has ‘its red liver tightly tucked in’; there is ‘a black colon’ of ink on somebody’s collar; a person’s rump is like ‘an inverted heart’. The shapes and colours, and the memories which they seem to represent, enable the reader to share a little of the synaesthetic condition to which Nabokov was subject. These symbolic strands eventually converge when Krug’s tormentor spills a glass of milk, forming a kidney-shaped puddle, providing an unnecessary reminder that Krug’s wife died following an operation on her kidney.
There are many mysteries that remain to be uncovered concerning the curious forms into which the body and its organs grow. Not the least of these is the matter of why we possess two kidneys. Nature’s general rule is to give us just as much of everything as we need, no more and no less. Two horizontally set eyes give us binocular vision by which we are able to judge distance. The spacing of our two ears likewise helps us to determine where a sound is coming from. The UK National Kidney Federation, however, says it’s not known why we have two kidneys. It may be a knock-on effect of the general anatomical doubling that produces two legs very early in the development of the embryo. This would also explain why we unnecessarily possess two testes or two ovaries. Or it may be the legacy of some necessity far back in our evolutionary past. Most animals have two kidneys like us, but some have more, and even the human embryo actually develops three pairs of kidneys about a month after conception, with only the last of the three becoming functional organs.
In the end, neither the shape nor the number of kidneys matters as much as their function. One in 400 of us in fact possesses a single kidney formed by the fusion across a central isthmus of two normally placed kidneys. Such ‘horseshoe’ kidneys often work perfectly well without producing any symptoms or evidence of their presence. It is typical of the kind of abnormality that can pass utterly without notice because it is internal, and yet which if found on the surface of the body can so easily cause people to recoil.
Its redundancy has made the kidney the trailblazing organ in human tissue transplantation. The kidney that remains in the body of a living donor soon grows by some 80 per cent, practically restoring full renal function. Surgeons at Harvard Medical School carried out the world’s first successful kidney transplant operation in 1954, using identical twins as donor and recipient in order to reduce the risk that the organ would be rejected. The recipient lived for another eight years; the donor only died in 2010, at the age of seventy-nine. In the United Kingdom, 2,732 people received a new kidney in the year to 2011, with just over 1,000 of these being transplants from living donors, but there are nearly 7,000 people on the waiting list. In the United States, around 15,000 operations are performed annually, but the waiting list is approaching 100,000 and rising fast. It is estimated that by 2015 this number of patients each year will be experiencing renal failure, for whom a kidney transplant may be their only hope.
Broadening the range of donors is fraught with both medical and ethical difficulties. For example, potential donors unrelated to the prospective recipient have been assessed in the past, but found to be borderline ‘psychopathological’. ‘Emotionally related donors’ are thought to be more reliable. Another controversial proposal is to grant clemency to death-row prisoners in exchange for a kidney. This almost Swiftian idea seems tempting when one remembers that there are more than 3,000 inmates facing the death sentence in the United States. However, since this number has remained virtually static since 1996, it seems more of a political gesture than a practical solution.
The idea of transplantation follows readily enough if we believe that parts are discrete and separable from the body that contains them. Greek surgeons carried out experiments transplanting human bones as early as 400 BCE. Reasons for failure were medical – there was no understanding of rejection and the immune system. But there were also powerful moral reasons for hesitation – such as the forcible means by which the body parts were then obtained, and the obvious infringement of the first injunction of the Hippocratic oath to do no harm.
The success of the first kidney transplants in the mid twentieth century was quickly eclipsed by the more glamorous and symbolic transplant of the heart. Being unique, a heart could not be provided by a perfectly matched donor, such as a twin, as with a kidney. Instead, much greater pre- and post-operational care was required in order to ensure a functional result, as well as great skill from the surgeon. Christiaan Barnard, the Cape Town surgeon who became a household name when he performed the first successful operations, practised first on dog hearts, performing more than fifty transplants. (He also grafted a second head on to a dog, simply, it seems, because he could.) Barnard’s first human heart recipient survived for eighteen days; the second for eighteen months. After these early successes, however, the image of heart transplantation suffered setbacks when others began to perform the operation with much lower rates of survival, and when some of Barnard’s own patients quite coincidentally began to exhibit psychotic behaviour after recovering from surgery.
Today, though, transplants are a standard if extreme option in the surgeon’s repertoire. Transplantation is broadly accepted not least for pragmatic reasons because of soaring demand for replacement organs. But it remains, in the words of Columbia University a
nthropologist Lesley Sharp, ‘simultaneously wondrous and strange’. It is a medical procedure, to be sure, but no amount of mechanistic jargon – the heart characterized as just a pump, the liver and kidneys mere filters – can disguise the fact that it is also a personal act, a gesture from one person to another that seems as if it ought at least to obey the usual social rules of giving. As Sharp explains: ‘donated cadaveric organs simultaneously emerge as interchangeable parts, as precious gifts, and as harboring the transmigrated souls of the dead.’
Surgeons and neurologists refute the notion that aspects of personality can be transferred from person to person during transplant operations. But nothing can prevent recipients from imagining things about the donor of their new organ, especially when that organ is the heart. Patients who express the sense that another person dwells within them – only a very few, medical agencies insist – are labelled as victims of ‘Frankenstein syndrome’. Fay Bound Alberti gives the example of Claire Sylvia, a heart recipient, who had been a healthy-eating dancer before her operation and inexplicably became a lover of chicken nuggets afterwards. More natural is the guilt that a recipient may feel at having received a replacement organ and given nothing in exchange. Michelle Kline, for one, felt so guilty about receiving her brother’s kidney that she was unable to talk to him at all until she had shown herself worthy by becoming Miss Pennsylvania and a finalist in the Miss America beauty pageant. When her brother saw her crowned, he remarked: ‘We looked good up there on stage.’
Anatomies: A Cultural History of the Human Body Page 16