Heart Sounds & Murmurs
History: Heart Sounds & Murmurs
Even before the invention of auscultation and percussion, physicians were able
to detect abnormalities in a patient's heart by palpation and by assessing the
pulse. For example, the connection between atrial fibrillation and mitral valve
disease was first made in the 1700s by Jean Baptiste de Senac (1693-1770), physician
to King Louis XV of France and author of the first text on cardiology (McMichael).
In 1816 Laennec created a paper acoustic device as a stethoscope in order to
examine the chest of a woman with cardiac symptoms. He listened to her heart
by the technique he called "mediate auscultation". Laennec described
his creation of the stethoscope instrument in The Treatise
on Mediated Auscultation in 1821:
"I was consulted in 1816 by a young woman who
presented some general symptoms of disease of the heart, in whose case the
application of the hand and percussion gave but slight indications, on account
of her corpulency. On account of the age and sex of the patient, the common
modes of exploration being inapplicable, I was led to recollect a well known
acoustic phenomenon, namely if the ear is applied to one extremity of a beam,
a person can, very distinctly, hear the scratching of a pin at the other end.
I imagined this property of bodies might be made use of in the present case.
I took a quire of paper which I rolled together as closely as possible, and
applied one end to the precordial region; by placing my ear at the other end,
I was agreeably surprised at hearing the pulsation of the heart much more
clearly and distinctly that I had ever been able to do by the immediate application
of the ear."