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Morals, Mammaries, and the Invention of the Stethoscope

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Robert A. Thom/clinmedres.org

In 1816, French physician Rene Theophile Hyacinthe Laennec had a young woman on his exam table, and no idea what to do with her. She’d come in complaining of chest pains, and their conversation and the examination up to that point suggested a diseased heart, but Laennec wasn’t sure how he would confirm that.

Since the days of Hippocrates, doctors had limited options when it came to assessing cardiac health, and mainly relied on auscultation, or listening to sounds of the body. Dulled sounds in an area of the chest that was normally more resonant, for example, could indicate extraneous fluid or a tumor. One way of doing this was to place an ear right on the patient’s chest and listen directly to the heart, lungs, and chest cavity. Another option was to tap on the chest or back and listen to the resulting sound, a method developed by an Austrian physician whose innkeeper father tapped on wine barrels to determine their fullness.

Laennec was familiar with both methods—in fact, one of his teachers (and Napoleon’s personal physician), Jean-Nicolas Corvisant, had helped popularize the percussion technique—but neither would do him any good with this patient. The young lady was on the heavier side and ample in the chest, which presented some complications.

“Percussion and the application of the hand were of little avail,” Laennec wrote of the exam, “on account of the great degree of fatness.” Putting his ear right up to her chest was also “rendered inadmissible” by the Catholic bachelor’s social unease at putting his head that close to a young woman’s bosom. He later said of examining female patients that, “direct auscultation was as uncomfortable for the doctor as it was for the patient…It was hardly suitable where most women were concerned and, with some, the very size of their breasts was a physical obstacle to the employment of this method.”

After a few embarrassing minutes, Laennec remembered “a simple and well known fact in acoustics…the augmented impression of sound when conveyed through certain solid bodies—as when we hear the scratch of a pin at one end of a piece of wood, on applying our ear to the other.”

He grabbed a sheet of paper, rolled it up and placed one end against the woman’s chest and the other against his ear. He was “surprised and elated to be able to hear the beating of her heart,” he wrote, “with far greater clearness than I ever had with direct application of my ear.”

Over the next few years, Laennec experimented with his improvised tool and perfected its design. A wooden tube carried sound better than paper, and pine seemed to work especially well. He struggled with a name for his invention, though, and toyed with pectrolique, medical cornet and thoraciscope before settling on stethoscope, from the Greek stethos (“chest”) + -scope (“look or examine”).

Satisfied with his design, Laennec went on to use the stethoscope to catalog and describe various sounds of the chest and correlate them to specific ailments. After three years, he published the landmark De l’Auscultation Médiate, ou Traité du Diagnostic des Maladies des Poumons et du Coeur (or, On Mediate Auscultation, or Treaty of Diagnosing Diseases of the Lungs and the Heart).

Besides having an advanced instrument for it, it seems only natural that Laennec would be drawn to treating diseases of the chest: his mother, the uncle that helped raise him, and a few of his mentors all died of tuberculosis. Laennec himself would eventually contract the disease and die from it in 1826. He left his personal stethoscope to his nephew.

Laennec’s invention received its fair share of criticism at first. Even John Forbes, the Scottish physician who translated De l’Auscultation Médiate into English, said that, “It must be confessed that there is something even ludicrous in a grave physician formally listening through a long tube applied to the patient's thorax, as if the disease within were a living being that could communicate its condition to the sense without.” Eventually, though, it gained wide acceptance. With modifications by others, like Arthur Leared and Nicholas Comins’ binaural versions, the stethoscope became an indispensable tool by the 20th century.

How much longer the stethoscope stays that way is uncertain, though. Dr. Bryan Vartabedian, MD, on his blog 33 charts, looked at a 1993 study done by researchers at the Medical College of Pennsylvania. They found, in a nationwide survey of medical training program directors and students, that only 27.1 percent of internal medicine and 37.1 percent of cardiology programs offered structured teaching of chest auscultation, and that accuracy with a stethoscope ranged from 0 percent to 56.2 percent for cardiology fellows, and from 2 percent to 36.8 percent for medical residents.

