The Invention of the Stethoscope

Nicolae Miruna -11M1

Prof. Pacu Iuliana

6.10.2020
 Introduction

✤ The stethoscope may be the one instrument common

to all doctors. This instrument may even supersede
the caduceus as the symbol of medicine – no other
symbol so strongly identifies a doctor than a
stethoscope dangling around the neck like a talisman

✤ Since mankind first began to study human

physiology, a it has been obvious that the heart plays
a crucial role in our bodies. The sounds it makes, as
well as the sounds that the surrounding organs, such
as the lungs, make can be crucial indicators when
examining a patient.
Before the stethoscope

In the early 1800’s, and prior to the development of the stethoscope,

physicians would often perform physical examinations using techniques
such as percussion and immediate auscultation. In immediate auscultation,
physicians placed their ear directly on the patient to observe internal sounds.

This technique suffered from several drawbacks, the foremost being that it
required physical contact between the physician and the patient and proper
placement of the ear. In addition, the sounds observed by the physician were
not amplified in any way and were of quite terrible quality, creating the
possibility of missing key sounds that might indicate potential illness.
 From a toy to a medical tool

✤ In September 1816, during a cool morning, while walking in

the courtyard of the The Louvre Palace in Paris, Dr. Rene
Theophile Hyacinthe Laënnec, a 35-year-old French
physician, observed two children sending signals to each
other using a long piece of solid wood and a pin. With an ear
to one end, the child received an amplified sound of the pin
scratching the opposite end of the wood.

✤ Later that year, Laënnec was called to a young woman with

“general symptoms of a diseased heart.” Both application of
1,2

his hand to the chest and percussion offered little diagnostic

assistance. Laënnec was reluctant to start immediate
auscultation and recalled his observation of the children’s
wood borne signaling.
Who was Rene Laënnec?

✤ He was born in Quimper, Brittany in 1781. He

studied medicine in France. An outstanding
student, he won prizes in medicine and surgery
and published several papers before graduating.
He was a consulting physician at the Hopital
Necker from 1816, where his interest in TB (which
he contracted later) kindled his interest in listening
to the chest. While Laënnec’s stethoscope
revolutionized diagnosis of diseases of the chest,
his name is eponymously associated with
micronodular cirrhosis of the liver (Laënnec’s
cirrhosis). He died in 1826.
 In his words…

“I recalled a well known acoustic phenomenon: if you place

your ear against one end of a wood beam the scratch of a
pin at the other end is distinctly audible. It occurred to me
that this physical property might serve a useful purpose in
the case I was dealing with. I then tightly rolled a sheet of
paper, one end of which I placed over the precordium
(chest) and my ear to the other. I was surprised and elated
to be able to hear the beating of her heart with far greater
clearness than I ever had with direct application of my ear. I
immediately saw that this might become an indispensable
method for studying, not only the beating of the heart, but
all movements able of producing sound in the chest cavity.”
✤ Later, Laennec, who was also a flute player,
traded the rolled-up piece of paper for a
hollow wooden tube with three detachable
parts. Great invention, with one serious
drawback: It was monaural, meaning he was
only able to listen with one ear.

✤ Laënnec’s introduction of mediate

auscultation using a stethoscope to listen for
sounds of the lungs and heart revolutionized
medicine. In 1818, Laënnec presented his
findings and research on the stethoscope to
the Academy of Sciences in Paris, and in 1819
he published his masterpiece covering the
subject. His work was acknowledged to be a
great advancement in the knowledge of chest
diseases.
Improving the stethoscope
✤ It would not be until 1851 when the stethoscope had its next
major improvement, which was to make the device bi-aural.
Invented by Irish physician Arthur Leared, it was refined in 1852
by George Cammann for commercialization. By the early 1900’s
these concerns had largely subsided and the bi-aural stethoscope
was a commonly used diagnostic instrument.

✤ Throughout the 20th century many minor improvements were

made to these iconic devices to reduce weight, improve acoustic
quality, and filter out external noise to aid in the process of
auscultation. Electronic versions of the stethoscope were
introduced to further amplify sound. Stethoscopes are now
available in a wide array of styles, with designs available for
virtually every branch of medicine.
The impact of the stethoscope

✤ Adopted gradually over 50 years in Western countries, with some reluctance particularly in the
US, the stethoscope was the first and primary diagnostic device for the physical examination of
the heart, lungs and to some extent abdomen. The location and type of pulmonary abnormalities
could be quite accurately detected by listening to the breath sounds on the chest. Similarly various
heart sounds began to be correlated with specific cardiac abnormalities. More accurate diagnosis
of disease, beyond identification of symptoms, was an important step toward effective treatment.
Even today with remarkable developments of diagnostic technologies, the physical examination,
including careful listening to the heart and lungs, is most important in establishing an initial
diagnosis. In many cases careful evaluation of sounds is sufficient for an accurate diagnosis, while
in others technology is needed to confirm the diagnosis.
Conclusion

✤ Despite all of the improvements and changes, the basic principle behind the
stethoscope continues to remain the same; to provide physicians with the means
to perform auscultation and identify specific sounds within the body.

✤ The bicentennial of the invention of the stethoscope by Laennec (discovery 1816,

publication 1818) is a moment to analyze the applications of this discovery by
physicians and nurses. Stethoscopes maintain their major role in practice and
teaching, despite the concurrence of X rays and other imaging techniques. The
stethoscope remains the major element in the representation of healthcare
providers and its invention has saved many lives in the past two centuries.
Bibliography

✤ https://www.ncbi.nlm.nih.gov/

✤ https://www.adctoday.com/learning-center/about-stethoscopes/history-steth
oscope

✤ Chang L. Development and use of the stethoscope in diagnosing cardiac

disease. Amer J Cardiology 1987;60:1378-1382

✤ https://www.sciencemuseum.org.uk/