(Delightfully jaunty accordion music that conjures a Parisian scene of a beautiful woman dragging on a Gitane, Asterix, beat poetry and a small dog chasing a string of sausages flying from the back of a moustached man's bicycle, with a baguette under his arm and a beret atop his bonce, on his way to the picket line where he will be striking for the sixth time this month)
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I'm in Paris and I'm actually on the Champs-Élysées,
you can probably just make out
the Arc de Triomphe behind me.
Not the greatest of places to choose to film
'cause it's very noisy here,
but while the traffic is stopped,
I thought I'd quickly tell you where I'm going.
I'm going on a pilgrimage
and Paris is my joint favorite city in the world.
I absolutely love visiting, but I'm normally with my wife.
In fact, that was where we first came
on our very first holiday when we were 18.
Oh God, this is starting to sound like a vlog, isn't it?
Normally when I come with the family,
I don't want to subject them
to my particular strange taste in tourist attractions.
So, because I'm here on my own,
I'm making a pilgrimage to an unassuming part of the city
where the history of medicine changed forever
just over 200 years ago.
This is the Necker Hospital in the 7th arrondissement
and back in 1816,
a young doctor called René Laennec was working here
in the tuberculosis wards.
Unfortunately, interloping tourists
aren't allowed to wander through hospitals
in these plague times,
so I can only show you the outside.
But while it is now an enormous modern hospital,
occupying an entire city block,
you can still see the old buildings where history was made.
To explain what momentous thing happened here,
I thought I'd wonder across town from my hotel
where I was attending a cardiology conference,
and it was a glorious day when I set off but,
heavens have opened on the Champs-Elysée
and it was a beautiful sunny day earlier, which has changed.
And I don't carry an umbrella
because it's an unnatural abomination
that goes against an act of god,
so I'm getting wet.
But our story starts here in the 7e arrondissement,
where Laennec was walking early one morning,
I think he was considerably less wet than me,
and he saw two children playing a game with a stick where
one of them put the stick to his ear and the other one
scratched the other end
and of course the sound was transmitted.
They understood the acoustics involved
transmitting a quiet sound to the ear in a different way.
And they gave Laennec an idea,
hence becoming history's first child StikTok influencers.
And sometime later back at the Necker hospital
Laennec was called to see a young woman
with general symptoms of heart disease.
And he described that she was particularly generously
proportioned, an overweight young lady.
And so the traditional way of listening to her heart
he felt wasn't entirely appropriate,
being a bashful gentleman with a young female patient,
which was for thousands of years, doctors have just
put their ear on the patient's chest to listen to the heart.
So realising this might not be appropriate
nor indeed effective,
he remembered the kids from here in the Tuileries Gardens
and rolled up a wad of paper, formed a cylinder
and placed it to her chest.
I was hoping my actually-French friend Barris would do
the voiceover here
but he decided to go on holiday.
- Very unprofessional Barris.
- I was surprised and elated to be able to hear the beating
of her heart with far greater clearness than I ever had
with direct application of my ear.
I immediately saw this might become an indispensable method
for studying not only the beating of the heart
but all movements able of producing sound
in the chest cavity.
I made a whole video about why the heart has
such an important role in the development of how
we use sound in medicine and why I, as a cardiologist,
am particularly passionate about the history
of this tool that has become the very symbol
of my profession.
But if there's one person who thinks about the history
of the stethoscope, more than even me, it's my friend,
Dr. Adam Rodman, who works out in Boston
and he has a fantastic podcast
about medical history called Bedside Rounds
that is honestly one of my favorites.
If you like the kind of historical stuff I make
you'll love his podcast.
I started by asking Adam about the history of sound
in how doctors make diagnoses and how
like some of the best things in life,
it began with wine.
- Sound as part of diagnosis is actually very, very old.
In the Hippocratic Corpus
we have this idea of this succession splash.
- Ah, Adam old chap, the succession splash, I think
is what happened when Kendall crashed into a river
but what I'm sure you meant to say was the succussion splash
which is the oldest known method
of using sound in diagnosis.
It wasn't particularly elegant,
you literally just shook the patient
and listened for a splash coming from the stomach
which might suggest distinction.
- I will say that sound in medicine certainly took
a backseat until the 18th century, right?
Now, if you want to talk about smell or taste in medicine,
which is rather gross, uroscopy and even examination
of the stool was very common, but not necessarily sound
until Auenbrugger,
he's working in the Spanish military hospital,
everyone is dying, this is the 1760s,
of tuberculosis and end stage tuberculosis
so people have very large pleural effusions fluid
in their lungs.
And this is at the, let's say the dawn
of pathological anatomy.
So his patients would die and he would autopsy them
and there would be a ton of fluid in their lungs.
And so the story goes is that his father was an innkeeper
and he would keep wine in the basement.
And you know, a lot of people come, you got to find
the barrel of wine that has enough to feed every,
well, to give libations to everybody
- What his father, the innkeeper did was to tap on the side
of a barrel to listen to how much liquid is inside.
