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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

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I. Noise in internal medicine form of , 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 : 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 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

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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

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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

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Lombard's screening test for audi- tory simulation. In 1910, he pub- lished: “Contribution to the semeiology of 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. He anticipated “the tubular duced into the external auditory ing air through the tube using a telephone” that was to interest canal of the ear to be masked. The Politzer bag as a mouthful of Escat about 100 years later in the clock mechanism was started, run- water is being swallowed or, in a 1930s. ning for the time needed to study more complicated approach, by the ear. Bluestone published a catheterisation of the tube open- model adapted for children, II. Noise in and in ing, followed by insufflation with replacing the teat with a cup that Audiology a Ladret de Lacharière ventilating encloses the pinna. fan. According to George • The masking of the normal ear Portmann, this made it possible to 1. Robert Barany's noisemaker4 during the Rinne test deliver more air smoothly under (Figure 6) Before the introduction of the continuous pressure that is built • Identifying profound unilateral audiometer, the Barany noise - up progressively. The entry of the deafness maker was also used to safeguard air into the Eustachian tube was Robert Barany described his the reliability of the Rinne tuning monitored using an “otoscopy” noisemaker for the first time in fork test. The Barany noise- tube (cf. “stethoscope”!) that was 1908. Originally, the device was maker became obsolete with the 60 to 80 cm long and ended in two developed to identify profound appearance of audiometers with nozzles: the first was introduced unilateral deafness. In 1903, an integrated masking noise. in the patient’s ear and the second Barany accepted the position of • Screening for auditory simula- in the examiner’s ear. assistant at the Otological clinic tion with the Lombard test5 It made it possible to ensure, by directed by Adam Politzer at the Another application of the means of auscultation, that some University of Vienna, and it was Barany noisemaker was the Ernest air penetrated in the , 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 73

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Figure 8. This white noise compares the masking effect of the noise at the subjective sensory level. Above 2000 Hertz, the noise is less active on the slope of the subjective sensory level in the case of a Ménière patient (right-hand graph). Figure 9. On the right, there is a profile showing click frequencies. On the left, we see the amplitude of vibration of a loudspeaker emitting a “click” over time: note the briskness and the amplitude of the initial phase of the click.

and also to determine how it did pure tone varies according to the activity. This cannot be done using so. Escat described an entire subjective perception of the inten - a pure tone with a longer rise time. symptomatology which was remi - sity of the pure tone. This makes it The “click” is a noise which is, by niscent of pulmonary auscultation. possible to study recruitment definition: a complex sound, the For instance, he spoke about “a using auditory levels in the pres - different frequencies of which souffle - mellow or full or broad - ence of noise. are not linked together by which was followed by a smooth In fact, comparing two audio - multiples or submultiples tympanic click” in healthy grams – one from a normal sub - expressed by whole numbers (in patients; or about “crackling rales, ject, and the other from a Ménière other words, there are no often very thin” in the case of patient – demonstrates that, in the harmonics) . Figure 9 shows the fluid exudation in the middle ear; Ménière patient, the ear suffering different frequencies present in a or about “a simple whistling” in from recruitment withstands bet - “click” and, indeed, there are no the case of a point-shaped perfora - ter the masking effect of the noise : harmonics of a particular frequen - tion of the tympanic membrane; or the curves of the hearing levels cy, but a series of frequencies that about “a whistling mixed with fall hardly at all in spite of the are not linked by harmonic moist rales” in the case of perfora - increase in the noise. On the con - connections. tion of the tympanic membrane trary, the hearing level of a normal with exudation in the middle ear; subject declines regularly in or finally about “a weak souffle, accordance with the intensity of 5. The masking device of Vernon sometimes staccato, and not the noise. (first generation) and the second- followed by a click” in the case of generation noise generator 6 a severe tubular obstruction. 4. The click used in the measure - (Figure 10) Georges Portmann was still using ment of the evoked auditory In both cases, these are noise this procedure in the 1940s. potentials of the brain stem maskers but they are based on dif - (Figure 9) ferent principles. The first-genera - 3. Tonal audiometry after Langen - The click is a stimulus. Its tion devices are masking devices beck (Figure 8) advantage is its suddenness, and they were introduced by Langenbeck's work dates from the which allows for the synchronous Vernon. The underlying principle 1950s. In cases of recruitment, it discharge of a large number of is simple: the intensity of the noise is conceivable that the masking nervous fibres, making it visible exceeds that of the and so effect caused by the noise on a against the background of cerebral masks it. 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 74

