1 00:00:01,280 --> 00:00:04,320 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,360 --> 00:00:13,480 Speaker 1: of I Heart Radio. Hello and welcome to the podcast. 3 00:00:13,520 --> 00:00:16,919 Speaker 1: I'm Holly Fry and I'm Tracy Wilson. One of the 4 00:00:16,960 --> 00:00:20,840 Speaker 1: most basic tools of the medical profession is a stethoscope. Yep, 5 00:00:21,120 --> 00:00:26,120 Speaker 1: nursing also, yeah, well the medical profession would include nurses. 6 00:00:26,760 --> 00:00:29,240 Speaker 1: I feel like we've had people argue with us about that. 7 00:00:30,200 --> 00:00:32,800 Speaker 1: I mean, it's all medicine. I'm not calling anybody a doctor. 8 00:00:33,760 --> 00:00:35,720 Speaker 1: If you have been to a doctor or a nurse 9 00:00:35,760 --> 00:00:37,280 Speaker 1: at any point in your life, and I hope you 10 00:00:37,280 --> 00:00:39,839 Speaker 1: do get the health care you need, you have probably 11 00:00:39,880 --> 00:00:42,519 Speaker 1: had some experience with a stethoscope, and I wanted to 12 00:00:42,560 --> 00:00:45,360 Speaker 1: peek at how they developed, just as a random Hey 13 00:00:45,360 --> 00:00:48,800 Speaker 1: where'd that come from? And then I accidentally landed on 14 00:00:48,880 --> 00:00:52,240 Speaker 1: another French medicine episode. I swear that was not my goal. 15 00:00:52,440 --> 00:00:55,520 Speaker 1: There are just so many there are. There was like 16 00:00:55,560 --> 00:00:58,319 Speaker 1: this cluster of time where France was doing a lot 17 00:00:58,320 --> 00:01:02,160 Speaker 1: of interesting things in in medicine. And that's because to 18 00:01:02,200 --> 00:01:05,520 Speaker 1: talk about the stethoscope, we have to talk first about 19 00:01:05,680 --> 00:01:10,360 Speaker 1: its inventor, reneet Field. He has sent lank and then 20 00:01:10,400 --> 00:01:13,479 Speaker 1: we're going to discuss how his original design which didn't 21 00:01:13,480 --> 00:01:15,560 Speaker 1: look like what we think of when we think of 22 00:01:15,560 --> 00:01:18,840 Speaker 1: a stethoscope, now changed in the hands of physicians who 23 00:01:18,880 --> 00:01:23,120 Speaker 1: wanted to improve on that original. Yeah, when we say change, 24 00:01:23,120 --> 00:01:24,920 Speaker 1: when I when I was looking for a picture to 25 00:01:25,000 --> 00:01:28,240 Speaker 1: go with this on our social media, there are pictures 26 00:01:28,240 --> 00:01:31,800 Speaker 1: of some of his actual stethoscopes. They are not recognizable 27 00:01:32,000 --> 00:01:35,399 Speaker 1: as a stethoscope unless you are maybe a medical historian 28 00:01:35,440 --> 00:01:39,119 Speaker 1: that knows what it looked like at that point. Yeah, 29 00:01:39,160 --> 00:01:41,880 Speaker 1: there are some in museums, uh. And there have even 30 00:01:41,920 --> 00:01:44,960 Speaker 1: been some cute staged photos throughout the years of people 31 00:01:45,520 --> 00:01:49,520 Speaker 1: using them to show how they worked. But they, yeah, 32 00:01:49,520 --> 00:01:51,320 Speaker 1: they don't look like what you would walk into a 33 00:01:51,320 --> 00:01:55,480 Speaker 1: doctor's office and see today. So Lani was born on 34 00:01:55,640 --> 00:01:59,960 Speaker 1: February seventeen eighty one in Campaire, on the far way 35 00:02:00,240 --> 00:02:04,800 Speaker 1: side of France in Brittany. His father, Teo fiel Marie Link, 36 00:02:05,040 --> 00:02:08,960 Speaker 1: was a civil servant and this family wasn't especially comfortable. 37 00:02:09,200 --> 00:02:12,280 Speaker 1: Part of that was because Teo field Marie was pretty 38 00:02:12,280 --> 00:02:17,600 Speaker 1: careless with the finances. Renee's mother, Michelle Felicete Gudstone, died 39 00:02:17,600 --> 00:02:22,000 Speaker 1: of tuberculosis when Renee was five, and he, along with 40 00:02:22,080 --> 00:02:25,680 Speaker 1: his brother, went to live with the Abbe Lanek, who 41 00:02:25,760 --> 00:02:30,760 Speaker 1: was his granduncle. He never was described as particularly hardy. 42 00:02:30,919 --> 00:02:33,400 Speaker 1: As a child, he had a lot of fevers. He 43 00:02:33,520 --> 00:02:36,400 Speaker 1: was described as physically weak, and it's believed that he 44 00:02:36,440 --> 00:02:40,880 Speaker 1: had asthma in his early years. Lannik was an artistic child. 45 00:02:40,960 --> 00:02:43,120 Speaker 1: He wrote poetry and he learned to play the flute. 46 00:02:43,280 --> 00:02:45,440 Speaker 1: He would actually play the flute throughout his life, and 47 00:02:45,480 --> 00:02:48,679 Speaker 1: some people draw a line between that in his original invention. 48 00:02:49,360 --> 00:02:52,200 Speaker 1: You'll see why when we talk about what it looked like. Uh, 49 00:02:52,240 --> 00:02:54,960 Speaker 1: he may have actually gone into a less scientific field 50 00:02:55,000 --> 00:02:58,280 Speaker 1: than medicine, given his proclivity towards the arts. Had he 51 00:02:58,320 --> 00:03:01,120 Speaker 1: not moved to Not at the twelve to live with 52 00:03:01,160 --> 00:03:05,960 Speaker 1: another uncle. This one was Dr Guillaume Flancis Lank and 53 00:03:06,000 --> 00:03:09,240 Speaker 1: in his new home it seems that Renee really flourished academically. 54 00:03:09,880 --> 00:03:13,080 Speaker 1: He had already studied Latin and Greek with his other uncle, 55 00:03:13,200 --> 00:03:16,400 Speaker 1: and in his new home he added English and German 56 00:03:16,440 --> 00:03:19,600 Speaker 1: to the list of languages that he spoke. Uncle Guillaume 57 00:03:19,919 --> 00:03:22,680 Speaker 1: was dean of the Faculty de Medicin at the University 58 00:03:22,680 --> 00:03:26,440 Speaker 1: of Nantes, and soon Renee was assisting him at the 59 00:03:26,520 --> 00:03:31,120 Speaker 1: Hotel Dieu, treating wounded from conflicts between revolutionaries and counter 60 00:03:31,200 --> 00:03:35,480 Speaker 1: revolutionaries in the area. At fourteen, Renee Laonik was assisting 61 00:03:35,560 --> 00:03:37,720 Speaker 1: his uncle and he was learning to dress wounds and 62 00:03:37,760 --> 00:03:40,920 Speaker 1: look after patients, and just four years later, in sevente 63 00:03:41,920 --> 00:03:44,720 Speaker 1: he was appointed to a post as third class surgeon 64 00:03:44,840 --> 00:03:48,760 Speaker 1: at the known military hospital before transferring to the Hospice 65 00:03:48,800 --> 00:03:52,440 Speaker 1: de la Frater. But that second post was also short 66 00:03:52,640 --> 00:03:55,920 Speaker 1: because in eighteen hundred Lantik moved to Paris to study 67 00:03:56,000 --> 00:04:01,040 Speaker 1: the section with expert anonomist Guillaume de p at Ecul Practique. 68 00:04:01,520 --> 00:04:04,720 Speaker 1: Lantic also studied with other luminaries of French medicine at 69 00:04:04,720 --> 00:04:08,560 Speaker 1: the time, as medical knowledge expanded rapidly. While still a 70 00:04:08,600 --> 00:04:11,680 Speaker 1: medical student working hard enough to gain top honors, he 71 00:04:11,760 --> 00:04:15,400 Speaker 1: also started publishing papers on a variety of medical topics 72 00:04:15,440 --> 00:04:20,040 Speaker 1: that started in eighteen o two. Before completing his medical degree. 