Listen to your heart


  • Health
  • Sunday, 05 Jan 2003

By PAUL YEO

The stethoscope, more than any other instrument, has been the doctor’s greatest weapon in the fight against disease. It has undergone many changes through the centuries, and today the basic stethoscope is fast turning into a high-tech gadget with many functions, a far cry from the first stethoscope invented in the 19th century

ARAGORN cups his ears to the ground, listens intently, then declares to his companions, Legolas and Gimli: “They’re less than a day ahead.” Or something to that effect.  

Fans of The Lord of the Rings will recognise this scene in part two of the trilogy, The Two Towers, as the trio race after the orcs who had abducted the hobbits, Merry and Pippin. 

Flash back to the 21st century, in the more mundane world of Earth (not Middle Earth). It’s a doctor’s surgery, and he’s examining a patient. He cups his ears to the patient’s chest, listens, and declares, “You’ve got a faulty valve in the heart that may require surgery.” Imagine doctors the world over cupping heads over chests and bosoms, trying their hardest to detect problems in hearts and lungs.  

Nah, not likely. First, they could hardly detect the sounds that indicate disease, not with just their ears (not on Earth anyway). Second, imagine trying to listen to the chest of a woman who is rather well endowed. An interesting proposition, but rather difficult when carrying out a diagnosis.  

In fact, it was more a matter of preserving patient dignity than any great medical breakthrough that gave rise to the stethoscope, arguably one of the greatest inventions of modern medicine.  

The story goes that French physician Renne Laennec invented the stethoscope in the 19th century (the year 1816 to be precise) when he was called to visit a sick young lady. He was wondering how to diagnose her, especially as he knew she was young and quite corpulent.  

Apparently, on his way to the appointment, the good doctor spotted two young boys tapping out messages to each other from either end of a hollow log. That gave him the germ of an idea, and when he arrived at his patient’s home, he asked for a sheet of cardboard, rolled it up, and used it to maintain a proper distance from his patient. And that marked the birth of the stethoscope. 

Of course, the stethoscopes of today are much more sophisticated, able to pick out the faintest of sounds within the body that could indicate disease. The stethoscope allows doctors to listen in to sounds from within the body, amplifying the heart and lungs to pick up murmurs and other potential problems. 

While the general principle of the stethoscope has changed little since then, its design makes it almost unrecognisable, with modifications to amplify the sound further. In the proper hands, the stethoscope can aid in diagnosing a wide variety of heart and lung conditions, including valve defects and holes in the heart.  

Before the advent of the stethoscope, life was a lot more “interesting” for doctors and patients. The first known references to examination of the chest date from the time of Hippocrates, around 400BC. Pictures as well as documents suggest Hippocrates placed his ear directly on the chest to hear the heartbeat. 

In addition, Hippocrates also used what he called the technique of “succussion” to help him in his diagnosis. This involved grabbing a patient by the shoulders and shaking him or her in order to listen to the sounds which would then come from within the chest. He was said to have actually described the “splash” of a hydropneumothorax (the term for a punctured lung that’s filled with fluid).  

Imagine surgeries the world over, with doctors shaking and rattling their patients for a diagnosis. How different the practice of modern medicine if it were not for the simple stethoscope.  

In the late 1600s, Robert Hooke (1635-1703), of the Royal Society of London, stated: “I have been able to hear very plainly the beating of a man’s heart ? Who knows, I say, but that it may be possible to discover the motion of the internal parts of bodies ? by the sound they make; one may discover the works performed in several offices and shops of a man’s body and thereby discover what instrument is out of order.” Yeah, try doing it without a stethoscope.  

Through the years, the stethoscope has undergone some changes, but the basic shape and function has remained constant. All that appears to be changing, what with the computer age and the plethora of high tech gadgetries in medicine today. And, of course, that word – digital.  

Even with the most sensitive of stethoscopes, it is entirely possible that some doctors may miss certain sounds, especially the low frequency ones. With digital stethoscopes, sounds can be stored, and these can be played back over and over again. Better still, the doctor could also send the sound to a colleague, or a consultant for a second opinion.  

Yes, the physical examination of the chest is much more than placing a stethoscope to listen to the heart and lungs. It is the most intensive part of the physical examination and requires keen skills and much practice. But with stethoscopes, the job is made much easier. And who knows, in the future, stethoscopes could detect sounds and even give out a list of the possible diagnoses. Now that’s high tech. 

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