September 6, 2021 • 35 mins
One of the most basic tools of the medical profession is the stethoscope, but it’s a more recent invention than you might suspect. Its invention is credited to French doctor René Laënnec.
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello and welcome to the podcast.
I'm Holly Fry and I'm Tracy Wilson. One of the
most basic tools of the medical profession is a stethoscope. Yep,
nursing also, yeah, well the medical profession would include nurses.
(00:26):
I feel like we've had people argue with us about that.
I mean, it's all medicine. I'm not calling anybody a doctor.
If you have been to a doctor or a nurse
at any point in your life, and I hope you
do get the health care you need, you have probably
had some experience with a stethoscope, and I wanted to
peek at how they developed, just as a random Hey
where'd that come from? And then I accidentally landed on
(00:48):
another French medicine episode. I swear that was not my goal.
There are just so many there are. There was like
this cluster of time where France was doing a lot
of interesting things in in medicine. And that's because to
talk about the stethoscope, we have to talk first about
its inventor, reneet Field. He has sent lank and then
(01:10):
we're going to discuss how his original design which didn't
look like what we think of when we think of
a stethoscope, now changed in the hands of physicians who
wanted to improve on that original. Yeah, when we say change,
when I when I was looking for a picture to
go with this on our social media, there are pictures
of some of his actual stethoscopes. They are not recognizable
(01:32):
as a stethoscope unless you are maybe a medical historian
that knows what it looked like at that point. Yeah,
there are some in museums, uh. And there have even
been some cute staged photos throughout the years of people
using them to show how they worked. But they, yeah,
they don't look like what you would walk into a
doctor's office and see today. So Lani was born on
(01:55):
February seventeen eighty one in Campaire, on the far way
side of France in Brittany. His father, Teo fiel Marie Link,
was a civil servant and this family wasn't especially comfortable.
Part of that was because Teo field Marie was pretty
careless with the finances. Renee's mother, Michelle Felicete Gudstone, died
(02:17):
of tuberculosis when Renee was five, and he, along with
his brother, went to live with the Abbe Lanek, who
was his granduncle. He never was described as particularly hardy.
As a child, he had a lot of fevers. He
was described as physically weak, and it's believed that he
had asthma in his early years. Lannik was an artistic child.
(02:40):
He wrote poetry and he learned to play the flute.
He would actually play the flute throughout his life, and
some people draw a line between that in his original invention.
You'll see why when we talk about what it looked like. Uh,
he may have actually gone into a less scientific field
than medicine, given his proclivity towards the arts. Had he
not moved to Not at the twelve to live with
(03:01):
another uncle. This one was Dr Guillaume Flancis Lank and
in his new home it seems that Renee really flourished academically.
He had already studied Latin and Greek with his other uncle,
and in his new home he added English and German
to the list of languages that he spoke. Uncle Guillaume
was dean of the Faculty de Medicin at the University
(03:22):
of Nantes, and soon Renee was assisting him at the
Hotel Dieu, treating wounded from conflicts between revolutionaries and counter
revolutionaries in the area. At fourteen, Renee Laonik was assisting
his uncle and he was learning to dress wounds and
look after patients, and just four years later, in sevente
he was appointed to a post as third class surgeon
(03:44):
at the known military hospital before transferring to the Hospice
de la Frater. But that second post was also short
because in eighteen hundred Lantik moved to Paris to study
the section with expert anonomist Guillaume de p at Ecul Practique.
Lantic also studied with other luminaries of French medicine at
the time, as medical knowledge expanded rapidly. While still a
(04:08):
medical student working hard enough to gain top honors, he
also started publishing papers on a variety of medical topics
that started in eighteen o two. Before completing his medical degree.
He had the distinction of being the first person in
medicine to lecture on melanoma, which he did in eighteen
o four. Also in eighteen o four, he wrote his
(04:29):
thesis propos depocrat Relatives a Lamedic and Platique that's Proposals
on the Doctrine of Hippocrates relative to practical medicine. So
he was talking about all of the work of Hippocrates
and how it applied to medicine in his contemporary time.
And he graduated from medical school as a result of
(04:50):
completing that, and he was invited to join the faculty
of the Society of the School of Medicine in Paris.
His melanoma lecture that he had given while still a
student was published in eighteen o six. At this point
it really seemed like his career was on the rise.
He already built a reputation through his writing. He had
made the discovery that tubercal lesions, which are the nodules
(05:11):
that form in the tissues of patients with tuberculosis, he
discovered that those lesions could form anywhere in the body,
not just in the lungs. Previously to this work, that
was what people thought that it was only in the lungs.
This actually tied to his work on melanoma because he
actually had discovered the distinction between lesions from melanoma and
(05:31):
lesions from consumption. Because he had studied with some of
the greatest medical experts of the time and had written
extensively about his studies and tuberculosis as well as peritonitis
and a minorrhea. He was recognized for a high level
of expertise in the field, and that was in spite
of his young age. His life was soon to have
(05:53):
some difficulties though. In a short span of time, Lenk
had a falling out with his mentor Deo and his
goal like his mother, died from tuberculosis. The issue with
Dup was rooted in his melanoma paper. His mentor had
also worked on similar research and felt that he had
not been properly credited in laon X work. That was
(06:14):
particularly insulting too, because his student was credited with having
discovered melanoma with no mention of de Potan's work at all.
The two men actually thought about this for several years,
and the stress of this and the loss of his
uncle caused laon X medical issues to flare up to
the point where he had to take a break from
(06:34):
his work and take a leave of absence, and during
that time he visited Brittany where he was born, to
relax and recover. When he felt better, renee Leonek returned
to Paris to try to pick up where he had
left off his private practice of medicine. Went pretty well.
He had lots of patience, and he became part owner
and editor of Journal de Medicine, which was not surprising
(06:55):
considering how much medical writing had been part of his career.
What he was hoping was that he would also get
a job in a leadership position on a Parisian hospital staff.
That didn't happen, though. In eighteen o eight he founded
attny Medical that's Medical Athenaeum, which was also eventually absorbed
in the academic society of Paris. This was a time
(07:18):
when Lanek, who had always been a devout Roman Catholic,
really recommitted to his religion, and that led to his
appointment as the personal physician of Cardinal Joseph Fish. That
religious devotion was the reason he found his aspirations at
a hospital job a little bit out of reach, because
while France was very Catholic, the academic community actually found
(07:39):
Lanek too conservative, and they thought he was a bit
out of step with his contemporaries, even though he was
making a lot of significant discoveries. During the War of
eighteen twelve, while still working for Cardinal Fish, Lane headed
up the care of wounded soldiers in Paris's salth Petriere Hospital.
All the hospital's wounded soldiers were given beds in words
(08:00):
that Lanek led, and two years later his position with
the Cardinal ended was the French ambassador to the Vatican
and more importantly, Napoleon's half brother. So when Napoleon fell,
he was exiled. Land X job was gone at that point.