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become the creed of Bruitism (or Futurism) (Figure 11). Russolo started from the principle that music had to take its inspiration from the reality of the sounds of the world, even if it meant treating it musically to touch the soul, which is the ultimate aim of music. But sonorous reality was in fact noise! There was no longer any question of pleasing the ear. In the past, “noise was excep - tional; it was limited to lightning, to the noise of a waterfall, to the roaring of a wild animal”. By con - trast, in Russolo's new view, it is noise that has occupied the field of daily life and musicians can no Figure 10. The range of the tonal frequencies making up the longer deny the evidence of what noise to combat the tinnitus is shown in light grey, resembling should be their true source of the profile of a chain of mountains. In the first case, the noise inspiration. Even though his envelopes the tinnitus: it conceals it. In the second case, the noise drowns it, makes it a part of everyday life, by over - claims were probably excessive, flowing it from all directions as far as the frequencies are they got more than one musician concerned, but not by masking it in the proper sense. thinking: “we must break at any price with that limited circle of the pure tones and conquer the infinite variety of the tone-noises. We The second type is called “a only because of the disruption due have had enough of the great mas - noise generator”. The aim is not to the First World War. The terrify - ters... That is why we take much to mask the tinnitus but, by pre - ing Mechanisation of the late 19th more pleasure in combining, in an senting the ear with a large range century gave way to Technology, ideal way, the sounds of trams, of non-masking tonal frequencies which was at least cleaner and motor cars, horse-drawn carriages which go far beyond the frequen - which had charms to which some and yelling masses than in listen - cy of the tinnitus, to create a dis - artists were susceptible. The pace ing to the Heroic or Pastoral sym - traction, make the tinnitus less and energy of urban life captivated phony, for instance”. alarming and, as it were, to desen - more than one artist, in spite of Adopting an approach which he sitise the ear to the tinnitus. That Saint Saens’ assertion in 1914: “ I wanted to be scientific, he process demands, by contrast with foresee, without any gaiety in my reviewed the different types of the simple masking device, a heart, the advent of noise ”. The noise, breaking them down into relatively long period of training new generation of artists included six families: (several hours a day over several the Italian writer F. T. Marinetti, 1. Roars, Thunderings, Explosi - months) to be effective. who claimed: “ the roaring of a ons, Hissing roars, Bangs, motor car is more beautiful than Booms the Victory of Samothrace ” 2. Whistling, Hissing, Puffing III. Noise in music, Luigi A certain Luigi Russolo (1885- 3. Whispers, Murmurs, Mum - Russolo and Bruitism (or 1947), who was both painter and bling, Muttering, Gurgling Futurism): 1913 7 musician, followed close behind 4. Screeching, Creaking, Rust ling, (Figures 11,12,13) him. In March 1913, he published Buzzing, Crackling, Scraping a manifesto addressed to his 5. Noises obtained by beating on In the early 20th century, the fellow-musician Pratella entitled metals, woods, skins, stones, world changed considerably, not “The art of noises”. It was to pottery, etc. 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 75

