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| ART AND MEDICINE |
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| Year : 2012 | Volume
: 13
| Issue : 1 | Page : 24-25 |
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The art of listening
Rachel Hajar
Department of Cardiology and Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| Date of Web Publication | 26-May-2012 |
Correspondence Address:
Rachel Hajar
Department of Cardiology and Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha
Qatar
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1995-705X.96668
How to cite this article:
Hajar R. The art of listening. Heart Views 2012;13:24-5 |
The engraving above shows a physician examining a patient by "immediate" auscultation, in which the doctor placed his ear on the chest of the patient to hear the sounds made by the lungs during breathing. The print shows a group of physicians, medical students, and nurses observing the physician performing his exam.
Analyzing the sounds emanating from the human body, descriptions of such sounds, and what they signify is integral to the training of a physician.
Amongst the earliest known medical manuscripts are the medical papyruses of ancient Egypt dating to the 17 th century BC, which referred to audible signs of disease within the body. Hippocrates advocated for the search of practical instruments to improve medicine in 350 BC. He discussed a procedure for shaking a patient by the shoulders (succussion) and listening for sounds evoked by the chest. Hippocrates also used the method of applying the ear directly to the chest and found it useful in order to detect the accumulation of fluid within the chest. In the 16 th century, the renowned surgeon Ambroise Pare noted that "if there is matter or other humors in the thorax, one can hear a noise like that of a half-filled gurgling bottle." The distinguished scientist William Harvey, in his 1616 lecture on the structure and function of the heart, described the heart's motion as "two clacks of a water-bellows to raise water" and noted that "with each movement of the heart, when there is delivery of a quantity of blood from the veins or arteries, a pulse takes place and can be heard within the chest." The French physician Jean-Nicolas Corvisart, who is considered the founder of French clinical medicine, was accustomed to placing his ear over the cardiac region of the chest to listen to the heart. Bayle and Double, who like Laennec were students of Corvisart, used the unaided ear to listen to the heart of their patients.
The stethoscope was invented in 1816 when a young French physician named Rene Theophile Hyacinthe Laennec was examining a young female patient. Laennec was embarrassed to place his ear to her chest, which was the method of auscultation used by physicians at that time. He remembered a trick he learned as a child that sound travels through solids and thus he rolled up 24 sheets of paper, placed one end to his ear and the other end to the woman's chest. He was delighted to discover that the sounds were not only conveyed through the paper cone, but they were also loud and clear.
Laennec preferred to have his instrument simply called "Le Cylindre," as he thought naming such a fundamental instrument was unnecessary. He decided that it should be called "stethoscope," which is derived from the Greek words for " I see" and " the chest."
Laennec was a skilled wood turner and set up a small shop in his home with a wood-turning lathe and stocked different types of wood. He created a stethoscope from a turned piece of wood with hollow bore in the center. It was made of two pieces. One end had a hole to place against the ear and the other end was hollowed out into a funnel-shaped cone. There was a plug that fitted into this cone which had a hollow brass tube placed inside it. This plug was put in the funnel-shaped end of the stethoscope to listen to the heart, and removed to examine the lungs. Laennec published his classic Treatise on Mediate Auscultation in 1819 in which he discussed mediate auscultation and illustrated the design of the stethoscope. A second edition was published in 1826, just after Laennec died from tuberculosis, a disease he spent long hours studying with his stethoscope. The stethoscope was described as being 12 inches long and 1.5 inches in diameter with a 3/8 inch central bore hole throughout its length. His stethoscope could be bought for 2 francs along with the purchase of the Treatise on Mediate Auscultation.
There have been many modifications to Laennec's original version of the stethoscope. With the proliferation of imaging techniques in medicine in the 21st century, the stethoscope is in danger of becoming extinct and the art of "listening" is becoming forgotten or about to be forgotten.
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