Engines of Our Ingenuity

No. 970:
STETHOSCOPES AND DISTANCE

by John H. Lienhard

Click here for audio of Episode 970.

Today, the stethoscope changes the rules of medical diagnosis. The University of Houston's College of Engineering presents this series about the machines that make our civilization run, and the people whose ingenuity created them.

Historian Stanley Reiser tells how a French doctor, René Laennec, tried to diagnose a heart disorder in an obese young woman in 1816. He'd tried thumping her chest, but she was too heavy. The sound told him nothing. The next logical step was to put an ear to her chest, but modesty forbade such intimacy. What to do!

Laennec had an idea. He rolled a sheaf of papers into a tube -- placed one end on her chest and his ear on the other end. He was able to make out what was going on in her heart. He had just created the first stethoscope. Three years later he published a book describing his design of a wooden stethoscope and its use.

By the 1830s stethoscopes appeared with pliable rubber tubes, then binaural ones with earplugs. All the while debate raged -- less over stethoscopes than the tactics of diagnosis.

Laennec's dilemma with that young patient wouldn't have been a dilemma for most doctors around him. Thumping the thorax or putting an ear to the heart wouldn't have occured to them. Those were pretty radical forms of medical diagnosis in 1816.

Diagnoses were usually based on looking at patients and hearing their own reports of symptoms. Doctors seldom questioned what patients said about themselves, and they tried to infer too much from a patient's outward appearance. Physical contact usually stopped at counting a pulse or touching a forehead.

Laennec's ideas about thumping, feeling, and placing an ear to a patient went way back to Hippocrates. Hippocrates believed that all our senses should be used in diagnosis. An ancient Greek doctor might've diagnosed diabetes by tasting a patient's urine. That kind of intimacy didn't appeal to 18th-century sensibilities!

Now stethoscopes let doctors keep their distance and still engage actual symptoms. This simple new instrument became the stalking horse for a whole new kind of medicine -- one in which we by-passed the patient's story and looked inside the patient's body for direct evidence of disease.

Stethoscopes were followed by opthalmoscopes, laryngoscopes, then X-rays, CAT-scans, and MRI. And all that has only intensified debate over how much doctor/patient intimacy is appropriate.

The stethoscope once promised to bridge the gap, to give some contact with patients' symptoms back to doctors. But it also gave doctors a way to stand even further away from patients.

Any of you who've ever watched the movement of your own internal organs on a cool green computer screen feel the contradiction: that a doctor may stand that close to your illness when she is, in fact, not listening to your story, not even in the same room -- when she may not even know your name.

I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.

(Theme music)


Reiser, S.J., Medicine and the Reign of Technology, New York: Cambridge University Press, 1978. (I am grateful to Dr. Reiser for his helpful advice on this subject.)


The Engines of Our Ingenuity is Copyright © 1988-1997 by John H. Lienhard.

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