In eighteen sixteen, Laonex finally got that position that had
always eluded him, an appointment as a hospital physician. He
(08:22):
was hired at Neck Hospital as head of hospital service,
and that same year he also created the medical apparatus
that would change medicine. That new position at the hospital
was not entirely a joyous appointment, however, it had opened
up because one of laon X mentors and his close friend,
Gaspar Laurent Bail, had died of tuberculosis. We're about to
(08:43):
talk about the moment of inspiration that led to the
first stath scope, but first we're going to take a
moment of our own responsive break. The story of the
stethoscope's actual moment of invention has taken on a few inconsistencies,
(09:06):
as we frequently see when it comes to historically significant events,
but these actually aren't too wildly varied. They mostly just
involved the timing of this inspiration. That inspiration was Lank
witnessing two children playing in the courtyard of Lularufe Palace.
So he's said to have seen these two kids using
(09:26):
a long piece of wood to send signals to each other.
They would scratch the end of the solid piece with
a pin. One child was doing the scratching while the
other one listened on the other end, listening for the
sound to travel through the wood. So in some versions
of this story he sees this happening and then a
lot of time passes before he tries to put it
into use. But in others, he was walking on the
(09:49):
way to see a patient when he saw these two
kids doing this. Either way, though, the kids and their
wooden sound conveyance are credited with inspiring Land. When the
doctor himself wrote about it, though he did not mention
these kids, he did mention the pen scratching a would beam. Yes,
(10:09):
he wrote it quote, I recalled a well known acoustic phenomenon.
If you place your ear against one end of a
would beam, the scratch of a pin at the other
end is distinctly audible. It occurred to me that this
physical property might serve a useful purpose in the case
I was dealing with. I then tightly rolled a sheet
of paper, one end of which I placed over the
(10:30):
precordium chest and my ear to the other. I was
surprised and elated to be able to hear the beating
of her heart with far greater clearness than I ever
had with direct application of my ear. I immediately saw
that this might become an indispensable method for studying not
only the beating of the heart, but all movements able
of producing sound in the chest cavity or jumping ahead
(10:55):
just a bit, though, because the case at hand was
also a source of inspiration, and this is often described
as lanex solving a problem of embarrassments as much as
one of medical met In September of eighteen sixteen, the
doctor was called to see a young woman who had
quote general symptoms of a diseased heart. He wanted to
(11:15):
listen to her chest to be clear asqultation, which is
listening to the sound of a patient's heart, lungs, or
other organs. That was not a new idea. In eighteen sixteen,
Hippocrates had made references to internal sounds as a means
of diagnosis, and doctors who preceded Lanek had theorized that
some sort of mechanism might eventually be developed that would
(11:38):
enable physicians to listen to their patient's bodily sounds. But
more specifically leading up to this particular moment and influencing
leon x idea was the work of Viennese doctor Leopold Aumbruger.
He had used an idea that he had seen in
his youth his father tapping a barrel to see how
full it was, and applied that concept to medical exam
(12:00):
do nations. He determined that a human chest that was
filled with fluid would sound dull when you tapped it,
whereas a healthy human chest cavity would have resonance when tapped.
And this percussive diagnosis method was something that had been
written about in the eighteenth century and translated into French
by Napoleon's doctor Jean Nicola, who was also one of
(12:21):
Latin teachers in eighteen o eight. Aside from tapping on
a patient's chest, the other method for collecting information for
diagnosis of chest ailments was immediate ascultation, which meant that
the doctor would put their head directly onto the patient's
chest and listen. But in this particular case, Lanik was
(12:41):
reluctant because of the patient's age and sex. He did
not want to put his head up against her chest.
And this is when he recalled the idea that we
just quoted. Because he recognized he could actually hear better
with his rolled up sheet of paper than with his
ear alone. Started him down a path of experimenting to
(13:01):
further develop this idea, and that came to be called
mediate ascultation. Yeah, we're going to talk about percussion again
a bit towards the end of the episode, but they
were kind of tied up together as this, like, listen
to the sounds the body makes and you will figure
things out. So he did as Tracy said, start experimenting
(13:22):
and created multiple versions, and his refined versions, which he
worked on for several years, still did not ever really
look like the stethoscopes were familiar with today. Remember, for
one thing, things like rubber tubing were just not around yet.
Lane focused on creating his stethoscopes out of wood. He
had experimented with other materials, but he found a hollow
wooden tube to produce the best sound. Sometimes people attribute
(13:46):
this back to his work playing the flute and how
he made that connection. But it's not entirely clear, but
he created a chest piece that fitted at one end
and further improved his ability to hear. And then he
made his stethoscope into two pieces that could be unscrewed
for ease of carrying, and then they could be quickly
screwed back together so that a doctor could use them
for diagnosis. In eighteen eighteen, Renee Lanek gave a presentation
(14:10):
about his stethoscope at the Paris Academy of Sciences. In
eighteen nineteen, he published a two volume book about his work,
was Mediate Ascultation or Treatise on Diagnosis of Lung and
Heart Diseases. He described his stethoscope in its This was
twenty five centimeters long and three and a half centimeters
in diameter, and the name for the stethoscope didn't come
(14:31):
into print until eighteen twenty. Before that, he just called
his device lu Celand, which if you see some pictures
of it, it just it looks like a cylinder. Does
not see how any fancy adornments. There's no like ear
trumpet kind of shape to it just looks like a cylinder. Eventually,
though he went with the root of stethos, which was
(14:53):
the Greek word for chest. Yeah, you'll see that second
part of the word. The scope attributed to like a
jillion diff rent words to create this portmanteau, everything from
Greek words to French words to um, you know some
that just go well, let's scope because it's a scope,
which is pretty funny. Uh uh. He also included in
(15:14):
that that work, his two volume book, extensive research that
he had done using this invention. He treated a lot
of patients with pneumonia and he used this stethoscope in
assessing their conditions. When any of his patients died, he
performed autopsies, and he found that the conclusions he had
been able to reach using his new instrument were corroborated
(15:35):
by what he found. Lane stethoscope was quickly recognized as
invaluable for diagnosis, and as his book was translated, starting
in eighty one in London, doctors from around the European
continent soon we're eager to learn how to use it,
and a lot of them traveled to Paris to hear
lectures from Leonek himself. After this, Lanek continued his medical
(15:57):
career Ino he was made the chair and Professor of
Medicine at the College of France, and the year after
became the Professor of Medicine at Opdachart. He was a
member of the French Academy of Medicine. Also, he quickly
garnered such a reputation for really excellent lectures that the
lecture halls were frequently packed with doctors that wished to
(16:20):
hear him speak. Lane kept a log of everyone who
attended his lectures and kept an almost ridiculously busy schedule
of hospital rounds, lectures and consultations. Yeah, there's a you
will occasionally find some papers that talk about how you
can trace laan X through these logs that he kept
(16:41):
of doctors that attended his lectures, and then how his
information and his knowledge of pulmonary disease in particular kind
of propagated throughout the world over time. At this point
he was in his forties and Laonek kindly settled into
his now successful career, and he actually got married to
a widow named Jacquette guilgu and the new leweds wanted
(17:01):
to start a family that was unfortunately not to be there.
One pregnancy ended in a miscarriage and Soon after that loss,
which he took quite hard, his health began to decline.
He was actually in a little bit of denial about
this for a while. He had not realized, despite all
of his work and research in tuberculosis, how very contagious
(17:22):
it was. There had been discussion of tuberculosis as a
contagious disease even before his time, but there were also
theories that it could be hereditary. There were some theories
that it could even be a type of cancer, so
it wasn't necessarily uh universally recognized as a contagious disease.
