Arthur Guyton

Arthur C. Guyton
Arthur C. Guyton
	Family photo, c. 1980
Born	September 8, 1919; Oxford, Mississippi, US
Died	April 3, 2003 (aged 83); Pocahontas, Mississippi, US
Alma mater	University of Mississippi (BA) ; Harvard Medical School (MD)
	Scientific career
Fields	Physiology
Institutions	University of Mississippi

Arthur Clifton Guyton (September 8, 1919 – April 3, 2003) was an American physiologist.

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

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]

Cardiovascular physiology

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.

Guyton model

The horizontal axis of Guyton diagram represents right atrial pressure or central venous pressure, and the vertical axis represents cardiac output or venous return. The red curve sloping upward to the right is the cardiac output curve, and the blue curve sloping downward to the right is the venous return curve. A steady state is formed at the point where the two curves meet.

Trend of central venous pressure as a consequence of variations in cardiac output. The three functions indicate the trend in physiological conditions (in the centre), in those of decreased preload (e.g. in hemorrhage, bottom curve) and in those of increased preload (e.g. following transfusion, top curve).

The cardiac function curve expresses how systemic flow changes as a function of the central venous pressure; it represents the Frank-Starling mechanism. The vascular function curve expresses how "central venous pressure" changes as a function of "systemic flow". Note that, for cardiac function curve, "central venous pressure" is the independent variable and "systemic flow" is the dependent variable; for vascular function curve, the opposite is true.

Venous return curves showing the normal curve when the mean systemic filling pressure (Psf) is 7 mm Hg and the effect of altering the Psf to 3.5, 7, or 14 mm Hg.

Guyton's model uses right atrial pressure as an independent variable (causal variable) but it's incorrect. The cardiac output is the independent variable.

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]

Respiratory Model and Control

Modeling Respiratory system

Biography

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, 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.^[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.

Obituary

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]

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.^[3]

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.^[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]

Notes

^ "Guyton, Arthur C".
^ Hall, John E.; Hall, Michael E. (16 June 2020). Guyton and Hall Textbook of Medical Physiology (14 ed.). Elsevier. ISBN 9781455770052. (The physiologist John E. Hall worked with Arthur Guyton for almost 30 years. "John E. Hall, PhD". The Bookmark, Elsevier Health.)
^ ^a ^b ^c ^d ^e ^f ^g ^h 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.
^ ^a ^b ^c ^d ^e ^f ^g 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.
^ ^a ^b ^c Guyton, Arthur C. (1991). Textbook of Medical Physiology (8th ed.). Philadelphia: W.B. Saunders. ISBN 0-7216-3994-1.
^ ^a ^b 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 Archived 2011-07-01 at the Wayback Machine
^ A.C. Guyton, Basic Neuroscience. Anatomy & Physiology, 2nd Edition, W.B. Saunders Company, Philadelphia, 1991.
^ ^a ^b Guyton, Arthur C. (1976). Textbook of Medical Physiology (5th ed.). Philadelphia: W.B. Saunders. ISBN 0-7216-4393-0.
^ Understanding Guyton's venous return curves, Daniel A. Beard, Eric O. Feigl, American JOurnal of Physiology-Heart and Circulatory Physiology, Vol. 301, No. 3, 01 Sep 2011, https://journals.physiology.org/doi/full/10.1152/ajpheart.00228.2011
^ Guyton, Arthur C., & Hall, John E (2006) p.ix (the textbook memoriam is almost verbatim of the online citation, with only minor variations)
^ ^a ^b Guyton, Arthur C., & Hall, John E (2006) p.vii

References

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.

Arthur Guyton

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