After 60 years at the vanguard of the physics of sound, prolific inventor James E. West is on to his next big project: a smart stethoscope.
At a seminar at the Whiting School a few years back, James E. West listened to public health specialists describe how the Global Campaign against lung disease faces an unusual challenge: Noise. And West, a physicist, Whiting School faculty member, and one of the country’s most prominent inventors, realized he had found his next big thing.
As part of a study looking at the health impact of toxic smoke from cook stoves, community health workers in villages in southern Nepal were using stethoscopes equipped with recording devices to capture the sound of children with suspected lung disease. Since they didn’t have the training to interpret the sounds themselves, they would send the recordings back to Tribhuvan University in Kathmandu, where a team of physicians and researchers at Johns Hopkins Bloomberg School of Public Health would listen for the telltale wheezing and crackling of ailing or damaged lungs.
Lung disease is one of the biggest killers of children worldwide. Pneumonia accounts for 1.5 million deaths each year among children 5 and under, more than AIDS and malaria combined. And 98 percent of those deaths occur in the developing world, where there are few medical specialists or well-equipped treatment centers.
But the recordings were so poor, less than half could be used to assess the child’s health. The health workers didn’t always seal the diaphragm of stethoscopes against the skin of patients, and they were working in such noisy conditions that the instruments were picking up the sounds of crying children, slamming doors, and passing trucks. The public health experts posed a challenge: Could someone at the Whiting School build a better stethoscope?
James Edward Maceo West volunteered. “My mouth usually gets me into a lot of trouble,” he says, wryly. “So I said basically, we ought to have enough technology to do better than that. And I got the job.”
The veteran inventor started coming up with several ideas for advanced stethoscopes on the spot, says James Tielsch, then a professor in the Department of International Health at the Bloomberg School of Public Health, who organized the seminar. “He’s one of these guys where you just have to get out of his way.”
Today, a small manufacturer in Baltimore’s Pigtown neighborhood has been hired to produce a couple dozen prototypes of the noise- filtering stethoscopes for testing in Bangladesh, Peru, and the Johns Hopkins Hospital’s pediatric emergency room.
Down the line, West has bigger ambitions. He wants to turn the device into an instrument that can use sound waves, plus some other simple sensors, to spot diseased and damaged lungs, hearts, guts, and joints, and flag them for diagnosis, testing, and treatment.
The research scientist, who has taught at Johns Hopkins since 2001, has been interested in the physics of sound for the past 60 years. He’s improved communications for Formula One racecar drivers, helped fix the poor acoustics of what is now Lincoln Center’s David Geffen Hall, found ways to make Johns Hopkins Hospital wards quieter, and is working on a scheme to harvest the energy contained in low-frequency sound waves. Recently, he helped NASA on a project to develop a lightweight, automated vest to monitor the health of Mars astronauts.
But West is best known, perhaps, for his work with the German electrical engineer Gerhard Sessler at Bell Labs, where the duo invented a revolutionary microphone that has been used since the late 1960s in toys, hearing aids, computers, and the vast majority of billions of mobile phones worldwide. Almost all phones have two of these microphones, West says, and some have up to five.
Today in his mid-80s, West is trim, favors polo shirts and khakis, and keeps his long, graying hair in a knot at the back of his head. He still considers himself something of an iconoclast and outsider, despite his 1999 induction into the National Inventors Hall of Fame, his 2002 election to the National Academy of Engineering, and his receipt of the National Medal of Technology in a White House ceremony in July 2007.
In September, West was honored again, this time at a ceremony marking his promotion to full professor. “The Whiting School is home to some remarkably accomplished faculty members, and there are few faculty members whose work has had the impact of Jim West,” says Whiting School Benjamin T. Rome Dean Ed Schlesinger, speaking at West’s professorial lecture at Mason Hall Auditorium.
William Wilson, director of the Center for Nanoscale Systems at Harvard, also spoke, calling the electret microphone “probably one of the most important pieces of technology ever developed,” a vital component in the advance of global telecommunications.
For an inventor, Wilson says, there are few more satisfying accomplishments than seeing your work touch the lives of billions of people. “When you walk around and everyone has something you invented in their pocket, it doesn’t get any better than that,” he says. West says that building a better stethoscope won’t be easy, and that it could take a decade or longer for his work to bear fruit. But he’s hoping once again to turn the world on its ear.
Public Health and Civil Rights
West began working on diagnostic medical devices in the 1980s while working as a research scientist at Bell Labs’ campus in Murray Hill, New Jersey. After William Baker retired as president of the storied research center in 1979, West says, Baker started wearing a portable heart monitor to collect data about his hypertension. But the microphone used by the device was inadequate for the task, and most of the monitor’s data were useless, West says. So, at Baker’s request, he redesigned it.
