Medicine: Chest Examiner

The patient was suspected of heart disease. But, because she was fat, female and modest, the doctor could not put his ear to her chest—and how else could he listen to her heart? Dr. René Théophile Hyacinthe Laënnec rolled a sheet of paper into a tube and held it against her chest. The heart noises came through perfectly to his respectfully distant ear.

That was the first stethoscope, in 1816. At New York's Academy of Medicine last week, Dr. Walter Barclay Mount reviewed the history of this No. 1 diagnostic tool.

Today's familiar metal and rubber stethoscope (Greek for chest examiner) is quite different from Laënnec's—a hollow bell or a cap with a hard rubber diaphragm to be placed on the chest or back and tubes to transmit sound to the earpieces. And its use is anything but simple. Since Laënnec hundreds of books have been written about the snaps, crackles, hums, gurgles, murmurs, booms, bubblings, gratings and rustlings which Laënnec first heard and doctors still listen for.

The beat of a healthy heart is lūbb-dūpp: a hollow boom as the ventricles contract to pump blood, followed by the soft snap of the closing of valves to the aorta and lungs. Weak, doubled, out-of-step or extra sounds mean trouble.

When the heart valves are defective and won't close properly, there is sometimes a telltale swishing as blood eddies back into the heart chambers. A sound like the rustle of new leather is an indication of pleurisy.

To diagnose chest diseases, doctors listen for rattling sounds which Laënnec called râles. Patients with early or late pneumonia have a crackling sound like hair being rubbed through the fingers. Tuberculosis can sometimes be spotted early in its course by a similar sound, which may later change to a clear, metallic ring.