The stethoscope is one thing which each medical student waited eagerly to possess. A hallmark of the profession it was the passport to the clinical years. Pre clinical years were dull and drab. It was very difficult to learn a subject like Anatomy but very easy to fail. With great difficulty when one almost lost faith in oneself and all interest in the subject and all hope of passing, one would pass and got into the clinical side. This desperate individual got to possess the stethoscope - the transformation was almost unbelievable and magical . The same student would be looked upon as a "senior" by the students then in the pre clinical years and would be the cynosure of their eyes! The stethoscope also brought the student closer to being a "real doctor".
What is the story behind such an important invention? It can be said that this invention was born out of child'splay! Rene Theophile Hyacinthe Laennec saw 2 children transmitting scratching sounds through a roll of folded paper to each other. This was the first stethoscope! It avoided the direct contact of the ears to the body (which had to be done till then). When he reported his invention in a journal, it was immediately taken up and translated widely. This invention (in 1819) made Laennec immortal. He became more famous than Auenbrugger who had become famous for his invention of percussion as a modality of clinical examination. Sadly, later Laennec succumbed to Tuberculosis.
Laennec not only invented the stethoscope but also named the lung sounds so heard (sibilant and sonorous rales); and was the origiantor of the terms like egophony and whispering pectoriloquey. It was also found to help in the auscultation of the heart. Naturally it became popular with the practicing doctors and medical and nursing students.
I clearly remembering possessing a basic model of the stethoscope. It cost Rs. 30 at that time. Better models like Littmann were expensive , lot more than Rs 1000 and were beyond the reach of common students. They were also the target of theft. I clearly remember the commotion caused by the theft of a Littmann stethoscope of one of the students from Malaysia. Everyone's bag was checked; it was never found. Once my ordinary stethoscope was stolen. I was wondering what to do. The next day, it promptly came back to the place where I had left it! Indeed, the thief had a class and he showed it! It was customary for the professors to demonstrate the main findings to the students - this included the auscultatory findings also. On one occasion, a senior professor, known for his sarcastic humour, reprimanded a student
saying that the student's father should not be stingy and should buy him a better stethoscope so that he can hear the findings better. Everyone started giggling hesitantly for the student was none other than the professor's own son!
I clearly remembering possessing a basic model of the stethoscope. It cost Rs. 30 at that time. Better models like Littmann were expensive , lot more than Rs 1000 and were beyond the reach of common students. They were also the target of theft. I clearly remember the commotion caused by the theft of a Littmann stethoscope of one of the students from Malaysia. Everyone's bag was checked; it was never found. Once my ordinary stethoscope was stolen. I was wondering what to do. The next day, it promptly came back to the place where I had left it! Indeed, the thief had a class and he showed it! It was customary for the professors to demonstrate the main findings to the students - this included the auscultatory findings also. On one occasion, a senior professor, known for his sarcastic humour, reprimanded a student
saying that the student's father should not be stingy and should buy him a better stethoscope so that he can hear the findings better. Everyone started giggling hesitantly for the student was none other than the professor's own son!
No wonder this instrument held the sway for almost 200 years. It seemed to be irreplacable to generations of medical students and doctors. Doppler ultrasound and ECHO gave it a big blow.ECHO was more reliable in some situations. The postgraduate thesis done by one of my PG students proved this. There were some situations where the stethoscope still proved superior. It has been observed that the Cardiologists are using the stethoscope less ans less.
Now HHUS (Hand Held Ultrasound ) is giving the stethoscope a serious competetion. Though expensive (about $10000 a piece), it may be more objective and more accurate. There is no evidence that the stethoscope improved the patient outcomes in its early years though it helped in better diagnosis of Congestive cardiac failure and some other potentially dangerous situations. The lives were saved only after the better drugs like diuretics became available. HHUS on the other hand can do much more. With the basic training, even the non doctor peripheral workers can pick up dangerous conditions like Cardiac failure and Pulmonary Embolism and save lives. Rural health workers can be made to diagnose abnormal fetal positions and fetal distress early and inform the doctors thus helping save lives. With mass production and encouraged sharing , the working cost may also come down.
Will we see the sad demise of a legendary icon of the medical profession shortly? Only time will tell. Let us wait and watch.
Now HHUS (Hand Held Ultrasound ) is giving the stethoscope a serious competetion. Though expensive (about $10000 a piece), it may be more objective and more accurate. There is no evidence that the stethoscope improved the patient outcomes in its early years though it helped in better diagnosis of Congestive cardiac failure and some other potentially dangerous situations. The lives were saved only after the better drugs like diuretics became available. HHUS on the other hand can do much more. With the basic training, even the non doctor peripheral workers can pick up dangerous conditions like Cardiac failure and Pulmonary Embolism and save lives. Rural health workers can be made to diagnose abnormal fetal positions and fetal distress early and inform the doctors thus helping save lives. With mass production and encouraged sharing , the working cost may also come down.
Will we see the sad demise of a legendary icon of the medical profession shortly? Only time will tell. Let us wait and watch.
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