A Life of Ernest Starling (review)

This brief, well-written book will be very useful to anyone wanting to understand the origins of modern British physiology or to know the large personalities involved. It should be required reading for anyone teaching Starling's work on the heart.

A place in scientific history is often marked by an accomplishment that can be summarized by a single phrase. In the case of Ernest Starling (1866–1927), it was his "Law of the Heart," the title of his 1918 Linacre Lecture, describing his 1914 work with Patterson and Piper. Most medical and physiology students will also have heard about the "Starling Principle" of fluid balance between capillaries and extracellular fluid, and know that this principle derives from his discovery that the osmotic pressure of blood proteins balances hydrostatic pressure in the capillaries. Only a few will know that he developed this principle as part of his research on lymph formation, which he showed to be a purely passive process, thus contradicting a secretory hypothesis put forward by Heidenhain a short time before.

Some scholars will know that Starling and Bayliss coined the word hormone to name their discovery of the first hormone, secretin. However, without biographer John Henderson's research, very few would know that the discovery of secretin made Starling a leading candidate for a Nobel Prize, until World War I suspended the awards. Starling's other accomplishments include: the discovery that omitting insulin from the perfusate of an isolated heart greatly reduces glucose uptake; the finding that glomerular filtration is a purely passive process, not the active secretory mechanism proposed by Heidenhain; the discovery with Bayliss that sympathetic stimulation increases heart rate while vagal stimulation lowers heart rate; the discovery, also with Bayliss, of peristaltic activity in the gut. Although intestinal contractions had been described earlier, Starling and Bayliss's finding of coordinated activity that moved semi-solid boluses along the gut brought substantial order to an area previously dominated by chaos and confusion.

In addition to his scientific genius, Starling was a remarkably warm and loyal person. His professional life was closely interwoven with personal relationships. William Bayliss married his sister, Sydney Patterson married his favorite daughter, and Starling himself married a colleague's widow. A strong sense of loyalty to Guy's Hospital, where he qualified in Medicine in 1889, also kept him from accepting a prestigious position at Oxford in 1892, even though he was woefully underpaid and poorly treated by his colleagues at Guy's.

After reviewing the available correspondence and the minutes of the Guy's Hospital Board, Henderson concludes that Starling was not well liked by his colleagues there, and that the cause of this dislike was almost certainly jealousy. After turning down the offer of a permanent job at Oxford, Starling was also forced to turn down a subsequent invitation from Burden Sanderson to give the student lectures in physiology at Oxford, when a colleague at Guy's refused to alter the lecture schedule. Henderson also points out that Frederick Gowland Hopkins, who was awarded the 1929 Nobel Prize for his discovery of vitamins, was in precisely the same position at Guy's and was rescued from it by an offer of a position in physiology at Cambridge, where he later became the first professor of biochemistry.

In spite of the hardships at Guy's, and perhaps because of the lack of distractions that might have been afforded by adequate salaries, both Starling and Hopkins were very productive there. In addition to their research, they have been credited by other authors with helping to design and build new laboratories for the Guy's Medical School, although Henderson admits that he was unable to document their precise contributions in the minutes of the Medical School Committee.

Starling was elected a fellow of the Royal Society early in 1899, about the time of his 33rd birthday, and later in the same year he applied for the Jodrell Chair of Physiology in University College. The competition was stiff and...