73 00:04:20,320 --> 00:04:22,920 Speaker 1: He had the distinction of being the first person in 74 00:04:23,080 --> 00:04:26,200 Speaker 1: medicine to lecture on melanoma, which he did in eighteen 75 00:04:26,240 --> 00:04:29,240 Speaker 1: o four. Also in eighteen o four, he wrote his 76 00:04:29,320 --> 00:04:36,560 Speaker 1: thesis propos depocrat Relatives a Lamedic and Platique that's Proposals 77 00:04:36,560 --> 00:04:39,960 Speaker 1: on the Doctrine of Hippocrates relative to practical medicine. So 78 00:04:40,400 --> 00:04:43,120 Speaker 1: he was talking about all of the work of Hippocrates 79 00:04:43,160 --> 00:04:47,440 Speaker 1: and how it applied to medicine in his contemporary time. 80 00:04:47,920 --> 00:04:50,279 Speaker 1: And he graduated from medical school as a result of 81 00:04:50,320 --> 00:04:53,200 Speaker 1: completing that, and he was invited to join the faculty 82 00:04:53,279 --> 00:04:55,839 Speaker 1: of the Society of the School of Medicine in Paris. 83 00:04:56,440 --> 00:04:58,680 Speaker 1: His melanoma lecture that he had given while still a 84 00:04:58,760 --> 00:05:01,960 Speaker 1: student was published in eighteen o six. At this point 85 00:05:02,000 --> 00:05:04,119 Speaker 1: it really seemed like his career was on the rise. 86 00:05:04,480 --> 00:05:07,720 Speaker 1: He already built a reputation through his writing. He had 87 00:05:07,720 --> 00:05:11,360 Speaker 1: made the discovery that tubercal lesions, which are the nodules 88 00:05:11,400 --> 00:05:15,039 Speaker 1: that form in the tissues of patients with tuberculosis, he 89 00:05:15,160 --> 00:05:17,880 Speaker 1: discovered that those lesions could form anywhere in the body, 90 00:05:18,040 --> 00:05:21,320 Speaker 1: not just in the lungs. Previously to this work, that 91 00:05:21,440 --> 00:05:23,360 Speaker 1: was what people thought that it was only in the lungs. 92 00:05:24,120 --> 00:05:26,920 Speaker 1: This actually tied to his work on melanoma because he 93 00:05:27,000 --> 00:05:31,680 Speaker 1: actually had discovered the distinction between lesions from melanoma and 94 00:05:31,920 --> 00:05:35,440 Speaker 1: lesions from consumption. Because he had studied with some of 95 00:05:35,440 --> 00:05:38,680 Speaker 1: the greatest medical experts of the time and had written 96 00:05:38,760 --> 00:05:42,960 Speaker 1: extensively about his studies and tuberculosis as well as peritonitis 97 00:05:43,160 --> 00:05:46,760 Speaker 1: and a minorrhea. He was recognized for a high level 98 00:05:46,839 --> 00:05:49,719 Speaker 1: of expertise in the field, and that was in spite 99 00:05:49,720 --> 00:05:53,039 Speaker 1: of his young age. His life was soon to have 100 00:05:53,120 --> 00:05:56,520 Speaker 1: some difficulties though. In a short span of time, Lenk 101 00:05:56,760 --> 00:05:59,800 Speaker 1: had a falling out with his mentor Deo and his 102 00:06:00,080 --> 00:06:03,640 Speaker 1: goal like his mother, died from tuberculosis. The issue with 103 00:06:03,720 --> 00:06:08,320 Speaker 1: Dup was rooted in his melanoma paper. His mentor had 104 00:06:08,360 --> 00:06:10,840 Speaker 1: also worked on similar research and felt that he had 105 00:06:10,880 --> 00:06:14,240 Speaker 1: not been properly credited in laon X work. That was 106 00:06:14,279 --> 00:06:18,920 Speaker 1: particularly insulting too, because his student was credited with having 107 00:06:18,960 --> 00:06:23,279 Speaker 1: discovered melanoma with no mention of de Potan's work at all. 108 00:06:23,920 --> 00:06:26,280 Speaker 1: The two men actually thought about this for several years, 109 00:06:26,800 --> 00:06:29,080 Speaker 1: and the stress of this and the loss of his 110 00:06:29,160 --> 00:06:32,359 Speaker 1: uncle caused laon X medical issues to flare up to 111 00:06:32,400 --> 00:06:34,280 Speaker 1: the point where he had to take a break from 112 00:06:34,320 --> 00:06:36,680 Speaker 1: his work and take a leave of absence, and during 113 00:06:36,720 --> 00:06:39,080 Speaker 1: that time he visited Brittany where he was born, to 114 00:06:39,160 --> 00:06:43,640 Speaker 1: relax and recover. When he felt better, renee Leonek returned 115 00:06:43,680 --> 00:06:45,600 Speaker 1: to Paris to try to pick up where he had 116 00:06:45,680 --> 00:06:49,360 Speaker 1: left off his private practice of medicine. Went pretty well. 117 00:06:49,360 --> 00:06:52,200 Speaker 1: He had lots of patience, and he became part owner 118 00:06:52,240 --> 00:06:55,800 Speaker 1: and editor of Journal de Medicine, which was not surprising 119 00:06:55,960 --> 00:06:59,080 Speaker 1: considering how much medical writing had been part of his career. 120 00:07:00,080 --> 00:07:02,960 Speaker 1: What he was hoping was that he would also get 121 00:07:02,960 --> 00:07:06,799 Speaker 1: a job in a leadership position on a Parisian hospital staff. 122 00:07:07,080 --> 00:07:10,680 Speaker 1: That didn't happen, though. In eighteen o eight he founded 123 00:07:10,760 --> 00:07:15,160 Speaker 1: attny Medical that's Medical Athenaeum, which was also eventually absorbed 124 00:07:15,200 --> 00:07:18,600 Speaker 1: in the academic society of Paris. This was a time 125 00:07:18,640 --> 00:07:21,520 Speaker 1: when Lanek, who had always been a devout Roman Catholic, 126 00:07:21,600 --> 00:07:24,920 Speaker 1: really recommitted to his religion, and that led to his 127 00:07:24,960 --> 00:07:29,160 Speaker 1: appointment as the personal physician of Cardinal Joseph Fish. That 128 00:07:29,240 --> 00:07:32,400 Speaker 1: religious devotion was the reason he found his aspirations at 129 00:07:32,400 --> 00:07:35,200 Speaker 1: a hospital job a little bit out of reach, because 130 00:07:35,240 --> 00:07:39,000 Speaker 1: while France was very Catholic, the academic community actually found 131 00:07:39,080 --> 00:07:42,040 Speaker 1: Lanek too conservative, and they thought he was a bit 132 00:07:42,080 --> 00:07:44,800 Speaker 1: out of step with his contemporaries, even though he was 133 00:07:44,880 --> 00:07:48,400 Speaker 1: making a lot of significant discoveries. During the War of 134 00:07:48,440 --> 00:07:52,440 Speaker 1: eighteen twelve, while still working for Cardinal Fish, Lane headed 135 00:07:52,480 --> 00:07:56,000 Speaker 1: up the care of wounded soldiers in Paris's salth Petriere Hospital. 136 00:07:56,760 --> 00:08:00,280 Speaker 1: All the hospital's wounded soldiers were given beds in words 137 00:08:00,320 --> 00:08:03,480 Speaker 1: that Lanek led, and two years later his position with 138 00:08:03,520 --> 00:08:06,840 Speaker 1: the Cardinal ended was the French ambassador to the Vatican 139 00:08:06,920 --> 00:08:10,840 Speaker 1: and more importantly, Napoleon's half brother. So when Napoleon fell, 140 00:08:11,040 --> 00:08:14,160 Speaker 1: he was exiled. Land X job was gone at that point. 141 00:08:14,680 --> 00:08:18,040 Speaker 1: In eighteen sixteen, Laonex finally got that position that had 142 00:08:18,080 --> 00:08:21,920 Speaker 1: always eluded him, an appointment as a hospital physician. He 143 00:08:22,000 --> 00:08:25,040 Speaker 1: was hired at Neck Hospital as head of hospital service, 144 00:08:25,080 --> 00:08:28,680 Speaker 1: and that same year he also created the medical apparatus 145 00:08:28,760 --> 00:08:32,040 Speaker 1: that would change medicine. That new position at the hospital 146 00:08:32,200 --> 00:08:36,000 Speaker 1: was not entirely a joyous appointment, however, it had opened 147 00:08:36,080 --> 00:08:38,800 Speaker 1: up because one of laon X mentors and his close friend, 148 00:08:38,960 --> 00:08:43,240 Speaker 1: Gaspar Laurent Bail, had died of tuberculosis. We're about to 149 00:08:43,240 --> 00:08:45,840 Speaker 1: talk about the moment of inspiration that led to the 150 00:08:45,840 --> 00:08:48,600 Speaker 1: first stath scope, but first we're going to take a 151 00:08:48,640 --> 00:09:01,480 Speaker 1: moment of our own responsive break. The story of the 152 00:09:01,480 --> 00:09:05,959 Speaker 1: stethoscope's actual moment of invention has taken on a few inconsistencies, 153 00:09:06,000 --> 00:09:10,120 Speaker 1: as we frequently see when it comes to historically significant events, 154 00:09:10,160 --> 00:09:13,080 Speaker 1: but these actually aren't too wildly varied. They mostly just 155 00:09:13,160 --> 00:09:18,160 Speaker 1: involved the timing of this inspiration. That inspiration was Lank 156 00:09:18,400 --> 00:09:22,760 Speaker 1: witnessing two children playing in the courtyard of Lularufe Palace. 