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(Circulation. 2002;106:2986.)
© 2002 American Heart Association, Inc.

Historical Review

Ernest Henry Starling, His Predecessors, and the "Law of the Heart"

Arnold M. Katz, MD

From the Cardiology Division, Department of Medicine, University of Connecticut Health Center, Farmington Conn.

Correspondence to Arnold M. Katz, MD, 1592 New Boston Rd, PO Box 1048, Norwich, VT 05055-1048. E-mail arnold.m.katz@dartmouth.edu

Key Words: physiology • muscles • contractility

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The discovery that end-diastolic volume regulates the work of the heart is generally credited to Ernest Henry Starling, who described this relationship in a series of papers between 1912 and 1914^1–4 and in his Linacre Lecture, which was given at Cambridge University in 1915 and published in 1918.⁵ In these papers, Starling and his collaborators acknowledge that they were not the first to describe this relationship⁶; they cite the work of Blix⁷ and Evans and Hill⁸ on the length-dependence of energy release by skeletal muscle, Frank’s 1895 description of the influence of diastolic volume on the work of the frog ventricle,⁹ and contemporary descriptions in canine¹⁰ and feline hearts.¹¹ The present article reviews evidence that what we now call "Starling’s Law of the Heart" or "The Frank-Starling Relationship" was widely appreciated by late 19th century physiologists.

The Length-Tension Relationship, Thermodynamics, and Muscle Energetics

Starling’s Law of the Heart is a manifestation of the length-tension relationship seen in skeletal muscle, which was well known to physiologists during the second half of the 19th century. This relationship was discovered in 1832 by Schwann; Needham, who described this history,¹² stated that Schwann’s discovery "caused a great sensation among physiologists of the time," in part because this discovery was made at a time when muscle performance was being analyzed in terms of the then new science of thermodynamics. That contracting muscles liberate energy as both work and heat was first noted by Helmholtz, whose 1848 description of heat production by muscle "... lighted a flame which... burnt brightly in Germany . . . [Full Text of this Article]

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