At the end of that decade, the lead author on that study conducted a similar survey, and found an uptick in the internal medicine programs teaching chest auscultation (up to 48 percent for cardiac auscultation). He didn’t check in on internal med programs again, but only 29.2 percent of family practice programs taught cardiac auscultation and 12.2 percent taught pulmonary auscultation.

This piece was originally published in 2013.

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Live Smarter
5 Tips for Becoming A Morning Person
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You’ve probably heard the term circadian rhythm. Your circadian rhythm is an internal clock that influences your daily routine: when to eat, when to sleep, and when to wake up. Our biological clocks are, to some extent, controlled by genetics. This means that some people are natural morning people while others are night owls by design. However, researchers say the majority of us fall somewhere in the middle, which is good news if you want to train yourself to wake up earlier.

In addition to squeezing more hours out of the day, there are plenty of other good reasons to resist hitting the snooze button, including increased productivity. One survey found that more than half of Americans say they feel at their best between 5 a.m. and noon. These findings support research from biologist Christopher Randler, who determined that earlier risers are happier and more proactive about goals, too.

If you love the idea of waking up early to get more done, but you just can't seem to will yourself from out under the covers, here are five effective tips that might help you roll out of bed earlier.

1. EASE INTO THE HABIT.

If you’re a die-hard night owl, chances are you’re not going to switch to a morning lark overnight. Old habits are hard to break, but they’re less challenging if you approach them realistically.

“Wake up early in increments,” Kelsey Torgerson, a licensed clinical social worker at Compassionate Counseling in St. Louis suggests. “If you normally wake up at 9:00 a.m., set the alarm to 8:30 a.m. for a week, then 8:00 a.m., then 7:30 a.m.”

Waking up three hours earlier can feel like a complete lifestyle change, but taking it 30 minutes at a time will make it a lot easier to actually stick to the plan. Gradually, you’ll become a true morning person, just don’t try to force it to happen overnight.

2. EXERCISE IN THE MORNING.

Your body releases endorphins when you exercise, so jumping on the treadmill or taking a run around the block is a great way to start the day on a high note. Also, according to the National Sleep Foundation, exercising early in the morning can mean you get a better overall sleep at night:

“In fact, people who work out on a treadmill at 7:00 a.m. sleep longer, experience deeper sleep cycles, and spend 75 percent more time in the most reparative stages of slumber than those who exercise at later times that day.”

If you don’t have much time in the morning, an afternoon workout is your second best bet. The Sleep Foundation says aerobic afternoon workouts can help you fall asleep faster and wake up less often throughout the night. “This may be because exercise raises your body’s temperature for about four to five hours,” they report. After that, your body’s core temperature decreases, which encourages it to switch into sleep mode.

3. MAKE YOUR BEDROOM IDEAL FOR SLEEP.

Whether it’s a noisy street or a bright streetlight, your bedroom environment might be making it difficult for you to sleep throughout the night, which can make waking up early challenging, as you haven’t had enough rest. There are, however, a few changes you can make to optimize your room for a good night’s sleep.

“Keep your bedroom neat and tidy,” Dr. Nancy Irwin, a Los Angeles-based doctor of psychology on staff as an expert in sleep hygiene at Seasons Recovery Centers in Malibu, suggests. “Waking up to clutter and chaos only makes it more tempting to crawl back in bed.”

Depending on what needs to be improved, you might consider investing in some slumber-friendly items that can help you sleep through the night, including foam earplugs (make sure to use a vibrating alarm), black-out drapes, light-blocking window decals, and a cooling pillow

Another simple option? Ditch the obnoxious sound of a loud, buzzing alarm.

