When you picture a doctor in your mind, what do they look like? Are they wearing a long white coat? Carrying a clipboard? Chances are, draped around their neck is a stethoscope. An iconic object, the stethoscope turns 200 this year. To celebrate, Alice is looking back at the history of the stethoscope in Edinburgh…
The stethoscope was invented in 1816 by the wonderfully-named Rene Theophile Hyacinthe Laënnec (phew!). The practice of listening to the sounds of the body as a method of diagnosis is known as auscultation, but before the stethoscope came on the scene, most diagnosis was done through observation and interviews with patients, and any attempts at auscultation required the doctor to place his ear directly onto the patient. In a world before deodorants and dental hygiene, many doctors felt that this physical contact was improper and unseemly – not to mention a bit smelly. Some even felt that a ‘good’ doctor shouldn't need to touch a patient – he should be able to diagnose by observations alone. Patients weren't too keen on physical contact either - women in particular felt that the process was invasive and degrading.
Laennec's stethoscope, c 1820. By Science Museum London / Science and Society Picture Library - CC BY-SA 2.0,
Dr Laënnec's solution was simple but very, very effective. He had found himself struggling to diagnose a patient because her weight prevented him from being able to hear her heart, and immediate auscultation – the ear-to-skin approach – was out of the question because of her sex. Laënnec improvised, possibly inspired by his other life as a flautist. He rolled up a piece of paper “into a kind of cylinder and applied one end of it to the region of the heart and the other to [his] ear, and was not a little surprised… to find that [he] could thereby perceive the action of the heart in a manner much more clear”.
While the idea of stethoscopy was well received in Britain, it took a while for the stethoscope to become the ubiquitous tool of the physicians' diagnostic arsenal that it is today. While many were keen on the instrument in theory, they didn't know how to use it in practice. The scientific art of auscultation involves a lot more than simply listening: it requires an educated ear to correctly interpret what is heard. In 1822 Dr Andrew Duncan, one of Edinburgh's early enthusiasts, tried to employ the methods he had read about, but found that "it requires attention and some adroitness to apply [the stethoscope] properly at one end to the chest of the patient, and at the other to the ear of the observer", and in the end conceded that he "had not acquired skill enough" to use it effectively.
Dr William Cullen seems to have reached the same conclusion. In the same year as Duncan was experimenting, Cullen submitted a thesis to the Royal College of Surgeons of Edinburgh which detailed the "usefulness of the stethoscope...in a manner which suggests he had had some experience of the use of the instrument” (Nicholson, 1993:144). In order to improve his skills, Cullen travelled to Paris to study under the masterful Laënnec himself, and by 1824 Cullen was back in Edinburgh and holding his own classes on stethoscopy.
With an educated teacher to instruct them, the Edinburgh medical community embraced the stethoscope: it became a feature of their medical textbooks from 1828, and in the same year Dr N. P. Comins (a physician at the Royal Infirmary of Edinburgh) remarked proudly that the new, more flexible stethoscope that he had designed was now being used in every one of the Infirmary's thoracic cases.
A stethoscope from LHSA's Objects collection
The stethoscope had well and truly arrived, and now this humble instrument is 200 years old. In light of ever-improving non-invasive diagnostic techniques, some medical commentators have questioned whether it still has a place in modern practice, but a study published earlier this year by the European Society of Cardiology argued that “the time-honoured stethoscope, in spite of its limitations, still has potential as a patient-friendly, effective, and economical instrument in medical practice”. Whatever the future for this iconic instrument, we are pleased to celebrate 200 years of stethoscopy. Thank you, Rene Laënnec!
If you'd like to see a stethoscope like Laënnec's up close, the National Museum of Scotland will have one on display in their new Enquire Galleries later this year, so 'keep an ear out'...!
Nicolson, M. (1993). The introduction of percussion and stethoscopy to early nineteenth-century Edinburgh. In: W. Bynum and R. Porter, ed., Medicine and the Five Senses, Cambridge: Cambridge University Ppess, pp.134-153.