And I'm going to try and demonstrate using some paint pots.
That's the nearest I've got to wine barrels
sadly that have got lying around.
Now, this one is full.
So let's hear what it sounds like.
(dull tapping)
So that's what we call dull
and if a chest is full of fluid
then we refer to this as a kind of stony dull sound,
whereas this one's about two thirds empty.
So let's have a listen and contrast.
Still kind of dull at the bottom,
(resonant tapping)
but as we move up,
(by jove that's hollow tapping)
it's got a much more hollow sound.
And I can demonstrate on myself
if I just come close to the mic.
(manly reverberation)
You can hear as I tap over my lungs,
(okay that's enough now)
it's a hollow sound
as I hope it should be, but it isn't always the case.
- And Auenbrugger remembered what his dad had done
and he started to do that
on his patients who were dying of tuberculosis.
And now the difference, well is actually very similar,
his father would confirm where his tapping was
by tapping the barrel and getting the wine out.
Auenbrugger would tap
out where he felt the pleural effusion was
and then when they died, he would perform an autopsy
and see where the fluid level was.
- And this is an examination technique called percussion.
And it's exactly what we still do to listen
for fluid that's collected in the chest.
It may seem obvious to you now, but this was the advent
of modern pathological anatomical diagnosis up until then,
apart from some basic external clues, we really had to rely
on postmortems, autopsies, to know what was going
on inside the body.
But this was really the advent
of figuring out what pathological processes,
what was going wrong while the patient was still alive.
- And this is really the first,
I think the first modern example
of sound being used in diagnosis.
So, right, he should have been a legend,
but in fact he was not, he was fired, right?
He was disowned by his mentor.
The world was not ready for his ideas.
He actually did quite well for himself.
Again, he was wealthy and I know he was friends
with Mozart and he commissioned an opera
so don't feel too bad for him
but that was basically the end of his career in medicine.
- Fast forward some years to our hero,
René Laennec in Paris
and by now the idea of recording examination findings
during life, and then correlating them
after death had become commonplace.
And after that momentous day that we've already heard
about when he first listened, he begins to hone his craft.
- He ausculates, he listens with his stethoscope
and when his patients died,
and you can still read his book today
you can see what they died from their horrific diseases,
he performed an autopsy and he was very, very careful
to link all of the findings that he heard
with his ear to what he found on autopsy.
- Here's some trivia for you.
Did you know that the stethoscope being invented
at The Necker Hospital by a man called Laennec is
actually the reason we wear it around le neck?
- He experimented with different types of wood.
He turned them on his lathe to see which type
of wood would allow for the best auscultation.
And if you want to do show and tell, this is a recreation
of Laennec's original cylindre I got it from,
this is 3D printed,
and I actually still listen with a wooden stethoscope,
so this is my stethoscope, and this is cherry,
which is the same wood that Laennec ended
up deciding that was the best for cardiac auscultation.
- NERDS!
- Unfortunately he died in his home
in Brittany of tuberculosis.
So one of the great ironies.
He was actually a very humanistic physician, very concerned
about his patients and very devastated when they died
and dedicated his career to them
and ended up dying of the same disease that he was treating.
- So why are Adam and I so obsessed with the history
of this one particular item from a doctor's bag?
- From my perspective
the stethoscope was really the first diagnostic test.
It is the first test that a physician,
it's a technology, right?
So it's the first test that a physician
could use to make a diagnosis
beyond effectively talking to the person.
And yes, there was percussion before that
but you're still using your hands.
So from a like 21st century perspective,
this was the first use
of technology in diagnosing a patient.
And if you think about the test that we order today
like the fact that I can order a PET scan, that we
that we put a radio tracer
in a person to literally look at metabolism
of cancer cells and then get a 3D recreation of that.
Well, the stethoscope is the beginning
of that long technological journey.
- And the stethoscope itself has come
on a journey from the hollow wooden cylinder
to the ubiquitous rubber tubes.
This is the Littmann Master Cardiology, because,
of course it is, what else would I use?
To something like this,
this is the Eko DUO, it's an electronic stethoscope
which can wirelessly send the sound via Bluetooth
to my phone, where I can record it and use it for teaching.
Some people say that the handheld ultrasound device,
like the one I used in my zero gravity video is
the natural evolution of the stethoscope.
It's many times more expensive, but,
of course at the end of the day, it does still use sound.
So it really is a direct descendant.
If you want to hear the whole unedited conversation
with Adam whose enthusiasm, I think is evident even
from these clips, it's available as a separate video
exclusively over on Nebula with a few extra bits as well.
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Well, thanks for watching.
Remember, if you want to practice any
of the skills that we've talked about today,
try going to your local pub and ask to tap the wine barrels,
place your ear against a stranger's chest
and most importantly
always perform autopsies to confirm your findings.
Au revoir!