A Life of Ernest Starling (review)

This volume, part profile and part biography, is a seamless narrative set in the era of British medicine and medical research during the late nineteenth and early twentieth centuries. Ernest Starling occupied center stage in British physiology for twenty-five productive years at the beginning of this remarkable period. John Henderson's intent—to keep up with all the Ernest Starlings simultaneously—translates into pure accomplishment: he captures the overall shape of Starling's life's work in medical education, the development of University College London, and the growth of physiology.

Starling, qualified in medicine at Guy's Hospital in 1889, was appointed lecturer in physiology at University College London in 1890. There he met William Bayliss, who became friend, collaborator, and brother-in-law. Their early research efforts in 1892—recording the human electrocardiogram—resulted in a disappointing second-place finish, and in science to be second is to be last. There followed a series of brilliant first-place finishes: the study of lymph formation and dynamics; capillary function, the osmotic pressure of plasma proteins, and the balance of forces across capillaries, known thereafter as "Starling forces" (1893–98); the function of the renal glomerulus; and gut physiology—the description of intestinal peristalsis (1899).

Starling and Bayliss's greatest joint accomplishment was the discovery of secretin (1902). They showed that when acid arrived from the stomach it liberated a chemical messenger from the jejunal mucosa, and this messenger traveled through the blood to excite the pancreas to secrete pancreatic juice. Starling then introduced the word "hormone" (1904), adapted from the Greek verb to excite or arouse (ormao). The discovery that hormones, or chemical messengers, were carried by the blood from the organ where they were produced to the organ that they affected, revolutionized physiology and provided the basis for endocrinology as a medical specialty. Starling's research then centered on the heart. His meticulous heart-lung preparation was the basis for brilliant series of seminal studies with long-standing impacts in the physiology of cardiovascular regulation that resonate to the present.

The Great War of 1914–18 paralyzed research. Starling, a forty-eight-year-old professor far removed from clinical medicine, was commissioned in the Royal Army Medical Corps. After a brief period with poison gas research, and at odds with War Office policy, he was promoted and then shunted to non-jobs in poison gas protection in Greece and Italy. During the postwar years, Starling, ever the iconoclast and reformer, found targets beyond the government and army: the public schools with their guilds and clubs, the medical establishment, and the medical education system. Henderson, former senior lecturer in physiology, discusses the long-term effects of Starling's sharp elbows, outspokenness, and prewar pro-German feelings. At the time in Starling's career when honors might have been expected (four of his contemporaries achieved knighthood, and two were Nobel Laureates), for Starling there were no honors, no Nobel. His death in 1927 far from home came about during a health-motivated ocean voyage to warm climates. His burial in an English churchyard in Jamaica in the rain amid a group of strangers provides a poignant end to the narrative.

Henderson's readable text is effectively illustrated and presented in a lean, spare manner. The significance of the research topics is carefully explained, and discussions about institutional politics, medical education, and family and personal matters appropriate to each time period are interspersed. There is an annotated bibliography for each chapter. This is an excellent, well-written book that will have widespread appeal—in particular, to historians of medicine, medical educators, and clinical and basic medical researchers.