ARCH2002 Australian Historical Archaeology s1

ARCH2002 Australian Historical Archaeology Life History of an Artefact Assignment

It is the universal sign of medicine. Used in so many ways the stethoscope has made I difference in the world of medicine. From the time it was invented in 1816 until early this century, the stethoscope was the most reliable and informative tool available for diagnosing cardiovascular disease. This new instrument was not embraced immediately, but it eventually became recognized by physicians as a valuable instrument for physical diagnosis. Although other, more sophisticated diagnostic methods have come into use since then, the stethoscope has never been discarded. The St John Ambulance Australia Historical Society in Unley has an early monaural stethoscope. (figure one) This stethoscope has been estimated to be made between 1820 and 1830. This is due to the markings on the side of the body. It was originally from London and is being displayed on behalf of a life member of St John Ambulance Australia Mrs. Lynette Dansie. Mrs. Dansie is heavily involved with the organisation and thought that the other members especially the cadets would be interested in past medical instruments. Although St John Ambulance Australia members today are not required to use stethoscopes often it is still interesting to show how medicine has developed over the years.

Stethoscopes in the 1820’s were still an innovation; this particular stethoscope is in the third stage of development. It has an overall length of 12 inches and a diameter of 1.5 inches. It was used for listening to patients lungs and for listening to the heart. This stethoscope was made in London by the company John Weiss & Son, who are known for their medical supplies in the 1800’s.

Technology of the stethoscope has come along way since 1816; it was invented when a young French physician named Rene Theophile Hyacinthe Laennec was examining a young obese female patient. The traditional method of listening to a patient’s chest is known as immediate auscultation, this involved “the direct application of an examiner's ear to the surface of a patient's body in order to listen to the internal sounds of the body.” (Answers Corporation 2005) Laennec was embarrassed to place his ear to her chest. He remembered a trick he learned as a child that sound travels through solids and thus he rolled up 24 sheets of paper, placed one end to his ear and the other end to the woman's chest. He was delighted to discover that the sounds were not only conveyed through the paper, but they were also louder and clearer. “I happened to recollect a

Danielle Modistach 2025424 1 simple and well-known fact in acoustics, and fancied it might be turned to some use on the present occasion. The fact I dllude to is the great distinctness with which we hear the scratch of a pin at one end of a piece of wood, on applying the ear to the other. Immediately, on this suggestion, I rolled a quire of paper (24 sheets) 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 suprised and pleased, to find that I could thereby percieve 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.” (Laennec 1821) Figure two is a picture of Laennec examining a tuberculous patient with the traditional way of ear to body method in the Necker Hospital, Paris. In his left hand is the stethoscope. Original version of the Laennec stethoscope made of a turned dense, finely grained, light coloured wood, approximately 1819. This cylindrical stethoscope is made with three parts fitting together by wood screw thread and brass tube fitting with an overall length of 12.6 inches and a diameter of 1.5 inches. Both ends are slightly concave. The cylindrical stethoscope is made in three parts fitting together by wood screw thread and brass tube fitting. A second version of the Laennec stethoscope is made of a turned finely grained, light wood, around 1826. The cylindrical stethoscope has three parts fitting together by rounded wood pressure fitting and brass tube fitting and horn rings at the juncture of the three parts. It has an overall length of 12 inches and a diameter of 1.5 inches. The third version of the stethoscope is the same as the artefact. A brass tube is no longer used to hold the chest plugs in place and that the parts of the stethoscope are attached by a funnel shaped, wood pressure fitting. In 1830 Laennec designed a one piece stethoscope and this is when his designs were coming to an end. As others were redeveloping his invention. There were several improvements to Laennec's stethoscope over the years; the most notable was that of Pierre Adolphe Piorry in 1828. Piorry also incorporated another diagnostic instrument, known as a pleximeter into his stethoscope. This is a small, hard, elastic plate, as of ivory, bone, or rubber, placed in contact with body to receive the blow, in examination by mediate percussion. The Piorry stethoscope evolved to have a thinner stem without an extension piece and was about half the size of Laennec's. It was trumpet shaped, made of wood, and had a removable wood plug, ivory earpiece and chest piece. The ivory chest piece also served as a pleximeter. The Piorry stethoscope became the model design for most stethoscopes after 1830.