The term tuberculosis didn't even exist yet. That wouldn't happen
(17:43):
until the following decade, when it was coined by German
Dr Johann Shaunlin. But over time he had all the
tell tale symptoms of tuberculosis. He was finally diagnosed by
his nephew, married at Lane, using a stethoscope to listen
to the much beloved doctor. Although Renee Lanek once again
(18:04):
traveled to Brittany in the spring of eighteen six hoping
that his health would improve, that did not achieve the
desired result. He was able to finish a revised edition
of his book on Mediate Escortation that was published that year.
It had specific details of certain sounds and what they
might indicate. This work laid the groundwork for knowledge of
(18:25):
pulmonary diseases. Lanek died not long after it was completed,
That was on August. Lan x work continues to be
part of modern medicine. He was the first to describe
micronodular cirrosis of the liver, which is still known as
lan X cirrhosis, and his extensive writing on pulmonary classifications
(18:45):
is still used. He advanced the medical community's understanding of pneumonia, emphysema,
and other conditions. There's a coda to this part of
the story, though, in terms of how Lanik was viewed,
just a decade after he died. In an eighteen thirty
eight English language translation of his Treatise on the Diseases
of the Chest and on Mediate Aescultation, the translator included
(19:09):
some interesting discussion about Lanox writings about himself. The translator's
note states in the first paragraph quote, the original treatise
will remain an imperishable monument of the genius and industry
of its author, and the discovery of which it treats
will entitle him to a distinguished rank among the benefactors
of mankind. As a standard work on the pathology and
(19:31):
diagnosis of the diseases of the chest, it is not
only without an equal, but may be considered as almost
perfect in its kind. But then, a couple of paragraphs down,
after continuing to mention the importance of escultation, the same
translator rights quote. At the same time, it would be
exacting too much from the weakness of humanity to expect
(19:53):
that the author of mediate ascultation should in no case
have yielded to the enthusiasm naturally inspired aired by the
consciousness of so great a discovery. And if in a
few passages of his book he should be found to
somewhat exaggerate the actual or relative importance of his method,
or even sometimes to appear rather as the partisan than
(20:14):
the historian of the stethoscope, i am sure that a
fault so venal and in such a man ought not
to be visited by heavy censure. Especially this says that
the translator thinks that laon X is puffing up the
importance of his invention, but that it's also okay, because
he really was pretty great, and he did advance medicine
with his work. It's a fascinating way to frame all this,
(20:35):
and it seems like maybe he's trying to pre address
critics of laon X, since he also mentions that some
people claim to have tried the stethoscope and found it unhelpful.
Just a glimpse into this perception of this device while
it was still in its infancy after lan x death. Yeah,
he a lot of doctors were super into it, but
there were something were like I tried to listen, I
(20:57):
didn't get anything. So it's just kind of an interesting
thing to know that there was a little bit of
controversy as much as as it does sound in a
lot of ways like the medical community pretty quickly picked
it up. But you may be wondering what came of
this invention because it obviously took a number of additional
turns as it developed into the tool that we see
commonly in use today. And we're going to talk about
(21:19):
some of those turns after we first hear from the
sponsors that keep stuff you missed in history class going.
Several other physicians contributed to the development of the stethoscope.
The first change to it actually appeared in the last
(21:40):
year of lan X life. That was the work of
Pierre Dave Pierri, who was born thirteen years after Lanek
on December and he started studying medicine when he was
just fifteen, and at the age of nineteen he became
ed chirogien militaire in the Napoleonic Wars when he was
drafted while he still a medical student. In that role,
(22:02):
he traveled to Spain and he got a very hands
on education at a military hospital in Barcelona. Like Laonek,
he studied medicine with men such as Clarvissard and Bail.
Once he got back to Paris and in eighteen sixteen
he completed the thesis that earned him his medical degree
that was titled on the danger of reading medical text
books by the laity. He started working at Lakatomie de
(22:26):
Medicine in eight and he was considered to be a
gifted teacher. From there he climbed the ladder in Paris's
medical facilities and became the chair of medicine at in
eighteen thirty seven. Pierre specialized in percussion as a clinician,
and that, as we mentioned earlier, is exactly what it
sounds like tapping parts of the body to gain an
(22:46):
understanding of the structures and the organs within, and Lanak
had actually used his cylindrical stethoscope for percussion as well.
He used it as a tapping tool. But the success
of the stethoscopes used in oscultation had to eclipse the
practice of percussion, and Pierre wanted to both replicate lane
success and reputation and gain his own renown while also
(23:09):
reiterating the usefulness of percussion as a diagnostic tool. Perhaps
the most charming thing about his story is that he
was a poet as well as a physician, and he
wrote about his work in percussion and his contribution to
the stethoscope in a poem titled Lamb or God's Soul.
In Nature and the poem, he described praying to God
(23:32):
to be able to contribute to the development of medicine
as Lanek had, and how he was inspired when he
came aware of the sound he heard when he scratched
his own chest. Immediately he began to experiment in this area,
eventually developing a method of placing a small plate between
the patient's skin and the doctor's finger to both control
(23:53):
the way the sound was heard and to reduce the
discomfort to the patient of being tapped in this one
spot repeatedly. Soon he integrated this plate with a stethoscope.
An example of Pierre's version of the tool was included
as an illustration in that same English language translation on
Lanox work that we referred to just a bit ago,
and it describes Pierres stethoscope this way quote. This stethoscope
(24:17):
is constructed exactly on the same principles as that of Lank,
but with several modifications intended to render it lighter, smaller,
and more portable. In it, the central bore and conical
cavity of the pectoral extremity are preserved of the original dimensions,
but the body of the instrument is greatly reduced in size,
and the proper width is given to the articular extremity
(24:39):
by screwing a thin ivory cap to the slender body
of the instrument. The pleximeter is attached to the stethoscope
merely with a view to render the former conveniently portable.
So in case that's not clear, it was a smaller
version of the stethoscope, but one end of it expanded
out in a wide, shallow conical shape with the plate
(24:59):
that was the plex seminar over the widest part of
the cone. The flat plate would be placed against the
torso of the patient, and then the doctor would tap
it with a finger or a small hammer. Today, physicians
will usually use their hand instead of a plate for this.
Lanek actually attended Puri's talk at the Royal Academy of
Medicine when he introduced these ideas. Although Pierre's book on
(25:22):
the subject didn't come out until well after Renee Lanek
had died, Perry had included the inventor of the stethoscope
in the dedication. You know, Uh, it's unclear. Uh, you
know what lanox response was. He was was the end
of his life, so he probably did not have a
lot of energy to write at length about it. The
(25:43):
first binaural stethoscope, meaning that it had separate earpieces for
each year, was the work of Dr Nathan B. Marsh.
You actually see a few different people credited with this
um because many people were trying to improve it at
the same time. Marsh was born in the late eighteen
teens in Newark, New Jersey, and moved when he was
still quite a small boy with his family to Cincinnati, Ohio.
