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14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 69 B-ENT, 2011, 7, 69-76 A Historical Vignette (21) A Tribute to Noise J. Tainmont Winston Churchill Avenue 172, P.O. Box 9, 1180 Brussels, Belgium Key-words. Noise; Audiology; Bruitism; Futurism; Music; Laennec; Russolo Abstract. A tribute to noise. Noise is not only the harmful waste of the world of sounds. Some noises have contributed, or continue to contribute, an added value in three fields at least: Internal Medicine, Audiology and Music. Moreover, they are perceived naturally by the ear (Figure 1). Figure 1. In the early 20th century, the Italian writer Marinetti declared: “The roaring of a motor car is more beautiful than the Victory of Samothrace”. In his slipstream, the Italian painter and musician Luigi Russolo painted “The dynamism of a motor car”, evoking speed and noise. A high-powered racing car is cut into sections by a number of red arrows with different angles, passing through the city and throwing off sparks. The form situated on the right half of the painting enclosed by the first two arrowheads resembles the modern Smart. The shape on the left resembles the profile of a high-speed train. The work dates from 1912-1913. (Museum of Modern Art, Centre Pompidou, Paris). 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 70 70 J. Tainmont I. Noise in internal medicine form of auscultation, which is was not well received by his col - described as “immediate” or leagues until it came to the atten - Hippocrates: direct auscultation 1 “direct”, was destined to be tion of Corvisart, Napoleon’s (Figure 2a) practised until the 19th century. physician, who translated it from The island of Cos, off Minor Even when use of the stethoscope Latin into French. Corvisart Asia, was home to the develop - was established among practition - recognised Auenbrügger’s pater - ment of the " clinical " school of ers, many a leading Paris physi - nity, put the finishing touches to medicine in the fourth and fifth cian still used a towel, which they the approach and propagated the centuries BC. Its principle was would lodge between their ear and method throughout France. defined by Hippocrates and his the patient’s thorax. school, requiring the practitioner René Hyacinthe Laennec. The to use his five senses to examine Leopold Auenbrügger: percus - stethoscope 3 (Figures 2c,3,4,5) his patient and then to use his sion 2 (Figure 2b) Unlike Auenbrügger, Laennec mind to arrive at a diagnostic con - This Austrian physician, the had a famous predecessor in the clusion. Of course, these five sens - son of an innkeeper, watched his person of Hippocrates, whose es included hearing: listening to father tapping wine barrels to works he had read. Laennec was a the physiological or of the patho - determine how full they were. Breton; he was a fervent Catholic logical noises produced by the When he became a physician in and a Royalist. Should we focus patient. Hippocrates described Vienna, he applied the same prin - exclusively on this context to succussion , the sound of a slosh - ciple to percussion of the thorax. explain a sense of modesty that ing noise when the patient was He practised it directly with the tip many will consider to be excessive shaken by the shoulders, indicating of his fingers, which allowed him and that made him uncomfortable hydropneumothorax. The Hippo - to diagnose pulmonary condensa - with direct auscultation on the cratic physician also sounded the tions or pleurisies on the basis of chest of a woman, especially chest of the patient by applying the flat sounds he heard or to iden - when she was young and pretty? It his own ear to the thorax, and he tify the presence of air when he is certainly the case that Laennec listened to the noises of the heart heard tympanic resonance. The was looking for another way of and of the respiratory system. That work describing his observations listening to the noises of the heart abc Figure 2. 2a. Hippocrates (460-377 BC), seated on the left, watches the god of medicine, Asclepius, coming on land on the island of Cos. An inhabitant of the island gives him a slightly warmer welcome (Roman mosaic of the second or third century AD, Cos Museum). 2b. Leopold Auenbrügger (1722-1809). 