|Arthur C. Guyton|
Family photo, c. 1980
|Born||September 8, 1919|
|Died||April 3, 2003(aged 83)|
|Institutions||University of Mississippi|
Nowadays Guyton is perhaps best known for his book Textbook of Medical Physiology, which quickly became the standard text about the subject in medical schools. The first edition was published in 1956, the 10th edition appeared in 2000, the last before Guyton's death, and the 12th appeared in 2010. It is the world's best-selling physiology book and has been translated into at least 15 languages.
Textbook of medical physiology
Textbook of Medical Physiology is the world's best-selling physiology text and has been translated into at least 13 languages (the textbook memoriam states 13, but the online memoriam states at least 15.)
From the ninth edition onwards, John E. Hall co-authored the textbook. However, all prior editions were written entirely by Guyton, with the eighth edition published in 1991. Subsequent editions, including the latest, preserve his legacy within the title, Guyton and Hall Textbook of Medical Physiology.
Despite revisions, much of the information in the Textbook of medical physiology has remained stable over time. Indeed, a comparison of say, the 5th, 8th and 11th editions shows that a substantial amount of information remains unchanged between the 5th and 11th editions, in many cases word for word. Mostly it has been updated and compressed as new information came available. Indeed, the 5th edition contains elaboration on some topics. For example, the effect of clothing on evaporative heat loss in hot-humid environments has been culled by the 8th edition. Such changes do not detract from the utility of the Textbook of medical physiology. But it does mean that one must refer to other texts (e.g. Weiss & Mann 1985.) to become aware of the relevance of the clothing issue to thermoregulation in hot-humid conditions. And of course it illustrates the usefulness of cross-checking current and earlier editions of textbooks on any subject.
Physiology of cardiac output
Guyton is most famous for his experiments in the 1950s which studied the physiology of cardiac output and its relationship with the peripheral circulation (see e.g. chapter 23 of Guyton 1976, or chapter 20 of both Guyton, 1991 and Guyton & Hall.
It was this work which overturned the conventional wisdom that it was the heart itself that controlled cardiac output. Guyton instead demonstrated that it was the need of the body tissues for oxygen which was the real regulator of cardiac output. The "Guyton Curves" which describe the relationship between right atrial pressures and cardiac output form the basis of understanding the physiology of circulation. This subject is well described in Guyton's textbook (e.g. Guyton 1976; Guyton 1991; Guyton & Hall 2006) which contains references to the original publications.
Arthur Guyton was born in Oxford, Mississippi, to Dr. Billy S. Guyton, a highly respected eye, ear, nose, and throat specialist, and Kate Smallwood Guyton, a mathematics and physics teacher who had been a missionary in China before marriage.
Guyton initially intended to be a cardiovascular surgeon but was partially paralysed after being infected with polio. He suffered from this infection in 1946 during his final year of residency training. Suffering paralysis in his right leg, left arm, and both shoulders, he spent nine months in Warm Springs, Georgia, recuperating and applying his inventive mind to building the first motorized wheelchair controlled by a “joy stick”, a motorized hoist for lifting patients, special leg braces, and other devices to aid the handicapped. For those inventions, he received a Presidential Citation.
Despite his disability, he was father to ten children who all went on to become celebrated physicians, including a professor of ophthalmology, a professor of surgery, a professor of medicine, a cardiothoracic surgeon, a rheumatologist, two anaesthesiologists and two orthopaedic surgeons. Eight of his children attended Harvard Medical School.
Due to his disability, he had to abandon his plan to become a surgeon. Instead he concentrated on physiology research and teaching, and became the head of the University of Mississippi Dept. of Physiology and Biophysics. He retired as department chair in 1989 but continued as emeritus professor up until his death on April 3, 2003, in a car accident.
Guyton's obituary states "unlike most major textbooks, which often have as many as 10-20 authors", the first eight editions "were written entirely by Guyton with a new edition always arriving on schedule for nearly 40 years. This feat is unprecedented for any physiology or medical text. His textbook is unique in the history of medical publishing".
