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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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Not Sure About Your Tap Water? Here's How to Test for Contaminants
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In the wake of Flint, Michigan's water crisis, you may have begun to wonder: Is my tap water safe? How would I know? To put your mind at ease—or just to satisfy your scientific curiosity—you can find out exactly what's in your municipal water pretty easily, as Popular Science reports. Depending on where you live, it might even be free.

A new water quality test called Tap Score, launched on Kickstarter in June 2017, helps you test for the most common household water contaminants for $120 per kit. You just need to take a few samples, mail them to the lab, and you'll get the results back in 10 days, telling you about lead levels, copper and cadmium content, arsenic, and other common hazardous materials that can make their way into water via pipes or wells. If you're mostly worried about lead, you can get a $40 test that only tells you about the lead and copper content of your water.

In New York State, a free lead-testing program will send you a test kit on request that allows you to send off samples of your water to a state-certified lab for processing, no purchase required. A few weeks later, you'll get a letter with the results, telling you what kind of lead levels were found in your water. This option is great if you live in New York, but if your state doesn't offer free testing (or only offers it to specific locations, like schools), there are other budget-friendly ways to test, too.

While mailing samples of your water off to a certified lab is the most accurate way to test your water, you can do it entirely at home with inexpensive strip tests that will only set you back $10 to $15. These tests aren't as sensitive as lab versions, and they don't test for as many contaminants, but they can tell you roughly whether you should be concerned about high levels of toxic metals like lead. The strip tests will only give you positive or negative readings, though, whereas the EPA and other official agencies test for the concentration of contaminants (the parts-per-billion) to determine the safety of a water source. If you're truly concerned with what's in your water, you should probably stick to sending your samples off to a professional, since you'll get a more detailed report of the results from a lab than from a colored strip.

In the future, there will likely be an even quicker way to test for lead and other metals—one that hooks up to your smartphone. Gitanjali Rao, an 11-year-old from Colorado, won the 2017 Young Scientist Challenge by inventing Tethys, a faster lead-testing device than what's currently on the market. With Tethys, instead of waiting for a lab, you can get results instantly. It's not commercially available yet, though, so for now, we'll have to stick with mail-away options.

[h/t Popular Science]

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Bill Gates is Spending $100 Million to Find a Cure for Alzheimer's
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Jamie McCarthy/Getty Images for Bill & Melinda Gates Foundation

Not everyone who's blessed with a long life will remember it. Individuals who live into their mid-80s have a nearly 50 percent chance of developing Alzheimer's, and scientists still haven't discovered any groundbreaking treatments for the neurodegenerative disease [PDF]. To pave the way for a cure, Microsoft co-founder and philanthropist Bill Gates has announced that he's donating $100 million to dementia research, according to Newsweek.

On his blog, Gates explained that Alzheimer's disease places a financial burden on both families and healthcare systems alike. "This is something that governments all over the world need to be thinking about," he wrote, "including in low- and middle-income countries where life expectancies are catching up to the global average and the number of people with dementia is on the rise."

Gates's interest in Alzheimer's is both pragmatic and personal. "This is something I know a lot about, because men in my family have suffered from Alzheimer’s," he said. "I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you're experiencing a gradual death of the person that you knew."

Experts still haven't figured out quite what causes Alzheimer's, how it progresses, and why certain people are more prone to it than others. Gates believes that important breakthroughs will occur if scientists can understand the condition's etiology (or cause), create better drugs, develop techniques for early detection and diagnosis, and make it easier for patients to enroll in clinical trials, he said.

Gates plans to donate $50 million to the Dementia Discovery Fund, a venture capital fund that supports Alzheimer's research and treatment developments. The rest will go to research startups, Reuters reports.

[h/t Newsweek]

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