Starling, Ernest Henry
STARLING, ERNEST HENRY
(b. London, England, 17 April 1866; d. Kingston, Jamaica, 2 May 1927)
In circulatory physiology the Starling legacy is conceptually one of the most influential in the twentieth century. The “Starling sequence,” embracing both central circulatory function and fluid exchange at the capillary level, was and remains the unifying theme of contemporary circulatory theory.
Starling was born into a family of limited financial means and fundamentalist religious belief. His father, Matthew Henry Starling, was a barrister and served for many years as clerk of the crown at Bombay, returning to England once every three years. Starling’s mother, the former Ellen Watkins, remained in Britain and had the responsibility of rearing their children, of whom Ernest was the eldest. He received his early education at Islington (1872–1879) and at King’s College School (1880–1882). In 1882 he entered Guy’s Hospital Medical School (London), where he set a record for scholarship and received his qualifying degree (M.B., Lond.) in 1889.
One of the most influential periods in Starling’s formative years was the summer of 1885 spent in kühne’s laboratory at Heidelberg. It probably marked the beginning of his strong rejection of empiricism as the basis for clinical practice, and it played a role in directing him toward physiology as a means of bringing basic science to the bedside. In 1887 he became demonstrator in physiology at Guy’s and in 1890 began part-time work in Schäfer’s laboratory at University College, where he began a lifelong association with William Maddock Bayliss.
It was a highly productive and complementary union. Bayliss was the learned, methodical, and cautious partner; Starling was the aggressive, impatient, and sometimes incautious visionary. The first of their joint papers appeared in 1891, and in January 1902 they presented a preliminary communication that opened the door to the vast field of hormonal function. Published in full in September 1902, the paper established the existence and role of secretin, a product of the duodenum; and in 1905 Starling coined the word “hormone” to designate the body’s “chemical messengers” produced by the endocrine glands.
In 1892 Starling again went to Germany, this time to work with Rudolf Heidenhain at Breslau; and on his return he attacked the problems of lymph production, capillary permeability, and the physiological effects of osmotic forces. On the basis of his findings, he began the synthesis of what came to be called the “Starling equilibrium,” referring to the balance between intravascular pressure and osmotic forces at the capillary level.
With his acceptance in 1899 of the Jodrell professorship at University College, Starling finally joined Bayliss full time. It was at University College that he shifted his interest from the peripheral circulation to the heart itself. His career as a scientific investigator reached a peak in the years immediately preceding World War I with the publication of two papers on control of the heart, written with S. W. Patterson, who later became his son-in-law.
Starling’s wartime service was turbulent, largely because of his outspoken impatience with the obtuseness, where scientific matters were concerned, of his military superiors. He was ultimately sent to Thessaloniki, Greece, with no specific assignment and little opportunity to apply his extraordinary talents in the service of his country. Paradoxically, the only recognition he ever received from his government (the comparatively minor Companion of the Order of St. Michael and St. George) came for his “services at Salonika.”
In 1919 Starling delivered the most significant lecture of his career, correcting some of his earlier oversimplified statements on circulatory control and anticipating many present-day workers. Unfortunately, the lecture received little attention at the time and was published in a journal of very limited circulation. His remaining years were vigorous but somewhat anticlimactic. In 1922 Starling accepted the Royal Society’s Foulerton research professorship. Despite deteriorating health, he continued his research work with fellows and students from all over the world. He died aboard ship, while on a Caribbean cruise, and was buried at Kingston, Jamaica.
Starling was elected fellow of the Royal Society in 1899 and was a prominent member of the Physiological Society. He was honorary member of many foreign scientific organizations and delivered the Harvey lecture for 1908 in New York.
Starling influenced several areas of physiology and medicine. His work with Bayliss on capillary function and on hormones would, in itself, guarantee him great prominence. But he is best-known for his work on the heart. Focusing primarily on the intrinsic response of the isolated heart to increased filling, Starling formulated a widely quoted law of the heart and summarized the concept in his Linacre lecture (1915). Unfortunately, in the lecture he attempted rather uncritically to extend his findings on the isolated heart to the intact organism at rest and under stress. Within the next few years he recognized the inadequacy of his earlier concepts, and in 1919 he extended and refined them, incorporating intrinsic myocardial response as one feature of a highly complex control system. Subsequent work in the field has, in large measure, consisted of extensions and elaborations of the views set out by Starling in 1919.
Starling was astonishingly gifted in synthesizing disparate views and information to produce meaningful and effective generalizations. His experimental work was often of simple design and yielded data that have sometimes been thought inadequate to support his conclusions. But using those data and building on the work of several German physiologists, of whom Otto Frank was the most significant. Starling arrived at an expansive and surprisingly accurate understanding of circulatory function as a whole.
Starling’s eloquent, often anguished, and biting comments on education still carry great conviction. He called for “. . . educational reform, or even revolution, for the maintenance of our place in the world,” and added that “. . . in matters of urgent necessity [such as education] it is unprofitable to count the cost.” Writing soon after the Armistice, he reserved his most forceful words for the great peril into which, in his view, the British educational system had brought the nation. “The astounding and disastrous ignorance [of science] . . . displayed by members of the government in the early days of the war raised some doubts. . . as to the efficiency of the education imparted to. . . the upper classes.” Noting that Germany had, since Napoleon’s day, laid great emphasis on education as a means of enhancing national power, he said that Britain, against such a force, could oppose only “. . . a kindly, gentlemanly stupidity.” He attributed Britain’s salvation to the self-sacrifice and bravery of her young people: “The great rally of the nation occurred in spite of an education which taught the ruling classes that their first duty was to their clan, their party, or their service. . .” (“Science in Education,” p. 474).
Views like these fill in the gaps left when one limits his attention to Starling’s scientific publications. Physiology was his passion, but it was not in itself sufficient. He emerges not only as a great scientist but also as a responsible and pragmatic activist in education. He and his colleagues, notably Bayliss, changed the face of classical physiology more, probably, than any other group since Harvey’s time. And in the course of his work on the circulation, Starling succeeded to a remarkable degree in replacing empiricism with scientific understanding as the basis for medical practice at its best. But if his pungent and highly critical attacks on British education affected the system, the results were, at least in his lifetime, very difficult to discern.
Starling’s publications include “The Arris and Gale Lectures on Some Points in the Pathology of Heart Disease. Lecture I . On the Compensatory Mechanisms of the Heart. Lecture II . The Effects of Heart Failure on the Circulation. Lecture III . On the Causation of Dropsy in Heart Disease,” in Lancet (1897), 1 , 569–572, 652–655, 723–726; “The Mechanism of Pancreatic Secretion,” in Journal of Physiology, 28 (12 Sept. 1902), 325–353, written with W. M. Bayliss; “On the Chemical Correlation of the Functions of the Body,” in Lancet (1905), 2 , 339–341, 423–425, 501–503, 579–583; “On the Mechanical Factors Which Determine the Output of the Ventricles,” in Journal of Physiology, 48 (8 Sept. 1914), 357–379, written with S. W. Patterson; “The Regulation of the Heart Beat,” ibid. (23 Oct. 1914), 465–513, written with S. W. Patterson and Hans Piper; The Linacre Lecture on the Law of the Heart (London, 1918), delivered at St. John’s College, Cambridge, in 1915; “Natural Science in Education: Notes on the Position of Natural Sciences in the Educational System of Great Britain,” in Lancet (1918), 2 , 365–368; “Science in Education,” in Science Progress, 13 (1918–1919), 466–475; and “On the Circulatory Changes Associated With Exercise,” in Journal of the Royal Army Medical Corps, 34 (1920), 258–272.
Carleton B. Chapman