(26:04):
There is a Marsh stethoscope in the collection of the
Smithsonian's National Museum of American History. It's not a fully
intact model. The earpieces and their connector tubes are missing,
but this one has three ebony bells of differing sizes
that you can screw off and on. Marsh received the
first patent for a binalstethoscope. That was US patent in
(26:27):
eighteen fifty one, but the following year a version was
invented by New York doctor George P. Cammon. Cammon, who
was born in eighteen o four, had actually traveled to
Paris for postgraduate work in the late eighteen twenties, and
he had studied with some of land ex colleagues, and
his work in New York with the city's poor population
(26:47):
at the Northern Dispensary, which was a free clinic that
opened in eighteen thirty. He wanted to improve his diagnostic
tools so that he could get as much information as
possible in cases where he just had limited time with
the patients. Yeah. I saw one one write up theorizing
that some of it too. Because New York had a
large immigrant population, he had to be able to do
(27:09):
diagnostics in ways that did not count on everyone speaking
the same language. I don't know if that's true or not.
That was a theorization. As a result of that desire, though,
to just improve his ability to work with his patients,
he built on models that he had already seen that
had two ear pieces, although in some cases those two
ear piece versions were designed so that two physicians could
(27:31):
listen to a person's chest at one time. There were
also other doctors working on binural stethoscopes, but there have
been problems making a model that was practical for continual
daily use. Camen tested various materials and designs, and he
finally came up with a design very similar to modern instruments.
If you see a picture of it. In Cammon's version,
(27:52):
there were two stiff metal tubes with ivory ear pieces,
and the ends opposite The ear pieces on those metal
tubes connected to two flexible too tubes with tightly wound
silk coverings. Those flexible tubes connected into a hollow ball
which connected to the bell section which was held to
the patient's chest. That hollow ball was said to um
amplify the sound. Canon's device was manufactured for wide distribution,
(28:16):
but he didn't patent it because he thought it should
be available to all physicians. In the eighteen nineties, the
fernendoscope was introduced by two Italian doctors, Eugenio Batsy and
Aurelio Bianchie. This design, which the inventors claimed was superior
to the stethoscope, had a rigid diaphragm disc and a
removable outer disc, and then a rod that extended from
(28:40):
one side of the larger disc and held a smaller
rubber disc the side opposite that had two metal tubes
extending from its center that could be fitted with rubber
tubes that ran up to earpieces. That was a departure
from the canon style that at that point had been
adopted by physicians around the world, and while it was
produced for several decades, eventually fell out of favor. It
(29:02):
is an odd looking thing to me if you see it,
It's like the little rod that extends with a smaller
piece looks so tiny compared to the larger disc it
comes from. I'm like, why why would you put such
a teeny piece up against the patient? But what do
I know. Also in the nineties, Massachusetts doctor Robert Bowles
invented a diaphragm chess piece, which was a departure from
(29:22):
the bell shape that had been the most common design,
and it was very simple to apply that because if
it's it's large surface area to the patient's chest. In
the Bulls design was incorporated with the bell design into
one chest piece by Boston's Howard Sprague to respond for
the demand for an instrument that had both options. So
in the Sprague version, instead of that bell, it created
(29:45):
a shape that looks like a cone with a diaphragm
over the widest part. This came to be known as
the Sprague Bowls stethoscope and it was very popular for
the next two decades. In the forties, Sprague, who was
a cardiologist, once again revisited the design at the at
the Scope, this time with collaborator Maurice Rappaport. Together they
came up with a chess piece that was two sided.
(30:07):
One side was optimal for listening to the cardiovascular system,
while the other was best for respiratory assessments. This is
attempt to separate out the best of both worlds approach
of the Sprague Bowls model, and it worked. But when
the two tubes that led from the double sided chess
piece to the airpieces rubbed together, it created so much
interference that could be really frustrating the doctors. Can you imagine,
(30:32):
like I'm trying to listen to your loan function, what
is that scraping noise? It's actually my instrument. The next
step in stethoscope evolution came from Dr. David Littman, who
was a Harvard Medical School professor and a cardiologist. And
Littman addressed those issues with the Sprague and Rappaport version
of the stethoscope by creating a one sided chess piece.
(30:54):
So unlike there's what you had to flip side to side,
his was just one sided, and it had a diaphragm
that had a dial that could be tuned for different purposes.
This nineteen sixties version remains the design for standard stethoscopes today.
Littman founded a company called Cardio Sonics to manufacture his device.
That company was eventually acquired by three M. Today, of course,
(31:16):
there are all kinds of specialized stethoscopes, stethoscopes with Bluetooth connectivity,
and even plans you can download online if you want
to print your own stethoscope with a three D printer,
among other developments. They're all still based on that Littman
design and that has roots that easily trace back to
Ladeck stethoscopes. Who knew? I, Um, it's it's I love
(31:39):
reading about how it was really all because he was
he didn't want to touch his patient directly. Honestly, they're
a little newer than I would have thought, because I
think things like ear trumpets are a little older than this.
There's at least like written, and it's like it just
seems like somebody would have stuck their ear trumpet onto
somebody's you know, chest man. No, they were just sticking
(32:03):
their ear up against their chest. Um. We can talk
somewhere about that in the behind the scenes. Yeah. But
in the meantime, I have a listener mail, which is
from our listener Angie, about one of our episodes that's
a little less lighthearted. It is the Mildred Fish Harneck episode. Sure,
it's hi, Tracy and Holly. I just got done listening
(32:24):
to the Mildred Fish Harneck episode. I adore your podcast,
and I listened to it while I jog after work.
This episode must have made me look crazy to passers by,
because I was openly sobbing like the ugly cry kinding
while still jogging and listening um boy, I know that feeling,
because I did that a few times while I was
prepping it. Uh. Mildred's story touched me deeply and more
than I thought it could. I am a graduate of
(32:46):
the University of Wisconsin Madison, and it made my heart
swell to learn how brave and true Mildred was. UH.
U W Madison places a strong emphasis on using your
education to help others. This is called the Wisconsin idea,
and I cannot help but think that moral compass was
cemented in Mildred's heart during her college years. I also
studied German languages as an undergrad at u W, where
(33:07):
we learned not just the language, but also about the
White Rose resistance group and others who stood up for
what was right and paid with their lives. Uh. One
of my professors in the German department grew up in
East Germany, and she described living through the horrifying experiences
of East German informants. It was a dystopia where anyone
would inform on anyone else. Children reported, parents, wives reported husbands.
(33:29):
You literally could not trust yourself to speak your thoughts,
even in your own room, because you never knew if
your own home was bugged. It was and still is
to this day. I believe the most widespread and organized
state surveillance effort in the world. Even then, though there
were people like my professor who met with other resistors
instead of for what was right, even in small ways.
She later found out she had a lengthy file with
(33:50):
the police. After reunification, East Germany ceased to be and
those files were made public. Uh, she asked if we
could potentially do a show on East German resistance, you
might Uh, we do definitely have one from the archives
on the White Rose. And then she also sent us
some beautiful, beautiful pictures. I'm sorry I made you cry,
but I'm glad that Mildred's story is getting more widespread, um,
(34:14):
you know, discussion in general. There's also a new book
about her. A couple of people have written to us
about so there's plenty to cover if you wanna to
read and learn about her. She was quite amazing. Thank
you for writing to us, Angie. If you would like
to write to us, you can do so at History
Podcast at iHeart radio dot com. You can also find
us on social media as Missed in History and subscribing
(34:36):
as easy as pie. You can do that on the
I heart radio app or anywhere else you listen to podcasts.
Stuff you Missed in History Class is a production of
I heart Radio. For more podcasts from I heart Radio,
visit the i heart radio app, Apple Podcasts, or wherever
you listen to your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello and welcome to the podcast.
