Dear Friends;

I am still fond of my old stethoscope. I have had it since medical school. The stethoscope has always been symbolic of medicine. It is usually the first "instrument" to be used by medical students, often in the sophomore year when they begin to learn physical diagnosis. The art of physical diagnosis comprises the taking of a careful medical history and a physical examination of the patient. 

The stethoscope was invented by Rene Laennec in 1819 in Kemper, France. Laennec was fascinated by what he could hear when listening over the heart and lungs. Laennec was both a physician and pathologist. By making careful examinations of his patients during life, and then, on occasion performing an autopsy immediately after death, he could correlate the sounds, heard by the stethoscope, with the anatomical changes of the organs. Laennec realized that emphysema was a different disease from asthma and quite different from tuberculosis, which dominated medicine in Laennec's era. Laennec died of tuberculosis, but not before writing and teaching about the stethoscope. His book, Le Mediate Auscultation, is a classic!

Today, all too few doctors know how to use a stethoscope correctly and accurately. They rely of echograms, scans, etc., i.e., high technology. True, these advances are useful in giving more detail than the stethoscope, but the stethoscope is fast, inexpensive and requires the doctor to touch the patient as he examines the heart and lungs for diagnostic purposes. I have always had confidence in what I heard with my old stethoscope.

Yesterday I saw a long-time elderly patient for a follow-up examination. I listened carefully to his chest, because he had previously had asthma, which was now completely controlled. He also had a heart murmur that was of some concern to him. I spent extra time listening to the heart, because I heard a new murmur that was coming from the aortic valve, at the exit of the heart into the body's circulation. "What did you hear, Doc? You listened to my heart longer than before," " Your heart is functioning fine," was my reply. "Your old murmur is not changed and the new one is not serious, because it has not affected the function of your heart." I could deduce this all with the stethoscope, which gave me great pleasure. 

"Guess it is okay for me to go skiing, fishing and hunting at high altitude?" He was an avid outdoorsman and enjoyed every day. Life was full and meaningful. He was 87. 

"I'll see you next year," I told him. "Thanks, Doc," he replied.

I will be in touch again next month.

     Your friend,

   
Thomas L. Petty, M.D.
Professor of Medicine, UCHSC
Co-Chairman, National Lung Health Education Program