Arthur C. Guyton, MD (1919–2003)
On April 3, 2003, cardiovascular science lost one of its most influential figures when Dr Arthur C. Guyton died. No one contributed more to our understanding of cardiovascular function in health and disease than Dr Guyton over more than the last half-century, which spanned his career.
He was born in Oxford, Mississippi, and graduated first in his high school class, and 3 years later in 1939, he was first in his class again at the University of Mississippi, where he majored in Chemistry, minored in Mathematics, and received the highest award for Physics. He received his MD from Harvard Medical School in 1943. His first love in medical school was surgery, and he completed a surgical internship and assistant residency in surgery at Massachusetts General Hospital in 1947, which was interrupted by 2 years of Naval service during World War II.
As with all great leaders and even research discoveries, serendipity, as well as meticulous planning, plays a role in determining the outcome. In Dr Guyton’s case, an unfortunate turn of events, his contraction of polio in 1947, left him paralyzed, but undaunted. This case of “bad luck” turned out to be a blessing for the field of cardiovascular physiology, since Dr Guyton relinquished his surgical career and became encompassed in physiology’s research, teaching, and administration. He assumed the Chair of the Department of Physiology and Biophysics at Mississippi in 1948 and held that post until he retired in 1989. It is interesting that although his first papers related to design and function of laboratory apparatus, he did publish concurrent studies on the physiology of poliomyelitis.
His own research career was spectacular. It was based solidly on his deep understanding of mathematics, physics, and chemistry, the underpinnings of modern-day biomedical engineering, as well as of medicine and physiology. Indeed, he was a biomedical engineer before this discipline came into prominence. Using all of the tools noted above, he changed our understanding of the control of circulation, proving that the importance of venous return and local metabolic control of the regional beds were paramount in regulating cardiac output, ie, were more important than the control exerted by the heart itself. Of course, this led to intense debate, which was fascinating as well as instructive, with other leading cardiac physiologists, such as Rushmer and Sarnoff. Another major novel concept of Dr Guyton’s was the difference between short-term and long-term regulation, the latter controlled by the kidney, which was paramount in chronic regulation of the circulation, eg, in heart failure and hypertension. This concept and further related work advanced Dr Guyton to the forefront of hypertension research.
Dr Guyton received almost every major award possible for a cardiovascular scientist including the Harvey Lecture at the Royal College of Physicians, the Einthoven Medal, the CIBA Award, the William Harvey Award, and the Flexner Award. In addition, Dr Guyton was the American Physiological Society President from 1974 to 1975, and he was the president of the Federation of American Societies of Experimental Biology from 1975 to 1976. He was involved extensively in the American Heart Association, receiving numerous honors including the Lifetime Research Achievement Award and most recently the Eugene Braunwald Award for mentorship.
Despite the international recognition for his research and over 550 publications, including his Textbook of Medical Physiology, which trained countless numbers of medical and graduate students, I believe he felt that his most important accomplishment revolved around his family. In this connection, “family” is taken in the broad sense. Of course, his devotion to his wife Ruth and his 10 children, leading to a further legacy of 10 MDs, was well recognized. However, he also considered his students as family and would often drive to national meetings, eg, FASEB at Atlantic City, with many of them in the car. At least 27 of his students have gone on to chair their own departments, and 6 have become presidents of the American Physiological Society, a testament to his legendary record in training graduate students.
To prepare this tribute, I solicited reflections from several of his former students who later rose to prominence as leaders in physiology and academic medicine. The unifying theme echoed by all the respondents was that Arthur Guyton was a figure “larger than life.” He remained their mentor throughout their careers. All consulted him for each of their career-changing options, and as John Hall, Dr Guyton’s successor as the Chair of the Department of Physiology and Biophysics at the University of Mississippi, succinctly relates, “He taught us a lot more than physiology—he taught us life.”
Aubrey Taylor, former Chair of the Department of Physiology at the University of South Alabama College of Medicine, shares, “Dr Guyton was the inspiration, the guide, and the final arbiter, and in later years, students tried to emulate his approaches to physiological science and teaching techniques in their own laboratories and departments. He has left this world, but his influence will live forever in the minds of his children, his students, their students, and the worldwide physiological research community.”
Allen Cowley, Chairman of the Department of Physiology at the Medical College of Wisconsin, reflects, “One quickly developed a deep respect for this strong-minded, but gentle intellectual giant. Having worked by his side for 12 years, there is not a single defining moment that would capture the essence of Dr Guyton. It was his total spirit and mind that captivated and inspired both my personal and professional life. These qualities, along with his approach to problem-solving, his logic, and depth of understanding of complex biological systems, contributed to the remarkable personality of this individual. Clearly, Dr Guyton’s scientific perceptive and creative mind transformed the understanding of cardiovascular function.”
