About neuroscience and music (mainly classical). Exploring the relationship of music and the brain based on experience of two careers.

December 4, 2015

Flutes and Stethoscopes

by Carl Ellenberger, MD

Even as a physician and flutist, I was unaware of the same duality in the career of the young French doctor, RenĂ© Laennec, inventor of the stethoscope.
In 1816, I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. 
Such "percussion and the application of the hand," augmented by placing the ear directly on the chest, were used by Laennec's contemporaries to examine the heart. The fact that Laennec played the flute might account for the novel way he solved his problem.
I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased, to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of the ear.
Eventually, he constructed other instruments out of various materials and called the technique, "mediate auscultation."
The most dense bodies do not, as might have been expected from analogy, furnish the best materials for these instruments.... Bodies of a moderate density, such as paper, the lighter kinds of wood, or Indian cane, are those which I always found preferable to others. A greater diameter renders its exact application to certain parts of the chest, impracticable; greater length renders its retention in exact apposition more difficult, and when shorter, it...frequently obliges [the doctor] to assume an inconvenient posture.... 
Flutes in Laennec's time were almost all made of wood. One might wonder whether Laennec as a flutist was especially able to evaluate sounds made by flow, of air through the flute and of blood through the heart. Laennec named his instrument, “stethoscope” (from the Greek stethos, chest or heart, and skopos, observer). Here is his drawing:

and an early model

and an early flute

Further reading: Edelman and Weber, Tenuous Tether, The New England Journal of Medicine, 373:2199, 2015. The authors lament the displacement of the stethoscope by modern techniques, like ultrasound, where the "mediate" part of the auscultation is a technician with a machine between the doctor and the patient. 

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