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Bulletin of the History of Medicine 77.1 (2003) 198-200



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M. Donald Blaufox. An Ear to the Chest: An Illustrated History of the Evolution of the Stethoscope. Lancaster, U.K.: Parthenon, 2002. xiv + 149 pp. Ill. $74.95, £52.99 (1-85070-278-0).

In retrospect, the stethoscope, invented in 1816 by French physician René Théophile Hyacinthe Laennec, was more than a simple tool to help physicians listen to the sounds that emanate from the heart and lungs: it signaled the [End Page 198] transformation of medical diagnosis from a mainly passive process, whereby the doctor listened to a patient's complaints and looked at his or her body or its fluids, into an active process whereby instruments and equipment were used to aid the physician's senses. The stethoscope helped transport physicians in search of a diagnosis from the outside to the inside of their patients. During the middle third of the nineteenth century, a multitude of "scopes" were invented to probe organs and orifices, both figuratively and physically. More recently, especially following World War I, the stethoscope became a symbol of the internal medicine physician.

Considering the stethoscope's importance as a professional tool and transformer—and its ubiquity—it is surprising that this is the first English-language book devoted to the instrument. Although relatively brief, this well-illustrated monograph is a useful addition to the history of medical diagnosis and technology. The author, Donald Blaufox, is a New York City clinician-historian-collector who in 1998 co-wrote an illustrated history of blood pressure measurement. He decided to write a history of the stethoscope a decade ago, when he acquired the medical artifact collection of Denver surgeon and author Nolie Mumey. Along with these collectibles, Mumey's widow sent a draft history and an extensive bibliography of primary sources on the stethoscope that her husband had prepared in 1947, hoping that Blaufox would complete the project.

The result is a concise history and iconography of the stethoscope. There are ten brief chapters totaling eighty-one pages on the evolution of monaural and binaural stethoscopes. Blaufox focuses on nineteenth-century innovations, and he includes several brief quotations from European and American physician-inventors who tried to improve the tool. In addition to several hundred articles, he used instrument catalogs and patent records to trace the evolution of the instrument. Blaufox's book also reflects his passion for collecting: there is a forty-six-page appendix that contains 113 annotated photographic illustrations of stethoscopes (or their components) from his collection. There is also an extensive bibliography of more than four hundred references, mainly primary sources.

Doctors who modified the stethoscope had a shared interest in promoting its use and enhancing its usefulness: they sought professional recognition from their peers, and some were motivated by the promise of profits if their version proved popular with practitioners. Blaufox shows that many models failed. There were several compelling innovations, however. Some medical inventors used new materials such as India rubber, while others created more-elaborate paths to carry sound from the patient's chest to the ear. George Cammann, a New York City physician, combined these approaches in 1855, when he developed the first practical binaural stethoscope that transmitted sound to both ears. In 1926, after several decades of mostly minor modifications, Boston cardiologist Howard Sprague reported an innovation that would define the "modern" stethoscope: he combined "bell" and "diaphragm" chest pieces into one unit that allowed the listener to selectively hear low- and high-pitched sounds.

Blaufox closes his narrative with a brief paragraph and a compelling illustration that reflect the significance of economic incentives and social forces as [End Page 199] determinants of medical practices and patient expectations. The illustration is from an advertisement appearing currently in several cardiology journals. Importantly, it reveals that the passive stethoscope, as it approaches its bicentennial, faces unprecedented competition from technology that is now easily portable. Reflecting technological trends toward miniaturization, the professional hand that long held a stethoscope is shown carrying...

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