157 00:09:23,440 --> 00:09:26,040 Speaker 1: So he's said to have seen these two kids using 158 00:09:26,040 --> 00:09:29,000 Speaker 1: a long piece of wood to send signals to each other. 159 00:09:29,120 --> 00:09:31,640 Speaker 1: They would scratch the end of the solid piece with 160 00:09:31,720 --> 00:09:34,720 Speaker 1: a pin. One child was doing the scratching while the 161 00:09:34,760 --> 00:09:37,360 Speaker 1: other one listened on the other end, listening for the 162 00:09:37,400 --> 00:09:40,600 Speaker 1: sound to travel through the wood. So in some versions 163 00:09:40,840 --> 00:09:43,280 Speaker 1: of this story he sees this happening and then a 164 00:09:43,280 --> 00:09:45,840 Speaker 1: lot of time passes before he tries to put it 165 00:09:45,880 --> 00:09:49,040 Speaker 1: into use. But in others, he was walking on the 166 00:09:49,080 --> 00:09:51,280 Speaker 1: way to see a patient when he saw these two 167 00:09:51,400 --> 00:09:55,200 Speaker 1: kids doing this. Either way, though, the kids and their 168 00:09:55,280 --> 00:10:00,560 Speaker 1: wooden sound conveyance are credited with inspiring Land. When the 169 00:10:00,640 --> 00:10:04,080 Speaker 1: doctor himself wrote about it, though he did not mention 170 00:10:04,160 --> 00:10:09,800 Speaker 1: these kids, he did mention the pen scratching a would beam. Yes, 171 00:10:09,920 --> 00:10:13,760 Speaker 1: he wrote it quote, I recalled a well known acoustic phenomenon. 172 00:10:14,000 --> 00:10:16,080 Speaker 1: If you place your ear against one end of a 173 00:10:16,120 --> 00:10:18,160 Speaker 1: would beam, the scratch of a pin at the other 174 00:10:18,320 --> 00:10:21,960 Speaker 1: end is distinctly audible. It occurred to me that this 175 00:10:22,000 --> 00:10:25,000 Speaker 1: physical property might serve a useful purpose in the case 176 00:10:25,040 --> 00:10:28,040 Speaker 1: I was dealing with. I then tightly rolled a sheet 177 00:10:28,080 --> 00:10:30,800 Speaker 1: of paper, one end of which I placed over the 178 00:10:30,800 --> 00:10:34,280 Speaker 1: precordium chest and my ear to the other. I was 179 00:10:34,320 --> 00:10:37,320 Speaker 1: surprised and elated to be able to hear the beating 180 00:10:37,400 --> 00:10:40,280 Speaker 1: of her heart with far greater clearness than I ever 181 00:10:40,360 --> 00:10:44,120 Speaker 1: had with direct application of my ear. I immediately saw 182 00:10:44,160 --> 00:10:47,640 Speaker 1: that this might become an indispensable method for studying not 183 00:10:47,760 --> 00:10:50,640 Speaker 1: only the beating of the heart, but all movements able 184 00:10:50,640 --> 00:10:54,920 Speaker 1: of producing sound in the chest cavity or jumping ahead 185 00:10:55,000 --> 00:10:57,960 Speaker 1: just a bit, though, because the case at hand was 186 00:10:58,040 --> 00:11:01,800 Speaker 1: also a source of inspiration, and this is often described 187 00:11:01,800 --> 00:11:05,360 Speaker 1: as lanex solving a problem of embarrassments as much as 188 00:11:05,640 --> 00:11:09,400 Speaker 1: one of medical met In September of eighteen sixteen, the 189 00:11:09,480 --> 00:11:11,559 Speaker 1: doctor was called to see a young woman who had 190 00:11:11,679 --> 00:11:15,679 Speaker 1: quote general symptoms of a diseased heart. He wanted to 191 00:11:15,720 --> 00:11:19,800 Speaker 1: listen to her chest to be clear asqultation, which is 192 00:11:19,920 --> 00:11:22,559 Speaker 1: listening to the sound of a patient's heart, lungs, or 193 00:11:22,600 --> 00:11:25,920 Speaker 1: other organs. That was not a new idea. In eighteen sixteen, 194 00:11:26,400 --> 00:11:30,320 Speaker 1: Hippocrates had made references to internal sounds as a means 195 00:11:30,360 --> 00:11:34,640 Speaker 1: of diagnosis, and doctors who preceded Lanek had theorized that 196 00:11:34,720 --> 00:11:38,160 Speaker 1: some sort of mechanism might eventually be developed that would 197 00:11:38,240 --> 00:11:42,160 Speaker 1: enable physicians to listen to their patient's bodily sounds. But 198 00:11:42,280 --> 00:11:46,319 Speaker 1: more specifically leading up to this particular moment and influencing 199 00:11:46,400 --> 00:11:50,840 Speaker 1: leon x idea was the work of Viennese doctor Leopold Aumbruger. 200 00:11:51,480 --> 00:11:53,640 Speaker 1: He had used an idea that he had seen in 201 00:11:53,720 --> 00:11:56,640 Speaker 1: his youth his father tapping a barrel to see how 202 00:11:56,679 --> 00:11:59,959 Speaker 1: full it was, and applied that concept to medical exam 203 00:12:00,040 --> 00:12:03,360 Speaker 1: do nations. He determined that a human chest that was 204 00:12:03,400 --> 00:12:05,880 Speaker 1: filled with fluid would sound dull when you tapped it, 205 00:12:06,160 --> 00:12:09,680 Speaker 1: whereas a healthy human chest cavity would have resonance when tapped. 206 00:12:10,240 --> 00:12:13,120 Speaker 1: And this percussive diagnosis method was something that had been 207 00:12:13,160 --> 00:12:16,760 Speaker 1: written about in the eighteenth century and translated into French 208 00:12:16,800 --> 00:12:21,480 Speaker 1: by Napoleon's doctor Jean Nicola, who was also one of 209 00:12:21,559 --> 00:12:25,360 Speaker 1: Latin teachers in eighteen o eight. Aside from tapping on 210 00:12:25,400 --> 00:12:29,400 Speaker 1: a patient's chest, the other method for collecting information for 211 00:12:29,559 --> 00:12:34,320 Speaker 1: diagnosis of chest ailments was immediate ascultation, which meant that 212 00:12:34,360 --> 00:12:37,560 Speaker 1: the doctor would put their head directly onto the patient's 213 00:12:37,640 --> 00:12:41,600 Speaker 1: chest and listen. But in this particular case, Lanik was 214 00:12:41,679 --> 00:12:44,880 Speaker 1: reluctant because of the patient's age and sex. He did 215 00:12:44,920 --> 00:12:47,240 Speaker 1: not want to put his head up against her chest. 216 00:12:48,240 --> 00:12:51,679 Speaker 1: And this is when he recalled the idea that we 217 00:12:51,760 --> 00:12:55,800 Speaker 1: just quoted. Because he recognized he could actually hear better 218 00:12:55,920 --> 00:12:58,040 Speaker 1: with his rolled up sheet of paper than with his 219 00:12:58,080 --> 00:13:01,599 Speaker 1: ear alone. Started him down a path of experimenting to 220 00:13:01,760 --> 00:13:05,720 Speaker 1: further develop this idea, and that came to be called 221 00:13:06,160 --> 00:13:09,920 Speaker 1: mediate ascultation. Yeah, we're going to talk about percussion again 222 00:13:09,960 --> 00:13:12,280 Speaker 1: a bit towards the end of the episode, but they 223 00:13:12,320 --> 00:13:15,080 Speaker 1: were kind of tied up together as this, like, listen 224 00:13:15,160 --> 00:13:17,920 Speaker 1: to the sounds the body makes and you will figure 225 00:13:17,960 --> 00:13:22,440 Speaker 1: things out. So he did as Tracy said, start experimenting 226 00:13:22,480 --> 00:13:25,720 Speaker 1: and created multiple versions, and his refined versions, which he 227 00:13:25,720 --> 00:13:28,480 Speaker 1: worked on for several years, still did not ever really 228 00:13:28,480 --> 