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EXAMINATION OF LUNGS: STETHOSCOPE
The art of examining the lungs has been used as long as there has been any real medicine and in recent years it has come pretty close to being a science. Until the last half century or so the only good methods that we had were percussion and auscultation. These are perfectly good Webster’s dictionary words, meaning striking and listening. Like the players of pianos, drums, and cymbals, we strike to produce a sound. Like persons striking partially filled barrels or carpenters pounding on plaster walls to locate concealed beams, we judge from the pitch produced whether we are striking over air or fluid or solid material. In pleurisy there may be fluid in the chest cavity. With pneumonia the affected part of the lung may become solid as liver, so we speak of the condition as hepatization.
The stethoscope
We share percussion with the symphony orchestras. The word auscultation we have almost entirely ursurped, thanks to the brilliancy of a most poetically named member of our profession. Many a person with a humdrum name has wished for a more picturesque one and not a few have helped themselves to better. A century and a half ago a French family bestowed upon their fortunate son the exquisite title of Rene-Theophile-Hyacinthe-Laennec. So far as I know he was never, despite this, a poet, but he was a great helper in the science of medicine. Several important diseased conditions were first described by him, but his great contribution was a new method of determining the faint sounds produced within the chest. He invented the stethoscope.
When a cartoonist wishes to picture a physician, he equips him with either a head mirror or a stethoscope. As a matter of fact, the former is pretty awkward for us who are not nose and throat specialists. But we all use stethoscopes. The principle is simple. Hearing is the effect produced on the ear by air waves from a vibrating object. It has long been realized that these waves can be directed or steered. For instance, in St. Paul’s Cathedral in London, one can whisper gently against the inside wall of the dome and the sound will be heard by a person holding the ear to the opposite wall a long distance away.
While Laennec was out walking one day, he saw some children playing about a long pipe lying upon the ground. The child at one end would whisper gently and the one at the other end could hear clearly. It occurred to Laennec that the scheme might work in listening to chests so he went home, rolled a piece of paper into a cylinder, one end of which he placed against his patient’s chest. It worked. He then made a hollow wooden tube. Now we have elaborate instruments with well-fitting ear pieces, flexible rubber tubing, and a bell or vibrating disk at the other end.
This is still a valuable machine despite the jokes that doctors make about it and their fellow medical men who use it. The Mayo brothers used to say that their doctors carried stomach tubes hung around their necks instead of stethoscopes. I have been told that Dr. Merrill C, Sosman, of the Peter Bent Brig-ham Hospital in Boston, who knows that his X-ray will show some fine changes in the lungs that cannot be located by a stethoscope, has a framed stethoscope, on the wall of his office, labeled: “Obsolete instrument formerly much used by internists.” But the internist cannot carry an X-ray machine hanging about his neck. He can quickly learn a lot with Rene Hyacinthe’s handy little gadget. Later he may supplement this with the X-ray.
Some of you may remember using crystal radio sets. To my mind, what you did hear over them had a clearer, more perfect note than what you often hear over expensive modern machines. Old-time medical practitioners thus compared the naked ear and the stethoscope. In our town, about the time when I commenced practice, there was a highly esteemed, elderly physician who when the stethoscope sounds did not quite satisfy him, would put his ear directly on the patient’s chest. One evening, after an unusually tiring day, he got an emergency call. Reluctantly he took his bag and trudged off, as he knew that his horse was also tired. The patient was a delicate young lady with a cough. With his stethoscope he listened long and carefully to her chest, but could not satisfy himself as to what he heard. Telling the maiden of the occasional advantage of listening with the naked ear, he abandoned his scope, placed his head upon her breast and again listened long and carefully. The patient finally became more and more restless, until, glancing down she saw that the old gentleman was sound asleep. So, put your calls in early, if you can. Don’t overwork a willing horse – or a willing doctor.
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