The Parish Magazine March 2023

HEALTH — 1
Dr Simon Ruffle writes . . . Stethoscope
Watch any medical drama, walk into most doctor’s
offices, see any article or advert on medicine and you will
see the ubiquitous stethoscope often worn like a scarf.
It is now nearly 36 years since this seemingly magical
piece of equipment in the hands of the wizards — male
or female — started to reveal its secrets to me. In all that
time no one actually told me what it meant or taught me
the history of this unsurpassed bit of kit!
The name stems from the Greek stēthos (breast) and
skopéō (examine). The sternum, or breastbone also derives
from stethos. So this becomes chest examine. Easy ain’t it?
ORIGINS
The stethoscope was invented in France in 1816 by René
Laennec. There are two stories of how he invented it:
— He saw children playing and listening to each other down a
tube and asked what they were doing. To his astonishment, he
listened and the sounds of the heart and chest were clearly audible.
He rushed back to his office and created the stethoscope.
— Being of delicate disposition, he found placing his ear directly
on a woman’s chest uncomfortable. Whether this was to protect
the women’s feelings or his own we shall never know, but he
invented the scope to relieve this embarrassment.
Personally, I hope he felt that a person’s privacy and space
should try to be maintained when, at a time of vulnerability,
they are being examined. Thus, I’d like to think both are true:
He was, wistfully, walking through a Parisian park, say, the
Bois de Boulogne, while thinking of his cases when he saw
the children and his uncomfortable coyness was cured by a
new idea. What a physician!
MISCOMPREHENSION
Sadly, I spent years thinking the game boules was named
such as it was played at the aforementioned park! It’s named
after the Latin bulla, thus boule which is the ‘round’ bread,
bowls and medical boils follow.
AUSCULTATION
This is listening. I don’t know any other time that this
word is used anywhere. It reminds me of why the word
tender is linked to legal. Apparently it’s only when people
want to pay stamps or use a Scottish bank note in England.
We use the stethoscope to listen to the chest, heart,
abdomen and blood vessels.
HEART
When taking blood pressure we use a balloon to compress
then release an artery and when we hear blood flow changes
that’s how we gauge blood pressure. Squeezing an artery
makes the blood turbulent and we can hear this — electronic
BP machines work as oscillometers. If we hear blood flow
in other arteries of the body that is usually a problem. The
neck is a common place but, much to Laennec’s chagrin, we
occasionally listen in the groin, I am eternally grateful to him
for this. The noise is called bruits (old French for roar).
When listening to someone’s heart this is often done in
five areas. Essentially we are listening for the rate, rhythm
and blood flow. When the heart beats we can hear the valves
of the heart open and close and the flow of blood in the heart.
The Parish Magazine - March 2023 33
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Mostly, we are hoping to hear ‘not a lot.’ Noise created
by damaged valves and abnormal blood flow causes ‘snaps’
and murmurs. The position where we hear these noises the
loudest can give us clues to which part of the heart or which
valve is causing a problem.
CHEST
‘Chest clear’ is often seen in your medical notes. Most of
us dissect chest clear from ‘heart sounds normal’ although
technically chest clear should encompass all.
In the chest we are listening for lots of different things.
When you breathe in and out air passes though your airways.
The air — like blood — becomes turbulent. In general a quiet
chest is good.
However, medics are pesky, a quiet or a silent chest
can be very worrying. In an asthmatic the airways can
become narrowed by swelling, mucus and abnormal muscle
contraction. Muscle is part of the structure of the airways.
This causes turbulent flow. If that flow is all the same
frequency — monophonic — it suggests one area is blocked,
often not asthma, but as many airways narrow the sound
becomes polyphonic — poly: many, phonic: sounds. The
wheeze will have as many frequencies.
A cancer or an object blocking an airway is monophonic.
Beyond this air can be prevented to getting to areas of the
lung which makes an area quiet or silent. A deep breath may
open those parts of the lung and the alveolar — air sacs —
pop open. These are crackles. Often we mistakenly call these
crepitations but for normal GPs we don’t need to really worry
as both are abnormal and caused by the same issues such as
infection or chronic lung disease.
Rhonchi is another sound we hear. Essentially its the
same as wheeze but is low frequency so related to the larger
of the airways.
Silence can represent part of the lung being consolidated
or blocked up, such as with infection in pneumonia, although
fluid in the chest cavity will cause silence. A sign known as
'whispering pectoriloquy' can help distinguish between fluid
and consolidation, but touching the patient also helps as
vibrations known as fremitus add information.
THERE MAY BE TROUBLE AHEAD
I got in trouble at medical school as I mentioned to a
consultant that the whispered word that we used ‘99'' was
wrong as it is a poor translation. ‘Neunundneunzig’ has
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