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The word stethoscope is derived from

the two Greek words, stethos (chest) and


scopos (examination).

Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the
internal sounds of an animal or human body. It typically has a small disc-shaped
resonator that is placed against the chest, and two tubes connected to earpieces. It is
often used to listen to lung and heart sounds. It is also used to listen to intestines and
blood flow in arteries and veins. In combination with a sphygmomanometer, it is
commonly used for measurements of blood pressure. Less commonly, "mechanic's
stethoscopes", equipped with rod shaped chestpieces, are used to listen to internal
sounds made by machines (for example, sounds and vibrations emitted by worn ball
bearings), such as diagnosing a malfunctioning automobile engine by listening to the
sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum
chambers for leaks, and for various other small-scale acoustic monitoring tasks. A Modern stethoscope

stethoscope that intensifiesauscultatory sounds is called phonendoscope.

Contents
History
Current practice
Types
Acoustic
Electronic
Recording
Fetal
Doppler
3D-printed
Earpieces
See also
References
External links

History
The stethoscope was invented in France in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris.[1][2][3] It
consisted of a wooden tube and was monaural. Laennec invented the stethoscope because he was uncomfortable placing his ear on
women's chests to hear heart sounds.[4][5]:186 He observed that a rolled notebook, placed between the patient's chest and his ear,
could amplify heart sounds without requiring physical contact.[6] Laennec's device was similar to the common ear trumpet, a
historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which
was commonly called a "microphone". Laennec called his device the "stethoscope"[7] (stetho- + -scope, "chest scope"), and he called
its use "mediate auscultation", because it was auscultation with a tool intermediate between the patient's body and the physician's ear.
(Today the word auscultation denotes all such listening, mediate or not.) The first flexible stethoscope of any sort may have been a
[8] In 1840, Golding Bird described a stethoscope he had
binaural instrument with articulated joints not very clearly described in 1829.
been using with a flexible tube. Bird was the first to publish a description of such a stethoscope but he noted in his paper the prior
existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird's stethoscope
[9]
had a single earpiece.[9]

In 1851, Irish physician Arthur Leared invented a binaural stethoscope and, in 1852,
George Philip Cammann perfected the design of the stethoscope instrument (that
used both ears) for commercial production, which has become the standard ever
since. Cammann also wrote a major treatise on diagnosis by auscultation, which the
refined binaural stethoscope made possible. By 1873, there were descriptions of a
differential stethoscope that could connect to slightly different locations to create a
slight stereo effect, though this did not become astandard tool in clinical practice.

Somerville Scott Alison described his invention of the stethophone at the Royal This early stethoscope belonged to
Laennec. (Science Museum,
Society in 1858; the stethophone had two separate bells, allowing the user to hear
London)
and compare sounds derived from two discrete locations. This was used to do
definitive studies on binaural hearing and auditory processing that advanced
knowledge of sound localization and eventually lead to an understanding of binaural
fusion.[1]

The medical historian Jacalyn Duffin has argued that the invention of the
stethoscope marked a major step in the redefinition of disease from being a bundle
of symptoms, to the current sense of a disease as a problem with an anatomical
system even if there are no noticeable symptoms. This re-conceptualization occurred
in part, Duffin argues, because prior to stethoscopes, there were no non-lethal
instruments for exploring internal anatomy.[10]

Rappaport and Sprague designed a new stethoscope in the 1940s, which became the
standard by which other stethoscopes are measured, consisting of two sides, one of
which is used for the respiratory system, the other for the cardiovascular system. The
Rappaport-Sprague was later made by Hewlett-Packard. HP's medical products
division was spun off as part of Agilent Technologies, Inc., where it became Agilent
Healthcare. Agilent Healthcare was purchased by Philips which became Philips
Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague
stethoscope was finally abandoned ca. 2004, along with Philips' brand Early stethoscopes
(manufactured by Andromed, of Montreal, Canada) electronic stethoscope model.
The Rappaport-Sprague model stethoscope was heavy and short (18–24 in (46–
61 cm)) with an antiquated appearance recognizable by their two large independent latex
rubber tubes connecting an exposed leaf-spring-joined pair of opposing F-shaped chrome-
plated brass binaural ear tubes with a dual-head chest piece.