I'm Holly Fry and I'm Tracy Wilson. One of the
most basic tools of the medical profession is a stethoscope. Yep,
nursing also, yeah, well the medical profession would include nurses.
(00:26):
I feel like we've had people argue with us about that.
I mean, it's all medicine. I'm not calling anybody a doctor.
If you have been to a doctor or a nurse
at any point in your life, and I hope you
do get the health care you need, you have probably
had some experience with a stethoscope, and I wanted to
peek at how they developed, just as a random Hey
where'd that come from? And then I accidentally landed on
(00:48):
another French medicine episode. I swear that was not my goal.
There are just so many there are. There was like
this cluster of time where France was doing a lot
of interesting things in in medicine. And that's because to
talk about the stethoscope, we have to talk first about
its inventor, reneet Field. He has sent lank and then
(01:10):
we're going to discuss how his original design which didn't
look like what we think of when we think of
a stethoscope, now changed in the hands of physicians who
wanted to improve on that original. Yeah, when we say change,
when I when I was looking for a picture to
go with this on our social media, there are pictures
of some of his actual stethoscopes. They are not recognizable
(01:32):
as a stethoscope unless you are maybe a medical historian
that knows what it looked like at that point. Yeah,
there are some in museums, uh. And there have even
been some cute staged photos throughout the years of people
using them to show how they worked. But they, yeah,
they don't look like what you would walk into a
doctor's office and see today. So Lani was born on
(01:55):
February seventeen eighty one in Campaire, on the far way
side of France in Brittany. His father, Teo fiel Marie Link,
was a civil servant and this family wasn't especially comfortable.
Part of that was because Teo field Marie was pretty
careless with the finances. Renee's mother, Michelle Felicete Gudstone, died
(02:17):
of tuberculosis when Renee was five, and he, along with
his brother, went to live with the Abbe Lanek, who
was his granduncle. He never was described as particularly hardy.
As a child, he had a lot of fevers. He
was described as physically weak, and it's believed that he
had asthma in his early years. Lannik was an artistic child.
(02:40):
He wrote poetry and he learned to play the flute.
He would actually play the flute throughout his life, and
some people draw a line between that in his original invention.
You'll see why when we talk about what it looked like. Uh,
he may have actually gone into a less scientific field
than medicine, given his proclivity towards the arts. Had he
not moved to Not at the twelve to live with
(03:01):
another uncle. This one was Dr Guillaume Flancis Lank and
in his new home it seems that Renee really flourished academically.
He had already studied Latin and Greek with his other uncle,
and in his new home he added English and German
to the list of languages that he spoke. Uncle Guillaume
was dean of the Faculty de Medicin at the University
(03:22):
of Nantes, and soon Renee was assisting him at the
Hotel Dieu, treating wounded from conflicts between revolutionaries and counter
revolutionaries in the area. At fourteen, Renee Laonik was assisting
his uncle and he was learning to dress wounds and
look after patients, and just four years later, in sevente
he was appointed to a post as third class surgeon
(03:44):
at the known military hospital before transferring to the Hospice
de la Frater. But that second post was also short
because in eighteen hundred Lantik moved to Paris to study
the section with expert anonomist Guillaume de p at Ecul Practique.
Lantic also studied with other luminaries of French medicine at
the time, as medical knowledge expanded rapidly. While still a
(04:08):
medical student working hard enough to gain top honors, he
also started publishing papers on a variety of medical topics
that started in eighteen o two. Before completing his medical degree.
He had the distinction of being the first person in
medicine to lecture on melanoma, which he did in eighteen
o four. Also in eighteen o four, he wrote his
(04:29):
thesis propos depocrat Relatives a Lamedic and Platique that's Proposals
on the Doctrine of Hippocrates relative to practical medicine. So
he was talking about all of the work of Hippocrates
and how it applied to medicine in his contemporary time.
And he graduated from medical school as a result of
(04:50):
completing that, and he was invited to join the faculty
of the Society of the School of Medicine in Paris.
His melanoma lecture that he had given while still a
student was published in eighteen o six. At this point
it really seemed like his career was on the rise.
He already built a reputation through his writing. He had
made the discovery that tubercal lesions, which are the nodules
(05:11):
that form in the tissues of patients with tuberculosis, he
discovered that those lesions could form anywhere in the body,
not just in the lungs. Previously to this work, that
was what people thought that it was only in the lungs.
This actually tied to his work on melanoma because he
actually had discovered the distinction between lesions from melanoma and
(05:31):
lesions from consumption. Because he had studied with some of
the greatest medical experts of the time and had written
extensively about his studies and tuberculosis as well as peritonitis
and a minorrhea. He was recognized for a high level
of expertise in the field, and that was in spite
of his young age. His life was soon to have
(05:53):
some difficulties though. In a short span of time, Lenk
had a falling out with his mentor Deo and his
goal like his mother, died from tuberculosis. The issue with
Dup was rooted in his melanoma paper. His mentor had
also worked on similar research and felt that he had
not been properly credited in laon X work. That was
(06:14):
particularly insulting too, because his student was credited with having
discovered melanoma with no mention of de Potan's work at all.
The two men actually thought about this for several years,
and the stress of this and the loss of his
uncle caused laon X medical issues to flare up to
the point where he had to take a break from
(06:34):
his work and take a leave of absence, and during
that time he visited Brittany where he was born, to
relax and recover. When he felt better, renee Leonek returned
to Paris to try to pick up where he had
left off his private practice of medicine. Went pretty well.
He had lots of patience, and he became part owner
and editor of Journal de Medicine, which was not surprising
(06:55):
considering how much medical writing had been part of his career.
What he was hoping was that he would also get
a job in a leadership position on a Parisian hospital staff.
That didn't happen, though. In eighteen o eight he founded
attny Medical that's Medical Athenaeum, which was also eventually absorbed
in the academic society of Paris. This was a time
(07:18):
when Lanek, who had always been a devout Roman Catholic,
really recommitted to his religion, and that led to his
appointment as the personal physician of Cardinal Joseph Fish. That
religious devotion was the reason he found his aspirations at
a hospital job a little bit out of reach, because
while France was very Catholic, the academic community actually found
(07:39):
Lanek too conservative, and they thought he was a bit
out of step with his contemporaries, even though he was
making a lot of significant discoveries. During the War of
eighteen twelve, while still working for Cardinal Fish, Lane headed
up the care of wounded soldiers in Paris's salth Petriere Hospital.
All the hospital's wounded soldiers were given beds in words
(08:00):
that Lanek led, and two years later his position with
the Cardinal ended was the French ambassador to the Vatican
and more importantly, Napoleon's half brother. So when Napoleon fell,
he was exiled. Land X job was gone at that point.
In eighteen sixteen, Laonex finally got that position that had
always eluded him, an appointment as a hospital physician. He
(08:22):
was hired at Neck Hospital as head of hospital service,
and that same year he also created the medical apparatus
that would change medicine. That new position at the hospital
was not entirely a joyous appointment, however, it had opened
up because one of laon X mentors and his close friend,
Gaspar Laurent Bail, had died of tuberculosis. We're about to
(08:43):
talk about the moment of inspiration that led to the
first stath scope, but first we're going to take a
moment of our own responsive break. The story of the
stethoscope's actual moment of invention has taken on a few inconsistencies,
(09:06):
as we frequently see when it comes to historically significant events,
but these actually aren't too wildly varied. They mostly just
involved the timing of this inspiration. That inspiration was Lank
witnessing two children playing in the courtyard of Lularufe Palace.