Baker lived for another quarter century. West continued to work on blood pressure monitoring with physicians at Cornell medical school’s Hypertension Center, where he helped develop an acoustic approach to measuring blood pressure that was more accurate than traditional methods—work, he believes, that has not gotten the attention it deserves.
West says that his interest in hypertension is due in part to his lifelong commitment to racial equality. For an African-American child growing up in Farmville, Virginia, in the 1930s, the tyranny of segregation was part of everyday life. His proud upper-middle class family—his father was a Pullman porter and entrepreneur, his mother, a schoolteacher and later data analyst at Langley Air Force Base outside Hampton, Virginia—lived in a world where whites consigned “coloreds” to second-class jobs, neighborhoods, schools, and hospitals, and expected deference in return.
Hypertension was then and still is a leading cause of mortality among African-Americans. Forty-one percent of African-Americans have high blood pressure, compared to 27 percent of whites, and as a result, they are much more likely to develop blindness, dementia, stroke, and kidney and heart disease.
Throughout his career, West has been an advocate for bolstering the ranks of African-American scientists and engineers. He drafted plans for a summer minority research program at Bell Labs decades ago, which opened its facilities to about 2,000 students annually, and today he sits on the board of the Ingenuity Project, a nonprofit that provides Baltimore City middle school students with a free, accelerated math and science curriculum.
West also has pressed Johns Hopkins to make a stronger effort to recruit and train outstanding African-American and Hispanic students in the sciences, saying they bring important perspectives to the direction of research.
Wilson of Harvard, an alumnus of the summer research program that West helped launch at Bell Labs, says West contributed to a “dramatic revival” of African-American science in the 1970s, 1980s, and 1990s. “Unfortunately, nothing like that exists anymore,” Wilson says. But he says that and other Bell Labs diversity initiatives showed that “diversity can be engineered. There is a way to do this and a way to do this correctly.”
Building a Better Stethoscope
When French physician Rene Laennec invented the first acoustic stethoscope in 1819, it was designed to be used by well-trained physicians sitting with patients in quiet hospital examination rooms. The simple design, though, can be difficult or impossible to use in ambulances, emergency rooms, and crowded clinics, as well as in developing countries, where both highly trained doctors and privacy may be in short supply.
The biggest challenge for West and his team was developing software that could filter out the cacophony of ambient noise without eliminating the faint telltale sounds of lung disease, the “wheezes” and “crackles” that physicians are taught to listen for when they examine patients.
Mounya Elhilali, Charles Renn Faculty Scholar and associate professor of electrical and computer engineering, leads the project’s software development effort, which is expected to continue as researchers and doctors dream up new ways to use the stethoscope. She specializes in studying the “cocktail party” problem, the riddle of how the brain focuses its attention on one voice out of many in a crowd.
Working with Elhilali and West, Dimitra Emmanouilidou, a PhD student from Greece, sought to teach the programmable stethoscope to mimic the brain’s strategy for filtering sounds. She spent long hours at her computer listening through headphones to a selection of about 2,000 recordings of children breathing, Emmanouilidou heard lots of babies crying, mothers trying to soothe them, birds chirping, and ambulances passing outside. Each sound had to be characterized, to make sure it was filtered out. She worked closely with physicians to make sure she wasn’t leaving nuisance sounds in or taking significant ones out.
The work also posed emotional challenges, she says. She would listen to recordings with the help of spreadsheets showing where and when each child was examined, their age, diagnosis, and treatment outcome. She had trouble listening to the breathing of children whom she knew had later died, she says. “But it does give you more motivation.”
The team has completed work on noise cancellation, and West says it was a complete success. “With our system, you have no background sound at all.”
With the noise-filtering software in hand, the stethoscope team now is focused on a computer algorithm to flag diseased or damaged lungs.
The aim, West says, is to develop a stethoscope that can be placed in the hands of a health worker with some basic training, who can put it against the chest of a patient and tell instantly whether that patient should be referred to a physician. Down the road, the researchers hope to expand the device’s capability to monitor the heart, the gut, and the joints. “Recording a body sound is a cheap thing,” Elhilali says. “And so part of the investigation is, well, how well can we do if we just rely on the sound itself?”
Diagnosing pneumonia typically requires X-rays and blood work as well as a chest exam, but lab tests and X-ray machines can be hard to find in poor countries. To compensate, the World Health Organization directs health workers to give antibiotics to children who exhibit several of a long list of symptoms of pneumonia, even though only about half will turn out to be ill, encourages the overuse of antibiotics, which in turn promotes the development of bacteria resistant to inexpensive, front-line drugs. Drug-resistant strains threaten to make the treatment far more costly and difficult in the long run.
Eric McCollum, a Johns Hopkins pediatric pulmonologist currently working among the tea plantations in northeast Bangladesh, is part of the team of researchers who plan to begin testing the digital stethoscope this year.
