STETHESCOPE’s days are numbered

The days of your doctor’s stethescope are numbered.

 

The stethoscope was invented in France in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural. Laennec invented the stethoscope because he was not comfortable placing his ear directly onto a woman’s chest to listen to her heart. He observed that a rolled piece of paper, placed between the patient’s chest and his ear, could amplify heart sounds without requiring physical contact. Laennec’s device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a “microphone”. Laennec called his device the “stethoscope” (stetho- + -scope, “chest scope”), and he called its use “mediate auscultation”, because it was auscultation with a tool intermediate between the patient’s body and the physician’s ear. (Today the word auscultation denotes all such listening, mediate or not.) The first flexible stethoscope of any sort may have been a binaural instrument with articulated joints not very clearly described in 1829. In 1840, Golding Bird described a stethoscope he had been using with a flexible tube. Bird was the first to publish a description of such a stethoscope, but he noted in his paper the prior existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird’s stethoscope had a single earpiece.

In 1851, Irish physician Arthur Leared invented a binaural stethoscope, and in 1852, George Philip Cammann perfected the design of the stethoscope instrument (that used both ears) for commercial production, which has become the standard ever since. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practice.

Somerville Scott Alison described his invention of the stethophone at the Royal Society in 1858; the stethophone had two separate bells, allowing the user to hear and compare sounds derived from two discrete locations. This was used to do definitive studies on binaural hearing and auditory processing that advanced knowledge of sound localization and eventually lead to an understanding of binaural fusion.

The medical historian Jacalyn Duffin has argued that the invention of the stethoscope marked a major step in the redefinition of disease from being a bundle of symptoms, to the current sense of a disease as a problem with an anatomical system even if there are no noticeable symptoms. This re-conceptualization occurred in part, Duffin argues, because prior to stethoscopes, there were no non-lethal instruments for exploring internal anatomy.

Rappaport and Sprague designed a new stethoscope in the 1940s, which became the standard by which other stethoscopes are measured, consisting of two sides, one of which is used for the respiratory system, the other for the cardiovascular system. The Rappaport-Sprague was later made by Hewlett-Packard. HP’s medical products division was spun off as part of Agilent Technologies, Inc., where it became Agilent Healthcare. Agilent Healthcare was purchased by Philips which became Philips Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague stethoscope was finally abandoned ca. 2004, along with Philips’ brand (manufactured by Andromed, of Montreal, Canada) electronic stethoscope model. The Rappaport-Sprague model stethoscope was heavy and short (18–24 in (46–61 cm)) with an antiquated appearance recognizable by their two large independent latex rubber tubes connecting an exposed leaf-spring-joined pair of opposing F-shaped chrome-plated brass binaural ear tubes with a dual-head chest piece.

Early flexible tube stethoscopes. Golding Bird’s instrument is on the left. The instrument on the right is the stethophone.

Several other minor refinements were made to stethoscopes until, in the early 1960s, David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics. In the late 1970s, 3M-Littmann introduced the tunable diaphragm: a very hard (G-10) glass-epoxy resin diaphragm member with an overmolded silicone flexible acoustic surround which permitted increased excursion of the diaphragm member in a Z-axis with respect to the plane of the sound collecting area. The left shift to a lower resonant frequency increases the volume of some low frequency sounds due to the longer waves propagated by the increased excursion of the hard diaphragm member suspended in the concentric accountic surround. Conversely, restricting excursion of the diaphragm by pressing the stethoscope diaphragm surface firmly against the anatomical area overlying the physiological sounds of interest, the acoustic surround could also be used to dampen excursion of the diaphragm in response to “z”-axis pressure against a concentric fret. This raises the frequency bias by shortening the wavelength to auscultate a higher range of physiological sounds.

In 1999, Richard Deslauriers patented the first external noise reducing stethoscope, the DRG Puretone. It featured two parallel lumens containing two steel coils which dissipated infiltrating noise as inaudible heat energy. The steel coil “insulation” added .30 lb to each stethoscope. In 2005, DRG’s diagnostics division was acquired by TRIMLINE Medical Products.

Today, there is a new medical examination device called a Butterfly IQ. Connected to your iPhone, this device makes the stethoscope look as old as it is. Given the range of examinations this new instrument provides, medical practitioners will soon be replacing their stethescopes with Butterfly IQ’s.

This entry was posted in HEALTH & SAFETY. Bookmark the permalink.

Leave a Reply

Your email address will not be published.