2c. René Hyacinthe Laennec (1781-1826) 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 71 Historical Vignette 71 and of the lungs. One day during a was the first mono-auricular Laennec and the auscultation of walk in Paris, he saw two children stethoscope. And indeed, in the the noises from the ENT cavities playing at what looked like an early 1818, he christened his Even though history has left amusing physics experiment: one device “a stethoscope”. He few traces of his work in this of them was rubbing one extremi - recorded his observations and respect, it should be pointed out ty of a tree trunk several metres his conclusions in the famous that in addition to his interest in long that was lying on the ground, Traité de l’auscultation médiate the heart and the lungs, Laennec while the other held his ear to the (“Treatise on mediate ausculta - also investigated the movements other end, allowing him to hear tion”), the first edition of which of air and liquids in other organs. clearly the corresponding noise. appeared in 1819. As Laennec was In 1837, a posthumous edition of In July 1817, Laennec had an an adept of the totally new anato - his treatise tells us that Laennec inspired idea: he took a bundle of mo-clinical method, he compared also used his stethoscope to study paper from a notebook. He tied it the noises perceived at the tho - the auricular and sinus cavities. up into a roll and then glued it racic level with the lesions He applied his stethoscope to the together. It did not take long observed during autopsies. That is mastoid apophysis, the frontal before this roll was abandoned in why his instrument was dubbed a prominences and the root of the favour of a solid wooden cylinder, stetho scope and not (for example) nose, to the upper dental arch and which was followed by a hollow “a stetho phone ”: listening to the to the cheekbone. He heard the cylinder: in this instance, an old cardio-respiratory noises allowed passage of air into the mastoid and oboe. He experimented with the him to fore see , in other words to in the various sinuses during a tube's length, breadth, thickness see the lesions in advance... Valsalva-type manoeuvre. In this and even the inner diameter. He The bi-auricular model was way, he monitored the patency of tested several materials before built after Laennec’s death, in the Eustachian tube by listening opting for beechwood. The result 1851. for the sound of the passage of air Figure 3. Different stages in the development of the stethoscope. A plate from the treatise on “mediate auscultation” (1819): a full cylinder, a hollowed cylinder with a flared opening. On the last model, you see, unscrewed and upside down, the conical shape of the widened end, intended to rest on the thorax. So the stethoscope had to be assembled first before use. Figure 4. The stethoscope has been assembled and is ready for use. The upper part will rest on the thorax; the ear fits over the lower part of the instrument. Figure 5. A posthumous portrait of Laennec showing him using the Hippocratic approach of direct auscultation at the Necker Hospital but holding his stethoscope in his hand! Take note of the top hat, morning coat and cane laid on the chair held by a nun. The picture also shows two medical students, one of whom is taking notes. This painting by Theobald Chartran is in the Sorbonne and dates from about 1889. 14-Hist.Vign.(Noise):Opmaak 1 15/03/11 14:30 Pagina 72 72 J. Tainmont Lombard's screening test for audi- tory simulation. In 1910, he pub- lished: “Contribution to the semeiology of deafness to reveal its simulation” in the Bulletin of the Academy of Medicine, 1910, 64, pp. 127-130. The next year in Paris, Lombard published “The sign of the rise of the voice” in the Annales des maladies de l’Oreille, du Larynx, du Nez et du Pharynx, 1911, 37, pp. 101-119. The Barany noisemaker was not the only masking device proposed by Figure 6. Barany noisemaker, adult model. Lombard for his test. He also had Figure 7. Georges Portmann sounding the patency of the Eustachian tube with “the a pressurised air projector in tubular telephone”. which the nozzle was directed in such a way that the flow was bro- ken at the entrance to the auditory canal (an approach adopted again and, in cases involving catarrh, while working there that he came later by Aubry and Giraud), and identified the presence of mucus up with the idea for his device. It also “a deafening phone which is in the Eustachian tube and in the included a clock mechanism for connected to an induction coil, the sinuso-nasal ducts on the basis of winding it up and it produced a power of which is regulated as humid rales. sort of buzzing, purring noise. The required”. One particularly striking com - intensity could be controlled using ment was: Auscultation will be a a polished metallic button situated 2. The tubular telephone reliable way of identifying the on the top of a metallic box. A (Figure 7) obliteration of the Eustachian tube shaped like a teat was intro- This procedure consisted of forc- tube.