Stethoscope: The following, from my book on the stethoscope (see reference 545) helps to place the origins of this device in perspective: “The stethoscope has come to represent the physician perhaps more than any other symbol save the staff of Aesculapius It has had a profound influence on the practice of medicine. Some have lamented that the stethoscope distanced the physician from the patient. Others have lauded the modesty it restored to the patient. Few can dispute its value in diagnostic medicine.

Recognition of the value of the stethoscope was relatively rapid for a profession which is so conservative in nature. However public skepticism remained. The London Times of 1824 stated “ A wonderful instrument called the Stethoscope, invented a few months ago, for the purpose of ascertaining the different stages of pulmonary affections, is now in complete vogue at Paris. It is merely a hollow wooden tube, about a foot in length (a common flute, with holes stopped and the top open, would do, perhaps just as well). One end is applied to the breast of the patient. The other to the ear of the physician, and according to the different sounds, harsh, hollow, soft loud etc, he judges of the state of the disease. It is quite a fashion if a person complains of a cough, to have recourse to the miraculous tube, which, however, cannot effect a cure; but should you unfortunately perceive in the countenance of the Doctor, that he fancies certain symptoms exist, it is very likely that a nervous person might become seriously indisposed and convert the supposition into reality”

Forbes translation of Laennec brought the stethoscope to the English speaking world. Among others who contributed greatly to its acceptance was James Hope (1801-1841), who worked as Physician to St. George’s Hospital, is credited with having influenced the acceptance of the stethoscope by the London medical community . Hope had passed two years studying on the continent after graduating from Edinburgh in 1825 and spent time in Laennec’s clinic. He suffered from tuberculosis during this time and died of the disease in 1841, but managed to publish a major contribution to the study of the heart “Treatise on the Diseases of the Heart and the Great Vessels” in which Hope reported on his systematic studies of the heart valves and the contraction of the heart.
Hope’s efforts in support of the stethoscope are the subject of several letters to the editor. T. W. Pocock of Knightbridge wrote an account in the London Medical Gazette in 1838 . He reports on an occasion when Dr. Hope using a blackboard during a ten minute period explained the mode of discriminating valvular disease with the aid of the stethoscope. Six patients were then presented to four students, one of whom was Mr. Pocock, from St. Georges Hospital who were selected for the demonstraton. Among sixteen diagnoses presented, one was incorrect. The letter is followed with each of the students diagnoses. Dr. Hope has a letter to the editor following this in which he states “an intelligent student, familiar with the anatomy of the heart and with its situation in reference to the surface, will learn the diagnosis of the several valvular diseases in two hours, if they be demonstrated to him on six or eight well marked cases, presenting all the varieties of valvular disease.”
Hope also established an annual prize in support of the stethoscope for proficiency in auscultation which he presented at the end of his teaching sessions.

The whole proceeding described above was in itself marked by controversy. In 1839, Drs. R.J. Graves and W. Stokes wrote about a similar episode “we write these remarks for the junior student, who might be deterred from studying an important and now indispensable part of his profession, by the statements above quoted” (These were remarks by Dr. Clutterbuck severely criticizing the use of the stethoscope). However, they also state “but that these conclusions were correct, we have only Dr. Hopes word for” .
William Stokes (1804-1878) was born in Dublin and he entered Edinburgh in 1823. There he came under the influence of S. Scott Alison, whose work is described below. Before he left Edinburgh to return to Dublin in 1825, he had written and published a book entitled The Use of the Stethoscope.

A review of his book in Lancet provides some skepticism of Stokes endorsement of the instrument. The review writes: “ But does it (the stethoscope) really deserve the extravagant praise of its admirers or the fastidious contempt of its enemies? We are pretty certain, it neither merits the one nor the other”. Although he essentially endorses its utility the author rather critical of Stokes, partly because of the young age and lack of experience at which he wrote the volume.

Stokes became a leading authority in diseases of the lungs and in 1837, he published Diseases of the Chest, in which he endorsed the use of auscultation in bronchitis and the affections of the chest. The series of publications about Hope, discussed above, include a contribution from him. In 1842, he became Regis Professor of Physic in Dublin University.
Another early text on the stethoscope originated in Germany from Karl Gastavus Schmalz who was one of the earliest Germans to use the instrument. The introduction to his text contains an extensive discussion of auscultation and percussion. An anonymous author reports that in 1826 the stethoscope was employed almost universally in France and extensively in Germany, but not as frequently in England as it deserved.

Frederick Irving Knight who was born at Newburyport, Massachusetts on May 18, 1841 is an excellent example of the ultimate acceptance of auscultation. He attended high school at Newburyport and then went to Yale College. He studied medicine at Harvard Medical School and in various European hospitals. He settled in Boston where he devoted his attention to diseases of the throat and chest. He was instructor in Auscultation, Percussion and Laryngoscopy in Harvard University . It is noteworthy that his professorship was named for these highly regarded diagnostic techniques rather than any disease or organ system.” from: Blaufox, M. Donald; An Ear to the Chest, Parthenon Publishers, 2002..

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