So he's said to have seen these two kids using
(09:26):
a long piece of wood to send signals to each other.
They would scratch the end of the solid piece with
a pin. One child was doing the scratching while the
other one listened on the other end, listening for the
sound to travel through the wood. So in some versions
of this story he sees this happening and then a
lot of time passes before he tries to put it
into use. But in others, he was walking on the
(09:49):
way to see a patient when he saw these two
kids doing this. Either way, though, the kids and their
wooden sound conveyance are credited with inspiring Land. When the
doctor himself wrote about it, though he did not mention
these kids, he did mention the pen scratching a would beam. Yes,
(10:09):
he wrote it quote, I recalled a well known acoustic phenomenon.
If you place your ear against one end of a
would beam, the scratch of a pin at the other
end is distinctly audible. It occurred to me that this
physical property might serve a useful purpose in the case
I was dealing with. I then tightly rolled a sheet
of paper, one end of which I placed over the
(10:30):
precordium chest and my ear to the other. I was
surprised and elated to be able to hear the beating
of her heart with far greater clearness than I ever
had with direct application of my ear. I immediately saw
that this might become an indispensable method for studying not
only the beating of the heart, but all movements able
of producing sound in the chest cavity or jumping ahead
(10:55):
just a bit, though, because the case at hand was
also a source of inspiration, and this is often described
as lanex solving a problem of embarrassments as much as
one of medical met In September of eighteen sixteen, the
doctor was called to see a young woman who had
quote general symptoms of a diseased heart. He wanted to
(11:15):
listen to her chest to be clear asqultation, which is
listening to the sound of a patient's heart, lungs, or
other organs. That was not a new idea. In eighteen sixteen,
Hippocrates had made references to internal sounds as a means
of diagnosis, and doctors who preceded Lanek had theorized that
some sort of mechanism might eventually be developed that would
(11:38):
enable physicians to listen to their patient's bodily sounds. But
more specifically leading up to this particular moment and influencing
leon x idea was the work of Viennese doctor Leopold Aumbruger.
He had used an idea that he had seen in
his youth his father tapping a barrel to see how
full it was, and applied that concept to medical exam
(12:00):
do nations. He determined that a human chest that was
filled with fluid would sound dull when you tapped it,
whereas a healthy human chest cavity would have resonance when tapped.
And this percussive diagnosis method was something that had been
written about in the eighteenth century and translated into French
by Napoleon's doctor Jean Nicola, who was also one of
(12:21):
Latin teachers in eighteen o eight. Aside from tapping on
a patient's chest, the other method for collecting information for
diagnosis of chest ailments was immediate ascultation, which meant that
the doctor would put their head directly onto the patient's
chest and listen. But in this particular case, Lanik was
(12:41):
reluctant because of the patient's age and sex. He did
not want to put his head up against her chest.
And this is when he recalled the idea that we
just quoted. Because he recognized he could actually hear better
with his rolled up sheet of paper than with his
ear alone. Started him down a path of experimenting to
(13:01):
further develop this idea, and that came to be called
mediate ascultation. Yeah, we're going to talk about percussion again
a bit towards the end of the episode, but they
were kind of tied up together as this, like, listen
to the sounds the body makes and you will figure
things out. So he did as Tracy said, start experimenting
(13:22):
and created multiple versions, and his refined versions, which he
worked on for several years, still did not ever really
look like the stethoscopes were familiar with today. Remember, for
one thing, things like rubber tubing were just not around yet.
Lane focused on creating his stethoscopes out of wood. He
had experimented with other materials, but he found a hollow
wooden tube to produce the best sound. Sometimes people attribute
(13:46):
this back to his work playing the flute and how
he made that connection. But it's not entirely clear, but
he created a chest piece that fitted at one end
and further improved his ability to hear. And then he
made his stethoscope into two pieces that could be unscrewed
for ease of carrying, and then they could be quickly
screwed back together so that a doctor could use them
for diagnosis. In eighteen eighteen, Renee Lanek gave a presentation
(14:10):
about his stethoscope at the Paris Academy of Sciences. In
eighteen nineteen, he published a two volume book about his work,
was Mediate Ascultation or Treatise on Diagnosis of Lung and
Heart Diseases. He described his stethoscope in its This was
twenty five centimeters long and three and a half centimeters
in diameter, and the name for the stethoscope didn't come
(14:31):
into print until eighteen twenty. Before that, he just called
his device lu Celand, which if you see some pictures
of it, it just it looks like a cylinder. Does
not see how any fancy adornments. There's no like ear
trumpet kind of shape to it just looks like a cylinder. Eventually,
though he went with the root of stethos, which was
(14:53):
the Greek word for chest. Yeah, you'll see that second
part of the word. The scope attributed to like a
jillion diff rent words to create this portmanteau, everything from
Greek words to French words to um, you know some
that just go well, let's scope because it's a scope,
which is pretty funny. Uh uh. He also included in
(15:14):
that that work, his two volume book, extensive research that
he had done using this invention. He treated a lot
of patients with pneumonia and he used this stethoscope in
assessing their conditions. When any of his patients died, he
performed autopsies, and he found that the conclusions he had
been able to reach using his new instrument were corroborated
(15:35):
by what he found. Lane stethoscope was quickly recognized as
invaluable for diagnosis, and as his book was translated, starting
in eighty one in London, doctors from around the European
continent soon we're eager to learn how to use it,
and a lot of them traveled to Paris to hear
lectures from Leonek himself. After this, Lanek continued his medical
(15:57):
career Ino he was made the chair and Professor of
Medicine at the College of France, and the year after
became the Professor of Medicine at Opdachart. He was a
member of the French Academy of Medicine. Also, he quickly
garnered such a reputation for really excellent lectures that the
lecture halls were frequently packed with doctors that wished to
(16:20):
hear him speak. Lane kept a log of everyone who
attended his lectures and kept an almost ridiculously busy schedule
of hospital rounds, lectures and consultations. Yeah, there's a you
will occasionally find some papers that talk about how you
can trace laan X through these logs that he kept
(16:41):
of doctors that attended his lectures, and then how his
information and his knowledge of pulmonary disease in particular kind
of propagated throughout the world over time. At this point
he was in his forties and Laonek kindly settled into
his now successful career, and he actually got married to
a widow named Jacquette guilgu and the new leweds wanted
(17:01):
to start a family that was unfortunately not to be there.
One pregnancy ended in a miscarriage and Soon after that loss,
which he took quite hard, his health began to decline.
He was actually in a little bit of denial about
this for a while. He had not realized, despite all
of his work and research in tuberculosis, how very contagious
(17:22):
it was. There had been discussion of tuberculosis as a
contagious disease even before his time, but there were also
theories that it could be hereditary. There were some theories
that it could even be a type of cancer, so
it wasn't necessarily uh universally recognized as a contagious disease.