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“the Coliseum” in London, accompanied by a symphonic orchestra. Russolo was not content with reproducing existing noises; he wanted to combine them, change their timbre and their rhythm with the aim of touching the soul, the listeners' sensibilities. Among the presented works, there was Figure 11. Opening and closing lines of Russolo’s manifesto “Wakening of a capital city”, “Meeting place of motor cars and aeroplanes”, “People dining on the terrace of the casino”... In 1924, he presented a new instrument called the “Rumorhar - mo nium” or “Russolophone”. It was like an upright piano equipped with three amplifiers. It produced noises and triads as well. For a while, this instrument was used as an accompaniment for the silent movies of the age but the advent of the talking movies from 1929 onwards put an end to this experiment. Russolo’s life came to an end rather sadly. Having refus - ing to cooperate with the Fascist movement of Mussolini, which Figure 12. Luigi Russolo (on the left) and his friend Ugo Pati with a few “Intonarumori” had supreme control over in 1913. Furthermore, Russolo liked a joke. He loved to pretend that he was a “Futurist” music, Russolo sank descendant of Cardinal Richelieu... something that was absolutely untrue. Nevertheless, into oblivion and died in poverty the resemblance is indeed striking on this portrait painted by Philippe de Champagne, a Belgian painter born in Brussels. in 1946. However, “Bruitism” was certainly known to a number of leading musicians, such as Stravinsky, Ravel, Milhaud, Edgard Varèse, Luciano Bério and others. The electronic music of 6. Voices of animals and people, boxes of bright colours: yellow, Pierre Schaeffer and Pierre Henry Shouts, Screams, Shrieks, green, pink, red (Russolo was also was also indebted to the legacy of Wails, Hoots, Howls, Death a painter) from which trumpets “Bruitism”. rattles, Sobs protruded. These noisemakers • In his opera “Porgy and Bess”, He asserted that these are the most were named “Intonarumori”. They which was staged for the first basic and fundamental noises, and produced noises of motorbikes, time on Broadway in 1935, that all other noises are only motor cars, engines and trains and reworked in subsequent associations and combinations of moving at high speed. The noises years, George Gershwin these. were produced by a strange sys - acknowledged in his way the Shortly thereafter, Russolo tem of handles and levers used to concept of noise in Scene 3 started building “noisemakers” control their pitch. In 1914, public of Act 3 by inserting a with his friend Ugo Patti concerts were given in Italian “Symphony of Noise ”, repro- (Figure 12). They looked like big cities like Milan and Genoa or ducing the sonorous and 14-Hist.Vign.(Noise):Opmaak 1 10/03/11 10:41 Pagina 76

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those familiar noises that awaken children's awareness of the world of sounds and introduce them to the external environment. Or these noises that calm the anxieties of isolated men immersed in silence. No, Noise is not only the harmful waste of the world of sounds.

References

1. Hippocrate de Cos. De l’art médical, de l’Officine du Médecin. Traduction d’Emile Littré, Bibliothèque classique, Figure 13. The first concert with the “Intonarumori” in 1914 Le Livre de Poche, Librairie générale française, Paris; 1994:343. 2. Auenbrugger L. Inventum novum ex percussione thoracis humanis ut signo abstrusos interni pectoris morbos laborious awakening of the Harnoncourt in his recent detegendi. Vindobonae, Trattner; 1761. city: one person is sawing compact disc from 2009. 3. Laennec RH. Traité de l’auscultation wood, another is still snoring, médiate . Brosson et Chaudé, Libraires, children are skipping, some - Conclusion Paris; 1819. body is beating an egg, another 4. Barany R. Barany noisemaker. is beating a carpet... And all This paper defended and Zeitschrift für Ohrenheilkunde . 1908; 56:287 these disparate noises combine described Noise, demonstrating its 5. Lombard E. Le signe de l’élévation de and gradually acquire the same potential benefits. We could also la voix. Annales maladies Oreille, rhythm before moving into have mentioned snowy crepitation Larynx, Nez, Pharynx . 1911;37:101- a Charleston. After being in the case of subcutaneous 119. neglected for 70 years, this emphysema or abdominal borbo - 6. Kellerhals B, Zogg R. Tinnitus part of the original score for rygmus... rehabilitation retraining . Karger; 1999. the incidental music by Finally, it would be reprehensi - 7. Russolo L. L’art des bruits . Manifeste Gershwin was restored to the ble to fail to mention the foot- Futuriste . 1913. Éd. Marguerite public domain by Nikolaus soldiers of the world of noise, Waknine, Angoulême; 2010.