“One great way to adapt to rising earlier is to have an alarm that is a pleasing sound to you versus an annoying one,” Dr. Irwin says. “There are many choices now, whether on your smartphone or in a radio or a freestanding apparatus.”

4. TAKE THE TIME TO PROPERLY WIND DOWN.

Getting up early starts the night before, and there are a few things you should do before hitting the sack at night.

“Set an alarm to fall asleep,” Torgerson says. “Having a set bedtime helps you stay responsible to yourself, instead of letting yourself get caught up in a book or Netflix and avoid going to sleep.”

Torgerson adds that practicing yoga or meditation before bed can help relax your mind and body, too. This way, your mind isn’t bouncing from thought to thought in a flurry before you go to bed. If you find yourself feeling anxious before bed, it might help to write in a journal. This way, you can get these nagging thoughts out of your head and onto paper.

Focus on relaxing at night and stay away from not just exercise, but mentally stimulating activities, too. If watching the news gets your blood boiling, for example, you probably want to turn it off an hour or so before bedtime.

5. GET YOUR DAILY DOSE OF LIGHT.

Light has a immense effect on your circadian rhythm—whether it’s the blue light from your phone as you scroll through Instagram, or the bright sunlight of being outdoors on your lunch break. In a study published in the Journal of Clinical Sleep Medicine, scientists compared the sleep quality of 27 subjects who worked in windowless environments with 22 subjects who were exposed to significantly more natural light during the day.

“Workers in windowless environments reported poorer scores than their counterparts on two SF-36 dimensions—role limitation due to physical problems and vitality—as well as poorer overall sleep quality," the study concluded. "Compared to the group without windows, workers with windows at the workplace had more light exposure during the workweek, a trend toward more physical activity, and longer sleep duration as measured by actigraphy.”

Thus, exposing yourself to bright light during the day may actually help you sleep better at night, which will go a long way toward helping you wake up refreshed in the morning.

Conversely, too much blue light can actually disturb your sleep schedule at night. This means you probably want to limit your screen time as your bedtime looms closer.

Finally, once you do get into the habit of waking up earlier, stick to that schedule on the weekends as much as possible. The urge to sleep in is strong, but as Torgerson says, “you won't want your body and brain to reacclimate to sleeping in and snoozing.”

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technology
New Device Sanitizes Escalator Handrails While They're in Use
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LG

If you have ever hesitated to touch a well-used escalator's handrails for fear of contracting some disease from the masses, LG Innotek has an answer for you. The company just released a handrail sterilizer that uses UV light to kill nearly every germ coating the rubber belts, according to The Verge.

As the railings move with the escalator, they pass through the UV light, which kills 99.99 percent of germs, according to tech developer LG Innotek. The sterilizer is placed just before escalator users hop on, ensuring the handrails are still relatively clean when you grab on at the bottom. The device is a little bigger than a regular hand sanitizer dispenser (around the size of a piece of paper) and starts automatically when the escalator begins moving. It runs on power generated by the movement of the escalator.

UV radiation is used to kill super-germs in hospitals (and one company wants to bring it to planes), but it's relatively easy to use on your phone, your toothbrush, or anywhere else in your house. You can already get handheld UV sterilizers online, as well as aquarium-specific ones. In April 2017, LG Innotek released a faucet that purifies water by UV-sterilizing it inside the aerator. However, the fact that escalator railings are constantly on the move makes them easier to clean automatically than subway railings, door handles, and other potentially germy public surfaces we touch every day.

Bear in mind that while nobody likes getting a cold, germs aren't always bad for you. Some types can even help protect you against developing asthma, as scientists found while researching the health differences between Amish children and their counterparts on more industrialized farms. Whether you touch the handrails or not, cities have their own unique microbiomes, and those ubiquitous bacteria are pretty much guaranteed to get on you whether you like it or not. On the bright side, if you are a germophobe, UV sterilization has been touted as a possible alternative to other antibacterial treatments that cause supergerms.

[h/t The Verge]

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