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Robert A. Thom/clinmedres.org
Robert A. Thom/clinmedres.org

Morals, Mammaries, and the Invention of the Stethoscope

Robert A. Thom/clinmedres.org
Robert A. Thom/clinmedres.org

In 1816, French physician Rene Theophile Hyacinthe Laennec had a young woman on his exam table, and no idea what to do with her. She’d come in complaining of chest pains, and their conversation and the examination up to that point suggested a diseased heart, but Laennec wasn’t sure how he would confirm that.

Since the days of Hippocrates, doctors had limited options when it came to assessing cardiac health, and mainly relied on auscultation, or listening to sounds of the body. Dulled sounds in an area of the chest that was normally more resonant, for example, could indicate extraneous fluid or a tumor. One way of doing this was to place an ear right on the patient’s chest and listen directly to the heart, lungs, and chest cavity. Another option was to tap on the chest or back and listen to the resulting sound, a method developed by an Austrian physician whose innkeeper father tapped on wine barrels to determine their fullness.

Laennec was familiar with both methods—in fact, one of his teachers (and Napoleon’s personal physician), Jean-Nicolas Corvisant, had helped popularize the percussion technique—but neither would do him any good with this patient. The young lady was on the heavier side and ample in the chest, which presented some complications.

“Percussion and the application of the hand were of little avail,” Laennec wrote of the exam, “on account of the great degree of fatness.” Putting his ear right up to her chest was also “rendered inadmissible” by the Catholic bachelor’s social unease at putting his head that close to a young woman’s bosom. He later said of examining female patients that, “direct auscultation was as uncomfortable for the doctor as it was for the patient…It was hardly suitable where most women were concerned and, with some, the very size of their breasts was a physical obstacle to the employment of this method.”

After a few embarrassing minutes, Laennec remembered “a simple and well known fact in acoustics…the augmented impression of sound when conveyed through certain solid bodies—as when we hear the scratch of a pin at one end of a piece of wood, on applying our ear to the other.”

He grabbed a sheet of paper, rolled it up and placed one end against the woman’s chest and the other against his ear. He was “surprised and elated to be able to hear the beating of her heart,” he wrote, “with far greater clearness than I ever had with direct application of my ear.”

Over the next few years, Laennec experimented with his improvised tool and perfected its design. A wooden tube carried sound better than paper, and pine seemed to work especially well. He struggled with a name for his invention, though, and toyed with pectrolique, medical cornet and thoraciscope before settling on stethoscope, from the Greek stethos (“chest”) + -scope (“look or examine”).

Satisfied with his design, Laennec went on to use the stethoscope to catalog and describe various sounds of the chest and correlate them to specific ailments. After three years, he published the landmark De l’Auscultation Médiate, ou Traité du Diagnostic des Maladies des Poumons et du Coeur (or, On Mediate Auscultation, or Treaty of Diagnosing Diseases of the Lungs and the Heart).

Besides having an advanced instrument for it, it seems only natural that Laennec would be drawn to treating diseases of the chest: his mother, the uncle that helped raise him, and a few of his mentors all died of tuberculosis. Laennec himself would eventually contract the disease and die from it in 1826. He left his personal stethoscope to his nephew.

Laennec’s invention received its fair share of criticism at first. Even John Forbes, the Scottish physician who translated De l’Auscultation Médiate into English, said that, “It must be confessed that there is something even ludicrous in a grave physician formally listening through a long tube applied to the patient's thorax, as if the disease within were a living being that could communicate its condition to the sense without.” Eventually, though, it gained wide acceptance. With modifications by others, like Arthur Leared and Nicholas Comins’ binaural versions, the stethoscope became an indispensable tool by the 20th century.

How much longer the stethoscope stays that way is uncertain, though. Dr. Bryan Vartabedian, MD, on his blog 33 charts, looked at a 1993 study done by researchers at the Medical College of Pennsylvania. They found, in a nationwide survey of medical training program directors and students, that only 27.1 percent of internal medicine and 37.1 percent of cardiology programs offered structured teaching of chest auscultation, and that accuracy with a stethoscope ranged from 0 percent to 56.2 percent for cardiology fellows, and from 2 percent to 36.8 percent for medical residents.