The term tuberculosis didn't even exist yet. That wouldn't happen
(17:43):
until the following decade, when it was coined by German
Dr Johann Shaunlin. But over time he had all the
tell tale symptoms of tuberculosis. He was finally diagnosed by
his nephew, married at Lane, using a stethoscope to listen
to the much beloved doctor. Although Renee Lanek once again
(18:04):
traveled to Brittany in the spring of eighteen six hoping
that his health would improve, that did not achieve the
desired result. He was able to finish a revised edition
of his book on Mediate Escortation that was published that year.
It had specific details of certain sounds and what they
might indicate. This work laid the groundwork for knowledge of
(18:25):
pulmonary diseases. Lanek died not long after it was completed,
That was on August. Lan x work continues to be
part of modern medicine. He was the first to describe
micronodular cirrosis of the liver, which is still known as
lan X cirrhosis, and his extensive writing on pulmonary classifications
(18:45):
is still used. He advanced the medical community's understanding of pneumonia, emphysema,
and other conditions. There's a coda to this part of
the story, though, in terms of how Lanik was viewed,
just a decade after he died. In an eighteen thirty
eight English language translation of his Treatise on the Diseases
of the Chest and on Mediate Aescultation, the translator included
(19:09):
some interesting discussion about Lanox writings about himself. The translator's
note states in the first paragraph quote, the original treatise
will remain an imperishable monument of the genius and industry
of its author, and the discovery of which it treats
will entitle him to a distinguished rank among the benefactors
of mankind. As a standard work on the pathology and
(19:31):
diagnosis of the diseases of the chest, it is not
only without an equal, but may be considered as almost
perfect in its kind. But then, a couple of paragraphs down,
after continuing to mention the importance of escultation, the same
translator rights quote. At the same time, it would be
exacting too much from the weakness of humanity to expect
(19:53):
that the author of mediate ascultation should in no case
have yielded to the enthusiasm naturally inspired aired by the
consciousness of so great a discovery. And if in a
few passages of his book he should be found to
somewhat exaggerate the actual or relative importance of his method,
or even sometimes to appear rather as the partisan than
(20:14):
the historian of the stethoscope, i am sure that a
fault so venal and in such a man ought not
to be visited by heavy censure. Especially this says that
the translator thinks that laon X is puffing up the
importance of his invention, but that it's also okay, because
he really was pretty great, and he did advance medicine
with his work. It's a fascinating way to frame all this,
(20:35):
and it seems like maybe he's trying to pre address
critics of laon X, since he also mentions that some
people claim to have tried the stethoscope and found it unhelpful.
Just a glimpse into this perception of this device while
it was still in its infancy after lan x death. Yeah,
he a lot of doctors were super into it, but
there were something were like I tried to listen, I
(20:57):
didn't get anything. So it's just kind of an interesting
thing to know that there was a little bit of
controversy as much as as it does sound in a
lot of ways like the medical community pretty quickly picked
it up. But you may be wondering what came of
this invention because it obviously took a number of additional
turns as it developed into the tool that we see
commonly in use today. And we're going to talk about
(21:19):
some of those turns after we first hear from the
sponsors that keep stuff you missed in history class going.
Several other physicians contributed to the development of the stethoscope.
The first change to it actually appeared in the last
(21:40):
year of lan X life. That was the work of
Pierre Dave Pierri, who was born thirteen years after Lanek
on December and he started studying medicine when he was
just fifteen, and at the age of nineteen he became
ed chirogien militaire in the Napoleonic Wars when he was
drafted while he still a medical student. In that role,
(22:02):
he traveled to Spain and he got a very hands
on education at a military hospital in Barcelona. Like Laonek,
he studied medicine with men such as Clarvissard and Bail.
Once he got back to Paris and in eighteen sixteen
he completed the thesis that earned him his medical degree
that was titled on the danger of reading medical text
books by the laity. He started working at Lakatomie de
(22:26):
Medicine in eight and he was considered to be a
gifted teacher. From there he climbed the ladder in Paris's
medical facilities and became the chair of medicine at in
eighteen thirty seven. Pierre specialized in percussion as a clinician,
and that, as we mentioned earlier, is exactly what it
sounds like tapping parts of the body to gain an
(22:46):
understanding of the structures and the organs within, and Lanak
had actually used his cylindrical stethoscope for percussion as well.
He used it as a tapping tool. But the success
of the stethoscopes used in oscultation had to eclipse the
practice of percussion, and Pierre wanted to both replicate lane
success and reputation and gain his own renown while also
(23:09):
reiterating the usefulness of percussion as a diagnostic tool. Perhaps
the most charming thing about his story is that he
was a poet as well as a physician, and he
wrote about his work in percussion and his contribution to
the stethoscope in a poem titled Lamb or God's Soul.
In Nature and the poem, he described praying to God
(23:32):
to be able to contribute to the development of medicine
as Lanek had, and how he was inspired when he
came aware of the sound he heard when he scratched
his own chest. Immediately he began to experiment in this area,
eventually developing a method of placing a small plate between
the patient's skin and the doctor's finger to both control
(23:53):
the way the sound was heard and to reduce the
discomfort to the patient of being tapped in this one
spot repeatedly. Soon he integrated this plate with a stethoscope.
An example of Pierre's version of the tool was included
as an illustration in that same English language translation on
Lanox work that we referred to just a bit ago,
and it describes Pierres stethoscope this way quote. This stethoscope
(24:17):
is constructed exactly on the same principles as that of Lank,
but with several modifications intended to render it lighter, smaller,
and more portable. In it, the central bore and conical
cavity of the pectoral extremity are preserved of the original dimensions,
but the body of the instrument is greatly reduced in size,
and the proper width is given to the articular extremity
(24:39):
by screwing a thin ivory cap to the slender body
of the instrument. The pleximeter is attached to the stethoscope
merely with a view to render the former conveniently portable.
So in case that's not clear, it was a smaller
version of the stethoscope, but one end of it expanded
out in a wide, shallow conical shape with the plate
(24:59):
that was the plex seminar over the widest part of
the cone. The flat plate would be placed against the
torso of the patient, and then the doctor would tap
it with a finger or a small hammer. Today, physicians
will usually use their hand instead of a plate for this.
Lanek actually attended Puri's talk at the Royal Academy of
Medicine when he introduced these ideas. Although Pierre's book on
(25:22):
the subject didn't come out until well after Renee Lanek
had died, Perry had included the inventor of the stethoscope
in the dedication. You know, Uh, it's unclear. Uh, you
know what lanox response was. He was was the end
of his life, so he probably did not have a
lot of energy to write at length about it. The
(25:43):
first binaural stethoscope, meaning that it had separate earpieces for
each year, was the work of Dr Nathan B. Marsh.
You actually see a few different people credited with this
um because many people were trying to improve it at
the same time. Marsh was born in the late eighteen
teens in Newark, New Jersey, and moved when he was
still quite a small boy with his family to Cincinnati, Ohio.
(26:04):
There is a Marsh stethoscope in the collection of the
Smithsonian's National Museum of American History. It's not a fully
intact model. The earpieces and their connector tubes are missing,
but this one has three ebony bells of differing sizes
that you can screw off and on. Marsh received the
first patent for a binalstethoscope. That was US patent in
(26:27):
eighteen fifty one, but the following year a version was
invented by New York doctor George P. Cammon. Cammon, who
was born in eighteen o four, had actually traveled to
Paris for postgraduate work in the late eighteen twenties, and
he had studied with some of land ex colleagues, and
his work in New York with the city's poor population
(26:47):
at the Northern Dispensary, which was a free clinic that
opened in eighteen thirty. He wanted to improve his diagnostic
tools so that he could get as much information as
possible in cases where he just had limited time with
the patients. Yeah. I saw one one write up theorizing
that some of it too. Because New York had a
large immigrant population, he had to be able to do
(27:09):
diagnostics in ways that did not count on everyone speaking
the same language. I don't know if that's true or not.