He says it could ultimately be automated to help health care workers in countries like Bangladesh and Malawi, where he previously worked, better interpret lung sounds. That would not just improve the diagnosis of lung disease and speed treatment, McCollum says, but it also could reduce the risk of developing dangerous new strains of disease organisms.
The World’s Most Powerful Microphone
Even as a child, West was independent-minded, strong-willed, and deeply curious. When he was about 12, he says, he took apart his grandfather’s expensive Hamilton watch and dismantled his brother’s toys. A few years later, he helped his cousin connect homes in rural Virginia to the grid as part of the New Deal’s electrification program.
He enrolled in Hampton University in Virginia as a premedical student in the late 1940s but wanted to switch to solid-state physics. His parents objected, worried that a scientific degree would be worthless in a world where African-Americans were barred from working in white institutions.
But then, he was drafted and sent to fight in Korea, where he received two Purple Hearts for wounds suffered in combat: Once, he was hit by a landmine, and a second time, an explosion flipped the jeep he was riding in. He declines to describe his wartime experiences in more detail, saying they still give him nightmares.
Following his discharge, West enrolled in Temple University in Philadelphia on the GI Bill, earning a bachelor’s degree in 1957. But the turning point in his professional career came when he was hired as a summer intern at Bell Laboratories, where he joined the tiny group of African-Americans working on the storied institution’s technical staff.
That first summer, he was asked to help design a new, more sensitive set of headphones for Bell Labs researchers trying to determine the limit of the brain’s ability to distinguish between two rapid pulses of sound. (The answer is at least 15 milliseconds.)
Standard condenser microphones weren’t sensitive enough to produce discrete signals over such a short interval. So West dug into the scientific literature and discovered that researchers had experimented with far more sensitive headphones made with polymers, which also functioned as capacitors, meaning they could hold an electric charge.
West built his first charge-holding microphones out of Mylar, but they lost their charges within a matter of months.
After intensive experimentation, West and Sessler in 1962 came up with an advanced microphone built of Teflon, or silicon dioxide, that kept its charge indefinitely. The microphone was far cheaper, smaller, and better than anything else on the market, and its tremendous commercial value was obvious from the start.
West says his director at Bells Labs asked if he and Sessler planned to go into the microphone manufacturing business. “I asked him if he was crazy,” West says. “Why would I ever want to leave Bell Labs? Every toy I could ever think of wanting and all the time I needed to play with it? What better life could there be?” Bell Labs paid West $1 for his share of the patent, he says, and put the design in the public domain.
While Bell Labs in those days was a hothouse for scientific discoveries, West says it was no paradise. “It was a cutthroat business, when you get down to it,” he says, noting that researchers who weren’t producing important work were nudged out the door. “You know, I’m still competitive, because that’s how I grew up. That was what was instilled in me, that you’ve got to come up with new and great things.”
West believes that with freedom comes responsibility. Ellington West, the youngest of the inventor’s four children, says that her father never told her what to do but made it clear that he expected her to do her best at whatever it was she did.
He dedicated himself to whatever task was in front of him, she says, whether it was a work project or coaching her elementary school soccer team. “He is very competitive,” says Ellington, now 25 and living in Baltimore. “But he wasn’t tough. It was just a level of expectations. There was no limit to my decision or choices, and he always supported them as long as I did them wholeheartedly and genuinely.”
West’s wife, Marlene, still a teacher in Plainfield, says she calls her husband “the tinkerer” because “to this day, he is fascinated by how things work, how you’re able to reconstruct things, how to look at things differently.”
A Rather Crooked Road
Ian McLane, who joined the stethoscope project as a sophomore at Johns Hopkins four years ago, is still working on it as a second-year graduate student at the Whiting School. McLane says he wanted to keep working with West because of his approach to teaching and mentoring, which is modeled after the culture of Bell Labs.
West gives his students an ambitious assignment, McLane says, and then provides them the time, the lab, and the support they need to finish it. “He’s been the kind of person who helped guide me without telling me what to do or how to do it,” he says. “I think that’s been very rewarding.”
Emmanouilidou says West is a “phenomenal” teacher, the kind of mentor whose wisdom and insight inspire everyone around him. “This world doesn’t give him enough credit,” she says, despite his long list of accolades and honors. “This person never ceases to amaze me.”
Today, West has published more than 237 scientific papers, book chapters, and other works, and holds more than 60 U.S. and some 200 foreign patents. He’s never formally received a master’s degree or PhD, but he’s been given honorary doctorates from six universities— and now a full professorship at Johns Hopkins.
West hasn’t taken the typical academic career path, he admits, but he wouldn’t have chosen any other. “It’s been a rather crooked road,” he says. “But I don’t know a straight road anyway.”