At the end of that decade, the lead author on that study conducted a similar survey, and found an uptick in the internal medicine programs teaching chest auscultation (up to 48 percent for cardiac auscultation). He didn’t check in on internal med programs again, but only 29.2 percent of family practice programs taught cardiac auscultation and 12.2 percent taught pulmonary auscultation.

This piece was originally published in 2013.

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Why You Should Think Twice About Drinking From Ceramics You Made by Hand
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Ceramic ware is much safer than it used to be (Fiesta ware hasn’t coated its plates in uranium since 1973), but according to NPR, not all new ceramics are free of dangerous chemicals. If you own a mug, bowl, plate, or other ceramic kitchen item that was glazed before entering the kiln, it may contain trace amounts of harmful lead.

Earthenware is often coated with a shiny, ceramic glaze. If the clay used to sculpt the vessel is nontoxic, that doesn’t necessarily mean the glaze is. Historically, the chemical has been used in glazes to give pottery a glossy finish and brighten colors like orange, yellow, and red.

Sometimes the amount of lead in a product is minuscule, but even trace amounts can contaminate whatever you're eating or drinking. Over time, exposure to lead in small doses can lead to heightened blood pressure, lowered kidney function, and reproductive issues. Lead can cause even more serious problems in kids, including slowed physical and mental development.

As the dangers of even small amounts of lead have become more widely known, the ceramics industry has gradually eliminated the additive from its products. Most of the big-name commercial ceramic brands, like Crock-Pot and Fiesta ware, have cut it out all together. But there are still some manufacturers, especially abroad, that still use it. Luckily, the FDA keeps a list of the ceramic ware it tests that has been shown to contain lead.

Beyond that list, there’s another group of products consumers should be wary of: kiln-baked dishware that you either bought from an independent artist or made yourself. The ceramic mug you crafted at your local pottery studio isn’t subject to FDA regulations, and therefore it may be better suited to looking pretty on your shelf than to holding beverages. This is especially true when consuming something acidic, like coffee, which can cause any lead hiding in the glaze to leach out.

If you’re not ready to retire your hand-crafted ceramic plates, the FDA offers one possible solution: Purchase a home lead testing kit and analyze the items yourself. If the tests come back negative, your homemade dishware can keep its spot on your dinner table.

[h/t NPR]

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Marathon Running Won't Undo Poor Lifestyle Choices, Study Suggests
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Even marathon participants can't outrun an unhealthy lifestyle, according to a new study highlighted by The New York Times.

For years, expert opinion has been mixed on whether long-distance running helps or hurts hearts. In the 1970s, research suggested that marathon running and a heart-healthy diet would completely prevent atherosclerosis (a buildup of harmful plaque in the arteries). But since high-profile runners have died of heart attacks, scientists in the 1980s began to worry that running might actually harm the vital organ. Compounding this fear in recent years were studies suggesting that male endurance athletes exhibited more signs of heart scarring or plaques than their less-active counterparts.

Experts don't have a verdict quite yet, but researchers from the University of Minnesota and Stanford and their colleagues have some good news—running doesn't seem to harm athletes' hearts, but it's also not a panacea for heart disease. They figured this out by asking 50 longtime marathon runners, all male, with an average age of 59, to fill out questionnaires about their training, health history, and habits, and then examining them for signs of atherosclerosis.

Only 16 of the runners ended up having no plaque in their arteries, and the rest exhibited slight, moderate, or worrisome amounts. The men who had unhealthy hearts also had a history of smoking and high cholesterol. A grueling training regime seemed to have no effect on these levels.

Bottom line? Marathon running won't hurt your heart, but it's not a magic bullet for poor lifestyle choices.

[h/t The New York Times]

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