Gabby Navar, Chairman of the Department of Physiology at Tulane University School of Medicine, says, “Arthur was a wonderful but tough mentor with very high expectations. I learned many things from him, but the most important lessons were about life as a scientist. He was an inspiration to us all, and I will always be thankful that I had the good fortune to be associated with this great man.”
Joey Granger, Professor at the University of Mississippi School of Medicine and one of three brothers who all studied under Dr Guyton, includes, “Although we have lost one of the greatest men who walked among us, Dr Guyton’s legacy will continue through his textbooks and research and through the Guyton family as well as his family of trainees. I was fortunate to have stood in the shadow of this great man. Students trained in his philosophy of research are commonly called ‘Guytonians.’ I will always be proud of being called a ‘Guytonian.’ We will always view him as our scientific father and an outstanding role model and human being.”
Dr Guyton was clearly fully committed to research and teaching, and this did not turn on and off when he entered his office or left for the day. Elvin Smith, Executive Vice President of the Texas A&M University System Health Science Center, wrote, “He was absolutely convinced of the power of intellect, coupled with determination. … As part of our orientation as students, he would tell us how much he often thought of physiology and future experiments. He encouraged us to do one thing, which he himself practiced. We should always keep a note pad and a pencil by our beds. When we woke up at night we would find ourselves thinking of our work, experiments, and problems connected with them. Some of the best insight occurs during these moments, and one can often solve problems heretofore unsolved. We should immediately write them down, or we would find the next morning that we were unable to recall the brilliant solution we had achieved.”
With many luminaries, you never have the chance to observe their human or humorous sides, but Dr Guyton’s students recall these aspects of his personality very well.
Harris Granger, Professor and Chair of the Department of Medical Physiology at Texas A&M University College of Medicine, noted, “Two qualities impressed me when I first met Dr Guyton. First and foremost was how comfortable I felt with this great man from the very beginning. He had a way of making anyone near him feel like an equal. This was a rare gift. In addition, Dr Guyton was an easy-going man who enjoyed being teased every once in a while. I remember having a session with him in his office to go over some data on autoregulation of blood flow. We were having a spirited discussion of possible involvement of the myogenic response (something in which he never believed), when he reached for his textbook to locate an argument he had developed against the mechanism. I chided him for using his textbook as an unbiased source. His eyebrows immediately furled in disbelief, but just as quickly his eyes brightened and that wonderful smile appeared. This is the image of Dr Guyton I will always carry with me.”
Another example was related by Jay Thomas, Professor of Physiology and Associate Dean of Medical Education at Northwestern University. When Dr Thomas moved from bench science in the Physiology department to administration in the Dean’s office, Dr Guyton, smiling, remarked to a colleague in a loud enough voice for Jay to hear—‘Did I ever tell you about one of my students who has unfortunately gone over to the other side?’ As also noted by Harris Granger, Dr Guyton enjoyed being teased, but also enjoyed teasing.
Dr Guyton influenced many more scientists and doctors than just his students and his students’ students. Indirectly, many thousands were influenced by his widely read textbook. Directly, there were numerous conversations he would have, particularly with young investigators, not only at his institution but also with others he would meet during his travel or scientific meetings. Because of his sincerity and openness, which are not found in many individuals of his stature, he was always available to discuss science or other topics. I first encountered Dr Guyton when I was a postdoctoral fellow in the Department of Physiology and Biophysics at the University of Washington. After he lectured in our department, I asked a question, to which he replied that the answer was obvious if I understood just one slide from his lecture (Figure 1). Clearly I didn’t. After the lecture he spent a considerable amount of time explaining his concept and control theory to me.
This raises another key point. An exceptional talent of Dr Guyton’s was his ability to teach at different levels. He was able to lecture to biophysicists at one level (Figure 1) and to medical students at another (Figure 2). His clear diagrammatic analysis of cardiac function, which has intentionally omitted data, was simple, but accurate and was a marvelous teaching tool (Figure 2).
A few years later I attended a satellite meeting of a World Congress in India, where we spent a week living in houseboats in Kashmir and discussing cardiopulmonary physiology. In that informal setting, my wife Dorothy and I were privileged to have the opportunity to converse with Arthur and his wife Ruth about science, careers, and family, and how the three are not mutually exclusive. His advice and his career as a role model were important for me, as a physician, to remain in basic research full time, as he did.
In closing, it is important to echo the sentiments of his students, who all remarked that his influence on their careers and personal lives will be missed. However, through his students and their students and through others he touched, as he did for me, his legacy will remain. It is most appropriate to have this tribute published in Circulation Research, where he published much of his work, to allow those of us who knew him to remember him once again and, for those who did not have the privilege of knowing him, to learn just a little bit about the personality of this wonderful scientist, teacher, mentor, and human being.⇓
The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.