Several other minor refinements were made


to stethoscopes until, in the early 1960s,
David Littmann, a Harvard Medical School
A Traube-type stethoscope in
professor, created a new stethoscope that
ivory
was lighter than previous models and had
improved acoustics.[11] In the late 1970s,
3M-Littmann introduced the tunable diaphragm: a very hard (G-10) glass-epoxy
resin diaphragm member with an overmolded silicone flexible acoustic surround
which permitted increased excursion of the diaphragm member in a Z-axis with
Early flexible tube stethoscopes.
respect to the plane of the sound collecting area. The left shift to a lower resonant
Golding Bird's instrument is on the
left. The instrument on the right is the frequency increases the volume of some low frequency sounds due to the longer
stethophone.[1] waves propagated by the increased excursion of the hard diaphragm member
suspended in the concentric accountic surround. Conversely, restricting excursion of
the diaphragm by pressing the stethoscope diaphragm surface firmly against the anatomical area overlying the physiological sounds
of interest, the acoustic surround could also be used to dampen excursion of the diaphragm in response to "z"-axis pressure against a
concentric fret. This raises the frequency bias by shortening the wavelength to auscultate a higher range of physiological sounds.

In 1999, Richard Deslauriers patented the first external noise reducing stethoscope, the DRG Puretone. It featured two parallel
lumens containing two steel coils which dissipated infiltrating noise as inaudible heat energy. The steel coil "insulation" added .30 lb
[12]
to each stethoscope. In 2005, DRG's diagnostics division was acquired by TRIMLINE Medical Products.

Current practice
Stethoscopes are often considered as a symbol of healthcare professionals, as various
healthcare providers are often seen or depicted with stethoscopes hanging around
their necks. A 2012 research paper claimed that the stethoscope, when compared to
other medical equipment, had the highest positive impact on the perceived
trustworthiness of the practitioner seen with it.[13]

The advent of practical, widespread portable ultrasonography (point-of-care


ultrasonography) in the late 1990s to early 2000s led some physicians to ask how
soon it would be before stethoscopes would become obsolete.[14] Others answered
that they thought the relationship of the various tools (stethoscopes and digital
A doctor using a stethoscope to
devices) would change but that it would be a long time before stethoscopes were
listen to a patient's abdomen
obsolete.[15] A decade later, in 2016, the same two sides of the coin were still
recognized.[16] One cardiologist said, "the stethoscope is dead", but a pediatrician
said, "We are not at the place, and probably won't be for a very long time", where stethoscopes were obsolete. One consideration is
that it depends on the segment of health care (emergency medical services, nursing, medicine) and the specialty. "Stethoscopes retain
their value for listening to lungs and bowels for clues of disease, experts agree."[16] But for the cardiovascular system, "auscultation
is superfluous", one cardiologist said.[16] Thus, it could be that cardiology in thesecondary and tertiary care settings may abandon the
stethoscope many years beforeprimary care, pediatrics, and physical therapy do.

Types

Acoustic
Acoustic stethoscopes are familiar to most people, and operate on the transmission
of sound from the chest piece, via air-filled hollow tubes, to the listener's ears. The
chestpiece usually consists of two sides that can be placed against the patient for
sensing sound: a diaphragm (plastic disc) or bell (hollow cup). If the diaphragm is
placed on the patient, body sounds vibrate the diaphragm, creating acoustic pressure
waves which travel up the tubing to the listener's ears. If the bell is placed on the
patient, the vibrations of the skin directly produce acoustic pressure waves traveling
up to the listener's ears. The bell transmits low frequency sounds, while the
diaphragm transmits higher frequency sounds. This two-sided stethoscope was Parts of a binaural stethoscope
invented by Rappaport and Sprague in the early part of the 20th century
.

One problem with acoustic stethoscopes was that the sound level was extremely low. This problem was surmounted in 1999 with the
invention of the stratified continuous (inner) lumen, and the kinetic acoustic mechanism in 2002.

