Ernest Henry Starling

British physiologist

• Born: April 17, 1866; London, England
• Died: May 2, 1927; near Kingston Harbor, Jamaica

Starling discovered the mechanisms that regulate the output of the heart and the flow of lymphatic fluid and discovered the role of hormones in the control of organ function.

Primary field: Biology

Specialty: Physiology

Early Life

Ernest Henry Starling was born in London and was reared there by his mother and a Canadian governess. His father was the Clerk of the Crown in Bombay, India, and returned to Great Britain on leave only once every three years. Despite the infrequent contact between father and son, the elder Starling is said to have influenced his son toward a career in medicine. Starling’s choice of a career in physiology was an extremely unlikely one in the educational setting of late nineteenth-century Great Britain. Education for everyone up to the age of ten became compulsory in 1876; any training beyond that age was mainly in the classics, with little emphasis on modern languages and even less on natural science. At age thirteen, he enrolled in King’s College School and studied divinity, Greek, Latin, French, ancient history, English, and mathematics. He distinguished himself in university entrance examinations and entered Guy’s Hospital Medical School in 1882.

Starling’s outstanding examination scores set him apart from his classmates and brought him to the attention of Leonard Charles Wooldridge, the demonstrator in physiology and later physician in chief at the hospital. Wooldridge introduced Starling to German experimental physiology and arranged for his protégé to spend a summer in Heidelberg studying under Wilhelm Kühne. The exciting discoveries of the German physiologists persuaded Starling to concentrate on physiology rather than opt for a medical practice. At the end of his clinical training in 1889, Starling accepted Wooldridge’s former position as demonstrator and began to lay the groundwork for modern cardiovascular physiology. Several years later, Starling joined William Maddock Bayliss at University College. It would prove to be a fruitful partnership. Starling was a forceful visionary, innovative and impatient, while Bayliss was deliberate, cautious, methodical, and kind. Together they would collaborate on some of the most important discoveries in the field of physiology.

Life’s Work

Starling’s first publication with Bayliss, written while he was still at Guy’s Hospital, described the earliest successful attempt to record a mammalian electrocardiogram and showed that contraction began at the base of the heart and proceeded to the apex. This study disproved the then-accepted hypothesis that all parts of the heart contracted simultaneously.

Starling next became interested in the formation of lymphatic fluid and the physical processes of secretion and absorption of this fluid in the cavities of the body. After four years of work with Bayliss, Starling showed that pressure inside a capillary determined the rate at which lymph seeped into the tissues, and that protein colloid determined the reabsorption of the lymphatic fluid from the tissues back into the capillary by osmotic pressure. Once this theory was established, Starling developed a model for heart failure in which the failing heart, unable to maintain arterial and capillary pressure, allows lymphatic fluid to enter the circulation under the influence of unopposed osmotic pressures. This model accounted for the dilated heart associated with heart failure, and Starling studied the significance of this dilation in his later work.

In 1897, a new physiology laboratory opened at Guy’s Hospital, but these new facilities were not sufficient inducements for Starling to leave University College; in 1899, Starling accepted the Jodrell Chair of Physiology at University College. In the same year, he was elected a Fellow of the Royal Society, at the age of thirty-three.

Starling and Bayliss next worked on intestinal function and in 1902 concentrated on pancreatic secretion. Injecting acid into a segment of jejunum (the middle part of the small intestine), completely isolated except for its blood supply, resulted in copious pancreatic secretion. In the absence of any other connection between jejunum and pancreas, the unknown messenger had to be carried through the blood; the chemical messenger was named secretin. To describe such chemical messengers, Starling coined the word hormone in 1905. He noted that the pancreas produced a hormone that regulated the ability of tissue cells to utilize glucose.

As chair of physiology, Starling undertook very little active research between 1904 and 1909. Instead, during this time he successfully sought funding for a new physiology building at University College and took elocution lessons to improve his public speaking, for he was frequently called to address large audiences. Starling was now in a position to modify the empirical, practical nature of British medical education. In 1903, his idea of a curriculum emphasizing basic science and a medical school with its own hospital for teaching and research was published in the British Medical Journal.

This publication marked Starling’s appearance as a thinker outside the laboratory, and in this role he became an effective public opponent of the antivivisection movement a few years later. In 1903, Stephen Coleridge, the leader of the antivivisectionists, publicly accused Starling and Bayliss of dissecting a dog without first anesthetizing it, a criminal offense. Bayliss failed to obtain a retraction from Coleridge and filed suit against him. As the dog had indeed been anesthetized, the jury awarded two thousand pounds and costs to Bayliss. This award was used to set up a research fund at University College.

As a result of these agitations, in 1906 Parliament set up a royal commission to investigate Coleridge’s criticisms of the 1876 act; Starling chaired a committee to select witnesses from the scientific community on behalf of scientific investigation. Starling himself testified before the commission. As a result of Starling’s efforts, the commission almost completely rejected the charges of the antivivisectionists.

Starling’s second great productive period, leading to his formulation of the “law of the heart,” began in 1911. World War I interrupted this work, however. Starling served in the Royal Army Medical Corps after being dissuaded from enlisting as an infantryman. In 1917, he resigned his commission and returned to London.

Starling left his professorship at University College in 1922 and became the Fullerton Research Professor of the Royal Society. At this time a new anatomy building and an extension to the physiology department were built at University College, and he saw his efforts to develop the medical school move closer to fruition.

In the next two years, Starling worked on renal function, showing that the glomerulus (a network of capillaries in the kidney) is in fact a simple filter and that the renal tubule actively secretes some substances into the urine while reabsorbing others. Discouraged about his health, in 1927 Starling took a cruise to the West Indies and died unexpectedly onboard ship near Kingston, Jamaica.

Impact

Ernest Henry Starling was responsible for numerous important physiological discoveries, including the Starling equation (regarding the way fluids move within the human body), peristalsis (the contraction of smooth muscles in the body), hormones, and many others. The law of the heart is perhaps Starling’s greatest contribution to clinical medicine, for it dictates the principles of the diagnosis and treatment of heart failure.

Moreover, he criticized a system and a society in which ignorance was prized, amateurism valued, muddling through was a virtue, and practical knowledge of the natural world was denigrated. His life’s work was a forceful statement of the opposite principle, for, based on reason and knowledge of natural phenomena, he made discoveries that were to prevent or relieve immeasurable human suffering.

Bibliography

Chapman, Carleton B. “Ernest Henry Starling: The Clinician’s Physiologist.” Annals of Internal Medicine 57. 2 (1962): 1–43. Print. An account of Starling’s life that sets his accomplishments against the background of early twentieth-century British society. Clearly describes the details of experiments, and includes a complete chronological annotated bibliography.

“Ernest Henry Starling (1866–1927): The Clinician’s Physiologist.” Journal of the American Medical Association 214 (1970): 1699–1701. Print. An overview of Starling’s life and work, including a brief section on his impact on medical education.

Fye, W. Bruce. “Ernest Henry Starling: His Law and Its Growing Significance in the Practice of Medicine.” Circulation 68 (1983): 1145–47. Print. Shows how Starling’s basic scientific discoveries have become increasingly important to clinical medicine.

Henderson, John. A Life of Ernest Starling. New York: Oxford UP, 2005. Print. A biography exploring the personal, clinical, and political aspects of Starling’s life, as well as his scientific discoveries.