Still is only death. When we are alive, the body is constantly making noises: the lungs are whistling, the intestines are gurgling, the heart is pounding and there is a rushing noise in the bloodstream. And if you listen carefully, the tones will tell you whether the person is sick or healthy. This is only possible with the stethoscope, a diagnostic instrument whose importance in medicine cannot be overstated. Placed on the chest or stomach, it picks up the vibrations via a membrane, transmits them to the earplugs, and the user hears sounds from inside the human being. For centuries it was the doctor’s most important tool. Due to its relative objectivity, it heralded the change in medicine from art to science. Even today, it creates identity, characterizes the image of the doctor like only the white coat would otherwise. However, the stethoscope may slowly become obsolete in times when devices provide detailed images of the organs.
Tom Rice and Anna Harris follow the journey of this “icon of medicine” in their book. They describe how the stethoscope blossomed from a hearing trumpet at the beginning of the nineteenth century into a modern rubber tube with digital skills. How doctors struggle with the art of auscultation to this day – that is what listening with a stethoscope is called in jargon. And they report on the curious sides of the stethoscope, such as how horse owners, soldiers or car mechanics can benefit from it. Indirectly, the book raises larger questions: Do we want human medicine or machine medicine? How close – in a physical and trusting sense – does the relationship between doctor and patient have to be?
Auscultation is an art that not everyone has mastered
While today blood tests or X-rays provide information about the patient, in the early nineteenth century a doctor like René Laennec in Paris still had to rely entirely on his impression and the words of the patient. Legend has it that when Laennec was walking through the Tuileries in 1816, he noticed children playing with a log: on one side some pressed their ears to the wood and apparently heard the children scratching on the other side of the hollow one tribal The idea for the stethoscope was born. Laennec rolled the first paper ear trumpet, and indeed he could hear the beating of his patient’s heart much more clearly. Thus, the device called the stethoscope (“stethos” is the chest, and “skopein” means something like seeing/examining in Greek) fulfilled another function: it created distance between the doctor and the patient. “The class of people you find in hospitals is disgusting,” Laennec wrote. The sick were often poor, dirty, or drenched in sweat. And in the case of young ladies, it was not proper for the doctor to press his ear directly to her breast anyway.
Anna Harris und Tom Rice: „Stethoscope“. The Making of a Medical Icon.
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Image: Reaction Books
The first stethoscopes were simple wooden tubes with a thin membrane at one end. For the first time, physicians were able to associate body changes with specific sounds. They had to do numerous autopsies to see what was causing the noise. For a long time, the stethoscope was associated with tuberculosis, which, as Laennec found out, changes the sound of speech by destroying the lung tissue.
What good are doctors who are stuck without CT and ultrasound?
The stethoscope spread all over the world, but despite its ubiquity, one hurdle has remained: auscultation is an art that not everyone has mastered. To this day, medical students fear that they should auscultate a patient in class – and not hear the said hissing or throbbing at all. The authors collect a few anecdotes on the learning process that is part of auscultation. Like that of the famous physician Proctor Harvey, who sixty years ago played Beethoven to his students to train their ears.
In the digital age, heart sounds and lung rales can easily be played on the Internet. Nevertheless, the stethoscope is given less and less attention in medical studies, as the authors note. Auscultation is a dying skill, at least in affluent countries. But in the so-called Global South, where doctors have hardly any technology at their disposal, the stethoscope is still essential. And in this country, too, one should ask oneself what doctors are good for who are stuck without CT, MRI and ultrasound.
Harris and Rice’s book is well researched and accessible. Although it also sheds light on the use of the stethoscope outside of the medical world, and incorporates literature and art installations, it will probably still primarily convince readers who have something to do with it – whether as a profession or in your favorite television series.
Anna Harris und Tom Rice: „Stethoscope“. The Making of a Medical Icon. Reaction Books, London 2022. 192 pp., ills., hardcover, €20.