Electronic
An electronic stethoscope (or stethophone) overcomes the low sound levels by electronically
amplifying body sounds. However, amplification of stethoscope contact artifacts, and component
cutoffs (frequency response thresholds of electronic stethoscope microphones, pre-amps, amps,
and speakers) limit electronically amplified stethoscopes' overall utility by amplifying mid-range
sounds, while simultaneously attenuating high- and low- frequency range sounds. Currently, a
number of companies offer electronic stethoscopes. Electronic stethoscopes require conversion of
acoustic sound waves to electrical signals which can then be amplified and processed for optimal
Acoustic stethoscope,
listening. Unlike acoustic stethoscopes, which are all based on the same physics, transducers in
with the bell upwards
electronic stethoscopes vary widely. The simplest and least effective method of sound detection is
achieved by placing a microphone in the chestpiece. This method suffers from ambient noise
interference and has fallen out of favor. Another method, used in Welch-Allyn's Meditron stethoscope, comprises placement of a
piezoelectric crystal at the head of a metal shaft, the bottom of the shaft making contact with a diaphragm. 3M also uses a piezo-
electric crystal placed within foam behind a thick rubber-like diaphragm. The Thinklabs' Rhythm 32 uses an electromagnetic
diaphragm with a conductive inner surface to form a capacitive sensor. This diaphragm responds to sound waves, with changes in an
electric field replacing changes in air pressure. The Eko Core enables wireless transmission of heart sounds to a smartphone or tablet.

Because the sounds are transmitted electronically, an electronic stethoscope can be a wireless device, can be a recording device, and
can provide noise reduction, signal enhancement, and both visual and audio output. Around 2001, Stethographics introduced PC-
based software which enabled a phonocardiograph, graphic representation of cardiologic and pulmonologic sounds to be generated,
and interpreted according to related algorithms. All of these features are helpful for purposes of telemedicine (remote diagnosis) and
teaching.

Electronic stethoscopes are also used withcomputer-aided auscultation programs to analyze the recorded heart sounds pathological or
innocent heart murmurs.

Recording
Some electronic stethoscopes feature direct audio output that can be used with an external recording device, such as a laptop or MP3
recorder. The same connection can be used to listen to the previously recorded auscultation through the stethoscope headphones,
allowing for more detailed study for general research as well as evaluation and consultation regarding a particular patient's condition
and telemedicine, or remote diagnosis.[17]

There are some smartphone apps that can use the phone as a stethoscope.[18] At least one uses the phone's own microphone to
amplify sound, produce a visualization, and e-mail the results. These apps may be used for training purposes or as novelties, but have
[19]
not yet gained acceptance for professional medical use.

[20]
The first stethoscope that could work with a smartphone application was introduced in 2015

Fetal
A fetal stethoscope or fetoscope is an acoustic stethoscope shaped like a listening trumpet. It is placed against the abdomen of a
pregnant woman to listen to the heart sounds of the fetus.[21] The fetal stethoscope is also known as a Pinard horn after French
obstetrician Adolphe Pinard (1844–1934).

Doppler
A Doppler stethoscope is an electronic device that measures the Doppler effect of ultrasound waves reflected from organs within the
body. Motion is detected by the change in frequency, due to the Doppler effect, of the reflected waves. Hence the Doppler
[22] It was recently demonstrated that continuous
stethoscope is particularly suited to deal with moving objects such as a beating heart.
Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a
stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while classic
stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was
superior in the detection of impaired ventricular relaxation. Since the physics of Doppler
auscultation and classic auscultation are different, it has been suggested that both methods could
complement each other.[23][24] A military noise-immune Doppler based stethoscope has recently
been developed for auscultation of patients in loud sound environments (up to10
1 dB).

3D-printed
A 3D-printed stethoscope is an open-source medical device meant for auscultation and
manufactured via means of 3D printing.[25] The 3D stethoscope was developed by Dr. Tarek
Loubani and a team of medical and technology specialists. The 3D-stethoscope was developed as
part of the Glia project, and its design is open source from the outset. The stethoscope gained
A Pinard horn used by a
widespread media coverage in Summer 2015.
U.S. Army Reserve
nurse in Uganda
The need for a 3D-stethoscope was borne out of a lack of stethoscopes and other vital medical
equipment because of the blockade of the Gaza Strip, where Loubani, a Palestinian-Canadian,
worked as an emergency physician during the 2012 conflict in Gaza. The 1960s-era Littmann Cardiology 3 stethoscope became the
[26]
basis for the 3D-printed stethoscope developed by Loubani.

