« 99% Invisible

270- The Stethoscope

2017-08-08 | 🔗

Imagine for a moment the year 1800. A doctor is meeting with a patient – most likely in the patient’s home. The patient is complaining about shortness of breath. A cough, a fever. The doctor might check the patient’s pulse or feel their belly, but unlike today, what’s happening inside of the patient’s body is basically unknowable. There’s no MRI. No X-rays. The living body is like a black box that can’t be opened. The only way for a doctor to figure out what was wrong with a patient was to ask them, and as a result patients’ accounts of their symptoms were seen as diseases in themselves. While today a fever is seen as a symptom of some underlying disease like the flu, back then the fever was essentially regarded as the disease itself. But in the early 1800s, an invention came along that changed everything. Suddenly the doctor could clearly hear what was happening inside the body. The heart, the lungs, the breath. This revolutionary device was the stethoscope.

 

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
MRS Ninety, nine percent, invisible, I'm roman Mars, imagine for a moment the year, eighteen hundred, is meeting with a patient most likely in the since home. The pay, is complaining about shortness of breath, a calf, a fever, the doktor listens to the patients. Complaints asks a ton of question scribble, some notes, producer and Fitzgerald, and the doktor might check the patient's pulse. But, unlike today, what's happening inside of the patient- is basically unknowable. There's no mri no X rays, the live body is like a black box that can't be opened, the only way for a doctor to figure out what's wrong with a patient is to ask them. You needed the patient, tell you what was wrong and what they were
Frank, so doctors were very interested in the patient's history. The story of what the symptom was, how long it had been there, how had changed? What made it better? What made it worse? This is doctor Jaclyn dozen I am a human taller just and, The historian of Medicine, Queens University Dozen says that, because the patient story was all the doktor had to go on the symptoms. Often seen as diseases in themselves. So, for example, call today? If you have a fever, you think of it as a symptom some underline disease like the flu, but back at the turn of the nineteenth century, the fever itself was considered. That is, Is there were all different kinds of fevers and fever itself was broad category of diagnosis because doctor, had no way of connecting symptoms with what was what's going on inside the body in
some someone built a device that would help the doktor open, the Black box and travel inside the human body, and suddenly the doktor could hear everything so much more. Clearly, the heart, the lungs, the breadth and everything changed. The envy two of the stethoscope was unsurprisingly, a doctor. Rene line neck was born in Brittany in seventeen eighty one and he went to bed. School in Paris where he learned a practice percussion technique in which the dock taps, their fingers against a patient's chest and list Instead, the sound to deter, and things like, if fluid is building up in the patient's lungs Linux uses,
technique for years and in eighteen, sixteen he's examining a patient and he precocity her torso, but she's a little bit pomp and beyond She's plump he's not getting much found that from progressing He thought about putting his ear right against the patient's breast, but he decided that that would be an appropriate. Shall we took note book netting without any rolled it up into a little cylinder, and he put one and on the patients chest and one and on his ear, he tells us he was struck by how clearly he could hear her heart, beating and her breath found. I was despite a year, the beating of the hard in a manner that was clearer and more distinct than I had ever heard by direct applicant, of the year. He was so impressed by the quality of the sound that he set about, trying to construct the perfect device for listening to the end Colonel sounds of the body all based on that same cylinder, shape.
He said that he became a shell Andrew Maniac cylinder maniac, because he he was convinced that the instrument mediating between the two bodies of the patient and the doktor in proved what the doctor could hear. Use delays to call herb, cylinders out of wood and at first he wanted to call his new device, the cylinder but essential, he sat alone, the stethoscope, which means to explore the chest, but, Linux original stethoscope looks pretty different from the ones or use do today it along two black cylinder. It looks like a small handheld telescope lie. Next. Started using his new invention to listen to the heart sounds and the breeding sounds of all of the patients in his hospital, and he started to indent words to describe the sounds cause. Nobody. Nobody had heard these sounds before lunch. The kid invented away to hear the inner workings of the human body, but that wasn't enough by itself. He wanted to connect
the sounds. He was hearing in his patience with what was actually happening, anatomically inside their bodies and how how do you connect sounds to what's actually happening inside a body you listen to people right before they die He ran around the board listening to all the patients documenting their symptoms. Listening to the sound thing aid and in connecting them to the discovery he would make at their autopsy when they died. He thought every abnormal sound he heard with his stethoscope should correspond. To an end a topical finding during the autopsy, so that, if you hear the sound it equal that anatomical finding later, though, that status cope with a way of practising the autopsy before adaptation became, a cadaver remain world, as future could ever his ring. But this The gave us a way of looking inside of a body before it was dead to see what was causing a particular medical problem.
