Stethoscope: The Making of a Medical Icon by Anna Harris and Tom Rice (review)

Abstract

Reviewed by:

• Stethoscope: The Making of a Medical Icon by Anna Harris and Tom Rice
• Shelley McKellar

Anna Harris and Tom Rice. Stethoscope: The Making of a Medical Icon. London: Reaktion Books, 2022. 224 pp. Ill. $27.50 ( 978-1-7891-4633-2).

The stethoscope is a familiar and "deceptively simple" medical instrument that the authors of this book complicate by exploring the multiple ways it has been "used and thought about" in its more than 200-year history (pp. 10–11). To great effect, anthropologists Anna Harris and Tom Rice conduct observer-participant field work to study the use and meaning of the stethoscope, also drawing from history, science, and sound studies for their analysis. It is worth noting that Harris, who is an Australian-trained physician, and Rice, who logged clinical hours training with medical students, bridge medical and social science worlds in their examination of the stethoscope. Harris and Rice describe the profession's use and adoption of the stethoscope as well as their personal experiences of their encounters with the stethoscope as patients. The latter stories highlight the emotional aspects arising out of the "auditory gaze" (p. 15).

The first three chapters explore the invention, reception, and use of the stethoscope in the medical world. Historians of medicine will already know much of this narrative as Harris and Rice describe Rene Laennec's paper cylinder, the practice of mediate auscultation, instrument modifications, a "golden age of stethoscopy" in the nineteenth century, and the embodiment of medical expertise via the stethoscope during the rise of physical diagnosis (p. 7). These chapters draw heavily from the strong scholarship of Jacalyn Duffin, Projit Bihari Mukharji, Roy Porter, Stanley Joel Reiser, and Malcolm Nicolson.¹

Chapters four and five muddy the waters of expertise with the involvement of non-medical users and the difficulties of learning auscultation to consolidate the placement of the stethoscope exclusively in the doctor's bag. By the early twentieth [End Page 520] century, according to Harris and Rice in chapter four, the stethoscope and its use had become routine, and it now served as a symbol and icon for the physician. But how does its medical use by nurses and vets as well as its non-medical use by plumbers and bomb disposal experts reinforce or disrupt this? Check out the image of the mechanic using a stethoscope to listen to an engine (p. 93)! Harris and Rice offer interesting non-medical usage of the stethoscope but leave out the degree to which this activity was undertaken and its effect. Chapter five offers a stronger argument about the difficulties with learning how to use a stethoscope, to detect and distinguish body sounds, and to produce "sonic alignment" (p. 106). Arguably, the mastery of mediate auscultation both established as well as threatened the practice as a medical expertise as the field grappled with teaching it to medical students. The section on teaching stethoscopes—consider a twelve-earpiece stethoscope or a stethophone transmitting sounds from hospital beds to large classrooms—was fascinating!

The last two chapters pair nicely to discuss current issues regarding instrument obsolescence and global medical inequities. In chapter six, newer medical technologies, such as point-of-care (bedside) ultrasound, are positioned as competing technologies to the stethoscope, possibly leading to the demise of the stethoscope. Is the stethoscope an outdated instrument for modern medicine? The debate wrangles over the significance of the information gleaned from auscultation and the physical examination alongside the ritual of using the stethoscope, according to Harris and Rice. Decades earlier, scholarship highlighted the distancing role of diagnostic instrumentation in the doctor-patient relationship as a negative, yet current discussions suggest that the stethoscope and auscultation "engenders a particular kind of presence" (more connection than distance?) and that it brings a "physicality and intimacy of touch in an era of increasing medical distance and detachment" (p. 137). Chapter seven raises aspects of improvisation or "diversity of stethoscopic activities" that the authors could have strengthened with greater content cohesion and analysis (p. 140). Acknowledging that the use of stethoscopes in Europe, North America and Australia may be declining, Harris and Rise state that this is not the case in the Global South...