00:13:31,960 Speaker 1: look like the stethoscopes were familiar with today. Remember, for 229 00:13:32,040 --> 00:13:34,480 Speaker 1: one thing, things like rubber tubing were just not around yet. 230 00:13:35,200 --> 00:13:39,040 Speaker 1: Lane focused on creating his stethoscopes out of wood. He 231 00:13:39,080 --> 00:13:42,240 Speaker 1: had experimented with other materials, but he found a hollow 232 00:13:42,240 --> 00:13:46,120 Speaker 1: wooden tube to produce the best sound. Sometimes people attribute 233 00:13:46,120 --> 00:13:48,520 Speaker 1: this back to his work playing the flute and how 234 00:13:48,559 --> 00:13:51,720 Speaker 1: he made that connection. But it's not entirely clear, but 235 00:13:51,800 --> 00:13:54,360 Speaker 1: he created a chest piece that fitted at one end 236 00:13:54,480 --> 00:13:57,440 Speaker 1: and further improved his ability to hear. And then he 237 00:13:57,520 --> 00:14:00,760 Speaker 1: made his stethoscope into two pieces that could be unscrewed 238 00:14:00,800 --> 00:14:03,360 Speaker 1: for ease of carrying, and then they could be quickly 239 00:14:03,360 --> 00:14:05,559 Speaker 1: screwed back together so that a doctor could use them 240 00:14:05,559 --> 00:14:10,400 Speaker 1: for diagnosis. In eighteen eighteen, Renee Lanek gave a presentation 241 00:14:10,440 --> 00:14:13,920 Speaker 1: about his stethoscope at the Paris Academy of Sciences. In 242 00:14:13,960 --> 00:14:17,199 Speaker 1: eighteen nineteen, he published a two volume book about his work, 243 00:14:17,720 --> 00:14:21,640 Speaker 1: was Mediate Ascultation or Treatise on Diagnosis of Lung and 244 00:14:21,680 --> 00:14:25,720 Speaker 1: Heart Diseases. He described his stethoscope in its This was 245 00:14:25,760 --> 00:14:28,400 Speaker 1: twenty five centimeters long and three and a half centimeters 246 00:14:28,400 --> 00:14:31,680 Speaker 1: in diameter, and the name for the stethoscope didn't come 247 00:14:31,680 --> 00:14:35,640 Speaker 1: into print until eighteen twenty. Before that, he just called 248 00:14:35,720 --> 00:14:39,800 Speaker 1: his device lu Celand, which if you see some pictures 249 00:14:39,840 --> 00:14:42,720 Speaker 1: of it, it just it looks like a cylinder. Does 250 00:14:42,800 --> 00:14:46,160 Speaker 1: not see how any fancy adornments. There's no like ear 251 00:14:46,280 --> 00:14:50,720 Speaker 1: trumpet kind of shape to it just looks like a cylinder. Eventually, 252 00:14:50,760 --> 00:14:53,280 Speaker 1: though he went with the root of stethos, which was 253 00:14:53,320 --> 00:14:56,400 Speaker 1: the Greek word for chest. Yeah, you'll see that second 254 00:14:56,480 --> 00:14:58,920 Speaker 1: part of the word. The scope attributed to like a 255 00:14:59,240 --> 00:15:03,680 Speaker 1: jillion diff rent words to create this portmanteau, everything from 256 00:15:03,680 --> 00:15:07,160 Speaker 1: Greek words to French words to um, you know some 257 00:15:07,280 --> 00:15:09,200 Speaker 1: that just go well, let's scope because it's a scope, 258 00:15:09,240 --> 00:15:14,120 Speaker 1: which is pretty funny. Uh uh. He also included in 259 00:15:14,120 --> 00:15:18,720 Speaker 1: that that work, his two volume book, extensive research that 260 00:15:18,800 --> 00:15:21,680 Speaker 1: he had done using this invention. He treated a lot 261 00:15:21,720 --> 00:15:24,880 Speaker 1: of patients with pneumonia and he used this stethoscope in 262 00:15:24,960 --> 00:15:28,600 Speaker 1: assessing their conditions. When any of his patients died, he 263 00:15:28,680 --> 00:15:32,240 Speaker 1: performed autopsies, and he found that the conclusions he had 264 00:15:32,240 --> 00:15:35,240 Speaker 1: been able to reach using his new instrument were corroborated 265 00:15:35,280 --> 00:15:39,600 Speaker 1: by what he found. Lane stethoscope was quickly recognized as 266 00:15:39,600 --> 00:15:43,560 Speaker 1: invaluable for diagnosis, and as his book was translated, starting 267 00:15:43,560 --> 00:15:47,160 Speaker 1: in eighty one in London, doctors from around the European 268 00:15:47,240 --> 00:15:50,120 Speaker 1: continent soon we're eager to learn how to use it, 269 00:15:50,160 --> 00:15:52,360 Speaker 1: and a lot of them traveled to Paris to hear 270 00:15:52,480 --> 00:15:57,720 Speaker 1: lectures from Leonek himself. After this, Lanek continued his medical 271 00:15:57,760 --> 00:16:01,760 Speaker 1: career Ino he was made the chair and Professor of 272 00:16:01,800 --> 00:16:04,360 Speaker 1: Medicine at the College of France, and the year after 273 00:16:04,520 --> 00:16:09,040 Speaker 1: became the Professor of Medicine at Opdachart. He was a 274 00:16:09,040 --> 00:16:13,080 Speaker 1: member of the French Academy of Medicine. Also, he quickly 275 00:16:13,160 --> 00:16:16,800 Speaker 1: garnered such a reputation for really excellent lectures that the 276 00:16:16,960 --> 00:16:20,760 Speaker 1: lecture halls were frequently packed with doctors that wished to 277 00:16:20,800 --> 00:16:24,360 Speaker 1: hear him speak. Lane kept a log of everyone who 278 00:16:24,360 --> 00:16:28,480 Speaker 1: attended his lectures and kept an almost ridiculously busy schedule 279 00:16:28,560 --> 00:16:33,880 Speaker 1: of hospital rounds, lectures and consultations. Yeah, there's a you 280 00:16:33,920 --> 00:16:36,880 Speaker 1: will occasionally find some papers that talk about how you 281 00:16:36,920 --> 00:16:41,120 Speaker 1: can trace laan X through these logs that he kept 282 00:16:41,120 --> 00:16:44,400 Speaker 1: of doctors that attended his lectures, and then how his 283 00:16:44,480 --> 00:16:47,800 Speaker 1: information and his knowledge of pulmonary disease in particular kind 284 00:16:47,800 --> 00:16:51,080 Speaker 1: of propagated throughout the world over time. At this point 285 00:16:51,160 --> 00:16:53,960 Speaker 1: he was in his forties and Laonek kindly settled into 286 00:16:54,040 --> 00:16:57,080 Speaker 1: his now successful career, and he actually got married to 287 00:16:57,160 --> 00:17:01,160 Speaker 1: a widow named Jacquette guilgu and the new leweds wanted 288 00:17:01,160 --> 00:17:04,360 Speaker 1: to start a family that was unfortunately not to be there. 289 00:17:04,400 --> 00:17:08,240 Speaker 1: One pregnancy ended in a miscarriage and Soon after that loss, 290 00:17:08,480 --> 00:17:11,440 Speaker 1: which he took quite hard, his health began to decline. 291 00:17:12,200 --> 00:17:14,760 Speaker 1: He was actually in a little bit of denial about 292 00:17:14,800 --> 00:17:18,000 Speaker 1: this for a while. He had not realized, despite all 293 00:17:18,040 --> 00:17:21,960 Speaker 1: of his work and research in tuberculosis, how very contagious 294 00:17:22,000 --> 00:17:25,879 Speaker 1: it was. There had been discussion of tuberculosis as a 295 00:17:25,880 --> 00:17:29,600 Speaker 1: contagious disease even before his time, but there were also 296 00:17:29,680 --> 00:17:32,560 Speaker 1: theories that it could be hereditary. There were some theories 297 00:17:32,560 --> 00:17:34,880 Speaker 1: that it could even be a type of cancer, so 298 00:17:34,960 --> 00:17:39,600 Speaker 1: it wasn't necessarily uh universally recognized as a contagious disease. 