Object 12: Stethoscope
What: Public Lecture, part of History & Philosophy of Science in 20 Objects
When: Tuesday 28th February, 6:30 – 7:30pm
Lecture 12: Laennec Stethoscope, or: is it?The stethoscope has long been an essential tool in a doctor’s kit, allowing them to “see” inside living patients and diagnose illnesses. Invented 200 years ago by the French physician Rene Laennec, it quickly grew in popularity and became emblematic of the modern approach to medicine in the 19th and 20th centuries.In this lecture, join Caroline Avery and Adrian Wilson as they explore the invention, use and spread of the stethoscope, and ask where exactly our Leeds model came from. Was it made by Laennec, or not?Tea and Coffee will be served outside the lecture theatre from 6.15pm. This lecture assumes no prior knowledge and all are welcome.This is also the launch event of “Leeds Laennec”, a commemoration of the instrument’s bicentennial, organised by the Leeds Institute of Medical Education to run through the year 2017.
Blog post by Polina Merkulova, PhD Student
The stethoscope is one of the most familiar medical instruments of our time and serves as a universal symbol of medical profession. In the 12th lecture of the HPS in 20 Objects series Dr Adrian Wilson and Caz Avery shed light on the incredible role this humble instrument played in bringing about the medicine as we know it now.
“What do you think of when you think of a doctor?” Dr Adrian Wilson and Caz Avery tell us that “stethoscope” is, of course, the right answer.
They started by explaining historical significance of the stethoscope and percussion (a clinical method of tapping on the chest to determine if there is liquid inside), which completely transformed diagnosis and medicine as a whole. Before those techniques were introduced – percussion in 1761, stethoscope in 1819 – medicine had largely been patient-led. It meant that doctors based their diagnosis on the symptoms described by the patients, which is reflected in the diagnostic categories of the time. However, the popularisation of those clinical methods brought forward anatomy-based medicine characterised by diagnosis founded on the combination of symptoms, anatomical causes and specific signs observable only to a trained practitioner.
Caz demonstrates percussion of the chest.
Why were the stethoscope and percussion crucial? Firstly, both of them allowed the doctors to “see” inside the living body by listening to the sounds it produced, hence, they provided the doctors with the means to make their own observations independent from the patients’ self-report. Secondly, both methods relied on anatomico-clinical correlation – the activity of relating symptoms in the living patient to the subsequent post-mortem findings in the dead body. The inventors of the new methods used it to prove that they helped to accurately identify causes of the patient’s symptoms, e.g. that a dull sound produced by percussion was the result of excess liquid in the lungs.
Although the necessity of linking symptoms to anatomical causes seems painfully obvious to a modern observer, Adrian explained that it was not always so. He argued that before the end of the 18th century the opportunities for carrying out anatomico-clinical correlation were severely limited; it was technically very difficult as both the symptoms and post-mortem findings were seldom simple; and it need to be done systematically on a vast scale to be useful for diagnosis. Until these difficulties were overcome they had not only prevented the invention of new effective methods of medical examination but, also, the recognition of their importance. For instance, other doctors did not accept percussion, invented by Auenbrugger in mid-18th century, until 1794, when it was taken up at the newly established Paris medical school, which offered the opportunity for anatomico-clinical correlation on an earlier unprecedented scale.
The stethoscope’s inventor, René Laennec, first studied and then taught at the Paris school. He frequently used percussion and a method known as immediate auscultation (listening to the patient’s chest by applying an ear to it directly) and, he claimed, that the relative ineffectiveness of the latter practice led him to inventing a better one – mediate auscultation or listening through the stethoscope. Caz told us, that Laennec first got his idea when faced with a difficult case in 1816 and then perfected it further working with the TB patients at Necker Hospital. He presented his invention to the Paris Académie des Sciences in 1817 and published the book on mediate auscultation in 1819.
Laennec examines a consumptive patient with a stethoscope in front of his students at the Necker Hospital by Théobald Chartran. As we now know, here Laennec is performing immediate auscultation, while simply holding the stethoscope in his hand.
In contrast with percussion, the stethoscope was taken up very quickly in most of the main centres of medical teaching across Europe. Our own stethoscope demonstrates as much. Its design clearly shows that it was made within 10 years of Laennec’s original invention. We know that it was donated by a Leeds doctor Edward Atkinson and that he had received it from his father, a surgeon John Atkinson, who studied in Paris. This furnishes us with three possible origin stories for our stethoscope: it might have come straight from Laennec himself, or made in France and imported to Britain, or made by one of the first British stethoscope-makers in London. Even though it would be interesting to determine which one of these options is true, the lecturers assured us, that, in a sense, it does not matter because all three point to the incredible and immediate popularity of the stethoscope not only in France but also in Britain.
A fragment of the relief in the Temple of Kom Ombo (Egypt) sometimes misidentified as a stethoscope.
The lecture was concluded by the handling session with the 3D-printed replica of the museum’s stethoscope and a brief Q&A session, during which Adrian and Caz dispelled a popular myth that the stethoscope was invented by ancient Egyptians and engaged the audience in a lively discussion about the future of the stethoscope.
*Join us on the 28th March for Lecture 13: A Perpetual Motion Machine*