His obituary notes that he triumphed over polio:
He had a special ability to inspire people through his indomitable spirit", and "his courage in the face of adversity humbled us. He would not succumb to the crippling effects of polio. It is very unlikely that a repairman ever crossed his doorstep, except perhaps for a social visit. He and his children not only built their home, but also repaired each and every malfunctioning appliance and home device no matter the difficulty or the physical challenge. He built a hoist to lower himself into the "hole" beneath their house to repair the furnace and septic lines when calling a repairman seemed to be the only option to those who did not know him well. On trips to meetings, he walked long distances across airport terminals when using a wheelchair would have been much easier. His struggle to rise from his chair and walk to the podium for a lecture was moving, but the audience was always more impressed when he forcefully articulated his brilliant concepts.
His obituary in The Physiologist journal, and Memoriam in the 11th edition of his book, are largely verbatim of each other, including as below:
Arthur Guyton's research contributions, which include more than 600 papers and 40 books, are legendary and place him among the greatest figures in the history of cardiovascular physiology. His research covered virtually all areas of cardiovascular regulation and led to many seminal concepts that are now an integral part of the understanding of cardiovascular disorders such as hypertension, heart failure, and edema. It is difficult to discuss cardiovascular regulation without including his concepts of cardiac output and venous return, negative interstitial fluid pressure and regulation of tissue fluid volume and edema, regulation of tissue blood flow and whole body blood flow auto-regulation, renal-pressure natriuresis, and long-term blood pressure regulation.
The Textbook Memoriam continues: "Indeed, his concepts of cardiovascular regulation are found in virtually every major textbook of physiology. They have become so familiar that their origin is sometimes forgotten".
- Hall, John E.; Cowley, Allen W. Jr.; Bishop, Vernon S.; Granger, D. Neil; Navar, L. Gabriel; Taylor,, Audrey E. (June 2003). "Obituary as published in". The Physiologist 46 (3): 122 124. Archived from the original on 2005-03-17.
- Guyton, Arthur C.; Hall, John E. (2006). Guyton and Hall Textbook of Medical Physiology with Student Consult Online Access (11th ed.). Philadelphia: Elsevier Saunders. ISBN 0-7216-0240-1.
- Guyton, Arthur C. (1991). Textbook of Medical Physiology (8th ed.). Philadelphia: W.B. Saunders. ISBN 0-7216-3994-1.
- Hall, John E. (2011). Guyton and Hall Textbook of Medical Physiology with Student Consult Online Access (12th ed.). Philadelphia: Elsevier Saunders. ISBN 978-1-4160-4574-8. see Table of Contents link
- Weiss, M.L., & Mann, A.E. (1985). Human Biology and Behaviour: An Anthropological Perspective. Boston: Little Brown & Co. ISBN 0-673-39013-6.
- Guyton, Arthur C. (1976). Textbook of Medical Physiology (5th ed.). Philadelphia: W.B. Saunders. ISBN 0-7216-4393-0.
- Guyton, Arthur C., & Hall, John E (2006) p.ix (the textbook memoriam is almost verbatim of the online citation, with only minor variations)
- Guyton, Arthur C., & Hall, John E (2006) p.vii
- Reference to Guyton's biographical details in the above text comes primarily from the obituary published in Physiologist magazine, and John E. Hall's memoriam and preface to the 11th edition of Textbook of Medical Physiology both of which contain overlapping statements, sometimes verbatim, sometimes almost verbatim.
- The pioneering use of systems analysis to study cardiac output regulation, John E. Hall
- Brinson C, Quinn J. Arthur C. Guyton—His Life, His Family, His Achievements. Jackson, MS, Hederman Brothers Press, 1989.
- Bode R. A Doctor Who’s Dad to Seven Doctors—So Far! Readers’ Digest, December, 1982, pp. 141–145.