299 00:17:40,280 --> 00:17:43,320 Speaker 1: The term tuberculosis didn't even exist yet. That wouldn't happen 300 00:17:43,400 --> 00:17:46,200 Speaker 1: until the following decade, when it was coined by German 301 00:17:46,280 --> 00:17:50,600 Speaker 1: Dr Johann Shaunlin. But over time he had all the 302 00:17:50,640 --> 00:17:54,800 Speaker 1: tell tale symptoms of tuberculosis. He was finally diagnosed by 303 00:17:54,840 --> 00:17:59,399 Speaker 1: his nephew, married at Lane, using a stethoscope to listen 304 00:17:59,440 --> 00:18:03,960 Speaker 1: to the much beloved doctor. Although Renee Lanek once again 305 00:18:04,000 --> 00:18:06,960 Speaker 1: traveled to Brittany in the spring of eighteen six hoping 306 00:18:06,960 --> 00:18:10,240 Speaker 1: that his health would improve, that did not achieve the 307 00:18:10,280 --> 00:18:14,320 Speaker 1: desired result. He was able to finish a revised edition 308 00:18:14,359 --> 00:18:18,000 Speaker 1: of his book on Mediate Escortation that was published that year. 309 00:18:18,520 --> 00:18:21,679 Speaker 1: It had specific details of certain sounds and what they 310 00:18:21,760 --> 00:18:25,520 Speaker 1: might indicate. This work laid the groundwork for knowledge of 311 00:18:25,520 --> 00:18:29,920 Speaker 1: pulmonary diseases. Lanek died not long after it was completed, 312 00:18:29,960 --> 00:18:34,760 Speaker 1: That was on August. Lan x work continues to be 313 00:18:34,840 --> 00:18:38,359 Speaker 1: part of modern medicine. He was the first to describe 314 00:18:38,440 --> 00:18:41,439 Speaker 1: micronodular cirrosis of the liver, which is still known as 315 00:18:41,520 --> 00:18:45,760 Speaker 1: lan X cirrhosis, and his extensive writing on pulmonary classifications 316 00:18:45,800 --> 00:18:51,440 Speaker 1: is still used. He advanced the medical community's understanding of pneumonia, emphysema, 317 00:18:51,560 --> 00:18:55,000 Speaker 1: and other conditions. There's a coda to this part of 318 00:18:55,000 --> 00:18:58,240 Speaker 1: the story, though, in terms of how Lanik was viewed, 319 00:18:58,320 --> 00:19:01,720 Speaker 1: just a decade after he died. In an eighteen thirty 320 00:19:01,760 --> 00:19:05,440 Speaker 1: eight English language translation of his Treatise on the Diseases 321 00:19:05,480 --> 00:19:09,560 Speaker 1: of the Chest and on Mediate Aescultation, the translator included 322 00:19:09,600 --> 00:19:14,520 Speaker 1: some interesting discussion about Lanox writings about himself. The translator's 323 00:19:14,560 --> 00:19:18,080 Speaker 1: note states in the first paragraph quote, the original treatise 324 00:19:18,119 --> 00:19:21,640 Speaker 1: will remain an imperishable monument of the genius and industry 325 00:19:21,680 --> 00:19:24,720 Speaker 1: of its author, and the discovery of which it treats 326 00:19:24,760 --> 00:19:28,200 Speaker 1: will entitle him to a distinguished rank among the benefactors 327 00:19:28,240 --> 00:19:31,800 Speaker 1: of mankind. As a standard work on the pathology and 328 00:19:31,840 --> 00:19:34,720 Speaker 1: diagnosis of the diseases of the chest, it is not 329 00:19:34,800 --> 00:19:37,840 Speaker 1: only without an equal, but may be considered as almost 330 00:19:37,880 --> 00:19:41,680 Speaker 1: perfect in its kind. But then, a couple of paragraphs down, 331 00:19:41,880 --> 00:19:46,160 Speaker 1: after continuing to mention the importance of escultation, the same 332 00:19:46,200 --> 00:19:49,359 Speaker 1: translator rights quote. At the same time, it would be 333 00:19:49,440 --> 00:19:53,280 Speaker 1: exacting too much from the weakness of humanity to expect 334 00:19:53,280 --> 00:19:56,800 Speaker 1: that the author of mediate ascultation should in no case 335 00:19:56,880 --> 00:20:00,520 Speaker 1: have yielded to the enthusiasm naturally inspired aired by the 336 00:20:00,560 --> 00:20:03,840 Speaker 1: consciousness of so great a discovery. And if in a 337 00:20:03,880 --> 00:20:06,159 Speaker 1: few passages of his book he should be found to 338 00:20:06,280 --> 00:20:10,560 Speaker 1: somewhat exaggerate the actual or relative importance of his method, 339 00:20:11,080 --> 00:20:14,160 Speaker 1: or even sometimes to appear rather as the partisan than 340 00:20:14,200 --> 00:20:16,920 Speaker 1: the historian of the stethoscope, i am sure that a 341 00:20:17,000 --> 00:20:19,399 Speaker 1: fault so venal and in such a man ought not 342 00:20:19,480 --> 00:20:23,520 Speaker 1: to be visited by heavy censure. Especially this says that 343 00:20:23,560 --> 00:20:26,239 Speaker 1: the translator thinks that laon X is puffing up the 344 00:20:26,280 --> 00:20:29,919 Speaker 1: importance of his invention, but that it's also okay, because 345 00:20:29,920 --> 00:20:32,280 Speaker 1: he really was pretty great, and he did advance medicine 346 00:20:32,280 --> 00:20:35,720 Speaker 1: with his work. It's a fascinating way to frame all this, 347 00:20:35,800 --> 00:20:38,760 Speaker 1: and it seems like maybe he's trying to pre address 348 00:20:38,920 --> 00:20:41,520 Speaker 1: critics of laon X, since he also mentions that some 349 00:20:41,560 --> 00:20:45,399 Speaker 1: people claim to have tried the stethoscope and found it unhelpful. 350 00:20:46,080 --> 00:20:49,200 Speaker 1: Just a glimpse into this perception of this device while 351 00:20:49,240 --> 00:20:53,080 Speaker 1: it was still in its infancy after lan x death. Yeah, 352 00:20:53,119 --> 00:20:55,480 Speaker 1: he a lot of doctors were super into it, but 353 00:20:55,520 --> 00:20:57,439 Speaker 1: there were something were like I tried to listen, I 354 00:20:57,440 --> 00:21:02,280 Speaker 1: didn't get anything. So it's just kind of an interesting 355 00:21:02,280 --> 00:21:03,760 Speaker 1: thing to know that there was a little bit of 356 00:21:03,760 --> 00:21:06,280 Speaker 1: controversy as much as as it does sound in a 357 00:21:06,280 --> 00:21:08,920 Speaker 1: lot of ways like the medical community pretty quickly picked 358 00:21:08,960 --> 00:21:11,399 Speaker 1: it up. But you may be wondering what came of 359 00:21:11,440 --> 00:21:14,480 Speaker 1: this invention because it obviously took a number of additional 360 00:21:14,520 --> 00:21:17,280 Speaker 1: turns as it developed into the tool that we see 361 00:21:17,320 --> 00:21:19,720 Speaker 1: commonly in use today. And we're going to talk about 362 00:21:19,760 --> 00:21:21,639 Speaker 1: some of those turns after we first hear from the 363 00:21:21,680 --> 00:21:24,200 Speaker 1: sponsors that keep stuff you missed in history class going. 364 00:21:33,720 --> 00:21:37,640 Speaker 1: Several other physicians contributed to the development of the stethoscope. 365 00:21:37,920 --> 00:21:40,600 Speaker 1: The first change to it actually appeared in the last 366 00:21:40,680 --> 00:21:43,199 Speaker 1: year of lan X life. That was the work of 367 00:21:43,240 --> 00:21:47,120 Speaker 1: Pierre Dave Pierri, who was born thirteen years after Lanek 368 00:21:47,200 --> 00:21:51,760 Speaker 1: on December and he started studying medicine when he was 369 00:21:51,800 --> 00:21:54,800 Speaker 1: just fifteen, and at the age of nineteen he became 370 00:21:55,000 --> 00:21:59,040 Speaker 1: ed chirogien militaire in the Napoleonic Wars when he was 371 00:21:59,160 --> 00:22:02,320 Speaker 1: drafted while he still a medical student. In that role, 372 00:22:02,359 --> 00:22:04,760 Speaker 1: he traveled to Spain and he got a very hands 373 00:22:04,760 --> 00:22:09,040 Speaker 1: on education at a military hospital in Barcelona. Like Laonek, 374 00:22:09,119 --> 00:22:12,560 Speaker 1: he studied medicine with men such as Clarvissard and Bail. 375 00:22:12,600 --> 00:22:15,280 Speaker 1: Once he got back to Paris and in eighteen sixteen 376 00:22:15,359 --> 00:22:18,399 Speaker 1: he completed the thesis that earned him his medical degree 377 00:22:18,920 --> 00:22:21,840 Speaker 1: that was titled on the danger of