Danielle Modistach 2025424 2 Charles James Blasius Williams developed another approach to the design of the stethoscope. He introduced a two-piece monaural stethoscope in 1843 with a trumpet shaped chest end that fit more comfortably against the chest wall. His stethoscope had a removable ear piece. There were also many different models of monaural stethoscopes produced. One example of this is the flexible monaural stethoscope. These were tubes of coiled spring covered with woven silk, usually 14 to 18 inches long, with a chest piece at one end and usually a very short, straight earpiece at the other. Flexible stethoscopes are often confused with conversation tubes, which looked the same, but were much longer than stethoscopes. The major difference between the flexible stethoscopes and conversation tubes, therefore, is in the convenience of use for the examining physician. Since physicians did not permit patients to hold the chest pieces on themselves during the examination, the length of useable tubing was limited to the length of the examiner's outstretched arm. The early development of the stethoscope took place on the wards of hospitals, where physicians could study the use of the stethoscope for mediate auscultation. Many patients were in hospitals because they had pulmonary infections, such as pneumonia or tuberculosis. Others were poor with little previous medical attention and, therefore, had far advanced disease often from a variety of infectious diseases. Although Laennec's stethoscope was a foot long, after the introduction of the Piorry stethoscope, most stethoscopes were about 7 inches in length. Yet unusually long stethoscopes could be seen in the hands of physicians examining these hospital ward patients. This type of long stethoscope was intended to keep the doctor a distance from the infested patient. These stethoscopes became known as ward or pauper's stethoscopes.

Stethoscopes were also developed for obstetrical and paediatric auscultation. Laennec's friend Jacques-Alexandre Lejumeau de Kergaradec was the first doctor to use the stethoscope for fetal auscultation and this technique was discussed by Laennec in his second edition text on auscultation. The fetal stethoscopes that emerged usually had a very wide or flaring bell and a wide ear plate, which prevented the stethoscope from rocking on the abdomen of the mother during fetal auscultation. Stethoscopes for children tended to be shorter than those for adults and were probably used as either paediatric or obstetrical stethoscopes. The monaural instrument was used exclusively for about 30 years, and was used into the late 19th and early 20th centuries. In fact, they are still used today in the obstetrical field in countries such as those of the Former Soviet Union, and were still being used in the

Danielle Modistach 2025424 3 United Kingdom as late as the 1980's. However, eventually physicians decided to find out if an instrument using both ears would be better than the simple monaural. This is where the more traditional stethoscopes that we see today are introduced.

By using the stethoscope physicians were able to diagnose a patent just by simply listening to their body. Auscultation used together with a light tapping of the chest, is a fundamental diagnostic measure in medical practice. The qualities of the sounds emitted by the lungs and heart denote the health or abnormality of these organs. Many diseases of the heart and lungs, and sometimes of the stomach, blood vessels, and intestines, can be recognized early by skilful use of the stethoscope. This made diagnosis more precise and therefore appropriate treatments could be provided sooner. The use of the stethoscope led to better descriptions of heart sounds and improved ability to distinguish among various murmurs and rhythmic disturbances. It increased understanding of how blood moves through the heart in each cardiac cycle, under normal and abnormal conditions.

The people who used the stethoscope were physicians of all areas. There were doctors who used them on pregnant women and children. It soon became a common piece of equipment for a doctor to have. There is a power relationship associated with the stethoscope for physicians used stethoscopes that were made in many different forms and from a variety of materials. Some stethoscopes were designed for special purposes. And some were made from special materials that generally signified a physician with an upper class clientele. Ivory or silver plated stethoscopes were used on the wealthier community and everyone else had the wooden variety. "A wonderful instrument called the stethoscope, invented a few months ago ... is now in complete vogue in Paris." (London Times December 19, 1824) This quote from a London newspaper shows how the stethoscope became more than a medical instrument and more of a medical accessory being adapted to suit the more wealthier clientele. Figure three shows an advertisement for stethoscopes from 1869. The advertisement shows the variety of stethoscopes available to doctors. As the beginning of the stethoscope was in an era where traditionally men were the doctors and inventors and women were the traditional nurses. This can suggest that it would have been improper for a woman to use the stethoscope, and if she were to use it that it was due to the doctor’s instruction.

