The Dittrick Medical History Center welcomes researchers from the community, the region, the nation, and abroad. We’ve been pleased to host a number of colleagues, including David Jones, Diana Day, Mike Sappol, and many others. But seasoned scholars and PhDs are not the only visitors to the collections here; Case Western Reserve University students frequently attend classes in the museum’s Zverina room. Today, we begin a three part series featuring some of their work. As always, we welcome all curious and intrepid explorers of our medical past!
There are few instruments more recognizable or emblematic of medicine than the stethoscope. Today’s post, from Cara Smith, will look at its history and development.
Sounds like Progress: The Stethoscope’s Impact on Medical Diagnosis and Knowledge
Medicine in the early 1800’s was a removed practice; doctors diagnosed and treated patients based on observations and conversations. During that era, physical contact and even physical observation was considered “unseemly” (Aronson 171). As a result, one can imagine the difficulties that this incurred in the field of medicine. In order to treat patients properly, doctors need direct and often physical observations, something patients of this time were not eager to provide to the prying gaze of a doctor. However, in 1816, Dr. Rene Laennec, in an imaginative improvisation, created a medical instrument that helped to break down this barrier between patient and doctor and initiate a shift in the mentality of medicine: the stethoscope (Aronson 171). At this point in time, auscultation, the art of listening to the human body to determine ailments, was already in existence. However, this process was done in an extremely invasive and uncomfortable manner, especially for females. The doctor would place his ear directly upon the patient’s chest and try to discern the sounds coming from within, a method known as immediate auscultation (Sterne 120). Because of the social stigma surrounding direct patient care, this method was only undertaken in dire circumstances, such as the case Dr. Laennec was faced with. An already socially awkward situation was made even more so as Dr. Laennec realized that the weight of his female patient prevented him from hearing her heart (Aronson 171). Thus, to solve this issue, Dr. Laennec improvised and “rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised… to find that I could thereby perceive the action of the heart in a manner much more clear” (Sterne 117). This seemingly simplistic adjustment was anything but simple; Dr. Laennec’s invention of the stethoscope, a device that allows doctors to obtain a direct audio of a patient’s insides from a socially acceptable distance, introduced an entire new mode of medical investigation and diagnosis that would eventually answer many questions of medicine -but would also create many unforeseen problems as well.
The invention of the stethoscope was so beneficial in answering questions of medicine because it began to melt away the social barrier placed between doctors and patients. The stethoscope was “designed to operate within the parameters of a set of social relationships, and it helped to cement and formalize those relations: the doctor-patient relationship, the structure of clinical research and pedagogy” (Sterne 116). Despite strict moral standards, the stethoscope allowed doctors to begin to transcend the stigmas of morality and privacy of the era. Patients became much more comfortable with physical examination, allowing doctors to not only diagnose and treat more effectively, but also to learn much more about the human body. Prior to the progress in the doctor-patient relationship initiated by the stethoscope, doctors had to resort to autopsy as their “primary site of knowledge” of the human anatomy (Sterne 125). While this source of data provided doctors with invaluable knowledge of the inner systems and structures of the body, the fact remained that these autopsies were performed on failed cases; patients who, unfortunately, were not provided with proper treatment either because they were not diagnosed properly or the treatment they sought simply did not exist. Armed with the stethoscope and patients’ trust, doctors were now able to begin delving into the mysteries of the living body without violating a patient’s comfort. Instead of observing human bodies in which the blood has stopped moving and the lungs have stopped breathing, doctors were able to shift the “primary site of knowledge in pathological anatomy back from the dead to the living” (Sterne 126). Thus, doctors could observe diseases and other medical problems inside of the body as they were occurring, granting them a new depth of insight. As a result, doctors were able to begin formulating a more detailed and accurate image of the human anatomy as well as the diseases that ravaged it, initiating a new era of medical investigation.
However, as with all major discoveries that initiate rapid progress, the stethoscope precipitated multiple concerns. For instance, the stethoscope created a concern of dealing with the accuracy of the information being obtained. First of all, because of the time period, many questioned the validity and accuracy of observations made with the stethoscope (Sterne 121). The philosophy of the time focused on the idea of the separation of mind and body. Descartes, a major philosopher of the time, claimed that any knowledge obtained through the human senses is inherently flawed. Because the body is separated from the “immaterial mind,” senses are easily deceived (Skirry). With this in mind, the question arises whether a diagnosis based solely on the sounds that doctors perceive to emanate from the body is valid enough to consider using as a basis for discovery, especially considering the difficulty to interpret sounds into symptoms (Sterne 132). In addition, another major problem was that many of the discoveries doctors were making in their living patients were those of diseases that had yet to be fully analyzed. Thus, the discoveries that doctors were making unfortunately caused patients great dread, as in many cases “diagnostic knowledge preceded any notion of a cure” (Sterne 129). While doctors were able to take these discoveries and eventually craft cures, the patients had to live with the dread of knowing they carried an incurable disease. Ethically, this relates to the idea of whether certain knowledge is worth the accompanying consequences. Do patients want to know if they have a disease that they will eventually die from? The patient has a right to know his or her ailment, but should the technology exist that can provide them this information if it is inherently unwanted?
In conclusion, despite the multiple drawbacks that the stethoscope inherently possesses, the stethoscope still persists today as one of the most widely recognized medical symbols. It has essentially inspired the modern medical attitude of “a diagnostically assertive domain” in which doctors depend on the “inner dynamics of the body’s organs… to infer the physical nature of the underlying pathological process” (Aronson 171). Once doctors realized the value of being able to interpret the inner workings of the human body, the idea of the stethoscope and auscultation expounded upon itself; doctors were eager to discover what other sounds they could interpret from different parts of the human body. New instruments and technologies from today reach even further inside of the body, revealing everything from broken bones to mutated DNA. As with the stethoscope, these new technologies such as X-Ray, MRI, and echocardiographs also risk moving at too fast of a pace, diagnosing patients with diseases that are currently beyond modern medicine’s healing capabilities. However, similar to the stethoscope, these developing technologies continue to play an integral role in identifying the causes of these incurable diseases, perpetuating the culture of discovery in medicine for years to come. Thus, the stethoscope can be considered one of the first steps toward the modern medical mentality; the mentality that understanding the inner workings of the body is the key to new knowledge.
ABOUT THE AUTHOR:
Cara Smith, a native Clevelander, is currently a sophomore Biomedical Engineering major at Case Western Reserve University. Within this field, she hopes to eventually pursue further education in neural engineering as well as travel as much as possible. Apart from being a student, she is also a supplemental instructor for Principles of Chemistry for Engineers and a member of multiple wind ensembles on campus in which she plays the flute.
Aronson, Stanley M. “A Heart-Beat Is Amplified and Then Resonates In History.” Medicine & Health Rhode Island 95.6 (2012): 171. Academic Search Complete. Web. 13 Sept. 2014.
Skirry, Justin. “Rene Descartes (1596-1650).” Internet Encyclopedia of Philsophy. Nebraska-Wesleyan University. IEP. Web. 15 Sep 2014.
Sterne, Jonathan. “Mediate Auscultation, The Stethoscope, And The “Autopsy Of The Living”: Medicine’s Acoustic Culture.” Journal Of Medical Humanities 22.2 (2001): 115-136. Academic Search Complete. Web. 13 Sept. 2014.
[Various stethoscopes; Blaufox Hall of Diagnostic Instruments]. [c. late 1800s early 1900s]. Metal and wooden stethoscopes. Dittrick Museum of Medical History, Cleveland.