Doctor Curmudgeon A Better Way

By Diane Batshaw Eisman, M.D. FAAP Doctor Eisman is in Family Practice in Aventura, Florida with her partner, Dr. Eugene Eisman, an internist/cardiologist

If I were a doctor in the early 1800s, I would lean over my patient with my ear on his chest so I could hear his heart and lung sounds. It wasn’t comfortable and my back would hurt.

Then along came Rene Laennec. He was a French physician who also found it an uncomfortable position.

Dr. Laennec realized that if he rolled up a long piece of paper into the shape of a tube, it would amplify the heart and lung sounds.

Soon, he devised a wooden tube that could be placed on the patient’s chest with the doctor’s ear on the other end. Much better!

In fact, the London Times noted on September 19, 1824, “A wonderful instrument…is now in complete vogue in Paris…it is quite a fashion, if a person complains of cough, to have recourse to the miraculous tube.”

Of course, this miraculous tube was monaural, you could only hear with one ear. But it was high tech for the time.

Then an Irish physician, Arthur Leared came along in 1851 and invented an even better way. He designed a binaural stethoscope so you could listen with both ears. Binaural hearing aided in localizing sounds.

And there are some who say it was George Cammann who really perfected the binaural stethoscope in 1852.

Whoever invented the binaural stethoscope—it is now the gold standard.

Bu then, somewhere in the 1940s, Rappaport and Sprague developed a brand new version of the binaural stethoscope. This one had two sides to the chest piece. One side is the diaphragm. This is a flat, circular part that enables the physician to listen to sounds of high frequency, such as heart beats and lung sounds. The other side is known as the bell. It’s smaller and concave and you can hear sounds of lower frequencies, like murmurs.

But the Rappaport-Sprague model was heavy and it had an antique look with its big latex rubber tubes that connected to an exposed leaf-spring-joined pair of ear tubes.

Lots of other inventive people created some minor changes until along came David Littman with the famous Littmann stethoscope. The prototype was built in his basement.

Littman’s stethoscope was much lighter. Light enough to dump into a little black bag, sling over your shoulders or store in a lab coat pocket. It was unique with its firm tubing and shorter length. It had a spring to keep the ear tubes apart. The ear tubes are softer.

I really appreciated the Littman when shortly after my graduation from medical school, I received a romantic gift.

A gorgeous box. Red bow.

And when I opened it, there was my Littman.

And a large box of dark chocolate nestled underneath.

Dr. Curmudgeon suggests “Bitter Medicine”, Dr. Eugene Eisman’s story of his experiences–from the humorous to the intense—as a young army doctor serving in the Vietnam War.
Bitter Medicine by Eugene H. Eisman, M.D. –on Amazon

Doctor Curmudgeon® is Diane Batshaw Eisman, M.D., a physician-satirist. This column originally appeared on SERMO, the leading global social network for doctors.
SERMO www.sermo.com

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