A relatively short period of time line neck made some key discoveries using his stethoscope. For example. Figured out that when a person has fluid beneath their lungs, they make a sound kind of like a go found idea a sound he called big off any he also discovered, sounds the tract with the different stages of tuberculosis, the number one killer in Europe, but the time minor problem. Tis results linking different diagnoses with anatomical changes in the body that could be detected using his new stethoscope doctors where his colleagues loved it. They felt that every disease would eventually be attacked. To an anatomical finding an anatomical change, some dog There's began using Linux new device themselves, even put a diagram of it in his book. So could make your own quite easily. Or have it made for you by any carpenter and as these actors used the stethoscope to make more important discoveries about the body new category
of disease were created, for example, before the stethoscope. A lot of differ elements were all lumped into one disease called dips, NEA, which means shortness of breath. But after lie, neck shortness of breath became a symptom of various heart or lung problems that could be diagnosed using as doctors, invented new and a topical words for diseases like bronchitis, which means the inflammation of the bronchial tubes, the Airways that lead to of the bronchial tubes, the Airways that led to the lungs Little by little, our entire understanding of disease shifted, it became more objective, diseases went from being constellations of symptoms felt subjectively by the patient to anatomic where chemical alterations inside the body detected by the doctor. I insist and help you thought about disease chain the relationships between doctors and patients with the Doktor
suddenly having a lot more power before the stethoscope to be figure had feel sick after the stethoscope to be sick. The doktor had to find something but didn't matter when the patient thought what was wrong with them? It mattered more what the doctor found a lighter teams of actually worried that many doctors were taking his ideas too far. He believed that sending to what patients had to say was still important to understanding disease, but the quest for a bit information about disease was under way in the stethoscope was just the beginning, and we got x rays which do the same thing at the end of the nineteenth century, and now we have cp scanners and MRI than pet skins, and all of these marvellous devices are basically trading upon the same paradigm that the stethoscope brought along that we should be able somehow to image the pathological anatomical abnormalities inside the body to reach the diagnosis when The patient has any symptoms, a tall or not these
new technologies have led to so many important discoveries about the human body and disease. Today we can spot tumors before they become life, threatening and diagnose problems like high blood pressure. Before it his heart disease, but there are also patients today who struggle, because they ve got tons of symptoms, but the doktor can't find anything court on quote wrong with them. Paradigm shift brought on by the stethoscope has pushed doctors and patients further apart. The doktor There is no longer visiting you in your bedroom interviewing you about. Every tiny detail of your experience, and sometimes patients end up feeling like just the collection of data points rather than a whole human being Rene Linux died in eighteen, twenty six, the age of forty five, most likely from tuberculosis,
these. He and his stethoscope helped us understand been two hundred years since he first rolled up his notebook and pressed it to that patients chest medicine looks completely different than it did back then, but somehow the stuff. Has endured. There are certain tools of the trade that we have got rid of. So you don't really doctors carrying around this big black bag. This is Doctor Andrew Bond back he's in a frolic. Just a kid. Doctor and an assistant professor at the Columbia University College of Physicians and surgeons, most doctors, nowadays, don't carry around reflex hammers unless they're neurologists, most doctors, don't wear that light on their head, but the stethoscope never really fallen out of practice. But, of course, matters are walking around with wooden cylinders, anymore and aid forties, they began experimenting with flexible tubing and soon after
An irish physician invented the minority stethoscope design with two earpieces we still use today, there are a few. I'm a specialised telescopes for particular types of listening and more recently, companies have developed electronic stethoscopes with enhanced sound quality and the ability to record but to this day, when you walk into a doctor's office for a routine exam, you can expect if. The old familiar stethoscope sliding along your back, but that could be changing for almost two hundred years, the trusty stethoscope has been at the forefront of the diagnostic procedure, constantly hanging around the necks of doctors and often used, but new technology is threatening to exile. This old friend to the archives of medical history, x rays and ultra sound have given. Doctors are clearer window into the body than ever before and with new port. Author, so machines, doctors can see an image, of a hole in a patient's heart right from the bedside
