Auscultatory Interregnum
Authors: M. Fuad Jan, A. Jamil Tajik
Journal: Circulation (2020)

lthough physicians had been listening to the heart and chest since the time of the Hindu Vedas (ca 1500-1200 bc), Ebers Papyrus (ca 1500 bc), and Hippocrates (ca 460-380 bc), it was René Théophile Hyacinthe Laënnec (1781-1826), a superb flutist and French physician, who truly revolutionized the art of bedside auscultation.Between 1816 and 1819, Laënnec experimented with hollow tubes fashioned out of cedar or ebony, arriving at a model ≈1 ft in length and 1.5 in in diameter with a quarter-inch central channel. 1 He named his invention the stethoscope, derived from the Greek stethos, meaning chest, and skopein, meaning to observe.He also coined the word auscultation, derived from the Latin auscultare, meaning to listen carefully, not simply to listen.Between May 1817 and May 1819, Laënnec used his stethoscope to study the cardiac and pulmonary sounds of ≈3000 patients, correlating his antemortem observations with autopsy findings.He presented the invention and his research at Académie de Médecine-the Paris Academy of Medicine-in 1818 and published the work De l'auscultation médiate or Traité du Diagnostic des Maladies des Poumon et du Coeur in August 1819, 200 years ago.The invention of the stethoscope marked an epoch in medicine; it was a new scientific and clinical tool that miraculously allowed the physician to transform the sounds heard into an image that could be seen.By the 1830s, the stethoscope was widely used by physicians and expected by patients; the 19th century became known as the golden age of stethoscopy.Suddenly, the barber surgeon had given way to the physician who was trying to make a diagnosis.The art of auscultation gained traction, and leading physicians published their new observations as the use of the stethoscope spread across Europe and the United States.Using onomatopoeia, clinicians learned the cadence of heart murmurs, which sometimes led to rapid recognition of valvular pathology. 2uscultation thus became an almost exact science for use by future generations of physicians and medical trainees.The list of auscultatory findings grew, as did a robust crop of eponyms, particularly in cardiology.Auscultation with a stethoscope became a central and essential tool of the trade, providing inexpensive clinical information useful in diagnosing, altering, and directing patient care.As new technology evolved, the stethoscope continued to play a sentinel role in auscultatory medicine and its teaching.The stethoscope became enshrined as the prized symbol of physicians, viewed as an invaluable tool for assessment of heart, lung, and vascular disease, as well as for providing an estimate of its severity, evolution, and prognosis.Medical historians consider the golden age of the stethoscope to have run from the publication of Laënnec's treatise in 1819 to the death of Sir William Osler in 1919.They believe that the stethoscope-emblematic of a physician-is on its way to becoming a historical curiosity that will someday be relegated to a museum shelf.The development of echocardiography played a particularly singular role in weakening the need for sophisticated physical examination or auscultation