reading medical text 378 00:22:21,880 --> 00:22:26,159 Speaker 1: books by the laity. He started working at Lakatomie de 379 00:22:26,240 --> 00:22:29,480 Speaker 1: Medicine in eight and he was considered to be a 380 00:22:29,520 --> 00:22:32,760 Speaker 1: gifted teacher. From there he climbed the ladder in Paris's 381 00:22:32,800 --> 00:22:37,040 Speaker 1: medical facilities and became the chair of medicine at in 382 00:22:37,160 --> 00:22:41,600 Speaker 1: eighteen thirty seven. Pierre specialized in percussion as a clinician, 383 00:22:41,720 --> 00:22:43,960 Speaker 1: and that, as we mentioned earlier, is exactly what it 384 00:22:44,000 --> 00:22:46,359 Speaker 1: sounds like tapping parts of the body to gain an 385 00:22:46,440 --> 00:22:49,920 Speaker 1: understanding of the structures and the organs within, and Lanak 386 00:22:49,960 --> 00:22:53,600 Speaker 1: had actually used his cylindrical stethoscope for percussion as well. 387 00:22:53,640 --> 00:22:57,040 Speaker 1: He used it as a tapping tool. But the success 388 00:22:57,080 --> 00:23:00,840 Speaker 1: of the stethoscopes used in oscultation had to eclipse the 389 00:23:00,880 --> 00:23:05,320 Speaker 1: practice of percussion, and Pierre wanted to both replicate lane 390 00:23:05,480 --> 00:23:09,480 Speaker 1: success and reputation and gain his own renown while also 391 00:23:09,560 --> 00:23:14,479 Speaker 1: reiterating the usefulness of percussion as a diagnostic tool. Perhaps 392 00:23:14,480 --> 00:23:17,280 Speaker 1: the most charming thing about his story is that he 393 00:23:17,320 --> 00:23:19,639 Speaker 1: was a poet as well as a physician, and he 394 00:23:19,680 --> 00:23:22,960 Speaker 1: wrote about his work in percussion and his contribution to 395 00:23:23,000 --> 00:23:28,440 Speaker 1: the stethoscope in a poem titled Lamb or God's Soul. 396 00:23:28,480 --> 00:23:32,760 Speaker 1: In Nature and the poem, he described praying to God 397 00:23:32,840 --> 00:23:35,720 Speaker 1: to be able to contribute to the development of medicine 398 00:23:35,720 --> 00:23:39,040 Speaker 1: as Lanek had, and how he was inspired when he 399 00:23:39,080 --> 00:23:41,960 Speaker 1: came aware of the sound he heard when he scratched 400 00:23:42,040 --> 00:23:46,600 Speaker 1: his own chest. Immediately he began to experiment in this area, 401 00:23:47,040 --> 00:23:50,280 Speaker 1: eventually developing a method of placing a small plate between 402 00:23:50,280 --> 00:23:53,280 Speaker 1: the patient's skin and the doctor's finger to both control 403 00:23:53,320 --> 00:23:55,879 Speaker 1: the way the sound was heard and to reduce the 404 00:23:55,960 --> 00:23:58,680 Speaker 1: discomfort to the patient of being tapped in this one 405 00:23:58,760 --> 00:24:03,080 Speaker 1: spot repeatedly. Soon he integrated this plate with a stethoscope. 406 00:24:03,480 --> 00:24:06,440 Speaker 1: An example of Pierre's version of the tool was included 407 00:24:06,520 --> 00:24:09,320 Speaker 1: as an illustration in that same English language translation on 408 00:24:09,440 --> 00:24:12,000 Speaker 1: Lanox work that we referred to just a bit ago, 409 00:24:12,560 --> 00:24:17,360 Speaker 1: and it describes Pierres stethoscope this way quote. This stethoscope 410 00:24:17,440 --> 00:24:20,840 Speaker 1: is constructed exactly on the same principles as that of Lank, 411 00:24:21,000 --> 00:24:25,240 Speaker 1: but with several modifications intended to render it lighter, smaller, 412 00:24:25,280 --> 00:24:28,840 Speaker 1: and more portable. In it, the central bore and conical 413 00:24:28,880 --> 00:24:32,840 Speaker 1: cavity of the pectoral extremity are preserved of the original dimensions, 414 00:24:33,240 --> 00:24:36,320 Speaker 1: but the body of the instrument is greatly reduced in size, 415 00:24:36,680 --> 00:24:39,679 Speaker 1: and the proper width is given to the articular extremity 416 00:24:39,760 --> 00:24:42,880 Speaker 1: by screwing a thin ivory cap to the slender body 417 00:24:42,920 --> 00:24:46,480 Speaker 1: of the instrument. The pleximeter is attached to the stethoscope 418 00:24:46,800 --> 00:24:49,960 Speaker 1: merely with a view to render the former conveniently portable. 419 00:24:50,560 --> 00:24:53,000 Speaker 1: So in case that's not clear, it was a smaller 420 00:24:53,080 --> 00:24:56,359 Speaker 1: version of the stethoscope, but one end of it expanded 421 00:24:56,400 --> 00:24:59,639 Speaker 1: out in a wide, shallow conical shape with the plate 422 00:24:59,800 --> 00:25:02,359 Speaker 1: that was the plex seminar over the widest part of 423 00:25:02,359 --> 00:25:05,560 Speaker 1: the cone. The flat plate would be placed against the 424 00:25:05,600 --> 00:25:08,320 Speaker 1: torso of the patient, and then the doctor would tap 425 00:25:08,359 --> 00:25:11,640 Speaker 1: it with a finger or a small hammer. Today, physicians 426 00:25:11,640 --> 00:25:14,280 Speaker 1: will usually use their hand instead of a plate for this. 427 00:25:15,080 --> 00:25:18,560 Speaker 1: Lanek actually attended Puri's talk at the Royal Academy of 428 00:25:18,640 --> 00:25:22,280 Speaker 1: Medicine when he introduced these ideas. Although Pierre's book on 429 00:25:22,280 --> 00:25:26,320 Speaker 1: the subject didn't come out until well after Renee Lanek 430 00:25:26,400 --> 00:25:30,640 Speaker 1: had died, Perry had included the inventor of the stethoscope 431 00:25:30,640 --> 00:25:34,639 Speaker 1: in the dedication. You know, Uh, it's unclear. Uh, you 432 00:25:34,640 --> 00:25:37,719 Speaker 1: know what lanox response was. He was was the end 433 00:25:37,760 --> 00:25:39,639 Speaker 1: of his life, so he probably did not have a 434 00:25:39,640 --> 00:25:43,439 Speaker 1: lot of energy to write at length about it. The 435 00:25:43,480 --> 00:25:46,960 Speaker 1: first binaural stethoscope, meaning that it had separate earpieces for 436 00:25:47,000 --> 00:25:49,399 Speaker 1: each year, was the work of Dr Nathan B. Marsh. 437 00:25:49,640 --> 00:25:51,840 Speaker 1: You actually see a few different people credited with this 438 00:25:52,560 --> 00:25:55,840 Speaker 1: um because many people were trying to improve it at 439 00:25:55,840 --> 00:25:58,439 Speaker 1: the same time. Marsh was born in the late eighteen 440 00:25:58,480 --> 00:26:01,199 Speaker 1: teens in Newark, New Jersey, and moved when he was 441 00:26:01,200 --> 00:26:04,080 Speaker 1: still quite a small boy with his family to Cincinnati, Ohio. 442 00:26:04,960 --> 00:26:07,200 Speaker 1: There is a Marsh stethoscope in the collection of the 443 00:26:07,240 --> 00:26:11,000 Speaker 1: Smithsonian's National Museum of American History. It's not a fully 444 00:26:11,040 --> 00:26:15,080 Speaker 1: intact model. The earpieces and their connector tubes are missing, 445 00:26:15,640 --> 00:26:18,840 Speaker 1: but this one has three ebony bells of differing sizes 446 00:26:18,880 --> 00:26:22,159 Speaker 1: that you can screw off and on. Marsh received the 447 00:26:22,200 --> 00:26:27,280 Speaker 1: first patent for a binalstethoscope. That was US patent in 448 00:26:27,320 --> 00:26:31,159 Speaker 1: eighteen fifty one, but the following year a version was 449 00:26:31,200 --> 00:26:35,560 Speaker 1: invented by New York doctor George P. Cammon. Cammon, who 450 00:26:35,600 --> 00:26:38,000 Speaker 1: was born in eighteen o four, had actually traveled to 451 00:26:38,119 --> 00:26:41,439 Speaker 1: Paris for postgraduate work in the late eighteen twenties, and 452 00:26:41,520 --> 00:26:44,879 Speaker 1: he had studied with some of land ex colleagues, and 453 