Arthur C Guyton Textbook Of Medical Physiology

[Rosella Bowlan]

Guyton is well known for his Textbook of Medical Physiology, which quickly became the standard text on the subject in medical schools. The first edition was published in 1956, the 10th edition in 2000 (the last before Guyton's death), and the 12th edition in 2010. The 14th edition (2020) is the latest version available.[2] It is the world's best-selling medical physiology textbook and has been translated into at least 15 languages.[3][4]

Textbook of Medical Physiology is one of the world's best-selling physiology books and has been translated into at least 13 languages (the textbook memoriam states 13,[4] but the online memoriam states at least 15.[3])

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.[5] Subsequent editions, including the latest, preserve his legacy within the title, Guyton and Hall Textbook of Medical Physiology.[6] He has also published renowned textbooks on neurosciences.[7]

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 edition,[8] or chapter 20 of both Guyton 1991[5] and Guyton & Hall 2006 edition[4]).[6]

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 true regulator of cardiac output. The "Guyton Curves" which describe the relationship between right atrial pressure and cardiac output form the basis for understanding the physiology of circulation. This subject is well described in Guyton's textbook (e.g. Guyton 1976;[8] Guyton 1991;[5] Guyton & Hall 2006[4]) which contains references to the original publications.

In Guyton model's venous return curve, he plotted the right atrial pressure on the x-axis and it can suggest incorrectly that the right atrial pressure was the independent variable in the experiments.[9]

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.[3][4]

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, recuperatingand applying his inventive mind to building the first motorized wheelchaircontrolled by a "joy stick", a motorized hoist for lifting patients, special legbraces, and other devices to aid the handicapped. For those inventions, hereceived a Presidential Citation.[4][3]

Despite his disability, he was father to 10 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, one attended Duke University School of Medicine, and one attended the University of Miami's medical school after obtaining a PhD from Harvard.[4][3]

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, less than one month after his first great-grandchild was born.

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".[3][10]

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.[3]

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.[3][11]

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".[11]

Guyton, 83, was chairman of the Department of Physiology and Biophysics at the Medical Center from 1955 until his retirement in 1989. Considered one of the world's leading physiologists, he is recognized for several major discoveries of the cardiovascular system.

In the 1950s, he overturned the conventional wisdom that the heart controlled the amount of blood pumped, or "cardiac output." He demonstrated that in most cases the need of body tissues for oxygen determined cardiac output rather than the pumping ability of the heart itself.

He also was the first to measure correctly the pressure in the interstitium, the fluid between cells that makes up about one-sixth of the body. These contributions were key to understanding clinical conditions such as edema and congestive heart failure.

In 1966, an early computer model led to his theory of "infinite gain," which gave the kidney preeminence as the long-term regulator of blood pressure. Other systems can only regulate pressure short-term and will eventually be overpowered by the key controller.

In addition to his huge research contributions that clarified and defined the cardiovascular system, Guyton was the author of what is probably the best-selling medical textbook of all time - the "Textbook of Medical Physiology," now in its 10th edition and translated into 15 foreign languages. It has been in print and in use by students all over the world for more than 45 years.

His successor as chairman of the department, Dr. John Hall, said Guyton taught and mentored more than 150 scientists and at least 27 who are now department chairs. Hall, himself one of Guyton's students and immediate past president of the American Physiological Society, also noted that the current president-elect of the society, Dr. Neil Granger, is the sixth Guyton-taught physiologist to head the prestigious scientific organization.

"Dr. Guyton inspired people to do their best. As his trainees continue to receive many awards and honors for their work, and as they are recognized for their 'insight,' it is perhaps easy to forget that we have had a tremendous advantage - we have stood on the shoulders of a giant. He was a shining example of the very best in humankind."

Dr. Allen W. Cowley, another Guyton trainee, chairman of the Department of Physiology at the Medical College of Wisconsin, said, "A better role model for life and science could not be imagined. No one had a greater influence upon my own life and scientific career."

Dr. Aubrey Taylor, chairman of physiology at the University of South Alabama, was one of Guyton's first graduate students. He said Guyton "always had superb ideas (for research) that embarked us on fantastic research and academic careers. And I marveled at his ability to do so many things well."

The Medical Center's vice chancellor, Dr. Wallace Conerly, said Guyton's textbook "got me through Tulane medical school." He also noted that "everything we know about high blood pressure and many of the drugs we now use to treat it, all we know about the treatment of congestive heart failure is because of Arthur Guyton. He had a way of thinking about and teaching physiology that is now commonly called 'Guytonian' physiology in scientific circles."

Guyton was born in Oxford, the son of Dr. Billy S. and Kate Smallwood Guyton. His father was an ophthalmologist and dean of the two-year medical school at the University from 1935 until 1944. His mother, a mathematician and physics teacher, had been a missionary in China for five years before she married.

He graduated at the top of his class from the University of Mississippi and entered Harvard Medical School in 1939. His surgery internship at Massachusetts General Hospital in Boston was interrupted by military service at Camp Detrick, Md. After World War II, he went back to Mass General to complete his surgery training, but contracted polio in 1947.

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