the rise of portable ultra sound. Has some doctors arguing that we don't need the stethoscope anymore? They say that if you have that technology, why not use it right away, but also sound, is in valuable in many developing countries and even in the United States, its expensive If we eliminated the stethoscope and everybody got an ultra sounded every visit, we would bankrupt our healthcare system. This is doctor. Dan Bernstein, a cardiologist at Stanford University. He says that when he hears something problematic during the stethoscope exam he immediately orders and ultra sound, but do I start with every patient comes in the emergency room, taking out profound machine looking the ones, I think, that's not a good use of their technology. Right now. He says the stethoscope functions as a screening tool so that peace Don't need to go, get an expensive ultrasound unless they need one step
there is no denying that advanced imaging has changed the instruments, role, Doktor Andrew I'm back says that medical students today are as good listening to the body as they once were an across the board doctors, rely less on the stethoscope to make a diagnosis. Become almost a ritual more than a actual all of the trade in terms of helping make diagnoses recently one of doktor bomb, backs most respected. Colleagues ass. To borrow a stethoscope and bomb back was embarrassed, he handed it over anyway, and he said. Oh, it thanks that's perfect unity and, as he was walking away he's like you, know, patient justice over anyway, and he You said, I think, that's perfect unity and, as he was walking away he's like you know, patient just expected to have this. When you see them, I'm not going to really need to use it.
But that is a funny story, because here someone that I consider the consummate clinician and he He was acknowledging that the stethoscope. What in many ways just sort of a problem, but it's an omnipresent, prop prob, If you do a Google in its search for doktor right away, you'll notice a couple of things about what a physician is supposed to look like most of the doctors pictured on First page of results are white men in white coats, some of them. Our peering inside a patient's ears. Other are writing something down the clipboard, but all of them have stethoscopes. But what I find so intriguing about the Google images searches for doktor- his knowledge every doctoring stethoscope, but they are most all wearing the stethoscope in the exact same way, which is like a shawl around the I gotta neck with the your pieces on one side and the bell on the other bombast says This way of wearing stethoscope draped over the shoulders
is a relatively recent fashioned trend. The first time I remember seeing that was the television, show ye and then, on Scrubbs, which is another very popular medical tv, show doctors used aware there, Ceta scopes dangling down the front of the shirt like a tie, and this was practical you needed to use your stethoscope in a hurry. You just pop that interiors, it's almost like this new version of wearing it like a scar for Shaw. Shawl is almost a concession that it's more fashion accessory, then actually, a too There were using but Eve if the stethoscope exam has become something of a ritual. It doesn't mean that doctors are ready to give it up. I mean I would never give up my set the scope, because I think, in the very least it's this conduit to connecting with the patient back says that physical kind- tax between a doctor and a patient has become increasingly rare. Doctors, vis It's a short.
Physicians often spend half the time staring at a computer screen. The stethoscope provides an important opportunity for intimacy The stethoscope is still apart. The exam that is still very much aligned with that idea of the laying down of hands at a healer can do when we go to do the physical exam we move away from our day we move away from the computer. We stand right next to the patient and it's more intimate conversation and even with all these powerful tool, walls for measuring. What's going on inside a body intimate, conversations are still really important in medicine, doktor bomb back says. He thinks that the stethoscope has come to symbolise the patient, but the doktor is there to listen and whether we are actually listening to their heart or their lungs is probably not that important. But what they really want to know is ever listening to what they say to it. Years gave way to more objective observation of the body this term
since own understanding of their disease, gave way It's a more objective observation of the body. This time Put a certain amount of distance between doctors and patients today, maybe this at the scope lives on to keep physicians and patients from drifting too far apart to make sure doctors keep close to their patience and keep listening.
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One is made by this company echo, which is based right here in Berkeley and their stethoscope can record a patient's heartbeat display the wave and are even working on software that can help doctors identify irregularities. I stopped by their offices and ask them to record my heart. They press. The device to my chest and a little way form popped up on a smartphone the top. Here you see the heart start to fire, yet she she that's called the p wave right there. That's ECHO founder Connor Land Graph and why he is not a doktor. He says my heart looks healthy, pretty normal Can we found nothing really interesting, looking there, unfortunately, for the areas, fortunately for you, so just to send us off here. I unfortunate heartbeat
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Transcript generated on 2020-02-14.