(b. Norwich. England, 1835; d. Lastingham. Yorkshire, England. 14 October 1910)
Ringer’s entire professional career was associated with the University College Hospital, London. In 1854 he entered the medical school of University College, where he graduated M.B. in 1860 and M.D. in 1863. He was, appointed assistant physician to the University College Hospital in 1863, physician in 1866. and consulting physician in 1900. Ringer also served successively as professor of materia medica, pharmacology and therapeutics and the principles and practice of medicine at the University College faculty of medicine. In 1887 he was named Holme professor of clinical medicine, a chair he held until his retirement in 1900. In 1870 he became a fellow of the Royal College of Physicians and in 1885 a fellow of the Royal Society.
Ringer was an outstanding bedside teacher who continued the high standard of clinical instruction that had been established at the University College Hospital by Sir William Jenner, Sir John Russell Reynolds, and Walter Hayle Walshe. Ringer’s clinical orientalion may be clearly seen from his popular Handbook of Therapeutics, which passed through thirteen editions between 1869 and 1897. This book was originally commissioned as a revision of Jonathan Pereira’s massive Elements of Materia Medica, but Ringer was little concerned with the minutiae of traditional medical botany and materia medica. He offered instead a thoroughly practical treatise in which the actions and indications of drugs were concisely summarized. Pharmacology remained one of Ringer’s lifelong interests, and he incorporated into the successive editions of the Handbook the essence of a burgeoning literature on the specific actions of medicines. Ringer’s own contribution to pharmacology included papers on the actions of various substances, including digitalis, atropine, muscarine, and pilocarpine. He was also the first person to investigate the direct effects of anesthetics on cardiac tissue.
Among Ringer’s other medical publications were a short work On the Temperature of the Body as a Means of Diagnosis in Phthisis and Tuberculosis (1865) and the sections on parotitis, measles, and miliaria in Reynolds’ System of Medicine (1866–1879).
Patient care, clinical teaching, and writing thus occupied most of Ringer’s career, but for many years he also maintained a small laboratory in the department of physiology; at that time there was no pharmacology laboratory at University College. With the aid of a series of collaborators, including E. G. A. Morshead, William Murrell, Harrington Sainsbury, and Dudley Buxton, Ringer published between 1875 and 1895 more than thirty papers devoted to the actions of inorganic salts on living tissues.
Carl Ludwig in his 1865 inaugural address at Leipzig had stressed the importance of studying isolated organs, and with various pupils he had developed some perfusion techniques. From the beginning the heart had served as the principal organ for these “extravital” investigations, and most of Ringer’s physiological work relied on Ludwig’s experimental model. In a classic series of experiments, performed between 1882 and 1885, Ringer began with the isolated heart of the frog suspended in a 0.75 percent solution of sodium chloride. He then introduced additional substances (for example, blood and albumin) to the solution and observed the effects on the beating heart. He demonstrated that the abnormally prolonged ventricular dilatation induced by pure sodium chloride solution is reversed by both blood and albumin. Ringer was able to identify the active substance as potassium. He also showed that small amounts of calcium in the perfusing solution are necessary for the maintenance of a normal heartbeat, a discovery he made after realizing that the distilled water he was using actually contained traces of calcium. Ringer thus gradually perfected Ludwig’s perfusion technique by proving that if small amounts of potassium and calcium are added to the normal solution of sodium chloride, isolated organs can be kept functional for long periods of time. “Ringer’s Solution” became an immediate necessity for the physiological laboratory.
Ringer subsequently broadened his investigations on the effects of inorganic salts on living tissues. He studied the influences of solutions on striated muscles, on the growth of the tadpole, and on the contractile tissue of fishes. He was also the first to show conclusively that the presence of calcium is necessary for the normal operation of the blood clotting mechanism.
Ringer’s researches were carried out independently of Arrhenius’ contemporary formulation of the theory of electrolyte dissociation. Consequently, Ringer’s papers record a series of well-planned and executed experiments devoid of a coherent theoretical framework. This deficiency diminished Ringer’s immediate influence, but by the time of his death the wider significance of his physiological work was more generally recognized.
I. Original Works. Most of Ringer’s physiological papers were published in the early volumes of the Journal of Physiology. Some of his more important papers in that journal include “Concerning the Influence Exerted by Each of the Constituents of the Blood on the Contraction of the Ventricle,” in Journal of Physiology, 3 (1880–1882), 380–393; and 4 (1883–1884), 29–42, 222–225; “The Influence of Saline Media on Fishes,” ibid., 4 (1883–1884), vi– viii; and 5 (1884–1885), 98–115; “On the Mutual Antagonism Between Lime and Potash Salts in Toxic Doses,” ibid., 5 (1884–1885), 247–254; and “Further Observations Regarding the Antagonism Between Calcium Salts and Sodium, Potassium and Ammonium Salts,” ibid., 18 (1895), 425–429. Ringer’s solution may be said to date from his paper “Regarding the Action of Hydrate of Soda, Hydrate of Ammonia, and Hydrate of Potash on the Ventricle of the Frog’s Heart,” ibid., 3 (1880–1882), 195–202.
With Buxton, Ringer wrote two important papers: “Concerning the Action of Calcium, Potassium, and Sodium Salts Upon the Eel’s Heart and Upon the Skeletal Muscles of the Frog,” ibid., 8 (1887), 15–19; and “Upon the Similarity and Dissimilarity of the Behaviour of Cardiac and Skeletal Muscle When Brought Into Relation With Solutions Containing Sodium, Calcium and Potassium Salts,” ibid., 8 (1887), 288–295.
Ringer’s major paper on calcium and blood clotting was written in collaboration with Sainsbury: “On the Influence of Certain Salts Upon the Act of Clotting,” ibid., 11 (1890), i–ii, 369–383.
A fuller bibliography of Ringer’s scientific papers may be found in the Royal Society Catalogue of Scientific Papers, V, 209; VIII, 752; XI, 185; XVIII, 214.
II. Secondary Literature. There is no full assessment of Ringer’s work. Contemporary obituaries include those in Lancet (1910), 2 , 1386–1387; British Medical Journal (1910), 2 , 1384–1386; Proceedings of the Royal Society, 84B (1912), i–iii; and the Biochemical Journal, 5 (1911), i–xix.
William F. Bynum