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When early physicians had little more to offer than herbs, potions, and minor surgical procedures, the art of physical diagnosis played a great role in the practice of medicine. Hippocrates (460-370 BC), "the Father of Medicine", examined his patients by inspection and palpation along with the use of smell and taste to evaluate bodily fluids (1). Careful observation was also stressed by the first modern physician, Thomas Sydenham (1624-1684), to help "nature to throw off the morbific matter".

Unfortunately, however, social customs impeded the inquisitive physician, making examination more and more difficult . Many oriental cultures considered physical contact inappropriate so that female patients were required to point out their areas of discomfort on "doctor's ladies" made of carved ivory (2-3).

Auscultation and Percussion

The discovery of the stethoscope, Greek for "I see the chest", is credited to Rene Laennec, a French physician who was required to examine a buxom female patient in 1817 (4,5). In order to listen to her chest and at the same time preserve decorum, he rolled up 24 sheets of paper and was surprised to find that the sounds were transmitted with more intensity. He published his famous text on auscultation of the chest in 1819; Laennec ironically died of consumption, or tuberculosis, 7 years later.

In the middle of the 18th century, Leopold Auenbrugger noted that tapping on barrels resulted in various pitched sounds, depending on the level of the fluid in the barrel. He extrapolated this tapping technique during his physical examination, now called percussion, to help evaluate respiratory function (6,7). This did not go unnoticed by Pierre-Adolphe Piorry who modified Laennec's stethoscope when he added a pleximeter (meaning, "I strike") (8,9). Monaural stethoscopes like that of Piorry were made of many materials including ebony, ivory, fruitwood, brass, pewter, and later aluminum (9a,9b). They evolved into a more convenient "flexible" type made of woven silk (10). Flexible stethoscopes can be differentiated from conversation tubes in that the former are usually less than 18" long and had ear pieces that were either straight or flat, but not curved.

1) Bust of Hippocrates

Early bronze representation of "the Father of Medicine", by Chardigny (1854). The Bust is in fine detail and 8 1/2" tall.

2,2a,3) The Propriety of a Physical Exam

Physical examination was done at arm's length through the 19th century. The pulse was checked in "Dr. William Gleason" (1785), by William Chandler while Dr. JP Maygrier discretely examined his patient in this famous representation from "Nouvelles Demonstrations D'Accouchemen" (1822). It was a geisha custom to wrap the feet early in life in order to stunt their growth. It was considered to be very attractive and is seen in the hand carved ivory Doctor's Lady.

4-5) Laennec Stethoscope

This was one of the first Laennec stethoscopes and was owned by Dr. Auzoux, the famous French paper mache anatomic model maker who graduated medical school in 1822, though never practiced medicine; 11.5" made of turned boxwood.

6-7) Percussor and Pleximeter

The ivory pleximeter is placed on the chest and struck with the percussor. The pitch of the resulting sound gave the physician a clue regarding the presence of pneumonia or fluid in the chest. This cased set was made by Hilliard in Edinburgh while Aitken made the very rare combination percussor-pleximeter.

8-9) Piorry Stethoscope

Second generation stethoscope made of ebony and ivory. The large ivory end is the earpiece and holds a small loose cone to aid in the transmission of sound.

9a,9b Maw Ivory Monaural Stethoscope

The monaural form was common in the 19th century, though very rarely were they cased and hallmarked. This may have been a presentation piece.

10) Flexible Stethoscope

The flat end is the earpiece. Longer length devices were called conversation tubes and used as hearing aids.

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1) Hippocrates

3) Doctor's Lady

5) Laennec, Open

6) Cased Percussor

8) Piorry
 

 
9a) Maw Ivory Stethoscope

10) Flexible Stethoscope