Sydney Ringer

Sydney Ringer was born into a Quaker family in Norwich. His father died whilst he was still very young, but both Sydney and his brothers proved exceptionally resourceful. His elder brother, John Melanothon, amassed a vast fortune in Shanghai, whilst his younger brother, Frederick, went to Japan, where he founded the company Holme, Ringer & Co in Nagasaki in 1868 and became so successful he was given the name “King of Nagasaki”

Ringer’s entire professional career was associated with the University College Hospital, London. He entered the medical faculty of University College, London, in 1854, and graduated M.B. in 1860, being a resident medical officer in the University Medical Hospital from 1861 to 1862. He gained his M.D. in 1863 and that same year was appointed as assistant physician to the hospital, becoming a full physician in 1866. From 1865 to 1869 he also held the position as assistant physician at the Children’s Hospital, Great Ormond Street.

Ringer was an outstanding bedside teacher who continued the high standard of clinical instruction that had been established at the University College Hospital. He was not, however, in his element in set lectures. Ringer served successively as professor of materia medica, pharmacology and therapeutics, and the principles and practice of medicine at the University College faculty of medicine. In 1887 he was named Holme professor of clinical medicine, a chair he held until his retirement in 1900. In 1870 he became a fellow of the Royal College of Physicians and in 1885 a fellow of the Royal Society.

Ringer’s Handbook of Therapeutics was a classic of its day and passed through thirteen editions between 1869 and 1897. This book was originally commissioned as a revision of Jonathan Pereira’s (1804-1853) massive Elements of Materia Medica (first edition from 1839), but Ringer was little concerned with the minutiae of traditional medical botany and materia medical. He offered instead a thoroughly practical treatise in which the actions and indications of drugs were concisely summarized.

Ringer was one of the early true clinical investigators. Patient care, clinical teaching, and writing occupied most of Ringer’s career, but for many years he also maintained a small laboratory in the department of physiology; at that time there was no pharmacology laboratory at University College. He was universally known for his punctuality and the fanatical way he would spend every spare moment in his laboratory. It is even recorded that he climbed the palings of the hospital wall one evening when he found the door locked, in order to get to his laboratory. Following his morning round he would always make an appearance in the physiological laboratory and make suggestions to the laboratory assistant, examine the traces and then depart for his rooms at Cavendish Place, where he would do his consultant work.

With the aid of a series of collaborators, including E. G. A. Morshead, William Murrell (1853-1912), Harrington Sainsbury, and Dudley Buxton, Ringer published between 1875 and 1895 more than thirty papers devoted to the actions of inorganic salts on living tissues.

In the 1860's Carl Friedrich Wilhelm Ludwig (1816-1895) had developed some perfusion techniques for the study of isolated organs. From the beginning the heart had served as the principal organ for these “extravital” investigations, and most of Ringer’s physiological work relied on Ludwig’s experimental model. In a classic series of experiments performed between 1882 and 1885, Ringer began with the isolated heart of the frog suspended in a 0.75 percent solution of sodium chloride. He then introduced additional substances (for example, blood and albumin) to the solution and observed the effects on the beating heart. He demonstrated that the abnormally long prolonged ventricular dilatation induced by pure sodium chloride solution is reversed by both blood and albumin. Ringer showed that small amounts of calcium in the perfusing solution are necessary for the maintenance of a normal heartbeat, a discovery he made after realizing that distilled water he was using actually contained traces of calcium. Ringer thus gradually perfected Ludwig’s perfusion technique by proving that if small amounts of potassium are added to the normal solution of sodium chloride, isolated organs can be kept functional for long periods of time. “Ringer’s solution” became an immediate necessity for the physiological laboratory.

Ringer died following a stroke.

“ . . .first and foremost to be open-eyed and open-minded; then to be honest. He never confirmed his diagnosis by an avoidance of the postmortem room. On the contrary, he there sought confirmation of its correctness or conviction of its error . . . but he never juggled with facts, never consciously strove to make things fit; facts were precious things to him. Further, he taught us by example to be strenuous; his life was full to the brim with energy, which he did not allow to remain potential, but forthwith made dynamic. Those who knew him more intimately – his house physicians and assistants – saw a great simplicity in his life; he hated display of all kinds of and all affectations.”
One of his students on what he had learned from his former tutor.

• On the Temperature of the Body as a Means of Diagnosis in Phthisis and Tuberculosis. 1865.
• Handbook of therapeutics. London, 1869; 13th edition, 1898.
• Regarding the action of hydrate of soda, hydrate of ammonia, and hydrate of potash on the ventricle of the frog’s heart.
  Journal of Physiology, Cambridge, 1880-1882, 3: 195-202.
• Regarding the Action of Hydrate of Soda, Hydrate of Ammonia, and Hydrate of Potash on the Ventricle of the Frog’s Heart.
  Journal of Physiology, Cambridge, 1880, 3: 195-202.
• Concerning the Influence Exerted by Each of the Constituents of the Blood on the Contraction of the Ventricle.
  Journal of Physiology, Cambridge, 1880-1882, 3: 380-393.
  Journal of Physiology, Cambridge, 1883-1884, 4: 29-42, 222-225.
• The Influence of Saline Media on Fishes.
  Journal of Physiology, Cambridge, 1883-1884, 4: vi-viii.
  Journal of Physiology, Cambridge, 1884-1885, 5: 87-115.
• On the Mutual Antagonism Between Lime and Potash Salts in Toxic Doses.
  Journal of Physiology, Cambridge, 1884-1885, 5: 247-254.
• Concerning the Action of Calcium, Potassium, and Sodium Salts Upon the Eel’s Heart and Upon the Skeletal Muscles of the Frog.
  With Dudley Buxton. Journal of Physiology, Cambridge, 1887, 8: 15-19.
• Upon the Similarity and Dissimilarity of the Behaviour of Cardiac and Skeletal Muscle When Brought Into Relation With Solutions Containing Sodium, Calcium and Potassium Salts.
  With Dudley Buxton. Journal of Physiology, Cambridge, 1887, 8: 288-295.
• On the Influence of Certain Salts Upon the Act of Clotting.
  Journal of Physiology, Cambridge, 1890, 11: i-ii, 369-383.
  His major paper on calcium and blood clotting.
• Further Observations Regarding the Antagonism Between Calcium Salts and Sodium, Potassium and Ammonium Salts.
  Journal of Physiology, Cambridge, 1895, 18: 425-429.
• W. G. Nayler:
  Sydney Ringer–Physician and Scientist.
  Journal of Molecular and Cellular Cardiology, London, 1984, 16, 113-116.
• C. H. Orchard, D. A. Eisner, and D. G. Allen:
  Sydney Ringer viewed in a new light.
  Cardiovascular Research, London, 1994, 28: 1765-1768. Obituaries:
  Lancet, London, 1910; 2: 1386-1387. (OKK).
  British Medical Journal, London, 1910; 2: 1384-1386.
  Proceedings of the Royal Society, 1912; 84B, I-III..
  Biochemical Journal, Liverpool, 1910-1911; 5: I-XIX. (B. Moore).