00:26:45,119 --> 00:26:47,800 Speaker 1: his work in New York with the city's poor population 454 00:26:47,840 --> 00:26:51,119 Speaker 1: at the Northern Dispensary, which was a free clinic that 455 00:26:51,160 --> 00:26:54,720 Speaker 1: opened in eighteen thirty. He wanted to improve his diagnostic 456 00:26:54,800 --> 00:26:57,120 Speaker 1: tools so that he could get as much information as 457 00:26:57,160 --> 00:27:00,159 Speaker 1: possible in cases where he just had limited time with 458 00:27:00,200 --> 00:27:04,000 Speaker 1: the patients. Yeah. I saw one one write up theorizing 459 00:27:04,040 --> 00:27:05,920 Speaker 1: that some of it too. Because New York had a 460 00:27:06,000 --> 00:27:09,359 Speaker 1: large immigrant population, he had to be able to do 461 00:27:09,440 --> 00:27:12,679 Speaker 1: diagnostics in ways that did not count on everyone speaking 462 00:27:12,680 --> 00:27:15,960 Speaker 1: the same language. I don't know if that's true or not. 463 00:27:16,040 --> 00:27:19,360 Speaker 1: That was a theorization. As a result of that desire, though, 464 00:27:19,400 --> 00:27:22,640 Speaker 1: to just improve his ability to work with his patients, 465 00:27:22,680 --> 00:27:24,879 Speaker 1: he built on models that he had already seen that 466 00:27:24,960 --> 00:27:28,560 Speaker 1: had two ear pieces, although in some cases those two 467 00:27:28,600 --> 00:27:31,720 Speaker 1: ear piece versions were designed so that two physicians could 468 00:27:31,760 --> 00:27:34,880 Speaker 1: listen to a person's chest at one time. There were 469 00:27:34,920 --> 00:27:38,080 Speaker 1: also other doctors working on binural stethoscopes, but there have 470 00:27:38,200 --> 00:27:41,719 Speaker 1: been problems making a model that was practical for continual 471 00:27:41,800 --> 00:27:46,080 Speaker 1: daily use. Camen tested various materials and designs, and he 472 00:27:46,119 --> 00:27:49,720 Speaker 1: finally came up with a design very similar to modern instruments. 473 00:27:49,720 --> 00:27:52,280 Speaker 1: If you see a picture of it. In Cammon's version, 474 00:27:52,280 --> 00:27:55,600 Speaker 1: there were two stiff metal tubes with ivory ear pieces, 475 00:27:55,680 --> 00:27:58,000 Speaker 1: and the ends opposite The ear pieces on those metal 476 00:27:58,040 --> 00:28:01,560 Speaker 1: tubes connected to two flexible too tubes with tightly wound 477 00:28:01,600 --> 00:28:05,919 Speaker 1: silk coverings. Those flexible tubes connected into a hollow ball 478 00:28:06,200 --> 00:28:08,560 Speaker 1: which connected to the bell section which was held to 479 00:28:08,640 --> 00:28:11,520 Speaker 1: the patient's chest. That hollow ball was said to um 480 00:28:11,560 --> 00:28:15,840 Speaker 1: amplify the sound. Canon's device was manufactured for wide distribution, 481 00:28:16,280 --> 00:28:18,399 Speaker 1: but he didn't patent it because he thought it should 482 00:28:18,400 --> 00:28:22,479 Speaker 1: be available to all physicians. In the eighteen nineties, the 483 00:28:22,520 --> 00:28:27,639 Speaker 1: fernendoscope was introduced by two Italian doctors, Eugenio Batsy and 484 00:28:27,720 --> 00:28:32,879 Speaker 1: Aurelio Bianchie. This design, which the inventors claimed was superior 485 00:28:32,920 --> 00:28:36,199 Speaker 1: to the stethoscope, had a rigid diaphragm disc and a 486 00:28:36,240 --> 00:28:40,120 Speaker 1: removable outer disc, and then a rod that extended from 487 00:28:40,200 --> 00:28:42,920 Speaker 1: one side of the larger disc and held a smaller 488 00:28:43,040 --> 00:28:47,440 Speaker 1: rubber disc the side opposite that had two metal tubes 489 00:28:47,480 --> 00:28:50,000 Speaker 1: extending from its center that could be fitted with rubber 490 00:28:50,040 --> 00:28:53,200 Speaker 1: tubes that ran up to earpieces. That was a departure 491 00:28:53,240 --> 00:28:55,360 Speaker 1: from the canon style that at that point had been 492 00:28:55,360 --> 00:28:58,520 Speaker 1: adopted by physicians around the world, and while it was 493 00:28:58,600 --> 00:29:02,080 Speaker 1: produced for several decades, eventually fell out of favor. It 494 00:29:02,200 --> 00:29:04,200 Speaker 1: is an odd looking thing to me if you see it, 495 00:29:04,200 --> 00:29:07,320 Speaker 1: It's like the little rod that extends with a smaller 496 00:29:07,360 --> 00:29:09,920 Speaker 1: piece looks so tiny compared to the larger disc it 497 00:29:10,000 --> 00:29:12,200 Speaker 1: comes from. I'm like, why why would you put such 498 00:29:12,200 --> 00:29:14,760 Speaker 1: a teeny piece up against the patient? But what do 499 00:29:14,800 --> 00:29:19,240 Speaker 1: I know. Also in the nineties, Massachusetts doctor Robert Bowles 500 00:29:19,320 --> 00:29:22,440 Speaker 1: invented a diaphragm chess piece, which was a departure from 501 00:29:22,480 --> 00:29:24,600 Speaker 1: the bell shape that had been the most common design, 502 00:29:25,040 --> 00:29:27,120 Speaker 1: and it was very simple to apply that because if 503 00:29:27,160 --> 00:29:30,520 Speaker 1: it's it's large surface area to the patient's chest. In 504 00:29:31,600 --> 00:29:34,600 Speaker 1: the Bulls design was incorporated with the bell design into 505 00:29:34,680 --> 00:29:38,720 Speaker 1: one chest piece by Boston's Howard Sprague to respond for 506 00:29:38,760 --> 00:29:42,120 Speaker 1: the demand for an instrument that had both options. So 507 00:29:42,320 --> 00:29:45,000 Speaker 1: in the Sprague version, instead of that bell, it created 508 00:29:45,000 --> 00:29:47,240 Speaker 1: a shape that looks like a cone with a diaphragm 509 00:29:47,320 --> 00:29:49,719 Speaker 1: over the widest part. This came to be known as 510 00:29:49,720 --> 00:29:52,560 Speaker 1: the Sprague Bowls stethoscope and it was very popular for 511 00:29:52,600 --> 00:29:56,560 Speaker 1: the next two decades. In the forties, Sprague, who was 512 00:29:56,600 --> 00:30:00,160 Speaker 1: a cardiologist, once again revisited the design at the at 513 00:30:00,160 --> 00:30:04,719 Speaker 1: the Scope, this time with collaborator Maurice Rappaport. Together they 514 00:30:04,760 --> 00:30:07,080 Speaker 1: came up with a chess piece that was two sided. 515 00:30:07,520 --> 00:30:10,880 Speaker 1: One side was optimal for listening to the cardiovascular system, 516 00:30:10,920 --> 00:30:14,200 Speaker 1: while the other was best for respiratory assessments. This is 517 00:30:14,240 --> 00:30:17,840 Speaker 1: attempt to separate out the best of both worlds approach 518 00:30:17,880 --> 00:30:21,280 Speaker 1: of the Sprague Bowls model, and it worked. But when 519 00:30:21,320 --> 00:30:23,960 Speaker 1: the two tubes that led from the double sided chess 520 00:30:23,960 --> 00:30:27,400 Speaker 1: piece to the airpieces rubbed together, it created so much 521 00:30:27,440 --> 00:30:32,000 Speaker 1: interference that could be really frustrating the doctors. Can you imagine, 522 00:30:32,040 --> 00:30:34,320 Speaker 1: like I'm trying to listen to your loan function, what 523 00:30:34,440 --> 00:30:39,560 Speaker 1: is that scraping noise? It's actually my instrument. The next 524 00:30:39,600 --> 00:30:43,200 Speaker 1: step in stethoscope evolution came from Dr. David Littman, who 525 00:30:43,240 --> 00:30:47,360 Speaker 1: was a Harvard Medical School professor and a cardiologist. And 526 00:30:47,440 --> 00:30:50,800 Speaker 1: Littman addressed those issues with the Sprague and Rappaport version 527 00:30:50,800 --> 00:30:53,960 Speaker 1: of the stethoscope by creating a one sided chess piece. 