Tuesday, 26 August 2008


Its been almost 5 years since the BMJ published my tribute to the greatest of American medical writers and physiologists, Arthur C Guyton. Its a perfect opportunity to commemorate this great man, the first in a series of medical and non-medical heroes I shall discuss on this blog.


Arthur Clifton Guyton

Former chairman Department of Physiology and Biophysics University of Mississippi and author of the Textbook of Medical Physiology (b Oxford, Mississippi, 1919; q Harvard 1943), was killed in a car crash in Mississippi on 3 April 2003.

Arthur Guyton was regarded by some as the person who had the greatest impact on medical education of all time. What made Guyton stand out from many other medical authors was his ability to highlight the wonder of it all—something that is all too lacking in modern day medical student curriculums. But this was hardly surprising from a man who regarded the human body as the "most beautiful field of knowledge" in the world. Every paragraph of his 1064 page Textbook of Medical Physiology illustrates this wonder and his great passion for the subject.
Guyton was a true scientific thinker who taught us not to accept things at face value. This is well illustrated in the following excerpt from the Textbook of Medical Physiology on the pathogenesis of tumours. Most medical textbooks discuss this topic in the same way, referring to facts and figures about oncogenes, tumour suppressor genes, cell cycle, and apoptosis. This is important, but for that extra bit of enlightenment and originality, one must refer to Guyton. What is it that causes the altered genes? When one realises that many trillions of new cells are formed each year in humans, this question probably is better asked in the following form: why is it that all of us do not develop literally millions or billions of mutant cancerous cells?

The answer is the incredible precision with which DNA chromosomal strands are replicated in each cell before mitosis can take place and also because the proofreading process cuts and repairs any abnormal strand before the mitotic process is allowed to proceed. Rather than discuss the failure of the human body to tackle cancers, Guyton twists the question around, demonstrating a thankfulness for health.

Guyton was a great example of the wondering type and one of the few writers who constantly asked "why?" Before Guyton, medical students had to rely on difficult and dense books for learning physiology. As he himself described, "Virtually all textbooks of medical physiology were well over 1000 pages and usually in very small print, making it very difficult for the medical students to read and study these books in a way that they could emphasise in their own minds the basic principles of physiology rather than great multitudes of indecipherable details . . . It was almost impossible to have significant discussion in class because all the students’ intent drive was directed toward the cryptic notes, not toward thinking through basic mechanisms of physiological principles."

It is hardly surprising then that Guyton’s textbook has been the world’s bestselling physiology textbook since it was first published in the 1950s. Until publication of the ninth edition, it was written solely by Guyton. The book is now into its 10th edition.

Doctors and patients are indebted to Guyton for his explanations of the pathophysiology of many cardiovascular disorders. As Professor Wallace Conerly has said, "Everything we know about high blood pressure and many of the drugs we use to treat it, all we know about the treatment of congestive heart failure is because of Arthur Guyton."

Guyton’s many discoveries in cardiovascular medicine, his myriad of academic honours and achievements, and his excellent textbooks are enough to place anyone on a list of great scientists. But for all his achievements to be made from the confines of a wheelchair makes them even more awe inspiring. In 1946, as a surgical intern in Boston, Guyton contracted polio, which left his right leg and shoulder paralysed. He was forced to give up his ambition of becoming a neurosurgeon and turn to his other great passion—physiology. His disability did not prove a barrier to his productivity; throughout his life Guyton was an innovator in developing aids for people with disabilities.

Guyton had 10 children, all of whom are doctors, and several of whom are pioneers in their fields. His eldest son, David, is a professor of ophthalmology at John Hopkins; Guyton also leaves three other professors—of surgery, medicine, and anaesthesiology. One family member is preparing documentation for a family listing in the Guinness Book of Records.

His wife, Ruth Weigle Guyton, died on 10 April 2003 from injuries sustained in the crash that also killed her husband.


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