Earpieces
Stethoscopes usually have rubber earpieces, which aid comfort and create a seal with the ear, improving the acoustic function of the
device. Stethoscopes can be modified by replacing the standard earpieces with moulded versions, which improve comfort and
transmission of sound. Moulded earpieces can be cast by an audiologist or made by the stethoscope user from a kit.

See also
Doppler fetal monitor
Speaking tube

References
1. Wade, Nicholas J.; Deutsch, Diana (July 2008). "Binaural Hearing—Before and After the Stethophone"(http://acousti
cstoday.org/wp-content/uploads/2017/07/Article_2of3_from_ATCODK_4_3.pdf) (PDF). Acoustics Today: 16–27.
2. Laennec, René (1819).De l'auscultation médiate ou traité du diagnostic des maladies des poumon et du coeur
(http
s://books.google.com/books?id=TtTTeKls2bUC&pg=PR5#v=onepage&f=false). Paris: Brosson & Chaudé.
3. 'Laennec, R. T. H.; Forbes, John, Sir, A Treatise on the Diseases of the Chest andon Mediate Auscultation(https://b
ooks.google.com/books?id=a1pBAQAAIAAJ&lpg=PR23&pg=PR1#v=onepage&q&f=false) (1835). New York :
Samuel Wood & Sons ; Philadelphia : Desilver, Thomas & Co. .
4. Roguin A (September 2006)."Rene Theophile Hyacinthe Laënnec (1781–1826): The Man Behind the Stethoscope"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570491). Clin Med Res. 4: 230–5. doi:10.3121/cmr.4.3.230 (https://
doi.org/10.3121%2Fcmr.4.3.230). PMC 1570491 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570491) .
PMID 17048358 (https://www.ncbi.nlm.nih.gov/pubmed/17048358).
5. Picard, Liza (2005). Victorian London: the life of a city, 1840–1870. London: Weidenfeld & Nicolson.
ISBN 0297847333.
6. Risse, Guenter (1999).Mending Bodies, Saving Souls. Oxford: Oxford University Press. p. 316.ISBN 0-19-505523-
3.
7. "Laennec's new system of diagnosis"(https://books.google.com/books?id=LNVLAAAA YAAJ&dq=stethoscope&pg=P
A58#v=onepage&q&f=false), The Quarterly Journal of Foreign Medicine and Surgery and of the Sciences
Connected with Them, 2: 51–68, 1820.
8. Wilks, p.490, cites Comins, "A flexible stethoscope",Lancet 29 August 1829.
9. Samuel Wilks, "Evolution of the stethoscope",Popular Science, vol.22, no.28, pp.488-491, Feb 1883ISSN 0161-
7370 (https://www.worldcat.org/search?fq=x0:jrnl&q=n2:0161-7370).
Golding Bird, "Advantages presented by the employment of a stethoscope with a flexible tube"
(https://books.google.
com/books?id=9FXVoGcVJygC&pg=PA440#v=onepage&q&f=true), London Medical Gazette, vol.1, pp.440-412, 11
December 1840.
10. Duffin, Jacalyn. "Big Ideas: Jacalyn Duffin on the History of the Stethoscope" (http://ww3.tvo.org/video/182217/jacaly
n-duffin-history-stethoscope). TVO. Retrieved 28 November 2012.
11. "History of Littmann Stethoscopes at a glance"(http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/
products/history/). 3M.com. Retrieved 2010-01-25.
12. "TRIMLINE Medical Products"(http://www.trimline.us). Retrieved 2010-01-25.
13. "JMIR-Impact of the Presence of Medical Equipment in Images on iV ewers' Perceptions of the Trustworthiness of an
Individual On-Screen - Jiwa - Journal of Medical Internet Research"(http://www.jmir.org/2012/4/e100/). Journal of
Medical Internet Research. Retrieved 24 September 2015.
14. Wilkins, RL (2004), "Is the stethoscope on the verge of becoming obsolete?",