528 00:30:54,000 --> 00:30:56,280 Speaker 1: So unlike there's what you had to flip side to side, 529 00:30:56,720 --> 00:30:59,280 Speaker 1: his was just one sided, and it had a diaphragm 530 00:30:59,280 --> 00:31:02,600 Speaker 1: that had a dial that could be tuned for different purposes. 531 00:31:03,200 --> 00:31:07,800 Speaker 1: This nineteen sixties version remains the design for standard stethoscopes today. 532 00:31:08,000 --> 00:31:12,040 Speaker 1: Littman founded a company called Cardio Sonics to manufacture his device. 533 00:31:12,520 --> 00:31:16,400 Speaker 1: That company was eventually acquired by three M. Today, of course, 534 00:31:16,440 --> 00:31:21,120 Speaker 1: there are all kinds of specialized stethoscopes, stethoscopes with Bluetooth connectivity, 535 00:31:21,200 --> 00:31:23,920 Speaker 1: and even plans you can download online if you want 536 00:31:23,920 --> 00:31:26,040 Speaker 1: to print your own stethoscope with a three D printer, 537 00:31:26,200 --> 00:31:29,560 Speaker 1: among other developments. They're all still based on that Littman 538 00:31:29,640 --> 00:31:32,480 Speaker 1: design and that has roots that easily trace back to 539 00:31:32,560 --> 00:31:38,920 Speaker 1: Ladeck stethoscopes. Who knew? I, Um, it's it's I love 540 00:31:39,080 --> 00:31:42,280 Speaker 1: reading about how it was really all because he was 541 00:31:42,440 --> 00:31:45,480 Speaker 1: he didn't want to touch his patient directly. Honestly, they're 542 00:31:45,480 --> 00:31:49,280 Speaker 1: a little newer than I would have thought, because I 543 00:31:49,320 --> 00:31:52,520 Speaker 1: think things like ear trumpets are a little older than this. 544 00:31:52,760 --> 00:31:56,040 Speaker 1: There's at least like written, and it's like it just 545 00:31:56,120 --> 00:31:59,040 Speaker 1: seems like somebody would have stuck their ear trumpet onto 546 00:31:59,080 --> 00:32:03,760 Speaker 1: somebody's you know, chest man. No, they were just sticking 547 00:32:03,800 --> 00:32:07,680 Speaker 1: their ear up against their chest. Um. We can talk 548 00:32:07,720 --> 00:32:11,040 Speaker 1: somewhere about that in the behind the scenes. Yeah. But 549 00:32:11,120 --> 00:32:14,040 Speaker 1: in the meantime, I have a listener mail, which is 550 00:32:14,480 --> 00:32:17,960 Speaker 1: from our listener Angie, about one of our episodes that's 551 00:32:18,000 --> 00:32:22,320 Speaker 1: a little less lighthearted. It is the Mildred Fish Harneck episode. Sure, 552 00:32:22,320 --> 00:32:24,400 Speaker 1: it's hi, Tracy and Holly. I just got done listening 553 00:32:24,440 --> 00:32:27,560 Speaker 1: to the Mildred Fish Harneck episode. I adore your podcast, 554 00:32:27,560 --> 00:32:29,400 Speaker 1: and I listened to it while I jog after work. 555 00:32:29,600 --> 00:32:32,600 Speaker 1: This episode must have made me look crazy to passers by, 556 00:32:32,640 --> 00:32:35,520 Speaker 1: because I was openly sobbing like the ugly cry kinding 557 00:32:35,560 --> 00:32:38,920 Speaker 1: while still jogging and listening um boy, I know that feeling, 558 00:32:38,960 --> 00:32:40,760 Speaker 1: because I did that a few times while I was 559 00:32:40,920 --> 00:32:44,000 Speaker 1: prepping it. Uh. Mildred's story touched me deeply and more 560 00:32:44,040 --> 00:32:46,080 Speaker 1: than I thought it could. I am a graduate of 561 00:32:46,080 --> 00:32:48,840 Speaker 1: the University of Wisconsin Madison, and it made my heart 562 00:32:48,880 --> 00:32:51,760 Speaker 1: swell to learn how brave and true Mildred was. UH. 563 00:32:51,880 --> 00:32:54,880 Speaker 1: U W Madison places a strong emphasis on using your 564 00:32:54,960 --> 00:32:58,320 Speaker 1: education to help others. This is called the Wisconsin idea, 565 00:32:58,360 --> 00:33:01,000 Speaker 1: and I cannot help but think that moral compass was 566 00:33:01,040 --> 00:33:04,480 Speaker 1: cemented in Mildred's heart during her college years. I also 567 00:33:04,520 --> 00:33:07,320 Speaker 1: studied German languages as an undergrad at u W, where 568 00:33:07,360 --> 00:33:10,080 Speaker 1: we learned not just the language, but also about the 569 00:33:10,120 --> 00:33:12,520 Speaker 1: White Rose resistance group and others who stood up for 570 00:33:12,560 --> 00:33:15,320 Speaker 1: what was right and paid with their lives. Uh. One 571 00:33:15,320 --> 00:33:17,520 Speaker 1: of my professors in the German department grew up in 572 00:33:17,560 --> 00:33:21,280 Speaker 1: East Germany, and she described living through the horrifying experiences 573 00:33:21,320 --> 00:33:24,320 Speaker 1: of East German informants. It was a dystopia where anyone 574 00:33:24,400 --> 00:33:29,160 Speaker 1: would inform on anyone else. Children reported, parents, wives reported husbands. 575 00:33:29,160 --> 00:33:31,720 Speaker 1: You literally could not trust yourself to speak your thoughts, 576 00:33:31,760 --> 00:33:34,040 Speaker 1: even in your own room, because you never knew if 577 00:33:34,080 --> 00:33:36,520 Speaker 1: your own home was bugged. It was and still is 578 00:33:36,560 --> 00:33:39,400 Speaker 1: to this day. I believe the most widespread and organized 579 00:33:39,440 --> 00:33:42,400 Speaker 1: state surveillance effort in the world. Even then, though there 580 00:33:42,400 --> 00:33:45,080 Speaker 1: were people like my professor who met with other resistors 581 00:33:45,280 --> 00:33:47,520 Speaker 1: instead of for what was right, even in small ways. 582 00:33:48,080 --> 00:33:50,240 Speaker 1: She later found out she had a lengthy file with 583 00:33:50,320 --> 00:33:53,680 Speaker 1: the police. After reunification, East Germany ceased to be and 584 00:33:53,720 --> 00:33:56,600 Speaker 1: those files were made public. Uh, she asked if we 585 00:33:56,640 --> 00:34:00,520 Speaker 1: could potentially do a show on East German resistance, you 586 00:34:00,600 --> 00:34:04,200 Speaker 1: might Uh, we do definitely have one from the archives 587 00:34:04,240 --> 00:34:07,560 Speaker 1: on the White Rose. And then she also sent us 588 00:34:07,560 --> 00:34:09,960 Speaker 1: some beautiful, beautiful pictures. I'm sorry I made you cry, 589 00:34:09,960 --> 00:34:14,800 Speaker 1: but I'm glad that Mildred's story is getting more widespread, um, 590 00:34:14,800 --> 00:34:17,480 Speaker 1: you know, discussion in general. There's also a new book 591 00:34:17,480 --> 00:34:19,200 Speaker 1: about her. A couple of people have written to us 592 00:34:19,239 --> 00:34:22,920 Speaker 1: about so there's plenty to cover if you wanna to 593 00:34:23,000 --> 00:34:25,799 Speaker 1: read and learn about her. She was quite amazing. Thank 594 00:34:25,840 --> 00:34:27,680 Speaker 1: you for writing to us, Angie. If you would like 595 00:34:27,719 --> 00:34:30,200 Speaker 1: to write to us, you can do so at History 596 00:34:30,239 --> 00:34:32,839 Speaker 1: Podcast at iHeart radio dot com. You can also find 597 00:34:32,920 --> 00:34:35,960 Speaker 1: us on social media as Missed in History and subscribing 598 00:34:36,000 --> 00:34:37,680 Speaker 1: as easy as pie. You can do that on the 599 00:34:37,719 --> 00:34:40,600 Speaker 1: I heart radio app or anywhere else you listen to podcasts. 600 00:34:45,640 --> 00:34:47,799 Speaker 1: Stuff you Missed in History Class is a production of 601 00:34:47,880 --> 00:34:51,080 Speaker 1: I heart Radio. For more podcasts from I heart Radio, 602 00:34:51,280 --> 00:34:54,280 Speaker 1: visit the i heart radio app, Apple Podcasts, or wherever 603 00:34:54,360 --> 00:34:55,840 Speaker 1: you listen to your favorite shows.