Friday, March 23, 2007

The Young Stethoscopist

I've been doing some collection development work on the History of Medicine Collection lately, assessing our strengths and weaknesses in key areas like cardiology/cardiothoracic surgery and physical diagnosis. These two areas in particular come together quite nicely in one volume on our shelves: Henry Bowditch's The Young Stethoscopist, or, the Student's Aid to Auscultation. (Our copy is actually the New York Academy of Medicine's reprint, since the original 1846 edition can't be had for less than $2500 these days.)

As we learned last week in Dr. Madison Macht's presentation on Howard P. Lewis, M.D., the art of auscultation and percussion was being practiced with astounding skill and adroitness on this campus during the middle years of the 20th century. But writing in 1846, Bowditch was breaking relatively new ground: although Laennec and Auenbrugger had established the foundations at the turn of the 19th century, their techniques were not fully embraced by the medical profession for another fifty years. Bowditch notes in his preface that "Fifteen years ago, [physical signs] were sneered at by many persons. Now, very few would be foolish to do so..."

But medicine then was just gathering its momentum, starting to show its own signs of rapid advancement, technological innovation, and the rush of new discoveries. Patients, too, have played a role in the move away from the art of medicine to the science behind it, demanding state of the art imaging and assays. So, the art of the physical examination has waned almost unto extinction among younger practitioners, who would be wise to heed Bowditch's advice, as salient now, surely, as it was 160 years ago:
"Amidst the niceties of our physical examinations we are apt to neglect the rational signs. The truth is, that he who scoffs at either must necessarily be a child in the diagnosis of not a few diseases; and he who cultivates both with the clear, keen-sighted eye of a true observer, and then notes their mutual relations, is the truly wise physician."

Let us hope that physicians embrace again the art of their profession, and let us hope that patients again begin to trust them in doing so.

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