Obituary

As originally published in The Physiologist
Volume 46, Number 3, June 2003, pages 122-124

In Memoriam
Arthur C. Guyton
(1919-2003)

    The sudden loss of Arthur C. Guyton in an automobile accident on April 3, 2003, and the loss of his devoted and remarkable wife Ruth Weigle Guyton one week later as a result of injuries from the accident, stunned and saddened all who were privileged to know them. Arthur Guyton was a giant in the fields of physiology and medicine, a leader among leaders, a master teacher, and an inspiring role model for people throughout the world.
    Arthur Clifton Guyton was born in Oxford, MS to William (Billy) S. Guyton, an eye, ear, nose and throat specialist and Dean of the University of Mississippi Medical School, and Kate Smallwood Guyton, a math and physics teacher who had been a missionary in China before their marriage. During his formative years, Arthur enjoyed watching his father work at the Guyton Clinic, playing chess and swapping stories with William Faulkner, and building sailboats (one of which he later sold to Faulkner) and countless mechanical and electrical devices, which he continued to do throughout his life. His brilliance shone early as he graduated top in his class at the University of Mississippi, distinguished himself at Harvard Medical School, and began his postgraduate surgical training at Massachusetts General Hospital. 
    His medical training was interrupted twice—once to serve in the Navy during World War II and again in 1946 when he was stricken with poliomyelitis 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, GA, recuperating and applying his inventive mind to building the first motorized wheelchair controlled by a “joy stick,” motorized hoists for lifting patients, special leg braces and other devices to aid the handicapped. For those inventions he received a Presidential Citation. He returned to Oxford where he devoted himself to teaching and research at the University of Mississippi School of Medicine and was named Chair of the Department of Physiology in 1948. In 1951 he was named one of the 10 outstanding men in the nation. When the University of Mississippi moved its Medical School to Jackson in 1955, he rapidly developed one of the world’s premier cardiovascular research programs. His remarkable life as a scientist, author, and devoted father is detailed in a biography published on the occasion of his “retirement” in 1989 (1). 
    A Great Physiologist. 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 our 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 autoregulation, renal-pressure natriuresis, and long-term blood pressure regulation. 
Perhaps his most important scientific contribution, however, was a unique quantitative approach to cardiovascular regulation through the application of principles of engineering and systems analysis. He had an extremely analytical mind and an uncanny ability to integrate bits and pieces of information, not only from his own research but also from others, into a quantitative conceptual framework. He built analog computers and pioneered the application of large-scale systems analyses to modeling the cardiovascular system before digital computers were available. With the advent of digital computers, his cardiovascular models expanded dramatically in the 1960’s and 70’s to include the kidneys and body fluids, hormones, autonomic nervous system, as well as cardiac and circulatory functions (2, 3). He provided the first comprehensive systems analysis of blood pressure regulation and used this same quantitative approach in all areas of his research, leading to new insights that are now part of the everyday vocabulary of cardiovascular researchers. 
    Many of his concepts were revolutionary and were initially met with skepticism, and even ridicule, when they were first presented. When he first presented his mathematical model of cardiovascular function at the Council for High Blood Pressure Research meeting in 1968, the responses of some of the hypertension experts, recorded at the end of the article (2), reflected a tone of disbelief and even sarcasm. Guyton’s systems analysis had predicted a dominant role for the renal pressure natriuresis mechanism in long-term blood pressure regulation, a concept that seemed heretical to most investigators at that time. One of the leading figures in hypertension research commented “I realize that it is an impertinence to question a computer and systems analysis, but the answers they have given to Guyton seem authoritarian and revolutionary.” Guyton’s concepts were authoritarian and revolutionary, but after 35 years of experimental studies by investigators around the world, they have also proved to be very powerful in explaining diverse physiological and clinical observations. His far-reaching concepts will continue to be the foundation for generations of cardiovascular physiologists.
    Guyton received more than 80 major honors from diverse scientific and civic organizations, and universities throughout the world. A few of these that are especially relevant to cardiovascular research include the Wiggers Award of the American Physiological Society, the Ciba Award from the Council for High Blood Pressure Research, The William Harvey Award from the American Society of Hypertension, the Research Achievement Award of the American Heart Association, and the Merck Sharp & Dohme Award of the International Society of Hypertension. It was appropriate that in 1978 he was invited by the Royal College of Physicians in London to deliver a special lecture honoring the 400th anniversary of the birth of William Harvey who discovered the circulation of the blood.
    Although honored by many professional organizations, Guyton’s scientific home was the American Physiological Society (APS). He became a member of APS in 1949 and continued as a regular dues-paying member until his death. He served as president of the APS and the Federation of American Societies of Experimental Biology from 1974-75. He also served as Councillor, Chair of the Education Committee, Chair of the Finance Committee, and a member of the editorial boards of APS journals. In 1981, he received the Ray G. Daggs Award for his outstanding service to the Society. 
    His love of physiology was beautifully articulated in his president’s address to the APS in 1975 (4), appropriately entitled “Physiology: a Beauty and a Philosophy.” Let us quote just one sentence from his address: “What other person, whether he be a theologian, a jurist, a doctor of medicine, a physicist, or whatever, knows more than you, a physiologist, about life? For physiology is indeed an explanation of life. What other subject matter is more fascinating, more exciting, more beautiful than the subject of life.”
