Stethoscope

  The stethoscope (Greek στηθοσκόπιο, of στήθος, stéthos - chest and σκοπή, skopé - examination) is an acoustic medical device for auscultation, or listening to, internal sounds in a human or animal body. It is most often used to listen to heart sounds and breathing. It is also used to listen to intestines and blood flow in arteries and veins. Less commonly, "mechanic's stethoscopes" are used to listen to internal sounds made by machines, such as diagnosing a malfunctioning automobile engine by listening to the sounds of its internal parts.

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History

  The stethoscope was invented in France in 1816 by René-Théophile-Hyacinthe Laennec.^[1] It consisted of a wooden tube and was monaural. His 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." In 1851 Arthur Leared invented a binaural stethoscope, and in 1852 George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since. Cammann also authored 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 a standard tool in clinical practise.

Rappaport and Sprague designed a new stethoscope in the 1940s which became the standard by which other stethoscopes are measured. The Rappaport-Sprague was later made by Hewlett-Packard, later Philips, and today there are still cardiologists who consider it to be the finest acoustic stethoscope.^{[citation needed]} Several other minor refinements were made to stethoscopes, until in the early 1960's Dr. David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics.^[2]

Current practice

The stethoscope is used in aid of diagnosing certain diseases and conditions. The stethoscope is able to transmit certain sounds and exclude others. Before the stethoscope was invented, doctors placed their ear next to the patient's body in hopes of hearing something.

Stethoscopes are often considered as a symbol of the doctor's profession, as doctors are often seen or depicted with a stethoscope hanging around their neck.

Types of stethoscopes

Acoustic

Acoustic stethoscopes are familiar to most people, and operate on the transmission of sound from the chestpiece, 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 2-sided stethoscope was invented by Rappaport and Sprague in the early part of the 20th century. One problem with acoustic stethoscopes is that the sound level is extremely low. Acoustic stethoscopes are the most commonly used.

Electronic

An electronic stethoscope (or stethophone) overcomes the low sound levels by amplifying body sounds. Currently, a number of companies offer electronic stethoscopes, and it can be expected that within a few years, the electronic stethoscope will have eclipsed acoustic devices.

Electronic stethoscopes require conversion of acoustic sound waves to electrical signals which can then be amplified and processed for optimal listening. Unlike acoustic stethoscopes, which are all based on the same physics, transducers in 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. Thinklabs uses a stethoscope diaphragm with an electrically conductive inner surface to form a capacitive sensor. This diaphragm responds to sound waves identically to a conventional acoustic stethoscope, with changes in an electric field replacing changes in air pressure. This preserves the sound of an acoustic stethoscope with the benefits of amplification.

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. All of these features are helpful for purposes of teaching.

Noise reduction

More recently, ambient noise filtering has become available in electronic stethoscopes, with 3M's Littmann 3000 and Thinklabs ds32a offering methods for eliminating ambient noise.

Recording stethoscopes

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. .

Fetal stethoscope

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. The fetal stethoscope is also known as a Pinard's stethoscope or a pinard, after French obstetrician Adolphe Pinard (1844-1934).

See also

• Doppler fetal monitor

References