Listening to the Chest – is the Stethoscope Obsolete?

A stethoscope draped around the neck is a familiar symbol of medical and nursing professionalism, but in recent years its role has changed significantly.

Listening to the Chest – is the Stethoscope Obsolete?
René Théophile Hyacinthe Laënnec auscultating a tuberculous patient at the Necker Hospital, Paris. Gouache .Chartran, Théobald, 1849-1907. Wellcome Collection.

The stethoscope was invented in 1816 by René Laennec, a French physician working in Paris. Until then doctors listened to heart sounds by placing their ears directly on the patient’s chest.

When faced with an obese young woman, Laennec found that he could hear more clearly and with less embarrassment when he listened through a paper cylinder. He was also a wood carver, and went on to make several modifications using wooden tubes. A common legend, probably apocryphal, has it that he had been repelled when placing his ear on the chests of the washerwomen by the Thames, but that when he listened to the hearts of the doyennes of the Parisian aristocracy, he could hear nothing but the sound of his own heart beating!

The instrument has since been through many modifications; the tubing – first rubber and later synthetic leading to both ears, and a diaphragm over the chest piece. The modern Littman stethoscope has a single tube with a divided channel, and models with electronic amplification and frequency modulation are now available.
Image Description
Ventricular septal defect seen through an echocardiogram, with colours used to represent blood flow direction and velocity. Image from Kjetil Lenes.

In the past cardiologists became remarkably accurate in diagnosis based largely on heart sounds, but in recent years angiography, echocardiography (ultrasound),and computerised tomography (CT) and magnetic resonance imaging (MRI) have come to provide a high degree of certainty. Though given issues around the availability and portability of these technologies, the stethoscope still plays an important role in initial assessment.

Image Description
Barratt-Boyes' stethoscope featured in Brave Hearts, our exhibition about the cardiac history of Aotearoa New Zealand. Check out the digitised exhibition here by searching for Brave Hearts.

In diseases of the lungs modern imaging has also largely supplanted the stethoscope, but it retains an important role in assessing the nature (or absence) of breath sounds in conditions such as asthma, bronchitis, pneumonia, and pneumothorax.

It is also useful for determining the presence or absence of bowel sounds in suspected peritonitis, and in listening to the foetal heart in pregnancy.

The stethoscope is far from obsolete!