Today, the stethoscope changes the rules of medical
diagnosis. The University of Houston's College of
Engineering presents this series about the machines
that make our civilization run, and the people
whose ingenuity created them.
Historian Stanley Reiser
tells how a French doctor, René Laennec,
tried to diagnose a heart disorder in an obese
young woman in 1816. He'd tried thumping her chest,
but she was too heavy. The sound told him nothing.
The next logical step was to put an ear to her
chest, but modesty forbade such intimacy. What to
do!
Laennec had an idea. He rolled a sheaf of papers
into a tube -- placed one end on her chest and his
ear on the other end. He was able to make out what
was going on in her heart. He had just created the
first stethoscope. Three years later he published a
book describing his design of a wooden stethoscope
and its use.
By the 1830s stethoscopes appeared with pliable
rubber tubes, then binaural ones with earplugs. All
the while debate raged -- less over stethoscopes
than the tactics of diagnosis.
Laennec's dilemma with that young patient wouldn't
have been a dilemma for most doctors around him.
Thumping the thorax or putting an ear to the heart
wouldn't have occured to them. Those were pretty
radical forms of medical diagnosis in 1816.
Diagnoses were usually based on looking at patients
and hearing their own reports of symptoms. Doctors
seldom questioned what patients said about
themselves, and they tried to infer too much from a
patient's outward appearance. Physical contact
usually stopped at counting a pulse or touching a
forehead.
Laennec's ideas about thumping, feeling, and
placing an ear to a patient went way back to
Hippocrates. Hippocrates believed that all our
senses should be used in diagnosis. An ancient
Greek doctor might've diagnosed diabetes by tasting
a patient's urine. That kind of intimacy didn't
appeal to 18th-century sensibilities!
Now stethoscopes let doctors keep their distance
and still engage actual symptoms. This simple new
instrument became the stalking horse for a whole
new kind of medicine -- one in which we by-passed
the patient's story and looked inside the patient's
body for direct evidence of disease.
Stethoscopes were followed by opthalmoscopes,
laryngoscopes, then X-rays, CAT-scans, and MRI. And
all that has only intensified debate over how much
doctor/patient intimacy is appropriate.
The stethoscope once promised to bridge the gap, to
give some contact with patients' symptoms back to
doctors. But it also gave doctors a way to stand
even further away from patients.
Any of you who've ever watched the movement of your
own internal organs on a cool green computer screen
feel the contradiction: that a doctor may stand
that close to your illness when she is, in fact,
not listening to your story, not even in the same
room -- when she may not even know your name.
I'm John Lienhard, at the University of Houston,
where we're interested in the way inventive minds
work.
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