    A Master Teacher. Although Guyton’s research accomplishments are legendary, his contributions as an educator have probably had an even greater impact on the world. The fact that he and Ruth raised 10 remarkable children who all became outstanding physicians is a great educational achievement in itself. Eight of the Guyton children graduated from Harvard Medical School, one from Duke Medical School, and one from The University of Miami Medical School after receiving a PhD from Harvard. An article published in Readers Digest in 1982 highlighted their extraordinary family life (5). 0   
    The success of the Guyton children did not occur by chance. Guyton’s philosophy of education was to “learn by doing.” The children, therefore, participated in countless family projects that included the design and construction of their home and heating system, swimming pool, tennis court, sailboats, homemade go-carts and electrical cars, gadgets for their home, and electronic instruments for their Oxford Instruments Company. Television programs such as “Good Morning America” and “20/20” described the remarkable home environment that Arthur and Ruth Guyton created to raise their family. They are a wonderful family, sharing the values of hard work and dedication, teamwork, the excitement of learning and discovery, and a deep love for each other. His devotion to family is beautifully expressed in his Textbook of Medical Physiology (6) that is dedicated: “To: My Father for His Uncompromising Principles That Guided My Life; My Mother for Leading Her Children Into Intellectual Pursuits; My Wife for Her Magnificent Devotion to Her Family; My Children for Making Everything Worthwhile.” 
    Guyton was a master teacher at the University of Mississippi for over 50 years. Even though he was always busy with service responsibilities, research, writing, and teaching, he was never too busy to talk about a new research idea, a new experiment, or to talk with a student who was having difficulty. He would never accept an invitation to give a prestigious lecture if it conflicted with his teaching schedule.
    His contributions to education are also far reaching through generations of graduate students and postdoctoral fellows. He trained over 150 scientists, at least 29 who became chairs of their own departments, and six who became presidents of the APS. He gave students confidence in their abilities and emphasized his belief that, “People who are really successful in the research world are self-taught because they are teaching themselves beyond where other people are.” He insisted that his trainees integrate their experimental findings into a broad conceptual framework that included other interacting systems. This usually led to our attempts to develop a quantitative analysis and to a better understanding of the particular physiological systems that we were studying.
No one has been more prolific in training leaders of physiology than Arthur Guyton. In 2001, he received the Eugene Braunwald Academic Mentorship Award by the American Heart Association.
    Guyton’s famous Textbook of Medical Physiology attracted many of his trainees to Mississippi. His book was a masterpiece, presenting the key concepts in a clear and interesting manner that made studying physiology fun. He wrote this book to teach his students, not to impress his professional colleagues, and its popularity with students has made it the most widely used physiology textbook in history. This accomplishment alone was enough to ensure his legacy. 
    Through his Textbook of Medical Physiology, which is translated in at least 15 languages, he has probably done more to teach physiology to the world than any other individual in history. Unlike most major textbooks which often have as many as 10-20 authors, the first eight editions of the Textbook of Medical Physiology 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. For his many contributions to medical education, Guyton received the 1996 Abraham Flexner Award from the Association of American Medical Colleges. He is also honored each year by APS through the Arthur C. Guyton Teaching Award.
    An Inspiring Role Model. Guyton’s accomplishments extended far beyond science, medicine, and education. He was an inspiring role model for life as well as for science. No one was more inspirational or influential on our scientific careers than Guyton. He taught us much more than physiology—he taught us life, not so much by what he said but by his unspoken courage and dedication to the highest standards.
    He had a special ability to inspire people through his indomitable spirit. Although he was severely crippled with polio, those of us who worked with Arthur Guyton thought of him as being handicapped. His brilliant mind, his indefatigable devotion to science, education, and family, and his spirit captivated students and trainees, professional colleagues, politicians, business leaders, and virtually everyone who knew him. 
    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 courage challenged and inspired us. He expected the best, and somehow brought out the very best in people. Seeing his indomitable spirit and the challenges that he overcame, how could his trainees not do their best?
    We celebrate the magnificent life of Arthur Guyton, recognizing that we owe him an enormous debt. He gave us an imaginative and innovative approach to research and many new scientific concepts of cardiovascular regulation, he gave countless students throughout the world a means of understanding physiology, he gave many of us exciting research careers and, most of all, he inspired us—with his devotion to education, his unique ability to bring out the best in those around him, his warm and generous spirit, and his courage. We will miss him tremendously, but he will remain in our memories as a shining example of the very best in human kind. Dr. Arthur Guyton was a real hero to the world, and his legacy is everlasting. 
References:
1. Brinson C., Quinn J. Arthur C. Guyton—His Life, His Family, His Achievements. Jackson, MS, Hederman Bothers Press, 1989.
2. Guyton A.C., Coleman T.G. “Quantitative analysis of the pathophysiology of hypertension.” Circ. Res. 1969, 24 (Suppl I): I1-I19. 
3. Guyton A.C., Coleman T.G., Granger H.J “Circulation: overall regulation.” Ann. Reviews Physiology, 1972; 34: 13-46.
4. Guyton A.C. “Past-President’s Address. Physiology, a Beauty and a Philosophy.” The Physiologist, 1975; 18: 495-501
5. Bode R. “A Doctor Who’s Dad to Seven Doctors—So Far!” Readers’ Digest, December 1982. pp. 141-145.
6. Guyton A.C. Textbook of Medical Physiology. Philadelphia, PA. W.B. Saunders Co., 1956.

John E. Hall, 
University of Mississippi 

Allen W. Cowley Jr.
Medical College of Wisconsin

Vernon S. Bishop
University of Texas 

D. Neil Granger
Louisiana State University 

L. Gabriel Navar
Tulane University

Aubrey E. Taylor
University of South Alabama

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