The Stethoscope in 19th-Century AmericanPractice: Ideas, Rhetoric, and Eventual Adoption.

Abstract

The stethoscope was invented in 1816 by the French physician R.T.H. Laennec, who, after three years of clinical observations, published his treatise Mediate Auscultation in 1819. In his treatise, Laennec included details of his new method of using the stethoscope to provide physiological and pathological evaluation of patients. American physicians attended lectures and clinics at Paris hospitals and carried this information back to their respective medical schools and practices. This was accomplished by a relatively limited number of elite American physicians who were able to take advantage of travel abroad and whose practices were academically affiliated. However, it is a well-substantiated historical claim that the adoption of the stethoscope by most American physicians was slow. There are many reasons for slow adoption of the stethoscope in America, among which are lack of formal education, including bedside training in the stethoscope, complexity of interpretation of auscultatory information, hesitancy of the patient and physician to have an instrument placed between them, and lack of opportunities for continuing education for physicians after leaving medical school. As the nineteenth century progressed, scientific ideas and rhetoric related to auscultation and the stethoscope became more widespread, reflecting gradual acceptance and adoption of the stethoscope by American practitioners. In this article, I examine the ideas and rhetoric in medical journal articles, advertisements, and medical school textbooks to learn what was thought by physicians to be important in their practice. Advertisement of medical school curricula with mention of specific course work or lectures related to auscultation or the stethoscope is noted, reflecting increased interest in the stethoscope as an adjunct to physical examination. This information introduces evidence to test and bolster the existing historical claims of slow adoption of the stethoscope by addressing in more detail when and why adoption by American physicians became widespread.