The first edition of the Textbook of Medical Physiology was written by Arthur C. Guyton almost 50 years ago. Unlike many major medical textbooks, which often have 20 or more authors, the first eight editions of the Textbook of Medical Physiology were written entirely by Dr. Guyton with each new edition arriving on schedule for nearly 40 years. Over the years, Dr. Guyton's textbook became widely used throughout the world and was translated into 13 languages. A major reason for the book's unprecedented success was his uncanny ability to explain complex physiologic principles in language easily understood by students. His main goal with each edition was to instruct students in physiology, not to impress his professional colleagues. His writing style always maintained the tone of a teacher talking to his students.

I had the privilege of working closely with Dr. Guyton for almost 30 years and the honor of helping him with the 9th and 10th editions. For the 11th edition, I have the same goal as in previous editions—to explain, in language easily understood by students, how the different cells, tissues, and organs of the human body work together to maintain life. This task has been challenging and exciting because our rapidly increasing knowledge of physiology continues to unravel new mysteries of body functions. Many new techniques for learning about molecular and cellular physiology have been developed. We can present more and more the physiology principles in the terminology of molecular and physical sciences rather than in merely a series of separate and unexplained biological phenomena. This change is welcomed, but it also makes revision of each chapter a necessity.

In this edition, I have attempted to maintain the same unified organization of the text that has been useful to students in the past and to ensure that the book is comprehensive enough that students will wish to use it in later life as a basis for their professional careers. I hope that this textbook conveys the majesty of the human body and its many functions and that it stimulates students to study physiology throughout their careers. Physiology is the link between the basic sciences and medicine. The great beauty of physiology is that it integrates the individual functions of all the body's different cells, tissues, and organs into a functional whole, the human body. Indeed, the human body is much more than the sum of its parts, and life relies upon this total function, not just on the function of individual body parts in isolation from the others.

This brings us to an important question: How are the separate organs and systems coordinated to maintain proper function of the entire body? Fortunately, our bodies are endowed with a vast network of feedback controls that achieve the necessary balances without which we would not be able to live. Physiologists call this high level of internal bodily control homeostasis. In disease states, functional balances are often seriously disturbed and homeosta-sis is impaired. And, when even a single disturbance reaches a limit, the whole body can no longer live. One of the goals of this text, therefore, is to emphasize the effectiveness and beauty of the body's homeostasis mechanisms as well as to present their abnormal function in disease.

Another objective is to be as accurate as possible. Suggestions and critiques from many physiologists, students, and clinicians throughout the world have been sought and then used to check factual accuracy as well as balance in the text. Even so, because of the likelihood of error in sorting through many thousands of bits of information, I wish to issue still a further request to all readers to send along notations of error or inaccuracy. Physiologists understand the importance of feedback for proper function of the human body; so, too, is feedback important for progressive improvement of a textbook of physiology. To the many persons who have already helped, I send sincere thanks.

A brief explanation is needed about several features of the 11th edition. Although many of the chapters have been revised to include new principles of physiology, the text length has been closely monitored to limit the book size so that it can be used effectively in physiology courses for medical students and health care professionals. Many of the figures have also been redrawn and are now in full color. New references have been chosen primarily for their presentation of physiologic principles, for the quality of their own references, and for their easy accessibility. Most of the selected references are from recently published scientific journals that can be freely accessed from the PubMed internet site at http:// Use of these references, as well as cross-references from them, can give the student almost complete coverage of the entire field of physiology.

Another feature is that the print is set in two sizes. The material in small print is of several different kinds: first, anatomical, chemical, and other information that is needed for immediate discussion but that most students will learn in more detail in other courses; second, physiologic information of special importance to certain fields of clinical medicine; and, third, information that will be of value to those students who may wish to study particular physiologic mechanisms more deeply.

The material in large print constitutes the fundamental physiologic information that students will require in virtually all their medical activities and studies.

I wish to express my thanks to many other persons who have helped in preparing this book, including my colleagues in the Department of Physiology & Biophysics at the University of Mississippi Medical Center who provided valuable suggestions. I am also grateful to Ivadelle Osberg Heidke, Gerry McAlpin, and Stephanie Lucas for their excellent secretarial services, and to William Schmitt, Rebecca Gruliow, Mary Anne Folcher, and the rest of the staff of Elsevier Saunders for continued editorial and production excellence.

Finally, I owe an enormous debt to Arthur Guyton for an exciting career in physiology, for his friendship, for the great privilege of contributing to the Textbook of Medical Physiology, and for the inspiration that he provided to all who knew him.

John E. Hall Jackson, Mississippi

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