John B. West

57th APS President (1984-1985)
John B. West
(b. 1928)

Like the other former presidents, West was asked to identify significant events in APS while he was in office. He wrote:

"I like to think that the establishment of the Section on the History of Physiology has been a significant advance and that I have been one of the main driving forces. Of course, the current interest in history because of the Centennial Celebrations helped a great deal as did the recruitment of Toby Appel as archivist. However, I think that the section helps form a focus for the many people in the society who have an interest in the history of physiology. The other significant events are well known. The animal rights problem is a continuing cause of great concern. The future direction of the Society worries many people. This is because of increasing fragmentation as different specialty areas form their own groups (e.g., neurophysiology). Another factor is that the cutting edge of research is moving more and more to cellular physiology, whereas integrative and organ physiology are so important in the teaching of medical students. This results in curious anomalies such as departments of physiology choosing chairmen who are not members of APS."

"My own attitude is that the discipline of physiology is not threatened so long as we all recognize that it includes many areas, such as cell biology, bioengineering, and biophysics. It may be, however, that the APS cannot include all these disciplines, just as biochemistry, which was originally part of physiology, eventually found its home elsewhere."

Now a citizen of the United States, West was born in Adelaide, Australia, where he received his early medical training (M.B.B.S., 1952) and where he was awarded M.D. (1959) and D.Sc. (1980) degrees. In the meantime he had gone to Hammersmith Hospital in London for an internship and residency, which he completed in 1960. That same year he received a Ph.D. degree from London University and joined Sir Edmund Hillary's Himalayan scientific and mountaineering expedition as a physiologist. In 1961-62 he was a postdoctoral fellow with Hermann Rahn at Buffalo; he then returned to London as director of the Respiratory Research Group at Postgraduate Medical School (1962-67). Advanced to the rank of reader in this school in 1968, he took a sabbatical leave for research at the NASA Ames Research Center at Moffett Field, California. The following year (1969) he was invited to become a member of the faculty of the new School of Medicine at the University of California at San Diego as professor of medicine and physiology.

When asked to tell about his training in physiology, West replied:

"My research training has been extremely haphazard by present-day standards. After I obtained my medical degree at the University of Adelaide and did the necessary internship year, I moved to London mainly because I wanted to see the world. Fortunately I gravitated to the Postgraduate Medical School where I first did a residency and then became a member of the Respiratory Research Group under Philip Hugh-Jones. It was at that time that the first respiratory mass spectrometer began working, and the first cyclotron designed for medical research also came on line at the same institution. The research opportunities offered by these two techniques were tremendous. There was a very stimulating intellectual atmosphere with chemists, physicists, and engineers all working in the same unit, but in terms of formal research training I grew like Topsy. My Ph.D. research was the analysis of regional blood flow and ventilation using the cyclotron-produced isotopes."

West has been able to continue his association with clinical disciplines, both inside and outside the University of California. He is a member of the American Society for Clinical Investigation and of the prestigious Association of American Physicians. He also belongs to the American Thoracic Society, AAAS, and ACDP. In Great Britain he holds membership in the Physiology Society and the Harveian Society of London. With Fishman, he initiated plans for the joint meeting of APS and the Physiological Society, held in Cambridge, England, in 1985. One is not surprised to find that he belongs to the Explorers Club.

In 1974 West was designated a Josiah H. Macy, Jr., Foundation Scholar, and he was given the Ernst Jung Prize for Medicine in Hamburg, West Germany, in 1977, as well as the Presidential Citation of the American College of Chest Physicians. In 1980 he won the Kaiser Award for Excellence in Teaching. He has held nearly twenty endowed lectureships, including the Wiltshire Memorial Lectureship at King's College, London (1971); the Brailsford Robertson Memorial Lectureship at Adelaide University (1978); the Brompton Annual Lectureship at Brompton Hospital, London (1979); the Harveian Lectureship in London (1981); a Centenary Lectureship at Auckland, New Zealand (1983); and a Telford Memorial Lectureship at Manchester University in England (1983). Invitation from societies in this country include those from the Anesthesia Research Society in 1975; AHA in 1978 and 1980; the American College of Surgeons in 1982; and the Aerospace Medical Association, the American Thoracic Society, and the Undersea Medical Society all in 1984. He has lectured at Washington University in St. Louis (1978), Loma Linda University Medical School (1979 and 1983), the College of Physicians and Surgeons of Columbia University (1981), and the Medical University of South Carolina (1982).