That was a theorization. As a result of that desire, though,
to just improve his ability to work with his patients,
he built on models that he had already seen that
had two ear pieces, although in some cases those two
ear piece versions were designed so that two physicians could
(27:31):
listen to a person's chest at one time. There were
also other doctors working on binural stethoscopes, but there have
been problems making a model that was practical for continual
daily use. Camen tested various materials and designs, and he
finally came up with a design very similar to modern instruments.
If you see a picture of it. In Cammon's version,
(27:52):
there were two stiff metal tubes with ivory ear pieces,
and the ends opposite The ear pieces on those metal
tubes connected to two flexible too tubes with tightly wound
silk coverings. Those flexible tubes connected into a hollow ball
which connected to the bell section which was held to
the patient's chest. That hollow ball was said to um
amplify the sound. Canon's device was manufactured for wide distribution,
(28:16):
but he didn't patent it because he thought it should
be available to all physicians. In the eighteen nineties, the
fernendoscope was introduced by two Italian doctors, Eugenio Batsy and
Aurelio Bianchie. This design, which the inventors claimed was superior
to the stethoscope, had a rigid diaphragm disc and a
removable outer disc, and then a rod that extended from
(28:40):
one side of the larger disc and held a smaller
rubber disc the side opposite that had two metal tubes
extending from its center that could be fitted with rubber
tubes that ran up to earpieces. That was a departure
from the canon style that at that point had been
adopted by physicians around the world, and while it was
produced for several decades, eventually fell out of favor. It
(29:02):
is an odd looking thing to me if you see it,
It's like the little rod that extends with a smaller
piece looks so tiny compared to the larger disc it
comes from. I'm like, why why would you put such
a teeny piece up against the patient? But what do
I know. Also in the nineties, Massachusetts doctor Robert Bowles
invented a diaphragm chess piece, which was a departure from
(29:22):
the bell shape that had been the most common design,
and it was very simple to apply that because if
it's it's large surface area to the patient's chest. In
the Bulls design was incorporated with the bell design into
one chest piece by Boston's Howard Sprague to respond for
the demand for an instrument that had both options. So
in the Sprague version, instead of that bell, it created
(29:45):
a shape that looks like a cone with a diaphragm
over the widest part. This came to be known as
the Sprague Bowls stethoscope and it was very popular for
the next two decades. In the forties, Sprague, who was
a cardiologist, once again revisited the design at the at
the Scope, this time with collaborator Maurice Rappaport. Together they
came up with a chess piece that was two sided.
(30:07):
One side was optimal for listening to the cardiovascular system,
while the other was best for respiratory assessments. This is
attempt to separate out the best of both worlds approach
of the Sprague Bowls model, and it worked. But when
the two tubes that led from the double sided chess
piece to the airpieces rubbed together, it created so much
interference that could be really frustrating the doctors. Can you imagine,
(30:32):
like I'm trying to listen to your loan function, what
is that scraping noise? It's actually my instrument. The next
step in stethoscope evolution came from Dr. David Littman, who
was a Harvard Medical School professor and a cardiologist. And
Littman addressed those issues with the Sprague and Rappaport version
of the stethoscope by creating a one sided chess piece.
(30:54):
So unlike there's what you had to flip side to side,
his was just one sided, and it had a diaphragm
that had a dial that could be tuned for different purposes.
This nineteen sixties version remains the design for standard stethoscopes today.
Littman founded a company called Cardio Sonics to manufacture his device.
That company was eventually acquired by three M. Today, of course,
(31:16):
there are all kinds of specialized stethoscopes, stethoscopes with Bluetooth connectivity,
and even plans you can download online if you want
to print your own stethoscope with a three D printer,
among other developments. They're all still based on that Littman
design and that has roots that easily trace back to
Ladeck stethoscopes. Who knew? I, Um, it's it's I love
(31:39):
reading about how it was really all because he was
he didn't want to touch his patient directly. Honestly, they're
a little newer than I would have thought, because I
think things like ear trumpets are a little older than this.
There's at least like written, and it's like it just
seems like somebody would have stuck their ear trumpet onto
somebody's you know, chest man. No, they were just sticking
(32:03):
their ear up against their chest. Um. We can talk
somewhere about that in the behind the scenes. Yeah. But
in the meantime, I have a listener mail, which is
from our listener Angie, about one of our episodes that's
a little less lighthearted. It is the Mildred Fish Harneck episode. Sure,
it's hi, Tracy and Holly. I just got done listening
(32:24):
to the Mildred Fish Harneck episode. I adore your podcast,
and I listened to it while I jog after work.
This episode must have made me look crazy to passers by,
because I was openly sobbing like the ugly cry kinding
while still jogging and listening um boy, I know that feeling,
because I did that a few times while I was
prepping it. Uh. Mildred's story touched me deeply and more
than I thought it could. I am a graduate of
(32:46):
the University of Wisconsin Madison, and it made my heart
swell to learn how brave and true Mildred was. UH.
U W Madison places a strong emphasis on using your
education to help others. This is called the Wisconsin idea,
and I cannot help but think that moral compass was
cemented in Mildred's heart during her college years. I also
studied German languages as an undergrad at u W, where
(33:07):
we learned not just the language, but also about the
White Rose resistance group and others who stood up for
what was right and paid with their lives. Uh. One
of my professors in the German department grew up in
East Germany, and she described living through the horrifying experiences
of East German informants. It was a dystopia where anyone
would inform on anyone else. Children reported, parents, wives reported husbands.
(33:29):
You literally could not trust yourself to speak your thoughts,
even in your own room, because you never knew if
your own home was bugged. It was and still is
to this day. I believe the most widespread and organized
state surveillance effort in the world. Even then, though there
were people like my professor who met with other resistors
instead of for what was right, even in small ways.
She later found out she had a lengthy file with
(33:50):
the police. After reunification, East Germany ceased to be and
those files were made public. Uh, she asked if we
could potentially do a show on East German resistance, you
might Uh, we do definitely have one from the archives
on the White Rose. And then she also sent us
some beautiful, beautiful pictures. I'm sorry I made you cry,
but I'm glad that Mildred's story is getting more widespread, um,
(34:14):
you know, discussion in general. There's also a new book
about her. A couple of people have written to us
about so there's plenty to cover if you wanna to
read and learn about her. She was quite amazing. Thank
you for writing to us, Angie. If you would like
to write to us, you can do so at History
Podcast at iHeart radio dot com. You can also find
us on social media as Missed in History and subscribing
(34:36):
as easy as pie. You can do that on the
I heart radio app or anywhere else you listen to podcasts.
Stuff you Missed in History Class is a production of
I heart Radio. For more podcasts from I heart Radio,
visit the i heart radio app, Apple Podcasts, or wherever
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Stuff You Missed in History Class News
Hosts And Creators
Holly Frey
Tracy Wilson
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