No other symbol so strongly identifies a doctor than the stethoscope hanging around the neck. It has become a universal icon of medicine and has transformed both diagnostics and the physician himself. The story of the stethoscope is a story that has had an immense impact on modern medicine and has shaped the role of physicians in today’s society. The middle of the nineteenth century was marked by the inventions of a series of new diagnostics instruments, which included the stethoscope, laryngoscope, and ophthalmoscope. These tools were revolutionary and completely altered the dynamics of doctors. In the early 1800s, physicians diagnosed patients primarily based on the patient’s history and often superficial observations. Manual examinations were relatively unimportant and misdiagnoses were a frequent dilemma. The new technology expanded the physician’s sensory powers and planted the focus of clinical medicine on the physical examination of the patient, an incidence that “strengthened the authority of internal medicine and radically altered the doctor-patient relationship."
Around the early 1800’s before the invention of the stethoscope, a new system of diagnostics began to emerge. Doctors were now starting to perform physical examinations by using techniques such as percussion and immediate auscultation, which involved placing one’s ear directly on the patient’s body in order to observe internal sounds. This was often quite inefficient and had several drawbacks, some being that the sounds observed were not amplified in any way, causing physicians to miss key sounds that might be essential to the correct diagnosis and the fact that the act of performing immediate auscultation was physically and socially awkward for both the physician and the patient. It was at this time that the French physician René-Théophile-Hyacinthe Laennec began his study of medicine at the University of Paris under the guidance of several famous physicians who trained him to use sound as a diagnostic aid. During a morning walk in September of 1861, Laënnec observed a well-known acoustic phenomenon: two children sending signals to each other using a long piece of wood that they held to their ears. The wood amplified sound as such that each child could hear the sound of a pin scratching the wood at the other end. Later that year, he was called to examine a young woman with “general symptoms of a diseased heart.” Reluctant and embarrassed to perform immediate auscultation on the young female patient, he recalled his observation of the children’s wooden tube and was inspired to use a rolled sheet of paper to create an aural tool to facilitate auscultation. He discovered that this mediate auscultation (indirect listening) allowed heart sounds to be heard more clearly than immediate auscultation and thus began the development of a device specifically designed for this purpose.
Laënnec named his tool the stethoscope, which comes from the Greek words stethos, meaning chest, and skopein, meaning to explore. He spent the next three years perfecting his instrument and used it to listen to the chests of pneumonia patients. He investigated sounds of the heart and lungs and confirmed his findings with observations made in autopsies, and in 1819, he published his well-known treatise De l'Auscultation Médiate, which underlines the discourse of a variety of heart and lung sounds heard through the stethoscope., By this era, physicians were generally supporting the idea that symptoms in the living patient correlated to structural changes found in the body during autopsies, and because of this, Laënnec’s stethoscope gained such popularity as he was able to demonstrate through autopsy that when certain sounds were heard through the instrument, particular lesions in the cadaver could be associated with the sound. Laënnec’s stethoscope was a monaural device, meaning sound was only heard through one ear and the stethoscope was later made binaural by Irish physician Arthur Leard in 1851. Over the next century, many improvements have been made to the instrument to improve acoustic quality, reduce weight, and minimize external noise, eventually leading to the modern designs used today. Perhaps one of the most famous versions of the stethoscope known today is Littmann, reputed for its high acoustic performance and auscultation, patented by Dr. David Littmann of Harvard University Medical School in the 1960s. However, despite all of these changes, Laënnec’s basic principle remains the same – to provide physicians an effective form of auscultation in order to “identify sounds within the body.”
This basic principle worked to transform the doctor’s understanding of disease as well as his interaction with the patient. On the one hand, the proliferated use of the stethoscope has widened the gap between the doctor and the patient in many ways. The physician no longer has to rely on the patient for accurate accounts and the stethoscope allows him to make objective diagnoses. In a doctor-patient dynamic, the stethoscope put complete power in the hands of the doctor as they are now using a tool to perform examinations that are beyond the patient’s understanding. The doctor became drawn away from the patient into his own private world where all he needs to know is communicated to him via qualitative signs from the body. This has led to the standardization of diseases because these objective diagnoses have caused physicians, and even patients, to lose touch with the personal aspects of illness. Before the use of specialized tools, diseases were often described in terms of the individual symptoms of each patient and this was often a crucial part in the healing process. Each patient was treated differently because their symptoms and personal relation to the illness differed. However, with the use of the stethoscope, doctors became distanced from each patient’s illness and therefore diseases became categorized. All patients with a particular disease were treated in the same manner and while this increased the efficacy of the medical profession, it often made the healing process for patients problematic.
On the other hand, it can be argued that the use of the stethoscope has created a more personal relation between the doctor and the patient. In a 2012 study conducted by Curtin University's Health Innovation Research Institute, it was shown that patients who saw a doctor wearing a stethoscope associated him with positive assumptions, such as being “more trustworthy, more honest and more honorable, ethical, and moral.” People have evolved to place their trust completely in the doctor’s hands and have once again become dependent on them. In many cases, an anxious patient will feel at ease when the physician places the stethoscope on their body and begins the process of auscultation. Looking at the doctor’s concentrated face, knowing that he is listening, and he will know if something is wrong through his observations gives the patient an assured feeling and an empowering trust towards the doctor. In this way, the stethoscope has played a significant part in our psychological evolution by causing us to put increased confidence in our doctors and thereby raising them to a higher social platform.
As doctors were raised to a higher standing due to increasing efficacy because of instruments like the stethoscope, they also gained higher ground in the economic and political world. America strove to follow Europe’s lead in medicine throughout the early 1800s and adapted the binaural stethoscope. Over the next century, many minor changes and improvements were made to it in the United States, and medicine was now making a difference in health. This growing importance of professional skills and technical knowledge allowed doctors to better understand and explain diseases, and as a result, they gained the public’s trust and were able to assert cultural authority. Diagnostics technologies were significant to the expanding role of physicians and allowed to them become “gatekeepers to positions and benefits in society.” With the use of the stethoscope, doctors could now set standards in human physiology, evaluate deviations and classify individuals, allowing them to set barriers of entry to the profession and thus strengthening their political and economic powers. The “renewal of legitimate complexity” emerged and doctors climbed the social hierarchical ladder via two lines. Firstly, they were able to prove their vital functional importance in society and secondly, they were able to distinguish themselves from other positions through differences in power. The growing functional importance of doctors can be attributed to professional skills and technical knowledge, in particular the use of the stethoscope as the one universal tool used in medicine, and the power theory can be supported by the monopolistic practices of the profession. The use of the stethoscope allowed physicians to advance themselves as professional and technical experts and they were able to utilize this to their advantage in order to monopolize their profession.
The stethoscope has become such an iconic symbol of medicine that doctors often seem incomplete without one around their neck. The Emory School of Medicine Alumni Association has embraced this archetypal tool and has even set up a Stethoscope Program which gifts each first year medical student a stethoscope. Patty Schiff of the alumni board comments that is a way for the “students to connect to the alumni from the beginning of their education” and the stethoscope has become a symbol that creates a deep connection between doctors of the past, doctors of the present, and doctors of the future.