Editorial responsibility assumed by West began with the American Journal of Physiology (1969-75) and the Journal of Applied Physiology (1969-75; associate editor, 1979-81). He was on the board of Respiration Physiology as a founder member (1966-71). Currently he serves with editorial boards for the American Review of Respiratory Disease (1975-), Circulation Research (1975-), Journal of Nuclear Medicine and Allied Sciences (Italy, 1975-), Microvascular Research (founder member, 1968-), and Clinical Physiology (Sweden, founder member, 1980).

Some twenty years after he jointed Hillary's expedition (1960), West led the American Medical Research Expedition to Everest in 1981 (see below). For NASA he has been chairman of the Science Verification Committee for Spacelab 4 in 1983 and a member of their Advisory Committee on Scientific Uses of Space Station in 1984. Also in that year he served as a member of a NAS Committee on Space Biology. Earlier in his career he was a member of the NIH Cardiovascular and Pulmonary Study Section (1971-75; chairman, 1973-75), the Physiology Committee of the National Board of Medical Examiners (1973-76), and the Cardiopulmonary Council of AHA (1977-78). Elected to membership in APS in 1970 and to Council in 1981, two years later he became president elect (1983).

West described his main research interests under five headings:

1. Investigation of pulmonary function, particularly ventilation-perfusion relationships, by analysis of expired gas with a respiratory mass spectrometer. This was my first project and came about partly because I had just joined a research group at the Postgraduate Medical School, London, where the first respiratory mass spectrometer had been constructed by K. T. Fowler.

2. Measurement of inequality of ventilation and blood flow in the lung by using short-lived radioactive gases. This was a very exciting project. It came about because the medical research cyclotron at Hammersmith Hospital in London had just begun to produce short-lived isotopes, including oxygen-15 (half-life 2 min). By having subjects inhale this isotope in various forms (e.g., molecular oxygen and oxygen-15-labeled CO2) we were able to show for the first time that blood flow is much greater at the bottom of the lung than at the top. I subsequently spent several years sorting out the reasons for the inequality of blood flow and ventilation.

3. High-altitude physiology. Again, this was serendipitous. I happened to be sitting next to someone at a meeting of the Physiological Society in England who told me of plans for the Himalayan Scientific and Mountaineering Expedition, which was to take place in 1960 and 1961. At that time I had no special interest in high altitude but was selected by Sir Edmund Hillary to go as one of the physiologists, and the expedition was a great success. We lived for several months during the winter at an altitude of 5,800 m, and I helped make the first measurements of maximal oxygen uptake at an altitude of 7,440 m on Mount Makalu.

4. Analysis of pulmonary gas exchange, particularly ventilation-perfusion relationships. This has been a continuing interest, and during the last ten years, my colleague Peter Wagner and I have developed the multiple inert gas elimination technique for measuring distributions of ventilation-perfusion ratios. One of my interests has been developing computer models for analyzing this difficult problem.
5. Effects of gravity on lung mechanics. At one stage I devoted a lot of time to a finite element analysis of lung distortion caused by gravity. This work was done with Frank Matthews of the Department of Aeronautical Structures in the University of London.

When asked to comment on favorite publications, West chose his first paper (1) and his most popular textbook (11). Then he noted:

"In a paper published in 1960 (2), topographical distribution of blood flow in the lung was first described. In the next three titles (3-5), we wrote of work done during the Himalayan Scientific and Mountaineering Expedition of 1960-61. For the first time, in 1967, we demonstrated directly regional differences of alveolar size in lungs, whereas the next paper (8) describes a computer model of pulmonary gas exchange, which has been very influential. In 1972 (9) we described a finite element analysis which is not very well known but actually was very innovative at the time. The 1974 paper (10) gives the method for determining distributions of ventilation-perfusion ratios, a goal that many respiratory physiologists have had for some time. In 1978 (12) we described the first measurements of the effects of weightlessness on the distribution of ventilation and blood flow in the lung, an experiment carried out on a Learjet aircraft flying a Keplerian profile. The next three articles (13-15) describe some of the results of our recent Everest expedition. I am particularly fond of the paper describing the first measurements on the summit (14).

