Happy Birthday Ernest Starling, 155 today.

Ernest Henry Starling CMG FRCP FRS (17 April 1866 – 2 May 1927) was very much a clinical scientist and believed that a bottle of intravenous gooey stuff would save Great War victims of wound shock. Research methodology and ethics was pretty rudimentary in the early twentieth century. He seems to have been unclear on which gooey property (density, viscosity, osmotic pressure) and which goo (acacia gum was an early favourite) to try, but he was enthusiastic for a good result.

Half a century earlier, Toronto physicians Drs. James Bovell and Edwin Hodder, looking for a colloid infusion for their patients, had tried milk. They believed that the fatty droplets in emulsion would become leucocytes, which in turn would become erythrocytes.

By 1884, intravenous crystalloid resuscitation was unsurprisingly back in favour.

The Starling Equation as we know it entered physiology teaching a quarter of a century after Starling’s death, as one of two K-K equations. In the past quarter of a century, the Starling Principle has been extended to explain how the trans endothelial colloid osmotic pressure difference changes with pressure-induced changes in the trans endothelial solvent filtration rate Jv. The consequence is to stabilise Jv at a surprisingly low rate in health in spite of different capillary pressures in the various tissues. Followers of FluidPhysiology will know I have tried to explain this to clinicians, but have been acutely aware that many find the concept difficult.

To celebrate Ernest’s Big 155, I am offering to host an international Zoom conference to take Questions, and hopefully provide Answers, about the workings of the Michel-Weinbaum model in the Starling Equation. Expressions of interest via email or Twitter are invited, if enough we will find a convenient time to meet and chat and share a virtual Gin and Tonic.

Essential preparatory reading is of course Levick & Michel (2010).

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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