Danielle Modistach 2025424 4 On the body of the stethoscope there is a trade mark engraved within the wood. It is marked Weiss, London, under a Crown and GR (figure four). The GR stands for George Regent who was King George IV who reigned from 1820-1830, thus clearly dating this stethoscope to that period. Weiss, London is the trademark of John Weiss and Son. The company manufacturer and distribute ophthalmic and ENT surgical instruments and consumables. They are a London based company and are still trading. Their business developed in America in the early 1870’s, providing stethoscopes and other medical instruments abroad. There are no evident alterations made to the stethoscope, but there is however a couple dents and scratches. This suggests that it was used as a medical instrument for listening to peoples chests. We know that it would’ve been used to listen to chests on an adult as the size suggests that it was designed for an adult. Also the shape and length proposes that it was for chest uses as apposed to abdomen uses. This could also mean that because there are only a few wear indications that it was taken care of well during the time that it was being used. The general look of it gives the feeling that it is old and delicate. It is now kept in a glass cabinet on display in the St John Ambulance historical society and is rarely handled. Having no archaeological context of this artefact makes it difficult to understand the life history of the artefact. This is because there is no way of knowing whether the stethoscope was used by a physician of whether it was obtained for another reason. It is unknown who owned it or how long it was used for. Who’s body it listened to and what it discovered. Not knowing much about the history of the artefact led to difficulty in researching the history. Only general information about all types of stethoscopes was possible to find. There were a select number of primary sources available, these included pictures from the time of the invention, newspaper articles by Laennec about his discovery and also articles from other physicians commenting on the stethoscope. From an advertisement for stethoscopes we are able to see what range were available for purchase. Ranging from the basic stethoscope up to the more advanced flexible stethoscope.

Its an object that today people take for granted, the stethoscope was apart of medical history in discovery and learning more about how the human body works. The stethoscope found in the St John Ambulance Australia Historical Society Museum in Unley is an example of how medical technology has changed over time.

Danielle Modistach 2025424 5 References

Answers Corporation Answers.com 2005 Site Viewed 5th October 2005 www.answers.com

Laennce. Rene Theophile-Hyacinthe 1824, Title Unknown, London Times December 19

Laennce. Rene Theophile-Hyacinthe 1821, A Treatise on Diseases of the chest and Mediate Auscultation, First Edition

The Wellcome Trust, The National Library of Medicine, 2005-10-31 Site Viewed 5th October 2005 http://library.wellcome.ac.uk/

Other Sources of Information

Benion, Elisabeth 1979. Antique Medical Instruments. Southeby's Publications London

Davis, Audrey B 1981. Medicine and its Technology. Greenwood Press London

Howard Hughes Medical Institute, History of Stethoscopes and Sphygmomanometers, 2005 Site Viewed 5th October 2005 http://www.hhmi.org/biointeractive/museum/exhibit98/content/b6_17info.html

Reiser, Stanley Joel 1978, Medicine and the reign of Technology, Cambridge University Press, Cambridge

Stethoscope.com, 2005 Site Viewed 5th October 2005 www.stethoscope.com

Danielle Modistach 2025424 6 FIGURE ONE

Picture of stethoscope artefact. Picture by Historical Society.

Danielle Modistach 2025424 7 FIGURE TWO

Picture by Theobold Chartan in the Sorbonne commemorating the invention of the stethoscope in 1816. (National Library of medicine)

Danielle Modistach 2025424 8 FIGURE THREE

Advertisement of stethoscopes from 1869. It shows what range of stethoscopes were available at the time.

Danielle Modistach 2025424 9 FIGURE FOUR

Picture of the trademark on the stethoscope. Picture by Historical Society.

Danielle Modistach 2025424 10