Respir Care, 49 (12): 1488–1489,
PMID 15571638 (https://www.ncbi.nlm.nih.gov/pubmed/15571638).
15. Murphy, R (2005), "The stethoscope—obsolescence or marriage?"(http://rc.rcjournal.com/content/50/5/660.full.pdf+
html), Respir Care, 50 (5): 660–661.
16. Bernstein, Lenny (2016-01-02),"Heart doctors are listening for clues to the future of their stethoscopes"
(https://ww
w.washingtonpost.com/national/health-science/heart-doctors-are-listening-for-clues-to-the-future-of-their-stethoscope
s/2016/01/02/bd73b000-a98d-11e5-8058-480b572b4aae_story .html), Washington Post.
17. Palaniappan R, Sundaraj K, Ahamed NU, Arjunan A, Sundaraj S. Computer-based Respiratory Sound Analysis: A
Systematic Review. IETE Tech Rev 2013;30:248-56
18. Bianca K. Chung, Brad Tritle, "The power of mobile devices and patient engagement",p.93 (https://books.google.co
m/books?id=7YMsAgAAQBAJ&pg=PA93), chapter 8 in Jan Oldenburg (ed),Engage! Transforming Healthcare
Through Digital Patient Engagement, Himss Books, 2012 ISBN 1938904397.
19. William Hanson, Smart Medicine: How the Changing Role of Doctors W
ill Revolutionize Health Care, pp. 20-22 (http
s://books.google.com/books?id=FKlKjUgduP0C&pg=P A22), Macmillan, 2011 ISBN 0230120938.
20. Matt McFarland, "Eko’s stethoscope shows the potential of digital technology to reinvent health care",[1] (https://ww
w.washingtonpost.com/news/innovations/wp/2015/09/02/ekos-stethoscope-shows-the-potential-of-digital-technology-
to-reinvent-health-care/), Washington Post
21. ARUP KUMAR MAJHI (2016-08-16).Bedside Clinics In Obstetrics(https://books.google.com/books?id=-7zfDAAAQ
BAJ&pg=PA47). Academic Publishers. pp. 47–.ISBN 978-93-83420-87-2.
22. S. Ananthi, A Textbook of Medical Instruments, pages 290-296, New Age International, 2006ISBN 8122415725.
23. Mc Loughlin MJ and Mc Loughlin S. Cardiac auscultation: Preliminary findings of a pilot study using continuous
Wave Doppler and comparison with classic auscultation Int J Cardiol. 2013 Jul 31;167(2):590-1
24. "Amazon.com: Cardiac Auscultation With Continuous W ave Doppler Stethoscope: A new method 200 years after
Laennec's invention eBook: Mario Jorge Mc Loughlin, Santiago Mc Loughlin: Kindle Store"
(https://www.amazon.co
m/Cardiac-Auscultation-Continuous-Stethoscope-ebook/dp/B00AXFB2IG/ref=sr_1_3?s=digital-text&ie=UTF8&qid=1
369946217&sr=1-3&keywords=mario+mc+loughlin) . amazon.com. Retrieved 24 September 2015.
25. Official project site (https://github.com/GliaX/Stethoscope)at GitHub
26. Pauli, Darren (2015-08-14)."Gazan medico team 3D-prints world-leading stethoscope for 30c"(https://www.theregist
er.co.uk/2015/08/14/printed_stethoscope_cccamp/). United Kingdom: The Register. Retrieved 2015-08-17.

External links
The Auscultation Assistant, provides heart sounds, heart murmurs, and breath sounds in order to help medical
students and others improve their physical diagnosis skills
Demonstrations: Heart Sounds & MurmursUniversity of Washington School of Medicine
VCU Libraries Medical Artifacts Collection: Stethoscopes
"The invention of the stethoscope: A milestone in cardiology", analysis of Laennec's text (1819) on
BibNum [click 'à
télécharger' for English version].

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