BORIS BURDA: How to hear any suspicious sound
Photo source: twitter.com
ATTENTION — QUESTION!
The famous doctor Grigory Zakharyin, entering a patient’s room, ordered to immediately take out of the cages with birds and stop the pendulums at the clock. Only then would he take out this newly-fashioned device. Which one?
ATTENTION — CORRECT ANSWER!
A stethoscope — he was trying to eliminate any interference with what he was hearing.
JUST WITH HIS EARS
The human being is essentially a classic example of a «black box». Without special equipment invented only recently, doctors could not see what it has inside because the skin is completely non-transparent. But by the way the «black box» reacts to this or that impact, in particular, what sounds it makes, you can judge a lot.
Even the world’s first doctors knew this, including the one who earned the honorable nickname of «the father of medicine» — the Great Hippocrates of Kos, who lived about 2500 years ago. He was one of the first people who dared to say that disease is not a punishment of the gods but a natural phenomenon and to combat it; you can not only pray but also treat.
Hippocrates said that death comes through three gates — heart, brain, and lungs. In order to detect any problems in the lungs early, he used the most straightforward means — to listen carefully to the noises arising from human breathing and catch in them the symptoms of disease in order to begin to treat it earlier. It seems that he was the first in the world to do such a thing…
It was Hippocrates who first described such methods of examination of patients as palpation, tapping, and, of course, auscultation — without any devices, just with the ears. The specific noise that occurs in the hydrothorax of the lungs, when the pleural cavity is simultaneously fluid and gas, is now called «The Hippocratic Splash».
Hippocrates’ successors developed his methodology. The great physician of the early modern era, Aretaeus of Cappadocia, whom «Britannica» calls the second after Hippocrates in the application of discernment and ethics in the art of healing, extends the technology of listening from the lungs to the heart, obtaining information about the condition of the patient also with the help of heart murmurs.
STEP RIGHT, STEP LEFT, RUN …
And there was worse to do with perfecting these valuable methods. Medicine turned out to be an extremely oblique science, overly deferential to the authorities of antiquity. The teachings of Hippocrates and his famous Roman successor, Galen, were elevated to the absolute and became an unquestioned authority, and medical students swore to believe only them and nothing else.
Some misconceptions of ancient authorities were simply blatant. The great Aristotle himself claimed that women had 4 fewer teeth than men (what was worth counting?). No less significant, Galen assured that the arteries flow not blood but air. And it was impossible to criticize this — for disrespect for the authorities could be accused of godlessness!
The remarkable medieval doctor Andreas Vesalius found more than 200 apparent errors in the works of Galen. But he got nothing but trouble for it. He was accused of ignorance and disrespect for authority, forcibly sent on a dangerous pilgrimage to wash away his sins, and on his way back home, he was shipwrecked and died.
So it is with listening, which was called auscultation in Latin because Hippocrates wrote about it — it was recognized and used. But since the time of Hippocrates, the way of doing this examination has not changed at all. The doctor put his ear to the patient’s chest and tried to hear unhealthy noises in his breathing and heartbeat. It was so-so…
ORPHAN FROM BRITTANY
The situation was radically changed by a man to whom fate dealt such bad cards that the worst was not worse. He was born in 1781 in the small Breton town of Quimper — and the place is not outstanding, and the date of birth is too close to the times of great change (we can not explain that it is not particularly worth rejoicing). His name was René-Théophile-Hyacinthe Laennec.
A beautiful name — a high honor, perhaps, but a poor helper in life. At the age of 5, he lost his mother, who died of then-incurable tuberculosis. The orphans could have been brought up by his father, but he was not interested in this — he hustled and persuaded his brother, a priest, and doctor of science at the famous Sorbonne, to save him from this trouble, taking the children in his care.
Little René was obviously more fortunate with his uncles than with his daddy. His other uncle, Guillaume Laennec, rector of the University of Nantes and quite a famous doctor, noticed his nephew’s outstanding ability and decided to give the child a chance. René was enrolled in a good school, and from the age of 14, he was given the opportunity to study medicine at the Nantes Hospital. This was a very successful decision.
At the age of 18, René had already become a surgeon and took the post of regimental doctor in Napoleon’s army. He served for a short time, finished his studies in Paris, and in 1804 defended his dissertation — incidentally, on Hippocrates. He published a number of medical works that clearly describe many diseases (in particular, cirrhosis of the liver, which is still long called «Laennec’s cirrhosis»).
The career of the able and hard-working physician also moves at a more than-normal pace. He became editor-in-chief of the «Medical Journal», a very prominent publication at the time; then he was appointed chief physician of the large hospital Necker. Not a bad career for an orphan from the Breton countryside, earned by his own labor! But the main thing is still ahead …
THANKS TO BABIES AND FATTIES!