West is well known to medical students and residents who regularly use his accounts of pulmonary function and pathology. For many of his friends in APS, however, his name evokes another type of association. Although using techniques far superior to what they had available, he has nevertheless recreated in our time a heroic age of physiology marked by names such as Joseph Barcroft, J. S. Haldane, L. J. Henderson, and others, perhaps even of G. H. L. Mallory---almost legendary figures of remarkable achievement. Everest without supplementary oxygen!

Selected Publications

1. West, J. B., K. T. Fowler, P. High-Jones, and T. V. O'Donnell. Measurement of the ventilation-perfusion ratio inequality in the lung by the analysis of a single expirate. Clin. Sci. Lond. 16: 529-547, 1957.

2. West, J. B., and C. T. Dollery. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive CO2. J. Appl. Physiol. 15: 405-410, 1960.

3. West, J. B. Diffusing capacity of the lung for carbon monoxide at high altitude. J. Appl. Physiol. 17: 421-426, 1962.

4. West, J. B., S. Lahiri, M. B. Gill, J. S. Milledge, L. G. C. E. Pugh, and M. P. Ward. Arterial oxygen saturation during exercise at high altitude. J. Appl. Physiol. 17: 617-621, 1962.

5. Pugh, L. G. C. E., M. B. Gill, S. Lahiri, J. S. Milledge, M. P. Ward, and J. B. West. Muscular exercise at great altitude. J. Appl. Physiol. 19: 431-440, 1964.

6. West, J. B., C. T. Dollery, and B. E. Heard. Increased pulmonary vascular resistance in the dependent zone of the isolated dog lung caused by perivascular edema. Circ. Res. 17: 191-206, 1965.

7. Glazier, J. B., J. M. B. Hughes, J. E. Maloney, and J. B. West. Vertical gradient of alveolar size in lungs of dogs frozen intact. J. Appl. Physiol. 23: 694-705, 1967.

8. West, J. B. Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respir. Physiol. 7: 88-110, 1969.

9. West, J. B., and F. L. Matthews. Stresses, strains, and surface pressures in the lung caused by its weight. J. Appl. Physiol. 31: 332-345, 1972.

10. Wagner, P. D., H. A. Saltzman, and J. B. West. Measurement of continuous distributions of ventilation-perfusion ratios: theory. J. Appl. Physiol. 36: 588-599, 1974.

11. West, J. B. Respiratory Physiology---the Essentials Baltimore, MD: Williams & Wilkins, 1974. [French ed., 1975; Spanish ed., 1976; Iranian ed., 1976; Portuguese ed., 1977; Italian ed., 1978; 2nd English ed., 1980; Japanese ed., 1981; Dutch ed., 1981; Bahasa Malaysia ed., 1984.]

12. Michels, D. B., and J. B. West. Distribution of pulmonary ventilation and perfusion during short periods of weightlessness. J. Appl. Physiol. 45: 987-998, 1978.

13. West, J. B., S. Lahiri, K. H. Maret, R. M. Peters, Jr., and C. J. Pizzo. Barometric pressures at extreme altitudes on Mt. Everest: physiological significance. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 54: 1188-1194, 1983.

14. West, J. B., P. H. Hackett, K. H. Maret, J. S. Milledge, R. M. Peters, Jr, C. J. Pizzo, and R. M. Winslow. Pulmonary gas exchange on the summit of Mt. Everest. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 55: 678-687, 1983.

15. West, J. B., S. J. Boyer, D. J. Graber, P. H Hackett, K. H. Maret, J. S. Milledge, R. M. Peters, Jr., C. J. Pizzo, M. Samaja, F. H. Sarnquist, R. B. Schoene, and R. M. Winslow. Maximal exercise at extreme altitudes on Mount Everest. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 55: 688-698, 1983.