Happy Birthday E.H. Starling

Ernest Henry Starling CMG FRCP FRS, born 17th April 1866.

Only by following out the injunction of our great predecessor William Harvey to search out and study the secrets of Nature by way of experiment, can we hope to attain to a comprehension of ‘the wisdom of the body and the understanding of the heart,’ and thereby to the mastery of disease and pain, which will enable us to relieve the burden of mankind.


In physiology, as in all other sciences, no discovery is useless, no curiosity misplaced or too ambitious, and we may be certain that every advance achieved in the quest of pure knowledge will sooner or later play its part in the service of man.


A physiologist who published a biography of E. H. Starling in 2005 nicely summarised the Starling principle as it was taught for over a century;

His analysis of capillary function demonstrated that equal and opposite forces move across the capillary wall–an outward (hydrostatic) force and an inward (osmotic) force derived from plasma proteins.

It is of course elementary physics that when opposing forces are equal and opposite they produce no movement. Of the many ways in which the Starling Principle has been extended in the twenty-first century, one of the more important is an appreciation that, in steady state conditions, hydrostatic pressure difference is at all points along a capillary greater than the osmotic pressure difference, creating a filtration of solvent from plasma to the interstitium. There is therefore a vital circulation of extracellular fluid operating alongside William Harvey’s circulation of the blood.

Starling himself would have appreciated William Harvey’s remark in his classic work, De Motu Cordis (1628):

I tremble lest I have mankind for my enemies, so much has wont and custom become second nature. Doctrine once sown strikes deep its root, and respect for antiquity influences all men.


As twenty-first century Starling physiologists we continue the struggle to uproot Victorian doctrine and to teach true Starling physiology with humility and respect for wont and custom. It is also proper to remember the dogs whose lives were sacrificed to reveal the secrets of Starling physiology.

By admin

after more than a quarter of a century of intensive care medicine consultancy in one of the UK's largest teaching hospitals Dr Woodcock is on a mission to ensure the steady state Starling principle is known and understood by every student and every practitioner.

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