What led Laennec to take the decisive step? He recalls it himself — it was about a child’s game. Two children stood at two different ends of a log, and one of them put his ear to its end while the other started scratching the opposite end of the log with a pin. It turned out that the wood perfectly conducts sound — it was heard even better than without the mediation of the wood…
And it so happened that soon after this meeting, Laennec was invited to a problem patient — a cardiac patient. In such a case, it is necessary to put an ear to the suffering organ and listen to it — maybe it will become clear what to do. But the young lady was very skinny, and large forms and fat layers deliberately muffled the sounds — how to hear?
The problem was also the morality of the time — it was indecent to press one’s ear (even through a handkerchief, as was done then) to the patient’s lush bust. In those days, when many doctors carried a doll for patients to show them where they were hurting (to look at a patient was an unacceptable shock!), a doctor could be called to a duel for such a thing!
That’s when Laennec remembered the children’s games he had seen recently. He didn’t have a log with him, so he did the simpler thing: he rolled up a few sheets of paper into a tube, put it on the diseased organ, and held the other end of the tube to his ear. He was pleasantly astonished — the heart tones were not merely audible, they were heard much more clearly than without this helpful instrument.
DEVELOPMENT OF THE IDEA
The advantage of such a device was evident, and Laennec began to improve it. Not to roll up sheets of paper into a tube every time — he had to choose a material for the new device. He tried leather, glass, and metal and then simply sawed off a piece from his cousin’s oboe — it worked well, and he built a similar tube out of walnut.
Being a gifted musician, Laennec tries to record the sounds he hears with sheet music (incidentally, it is said that the very first paper pipe was made of note paper). This did not catch on, but the exact names given by Laennec to various noises («noise of blowing fur», «amphoric breathing», «cat purr» etc.) — caught on.
A name for the new device was also invented. At first, Laennec called it simply «cylinder» — and it was a wooden cylinder 12,5 inches long, about the length of a school ruler. But since it is customary to use ancient languages in medicine, Laennec endowed his device with the ancient Greek name «stethoscope» — literally, «the keeper of the chest».
A new kind of stethoscope became popular — not a solid tube, but two flexible rubber sound conduits connected not to a funnel but to a diaphragm. It came to be called a phonendoscope — «the watcher of sound within». Then came the stethophonendoscopes, which have both a funnel and a diaphragm. In general, it soon appeared that without them, the physician was as without hands.
EVERY DOCTOR HAS ONE
Among Laennec’s colleagues, of course, there were skeptics, but they remained in the minority — the usefulness of the new invention was obvious. Soon, a doctor without a stethoscope became a rarity. Even Sherlock Holmes told Dr. Watson that anyone could recognize him as a doctor just by seeing a bump on his cylinder, which indicated where he hid his stethoscope. The stethoscope was also carried in a cane.
Laennec had time to write and publish a book about the method he had invented. Each copy of the first edition of the book came with a stethoscope. Unfortunately, he did not live long — his nephew’s doctor, listening to his lungs with his stethoscope, found a typical picture of tuberculosis, which he would not soon learn to treat. But his invention was destined for a long life.
After it turned out that stethoscopes were also needed for the most common process of measuring blood pressure, a doctor without a stethoscope became a rarity. The famous Dr. Bekhterev, who sometimes received patients until night, sometimes even mistook his stethoscope for a telephone receiver of those times — he put it to his lips and said: «Hello, Bekhterev here».
That’s how important it turned out to be when you see a child’s game, which seems to give nothing to your mind or heart, to think about what it surprised you with and find a way to apply it. A human being tirelessly thinks over the problems he solves and certainly encounters clues, but he does not always notice them. He who knows how to notice them remains in history, like René-Théophile-Hyacinthe Laennec.
NOT ONLY MEDICINE
In winter, among the Tyrolean spruce trees, they looked for the one on which the birds perched, then carefully listened to it with a stethoscope and cut it down so that it did not fall but was carefully lowered to the ground. The best violins were made from such wood.
Unfortunately, the stethoscope didn’t just serve doctors. Safecrackers sometimes spun the wheels of their drum locks, listening to them with a stethoscope — the difference in the sounds they heard, it turns out, helped them pick the lock’s cipher.
John Lennon’s wife, Yoko Ono, once created an installation that was supposed to help people hear the passage of time. It was very simple: under a glass cover, there was a mechanical clock, and next to it, there was a stethoscope. Pick it up and listen.
Canadian composer Richard Perry wrote an orchestral piece, «For Heart, Breath and Orchestra», in which each musician plays at his own pace — with the help of a stethoscope, he is guided by the rhythm of his heart. I wouldn’t risk listening to it…
Even caricaturists know something about the stethoscope. In one of the cartoons, the doctor puts the stethoscope to the patient’s head and says to him: «Think. Don’t think…»
