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Doctor Curmudgeon ® Lub Dub… Lub Dub…

By Diane Batshaw Eisman, M.D. FAAP Doctor Eisman is in Family Practice in Aventura, Florida with her partner, Dr. Eugene Eisman, an internist/cardiologist

Just two easily pronounceable syllables: lub dub.

Lub and dub: the sounds heart valves make when they snap shut.

And I would not be able to hear them without that simple piece of medical equipment that is slung around my neck.

The stethoscope.

In the olden days before the stethoscope was born, doctors would put their heads on a patient’s chest in order to hear the sounds of the heart.

Or course, this was not ideal.

Then, along came Dr. Theophile Hycanith Laennec.

It was in 1816 that Laennec got the idea for his stethoscope. Taking a piece of paper, he rolled it up into a long cone shaped tube.

Holding one piece against his ear, he placed the other end against his patient’s chest…and his ability to hear the sounds of a heart was miraculously improved.

According to Dr. Ariel Roquin in Clinical Medicine & Research, Laennec described his innovation as follows:

“I recalled a well known acoustic phenomenon: if you place your ear against one end of a wood beam the scratch of a pin at the other end is distinctly audible. It occurred to me that this physical property might serve a useful purpose in the case I was dealing with. I then tightly rolled a sheet of paper, one end of which I placed over the precordium (chest) and my ear to the other. 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 that 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.”

Dr. Laennec continued perfecting the stethoscope and discovered that a hollow wooden tube gave him even greater clarity. There are theories that his diligent work into hearing accurate cardiac sounds stemmed from his musical ear and great skill as a flautist. His wooden stethoscope looked a bit like a trumpet.

In the 1820s, other physicians began trying out all kinds of materials and shapes. Those early stethoscopes were placed in one ear.

It wasn’t until 1851 that Dr. Arthur Leared, an Irish physician invented a stethoscope with two earpieces…the first binaural stethoscope!

Thanks to those early physicians, I have a ritual before seeing my first patient of the day. I reach for my most important accessory: my stethoscope.

It is a Littmann stethoscope.

Placing it around my neck, I recall a Valentine’s Day of several years ago.

On that historic Valentine’s Day, a beautifully wrapped package sat atop a pile of papers on my desk. Expecting chocolate, I raced over to attack the box.

As is my wont, I first sniffed the box. I was somewhat dismayed when I was not able to detect the aroma of chocolate from this gift.

Tearing it open anyway, I found that there was no chocolate.

Nestled in the pink tissue paper was a Littmann Stethoscope…almost as wonderful as chocolate.

It was Dr. David Littmann, a cardiologist, who was the creator of my prized stethoscope.

Dr. Littmann designed it to be lighter, easier on the doctor’s neck. It had a spring to keep the two earpieces apart. The tubing was firm and it had a chest piece with two sides. One side was a diaphragm that can better hear high pitched sounds. Turn the chest piece around and you have a concave bell that is best for those low frequency sounds.

Before Littmann, there were stethoscopes with two chest pieces, but they were connected by two tubes which frequently rubbed together and the sound was not clear. Littman’s innovation had a single tube.

On that Valentine’s Day several years ago, I carefully placed my treasured stethoscope in the largest pocket of my ink-stained lab coat.

My Littmann and I have been together ever since.

And now here is the rest of the story.

On arriving home, on that Valentine’s Day, I found a huge box of dark chocolates waiting for me.

A memorable day…

A Littmann stethoscope…

Lots of dark chocolate…

Lub Dub went my heart.

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