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No implement better visually identifies a physician than does the stethoscope, the acoustic medical device that enables medical personnel to listen to the internal sounds produced by the body. Stethoscopes have been used by doctors since their invention in 1816 by French physician Rene Laennec (1781-1826), who on one momentous day in his office rolled a sheaf of paper into a tube and placed one end on his patient's chest and his own ear at the other. As Dr. Laennec described the incident in his writings, he rolled a quire of paper 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 surprised and pleased to find that I could thereby perceive 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 my ear. However, while the when and who of that creation are well known, there remains a bit of question as to the why. According to some tellings of the moment that inspired Laennec to first conceive of using an implement to better listen to his patients' heart and lung sounds, it was the doctor's own sense of modesty that drove him to the unusual act of placing something substantial between him and his patient. The person he was treating that day was a young woman, and according to some accounts, although she did present as having a heart problem and thus he did indeed need to listen to her cardiac function, the good doctor did not feel it proper to rest his head against her bosom. (Other physicians of the day got around this matter of seeming indelicacy by placing handkerchiefs on the chests of female patients, thus at least creating a symbolic barrier between their ears and the actual flesh of those they were examining.) Yet other accounts describe Laennec's inspiration as having to do with the woman's size: He feared he would not be able to get a good aural reading of her chest function due to how well padded she was and thus cast about for something that might serve to amplify the sound. Whatever the cause of his inspiration, Laennec took what he'd learned from that examination and set about building an instrument which would assist him in better listening to heart sounds. His resulting stethoscope (from the Greek words stethos, meaning chest, and skopos, meaning observer) was a hollow wooden cylinder with a small funnel at one end. While many authorities cite Dr. Arthur Leared as the inventor in 1850 of the binaural (two-earpiece) stethoscope, that honor more properly belongs to Dr. Charles J.B. Williams, who had in 1829 sketched the very same thing. In 1850 Dr. George Camman improved the existing design by substituting rubber tubing for materials previously used to transmit amplified chest sounds to the examining physician's ears. Few today would have difficulty in recognizing Camman's improved design as a stethoscope, as it looks very much like those used by doctors of the modern era. Modern stethoscopes range from inexpensive models that can be purchased for about $10, which are useful for blood pressure readings but not that effective for listening to heart or lung sounds, up to ones that go for about $200, which are favored by cardiologists who need to be able to distinguish every sound made by their patients' hearts.
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